OBJECTIVES: We were commissioned by the behavioural insights team at Public Health England to synthesise the evidence on choice architecture interventions to increase healthy purchasing and/or consumption of food and drink by National Health Service (NHS) staff.
DATA SOURCES: MEDLINE, EMBASE, CINAHL, Cochrane Central register of Controlled Trials, PsycINFO, Applied Social Sciences Index and Abstracts and Web of Science were searched from inception until May 2017 and references were screened independently by two reviewers.
DESIGN: A systematic review that included randomised experimental or intervention studies, interrupted time series and controlled before and after studies.
PARTICIPANTS: Healthcare staff of high-income countries.
INTERVENTION: Choice architecture interventions that aimed to improve dietary purchasing and/or consumption (outcomes) of staff.
APPRAISAL AND SYNTHESIS: Eligibility assessment, quality appraisal, data abstraction and analysis were completed by two reviewers. Quality appraisal of randomised trials was informed by the Cochrane Handbook, and the Risk of Bias Assessment Tool for Nonrandomized Studies was used for the remainder. Findings were narratively synthesised.
RESULTS: Eighteen studies met the inclusion criteria. Five studies included multiple workplaces (including healthcare settings), 13 were conducted in healthcare settings only. Interventions in 10 studies were choice architecture only and 8 studies involved a complex intervention with a choice architecture element. Interventions involving a proximity element (making behavioural options easier or harder to engage with) appear to be frequently effective at changing behaviour. One study presented an effective sizing intervention. Labelling alone was generally not effective at changing purchasing behaviour. Interventions including an availability element were generally reported to be successful at changing behaviour but no included study examined this element alone. There was no strong evidence for the effect of pricing on purchasing or dietary intake.
CONCLUSION: Proximity, availability and sizing are choice architecture elements that are likely to be effective for NHS organisations.
TRIAL REGISTRATION NUMBER: CRD42017064872.
CONTEXT: In recent decades, portion sizes have increased significantly. Although previous research indicates that food labels impact on product choice and healthiness perception, their impact on portion sizes consumed is less clear.
OBJECTIVE: This systematic review examined whether food label information influenced portion size consumption.
DATA SOURCES: A search of 7 major electronic databases for studies published from 1980 to April 2016 was conducted.
DATA EXTRACTION: Two reviewers independently screened 11 128 abstracts. Data were extracted from 32 articles (comprising 36 studies).
RESULTS: Based on the test food used, the overall effects were found to be: no effect, a positive effect, or a negative effect. Labels displaying energy content (n = 15 studies, 17 effects) and fat content information (n = 13 studies, 14 effects) were evaluated most commonly, with exercise equivalent labels evaluated least (n = 2 studies, 2 effects).
CONCLUSIONS: Nutrition and health information presented on food labels has varying impacts on portion sizes consumed, from increased to decreased intake. Recommendations for future research include evaluating more recent food label types and achieving more consistent reporting standards.
CONTEXTO: falta evidência de que a rotulação do menu influencie as escolhas alimentares nas configurações da vida real. Os comentários geralmente se concentram nas contagens de calorias sem abordar questões mais amplas relacionadas à alimentação saudável. OBJETIVO: Esta revisão sistemática avaliou a influência de diversos formatos de rotulagem de menu sobre escolhas alimentares em configurações da vida real. FUÍAS DE DADOS: Foram pesquisadas várias bases de dados: Cochrane Library, Scopus, MEDLINE, Web of Science, Science Science e Technology Abstracts, Biological Abstracts, CAB Abstracts, EconLit, SciELO e LILACS. SELEÇÃO DE ESTUDO: dois revisores selecionaram cegamente os artigos que relatam experiências, quase-experimentos e estudos observacionais usando grupos de controle ou pré-intervenção. EXTRACÇÃO DE DADOS: os dados foram extraídos usando um formulário padrão. Análises diferenciadas entre os tipos de serviços alimentares. A qualidade dos 38 estudos incluídos foi avaliada cegamente por dois revisores. ANÁLISE DE DADOS: os resultados foram misturados, mas uma influência parcial da rotulagem do menu em escolhas alimentares foi mais freqüente do que uma influência geral ou nenhuma influência. A rotulagem do menu foi mais eficaz nas cafeterias do que nos restaurantes. Informações qualitativas, como símbolos de alimentos saudáveis e rotulagem de semáforos, foram mais eficazes na promoção de uma alimentação saudável. Em geral, os estudos foram de qualidade moderada e não utilizaram grupos de controle. CONCLUSÕES: A rotulagem de calorias nos menus não é eficaz para promover escolhas alimentares mais saudáveis. Outras pesquisas em configurações da vida real com grupos de controle devem testar diversas informações qualitativas na rotulagem de menu.
We were commissioned by the behavioural insights team at Public Health England to synthesise the evidence on choice architecture interventions to increase healthy purchasing and/or consumption of food and drink by National Health Service (NHS) staff.
DATA SOURCES:
MEDLINE, EMBASE, CINAHL, Cochrane Central register of Controlled Trials, PsycINFO, Applied Social Sciences Index and Abstracts and Web of Science were searched from inception until May 2017 and references were screened independently by two reviewers.
DESIGN:
A systematic review that included randomised experimental or intervention studies, interrupted time series and controlled before and after studies.
PARTICIPANTS:
Healthcare staff of high-income countries.
INTERVENTION:
Choice architecture interventions that aimed to improve dietary purchasing and/or consumption (outcomes) of staff.
APPRAISAL AND SYNTHESIS:
Eligibility assessment, quality appraisal, data abstraction and analysis were completed by two reviewers. Quality appraisal of randomised trials was informed by the Cochrane Handbook, and the Risk of Bias Assessment Tool for Nonrandomized Studies was used for the remainder. Findings were narratively synthesised.
RESULTS:
Eighteen studies met the inclusion criteria. Five studies included multiple workplaces (including healthcare settings), 13 were conducted in healthcare settings only. Interventions in 10 studies were choice architecture only and 8 studies involved a complex intervention with a choice architecture element. Interventions involving a proximity element (making behavioural options easier or harder to engage with) appear to be frequently effective at changing behaviour. One study presented an effective sizing intervention. Labelling alone was generally not effective at changing purchasing behaviour. Interventions including an availability element were generally reported to be successful at changing behaviour but no included study examined this element alone. There was no strong evidence for the effect of pricing on purchasing or dietary intake.
CONCLUSION:
Proximity, availability and sizing are choice architecture elements that are likely to be effective for NHS organisations.
