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A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial.
Int J Behav Nutr Phys Act. 2019 02 13; 16(1):20.IJ

Abstract

BACKGROUND

Research has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet. This study set out to trial a simple, low-cost behavioural nudge intervention to encourage children to select and consume more fruit and vegetables with their lunchtime meal in a primary school cafeteria.

METHODS

Four primary schools were randomly allocated to either the control or the intervention condition and baseline data were collected over two days in each school. Following this, changes were made to the choice architecture of the school cafeterias in the intervention schools and maintained over a three-week period. The intervention included improved positioning and serving of fruit, accompanied by attractive labelling of both fruit and vegetables on offer. Next, data were collected over two days in each school, with menus matched in each instance between baseline and follow-up. We employed a validated and sensitive photographic method to estimate individual children's (N = 176) consumption of vegetables, fruit, vitamin C, fibre, total sugars, and their overall calorie intake.

RESULTS

Significant increases were recorded in the intervention schools for children's consumption of fruit, vitamin C, and fibre. No significant changes were observed in the control condition. The increases in fruit consumption were recorded in a large proportion of individual children, irrespective of their baseline consumption levels. No changes in vegetable consumption were observed in either condition.

CONCLUSIONS

These results are the first to show that modest improvements to the choice architecture of school catering, and inclusion of behavioural nudges, can significantly increase fruit consumption, rather than just selection, in primary-age children. This has implications for the development of national and international strategies to promote healthy eating in schools.

TRIAL REGISTRATION

AsPredicted: 3943 05/02/2017. URL: https://aspredicted.org/see_one.php?a_id=3943.

Authors+Show Affiliations

The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), Wales, LL57 2AS, UK.The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), Wales, LL57 2AS, UK.The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), Wales, LL57 2AS, UK.The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), Wales, LL57 2AS, UK.The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), Wales, LL57 2AS, UK.The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), Wales, LL57 2AS, UK. m.erjavec@bangor.ac.uk.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30760296

Citation

Marcano-Olivier, Mariel, et al. "A Low-cost Behavioural Nudge and Choice Architecture Intervention Targeting School Lunches Increases Children's Consumption of Fruit: a Cluster Randomised Trial." The International Journal of Behavioral Nutrition and Physical Activity, vol. 16, no. 1, 2019, p. 20.
Marcano-Olivier M, Pearson R, Ruparell A, et al. A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial. Int J Behav Nutr Phys Act. 2019;16(1):20.
Marcano-Olivier, M., Pearson, R., Ruparell, A., Horne, P. J., Viktor, S., & Erjavec, M. (2019). A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial. The International Journal of Behavioral Nutrition and Physical Activity, 16(1), 20. https://doi.org/10.1186/s12966-019-0773-x
Marcano-Olivier M, et al. A Low-cost Behavioural Nudge and Choice Architecture Intervention Targeting School Lunches Increases Children's Consumption of Fruit: a Cluster Randomised Trial. Int J Behav Nutr Phys Act. 2019 02 13;16(1):20. PubMed PMID: 30760296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial. AU - Marcano-Olivier,Mariel, AU - Pearson,Ruth, AU - Ruparell,Allycea, AU - Horne,Pauline J, AU - Viktor,Simon, AU - Erjavec,Mihela, Y1 - 2019/02/13/ PY - 2018/05/21/received PY - 2019/01/22/accepted PY - 2019/2/15/entrez PY - 2019/2/15/pubmed PY - 2019/8/6/medline KW - Behavioural nudges KW - Cafeteria KW - Children KW - Choice architecture KW - Consumption KW - Fruit KW - Healthy eating KW - Plant-based foods KW - School lunch SP - 20 EP - 20 JF - The international journal of behavioral nutrition and physical activity JO - Int J Behav Nutr Phys Act VL - 16 IS - 1 N2 - BACKGROUND: Research has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet. This study set out to trial a simple, low-cost behavioural nudge intervention to encourage children to select and consume more fruit and vegetables with their lunchtime meal in a primary school cafeteria. METHODS: Four primary schools were randomly allocated to either the control or the intervention condition and baseline data were collected over two days in each school. Following this, changes were made to the choice architecture of the school cafeterias in the intervention schools and maintained over a three-week period. The intervention included improved positioning and serving of fruit, accompanied by attractive labelling of both fruit and vegetables on offer. Next, data were collected over two days in each school, with menus matched in each instance between baseline and follow-up. We employed a validated and sensitive photographic method to estimate individual children's (N = 176) consumption of vegetables, fruit, vitamin C, fibre, total sugars, and their overall calorie intake. RESULTS: Significant increases were recorded in the intervention schools for children's consumption of fruit, vitamin C, and fibre. No significant changes were observed in the control condition. The increases in fruit consumption were recorded in a large proportion of individual children, irrespective of their baseline consumption levels. No changes in vegetable consumption were observed in either condition. CONCLUSIONS: These results are the first to show that modest improvements to the choice architecture of school catering, and inclusion of behavioural nudges, can significantly increase fruit consumption, rather than just selection, in primary-age children. This has implications for the development of national and international strategies to promote healthy eating in schools. TRIAL REGISTRATION: AsPredicted: 3943 05/02/2017. URL: https://aspredicted.org/see_one.php?a_id=3943. SN - 1479-5868 UR - https://www.unboundmedicine.com/medline/citation/30760296/A_low_cost_Behavioural_Nudge_and_choice_architecture_intervention_targeting_school_lunches_increases_children's_consumption_of_fruit:_a_cluster_randomised_trial_ L2 - https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0773-x DB - PRIME DP - Unbound Medicine ER -