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Randomized Controlled Trial
. 2019 Feb 13;16(1):20.
doi: 10.1186/s12966-019-0773-x.

A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial

Mariel Marcano-Olivier  1 , Ruth Pearson  1 , Allycea Ruparell  1 , Pauline J Horne  1 , Simon Viktor  1 , Mihela Erjavec  2
Affiliations
Randomized Controlled Trial

A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial

Mariel Marcano-Olivier et al. Int J Behav Nutr Phys Act. .

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.

Keywords: Behavioural nudges; Cafeteria; Children; Choice architecture; Consumption; Fruit; Healthy eating; Plant-based foods; School lunch.

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Conflict of interest statement

Ethics approval and consent to participate

Approval to conduct this investigation was granted by the School of Psychology Ethics and Research Governance Committee at Bangor University (approval number: 2014000089). Opt-out consent forms were distributed to participants one week prior to study commencement.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Boxplots showing children’s daily consumption of fruit and vegetables at lunchtime. Medians, interquartile ranges, and distributions of children’s consumption in grams for fruit, fiber and sugar, and milligrams for vitamin C are shown at baseline (striped bars) and follow-up (solid bars) for the intervention and control condition. Key statistics for pairwise within- and between-condition tests are presented to aid interpretation of the data
Fig. 2
Fig. 2
Boxplots showing children’s daily consumption of fiber, vitamin C, and sugar at lunchtime. Medians, interquartile ranges, and distributions of children’s consumption in grams for fruit, fiber and sugar, and milligrams for vitamin C are shown at baseline (striped bars) and follow-up (solid bars) for the intervention and control condition. Key statistics for pairwise within- and between-condition tests are presented to aid interpretation of the data
See this image and copyright information in PMC

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