Trial reportThe international journal of behavioral nutrition and physical activity2020
Prompting consumers to make healthier food choices in hospitals: a cluster randomised controlled trial.
Trial report in The international journal of behavioral nutrition and physical activity, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Calorie (energy) labelling for changing selection and consumption of food or alcohol.The Cochrane database of systematic reviews · 2025Pooled it
- A systematic review of the implementation of healthy food retail interventions in settings with multiple food retail outlets (complex food retail settings).Journal of nutritional science · 2024Pooled it
- Pooled it
- Article
- A Scoping Review of Choice Architecture to Promote Healthy Nutrition in Health and Care Settings.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2025Article
- In-hospital nudging intervention increases patients' healthy dietary choices: a quasi-experimental study.BMJ nutrition, prevention & health · 2025Article
- Determining food choice motivations in Turkish adults: sustainable and healthy eating behavior, ecological footprint awareness, and food insecurity perspective.BMC public health · 2024Article
- Using salience and availability to promote sustainable and healthy food choices in hospital cafeterias.Scientific reports · 2024Article
- Impact of a nudge-based food environment intervention in a hospital convenience store on staff's food intake and Na/K.BMC nutrition · 2024Article
- Identifying barriers and facilitators to adopting healthier dietary choices in clinical care: a cross-sectional observational study.Frontiers in nutrition · 2023Article
- Work site food purchases among healthcare staff: Relationship with healthy eating and opportunities for intervention.Nutrition & dietetics : the journal of the Dietitians Association of Australia · 2022Article
- Contributions of Food Environments to Dietary Quality and Cardiovascular Disease Risk.Current atherosclerosis reports · 2021Review
- Hospital-Based Food Environment Interventions to Improve Workforce Dietary Behaviour: A Systematic Literature Review.American journal of lifestyle medicineArticle
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHospitals in the UK offer snacks for sale to patients, staff and visitors. Despite the NHS's health promoting role, and tightening of regulations around which foods can be sold in hospitals, many snacks purchased in this setting are unhealthy. The present project tests the effectiveness of theory-based point of purchase prompts (PPPs; a form of cognitive nudge) designed to make it cognitively easier for consumers to compare available products and choose healthier options.
methodsHospital shops in Scotland (n = 30) were recruited into a cluster randomised controlled trial to test whether a PPP could reduce the average calorie, fat and/or sugar content of purchased snacks. Inclusion criteria stated that eligible sites; sold food; were located in a hospital; and were accessible to staff, patients and visitors. The PPP intervention was a theory-based sign (tailored to the available range in each location) designed to cognitively simplify healthier snack choices by facilitating cross-product comparison. Shops were randomised to display PPPs (intervention; n = 15) or not (control; n = 15) using block randomisation controlling for shop size. Data on all snacks purchased from participating shops were obtained from retailers for a 12-week baseline and 12-week follow-up period. Primary outcomes were the average calorie (kcals), fat(g) and sugar(g) content of snacks purchased each day. Secondary outcomes were the average customer spend per item purchased (£,p) and the total number of snacks purchased daily. Shop staff were not blinded to group assignment but data providers were. Data were analysed using mixed effects multi-level regression models.
resultsData from > 1 million snack purchases were analysed. Snacks purchased from intervention sites were on average significantly lower in calorie (γ = - 1.84, p < .001) and sugar (γ = - 0.18, p = .030) at follow up relative to baseline but only the reduction in calories was significantly different to control. Average spend per item also reduced significantly in intervention (but not control) sites (γ = - 0.89, p < .001). The intervention had no effect on the fat content of snacks or the number of snacks sold.
conclusionsSimple, theory-based point of purchase prompts can produce small but statistically significant reductions in the energy content of snack purchases from hospital shops.
trial registrationRetrospectively registered (8/Oct/2018) with ISRCTN (ID: ISRCTN90365793 ).
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