Academic journal article Perspectives in Public Health

Choice Architecture Interventions for Increased Vegetable Intake and Behaviour Change in a School Setting: A Systematic Review

Academic journal article Perspectives in Public Health

Choice Architecture Interventions for Increased Vegetable Intake and Behaviour Change in a School Setting: A Systematic Review

Article excerpt

INTRODUCTION

The average european consumption of fruit and vegetables is considered to be generally inadequate among all age groups compared to official dietary guidelines.1-7 especially, vegetable consumption is insufficient, which is a public health challenge as vegetables may have a more important effect per portion than fruit in the prevention of chronic disease.8,9 Additionally, from a public health nutrition perspective, the food patterns and dietary habits of adolescents are of concern since once consolidated by midadolescence, they will tend to persist into adulthood.10,11

A low intake of vegetables is associated with increased risk of obesity and several lifestyle diseases such as various types of cancers as well as cardiovascular disease.12-15 Consequently, increasing vegetable intake among the european population could reduce or delay the onset of lifestyle-related diseases. Food-related behaviours are complex and multifactorial, and changes in food consumption are often difficult to achieve. Barriers to increase vegetable consumption involve an interaction between different factors such as acceptability, availability, intention, attitudes and beliefs as well as sociodemographic characteristics.16-18

If healthy dietary habits are introduced and practised from early in life, they tend to persist into adulthood,10,11 but as children enter the transitional phase from childhood to adolescence, their eating habits are easily affected by the so-called obesogenic environment, peer pressure and trendiness. As a consequence, these young people may develop dietary habits that are nutritionally inadequate; low in fibres, fruits and vegetables; high in energy density; high in fat and sugar content, consisting of ultra processed food items; and more frequent snacking.19,20

Adolescents spend a considerable part of their day in school where they often consume one or several of their meals, for which reason this arena is ideal for executing health promotion and promoting healthy eating habits.21,22 Numerous interventions focusing on nutrition education have been implemented in schools worldwide, but many studies have been unable to show significant associations with improved dietary habits,23-25 and studies point towards expanding the focus to include environmental influences instead of solely aiming to influence individual factors.26,27

Researchers, policy-makers, private companies and practitioners alike have embraced the relatively new field of choice architecture and nudging. research has shown that subtle alterations in the food choice environment such as health labelling or manipulating sizes of plates and cutlery can modify eating behaviour and food choices in the desired direction and thus constitute promising intervention alternatives or accompanying measures for achieving sustained behavioural change.28-36

The objectives of the present literature review were to identify and assess the quality of existing studies investigating desired attitudes towards choice architectural nudge interventions as well as the effects of such interventions on promoting the intake of vegetables among school attending adolescents. These attitudes are an important and neglected necessity in order to assess public approval for policies and interventions of this nature.

Theoretical framework

This systematic review investigates the effects of nudge interventions among adolescents. Nudging is a tool within choice architecture that is defined as 'ways of influencing choice without limiting the choice set or making alternatives appreciably more costly in terms of time, trouble, social sanctions, and so forth'.37 Nudging has its foundation in the Dual Process Theory originating from the field of psychology, which involves a division of the human cognition into two systems: the reflective system and the automatic system. The reflective system is rational and involves conscious reasoning, whereas the automatic system is more unreflective and controlled by instinct. …

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