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Choice architecture interventions to improve diet and/or dietary behaviour by healthcare staff in high-income countries: a systematic review
  1. Lena Al-Khudairy1,
  2. Olalekan A Uthman1,
  3. Rosemary Walmsley1,2,
  4. Samantha Johnson1,
  5. Oyinlola Oyebode1
  1. 1 Warwick Medical School, University of Warwick, Coventry, UK
  2. 2 Worcester College, University of Oxford, Oxford, UK
  1. Correspondence to Dr Oyinlola Oyebode; O.R.O.Oyebode{at}


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.

  • choice architecture
  • diet
  • health care
  • public health

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  • Contributors LA-K and OO designed the protocol. LA-K, OO and SJ designed and ran the searches. LA and OO performed the initial screening. LA-K, OO and OAU screened full-text articles. LA-K, OO, OAU and RW extracted data from included studies. LA-K and OO synthesized extracted data and wrote the first draft of the manuscript. All authors contributed to the final submitted manuscript.

  • Funding This piece of research was funded by Public Health England Behavioural Insights Team who gave feedback on the study protocol. LA and OO are supported by the National Institute of Health Research (NIHR) Collaboration for Applied Health Research and Care West Midlands initiative. RW was supported by University of Warwick through its Global Research Priority on Food. SJ was supported by the University of Warwick.

  • Disclaimer The funder had no role in the collection, analysis or interpretation of data, in the writing of the report or decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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