The Promotion of Eating Behaviour Change through Digital Interventions.

Diet-related chronic disease is a global health epidemic giving rise to a high incidence of morbidity and mortality. With the rise of the digital revolution, there has been increased interest in using digital technology for eating behavioural change as a mean of diet-related chronic disease prevention. However, evidence on digital dietary behaviour change is relatively scarce. To address this problem, this review considers the digital interventions currently being used in dietary behaviour change studies. A literature search was conducted in databases like PubMed, Cochrane Library, CINAHL, Medline, and PsycInfo. Among 119 articles screened, 15 were selected for the study as they met all the inclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search strategy. Four primary digital intervention methods were noted: use of personal digital assistants, use of the internet as an educational tool, use of video games and use of mobile phone applications. The efficiency of all the interventions increased when coupled with tailored feedback and counselling. It was established that the scalable and sustainable properties of digital interventions have the potential to bring about adequate changes in the eating behaviour of individuals. Further research should concentrate on the appropriate personalisation of the interventions, according to the requirements of the individuals, and proper integration of behaviour change techniques to motivate long-term adherence

Exploring salient dimensions in a free sorting task: A cross-country study within the elderly population

Free sorting tasks have been widely applied on different age segments to study the categorization of foods. However the method has received little attention in the investigation of older adults’ perception. Given the importance of understanding elderly perceptions in order to develop acceptable products, the main objective of this study was to investigate the factors that were able to affect the categorization of samples within different age segments of the healthy elderly consumers. Furthermore, in order to support the obtained configurations, the applicability of a free sorting task within different age segments of elderly population was investigated. The role of familiarity was considered to better understand the process of food categorization. A free sorting and a liking task were applied on French and Italian elderly to study perception and preference of familiar (peas) and less familiar (sweetcorn) vegetables. Similarities between the categorization maps, the preference maps and the sensory maps from vegetable samples were assessed through the RV coefficient and map visual inspection. Familiarity with the product was the main factor affecting the categorization among elderly. Categorization maps from a familiar vegetable were found to be suitable to obtain information on sensory and hedonic dimensions, while maps obtained from a less familiar vegetable mainly depicted sensory variability. The free sorting task was found to be a suitable method to use with healthy older adults, that allowed the detection of differences in the categorization of stimuli even among the more aged representatives of the elderly population

Familiarity and liking of vegetables: Is it important for vegetable consumption?

The results presented in this paper are part of the early findings from a large European study, VeggiEAT involving the UK, Denmark, France and Italy with the aim of improving vegetable consumption in young people and older people. The results presented here are from UK young people (aged 12–14) focusing on familiarity and liking of vegetables and looking at their vegetable consumption and awareness of what constitutes a healthy diet. The study adds to the literature on vegetable familiarity, liking and consumption in this age group. Early exposure of young children to a variety of vegetables is very important and parents/carers and school nurses need to understand the importance of this in terms of the foods offered and available early within a child`s life and the potential influence of this on vegetable consumption over their lifetime

Nudging using the ‘dish of the day’ strategy does not work for plant-based meals in a Danish sample of adolescent and older people

© 2018 John Wiley & Sons Ltd Adequate nutrition is an important factor for health and well-being in adolescents and later years. Fruits and vegetables are part of a healthy diet as important source of nutrients, but their intakes are lower than the recommendations in European countries. This study aimed to compare the choices made by adolescents and older people between three similar dishes, one based on meat, one on fish and one on vegetables, in two different conditions: a neutral (control) situation and an intervention situation in which the vegetable-based meal was designated ‘dish of the day’. The comparisons of choices will be made within the same age group (adolescents in the control group vs. adolescents in the intervention group; older people in the control group vs. older people in the intervention group). A quasi-randomised field trial design was used with a sample of 94 adolescents (aged 10–19 years) and 97 older people (aged ≥65 years), who were randomly allocated to intervention or control groups. In the control situation participants were asked to choose between three similar meals, one meat, one fish and one the VeggiEat dish. In the intervention, the VeggiEat dish was labelled the ‘Dish of the day’. All dishes were provided free of charge, displayed side by side in the same order and served in same portions. The dish choices showed no differences between the control and intervention groups in both age groups, and no differences were found among the other variables analysed. This nudging strategy, ‘dish of the day’, seems not to work for the Danish sample of adolescents and older people. Future nudging studies with these populations are needed in order to find the best strategy to move adolescents' and older people's food habits toward a healthier pattern

A Systematic Review of Behavioural Interventions Promoting Healthy Eating among Older People.

Because eating habits are inseparably linked with people's physical health, effective behaviour interventions are highly demanded to promote healthy eating among older people. The aim of this systematic review was to identify effective diet interventions for older people and provide useful evidence and direction for further research. Three electronic bibliographic databases-PubMed, Scopus and Web of Science Core Collection were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria. English language peer-reviewed journal articles published between 2011 and 2016 were selected for data extraction and quality assessment. Finally, a total of 16 studies were identified. The studies' duration ranged from three weeks to seven years. The majority of studies were carried out in European countries. Seven studies had a moderate quality while the remaining studies were at a less than moderate level. Three dietary educational interventions and all meal service related interventions reported improvements in older people's dietary variety, nutrition status, or other health-related eating behaviours. Multicomponent dietary interventions mainly contributed to the reduction of risk of chronic disease. The results supported that older people could achieve a better dietary quality if they make diet-related changes by receiving either dietary education or healthier meal service. Further high-quality studies are required to promote healthy eating among older people by taking regional diet patterns, advanced information technology, and nudging strategies into account

Increasing vegetable consumption out-of-home: VeggiEAT and Veg+projects

© 2020 The Authors. Nutrition Bulletin published by John Wiley & Sons Ltd on behalf of British Nutrition Foundation Adequate vegetable consumption is fundamental to a healthy, balanced diet; however, global compliance with recommendations to increase consumption is poor. There is a growing interest in the sustainability of current dietary patterns in light of expected climate change and an expanding global population where part of the response is increasing vegetable intake. Two international projects, VeggiEAT and Veg+, explored the determinants of vegetable liking and consumption in different age groups and countries and the effect of a nudging strategy on vegetable consumption in an out-of-home setting. The projects found that the importance given by consumers to natural or healthy ingredients, social norms, female gender and positive attitudes towards nudging all influenced vegetable consumption. Some sensory factors, such as bitterness and sourness, had a negative loading, while others, such as sweetness, had a positive effect on liking for vegetables. ‘Dish of the day’, as a nudging strategy in a workplace canteen setting, increased vegetable dish selection for some of the sample (adolescent females) but not for males or older people. Globally, there is a strong need to promote the consumption of vegetables as a public health issue but also to improve their availability and uptake, especially within out-of-home foodservice

Impact of a nudging intervention and factors associated with vegetable dish choice among European adolescents.

PURPOSE: To test the impact of a nudge strategy (dish of the day strategy) and the factors associated with vegetable dish choice, upon food selection by European adolescents in a real foodservice setting. METHODS: A cross-sectional quasi-experimental study was implemented in restaurants in four European countries: Denmark, France, Italy and United Kingdom. In total, 360 individuals aged 12-19 years were allocated into control or intervention groups, and asked to select from meat-based, fish-based, or vegetable-based meals. All three dishes were identically presented in appearance (balls with similar size and weight) and with the same sauce (tomato sauce) and side dishes (pasta and salad). In the intervention condition, the vegetable-based option was presented as the "dish of the day" and numbers of dishes chosen by each group were compared using the Pearson chi-square test. Multivariate logistic regression analysis was run to assess associations between choice of vegetable-based dish and its potential associated factors (adherence to Mediterranean diet, food neophobia, attitudes towards nudging for vegetables, food choice questionnaire, human values scale, social norms and self-estimated health, country, gender and belonging to control or intervention groups). All analyses were run in SPSS 22.0. RESULTS: The nudging strategy (dish of the day) did not show a difference on the choice of the vegetable-based option among adolescents tested (p = 0.80 for Denmark and France and p = 0.69 and p = 0.53 for Italy and UK, respectively). However, natural dimension of food choice questionnaire, social norms and attitudes towards vegetable nudging were all positively associated with the choice of the vegetable-based dish. Being male was negatively associated with choosing the vegetable-based dish. CONCLUSIONS: The "dish of the day" strategy did not work under the study conditions. Choice of the vegetable-based dish was predicted by natural dimension, social norms, gender and attitudes towards vegetable nudging. An understanding of factors related to choosing vegetable based dishes is necessary for the development and implementation of public policy interventions aiming to increase the consumption of vegetables among adolescents

Shaping smarter consumer food choices: The FoodSMART project.

Compared to meals prepared at home, meals eaten out of home tend to contain more energy, total fat and saturated fat and it is here where consumers can have very little knowledge of the nutrient profile of the dish they are eating. The aim of the European Union-funded FoodSMART project (www.foodsmartproject.net) was to develop an innovative technical menu solution ‘app’ that enables informed consumer food choice, which takes into account individual preferences (such as dietary requirements) as well as food product specifications, in a workplace canteen setting. A best–worst scaling questionnaire was conducted to identify consumers’ functional app requirements and inform the development of personalised food choice messages. Proof of concept was tested using the System Usability Scale in consumers from four European countries (Denmark, France, Greece and the UK). Information on ingredients, nutrition, food ‘naturalness’ and value for money were those most valued by consumers, with this presented ideally in a personalised way and using a traffic light model. Field trials of the FoodSMART app indicated that consumers found it to be simple, easy to use and attractive for frequent use. By gaining insight into the needs of consumers, dietary information can be better tailored and provided in an appropriate format to enable informed food choice

When are “Dish of the Day” nudges most effective to increase vegetable selection?

Previous research has suggested that featuring vegetable-rich dishes as “Dish of the day” (DoD) could be an operationally feasible and straightforward strategy to promote healthier food choices in restaurants. However, the available evidence regarding the effect of DoD on food choices is limited, and little is known about the conditions of its effectiveness in the field. This study investigates the effect of introducing DoD options in a real self-service restaurant setting on the selection of vegetable-rich options. The objectives are to (1) replicate and measure the DoD effect in this situation; and (2) investigate the moderating role of two features of the choice set: (i) the type of option set as DoD and (ii) the number of alternatives options to choose from. In a living lab experiment, 294 consumers came for lunch to a self-service restaurant and chose between a target vegetable-based dish (vg1) and respectively one, or two, alternatives: a meat-based dish (nvg) and another vegetable dish (vg2). Five choice task conditions were tested, in a between-subjects design: three conditions examined dish choices when two options were available (vg1 versus nvg): no DoD (T1-0); vg1 as DoD (T1a); or nvg as DoD (T1b). Two further conditions used three options (vg1 versus nvg versus vg2): no nudge (T2-0), or vg1 as DoD (T2a). In neutral conditions T1-0 and T2-0 respectively, 34.4% and 23.3% of consumers chose vg1. The DoD effect was observed in all conditions: choices in favour of vg1 increased by 25.2% when in was DoD by 25.2% in T1a vs. T1-0 and by 30% in T2a vs T2-0; while 7.6% more consumers chose nvg in T1b vs T1-0. Regarding the conditions of DoD effectiveness, the size of the DoD effect was larger for the initially less popular dish vg1 (T1a) compared with nvg (T1b). Introducing more options also increased the relative effect of DoD in favour of vg1, from 73% (T1a) to 129% (T2a). There were no effects of the condition on consumer satisfaction with the dish chosen, nor on the amount of food wasted. This research gives insight into the elements of the choice task to consider when setting up nudges, and could help choice architect to better design efficient and acceptable nudges in foodservice settings