Aims: Most hospitals still lag behind in their policies to stimulate healthier dietary choices by their patients. This study investigates whether a multicomponent nudging intervention, designed to prompt healthy food choices, can influence dietary choices of hospitalised patients.

Methods: This pre-postintervention study included a baseline phase and an intervention phase (7+7 months) and was carried out at the cardiology ward of a large hospital. All 2419 cardiac patients admitted to the ward during this period, and their 7559 meals were part of this study. The nudging intervention consisted of choice architecture, visual cues and informational nudges (eg, traffic light menus, posters). Data on dietary choices (vegetarian, fish, meat, side salad and fruit salad) were collected from the electronic food ordering system. As a secondary outcome, the intention to eat healthy after discharge was measured using the 20-item long Dutch Dietary Intention Evaluation Tool.

Results: During the intervention period, there was a statistically significant increase in the selection of vegetarian meals (20.1% vs 16.3%, p<0.001), fish meals (24.6% vs 18.7%, p<0.001), side salads (54.5% vs 49.5%, p<0.001) and fruit salads (12.8% vs 8.6%, p<0.001) when compared with the baseline period. In addition, patients in the intervention period expressed a significantly higher intention to eat healthy after discharge compared with the baseline period (β=0.167, SE=0.083, p=0.045).

Conclusion: This study demonstrates that a straightforward, easily implementable nudging intervention effectively promotes healthy dietary choices among in-hospital cardiac patients and enhances their intention to eat healthy after discharge.

Background: Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with persisting leg pain after six to eight weeks were found to have similar clinical outcomes and associated costs after prolonged conservative treatment or surgery at one year follow-up. Guidelines recommend that the team of professionals involved in sciatica care and patients jointly decide about treatment options, so-called interprofessional shared decision making (SDM). However, there are strong indications that SDM for sciatica patients is not integrated in daily practice. We designed a study aiming to explore the barriers and facilitators associated with the everyday embedding of SDM for sciatica patients. All related relevant professionals and patients are involved to develop a tailored strategy to implement SDM for sciatica patients.Methods: The study consists of two phases: identification of barriers and facilitators and development of an implementation strategy. First, barriers and facilitators are explored using semi-structured interviews among eight professionals of each (para)medical discipline involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons). In addition, three focus groups will be conducted among patients. Second, the identified barriers and facilitators will be ranked using a questionnaire among a representative Dutch sample of 200 GPs, 200 physical therapists, 200 neurologists, all 124 neurosurgeons, 200 orthopedic surgeons, and 100 patients. A tailored team-based implementation strategy will be developed based on the results of the first phase using the principles of intervention mapping and an expert panel.Discussion: Little is known about effective strategies to increase the uptake of SDM. Most implementation strategies only target a single discipline, whereas multiple disciplines are involved in SDM among sciatica patients. The results of this study can be used as an example for implementing SDM in other patient groups receiving multidisciplinary complex care (e.g., elderly) and can be generalized to other countries with similar context, thereby contributing to a worldwide increase of SDM in preference sensitive choices.