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: Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process. Objective: The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D. Methods: The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together. Results: The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box. Conclusions: After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail.