In-hospital nudging intervention increases patients' healthy dietary choices
A quasi-experimental study
Daan Leonhard de Frel (Leiden University Medical Center)
Veronica R. Janssen (Leiden University Medical Center)
Hope Wicks (Leiden University Medical Center)
Zsuzsa Bakk (Universiteit Leiden)
Nicole van Keulen (Leiden University Medical Center)
Maaike S. Kleinsmann (National eHealth Living Lab, TU Delft - DesIgning Value in Ecosystems)
Willem J.J. Assendelft (Radboud University Medical Center)
Douwe Atsma (Leiden University Medical Center, TU Delft - DesIgning Value in Ecosystems, National eHealth Living Lab)
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Abstract
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.
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