Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. box 85500, 3508 GA, Utrecht, The Netherlands.
Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands.
Nutr J. 2020 Sep 17;19(1):103. doi: 10.1186/s12937-020-00623-y.
Adults with a low socioeconomic position (SEP) are more likely to engage in unhealthy diets as compared to adults with high SEP. However, individual-level educational interventions aiming to improve food choices have shown limited effectiveness in adults with low SEP. Environmental-level interventions such as nudging strategies however, may be more likely to benefit low SEP groups. We aimed to review the evidence for the effectiveness of nudges as classified according to interventions in proximal physical micro-environments typology (TIPPME) to promote healthy purchases, food choice, or affecting energy intake or content of purchases, within real-life food purchasing environments. Second, we aimed to investigate the potentially moderating role of SEP.
We systematically searched PubMed, EMBASE, and PsycINFO until 31 January 2018. Studies were considered eligible for inclusion when they i) complied with TIPPME intervention definitions; ii) studied actual purchases, food choice, or energy intake or content of purchases, iii) and were situated in real-life food purchasing environments. Risk of bias was assessed using a quality assessment tool and evidence was synthesized using harvest plots.
From the 9210 references identified, 75 studies were included. Studies were generally of weak to moderate quality. The most frequently studied nudges were information (56%), mixed (24%), and position nudges (13%). Harvest plots showed modest tendencies towards beneficial effects on outcomes for information and position nudges. Less evidence was available for other TIPPME nudging interventions for which the harvest plots did not show compelling patterns. Only six studies evaluated the effects of nudges across levels of SEP (e.g., educational level, food security status, job type). Although there were some indications that nudges were more effective in low SEP groups, the limited amount of evidence and different proxies of SEP used warrant caution in the interpretation of findings.
Information and position nudges may contribute to improving population dietary behaviours. Evidence investigating the moderating role of SEP was limited, although some studies reported greater effects in low SEP subgroups. We conclude that more high-quality studies obtaining detailed data on participant's SEP are needed.
This systematic review is registered in the PROSPERO database ( CRD42018086983 ).
与社会经济地位较高的成年人相比，社会经济地位较低的成年人更有可能选择不健康的饮食。然而，旨在改善食物选择的个体层面教育干预措施在社会经济地位较低的成年人中效果有限。然而，环境层面的干预措施，如推动策略，可能更有利于社会经济地位较低的群体。我们旨在根据近端物理微观环境分类（TIPPME）的干预措施，审查推动策略在促进健康购买、食物选择或影响购买的能量摄入或内容方面的有效性证据，这些干预措施是在现实的食物购买环境中进行的。其次，我们旨在调查社会经济地位的潜在调节作用。
我们系统地检索了 PubMed、EMBASE 和 PsycINFO，直到 2018 年 1 月 31 日。当研究符合 TIPPME 干预定义时，我们认为研究符合纳入标准；二）研究实际购买、食物选择或能量摄入或购买内容；三）并且位于现实的食物购买环境中。使用质量评估工具评估风险偏倚，并使用收获图综合证据。
从确定的 9210 条参考文献中，纳入了 75 项研究。研究质量一般较弱至中等。研究最多的推动因素是信息（56%）、混合（24%）和位置推动因素（13%）。收获图显示，信息和位置推动因素对结果有适度的有益趋势。对于其他 TIPPME 推动干预措施，收获图没有显示出令人信服的模式，因此证据较少。只有六项研究评估了推动因素对社会经济地位不同水平的影响（例如，教育水平、粮食安全状况、工作类型）。尽管有一些迹象表明，在社会经济地位较低的群体中，推动因素更有效，但证据有限，并且使用的社会经济地位不同的指标都需要谨慎解释研究结果。
信息和位置推动因素可能有助于改善人群的饮食行为。关于社会经济地位调节作用的证据有限，尽管一些研究报告称，在社会经济地位较低的亚组中效果更大。我们的结论是，需要更多高质量的研究，获得关于参与者社会经济地位的详细数据。
本系统评价在 PROSPERO 数据库（CRD42018086983）中注册。
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