Wyse Rebecca, Delaney Tessa, Stacey Fiona, Lecathelinais Christophe, Ball Kylie, Zoetemeyer Rachel, Lamont Hannah, Sutherland Rachel, Nathan Nicole, Wiggers John H, Wolfenden Luke
Hunter New England Population Health, Wallsend, Australia.
School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
J Med Internet Res. 2021 Nov 29;23(11):e31734. doi: 10.2196/31734.
School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online.
This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students' lunch orders 18 months after baseline.
This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up.
In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (-74.1 kJ; 95% CI [-124.7, -23.4]; P=.006) and saturated fat (-0.4 g; 95% CI [-0.7, -0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a -2.6% change). There was no between-group difference over time in canteen revenue.
This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required.
Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075.
学校餐饮服务，包括自助餐厅和食堂，是改善儿童营养的理想场所。在线食堂点餐系统越来越普遍，为实施选择架构策略以促使用户选择更健康的菜品提供了独特机会。尽管有证据表明其短期有效性，但关于选择架构干预措施的长期有效性的证据很少，尤其是那些通过在线方式实施的干预措施。
本研究确定了嵌入现有在线学校午餐点餐系统中的多策略行为干预（点击与 crunch）对基线后 18 个月小学生午餐订单的能量、饱和脂肪、糖和钠含量的长期有效性。
这项整群随机对照试验（RCT）涉及来自澳大利亚新南威尔士州 17 所学校的 2207 名学生（5 - 12 岁）。学校被随机分配接受多策略行为干预或对照（仅常规在线点餐）。干预策略持续运行 14 - 16.5 个月，直至随访数据收集结束。在基线和 18 个月随访时的 8 周期间评估试验主要结局（即学生在线午餐订单的平均总能量、饱和脂肪、糖和钠含量）和次要结局（即分类为日常、偶尔和需谨慎选择的在线午餐订单项的比例）。
共有 16 所学校（94%）参与了 18 个月的随访。随着时间推移，从基线到随访，相对于对照订单，干预订单的能量（-74.1 千焦；95%置信区间[-124.7, -23.4]；P = 0.006）和饱和脂肪（-0.4 克；95%置信区间[-0.7, -0.1]；P = 0.003）显著降低，但糖或钠含量无显著差异。相对于对照学校，干预学校购买日常菜品的几率显著增加（优势比[OR]1.2；95%置信区间[1.1, 1.4]；P = 0.009，相当于 +3.8%的变化），购买需谨慎选择菜品的几率显著降低（OR 0.7，95%置信区间[0.6, 0.9]；P = 0.002，相当于 -2.6%的变化）。食堂收入在组间随时间无差异。
这是第一项研究通过学校在线食堂点餐系统实施的选择架构干预措施的持续效果的研究。研究结果表明，在基线后长达 18 个月，在降低能量和饱和脂肪含量以及学生午餐购买的健康和不健康食品相对比例变化方面存在干预效果。因此，这种干预方法作为学校内的一种群体健康行为改变策略可能具有前景，并且可能对更广泛地使用在线食品点餐系统有影响；然而，还需要更多研究。
澳大利亚新西兰临床试验注册中心 ACTRN12618000855224；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075。
