Can Simple Nudges and Workshops Improve Diet Quality? Evidence from a Randomized Trial in Bangladesh

Abstract

Despite improvements in food access and affordability around the world, low-quality diets persist. Public policy affecting food choice may have a role to play alongside efforts to improve access to healthy foods. This study uniquely explores the potential for dietary interventions to encourage healthy food choice among adults in a developing country. We evaluate two dietary interventions using a randomized control trial in Bangladesh: a behavioral change communication workshop that emphasized national dietary guidelines and a "nudge" in the form of a plate printed with nutrition recommendations. We study the performance of both interventions in two environments: a lab-in-the-field experiment where food choices are discreetly observed at two lunch events and in the home using household survey data. The workshop improves diet quality in the lab and the home, although its impact is less precisely estimated in the latter setting. We find no effect of the plate in the lab during the same lunch event when the plate is received. The plate is effective at home, and the nudge effects of in-home exposure persist in the lab even when the plate is not being used. Receipt of the plate at the first lunch event followed by one month of subsequent in-home access to the plate improves food choice at the second event. Combining treatments does not increase their effectiveness. We conclude that nudges improve diet quality in our study context, but more evidence is needed to determine the effects of workshop messages in the home.

Does nutrition knowledge training improve dietary diversity and nutrition intake? Insights from rural China

“…The selection of control variables is drawn upon existing literature related to nutrition knowledge programs (e.g., Davidson et al, 2021;Hou et al, 2021;Mwale et al, 2022) and household food consumption and nutrition intake (e.g., Korir et al, 2023;Ma et al, 2022aMa et al, , 2022bQin et al, 2023). Specifically, the selected control variables capture respondents' characteristics (e.g., age, gender, education level, and health knowledge), household-level characteristics (household size, children ratio, and asset ownership), and villagelevel characteristics (e.g., income level, number of food stores, express service outlet, ICT facility and distance to the food market).…”

“…If the training status is randomly assigned in an experimental context, we can compare the mean outcomes between respondents with training and their counterparts without training directly to understand the impact of nutrition knowledge training on dietary diversity and nutrition intake. However, in our case, nutrition knowledge training is not randomly assigned between the treated samples (rural residents receiving nutrition knowledge training) and untreated samples (rural residents without receiving nutrition knowledge training) because the availability of nutrition knowledge training in a village is determined by observed characteristics (e.g., income level, infrastructure facilities, and geographical locations) (Davidson et al, 2021; Seetha et al, 2018; Sibhatu et al, 2022). Thus, nutrition knowledge training is potentially endogenous, which should be addressed when estimating the effects of nutrition knowledge training.…”

“…Nevertheless, the achievement of Sustainable Development Goals is still facing various challenges. In many low and middle‐income countries like Zambia (Sibhatu et al, 2022), Tanzania (Debela et al, 2021), and Bangladesh (Davidson et al, 2021), low agricultural productivity and income level lead to hunger and malnutrition among rural households. Although China has alleviated absolute poverty in 2020 and the country does not worry about eating satisfaction (Liu et al, 2020), Chinese residents, due to nutrition knowledge deficiencies, are still prone to health risks associated with being overweight, obesity, micronutrient malnutrition, and inadequate nutrient balance (Hou et al, 2021; Ma et al, 2022a; Xue et al, 2021).…”

“…It is essential to improve rural residents' nutrition knowledge and change their diet perceptions towards a healthier direction, as this helps them better understand the relationship between eating and health. An increasing number of studies have highlighted that public policies, programs, and interventions on nutrition knowledge play a key role in improving diet quality and nutrition intake (Davidson et al, 2021; Hamulka et al, 2018; Mwale et al, 2022; Ollberding et al, 2011; Seetha et al, 2018; Sibhatu et al, 2022; Sunguya et al, 2013). The rationale is that improving the individuals' nutrition knowledge would help them diversify the food consumed and transfer to a more balanced diet.…”

Video‐based behavioral change communication to change consumption patterns: Experimental evidence from urban Ethiopia

“…The third concern could be addressed through behavior change communication (BCC) campaigns designed to improve dietary habits. Indeed, a growing body of evidence shows that BCC interventions can improve nutritional knowledge and promote adoption of improved dietary habits in low‐income settings (e.g., Davidson et al, 2021; Fitzsimons et al, 2016; Galasso et al, 2011; Kim et al, 2019; Lubega et al, 2021; Menon et al, 2016; Penny et al, 2005; Warren et al, 2020; Zaman, Ashraf, & Martines, 2008). However, the scalability and sustainability of such resource‐intensive activities—which often involve home visits and/or support groups—is uncertain.…”