Choice Architecture Cueing to Healthier Dietary Choices and Physical Activity at the Workplace: Implementation and Feasibility Evaluation

Abstract

Redesigning choice environments appears a promising approach to encourage healthier eating and physical activity, but little evidence exists of the feasibility of this approach in real-world settings. The aim of this paper is to portray the implementation and feasibility assessment of a 12-month mixed-methods intervention study, StopDia at Work, targeting the environment of 53 diverse worksites. The intervention was conducted within a type 2 diabetes prevention study, StopDia. We assessed feasibility through the fidelity, facilitators and barriers, and maintenance of implementation, building on implementer interviews (n = 61 informants) and observations of the worksites at six (t1) and twelve months (t2). We analysed quantitative data with Kruskall–Wallis and Mann–Whitney U tests and qualitative data with content analysis. Intervention sites altogether implemented 23 various choice architectural strategies (median 3, range 0–14 strategies/site), employing 21 behaviour change mechanisms. Quantitative analysis found implementation was successful in 66%, imperfect in 25%, and failed in 9% of evaluated cases. These ratings were independent of the ease of implementation of applied strategies and reminders that implementers received. Researchers’ assistance in intervention launch (p = 0.02) and direct contact to intervention sites (p < 0.001) predicted higher fidelity at t1, but not at t2. Qualitative content analysis identified facilitators and barriers related to the organisation, intervention, worksite environment, implementer, and user. Contributors of successful implementation included apt implementers, sufficient implementer training, careful planning, integration into worksite values and activities, and management support. After the study, 49% of the worksites intended to maintain the implementation in some form. Overall, the choice architecture approach seems suitable for workplace health promotion, but a range of practicalities warrant consideration while designing real-world implementation.

Effectiveness of workplace choice architecture modification for healthy eating and daily physical activity

“…We rolled out a one-year hybrid type 2 implementation-effectiveness trial, StopDia at Work, between 2017 and 2019 in natural settings at workplaces from three regions of Finland (Northern Savo, South Karelia, and Päijät-Häme) [ 31 ]. The intervention aimed to promote healthy dietary choices and daily physical activity with subtle modifications to the worksite choice architecture.…”

The effect of nutrition labels on lunch buffet consumption: a real-life experiment

“…However, the consumption of healthier nutrition-labelled products did not change during the intervention in either study group. Rantala et al (2022) reported a reduction of 15-24 g/customer in the absolute consumption of salad bar items, warm meals, and condiments in the self-serving lunch buffet among Finnish adults after Heart Symbol posting. Although the results of Rantala et al are in line with those of our study, they are not entirely comparable because the data collection methods and product category classifications used in their study differed from ours.…”

Snudgers

“…Lastly, it would be remiss of us to not mention StopDia at Work by Rantala et al (15), a 12-month intervention targeting the environment of diverse worksites aimed at encouraging healthier eating and physical activity. In it, they listed 53 practical strategies (aka nudges) for creating healthy work environments focused on both healthy eating and physical activity (15). Some of our favorites include placing food physically closer to the individual, using larger tongs and spoons for healthy foods and smaller tongs and spoons for less healthy foods, leaving height-adjustable desks in the upright position at the end of the day, slowing down elevator doors to encourage stair use (this one made us chuckle), and posting an attention-getting story or riddle that leads to the stairs from the point-of-choice between the stairs and the elevator (oh, how we love a good riddle) (15).…”

“…Point-of-choice prompts have been popular and shown to be effective in increasing physical activity, with stair-use interventions most often studied (13,14). Lastly, it would be remiss of us to not mention StopDia at Work by Rantala et al (15), a 12-month intervention targeting the environment of diverse worksites aimed at encouraging healthier eating and physical activity. In it, they listed 53 practical strategies (aka nudges) for creating healthy work environments focused on both healthy eating and physical activity (15).…”