Grocery store interventions to change food purchasing behaviors: a systematic review of randomized controlled trials

Abstract

BackgroundDiet is an important determinant of health, and food purchasing is a key antecedent to consumption.ObjectiveWe set out to evaluate the effectiveness of grocery store interventions to change food purchasing, and to examine whether effectiveness varied based on intervention components, setting, or socioeconomic status.DesignWe conducted a systematic review of randomized controlled trials (search performed June 2017). Studies must have: aimed to change food purchasing; been implemented in grocery stores (real or simulated); reported purchasing; and had a minimal control or compared interventions fulfilling our criteria. Searching, screening, bias assessment, and data extraction followed Cochrane methods. We grouped studies by intervention type (economic, environmental, swaps, and/or education), synthesized results narratively, and conducted an exploratory qualitative comparative analysis.ResultsWe included 35 studies representing 89 interventions, >20,000 participants, and >800 stores. Risk of bias was mixed. Economic interventions showed the most promise, with 8 of the 9 studies in real stores and all 6 in simulated environments detecting an effect on purchasing. Swap interventions appeared promising in the 2 studies based in real stores. Store environment interventions showed mixed effects. Education-only interventions appeared effective in simulated environments but not in real stores. Available data suggested that effects of economic interventions did not differ by socioeconomic status, whereas for other interventions impact was variable. In our qualitative comparative analysis, economic interventions (regardless of setting) and environmental and swap interventions in real stores were associated with statistically significant changes in purchasing in the desired direction for ≥1 of the foods targeted by the intervention, whereas education-only interventions in real stores were not.ConclusionsFindings suggest that interventions implemented in grocery stores—particularly ones that manipulate price, suggest swaps, and perhaps manipulate item availability—have an impact on purchasing and could play a role in public health strategies to improve health. Review protocol registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42017068809.

Restructuring physical micro-environments to reduce the demand for meat: a systematic review and qualitative comparative analysis

“…Outcome measures often relied on self-reported data or approximated estimates, which might have introduced bias and error variance. Additionally, selection of meat products in virtual settings is a suboptimal measure of meat demand in real-life settings and might thus lack external validity 53, 54. Part of our synthesis was based on results presented in conference abstracts, 50 dissertations,41, 52 or online reports 38 and their conclusions could vary following further analyses and peer review.…”

“…Finally, one study evaluating a pricing intervention in a virtual task did not find evidence to suggest that this intervention reduced the demand for meat. However, a substantial body of evidence exists to suggest that price is an important determinant of food choices, including a systematic review of randomised controlled trials in grocery stores, in which economic interventions were found to be the most promising approach to change food purchasing behaviour 54 . Further research exploring the effectiveness of pricing strategies to reduce the demand for meat is therefore warranted.…”

Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores

“…For example, one systematic review reported that several interventions targeting the availability of FVs (e.g., increasing the number of FVs stocked) observed increases in the overall sales or individual-level purchases of healthy foods such as FVs, however, two interventions using FV availability approaches observed no improvement in the overall purchasing of healthy foods such as FVs [9]. In a separate systematic review, mixed results were reported for interventions targeting the placement or location of FVs throughout the store (e.g., FVs placed in the front versus the back of the store) and the impact on purchases [10]. One intervention placed FV displays near the front of the store to increase their visibility and reported increases in FV purchases among customers; however, other similar interventions reported no improvement in FV purchases [10,11].…”

“…In a separate systematic review, mixed results were reported for interventions targeting the placement or location of FVs throughout the store (e.g., FVs placed in the front versus the back of the store) and the impact on purchases [10]. One intervention placed FV displays near the front of the store to increase their visibility and reported increases in FV purchases among customers; however, other similar interventions reported no improvement in FV purchases [10,11]. A different systematic review concluded that multipronged strategies to increase both the supply (e.g., availability of healthy foods) and demand (e.g., strategies to encourage purchasing at the point-of-purchase [POP]) of FVs were more likely to increase purchases of FV among customers than in-store interventions using single strategies to increase either supply or demand [12].…”

“…Previous studies and systematic reviews on in-store interventions provide evidence for the feasibility of implementation and potential to improve the food store environment [8][9][10]12,18,19]. In studies that aimed to increase the availability of healthier foods such as FVs, low-fat milk, and low-fat baked goods in food stores, they were able to successfully increase the overall number of these products within targeted stores based on observed data [20][21][22][23].…”