Improving cardiometabolic health through nudging dietary behaviours and physical activity in low SES adults: design of the Supreme Nudge project

Abstract

BackgroundInitiating and maintaining a healthy lifestyle -including healthy eating and sufficient physical activity- is key for cardiometabolic health. A health-promoting environment can facilitate a healthy lifestyle, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In the Supreme Nudge project, we will study the effects of pricing and nudging strategies in the supermarket – one of the most important point-of-choice settings for food choices – and of a context-specific mobile physical activity promotion app. This paper describes the stepwise and theory-based design of Supreme Nudge, which aims to develop, implement and evaluate environmental changes for a sustained impact on lifestyle behaviours and cardiometabolic health in low SES adults.MethodsSupreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 low SES adults will be recruited across 8–12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours and physical activity will be evaluated at 3, 6 and 12 months, and on cardiometabolic health at 6 and 12 months. Finally, we will evaluate the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention, and we will use insights from System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period.DiscussionThe Supreme Nudge project is likely to generate thorough evidence relevant for policy and practice on the effects of a mixed method and multi-disciplinary intervention targeting dietary behaviours and physical activity.Trial registrationThe real-life trial has been registered on 30 May 2018, NTR7302.

The effects of nudging and pricing on healthy food purchasing behavior in a virtual supermarket setting: a randomized experiment

“…We used a three-dimensional (3D) web-based virtual supermarket (the SN VirtuMart) to test the efficacy of nudging, pricing and combined nudging and pricing strategies. This experimental study was part of the 'Sustainable Prevention of Cardiometabolic Risk through Nudging Health Behaviors' (Supreme Nudge) project [21]. This randomized trial (NTR7293) was registered in the Dutch trial registry.…”

Choice architecture interventions to change physical activity and sedentary behavior: a systematic review of effects on intention, behavior and health outcomes during and after intervention

“…In recent decades, choice architecture has gained momentum in the field of public health and health promotion [10,12,25,26]; however, its theoretical principles originate in a long tradition of judgment and decision making research [16,20,27]. Past research has demonstrated that choice architecture interventions can effectively change behavior in a variety of health domains [10]; however, studies on choice architecture in the domain of physical activity and sedentary behavior have received relatively little attention compared to, for example, dietary behavior (e.g.…”

Reducing cardiometabolic risk in adults with a low socioeconomic position: protocol of the Supreme Nudge parallel cluster-randomised controlled supermarket trial

“…The trial design deviates from the initial plan as described in the Supreme Nudge project design paper [54], in which the mobile PA app was treated as clusterrandomised intervention arm. However, smartphone ownership could hinder recruitment of participants in the trial and the approach unnecessarily randomised the individual-level PA app intervention at the cluster level, thereby increasing the required sample size.…”

“…Following the previously described [54] approach for applying System Innovation and Transition Management theories to define the best strategies for implementation and upscaling beyond the study period we will use the reflexive monitoring of this trial as part of the cocreation of the final roadmap. This strategic roadmap will be based on gathered evidence on underlying mechanisms and structures and will include identified systemic barriers and facilitators, as well as strategies to overcome identified barriers for future supermarketbased health interventions.…”

“…Furthermore, we aim to contribute to an implementation roadmap to guide future supermarket-based health interventions. This trial is embedded within the larger Supreme Nudge project of which the overarching relevance and design has previously been described [54]. The current protocol focuses on participant-level related outcomes.…”