Nutrition interventions at point-of-sale to encourage healthier food purchasing: a systematic review

Abstract

BackgroundPoint-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting.MethodsRecords from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome.ResultsThe search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions.ConclusionsA range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-919) contains supplementary material, which is available to authorized users.

Outcomes of a randomized controlled trial of nutrition education to promote farmers’ market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

“…Addressing this barrier was considered beyond the scope of the work. Social Cognitive Theory emphasizes intervening to improve both the food environment (e.g., FV access) and behavioral capacity (knowledge and skills to increase FV intake) [41,42]. As such, a multilevel approach to comprehensively address influences on farmers' market use may have improved lesson effectiveness.…”

Feasibility of a Healthy Trolley Index to assess dietary quality of the household food supply

“…Nonetheless, strong evidence for supermarket interventions, particularly those that provide nutrition education only at point of purchase, is somewhat lacking (8) , although interventions with a price intervention show more promise (13,45,46) . Nutrition education alone may not be adequate to drive real and sustained change to the household food supply.…”

“…BMI was categorised into three weight status groups consistent with the World Health Organization (20) cut-offs. Age was categorised into three groups consistent with those used in the latest Australian Health Survey (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50) and 51-70 years).…”

The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities

“…32 Other studies that examined the impact of price discounting strategies have shown promise, but are difficult to compare with our findings. 10,11 The discounts were offered via different mediums and in different populations, assessed benefits differently and offered smaller or larger discounts. This current study adds modelled fiscal strategies to the list of modelled vaccination and pharmacotherapy strategies that have been shown to be cost-effective specifically for the Aboriginal and Torres Strait Islander population, using similar economic 36 It highlights useful areas of potential future nutrition research (dietary behaviour response to fiscal strategies and/or nutrition education).…”

“…6,7 However, the cost of food and the socioeconomic position of the Aboriginal and Torres Strait Islander population in remote locations are key determinants of their poor quality diet. 8,9 While there is growing evidence that fiscal measures applied to food and beverages can potentially influence consumption patterns and improve health outcomes, 10,11 most preventive interventions in Australia use nutrition information and education approaches alone where the evidence is less clear.…”