Using a verbal prompt to increase protein consumption in a hospital setting: a field study

Abstract

BackgroundSufficient protein intake among hospitalized patients may contribute to faster recovery and a decrease in healthcare costs. Nevertheless, hospitalized patients are often found to consume too little protein. This field study explored the success of a small, inexpensive intervention adapted from the marketing literature, to encourage protein consumption among hospitalized patients.MethodsThe study was performed at a hospital where patients order food by calling to the meal service. The intervention consisted of a verbal prompt: “Would you like some [target product] with that?”, which was presented to patients by trained telephone operators, after patients finished ordering their lunch. Target products were two foods rich in protein; fruit quark and yoghurt drink. For half of the patients, the verbal prompt was preceded by verbal praise on their lunch order, which was aimed to increase compliance with the verbal prompt.ResultsThree hundred and fifteen hospitalized patients, aged 18–87 years took part in the study. Verbal prompts significantly increased ordering of the target products nearly sevenfold (from ordering by 6.5 % of patients to 45.2 % of patients). Protein content of ordered lunch and all food orders of the day combined showed a trend, with orders of patients receiving only a verbal prompt or a verbal prompt and verbal praise containing a larger amount of protein than lunch orders of patients in the control condition. At an individual level, protein content of ordered food increased significantly, reaching the 25–30 g of protein per main meal recommended by dieticians of the hospital. Verbal praise did not increase compliance with the verbal prompt. Patients consumed most or all of the target product and verbal prompts were not perceived to be obtrusive.ConclusionsAlthough changing eating patterns is challenging, this study shows that simple interventions such as verbal prompts may be useful tools for health professionals to stimulate healthy food consumption among patients during hospitalization.

Undernutrition: who cares? Perspectives of dietitians and older adults on undernutrition

“…Another option is to stimulate intake by 'nudging' , an example of nudging in the hospital setting was a study by van der Zanden et al In this study, call centre employees asked a patient with every meal order if they would like a dairy, or other protein-rich, product with their meal. Patients often replied positively and they increased their protein intake by this simple method [22].…”

Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review

“…The selected studies were conducted worldwide between 2010 and 2019. Most of them were conducted in Australia [10,18,24,25,30,31,34,35,38,40,41,43,46], followed by Denmark [16,21,22,28,35,39,42,44], the Netherlands [15,23,26,36], Canada [47,48], Israel [17,45], and Spain [32], Hong Kong [29],…”

“…Belgium [37], United Kingdom [27], Iceland [20], Switzerland [19], and India [33], respectively. Six articles were intervention studies [20][21][22][23][24]28], five were randomized control trial studies [15][16][17][18][19], four were pre-post studies [10,[29][30][31], cohort studies [34,36,37,49] and pilot studies [35,[39][40][41], three were observational studies [25][26][27], cross-sectional studies [32,33,38], and quasi-experimental studies [42][43][44]. Our selection additionally comprised non-randomized control trial studies [45], mixed-method studies [46], prospective interrupted time-series studies [47], and case study approaches [48].…”

“…Eight studies (n = 8, 22.2%) implemented a new food service system in their hospital to improve patients' food intake, focused on the meal-ordering system, service styles, and meal delivery [23,25,26,30,32,34,37,43]. Most of the studies reported positive improvements in patients' food intake and satisfaction.…”

Got Milk? Using Nudges to Reduce Consumption of Added Sugar

“…Studies of verbal prompts among adults are also scarce, but the results are promising. Van der Zanden et al (2015) found that prompting hospital patients to order protein‐rich side items increased selection of the item. Ebster, Wagner, and Valis (2006) found that prompts to purchase of sides with the main meal at a restaurant resulted in greater sales.…”