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CIPH Away Day 25th June 2014. Exploring the potential of “choice architecture” interventions to change population health behaviour. Dr Gareth Hollands. Background. - PowerPoint PPT Presentation
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CIPH Away Day25th June 2014
Exploring the potential of “choice architecture” interventions to change
population health behaviourDr Gareth Hollands
Background• Idea of ‘nudging’ people — changing the
environments within which they make choices (choice architecture) — has gained traction in policy circles
• Empirical evidence is limited, but have significant potential to change behaviour at population level
• Coherent definition and map of existing evidence for choice architecture interventions has been missing, hampering their evaluation
Scoping review
• Large-scale systematic scoping review of primary and secondary research of interventions with behavioural outcomes
• Preliminary stage to systematic reviews of effectiveness, with principal aim to describe (not evaluate) an evidence base with uncertain characteristics
(Hollands et al (2013), BMC Public Health)
Defining choice architecture interventionsInterventions that involve altering
i. the properties or ii. the placement
of objects or stimuli within micro-environments with the intention of changing health-related behaviour
– implemented within the same micro-environment as the target behaviour is performed
– can influence many people simultaneously– typically require minimal conscious engagement
BHRU projects on choice architecture• Scoping review helped identify and
contextualise opportunities for systematic reviews and primary research to aid in generating estimates of effect size
• Examples include: i) Sizing review ii) Observational study of end-of-aisle promotions
Systematic review in progress• Registered Cochrane review protocol: ‘Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco’ AIMSi. to estimate the effects of manipulating different portion, package or tableware sizes on selection or consumption of food, alcohol or tobacco products;
ii. to estimate the extent to which these effects may be modified by characteristics of the study, the intervention and the participants.
(Hollands et al (2014), Cochrane Database of Systematic Reviews)
Characteristics of included studies
• Large scale review (42,424 abstracts dual-screened) • 72 studies included (randomised between-subjects and within-
subjects designs), mainly conducted in laboratory settings (71%; 51/72)
• The great majority of studies concern food products (96%; 69/72).
• Preliminary results expected late summer 2014
Study aim: • To estimate the effect of end-of-aisle display on item-level sales
of alcohol, controlling for price, price promotion and the number of display locations for each product
NB Example of a choice architecture intervention to detrimentally alter health behaviour
Methods• A proportion of trolleys are tracked around a map of one UK
store and purchases recorded
(Nakamura et al (2014), Social Science & Medicine)
ii) Sales impact of end-of-aisle promotions
Example product
0
50
100
150
200
250
300
350
0102030405060708090100
Standard aisle only % trolleys passing
Week beginning…
Num
ber o
f ite
ms p
urch
ased
Min
% o
f tro
lleys
pas
sing
prod
uct
0
50
100
150
200
250
300
350
0102030405060708090100
Standard aisle & end-of-aisle % trolleys passing
Week beginning…
Num
ber o
f ite
ms p
urch
ased
Min
% o
f tro
lleys
pas
sing
prod
uct
Number of 4-packs of Carlsberg Export sold over 12-month period
Results
Beer Wine Spirits Fizzy drinks
Coffee Tea0
20
40
60
80
100
120
140
Off gondola end On gondola end
Wee
kly
sale
s vol
ume
(l/kg
)fo
r ave
rage
pro
duct
in ca
t-eg
ory
34% 46%
52%
74% 114%
23%
• All categories of drinks increase sales when placed in the more visible location
Next steps• Further primary research where absence of evidence e.g.
effects of choice architecture interventions on alcoholic and non-alcoholic drink consumption
• Rigorous systematic reviews of effects of interventions and their moderators
• Conceptual development of definitions and typology• Focus on: i) durability of effects ii) hypothesis that interventions relying on minimal conscious engagement have potential to reduce health inequalities
