Overview of existing knowledge concerning food behaviourinterventions out-of-home, in the working environment and in health care settings : a literature review

Reinders, Machiel; Bouwman, Emily; Taufik, Danny


So-called ‘closed settings’, like restaurants, canteens, hospitals and other out-of-home locations, can play an important role in improving diet quality by offering healthier and more sustainable food choices (i.e., more vegetables, less meat) on their menus. This report aims to provide an overview of different real-life interventions focused on food choice behaviour of consumers in these closed settings. For this purpose, a review of the literature has been conducted with a main focus on interventions promoting healthy and sustainable food choicesinthree real-life closed settings, namely out-of-home, the working environmentand health care settings. This deliverable provides insight into which type of behavioural interventions have been tested and are particularly effective in stimulating healthy and/or sustainable food choices in each of these settings. The overview is based on 79 studies in total (out-of-home: 24; working environment: 33; health care: 22), that were found by doing a literature search in the database Web of Science. Results show that across the three settings, the large majority of the interventions were through an environmental intervention,for example a type of nudging, and fewer studies used and tested some form of education/information provision. More specifically, in the settings out-of-homeand working environment most interventions tested a type of nudging strategy to stimulate healthy and/or sustainable food choices. In the health caresetting, studies consisted mostly of a type of environmental intervention, where modifications were made in, for example, the way menus were offered or the type of offered products was altered. Across settings, most studies were successful in influencing their outcome variable of interest. Overall, multi-component studies appear to be somewhat more successful than single-component interventions. In both out-of-homeand working environment settings, studies that use priming nudges (i.e., by means of visibility, accessibility and availability) seem to be most successful, whereas mixed results were found for salience nudges (i.e., colour-coded labelling appeared to be more effective than calorie labelling). In the health caresetting, environmental interventions were more successful than educational interventions. Specifically, the environmental studies using salience nudges, by means of labelling and verbal prompts, were effective. Priming nudges by means of accessibility (i.e., an alternative menu-ordering system) and visibility (enhancing ambiance) were also effective. Note that, although the studies that are described in this deliverable are based on a thorough assessment of the literature, it cannot be labelled as a systematic review as it did not follow all necessary steps that are needed to qualify as a systematic review. The articles described depend on the search criteria that were set for the literature search. Therefore it is possible that some relevant studies might be missing. Nevertheless, this literature review gives an overview of which intervention components are particularly effective in stimulating healthy and/or sustainable food choices in each of the settings. This overview can be helpful for practitioners who want to stimulate healthy and sustainable food choices within closed settings, like caterers, restaurant owners, health care staff, employers or other providers of food. Additionally, this overview can be helpfulfor researchers who are interested or want to develop an intervention in one of these settings. This report is an update of the report 'Overview of existing knowledge concerning food behaviourinterventions out-of-home, in the working environment and in online settings' from the PPP project Food, Value, Impact with input from the PPP projectImplementation of food interventions in health care and out of home(in Dutch: Implementatie van voedingsinterventies in intramurale zorginstellingen en horeca).