CIPH Away Day 25th June 2014 Exploring the potential of “choice architecture” interventions to change population health behaviour Dr 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 interventions Interventions 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

Provisional typology and evidence map

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

i) Sizing review

Systematic review in progress Registered Cochrane review protocol: ‘Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco’ AIMS i.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 Number of 4-packs of Carlsberg Export sold over 12-month period

Results 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

Thanks for listening For papers: