The efficacy of a multi-strategy behavioral intervention on improving the nutritional quality of high school students’ lunch purchases from online canteens (Click & Crunch High Schools): a pilot cluster randomized controlled trial. (Preprint)
BACKGROUND High school canteens are a recommended setting for public health nutrition intervention. The rapid uptake of online lunch ordering within school canteens provides a unique opportunity to support the purchase healthier lunch items via the use of choice architecture strategies. Despite this, no trial has tested the efficacy of choice architecture strategies within an online lunch ordering system on improving the nutritional quality of high school student lunch purchases. OBJECTIVE To assess the impact of embedding choice architecture strategies into an online lunch ordering system (menu labelling, prompts, item positioning, and feedback) on the nutritional quality of the school canteen lunch purchases of high school students (aged 12-19 years). METHODS A cluster randomized controlled trial was conducted with nine high schools in one Australian state. Schools were randomized to receive either the choice architecture intervention, or usual online ordering. Nutrient quality was assessed using routine data collected by the online ordering system. Primary outcomes were the proportion of ‘Everyday’, ‘Occasional’, and ‘Should Not Be Sold’ items purchased, categorized using the state healthy canteen policy. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Linear mixed models were analyzed to assess outcomes. RESULTS There were significant between group differences over time for the intervention group for the mean percentage of online lunch items per student that were ‘Everyday’ (+5.5%; [95% CI 2.2, 8.9]; P <0.001) and ‘Should Not Be Sold’ (-4.4%; [95% CI -7.0, -1.8]; P <0.001). There were no between group differences over time in the mean percentage of online lunch items that were ‘Occasional’ or the average energy, saturated fat, sugar, or sodium content of lunch orders. CONCLUSIONS These findings suggest that a low intensity, choice architecture intervention embedded within an online ordering system can increase the purchase of healthier food items for high school students. CLINICALTRIAL This trial was prospectively registered on Open Science Framework on 23rd October 2020 as osf.io/h8zfr.