(P22-015-23) Opportunities for Choice Architecture Interventions in School Food Settings in Low- and Middle-Income Countries: A Study Protocol

Objectives: How a choice is presented or framed to an individual, the choice architecture, influences subsequent decisions. Supporting better food choice behavior is critical to addressing shortfalls in children’s dietary intakes. Implementing nudges (changes to the choice architecture) within school food environments, where children choose between available options, can influence what they select to eat. Such interventions are grounded in nudge theory and behavioral economics. Much of the evidence originates from high income countries and there is now a recognised need for research on the relevance/feasibility of nudges in diverse cultural and income settings. This study aims to examine the potential of choice architecture interventions in school food settings in low- and middle-income countries (LMIC) and add to the literature with evidence from the design and development of nudges for school food environments in diverse settings.

Methods: This study comprises three phases. First, a scoping review (encompassing grey literature) will consider food provision in schools, including at different food/beverage points, e.g. food vendors, tuck shops – with a focus on the extent of the choice available in different countries. This work will consider the choice architecture, potential utility of nudge-based approaches, and barriers/difficulties that proponents may face. Second, having identified two/three different settings in LMIC, stakeholder engagement will explore the potential for choice architecture interventions in schools. The third phase entails the design, development and evaluation of a nudge-based intervention comprising changes to the choice architecture within school food settings, context-specific and adapted to the identified schools and countries.

Results: N/A - study protocol abstract

Conclusions: This study will add to the literature on nudges to complement school-based interventions to improve the school food environment, and will provide documented experience from more diverse settings. This will include how contextual factors may affect the implementation and effectiveness of nudges and how these can best be incorporated. The study will also provide a greater understanding of the scope and potential for nudges to promote better food choice from available options, for children in LMIC.

Funding Sources: Medical Research Council (IAA) & University of Leeds