License: Licensed by JMIR
September 7, 2021
The world is increasingly surfing the web to access a wide range of goods and services, and food is no exception. In 2020, web-based food ordering platforms were used by almost 1 billion people across the world. The wide reach of these systems provides a tremendous opportunity to deliver public health interventions, and new research by the University of Newcastle published today in the Journal of Medical Internet Research has investigated the potential of these systems to improve food choices among primary school children.
School canteens are the most common take-away food service used by Australian children, and 95% of schools have a canteen. Web-based canteens allow users to view the school canteen menu and prepurchase items on the internet for collection during the school meal breaks, and they are increasingly popular. Flexischools, the leading Australian provider services 1350 schools nationwide and processes over 13 million lunch orders each year; this provider was a partner in this study that investigated the effectiveness of using web-based canteens to deliver a public health nutrition intervention.
“The ‘Click and Crunch’ intervention used simple choice architecture strategies to make small changes to the online interface of the ordering system,” said Dr Rebecca Wyse, lead researcher and senior lecturer at the University of Newcastle, Australia. The intervention included the following:
• Menu-labeling: color symbols to indicate the relative healthiness of each menu item).
• Positioning: menu items and categories were arranged to make healthier options more prominent.
• Prompting: when users selected certain less healthy hot food items, they received a prompt to purchase water or a piece of fruit or vegetables.
• Feedback: prior to finalizing their lunch order, the user was shown feedback and a pie graph displaying the proportion of healthy versus less healthy items in their order.
• Incentives: Orders that contained 100% healthy items had a cartoon character and congratulatory text printed on the lunch label.
In total, 17 primary schools in New South Wales, Australia, were recruited to this cluster randomized controlled trial, of which 9 were randomized to receive “Click & Crunch” over a 12-month period. Automatically collected purchasing data from 2207 students, and over 16,000 lunch orders were analyzed.
The researchers found that after 12 months, the energy content of intervention lunch orders was significantly lower (energy=–69.4 kJ, 95% CI –119.6 to –19.1 kJ; P=.01) and intervention schools had significantly greater odds of having healthier “Everyday” items purchased (odds ratio 1.7; P<.001), corresponding to a 9.8% increase, and lower odds of having less healthy “Occasional” items purchased (odds ratio 0.7; P<.001), corresponding to a 7.7% decrease. Importantly, there was no change in the schools’ revenue, indicating no adverse effects on canteen costs.
“It’s exciting to see that we can embed a public health nutrition intervention in an existing system used by tens of thousands of people, everyday,” said Dr Wyse, “and that it increased the selection of healthy items by almost 10% with no decrease in canteen revenue.” Given the evidence of its effectiveness, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. The researchers are now investigating whether these findings can be replicated among high school students.
Wyse R, Delaney T, Stacey F, et al. Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial. J Med Int Res.