Search Results (46)

Background/Objectives: The global syndemic of obesity, undernutrition, and climate change highlight the complex health and environmental challenges faced by young adults. These challenges may intensify during the transition to university. As a matter of fact, limited budgets, time constraints, and insufficient culinary skills often lead to unbalanced diets and increased risk of obesity. University cafeterias, serving large numbers of students, represent an ideal setting to promote healthier and more sustainable eating behaviors. The FOOD-HACK Project aimed to design and implement a cafeteria-based intervention using nudging strategies to promote healthier and more sustainable lunch choices among university students. Methods: This pilot study employed a pre–post design with two independent phases in the Polo Cravino cafeteria at the University of Pavia. Food consumption was assessed over 12 non-consecutive days across four weeks. During the intervention, three nudging strategies were implemented: (1) choice architecture, (2) salient labeling, highlighting healthy and sustainable options, and (3) educational prompts. Results: Across both phases, 2400 tray photographs were collected. Post-intervention, the proportion of trays aligned with the Harvard Healthy Eating Plate and EAT-Lancet Planetary Diet models increased, reflecting higher consumption of vegetables and fruit. Legume-based first courses increased; however, legumes did not substantially replace animal proteins as the main protein source, and meat remained predominant in second courses. Reductions in trays containing multiple carbohydrate sources were also observed. Conclusions: The nudging intervention improved overall meal quality, demonstrating that subtle environmental modifications can guide students toward healthier dietary choices, particularly by increasing fruit and vegetable intake. However, the persistent preference for animal proteins highlights the challenge of shifting protein consumption toward more sustainable sources. These findings suggest that nudging can be an effective tool to promote healthier and more balanced eating behaviors in university settings, though complementary strategies may be needed to foster substantial changes in protein choices. Full article

Background: The climate impacts of health professionals’ work are significant. The potential role and opportunities for regulators of health professionals’ work to drive behavioural and practice change have not been adequately explored in the literature. The objective of this research was to examine regulators’ perspectives on the potential role of health professions’ regulatory bodies in advancing the adoption of climate-conscious professional practice. Methods: Semi-structured interviews with 19 regulators overseeing the practice of health professionals in medicine, nursing, pharmacy, and dentistry in Canada were undertaken. Constant comparative data analysis using nVivo v15 was undertaken to identify common themes. The COREQ framework was applied to ensure the quality of the research processes used. Results: Participants highlighted their belief that there are only limited opportunities for health professions’ regulators to lead climate-positive practice change, despite their personal beliefs in the importance of the topic. The use of educational approaches, rather than legal or regulatory tools, was emphasized. Concerns were raised regarding regulatory overreach, practitioner blowback, and practical/logistical considerations. Coalition building across different facets of a profession (including educational institutions, unions, workplaces, and professional/advocacy groups) was identified as potentially most impactful. Conclusions: Previous research had highlighted practitioners’ beliefs that regulators had significant legal and practice-directed levers that could drive behavioural change towards more climate-friendly health care work. This research has highlighted regulators’ discomfort with assuming a legalistic role. Instead, they favoured persuasive techniques such as education and coalition building that may nudge, rather than compel, practitioners towards more climate-friendly practice. Full article

Background: Nurse-manager competencies shape workforce stability, yet role-based perception gaps between managers and staff may influence staff nurses’ turnover cognitions. Objectives: To (1) compare nurse managers’ self-ratings with staff nurses’ ratings of the same managers on the Nurse Manager Competency Inventory (NMCI); (2) compare both groups’ perceptions of staff nurses’ turnover intention (EMTIS); (3) examine domain-specific links between perceived competencies and perceived turnover intention; and (4) explore demographic influences (age, education, experience) on these perceptions. Methods: Cross-sectional dual-rater study with 225 staff nurses and 171 nurse managers in two tertiary hospitals in Saudi Arabia. Data were collected from August to November 2024. Managers completed NMCI self-ratings, and staff nurses rated their managers on the same NMCI domains; both groups rated staff nurses’ turnover intention using EMTIS. Between-group differences were tested with one-way ANOVA (two-tailed α = 0.05), and associations were examined with Pearson’s r (95% CIs). Findings: Managers consistently rated themselves higher than staff rated them across all nine NMCI domains; the largest descriptive gaps were in Promoting Staff Retention, Recruit Staff, Perform Supervisory Responsibilities, and Facilitate Staff Development (e.g., overall NMCI: managers M = 3.67, SD = 0.61 vs. staff M = 3.04, SD = 0.74; F = 0.114, p = 0.73)with comparatively smaller divergence for Ensure Patient Safety and Quality. Managers and staff did not differ significantly on EMTIS (overall EMTIS: managers M = 3.16, SD = 1.28 vs. staff M = 3.00, SD = 1.15; F = 21.32, p = 0.173). Specific competency domains—retention, supervision, staff development, safety/quality leadership, and quality improvement—showed small inverse correlations with EMTIS facets (typical r ≈ −0.11 to −0.19; p < 0.05), whereas the global NMCI–overall EMTIS correlation was non-significant (r = −0.077, p = 0.124). Effect sizes were modest and should be interpreted cautiously. Conclusions: Actionable signals reside at the domain (micro-competency) level rather than in global leadership composites. Targeted, continuous, unit-embedded development in human- and development-focused competencies—tracked with dual-lens (manager–staff) measurement and linked to retention KPIs—may help nudge turnover cognitions downward. Key limitations include the cross-sectional, perception-based design and two-site setting. Findings nonetheless align with international workforce challenges and may be transferable to similar hospital contexts. Full article

With increasing digitalization of learning environments, concerns regarding the psychological effect of seductive interface design on the motivational level and cognitive health of learners have been raised. This research investigates the effects of certain persuasive and adaptive design elements, i.e., Perceived Persuasiveness of Platform Design (PPS), Frequency of Nudge Exposure (NE), and Perceived Personalization (PP), on intrinsic motivation in virtual learning environments (INTR). We draw on Self-Determination Theory, Cognitive Load Theory, and Persuasive Systems Design to develop and test a conceptual model featuring cognitive overload (COG) and perceived autonomy (PAUTO) as mediating variables. We used a cross-sectional survey of university students (N = 740) and used Partial Least Squares Structural Equation Modeling (PLS-SEM) for data analysis. The findings show that all three predictors have significant impacts on intrinsic motivation, with PP as the strongest direct predictor. Mediation analyses produced complementary effects for NE and PP in that these traits not only boosted motivation directly, but also autonomy, and they decreased cognitive overload. Alternatively, PPS showed competitive mediation, boosting motivation directly but lowering it indirectly by increasing overload and decreasing autonomy. Multi-Group Analysis also revealed that such effects differ by gender, age, education, digital literacy, exposure to persuasive features, and use frequency of the platform. The results underscore the imperative for educational technology design to reduce cognitive load and support user control, especially for subgroups at risk. Interface designers, teachers, and policymakers who are interested in supporting healthy and ethical digital learning environments are provided with implications. This work is part of the new generation of research in the field of the ethical design of impactful education technologies, focusing on the balance between motivational-enabling functions and the psychological needs of users. Full article

Plastic recycling is an important but complicated issue. Some plastics are currently readily recyclable with existing technologies, whereas others are not. However, the general public often does not appreciate the benefits and costs associated with hard-to-recycle (e.g., multi-material) plastics, potentially causing confusion and, in some cases, backlash. While some methods of relaying information to the public have been previously studied (e.g., infographics, descriptive labeling), educational videos have not. We created an educational video on the properties and functions of single- and multi-material plastic. Participants who viewed the educational video were more knowledgeable about multi-material plastic recycling and had higher intentions to use and be satisfied with a hypothetical recycling company that intends to begin recycling multi-material plastic. Our data suggest that education interventions have the potential to inform and empower the public while protecting common values. Full article

Background: This project focuses on the relevance of using a health literacy approach to educating children about obesity prevention. The Habits of Health and Habits of Mind© model was used to write Electronic Texts for Health Literacy© to encourage actions that support obesity prevention. Guided by the Integrative Theory of Behavioral Prediction, the design template for a new genre of digital texts called Electronic Texts for Health Literacy© emerges for exploring children’s frame of mind, health literacy skills, and behavioral intentions toward obesity prevention. Methods: Online materials from selected websites were strategically reviewed for improving obesity prevention and child health literacy. The digital resources were juxtaposed with the Electronic Texts for Health Literacy©, with the latter written by and for children. Discussion: Health educators who use a constructivist pedagogy can help students to write health literacy narratives about obesity prevention, then read and talk about their multimodal compositions to further the practice and development of their health literacy skills. Children with obesogenic body frames can also gain from cowriting visual–textual–gestural health narratives with their peers or health professionals. Co-constructed narratives can help children make deeper connections about their identity, frame of mind, and social agency. Summary: Although this untested resource is available as a new genre of digital text, health educators could nudge children toward developing a stronger frame of mind and behavioral intentions toward obesity prevention when they write health literacy narratives that focus on decision making, goal setting, and communication in the context of eating nutritious foods and participating in physical activities. Full article

Background/Objectives: Traditional diet management for type 2 diabetes (T2DM) is often complex and effortful to sustain. Nudging offers low-effort and automatic approaches to dietary behaviour change yet remains underexplored in T2DM. This study evaluated the independent and combined 6-month effects of nudging education (NE) and nudging tableware (NT) on HbA1c, along with other secondary health outcomes, among adults with T2DM and overweight/obesity, compared to their non-nudge counterparts (control education, CE; control tableware, CT). Methods: A 2 × 2 factorial cluster RCT was conducted in 12 primary healthcare settings in China (pre-registered as ChiCtr2100044471). Participants were randomly assigned to the nudging education group (NE + CT), the nudging tableware group (CE + NT), the combined group (NE + NT) or the full-control group (CE + CT) for 1 month. The primary outcome was HbA1c. Secondary outcomes included dietary behaviours, metabolic indicators, and psychological health. Generalized linear mixed models were used for analysis. Results: A total of 284 participants (mean age, 52.28 years; 54.3% male) were randomly assigned and included in the analysis. After 6 months, NE and NT independently led to HbA1c reductions (−0.76%, p < 0.001; −0.33%, p = 0.042, vs. controls), with an additive but non-interactive effect when combined, resulting in a 1.04% reduction (p < 0.001) in the combined group. They also improved total calorie, macronutrient, and vegetable intake, FBG, plasma lipids, and BMI. NE additionally reduced diabetes distress and enhanced self-efficacy. Conclusions: Both NE and NT improved dietary and metabolic outcomes without increasing the psychological burden. The combined group showed the greatest benefits. Findings highlighted the importance of considering automatic processes in diabetes management. Full article

According to “The World Health Organization”, obesity during childhood is directly associated with multiple complications and with an increased risk of the installation of various pathologies. Considering the increase in this pathology among children and teenagers, new instruments of prevention are needed. Virtual reality is an innovative tool that offers several advantages over classical therapies, becoming important in various medical fields, starting from phobia treatment, pain relief, and body image perception to education. This technology has been successfully used to study the influence of virtual cues on behavioral responses and can be useful in nutritional education as well as understanding eating behavior. The objective of this scoping review study is to understand the impact of virtual supermarket exposure on individuals’ food choices and to explore the potential of technology on nutrition education in the general population. It seeks to explore purchasing based on product appearance and placement, food prices, nudging conditions and under-pressure decision making. A manual literature search was conducted using the databases Web of Science, SCOPUS and Google Scholar. Included articles were published between 2012 and 2024 using immersive virtual and augmented supermarket environments as a tool to understand food choices and education. The results showed that using higher immersion can be efficient in understanding food choices, rather than a lower immersive tool. The advantage of immersive virtual reality is highlighted by the sense of presence it offers, compared to other devices, providing a safe, controlled environment for users. Full article

Background: The organic sector is often suggested as a lever with a potential for contributing to the three dimensions of sustainability: social, environmental, and economic. This study aims to investigate selected organic initiatives and organic food sectors in different locations, such as capital cities, rural areas, and the bio-district in SysOrg project consortium, in the Warsaw municipality in Poland, North Hessia region in Germany, Cilento bio-district in Italy, Kenitra province in Morocco, and Copenhagen municipality in Denmark to uncover the diverse drivers, barriers, and entry points to enable a transformation process to resilient and sustainable organic food systems. Methods: Following the methodology of the SysOrg project, this study relied on the following mixed data collection methods: quantitative (a household survey distributed among citizens) and qualitative (semi-structured interviews with organized initiatives). Results: The results demonstrate that, despite being in different stages of development in the investigated territories, the organic sector is challenged by similar barriers (e.g., undeveloped market, regulatory/budgetary constraints, and lack of knowledge and awareness) and benefits from analogous drivers (e.g., awareness and education, community support, and incentives). Conclusions: Those similarities, but also analyses of their differences and origins, allowed us to establish critical entry points for the development of a sustainable organic food system, e.g., promoting organics through a top-down approach, providing training and education, reducing information delay, popularizing negative feedback, strengthening the effectiveness of a given incentives scheme by tailored nudging mechanisms, establishing country/regional specific traditional frames, making the system more inclusive, building organic communities, and awareness-building. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a global public health concern exacerbated by inappropriate antimicrobial prescribing practices, particularly in low-resource settings such as Uganda. The research aimed to develop a culturally sensitive behavioral intervention, leveraging a “nudge” strategy, to improve healthcare provider adherence to the 2016 Uganda Clinical Guidelines (UCG 2016) in five Ugandan hospitals. This intervention formed part of broader antimicrobial stewardship initiatives led by the United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program. Methods: This study employed a mixed-methods approach, combining formative research and behavioral intervention. Guided by the Deloitte Behavioral Insights Framework, the research team conducted key informant interviews to identify prescribing barriers and motivators and developed three suitable behavioral interventions: perceived monitoring, ward leaderboards, and educational workshops. The study evaluated the interventions’ impact through point prevalence surveys (PPS), using the World Health Organization PPS methodology at three stages: pre-intervention, immediate post-intervention, and one-month post-intervention. Results: Key behavioral themes across individual, social, environmental, and organizational elements informed the intervention design and implementation. The behavioral intervention package increased antimicrobial prescription compliance with the UCG 2016 from 27% at baseline to 50% immediately post-intervention, though these effects diminished at one-month post-intervention. Conclusions: Our study addresses an existing gap in behavioral nudges-based operational research on antimicrobial prescribing in low- and middle-income countries. These results showed an immediate improvement in adherence to the UCG 2016 among healthcare providers in Ugandan hospitals, though the effect was attenuated at one-month follow-up. Despite the attenuation, behavior change presents a feasible, cost-effective, and sustainable approach to improving antimicrobial prescribing practices and addressing AMR. Full article

Nudge theory proposes using subtle interventions to encourage individuals to make better decisions. The aim of this study was to evaluate the effectiveness of the Nudge theory in plaque control and assess caries experience among third-grade primary schoolchildren with refugee and immigrant backgrounds in Mashhad, Iran. Moreover, Afghan and Iranian schoolchildren were compared to assess differences in oral health outcomes. A quasi-experimental field trial was conducted in three public primary schools, comprising 309 participants approximately 9 years old. Interventions were randomly assigned to three schools: School I Messages based on Social Norms (MSN), School II Messages based on Fear of Negative Outcome (MFNO), and School III control group (C). MSN and MFNO received customized motivational video clips at baseline, while C only received Oral hygiene instruction (OHI). All participants received OHI, a brush, and toothpaste. Baseline plaque index (PI) and caries experience in primary and permanent dentition (dmft/DMFT) were recorded. PI was reassessed at two weeks, two months, and six months post-intervention. All data were subjected to statistical analysis. The mean PI decreased significantly in all three groups at the two-week follow-up (p < 0.01). The PI improvements declined over a six-month follow-up period in all groups, and the mean PI difference after six months compared to the pre-intervention was significant only in MSN and MFNO (p < 0.01), while C reverted almost to the pre-study level. Schoolchildren with at least one filled tooth or Iranian nationality showed a greater PI reduction (p < 0.01, p = 0.05). The overall mean ± SD dmft and DMFT were 4.24 ± 2.11 and 1.70 ± 1.24, respectively. Among all the examined participants, 32 (10.40%) individuals were caries-free. The mean dmft was statistically significantly higher in Afghan children than in Iranians (p = 0.01). MSN was more effective on PI reduction in the short term, while MFNO was more long-lasting. Using the Nudge theory via visual aids was more effective in motivating children to perform better oral self-care than solely traditional OHI. Full article

Background: A nudge intervention against Herpes Zoster, created and implemented in Italy, is presented in order to administer the Shingrix vaccine on a sample of frail patients, as required by the National Prevention Plan. Individual and contextual factors associated with vaccine adherence were investigated. Method: 300 frail adult subjects underwent a full vaccine cycle with recombinant-Shingrix vaccine (RZV vaccine). Hospital Presidia of the Salerno University Hospital Authority, a Hospital Presidium of the Salerno Local Health Authority, and the Public Health Laboratory of the University of Salerno (Campania) participated in the intervention. An ad hoc questionnaire was administered with the following scales: EQ-5D, PSS-10, MSPSS, and representations of HZ and its consequences. Results: Some variables, such as peer support, doctor–patient relationship, level of education, and perception of health, are important in vaccine adherence and information processing. The following factors emerged from the factor analysis: Trust in collective knowledge and collective responsibility (F1); beliefs about virus risk and vaccine function (F2); information about virus and symptomatology (F3); and vaccine distrust (F4). Factor 4 correlates negatively with social support indices (R = −0.363; p < 0.001). There is a significant relationship between factor 3 and satisfaction with national information campaigns (F = 3.376; gdl = 5; p-value = 0.006). Conclusions: Future vaccination campaigns should be built with the aim of personalizing information and developing contextualized strategies, starting from understanding the stakeholders involved, cultural contexts, and organizational settings. Full article

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (−11%), functional handwashing access points accessible for individuals with disabilities (−17%) and small children (−29%), and functional alcohol-based hand rub dispensers (−13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures. Full article

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant (p-interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context. Full article

While policies targeting education in schools, marketing campaigns, and taxation strategies are of great importance to tackle our population’s malnutrition, there is growing concern about enhancing the supermarket environment to promote healthier food consumption. Public and private policies targeting the food retail sector can contribute to achieving this goal. Supermarkets play a significant role in presenting food options. As gatekeepers of the food system’s impact on consumers’ health, they have the power to help people make better food choices. Examples include making healthy checkouts and nudging consumption of vegetables through infographics. Currently, few policies specify how supermarkets’ environments could be set up to improve healthy purchases (e.g., the “Partnership for a healthy diet” in Norway and “hange4Life Convenience Stores” in the UK). Furthermore, we see recent shifts in the policy agendas of countries like Germany and Argentina, with new nutrition behavioural policies being legislated and implemented. However, we lack general guidelines that unify the available information on this topic. Addressing this gap has the potential to guide future supermarket policy recommendations. We will perform a review and delve deeper to search for governmental policies and policies of major supermarket brands in selected countries (i.e., Germany and Argentina) to taxonomize the policy initiatives, examining their projects and campaigns designed to improve supermarket environments and encourage consumers to choose healthy options. We will harvest sources published since the release of the SDGs (2015), from ScienceDirect, the FAO policy search engine Informas, and the NOURISHING platform. We will identify the grey literature by searching related websites and databases as well as national government pages or private supermarket policy documents. We will extract the information relevant to policymaking to improve environments in terms of product reformulation, labelling strategies, placement, product processes, and sweet beverage representation. While spotting incentive, procurement, and regulative policies, we will group them in terms of interventions and further taxonomize the different approaches/initiatives. Our objective is to provide unified policy recommendations by leveraging existing experiences and policies and designing applicable recommendations to improve the food environment in supermarkets. Furthermore, we aim to promote the creation of science-based policies that consider these recommendations. Full article