{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T18:08:31Z","timestamp":1778695711030,"version":"3.51.4"},"reference-count":109,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Human Nutrition Diet"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Poor diets are a remediable risk factor for non\u2010communicable diseases. Sickness absence rates for national health service (NHS) staff are substantially higher than the public sector average (5.6% vs. 3.6%). Hospital inpatients are often being treated for the downstream consequences of poor diets. Systematic reviews and meta\u2010analyses support national health recommendations for plant\u2010based diets that emphasise consumption of varied whole plant\u2010source foods with minimal consumption of animal products. These diets are increasingly recognised as compatible with planetary health and are associated with lower greenhouse gas emissions. There is increasing interest in using choice architecture interventions (subtly changing the environment in which individuals make decisions) to encourage healthier plant\u2010based food choices in health and care settings. This approach may prove cost effective, encouraging better choices for staff and inpatients with minimal upfront investment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To summarise evidence for choice architecture interventions aimed at changing dietary choices made by staff and inpatients in high\u2010income health and care settings. This review aims to inform decision making on food service provision in health and care organisations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Medline, CINAHL PLUS, GreenFile, and Web of Science were searched for studies which examined choice architecture on dietary choices in high\u2010income health and care settings. Studies referenced in systematic reviews were examined for inclusion from 4th to 10th June 2024. A typology used in a previous review conducted by Public Health England (categories: availability, positioning, pricing, functionality, presentation, information, sizing) was modified to include a category for using defaults (the action that occurs when no choice is made). Randomised experimental, quasi\u2010experimental, interrupted time series and before and after studies reporting on nutritional measures or a measure of healthy food purchases were included. Studies from non\u2010healthcare settings were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>None of the studies explicitly encouraged plant\u2010based diets or measured environmental impact although 12 studies measured change in plant\u2010based choices using measures such as fruit and vegetable servings. A total of 51 studies were included focused on other healthy dietary interventions. A total of 31 of these studies implemented more than one type of choice architecture. Twenty studies were conducted in cafeterias, eight on hospital vending machines, six in hospital retail stores, three in residential care homes, and five in an inpatient setting. A further nine studies either implemented changes across multiple aspects of healthcare food provision, included non\u2010healthcare workplaces, or examined hospital office\u2010based interventions. Overall, 34 of the 51 studies reported a positive change in healthy food choices and only six studies reported no significant change or an adverse change. Availability, pricing and positioning of items are associated with a change in dietary choices. Evidence for informational changes was mixed and at worst, had a negative reaction, increasing unhealthy purchasing. Few studies used sizing or presentation elements and none of the studies evaluated functionality or default elements. None of the inpatient studies examined persistent change in dietary choices for long\u2010term health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this review, the evidence indicates that choice architecture interventions can support healthier food choices in health and care settings. However, there is limited research and nutritional evaluation of choice architecture interventions that encourage plant\u2010based diets. Further well\u2010conducted studies are needed in health and care settings to determine optimal typologies, or combined approaches, for making healthier dietary choices. Given the established evidence of plant\u2010based diets for long\u2010term health, and the lower environmental impact of these diets, studies using choice architecture to encourage plant\u2010based choices in health and care settings should be conducted and should evaluate nutritional, financial, and environmental outcomes. The effectiveness of choice architecture techniques in inpatient catering to encourage and role model healthier diets should be investigated to tackle dietary inequality and the burden of diet\u2010related chronic disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jhn.70111","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T06:02:16Z","timestamp":1756188136000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Scoping Review of Choice Architecture to Promote Healthy Nutrition in Health and Care Settings"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6271-6106","authenticated-orcid":false,"given":"Victoria","family":"Bion","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"Turner","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"},{"name":"NIHR Health Protection Research Unit in Environmental Change and Health, London School of Hygiene and Tropical Medicine London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Health Survey for England 2021 Part 2","author":"Office for National Statistics","year":"2023"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.036491"},{"key":"e_1_2_10_4_1","volume-title":"Health in 2040: Projected Patterns of Illness in England","year":"2023"},{"key":"e_1_2_10_5_1","volume-title":"Hospital Admitted Patient Care Activity 2019\u201020 England2020"},{"key":"e_1_2_10_6_1","volume-title":"The Broken Plate: The State of the Nation's Food System","year":"2023"},{"key":"e_1_2_10_7_1","volume-title":"Health Matters: Ambitions to Tackle Persisting Inequalities in Cardiovascular Disease","year":"2019"},{"key":"e_1_2_10_8_1","volume-title":"NHS Workforce Statistics \u2010 April 2024 (Including Selected Provisional Statistics for May 2024) England","year":"2024"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13114178"},{"key":"e_1_2_10_10_1","unstructured":"W.PalmerandL.RolewiczAll is not well: Sickness Absence in the NHS in England: Nuffield Trust; 2023. 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