Abstract
OBJECTIVES: To evaluate the association between three behavioral economics “nudges” and store sales of promoted healthier foods. METHODS: A multiple interrupted time series design was conducted to test four retail-based nutrition interventions in rural North Carolina from March to August 2017. Each intervention ran for four weeks, followed by a two-week washout period. The interventions were implemented in both a convenience store setting (one intervention store and one control store) and a grocery store setting (one intervention store and one control store), for a total of four stores. The interventions tested three different low-cost strategies that incorporated insights from Behavioral Economics to “nudge” customers toward the purchase of healthier foods. The strategies, also referred to as “nudges”, included: a cognitive fatigue experiment, in which floor arrows guided customers to the produce section; a scarcity experiment, in which signs in the produce section portrayed “limited amount” messages; and a product placement experiment, where granola bars were moved into the candy bar aisle. The fourth intervention implemented all three strategies concurrently. Aggregated store transaction data was analyzed using analysis of variance to examine the association between the nudges and the sale of promoted foods in the stores. RESULTS: In convenience stores, there were no significant differences between sales of the promoted items during the intervention period for the scarcity, product placement or cognitive fatigue nudges when implemented individually. However, implementation of all three nudges simultaneously was associated with a 16.96 unit increase in sales of the promoted intervention items compared to baseline sales (P < .01), whereas no significant changes in sales were observed in the control convenience store. Among the grocery stores, there were no significant differences between sales of the promoted items during the intervention period for any of the nudges compared to baseline sales. CONCLUSIONS: Implementing three nudges concurrently in a convenience store setting may increase sales of promoted items. However, before stores consider implementing these nudges to increase sales of nutritious foods, additional research is warranted. FUNDING SOURCES: Funding provided by a grant from the USDA through the NC Department of Health and Human Services. SUPPORTING TABLES, IMAGES AND/OR GRAPHS: