Impact of an intervention based on choice architecture in school feeding and water intake: school-based randomized trial

To consider the context and environment in which individuals make their choices is a possible strategy for improving food choices. Based on the concept of choice architecture, interventions focused on positively influencing individual's decisions have been suggested to promote healthy food habits. In this sense, the aim of the present study was to evaluate the impact of an intervention based on choice architecture applied in school cafeterias and drinking fountains on the consumption of school feeding and water. A randomized community trial was conducted in seven public schools (three in the control group and four in the intervention group) in the municipality of Duque de Caxias/RJ in 2017, with fifth and sixth grade students The schools in the intervention group were exposed to changes in the school environment based on choice architecture strategies that included: (1) elaboration of a colorful banner for the daily school feeding menu, positioned outside the cafeteria; (2) placing waterproof tablecloths in the cafeteria tables; (3) manufacture of displays and posters with phrases and images to encourage healthy food habits; (4) allocation of large transparent containers with fruits to draw attention to it in the cafeteria; (5) elaboration of two superheroes characters to encourage the consumption of water, fruits and vegetables, and; (6) inclusion of colored footprints on the floor that led to the cafeteria and the school drinking fountain. In order to evaluate the effect of the intervention, after one month of exposure, on the time variation rate of school feeding, total daily water consumption and daily water consumption in the school drinking fountain, longitudinal analyzes were performed, considering groups intention to treat, using generalized estimating equations models for repeated measures. Data from 982 students were analyzed (control group = 363; intervention group = 619). At baseline, about 46.9% of all students were female, with an average age of 12 years, 39.3% reported daily consumption of school feeding, 54.9% consumed five or more glasses of water a day and 45.7% consumed water at the school drinking fountain three or more times a day. There was a significant increase in the odds of increasing daily water consumption in the school drinking fountain in the intervention group when compared to the control group (OR = 1.42 95% CI = 1.05; 1.93). It wasn't observed significant effects for further outcome variables. Regard water consumption, low cost and low complexity strategies based on choice architecture can be promising to improve water consumption in the school environment.