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Background <p>The global food system is responsible for climate change, biodiversity loss, and land-use changes. At the same time, the prevalence of diet-related, chronic diseases is increasing worldwide. A dietary shift to a plant-based diet could protect both planetary and individual health. Nudging can positively influence dietary choices. We investigated how different nudges influenced inpatients’ choices of plant-based menus.</p> Methods <p>A quasi-experimental study was conducted across three consecutive four-week phases at the University Hospital Essen, Germany. In the baseline phase, inpatients chose meals from a standard menu without any intervention. In a second phase, an order nudge was applied by listing the plant-based dish first on the menu. In the third phase, a combined nudge was applied, adding a verbal recommendation to the order nudge. Data from 6,575 inpatients (mean age: 57.3 ± 18.7; 50.6% female) covering 26,949 meal choices were analyzed using logistic regression and generalized linear modeling.</p> Results <p>Independent of nudging, female sex and younger age predicted plant-based menu choices (<i>p</i> &lt;. 001, respectively). Controlling for the effects of sex and age, patients were nearly twice as likely to choose the plant-based menu during both intervention phases compared to baseline (order nudge: OR = 1.95; 95% CI [1.55–2.45]; <i>p</i> &lt;.001; combined nudge: OR = 1.95; 95% CI, [1.56–2.44]; <i>p</i> &lt;.001). However, there was no significant difference in plant-based menu selection between the two nudges (OR = 1.00; 95% CI [0.80–1.25]; <i>p</i> =.992). Subgroup analyses further revealed that both women and men as well as middle-aged (36–64 years) and older adults (≥ 65 years), but not younger adults (18–35), were significantly more likely to select plant-based menus during the interventions compared to baseline. Among both sexes and across all age groups, no differences in plant-based meal selection were found between the order and the combined nudge (all <i>p</i> &gt;.001).</p> Conclusion <p>Centrally implemented nudging is a simple and effective strategy that can increase patients’ choice of plant-based menus, which in turn may promote patient health and contribute to positive environmental outcomes.</p> Trial registration <p>DRKS00036763. Registered 29 April 2025.</p>

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Exploring nudging strategies for plant-based dietary choices in hospital patients: a quasi-experimental study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月1日

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  • Kristin Hünninghaus,
  • Hannah Caroline Schäfer,
  • Maik Plonka,
  • Rebeca Montejano Vallejo,
  • Gustav Dobos,
  • Heidemarie Haller

摘要

Background

The global food system is responsible for climate change, biodiversity loss, and land-use changes. At the same time, the prevalence of diet-related, chronic diseases is increasing worldwide. A dietary shift to a plant-based diet could protect both planetary and individual health. Nudging can positively influence dietary choices. We investigated how different nudges influenced inpatients’ choices of plant-based menus.

Methods

A quasi-experimental study was conducted across three consecutive four-week phases at the University Hospital Essen, Germany. In the baseline phase, inpatients chose meals from a standard menu without any intervention. In a second phase, an order nudge was applied by listing the plant-based dish first on the menu. In the third phase, a combined nudge was applied, adding a verbal recommendation to the order nudge. Data from 6,575 inpatients (mean age: 57.3 ± 18.7; 50.6% female) covering 26,949 meal choices were analyzed using logistic regression and generalized linear modeling.

Results

Independent of nudging, female sex and younger age predicted plant-based menu choices (p <. 001, respectively). Controlling for the effects of sex and age, patients were nearly twice as likely to choose the plant-based menu during both intervention phases compared to baseline (order nudge: OR = 1.95; 95% CI [1.55–2.45]; p <.001; combined nudge: OR = 1.95; 95% CI, [1.56–2.44]; p <.001). However, there was no significant difference in plant-based menu selection between the two nudges (OR = 1.00; 95% CI [0.80–1.25]; p =.992). Subgroup analyses further revealed that both women and men as well as middle-aged (36–64 years) and older adults (≥ 65 years), but not younger adults (18–35), were significantly more likely to select plant-based menus during the interventions compared to baseline. Among both sexes and across all age groups, no differences in plant-based meal selection were found between the order and the combined nudge (all p >.001).

Conclusion

Centrally implemented nudging is a simple and effective strategy that can increase patients’ choice of plant-based menus, which in turn may promote patient health and contribute to positive environmental outcomes.

Trial registration

DRKS00036763. Registered 29 April 2025.