Diet QualityDINENCT05070442
Diet Improvement Through Normative Experimentation
A study testing Norm-based messaging and peer comparison features and Financial Incentives leveraging on loss aversion in people with Diet Quality, run by Duke-NUS Graduate Medical School at 1 site in Singapore.
Trial summary
This study aims to use a three-arm randomized control trial (RCT) implemented in a fully functional experimental online grocery store, to explore the effects of two low-cost information and incentive-based strategies. Read more about this study
- Who is it for?
- Ages 21 years and olderHealthy volunteers can take part
- Conditions the study is for
- Diet Quality
- What is being tested?
- Norm-based messaging and peer comparison features and Financial Incentives leveraging on loss aversion
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 248 participants
- Where
- 1 siteSingapore
- Study dates
- 22 Apr 2022to 26 Oct 2022
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 21 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Singapore resident
- Age 21 and above
- Must be the primary weekly grocery shopper in their household
Who cannot join
- Non-Singapore resident
- Non-primary grocery shopper in their household
- Less than 21 years old
Trial locations and contacts
1 site in 1 country.
About this study
This study aims to use a three-arm randomized control trial (RCT) implemented in a fully functional experimental online grocery store, to explore the effects of two low-cost information and incentive-based strategies. These strategies comprise of injunctive norm-based messaging and the use of financial incentive leveraging on loss aversion to encourage the purchase of healthy foods. The investigators have set up a store wherein products may be purchased by participants and subsequently delivered to homes in some of the conditions. This increases the external validity of these interventions and enables investigators to establish greater confidence in their generalizability.
Read the detailed description
The Asia-Pacific is faced with an epidemic of rising rates of chronic disease. Poor diet quality is a demonstrated risk factor for non-communicable diseases. Excess intake of calories, saturated fat and sodium increases the risk of obesity, heart disease, diabetes, and other chronic conditions.
Behavioral economics has emerged as a promising strategy to increase the effectiveness of interventions aimed to address risk factors for non-communicable diseases (NCDs). Yet, there is a gap in knowledge concerning how norm-based messaging and peer influence interventions can be implemented to improve diet quality.
Using a three-arm randomized trial with a 3x3 crossover design, investigators aim to determine whether norm-based messaging and peer comparisons, with or without financial incentives, improve diet quality.
Each participant will be exposed to all of the following intervention arms in random order:
Arm 1: Control arm. Participants will experience an unmodified version of NUSMart which replicates the traditional shopping experience of online grocery stores.
Arm 2: Participants will experience a modified version of NUSMart with norm-based messaging and peer comparison features enabled. Nutri-Score labels will be enabled and displayed on all products within the store. A floating side panel will provide a visual indicator of the participants' average weighted Nutri-Score.
Arm 3: Same as Arm 2, except participants are notified of an additional $5 reward towards participation reimbursement. However, this additional $5 will be forfeited if the basket average weighted Nutri-Score falls below the average of participants' peers'. (Financial incentive leveraging on loss aversion).
Investigators hypothesize the following:
Primary hypothesis: Diet quality, as measured by mean Nutri-Score weighted by number of servings of all basket items, will be greatest when exposed to the intervention with norm-based messaging with incentive (Arm 3), followed by the intervention with norm-based messaging without the incentive (Arm 2), followed by Control (Arm 1).
Investigators will test this hypothesis in total, and separately for foods and beverages given Singapore's focus on reducing intake of sugar-sweetened beverages.
- Conditions
- Diet Quality
- Being tested
- Norm-based messaging and peer comparison features, Financial Incentives leveraging on loss aversion
- Keywords
- Nutri-Score labels, Social norms, Peer comparison, Financial incentives, Loss aversion, Online grocery shopping
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Norm-based messaging and peer comparison featuresBehavioural
Participants are shown a version of NUSMart which includes Nutri-Score labels that are enabled and displayed besides all the products in the store. Additionally, they are shown a video that gives them background information about Nutri-Score labels and describes the following features enabled in this intervention:
- Norm-based messaging will be displayed in the form of a happy or sad emoticon based on whether the participant's current basket average Nutri-Score (weighted by number of servings) is above or below "other shoppers" (Nutri-Score=3.98).
- Peer comparison will be implemented as a vertical ruler display of the participant's current basket average Nutri-Score (weighted by number of servings) as well as that of their "peers".
Nutri-Score=3.98 was chosen as it is 10% better than the mean Nutri-Score of baskets purchased by participants in the Nutri-Score labelled intervention arm of a prior study.
Financial Incentives leveraging on loss aversionBehavioural
Participants are informed that they have received an additional $5 towards their participant reimbursement. However, this amount will be forfeited if they check-out with a basket average Nutri-Score (weighted by the number of servings) that falls below the average Nutri-Score of "other shoppers" i.e. 3.98. An indicator on the screen that informs the participants of this potential forfeiting will be included.
| Study group | Role | What they receive |
|---|---|---|
| Control Arm (Arm 1) | No intervention | Participants will experience an unmodified version of NUSMart which replicates the traditional shopping experience of online grocery stores. |
| Norms Arm (Arm 2) | Experimental | Participants will experience a modified version of NUSMart with norm-based messaging and peer comparison features enabled. Nutri-Score labels will be enabled and displayed on all products within the store. A floating side panel will provide a visual indicator of the participants' average weighted Nutri-Score. Receives: Behavioral: Norm-based messaging and peer comparison features |
| Norms and Incentive Arm (Arm 3) | Experimental | Same as Arm 2, except participants are notified that they have been awarded an additional $5 towards their participation reimbursement. However, this additional $5 will be forfeited if their basket average weighted Nutri-Score falls below the average of their peers'. (Financial incentive leveraging on loss aversion). Receives: Behavioral: Norm-based messaging and peer comparison features; Behavioral: Financial Incentives leveraging on loss aversion |
What is being measured
The primary outcome is the main question the study is designed to answer.
Diet Quality
Diet quality, as measured by raw Nutri-Score points (-15 to 40) weighted by number of servings of all basket items. Here, a smaller value means a better outcome. Raw Nutri-Score is measured according to the guidelines from the Sante Publique France.
Measured: After completion of data collection, an average of about 5 months
Secondary outcomes (6)
Average Nutri-Score
Average Nutri-Score (1 to 5) weighted by number of servings of all basket items. Here, a higher value means a better outcome. This is calculated by converting Nutri-Score letters to numbers such that Nutri-Score E is 1, D is 2 and so on till Nutri-Score A which is 5.
Measured: After completion of data collection, an average of about 5 months
Average Calories
Average calories per shopping trip.
Measured: After completion of data collection, an average of about 5 months
Average Sodium
Average sodium per shopping trip.
Measured: After completion of data collection, an average of about 5 months
Average Sugar
Average sugar per shopping trip.
Measured: After completion of data collection, an average of about 5 months
Average Fat
Average fat per shopping trip.
Measured: After completion of data collection, an average of about 5 months
Average Saturated Fat
Average saturated fat per shopping trip.
Measured: After completion of data collection, an average of about 5 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Oct 2021
- Study start22 Apr 2022
- Primary completion26 Oct 2022
- Study completion26 Oct 2022
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Diet QualityStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 248 participants (actual)
Sponsor and investigators
- Lead sponsor
- Duke-NUS Graduate Medical School
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Eric A. Finkelstein, Duke-NUS Graduate Medical School
- Investigators
- Eric A Finkelstein, PhD MHA, Principal investigator, Duke-NUS Graduate Medical School
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05070442
- Sponsor's protocol ID
- NIHA-2018-002 (Study 2)
- Acronym
- DINE
- Status last verified
- Feb 2023
- First submitted
- 20 Sep 2021
- Last updated
- 15 Feb 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 15 Feb 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Diet Improvement Through Normative Experimentation
- ClinicalTrials.gov ID
- NCT05070442
- Acronym / sponsor ID
- DINE / NIHA-2018-002 (Study 2)
- Conditions
- Diet Quality
- Keywords
- Nutri-Score labels, Social norms, Peer comparison, Financial incentives, Loss aversion, Online grocery shopping
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 248 participants (actual)
- Lead sponsor
- Duke-NUS Graduate Medical SchoolUniversity, hospital or other
- Study start
- 22 Apr 2022 (actual)
- Primary completion
- 26 Oct 2022 (actual)
- Study completion
- 26 Oct 2022 (actual)
- First posted
- 7 Oct 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to use a three-arm randomized control trial (RCT) implemented in a fully functional experimental online grocery store, to explore the effects of two low-cost information and incentive-based strategies. These strategies comprise of injunctive norm-based messaging and the use of financial incentive leveraging on loss aversion to encourage the purchase of healthy foods. The investigators have set up a store wherein products may be purchased by participants and subsequently delivered to homes in some of the conditions. This increases the external validity of these interventions and enables investigators to establish greater confidence in their generalizability.
Detailed description
The Asia-Pacific is faced with an epidemic of rising rates of chronic disease. Poor diet quality is a demonstrated risk factor for non-communicable diseases. Excess intake of calories, saturated fat and sodium increases the risk of obesity, heart disease, diabetes, and other chronic conditions.
Behavioral economics has emerged as a promising strategy to increase the effectiveness of interventions aimed to address risk factors for non-communicable diseases (NCDs). Yet, there is a gap in knowledge concerning how norm-based messaging and peer influence interventions can be implemented to improve diet quality.
Using a three-arm randomized trial with a 3x3 crossover design, investigators aim to determine whether norm-based messaging and peer comparisons, with or without financial incentives, improve diet quality.
Each participant will be exposed to all of the following intervention arms in random order:
Arm 1: Control arm. Participants will experience an unmodified version of NUSMart which replicates the traditional shopping experience of online grocery stores.
Arm 2: Participants will experience a modified version of NUSMart with norm-based messaging and peer comparison features enabled. Nutri-Score labels will be enabled and displayed on all products within the store. A floating side panel will provide a visual indicator of the participants' average weighted Nutri-Score.
Arm 3: Same as Arm 2, except participants are notified of an additional $5 reward towards participation reimbursement. However, this additional $5 will be forfeited if the basket average weighted Nutri-Score falls below the average of participants' peers'. (Financial incentive leveraging on loss aversion).
Investigators hypothesize the following:
Primary hypothesis: Diet quality, as measured by mean Nutri-Score weighted by number of servings of all basket items, will be greatest when exposed to the intervention with norm-based messaging with incentive (Arm 3), followed by the intervention with norm-based messaging without the incentive (Arm 2), followed by Control (Arm 1).
Investigators will test this hypothesis in total, and separately for foods and beverages given Singapore's focus on reducing intake of sugar-sweetened beverages.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Control Arm (Arm 1) | No intervention | –Participants will experience an unmodified version of NUSMart which replicates the traditional shopping experience of online grocery stores. |
| Norms Arm (Arm 2) | Experimental | Behavioral: Norm-based messaging and peer comparison featuresParticipants will experience a modified version of NUSMart with norm-based messaging and peer comparison features enabled. Nutri-Score labels will be enabled and displayed on all products within the store. A floating side panel will provide a visual indicator of the participants' average weighted Nutri-Score. |
| Norms and Incentive Arm (Arm 3) | Experimental | Behavioral: Norm-based messaging and peer comparison features, Behavioral: Financial Incentives leveraging on loss aversionSame as Arm 2, except participants are notified that they have been awarded an additional $5 towards their participation reimbursement. However, this additional $5 will be forfeited if their basket average weighted Nutri-Score falls below the average of their peers'. (Financial incentive leveraging on loss aversion). |
Who may qualify
- Ages
- 21 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Singapore resident
- Age 21 and above
- Must be the primary weekly grocery shopper in their household
Key exclusion criteria (3 listed)
- Non-Singapore resident
- Non-primary grocery shopper in their household
- Less than 21 years old
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Norm-based messaging and peer comparison featuresParticipants are shown a version of NUSMart which includes Nutri-Score labels that are enabled and displayed besides all the products in the store. Additionally, they are shown a video that gives them background information about Nutri-Score labels and describes the following features enabled in this intervention: * Norm-based messaging will be displayed in the form of a happy or sad emoticon based on whether the participant's current basket average Nutri-Score (weighted by number of servings) is above or below "other shoppers" (Nutri-Score=3.98). * Peer comparison will be implemented as a vertical ruler display of the participant's current basket average Nutri-Score (weighted by number of servings) as well as that of their "peers". Nutri-Score=3.98 was chosen as it is 10% better than the mean Nutri-Score of baskets purchased by participants in the Nutri-Score labelled intervention arm of a prior study. | Behavioural | Norms Arm (Arm 2), Norms and Incentive Arm (Arm 3) |
| Financial Incentives leveraging on loss aversionParticipants are informed that they have received an additional $5 towards their participant reimbursement. However, this amount will be forfeited if they check-out with a basket average Nutri-Score (weighted by the number of servings) that falls below the average Nutri-Score of "other shoppers" i.e. 3.98. An indicator on the screen that informs the participants of this potential forfeiting will be included. | Behavioural | Norms and Incentive Arm (Arm 3) |
Primary outcome
Diet Quality
Time frame: After completion of data collection, an average of about 5 months
Diet quality, as measured by raw Nutri-Score points (-15 to 40) weighted by number of servings of all basket items. Here, a smaller value means a better outcome. Raw Nutri-Score is measured according to the guidelines from the Sante Publique France.
6 secondary outcomes
Average Nutri-Score
Time frame: After completion of data collection, an average of about 5 months
Average Calories
Time frame: After completion of data collection, an average of about 5 months
Average Sodium
Time frame: After completion of data collection, an average of about 5 months
Average Sugar
Time frame: After completion of data collection, an average of about 5 months
Average Fat
Time frame: After completion of data collection, an average of about 5 months
Average Saturated Fat
Time frame: After completion of data collection, an average of about 5 months
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 15 Feb 2023.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Eric A Finkelstein, PhD MHA principal investigator
Duke-NUS Graduate Medical School
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Norm-based messaging and peer comparison features and Financial Incentives leveraging on loss aversion in people with Diet Quality, run by Duke-NUS Graduate Medical School at 1 site in Singapore.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 15 Feb 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Singapore. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Diet Quality (time frame: After completion of data collection, an average of about 5 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 15 Feb 2023.