Women's Responses to Adjusted Product Placement and Its Effects on Diet - 2 (WRAPPED2)

Nudging Healthier Dietary Habits: Evaluation of a Supermarket Placement Strategy in the WRAPPED Study

This study is the largest supermarket trial internationally and will assess the effectiveness and cost-effectiveness of improving the placement of fresh fruit and vegetables in discount supermarkets in improving the fresh fruit and vegetable purchasing of women aged 18-45 years.

Study Overview

• Status: Active, not recruiting
• Conditions: Diet Modification
• Intervention / Treatment: Other: Improved product placement of fresh fruit and vegetables; Other: Sham comparator

Detailed Description

WRAPPED2 (Women's Responses to Adjusted Product Placement and its Effects on Diet - 2) is a natural experiment with a prospective matched controlled cluster design. The setting is a discount supermarket chain in the United Kingdom regularly used by disadvantaged families for their main shop. The intervention is a store refurbishment programme that involves creation of a new fresh fruit and vegetable section in the store entrance. Control stores keep the existing layout with a limited range of fresh fruit and vegetables and placement of fresh fruit and vegetables at the back of the store.

A total of 45 participants will be recruited from each of 18 intervention and 18 matched control stores through the retailer's loyalty card scheme (postal letter) and shop floor recruitment; these methods proved effective during the pilot. Participants will be women aged 18-45 years who shopped at a study store in the 12 weeks before recruitment. This study is unique in its collection of individual level sales data, as well as demographic and dietary information, and is the first to collect outcome data for more than one family member. Participant's weekly sales data will be obtained through the retailer's loyalty card scheme and will cover 3 months before refurbishment, plus 0-3 months and 3-6 months after. Change in women's fresh fruit and vegetable purchasing from baseline to 3 months is the primary outcome. Secondary outcome data about women's diets, their young child's diet (2-6 years), food shopping habits, perceptions of supermarket environment, and psychosocial and demographic characteristics will be collected by telephone survey before refurbishment, and 1, 3 and 6 months after. Weekly sales data for study stores will be provided by the retailer.

Cost-effectiveness will be assessed from individual, retailer and societal perspectives. Process evaluation will assess implementation, mechanisms of impact and context.

This study is politically and scientifically important being one of the first field studies of this kind. The findings could provide strong evidence for future public health policy interventions to help address inequalities in diet and non-communicable disease risk by supporting development of a healthy store layout that could be adopted more widely in food retail outlets.

• Study Type: Interventional
• Enrollment (Actual): 667
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Christina Vogel, PhD; Phone Number: +44 2380 764042; Email: cv@mrc.soton.ac.uk
• Study Contact Backup: Name: Janis Baird, PhD; Phone Number: +44 2380 764057; Email: jb@mrc.soton.ac.uk

Study Locations

• United Kingdom
  • Hampshire
    • Southampton, Hampshire, United Kingdom, SO16 6YD
      • Univeristy of Southampton

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 45 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Women aged 18-60 years
• Hold a store loyalty card
• Shop regularly in a study store
• Shoppers who choose items in-store but opt for home delivery

Exclusion Criteria:

• Women under the age of 18 or over 60 years
• Males or children
• Irregular shopper or online-only shopper
• Do not hold store loyalty card

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Fresh fruit and vegetable placement intervention; The intervention is a store refurbishment programme that includes the creation of a new fresh fruit and vegetable section at the store entrance with expanded range thus improving the availability and position of fresh fruit and vegetables.	Other: Improved product placement of fresh fruit and vegetables; The intervention includes the creation of a new fresh fruit and vegetable section at the store entrance with expanded range thus improving the placement (availability and position) of fresh fruit and vegetables.
Sham Comparator: Control; The control condition is the existing store layout with a limited range of fresh fruit and vegetables that are placed at the back of the store.	Other: Sham comparator; The control condition is the existing store layout with a limited range of fresh fruit and vegetables that are placed at the back of the store.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participant's weekly fruit and vegetable purchasing patterns	These data will be obtained through the retailer's loyalty card scheme and provide information about the number of items of each product purchased at each store visit.	0-6 month period post-refurbishment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Women's dietary quality	20-item food frequency questionnaire (FFQ) will be used to create standardised diet quality scores for each woman. A dietary quality score for each woman will be calculated by multiplying their reported frequency of consumption of each of the 20 items from their FFQ by corresponding weightings derived from the appropriate principal components analysis and then summing the results.	3 and 6 month follow-up post intervention commencement
Children's dietary quality	20-item food frequency questionnaire (FFQ) will be used to create standardised diet quality scores for each child. Dietary quality scores will be calculated by multiplying the reported frequency of consumption of each of the 20 items from their FFQ by corresponding weightings derived from the appropriate principal components analysis and then summing the results.	3 and 6 month follow-up post intervention commencement
Women's daily fruit and vegetable intake	2-item tool has been validated against urinary potassium and plasma ascorbic acid to describe high (≥5 portions/day) and low (≤2.5 portions/day) intake.	3 and 6 months follow-up post intervention commencement
Weekly store sales of fresh fruit and vegetables	Store sales data will be provided from electronic transaction records aggregated to the weekly level	0-3 and 0-6 month periods post-refurbishment
To determine whether change in participants' in fruit and vegetable purchasing patterns (intervention effects) differ according to their level of educational attainment	To assess interaction on intervention effects according to participants' highest educational qualification attained in 3 groups (low=GCSE/school departure before 16 years of age, medium=A-levels/HND/diploma, high=degree)	0-6 month period post-refurbishment
Economic evaluation to assess the costs and benefits of the intervention from individual, retailer and societal perspectives	Use participant survey and purchasing data for food expenditure, time spent food shopping, as well as travel costs to and from supermarkets; retailer costs will be estimates generated through discussion with supermarket staff; societal costs will be estimated for resources associated with the capital investment, changes in food expenditure, time and travel costs for individuals and health and social care costs for diet-related health conditions.	6 month period post-refurbishment

Collaborators and Investigators

• Sponsor: University Hospital Southampton NHS Foundation Trust
• Collaborators: Medical Research Council; University of Southampton; National Institute for Health Research, United Kingdom; City, University of London

Publications and helpful links

General Publications

• Vogel C, Crozier S, Dhuria P, Shand C, Lawrence W, Cade J, Moon G, Lord J, Ball K, Cooper C, Baird J. Protocol of a natural experiment to evaluate a supermarket intervention to improve food purchasing and dietary behaviours of women (WRAPPED study) in England: a prospective matched controlled cluster design. BMJ Open. 2020 Feb 10;10(2):e036758. doi: 10.1136/bmjopen-2020-036758.
• Muir S, Dhuria P, Roe E, Lawrence W, Baird J, Vogel C. UK government's new placement legislation is a 'good first step': a rapid qualitative analysis of consumer, business, enforcement and health stakeholder perspectives. BMC Med. 2023 Jan 26;21(1):33. doi: 10.1186/s12916-023-02726-9.
• Muir S, Dhuria P, Vogel C. Government must proceed with landmark anti-obesity regulations in England. BMJ. 2022 Sep 30;378:o2358. doi: 10.1136/bmj.o2358. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): May 9, 2018
• Primary Completion (Actual): April 30, 2023
• Study Completion (Anticipated): October 31, 2023

Study Registration Dates

• First Submitted: April 25, 2018
• First Submitted That Met QC Criteria: June 27, 2018
• First Posted (Actual): June 29, 2018

Study Record Updates

• Last Update Posted (Actual): May 15, 2023
• Last Update Submitted That Met QC Criteria: May 11, 2023
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Keywords: Public Health; Supermarkets; Choice architecture; Dietary inequalities
• Other Study ID Numbers: 20986

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No