Emprego de estratégias nudge em ensaio comunitário randomizado de base escolar para estimular o consumo de alimentação escolar, água e atividade física.

Abstract

Nudge is any aspect of the choice architecture employed with the aim of changing people behavior in a predictable way without any forbiddance. These are subtle modifications in the environment, low cost, easy to implement and difficult to perceive. Making healthy options more convenient can lead individuals to select them, generating positive health impact. Therefore, the objective of this work is to estimate the impact of nudge proposals to stimulate the consumption of school feeding, water and physical activity practice due to changes made in the school environment in public schools in Duque de Caxias, Rio de Janeiro. This is a randomized community trial conducted in 18 public schools with three comparison groups: group 1 (control: 9 schools), group 2 (intervention: 4 schools) and group 3 (intervention + nudge: 5 schools). Group 2 participated in educational activities and in group 3, in addition, modifications were made in the last school environment (fruits in the spotlight, mascot "Super Water", markings on the ground in the path of water and availability of sports materials) during one month. Data analysis for repeated measures evaluated the rate of change over time of school feeding, water consumption and physical activity among the comparison groups. The study involved 2,600 students, 52% male, with a mean age of 11.5 years. At baseline, 34% of the participants reported consuming school meals every day and the frequency of physical inactivity among adolescents was 21%. After the intervention, participants in groups 2 (p = 0.011) and 3 (p = 0.011) increased water consumption when compared to group 1. The level of physical activity increased among participants in group 3 when compared to group 1 (p = 0.015). Thus, it can be concluded that the intervention was effective for the increase of water consumption, with no additional effect of the nudge strategy. The nudge strategy proved to be effective for the increase in the level of physical activity. Low-cost and easy-to-implement strategies can be potentiating the role of the school as a health promoter.