Nudging healthier snack choices among hospital visitors in Greece

The consumption of meals and snacks outside the home is increasing, often leading to mindless snack choices that neglect health considerations. Subtle, targeted modifications to the food environment can promote healthier dietary decisions, offering significant public health benefits. Nudging interventions are increasingly employed in public health efforts to encourage healthier behaviours, such as improved food choices. This study evaluated the effectiveness of a nudge-based intervention aimed at increasing healthy snack choices at the cashier checkout of a hospital cafeteria among visitors in Athens, Greece. Snack choices were recorded across five phases: a baseline, two intervention phases, and two post-intervention phases, each lasting four days. A total of 1966 snack selections were documented. Differences in the proportions of healthy snack choices across phases were analysed using the Chi-square test. Healthy snack choices increased significantly during the intervention phases but declined during the post-intervention periods. Specifically, selections of healthy snacks rose from 21 % at baseline to 37.9 % during the first intervention phase (χ 2 (1) = 26.68, p < 0.05), then dropped to 20.6 % in the first post-intervention phase (χ 2 (1) = 0.0035, p > 0.05). Similarly, during the second intervention phase, healthy snack choices increased to 48.1 % (χ 2 (1) = 62.89, p < 0.05), followed by a decline to 21.7 % in the second post-intervention phase (χ 2 (1) = 0.005, p > 0.05). These findings underscore the potential of simple, low-cost nudging interventions at cashier checkouts to prompt immediate behavioural change. Such interventions are particularly suitable for hospital environments and may be adapted to other settings to promote healthier food choices. • Healthy snack choices rose by 16.9 % and 27.1 % during the nudging interventions. • Adding a nudge-based poster further increased healthy choices by 10.2 %. • Low-cost nudging interventions at checkout points effectively prompt immediate behaviour change.