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The objective of this study was to determine the impact of two nudge interventions on customers' produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p < 0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p < 0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada. [ABSTRACT FROM AUTHOR]

Background: Sustainable Childhood Obesity Prevention Through Community Engagement is an initiative that engages stakeholders across multiple sectors to promote the Live-5-2-1-0 message (5 vegetables and fruits, 2 hours at most of recreational screen time, 1 hour of physical activity, 0 sugar-sweetened beverages each day) and implement action to support healthy behaviors. As part of this initiative, an intervention using the Live 5-2- 1-0 Toolkit for family physicians (FPs) was piloted in two communities. This study aimed to identify barriers and aids to toolkit implementation, and to determine whether the toolkit improves physicians' capacity to promote healthy childhood behaviors. Methods: FPs completed preintervention and postintervention surveys and participated in semistructured interviews after implementation of the Live 5-2-1-0 Toolkit intervention. Implementation occurred sequentially in two communities and involved a total of 21 FPs in six primary care clinics. Descriptive statistics were used for quantitative data, and content analysis was used for qualitative data. Results: Of the 21 participating FPs, 14 completed the preintervention and the postintervention surveys (67%) and 7 completed the preintervention survey only (33%). FPs reported increased knowledge of medical evaluation of pediatric patients with obesity (from 14% preintervention to 36% postintervention), behavioral goal setting (from 36% to 93%), and motivational interviewing (from 57% to 79%). FPs' perceived efficacy in addressing the subject of weight improved (from 43% preintervention to 93% postintervention). Increases were also observed in routinely addressing nutrition (from 43% preintervention to 79% postintervention), physical activity (from 50% to 79%), screen time (from 14% to 64%), and sugar-sweetened beverage consumption (from 29% to 71%). As a result of toolkit implementation, 71% of FPs felt their patients were more aware of long-term complications related to lifestyle, 64% felt patients were more willing to set behavioral goals with providers, and 50% felt patients were more able to selfmanage issues related to lifestyle. The predominant barrier to implementation was lack of staff/clinic capacity to measure BMI; the most noted aid to implementation was access to ready-to-use Live 5-2-1-0 resources. Conclusions: The Live 5-2-1-0 Toolkit facilitated health promotion to pediatric patients in the primary care setting. Increasing routine BMI measurement in primary care remains challenging due to clinical capacity issues. Results of this pilot study will be used to refine the toolkit prior to wider dissemination across British Columbia. [ABSTRACT FROM AUTHOR]