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Nudging Children to Make Healthier Food Choices and the Information Environment: Evidence from Indonesia
Last registered on November 15, 2019

Pre-Trial

Trial Information
General Information
Title
Nudging Children to Make Healthier Food Choices and the Information Environment: Evidence from Indonesia
RCT ID
AEARCTR-0005025
Initial registration date
November 14, 2019
Last updated
November 15, 2019 10:03 AM EST
Location(s)

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Primary Investigator
Affiliation
Erasmus University Rotterdam
Other Primary Investigator(s)
PI Affiliation
PI Affiliation
PI Affiliation
Additional Trial Information
Status
In development
Start date
2019-11-18
End date
2020-12-31
Secondary IDs
Abstract
The study examines the effectiveness of nutrition-related nudges among primary school students using a lab-in-the-field food choice experiment in urban Indonesia. The rapid economic development of Indonesia is accompanied with important changes in lifestyles and diets. The shift of people’s dietary consumption towards processed foods dense in calories, fat, and sugar is accompanied by reduced intake of fruits and vegetables. Especially for children, this nutrition transition may have long-term consequences of an increased risk of non-communicable diseases.

The aim of this study is to evaluate the effect of simple nudges to encourage children’s healthier food choices, and to examine how such effects vary depending on the information environment. Specifically, we will study how nudges work with and without prior exposure to educational messages about healthy eating. Provision of information about healthy nutrition is a cornerstone of many interventions to improve people’s diets. However, by themselves educational messages tend to have weak effects and so we aim to investigate their interactive effect with nudging treatments. The study aims to inform policymakers and future studies on efficient approaches to healthy eating interventions targeted at children.
External Link(s)
Registration Citation
Citation
Agustina, Rina et al. 2019. "Nudging Children to Make Healthier Food Choices and the Information Environment: Evidence from Indonesia." AEA RCT Registry. November 15. https://doi.org/10.1257/rct.5025-1.0.
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Experimental Details
Interventions
Intervention(s)
In a simple, one-shot snack choice experiment between a healthy (banana) and unhealthy, processed food (chocolate covered snack cake), we test three nudging treatments (T1, T2, T3). We compare choices with one control arm without any nudges (Base). This study will inform potential scale-ups of such nudges.

In addition, we study above treatments within two randomized group treatments (4 children) (Block 1: short nutrition video, Block 2: no video).
Intervention Start Date
2019-11-18
Intervention End Date
2019-12-20
Primary Outcomes
Primary Outcomes (end points)
A binary indicator based on the observed choice between a fresh banana and a chocolate-covered snack cake with marshmallow (banana=1, zero otherwise).
Primary Outcomes (explanation)
Children are participating in a one-off, snack choice experiment. They make a choice between a healthy and unhealthy, processed snack.
Secondary Outcomes
Secondary Outcomes (end points)
None
Secondary Outcomes (explanation)
None
Experimental Design
Experimental Design
Study Population
The study uses a randomized control design at the child level based among 7-10 year old children (grades 2-5) in 20 public primary schools in Central Jakarta.

The schools were selected using simple random sampling from a database of 279 primary schools in Jakarta provided by The Ministry of Education and Culture. We further checked the schools’ eligibility to participate in the study by verifying whether they are not currently enrolled in any other nutrition programs, and have a homogeneous student population.

Parental Survey
Before the experiment we ask parents to sign an informed consent form and to fill a survey in which we will collect contextual information on the child’s socio-economic background, anthropometrics (height and weight) etc..

Eligible Sample
All target group children for whom prior parental consent is obtained are eligible to participate in the study. Children with food allergies are excluded.

Snack Choice (Primary Outcome Variable)
During the experiment the children are participating in a snack choice experiment (similar to List and Samek, 2015). They make a choice between a healthy and unhealthy snack. Each child sees a table with a plain tray on which a chocolate covered snack cake and a banana are placed.

We collaborate with teachers. At least one is present during the data collection. The teacher’s presence is meant to provide comfort and safety of children to participate in the study. However the teacher does not observe a child while he/she is choosing a snack.

Treatments (Details Hidden)
Before the snack choice some groups of children receive nutrition information:
-Randomized information provision by video

During the snack choice some children are further exposed to individual treatments:
-Three one time nudge treatment arms during the snack choice.
Experimental Design Details
Not available
Randomization Method
In class - public lottery: Kids pick number to determine sequence of participating in the food choice.
We randomize sequence of block 1 (video) or block 2 (no video) per class.
We randomize sequence of individual treatments for each block.
Randomization Unit
Individual level randomization of experimental conditions: base, T1, T2, T3.
Group level randomization to video (block 1) or no video (block 2).
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
~400 groups (50% block 1, 50% block 2).
Sample size: planned number of observations
1600 children
Sample size (or number of clusters) by treatment arms
Base: 400 (50% in block 1, 50% in block 2)
T1: 400 (50% in block 1, 50% in block 2)
T2: 400 (50% in block 1, 50% in block 2)
T3: 400 (50% in block 1, 50% in block 2)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Sample size was determined based on power calculation for the test of differences in proportions. Our power calculations were focusing on the individual treatments to be able to test individual treatment effects treating the two block samples separately (that is in the separate samples with and without information provision). We did not power the experiment to be able to test differences in treatment effects between the blocks. More specifically, we assumed that in the control condition 57% of children will pick the chocolate cake. We further assumed that the nudge will reduce the proportion to 42% picking the chocolate cake (a reduction of a little more than 25%). In STATA 13.0 the command [sampsi 0.57 0.42, power(0.8) alpha(0.05)] provided a sample size of 187 per experimental arm within each block. We rounded up to 200 observations. The target total sample size for four treatment arms and two information blocks is therefore 1600 (4 conditions * 200 kids * 2 blocks).
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Ethics Committee, Institute of International Social Studies
IRB Approval Date
2019-04-02
IRB Approval Number
Ethics 2018‐07