A Systematic Review of Food Swap Interventions used in Grocery Store Settings. Under Review

With Helena Bentil, Eddie Hillier, Oliver Huse, Sarah Shaw, Viktorija Kesaite, Jess Brock, Bisola Osifowora, Jessica Renzella, Thijs van Rens, Oyinlola Oyebode,

Abstract:

Context: Food swap interventions provide an approach to influence consumer food choices. However, evidence on their implementation and effectiveness has not yet been synthesised.

Objective: To systematically synthesise the literature on food swap interventions in grocery settings by addressing the following questions: 1) In which settings have these interventions been implemented? 2) Who was the target population? 3) How were the interventions implemented and what was their purpose? 4) What outcome measures have been examined? 5) Have food swap interventions been effective in changing behaviour?

Data sources, extraction, and analysis: A search of MEDLINE, Scopus, and Web of Science up to 23/01/2025 was conducted to identify food swap intervention trials in grocery settings, with no limits on language or publication year. Covidence was used to screen titles, abstracts, and full-text articles in duplicate. Risk of bias was assessed using the Cochrane tools. Data were synthesised narratively.

Results: Eleven studies, published between 2006 and 2024, were included in the review. Interventions were implemented in various settings: 1 in a real grocery store, 3 in real online supermarkets, and 7 in simulated online supermarkets. Most included studies targeted adults with primary or partial responsibility for their household’s grocery shopping. All the swaps offered healthier alternatives to selected products, mostly at the point of selection. Outcomes examined included the healthiness of shopping baskets, energy content, saturated fat (SFA) content, salt density, sodium and sugar content. All but 1 study noted statistically significant effects of the studied interventions. Two studies found significant improvements in overall nutritional quality. Salt/sodium reductions were significant in 2 studies, while reductions in sugar content were significant in 1 study but not in another study. Studies also demonstrated significant reductions in purchased energy content/density, and SFA.

Conclusion: Food swap interventions improved the healthiness of food purchases. However, none of the studies examined the potential for food swap interventions to promote more sustainable food choices, and all but one targeted online grocery shoppers. Future research could explore the effectiveness of food swaps in promoting sustainable food choices and consider how these promising interventions could be implemented in physical stores.