Introduction
Health literacy and numeracy are linked to obesity and dietary behaviors. This study
investigates whether the effect of a workplace behavioral intervention to prevent
weight gain and improve diet differed by employee health literacy and numeracy.
Methods
ChooseWell 365 was an RCT of hospital employees testing a 12-month intervention using
nudges and feedback to promote healthier choices, building on existing cafeteria traffic
light labels (e.g., green=healthy, red=unhealthy). Health literacy and numeracy were
measured with the Newest Vital Sign (range=0−6) and General Numeracy Scale (range=0−3).
Mixed-effects linear models examined if intervention effects on cafeteria purchases,
diet quality (Healthy Eating Index 2015, range=0−100), and weight change over 24 months
differed by higher versus lower health literacy or numeracy. Data were collected in
2016–2020 and analyzed in 2020–2021.
Results
In 12 months, 510 participants completed the Newest Vital Sign and General Numerancy
Scale; 36.7% had Newest Vital Sign<6 (lower health literacy) and 31.6% had General
Numerancy Scale<2 (lower numeracy). Intervention participants increased healthy purchases
over 24 months compared with controls in both higher and lower health literacy and
numeracy groups. At 12 months, Healthy Eating Index 2015 scores increased in intervention
versus control participants with lower health literacy (5.5 points, 95% CI=1.51, 9.54)
but not in those with higher health literacy (p-interaction=0.040). BMI did not differ by health literacy or numeracy.
Conclusions
A behavioral intervention improved cafeteria food choices of hospital employees of
varying health literacy and numeracy levels and improved diet quality among employees
with lower health literacy, suggesting this group also improved food choices outside
of work.
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Article Info
Publication History
Published online: March 10, 2022
Identification
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
