The TIPPME intervention typology for changing environments to change behaviour

Reflecting widespread interest in concepts of ‘nudging’ and ‘choice architecture’, there is increasing research and policy attention on altering aspects of the small-scale physical environment, such as portion sizes or the placement of products, to change health-related behaviour at the population level. There is, however, a lack of clarity in characterizing these interventions and no reliable framework incorporating standardized definitions. This hampers both the synthesis of cumulative evidence about intervention effects, and the identification of intervention opportunities. To address this, a new tool, TIPPME (typology of interventions in proximal physical micro-environments), has been developed and here applied to the selection, purchase and consumption of food, alcohol and tobacco. This provides a framework to reliably classify and describe, and enable more systematic design, reporting and analysis of, an important class of interventions. In doing so, it makes a distinct contribution to collective efforts to build the cumulative evidence base for effective ways of changing behaviour across populations.

Unhealthy patterns of food, alcohol and tobacco consumption are major contributors to the burden of non-communicable diseases—currently accounting for more than two-thirds of deaths worldwide1,2. It is now widely recognized that the physical environments that surround us exert considerable influence on these patterns of consumption, and that changing these environments holds corollary potential as a catalyst for changing consumption. Whilst not new, the idea that behaviour can be changed in predictable ways, by changing the environments in which people make choices—‘choice architecture’3—has gained traction globally among the public, the research community and policymakers4,5. However, despite the recent popularization and intuitive appeal of these approaches, there has been an absence of definitional and conceptual clarity in characterizing such interventions, particularly regarding applications to public health. The absence of a reliable framework that incorporates standardized labels and definitions has hampered the synthesis of cumulative evidence about intervention effects, resulting in an evidence base that remains uneven and uncertain. It has also hindered the identification and discussion of opportunities to intervene to change environments.

In response to these observations, we present and provide guidance for a new tool—TIPPME (typology of interventions in proximal physical micro-environments)—that aims to improve researchers’ and practitioners’ ability to clearly and consistently classify and describe an important class of behaviour change interventions related to concepts of ‘nudging’ and ‘choice architecture’. The focus of the typology is on interventions that involve altering aspects of physical micro-environments to change health-related behaviour, here specifically applied to the selection, purchase and consumption of food, alcohol and tobacco products. A more detailed discussion of definitions and concepts follows below, but in essence, these interventions involve changing characteristics of the products themselves and the environments in which they are available, within places such as shops, restaurants, bars and workplaces. Examples include altering the portion size of food, alcohol and tobacco products, and changing their availability or position in an environment, such as providing additional healthier options to select from or placing less healthy options further away from potential consumers.