Background: Unhealthy lifestyle are important contributors to chronic illness in Hong Kong and worldwide. Lifestyle modification, particularly improving healthy diet and physical activity, can prevent the development of various chronic illnesses, improve disease conditions, reduce the risk of complications and enhance the quality of life. Many behavioural models have been applied to achieve lifestyle modification, but the major limitation was that they mainly treated human behaviours as individual behaviours that were subsequent to rational thinking. Nudge theory, an advanced behavioral concept, proposed to change individual’s motivation, incentives and decision making through non-direct suggestion and non-forced reinforcement. However, the application of Nudge theory has been challenged on the lack of evidence to prove its effectiveness, and its controversial framework for ethical analysis. Objectives: This review was to synthesize the empirical findings about the effectiveness of using nudge theory for lifestyle modification including healthy diet and physical activity. Methodology: Interventional and experimental studies that were conducted based on Nudge theory to change diet or physical activity was identified from the published literature. The studies were divided into two large groups according to outcome measured: healthy diet and physical activity, and they were systematically synthesized. The “nudges” used in these studies were categorized as six types of “nudges” summarized by “nudge unit” as “MINDSPACE” for further discussion. The type of “nudges” that were used in the studies and their effectiveness on changing diet and physical activity was abstracted. Results: Totally, nine articles that met the inclusion criteria were included. Five nudges were identified from the included studies, including Priming (P), Default (D), Salience & Affect (SA), Incentives (I) and Messenger & Norms (MN). It is found that the strategies and methods applied on the same nudge may have different effectiveness. Seven studies applied Priming (P) as nudge to motivate change in diet, which used two major strategies: “availability” and “accessibility”. The evidence was strong that altering the availability of food presence could be effective to change food selection. The results of studies using accessibility were heterogeneous and contradictive with each other. Another three studies used different nudges including Default, Salience & Affect and Incentive. The effectiveness of Default (D) as nudge seemed to be blurry, and the sustainability remained questionable. The ethical consideration is always the primary pillar for applying nudging theory. As long as the applications are stick to necessary ethical concerns, the nudging model can be beneficial through mild “manipulation” rather than harmful. Conclusion: It has potential opportunity to carry out “libertarian paternalism” in Hong Kong. However, it is still a long way to take application of nudging model into regulation, legislation and daily practice. The evidences for each type of nudge were not consistent and enough. Besides, the monitoring and evaluation are not available yet. Future research can be focused on transferring these applications into real practice with an effective monitoring and evaluation system. / published_or_final_version / Public Health / Master / Master of Public Health

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Funded by Nellis Air Force Base (NAFB), my thesis research and analysis examined Native American knowledge of heritage foods and how diminished access to food resources has affected Native American identity and health. NAFB manages the Nevada Test and Training Range (NTTR), land and air space in southern Nevada, which includes Native American ancestral lands. During a research period of 3 months in the spring/summer of 2012, I interviewed members of Native American nations culturally affiliated with ancestral lands on the NTTR, the Paiute Indian Tribe of Utah (PITU) and the Bishop Paiute Tribe. My research included participant observation and 31 interviews with tribal members considered knowledge holders by tribal leaders. In dialogue with the literature of the anthropology of food, political economy, and Critical Medical Anthropology, my analysis focused on the role of heritage foods in everyday consumption, taking into account the economic, social, environmental, and political factors influencing heritage foods access and diet. My work explored the effects of structural forces and rapid changes in diet and social conditions on Native American health. I found shifts in concepts of food-related identity across ethnic groups, tribes, ages, and genders. I also found evidence of collective efforts to improve diet-related health at tribal and community levels. Through the applied aspects of my research, participants and their families had the opportunity to share recipes and food dishes containing heritage foods as a way to promote human health and knowledge transmission.