Understanding Food Choices in Bahrain Using Bahrain e-Mart

NCT06440421 | Completed

• 1 other identifier: #0002004615
• Study Type: interventional
• Target: 395
• Locations: 1 country
• Sites: 1

Brief Summary

Using a two-arm randomized controlled trial (RCT) and an intercept survey, the investigators aim to evaluate the effects of the Multiple-Traffic Light (MTL) front-of-pack (FOP) food labels in Bahrain, on diet quality of grocery shoppers in the Kingdom of Bahrain. The investigators will use an experimental online grocery store, called Bahrain e-Mart, which is similar in design to commercial web-based grocery stores to test these labels. Participants will complete an online shopping experiment on Bahrain e-Mart such that those assigned to the control arm and those assigned to the intervention arm would be exposed to food and beverage products with no FOP labels and with MTL labels, respectively. Participants will randomly be assigned to one of the following arms and asked to complete a one-time shop. Arm 1 (Control): Participants will experience a default version of Bahrain e-Mart which replicates the traditional shopping experience of online grocery stores with no FOP labels. Arm 2 (MTL): Same as Arm 1 Bahrain e-Mart except that Multiple-Traffic Light (MTL) labels are displayed on all food and beverage products. The investigators hypothesize the following: Hypothesis 1: Diet quality, as measured by weighted (by the number of servings) average of all purchased products' Multiple Traffic Light scores for the shopping trip, will be greater in Arm 2 as compared to Control. Multiple Traffic Light is a nutrition labelling system wherein each nutrient attribute constituting this label is assigned different colours according to whether the amount of that nutrient is low (green), medium (amber) or high (red). Hypothesis 2: Diet quality, as measured by weighted (by the number of servings) average of all purchased products' Nutri-Score points for the shopping trip, will be greater in Arm 2 as compared to Control. Relying on the British Food Standard Agency Nutrient Profiling System, the Nutri-Score (NS) point system assigns points to each product based on levels of 7 nutrients (calories, saturated fats, sugar, salt, fibre, protein and percentage of fruits, vegetables, and nuts) per 100g or 100 ml to assess overall nutritional quality. The final NS points range from 0 to 55, with 0 being the least healthy score and 55 the healthiest. Hypothesis 3: The weighted (by the number of servings) average calories (kcal), sugar (g), sodium (mg), total fat (g), and saturated fat (g) per serving will be less in Arm 2 as compared to Control.

Conditions

Diet, Healthy

Keywords

Front of pack labels; Diet quality; Online grocery shopping; Kingdom of Bahrain; Multiple traffic light labels

Outcome Measures

Primary Outcomes (1)

• Value of Multiple Traffic Light Score

  Diet quality measured by the weighted (by the number of servings) average of all purchased products' Multiple Traffic Light scores for the shopping trip. Multiple Traffic Light is a nutrition labelling system wherein each nutrient attribute constituting this label is assigned different colours according to whether the amount of that nutrient is low (green), medium (amber) or high (red). MTL Scores are calculated by assigning values to the 4 nutrients that constitute Multiple Traffic Light labels i.e., sugar, fat, saturated fat, and sodium wherein each nutrient classified with a green colour is assigned a score of 3, amber ones are assigned a score of 2 and red ones are assigned a score of 1. Then, the resulting average is computed for each product on the store.

  After completion of data collection, an average of about 5 months

Secondary Outcomes (5)

• Value of Nutri-Score points

  After completion of data collection, an average of about 5 months

• Quantity of calories that MTL labels display

  After completion of data collection, an average of about 5 months

• Quantity of sugars that MTL labels display

  After completion of data collection, an average of about 5 months

• Quantity of sodium that MTL labels display

  After completion of data collection, an average of about 5 months

• Quantity of saturated fat that MTL labels display

  After completion of data collection, an average of about 5 months

Study Arms (2)

Control Arm (Arm 1)

NO INTERVENTION

Participants will experience a default version of Bahrain e-Mart which replicates the traditional shopping experience of online grocery stores with no FOP labels.

MTL Labels (Arm 2)

EXPERIMENTAL

Same as Arm 1 Bahrain e-Mart except that Multiple-Traffic Light (MTL) labels are displayed on food and beverage products.

Behavioral: MTL Labels

Interventions

MTL Labels BEHAVIORAL

The MTL label developed by the United Kingdom (UK) Food Standards Agency (FSA) includes per serving size information and grades each nutrient i.e., energy, sugar, fat, saturated fat, and sodium separately based on recommended thresholds. Green signifies a healthy amount of that nutrient; red signifies an unhealthy amount, and amber signifies that the nutrient levels fall between healthy and unhealthy amounts. Additionally, the label also shows how much of a person's daily allowance for a particular nutrient is met by consuming one serving of the product. Lastly, MTL includes the absolute values of each nutrient per serving of a product and the percentage of an adult's daily reference intake that is met by consuming a serving of this product. These will be displayed on all food and beverage products shown on this version of Bahrain e-Mart.

MTL Labels (Arm 2)

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• People who are residents of the Kingdom of Bahrain
• Age of 21 and above,
• Arabic OR English speakers and readers, and
• A weekly primary grocery shopper for their households can participate in this study.

You may not qualify if:

• People who are not residents of the Kingdom of Bahrain
• Under 21 years of age,
• Cannot speak or read Arabic AND English, or
• Are not weekly primary grocery shoppers for their households cannot participate in this study.

Sponsors & Collaborators

• Duke-NUS Graduate Medical School: lead
• Ministry of Industry and Commerce, Bahrain: collaborator
• Ministry of Health, Bahrain: collaborator
• World Bank: collaborator

Study Sites (1)

Seef Mall

Manama, Manama, Bahrain

Location

Study Officials

• Soye Shin, PhD

  Duke-NUS Graduate Medical School

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: May 24, 2024
• First Posted: June 3, 2024
• Study Start: January 1, 2025
• Primary Completion: May 30, 2025
• Study Completion: June 30, 2025
• Last Updated: September 5, 2025

Record last verified: 2025-08

Data Sharing

• IPD Sharing: Will not share

Locations

BA (1)