Process evaluation of two environmental nutrition programmes and an educational nutrition programme conducted at supermarkets and worksite cafeterias in the Netherlands

Barriers and facilitators to implementation of healthy food and drink policies in public sector workplaces: a systematic literature review

CONTEXT

Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces.

OBJECTIVE

The objective of this review was to systematically synthesize evidence on barriers and facilitators to implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces.

DATA SOURCES

Nine scientific databases, 9 grey literature sources, and government websites in key English-speaking countries along with reference lists.

DATA EXTRACTION

All identified records (N = 8559) were assessed for eligibility. Studies reporting on barriers and facilitators were included irrespective of study design and methods used but were excluded if they were published before 2000 or in a non-English language.

DATA ANALYSIS

Forty-one studies were eligible for inclusion, mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centers, and government agencies. Interviews and surveys were the predominant methods of data collection. Methodological aspects were assessed with the Critical Appraisal Skills Program Qualitative Studies Checklist. Generally, there was poor reporting of data collection and analysis methods. Thematic synthesis identified 4 themes: (1) a ratified policy as the foundation of a successful implementation plan; (2) food providers' acceptance of implementation is rooted in positive stakeholder relationships, recognizing opportunities, and taking ownership; (3) creating customer demand for healthier options may relieve tension between policy objectives and business goals; and (4) food supply may limit the ability of food providers to implement the policy.

CONCLUSIONS

Findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested or engaging in healthy food and drink policy development and implementation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021246340.

How to enable healthier and more sustainable food practices in collective meal contexts: A scoping review

Collective meal contexts such as restaurants, cafeterias and canteens can help accelerate transitions to healthier and more sustainable diets. However, evidence from intervention studies on these contexts lacks integration. This scoping review aimed to map determinants of dietary change in collective meal contexts across multiple settings, interventions, target groups, and target behaviors. The review provided two main outcomes: (i) identifying intervention components to promote dietary change in collective meal contexts, based on the existing body of evidence; and (ii) classifying and integrating these intervention components into an overarching framework of behavior change (i.e., COM-B system). The review encompassed twenty-eight databases via two indexing services and extracted information from 232 primary sources (27,458 records selected for title and abstract screening, 574 articles selected for full-text screening). We identified a total of 653 intervention activities, which were classified into intervention components and grouped under three broad themes, namely contextual and environmental changes, social influence, and knowledge and behavioral regulation. Multi-component interventions tended to report overall positive outcomes. The review proposes several directions for future research, including: (i) moving toward more theory-based interventions in collective meal contexts; (ii) providing more detailed information about intervention settings, implementation, target groups, activities, and materials; and (iii) improving the use of open science practices in the field. Furthermore, the review offers a free, original, open-access list and synthesis of 277 intervention studies in collective meal contexts, which can help intervention planners and evaluators optimize their efforts to promote healthier and more sustainable food practices in these contexts.

Involving supermarkets in health promotion interventions in the Danish Project SoL. A practice-oriented qualitative study on the engagement of supermarket staff and managers

BACKGROUND

Supermarkets have been suggested as relevant settings for environmental and educational initiatives encouraging healthier shopping and eating decisions, but in the literature, limited attention has been paid to the context, perspectives, and everyday practices of supermarket staff. The aim of this study was to examine the engagement of supermarket staff in a health promotion project from a practice-oriented perspective.

METHODS

The study was based on qualitative data collected in the supermarket setting of Project SoL; a community-based health promotion project in Denmark. We conducted 26 in-depth interviews with store managers and other key staff members in seven participating supermarkets. In addition, we collected data on planning, implementation, and perceptions of supermarket staff of in-store interventions and other project-related activities. These field data included short telephone interviews, observational notes, photos, and audiotapes of meetings. Data were analysed from the perspective of practice theory.

RESULTS

Although supermarket staff found community-based health promotion meaningful to engage in, the study observed that their engagement was challenged by a business mindset, practical routines and structural requirements favouring sales promotion over health promotion. Nevertheless, there were also examples of how health promotion activities and ways of thinking were successfully incorporated in everyday staff practices during and after Project SoL.

CONCLUSIONS

Our findings point to both potentials and challenges for using supermarkets as settings for health promotion. The voluntary engagement of supermarket staff in community-based health projects cannot stand alone but should be supplemented by more long-lasting strategies and policies regulating this and other food environments. Context-sensitive and practice-oriented analyses in local food environments could inform such strategies and policies to make sure they target unwanted elements and practices and not just individual behavior.

Food Consumption Determinants and Barriers for Healthy Eating at the Workplace-A University Setting

BACKGROUND

A wide variety of social, cultural and economic factors may influence dietary patterns. This work aims to identify the main determinants of food consumption and barriers for healthy eating at the workplace, in a university setting.

METHODS

A cross-sectional observational study was conducted with 533 participants. Data were obtained through the application of a self-administered questionnaire that included socio-demographic information, food consumption determinants and the main perceived barriers for healthy eating at the workplace.

RESULTS

The respondents identified "price" (22.5%), "meal quality" (20.7%), and "location/distance" (16.5%). For women, the determinant "availability of healthy food options" was more important than for men (p < 0.001). The food consumption determinants at the workplace most referred to by respondents were related to the nutritional value. Smell, taste, appearance and texture, and good value for money, were also considered important for choosing food at the workplace. Respondents referred to work commitments and lack of time as the main barriers for healthy eating at the workplace.

CONCLUSIONS

Identification of determinants involved in food consumption, and the barriers for healthy eating, may contribute to a better definition of health promotion initiatives at the workplace aiming to improve nutritional intake.

The 'Eat Well @ IGA' healthy supermarket randomised controlled trial: process evaluation

Background

Successful implementation and long-term maintenance of healthy supermarkets initiatives are crucial to achieving potential population health benefits. Understanding barriers and enablers of implementation of real-world trials will enhance wide-scale implementation. This process evaluation of a healthy supermarket intervention sought to describe (i) customer, retailer and stakeholder perspectives on the intervention; (ii) intervention implementation; and (iii) implementation barriers and enablers.

Methods

Eat Well @ IGA was a 12-month randomised controlled trial conducted in 11 Independent Grocers of Australia (IGA) chain supermarkets in regional Victoria, Australia (5 intervention and 6 wait-listed control stores). Intervention components included trolley and basket signage, local area and in-store promotion, and shelf tags highlighting the healthiest packaged foods. A sequential mixed-methods process evaluation was undertaken. Customer exit surveys investigated demographics, and intervention recall and perceptions. Logistic mixed-models estimated associations between customer responses and demographics, with store as random effect. Supermarket staff surveys investigated staff demographics, interactions with customers, and intervention component feedback. Semi-structured stakeholder interviews with local government, retail and academic partners explored intervention perceptions, and factors which enabled or inhibited implementation, maintenance and scalability. Interviews were inductively coded to identify key themes.

Results

Of 500 customers surveyed, 33%[95%CI:23,44] recalled the Eat Well @ IGA brand and 97%[95%CI:93,99] agreed that IGA should continue its efforts to encourage healthy eating. The 82 staff surveyed demonstrated very favourable intervention perceptions. Themes from 19 interviews included that business models favour sales of unhealthy foods, and that stakeholder collaboration was crucial to intervention design and implementation. Staff surveys and interviews highlighted the need to minimise staff time for project maintenance and to regularly refresh intervention materials to increase and maintain salience among customers.

Conclusions

This process evaluation found that interventions to promote healthy diets in supermarkets can be perceived as beneficial by retailers, customers, and government partners provided that barriers including staff time and intervention salience are addressed. Collaborative partnerships in intervention design and implementation, including retailers, governments, and academics, show potential for encouraging long-term sustainability of interventions.

Trial registration

ISRCTN, ISRCTN37395231 Registered 4 May 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01104-z.

Factors influencing the implementation of workplace health promotion in companies in rural areas

Purpose

Workplace health promotion (WHP) is becoming increasingly important due to the ageing workforce and a shortage of skilled workers. Nevertheless, too few companies have reacted to the demographic change and introduced health-promoting measures. This paper aims to identify which factors influence the implementation of WHP, especially in small and medium-sized enterprises (SMEs) in rural areas.

Design/methodology/approach

253 companies in a rural area in the federal state of Saxony (Germany) were surveyed using a standardised questionnaire via a computer-assisted telephone interview. Bivariate analyses and logistic regression models were carried out. The focus was on the relationship between the status of WHP and the size of the company, pressure of demographic change, health-related attitude and organisational capacity factors.

Findings

It was shown that, in addition to the control variables company size and pressure of the shortage of skilled workers, a company's attitude regarding health promotion, financial capacity and planning and development capacity has a relevant influence on the status of WHP.

Practical implications

Based on the results, targeted measures can be developed and converted to implement WHP, particularly in SMEs in rural regions. The focus should be on sensitisation, knowledge transfer and capacity development.

Originality/value

The present paper reveals the relationship between company size, pressure of demographic change, health-related attitude and organisational capacities regarding the status of health-promoting measures in SMEs in a rural region.

Workplace cafeteria and other multicomponent interventions to promote healthy eating among adults: A systematic review

The objective of this review is to evaluate evidence for the effectiveness of workplace cafeteria and other supporting multicomponent interventions to promote healthy eating and reductions in health risks among adults. We conducted an electronic search in EMBASE, CINAHL, EconLit, Ovid, Cochrane, Web of Science and PubMed for English-language articles published from 1985 to July 2019. Studies were original articles reporting the results of workplace cafeteria interventions to promote healthy eating and reduction in health risks. Outcomes were classified as changes in fruit and vegetable intake, health risk indicators, dietary intake, and food sales. Interventions were categorized as interventions targeting food quality or quantity, targeting price, targeting food choice at point of purchase, targeting improved supply, targeting client's information, education or motivation and targeting organization policies. Behavioral change conditions used in interventions were identified using the COM-B system of behavioral change. Results were presented in a narrative summary. A total of 55 studies out of 6285 articles were identified for this review. Several studies used multicomponent interventions and the most featured interventions included interventions targeting food quality or quantity, targeting client's information, education or motivation and targeting food choice at point of purchase. There is evidence that workplace cafeteria and other supporting multicomponent interventions resulted in higher intake of fruit and vegetables, improved dietary intake, improved health outcomes and healthy food sales. The findings of this review have the potential to inform future cafeteria-based and other supporting multicomponent workplace health interventions. The review protocol was not registered in a repository.

Systematic review: a systems innovation perspective on barriers and facilitators for the implementation of healthy food-store interventions

BACKGROUND

Due to their central position in the modern food system, food stores present a unique opportunity to promote healthy dietary behaviour. However, there is a lack of insight into the factors that impede or enhance the implementation of nutritional interventions in food stores. We applied a systems innovation and implementation science framework to the identification of such barriers and facilitators.

METHODS

We conducted a systematic literature review. A search string was developed to identify qualitative and quantitative articles on environmental nutritional interventions in the food store. Four databases were systematically searched for studies published between 2000 and 2018. Eligible publications described study designs or original studies, focused on stimulating healthier dietary behaviour through environmental changes in retail settings and contained information on the perceptions or experiences of retailers or interventionists regarding the implementation process of the intervention. Context-descriptive data was extracted and a quality assessment was performed.

RESULTS

We included 41 articles, of which the majority was conducted in the USA and involved single stores or a mix of single and multi-store organisations. We categorized barriers and facilitators into 18 themes, under five domains. In the 'outer setting' domain, most factors related to consumers' preferences and demands, and the challenge of establishing a supply of healthy products. In the 'inner setting' domain, these related to conflicting values regarding health promotion and commercial viability, store lay-out, (insufficient) knowledge and work capacity, and routines regarding waste avoidance and product stocking. In the 'actors' domain, no major themes were found. For the 'intervention 'domain', most related to intervention-context fit, money and resource provision, material quality, and the trade-offs between commercial costs and risks versus commercial and health benefits. For the 'process' domain, most factors related to continuous engagement and strong relationships.

CONCLUSIONS

This review provides a comprehensive overview of barriers and facilitators to be taken into account when implementing nutritional interventions in food stores. Furthermore, we propose a novel perspective on implementation as the alignment of intervention and retail interests, and a corresponding approach to intervention design which may help avoid barriers, and leverage facilitators.

TRIAL REGISTRATION

PROSPERO; CRD42018095317.

Investigating business outcomes of healthy food retail strategies: A systematic scoping review

Large changes to food retail settings are required to improve population diet. However, limited research has comprehensively considered the business implications of healthy food retail strategies for food retailers. We performed a systematic scoping review to identify types of business outcomes that have been reported in healthy food retail strategy evaluations. Peer-reviewed and grey literature were searched. We identified qualitative or quantitative real-world food or beverage retail strategies designed to improve the healthiness of the consumer nutrition environment (eg, changes to the "marketing mix" of product, price, promotion, and/or placement). Eligible studies reported store- or chain-level outcomes for measures of commercial viability, retailer perspectives, customer perspectives, and/or community outcomes. 11 682 titles and abstracts were screened with 107 studies included for review from 15 countries. Overall item sales, revenue, store patronage, and customer level of satisfaction with strategy were the most frequently examined outcomes. There was a large heterogeneity in outcome measures reported and in favourability for retailers of outcomes across studies. We recommend more consistent reporting of business outcomes and increased development and use of validated and reliable measurement tools. This may help generate more robust research evidence to aid retailers and policymakers to select feasible and sustainable healthy food retail strategies to benefit population health within and across countries.

Enablers and barriers to improving worksite canteen nutrition in Pudong, China: a mixed-methods formative research study

OBJECTIVE

To identify individual-level and organisation-level enablers and barriers to the provision and consumption of healthier foods at worksite canteens in China and to develop a theoretical framework and evidence-based, specific, practical intervention strategies.

DESIGN

Mixed-methods formative research, with in-depth interviews, focus group discussions and quantitative questionnaires.

SETTING

Two community health centres (CHCs) in Pudong, Shanghai, China.

PARTICIPANTS

In-depth interviews with three CHC administrators and three canteen managers and staff. Six focus groups with a total of 19 male and 36 female employees, aged 25-67 years.

RESULTS

Three subthemes were identified as important for influencing individual food choice: the cultural perception of 'eating well', the need to balance taste preferences and nutrition, and the emphasis on food safety in healthfulness. At the organisation level, two related subthemes emerged: the balance of canteen budget and food safety with the variety and quality of offerings, and the interplay between key stakeholders. Key barriers included cost, poor communication between employees and management, individuals' emphasis on taste over healthfulness, variation in individual preferences and discordance between perceived and actual weight status, particularly among men. Key enablers included strong, positive food culture in China and trust in canteen food. An ecological framework to describe determinants of worksite food environment in Shanghai was developed and intervention strategies were mapped onto this framework.

CONCLUSIONS

A balancing act occurs at multiple levels and ultimately determines the worksite food environment and employee food choice at CHCs in Shanghai of China. There is a need to implement these findings and evaluate their impact on diet and health.

What happened in the 'Move for Well-being in School': a process evaluation of a cluster randomized physical activity intervention using the RE-AIM framework

BACKGROUND

The aim of this study was to address the gap in the translation of research into practice through an extensive process evaluation of the Move for Well-being in School programme using the RE-AIM framework. The purpose was to gain insight into the extent by which the intervention was adopted and implemented as intended and to understand how educators observed its effectiveness and maintenance.

METHODS

Public schools located in seven municipalities in Denmark were invited to enroll their 4th to 6th grade classes in the project. Of these, 24 school decided to participate in the project in the school-year 2015-16 and were randomly (cluster) allocated to either intervention or control group. A process survey was completed online by school personnel at the start, at midterm, and at the end of the school year. Additionally, informal interviews and observations were conducted throughout the year.

RESULTS

At the 12 intervention schools, a total of 148 educators were involved in the implementation of the programme over the school-year. More than nine out of ten educators integrated brain breaks in their lessons and practically all the physical education teachers used the physical education lesson plans. The educators delivered on average 4.5 brain breaks per week and up to 90% of the physical education teachers used the project lesson plans for at least half of their classes. Half of the educators initiated new recess activities. A total of 78%, 85% and 90% of the educators believed that the implemented recess, brain break and physical education components 'to a high degree' or 'to some degree' promoted the pupils' well-being, respectively.

CONCLUSIONS

This study shows that it is possible to design a school-based PA intervention that educators largely adopt and implement. Implementation of the PA elements was stable throughout the school year and data demonstrate that educators believed in the ability of the intervention to promote well-being among the pupils. Finally, the study show that a structured intervention consisting of competence development, set goals for new practices combined with specific materials, and ongoing support, effectively reached a vast majority of all teachers in the enrolled schools with a substantial impact.

TRIAL REGISTRATION

Date of registration: retrospectively registered on 24 April 2015 at Current Controlled Trials (DOI 0.1186/ ISRCTN12496336 - named: "The role of physical activity in improving the well-being of children and youth").

What is the effectiveness of obesity related interventions at retail grocery stores and supermarkets? -a systematic review

Background

The Prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review’s key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them.

Methods

Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD).

Results

The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods.

Conclusion

Given the diverse study settings and despite the challenges of methodological quality for some papers, we find efficacy of in-store healthy food interventions in terms of increased purchase of healthy foods. Researchers need to take risk of bias and methodological quality into account when designing future studies that should guide policy makers. Interventions which combine price, information and easy access to and availability of healthy foods with interactive and engaging nutrition information, if carefully designed can help customers of food stores to buy and consume more healthy foods.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3985-x) contains supplementary material, which is available to authorized users.

Effects of interpretive front-of-pack nutrition labels on food purchases: protocol for the Starlight randomised controlled trial

Background

Interpretive front-of-pack nutrition labels are better understood than non-interpretive labels. However, robust evidence on the effects of such labels on consumer food purchases in the real-world is lacking. Our aim is to assess the effects of two interpretive front-of-pack nutrition labels, compared with a non-interpretive label, on the healthiness of consumer food purchases.

Methods/Design

A five-week (1-week baseline and 4-week intervention) three-arm parallel randomised controlled trial will be conducted using a bespoke smartphone application, which will administer study questionnaires and deliver intervention (Multiple Traffic Light and Health Star Rating) and control (Nutrition Information Panel) labels. To view their allocated nutrition label, participants scan the barcode of packaged food products using their smartphone camera. The assigned label is displayed instantly on the smartphone screen.1500 eligible participants (New Zealand adult smartphone owners who shop in a supermarket at least once a week and are main household shoppers) will be randomised in a 1:1:1 ratio to one of the three nutrition label formats, using computer-generated randomisation sequences. Randomisation will be stratified by ethnicity and interest in healthy eating. Food and beverage purchase data will be collected continuously throughout the study via hard copy till receipts and electronic grocery purchase lists recorded and transmitted using the smartphone application. The primary outcome will be healthiness of food purchases in each trial arm, assessed as mean Food Standards Australia New Zealand nutrient profiling score criterion score for all food and beverages purchased over the intervention period. Secondary outcomes will include saturated fat, sugar, sodium and energy content of food purchases; food expenditure; labelling profile of food purchases (i.e. mean number of Health Star Rating stars and proportion of red, green and amber traffic lights); nutrient profiling score over time and by food categories; purchases of unpackaged foods; self-reported nutrition knowledge and recorded use of assigned labelling system.

Discussion

The Starlight randomised, controlled trial will determine the effects of interpretive front-of-pack nutrition labels on the healthiness of consumer food purchases in the real world.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12614000644662 (registered 18 June 2014).

Process evaluation of a food marketing and environmental change intervention in Tiendas that serve Latino immigrants in North Carolina

This article describes a comprehensive process evaluation of an efficacious store-based intervention that increased store customers' fruit and vegetable consumption. The process evaluation plan was designed at study inception and implemented at baseline, during the intervention, and at immediate postintervention. Four Latino food stores were randomly assigned either to an intervention or to a control condition. Data were collected from store managers, employees, and 139 Latino customers. Researchers used manager, employee, and customer interviews; weekly observations of the store environment; and implementation logs to assess reach, dose delivered, dose received, and fidelity. Results indicated that it is possible to reach customers in a store-based intervention. Indicators of dose delivered demonstrated that the intervention was implemented as planned, and in the case of employee training, it exceeded the plan. Dose received data indicated that customers moderately engaged with the intervention activities. Together these suggest that the intervention was delivered with good fidelity. Comprehensive process evaluation efforts can facilitate the identification and elimination of barriers to implementation. This approach can serve as a model for future store-based interventions. The study demonstrated that it is feasible to implement Latino food store-based interventions to increase access to and consumption of fruits and vegetables.

What is actually measured in process evaluations for worksite health promotion programs: a systematic review

Background

Numerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle (i.e., physical activity, nutrition, smoking, alcohol use and relaxation). Research primarily focused on the effectiveness of these WHPPs. Whereas process evaluations provide essential information necessary to improve large scale implementation across other settings. Therefore, this review aims to: (1) further our understanding of the quality of process evaluations alongside effect evaluations for WHPPs, (2) identify barriers/facilitators affecting implementation, and (3) explore the relationship between effectiveness and the implementation process.

Methods

Pubmed, EMBASE, PsycINFO, and Cochrane (controlled trials) were searched from 2000 to July 2012 for peer-reviewed (randomized) controlled trials published in English reporting on both the effectiveness and the implementation process of a WHPP focusing on physical activity, smoking cessation, alcohol use, healthy diet and/or relaxation at work, targeting employees aged 18-65 years.

Results

Of the 307 effect evaluations identified, twenty-two (7.2%) published an additional process evaluation and were included in this review. The results showed that eight of those studies based their process evaluation on a theoretical framework. The methodological quality of nine process evaluations was good. The most frequently reported process components were dose delivered and dose received. Over 50 different implementation barriers/facilitators were identified. The most frequently reported facilitator was strong management support. Lack of resources was the most frequently reported barrier. Seven studies examined the link between implementation and effectiveness. In general a positive association was found between fidelity, dose and the primary outcome of the program.

Conclusions

Process evaluations are not systematically performed alongside effectiveness studies for WHPPs. The quality of the process evaluations is mostly poor to average, resulting in a lack of systematically measured barriers/facilitators. The narrow focus on implementation makes it difficult to explore the relationship between effectiveness and implementation. Furthermore, the operationalisation of process components varied between studies, indicating a need for consensus about defining and operationalising process components.

Efficacy of a store-based environmental change intervention compared with a delayed treatment control condition on store customers' intake of fruits and vegetables

OBJECTIVE

The present store-based intervention was designed to promote sales of fruits and vegetables (F&V) to increase intake among store customers--specifically customers of tiendas, small-to-medium-sized Latino food stores.

DESIGN

Four tiendas were randomized to a 2-month environmental change intervention or a delayed treatment control condition. Employees and managers were trained to promote F&V sales, including how to implement a food marketing campaign and installing store equipment to promote fresh fruits and vegetables. The primary outcome was self-reported daily intake of F&V among a convenience sample of customers (at least forty per store) collected at baseline prior to randomization and then 4 months later. In addition, changes in availability of F&V in the tiendas, using unobtrusive observational methods, provided evidence of intervention fidelity.

SETTING

Tiendas in central North Carolina.

SUBJECTS

Participants included 179 customers who were recent immigrants from Mexico and Central America.

RESULTS

A group-by-time interaction approached significance on daily servings of F&V; intervention customers reported an increase in F&V intake over time and as a function of the intervention (P < or = 0.06). Unexpectedly, self-efficacy for consuming more fruits (P < or = 0.01) and more vegetables (P < or = 0.06) decreased. In our store-level analyses, a group-by-time interaction was observed for availability of fresh and canned vegetables; the intervention increased availability of vegetables but not fruit.

CONCLUSIONS

Environmental change strategies to promote healthy eating are needed given the rates of obesity and diabetes in the Latino population. A store-based intervention was moderately effective at increasing customers’ reported F&V intake. Such strategies can have a public health impact on underserved populations.

The process evaluation of two interventions aimed at portion size in worksite cafeterias

BACKGROUND

  In a previous study, the effectiveness of introducing a small meal in addition to the existing size and a proportional pricing strategy have been assessed in Dutch worksite cafeterias. To assess the degree of implementation and to inform the design of future interventions, the present study aimed to describe the process evaluation of both interventions.

METHODS

  Process evaluation components from Baranowski and Stables, and Rogers (i.e. Recruitment, Maintenance, Context, Resources, Implementation, Exposure, Contamination, and Continued use) were chosen as a theoretical basis. The process evaluation involved qualitative (e.g. structured observations, semi-structured interviews) and quantitative data (e.g. consumer questionnaires) collected from 17 intervention and eight control worksite cafeterias.

RESULTS

  In all intervention cafeterias, two portion sizes were offered. The pricing instructions were followed in 13 intervention cafeterias. The cafeterias managers indicated that they did not consider offering large and small meals as being complex, risky or time-consuming to implement. Some managers perceived the consumer demand as high, others as (too) low. One year after the study had ended, nine of the intervention cafeterias had continued (at least partly) to follow the protocol.

CONCLUSIONS

  Offering a smaller portion size in addition to the existing size, as well as proportional pricing, was generally implemented as prescribed by the protocol and can be considered promising in terms of continued use. However, additional efforts are needed to make the intervention more effective in motivating consumers to replace their large portion with a small portion.

Improving the diet of employees at blue-collar worksites: results from the ‘Food at Work’ intervention study

Objective

To examine the impact of a 6-month participatory and empowerment-based intervention study on employees’ dietary habits and on changes in the canteen nutrition environment.

Design

Worksites were stratified by company type and by the presence or absence of an in-house canteen, and randomly allocated to either an intervention group (five worksites) or a minimum intervention control group (three worksites). The study was carried out in partnership with a trade union and guided by an ecological framework targeting both individual and environment levels. Outcome measures included: (i) changes in employees’ dietary habits derived from 4 d pre-coded food diaries of a group of employees at the worksites (paired-data structure); and (ii) the canteen nutrition environment as identified by aggregating chemical nutritional analysis of individual canteen lunches (different participants at baseline and at endpoint).

Setting

Eight blue-collar worksites (five of these with canteens).

Subjects

Employees.

Results

In the intervention group (n102), several significant positive nutritional effects were observed among employees, including a median daily decrease in intake of fat (−2·2 %E,P= 0·002) and cake and sweets (−18 g/10 MJ,P= 0·002) and a median increase in intake of dietary fibre (3 g/10 MJ,P< 0·001) and fruit (55 g/d,P= 0·007 and 74 g/10 MJ,P= 0·009). With regard to the canteen nutrition environment, a significant reduction in the percentage of energy obtained from fat was found in the intervention group (median difference 11 %E,P< 0·001,n144).

Conclusions

The present study shows that moderate positive changes in dietary patterns can be achieved among employees in blue-collar worksites.

A front-of-pack nutrition logo: a quantitative and qualitative process evaluation in the Netherlands

This study aimed to perform a quantitative and qualitative process evaluation of the introduction of the Choices logo, a front-of-pack nutrition logo on products with a favorable product composition, adopted by many food producers, retail and food service organizations, conditionally endorsed by the Dutch government, validated by scientists, and in the process of international dissemination. An online questionnaire was sent to adult consumers 4 months after the introduction of the logo (n = 1,032) and 1 year later (n = 1,127). Additionally, seven consumer focus groups (n = 41) were conducted to provide more insight into the questionnaire responses. Quantitative analyses showed that exposure to the logo had significantly increased. Elderly and obese respondents reported to be more in need of a logo than younger and normal-weight individuals. Women perceived the logo more attractive and credible than men did. Further qualitative analyses indicated that the logo's credibility would improve if it became known that governmental and scientific authorities support it. Elderly respondents indicated that they needed a logo due to health concerns. Consumers interested in health reported that they used the logo. Further research focusing on specific target groups, forming healthful diets, and health outcomes is needed to investigate the effectiveness of the Choices logo.

Comparison of buffet and à la carte serving at worksite canteens on nutrient intake and fruit and vegetable consumption

OBJECTIVE

To evaluate the nutritional composition of worksite canteen lunches and to examine the impact of two meal serving systems on employee intake, i.e. buffet style with a fixed price for a varied number of dishes and à la carte style with a separate price for each item on the menu.

DESIGN

Laboratory technicians observed employees' food selection and collected identical dishes. Food items were weighed separately to calculate the content of fruit and vegetables. The content of protein, fat and ash of each dish was chemically analysed and the carbohydrate and energy content calculated.

SETTING

Fifteen randomly chosen worksite canteens in Denmark: eight canteens serving buffet style and seven canteens with an à la carte line.

SUBJECTS

one hundred and eighty randomly chosen employees having lunch at the worksite canteens.

RESULTS

The average percentage energy from fat was 37 +/- 12 among men and 33 +/- 12 among women. No association was found between the meal serving system and energy intake or macronutrient composition. Eating at canteens serving buffet style, on the other hand, was associated with an increased intake of fruit and vegetables, on average 76 g, and a lower energy density of the food for both genders.

CONCLUSION

The results highlight the possibilities of promoting healthy food choices in the catering sector and the need to identify models of healthy catering practice. Serving buffet style appears to be a promising strategy in order to increase fruit and vegetable consumption in food served away from home.