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Mackay S, Rosin M, Kidd B, Gerritsen S, Shen S, Jiang Y, Te Morenga L, Ni Mhurchu C. Slow and steady-small, but insufficient, changes in food and drink availability after four years of implementing a healthy food policy in New Zealand hospitals. BMC Med 2024; 22:437. [PMID: 39380022 PMCID: PMC11462770 DOI: 10.1186/s12916-024-03663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 09/26/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND A voluntary National Healthy Food and Drink Policy (the Policy) was introduced in public hospitals in New Zealand in 2016. This study assessed the changes in implementation of the Policy and its impact on providing healthier food and drinks for staff and visitors in four district health boards between 1 and 5 years after the initial Policy introduction. METHODS Repeat, cross-sectional audits were undertaken at the same eight sites in four district health boards between April and August 2017 and again between January and September 2021. In 2017, there were 74 retail settings audited (and 99 in 2021), comprising 27 (34 in 2021) serviced food outlets and 47 (65 in 2021) vending machines. The Policy's traffic light criteria were used to classify 2652 items in 2017 and 3928 items in 2021. The primary outcome was alignment with the Policy guidance on the proportions of red, amber and green foods and drinks (≥ 55% green 'healthy' items and 0% red 'unhealthy' items). RESULTS The distribution of the classification of items as red, amber and green changed from 2017 to 2021 (p < 0.001) overall and in serviced food outlets (p < 0.001) and vending machines (p < 0.001). In 2021, green items were a higher proportion of available items (20.7%, n = 815) compared to 2017 (14.0%, n = 371), as were amber items (49.8%, n = 1957) compared to 2017 (29.2%, n = 775). Fewer items were classified as red in 2021 (29.4%, n = 1156) than in 2017 (56.8%, n = 1506). Mixed dishes were the most prevalent green items in both years, representing 11.4% (n = 446) of all items in 2021 and 5.5% (n = 145) in 2017. Fewer red packaged snacks (11.6%, n = 457 vs 22.5%, n = 598) and red cold drinks (5.2%, n = 205 vs 12.5%, n = 331) were available in 2021 compared to 2017. However, at either time, no organisation or setting met the criteria for alignment with the Policy (≥ 55% green items, 0% red items). CONCLUSIONS Introduction of the Policy improved the relative healthiness of food and drinks available, but the proportion of red items remained high. More dedicated support is required to fully implement the Policy.
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Affiliation(s)
- Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
| | - Magda Rosin
- School of Population Health, Centre for Translational Health Research: Informing Policy and Practice (TRANSFORM), Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Bruce Kidd
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Sarah Gerritsen
- Department of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Stephanie Shen
- National Institute for Health Innovation, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Yannan Jiang
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
- School of Population Health, Centre for Translational Health Research: Informing Policy and Practice (TRANSFORM), Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Lisa Te Morenga
- Research Centre for Hauora and Health, Massey University, Wellington, PO Box 756, Wellington, 6140, New Zealand
| | - Cliona Ni Mhurchu
- School of Population Health, Centre for Translational Health Research: Informing Policy and Practice (TRANSFORM), Faculty of Medical and Health Sciences, University of Auckland, Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
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Underwood RA, Wood RJ, Tomchek AD, Celestin MD, Culbertson R, Phillippi S, Broyles ST. Exploring Successful Implementation of Organizational Supports at the Worksite Environment: A Mixed Methods Approach. Health Promot Pract 2024; 25:188-195. [PMID: 36321610 DOI: 10.1177/15248399221127045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
While there is evidence that organizational supports may lead to better employee health, research on implementing such organizational supports is lacking. This research sought to understand organizational supports and implementation of those supports using an Explanatory Sequential Mixed Methods design approach. Employee survey responses (n = 202) were used to classify organizations into "high" and "low" categories for employee-reported health behavior improvement, agreement, and readiness for implementing change. For the qualitative phase of research (organization-level), semi-structured interviews were conducted with organization leads, and data were analyzed through constant comparative analysis procedure. Analyses sought to identify differences between "high" versus "low" organizations. In addition, the researcher used the "high" and "low" classifications to further review themes that emerged, to determine where there may be differences in organizations classified as "high" versus "low." Study results found the following nine themes to explain how organizations can improve implementing organizational supports: provide a contracted wellness program, formalized programming, and wellness incentives; create a culture of wellness in the organization; provide consistency in the supports offered; provide clear communication to employees; utilize leadership role modeling to show support; focus on leadership support that ensures organizational supports are implemented and sustained; and work to combat employee hesitation of organizational supports. The results of this study show that organizations have the opportunity to improve implementation of their organizational supports by applying the nine themes found.
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Affiliation(s)
| | - Ralph J Wood
- Southeastern Louisiana University, Hammond, LA, USA
| | | | - Michael D Celestin
- CTTS Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Stephen Phillippi
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Stephanie T Broyles
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Stern D, Blanco I, Olmos LA, Valdivia JJ, Shrestha A, Mattei J, Spiegelman D. Facilitators and barriers to healthy eating in a worksite cafeteria: a qualitative study. BMC Public Health 2021; 21:973. [PMID: 34022846 PMCID: PMC8141192 DOI: 10.1186/s12889-021-11004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Worksite-based nutrition interventions can serve as access points to facilitate healthy eating and translate existing knowledge of cardiometabolic disease prevention. We explored perceptions, facilitators, and barriers for healthy eating in a cafeteria at a large worksite in Mexico City. METHODS We conducted an exploratory qualitative study in a large department store in Mexico City with ~ 1500 employees. We conducted eight focus group discussions (FGD) with 63 employees stratified by job category (sales, maintenance, shipping, restaurant, cafeteria, administrative staff, and sales managers). Employees were invited to participate in the FGD if they were at the store at the day and time of the FGD for their job type. FGDs were audio-recorded, transcribed verbatim and analyzed using the thematic method. This process involved the researches´ familiarizing themselves with the data, generating initial codes, searching for themes, reviewing the themes, defining and naming themes, and then interpreting the data. RESULTS Employees defined healthy eating as eating foods that are fresh, diverse, and prepared hygienically. The most commonly reported facilitators of healthy eating at the worksite were availability of affordable healthy food options and employees' high health awareness. Major barriers to healthy eating included unavailability of healthy foods, unpleasant taste of food, and preference for fatty foods and meat. For lower-wage workers, affordability was a major concern. Other barriers included lack of time to eat work and long working hours. CONCLUSION A broad range of factors affect healthy eating at the cafeteria, some related to nutrition and some related to the employees type of job. Availability of healthy, hygienic, and tasty food at an affordable price could lead to healthier food choices in the worksite cafeteria. These strategies, along with work schedules that allow sufficient time for healthy eating, may help improve dietary behaviors and health of employees.
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Affiliation(s)
- Dalia Stern
- CONACyT-Center for Research on Population Health, National Institute of Public Health, Cuernavaca, 7ª Cerrada Fray Pedro de Gante # 50, Col. Sección XVI Tlalpan, 14080, Mexico City, Mexico.
- Lown Scholar, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ilian Blanco
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Lucy A Olmos
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Joel J Valdivia
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Archana Shrestha
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute of Implementation Science and Health, Kathmandu, Nepal
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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Tabak RG, Strickland JR, Kirk B, Colvin R, Stein RI, Dart H, Colditz GA, Dale AM, Evanoff BA. Pilot test of an interactive obesity treatment approach among employed adults in a university medical billing office. Pilot Feasibility Stud 2020; 6:57. [PMID: 32355567 PMCID: PMC7187490 DOI: 10.1186/s40814-020-00599-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/13/2020] [Indexed: 02/07/2023] Open
Abstract
Background There is a need for workplace programs promoting healthy eating and activity that reach low-wage employees and are scalable beyond the study site. Interventions designed with dissemination in mind aim to utilize minimal resources and to fit within existing systems. Technology-based interventions have the potential to promote healthy behaviors and to be sustainable as well as scalable. We developed an interactive obesity treatment approach (iOTA), to be delivered by SMS text messaging, and therefore accessible to a broad population. The aim of this pilot study was to evaluate participant engagement with, and acceptability of, this iOTA to promote healthy eating and activity behaviors among low-wage workers with obesity. Methods Twenty participants (self-reporting body mass index ≥ 30 kg/m2) of a single workgroup employed by a university medical practice billing office had access to the full intervention and study measures and provided feedback on the experience. Height and weight were measured by trained research staff at baseline. Each participant was offered a quarterly session with a health coach. Measured weight and a self-administered survey, including dietary and activity behaviors, were also collected at baseline, 3, 6, 12, 18, and 24 months. Participant engagement was assessed through responsiveness to iOTA SMS text messages throughout the 24-month pilot. A survey measure was used to assess satisfaction with iOTA at 3 months. Due to the small sample size and pilot nature of the current study, we conducted descriptive analyses. Engagement, weight change, and duration remaining in coaching are presented individually for each study participant. Results The pilot was originally intended to last 3 months, but nearly all participants requested to continue; we thus continued for 24 months. Most (14/20) participants remained in coaching for 24 months. At the 3-month follow-up, eight (47%) of the remaining 17 participants had lost weight; by 24 months, five (36%) of the remaining 14 participants had lost weight (one had bariatric surgery). Participants reported very high satisfaction. Conclusions This pilot provides important preliminary results on acceptability and participant engagement with iOTA, which has significant potential for dissemination and sustainability.
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Affiliation(s)
- Rachel G Tabak
- 1The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130 USA
| | - Jaime R Strickland
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Bridget Kirk
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Ryan Colvin
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Richard I Stein
- 3Center for Human Nutrition, Department of Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8031, St. Louis, MO 63110 USA
| | - Hank Dart
- 4Division of Public Health Sciences, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8100, St Louis, MO 63110 USA
| | - Graham A Colditz
- 5Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8100, St. Louis, MO 63110 USA
| | - Ann Marie Dale
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
| | - Bradley A Evanoff
- 2Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8005, St. Louis, MO 63110 USA
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Tamrakar D, Shrestha A, Rai A, Karmacharya BM, Malik V, Mattei J, Spiegelman D. Drivers of healthy eating in a workplace in Nepal: a qualitative study. BMJ Open 2020; 10:e031404. [PMID: 32102804 PMCID: PMC7045197 DOI: 10.1136/bmjopen-2019-031404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To explore the perceptions, enablers and barriers to employees' healthy eating in a hospital site. DESIGN A qualitative study including focus group discussion and in-depth interview, data were analysed using thematic analysis method. SETTING The study was carried out among employees of Dhulikhel Hospital-Kathmandu University Hospital, located about 30 km east of Nepal's capital Kathmandu. PARTICIPANTS Focus group discussions were conducted among the 33 participants, who were divided into four groups: (a) support staff (drivers, cook, laundry, gardeners and ward boys), (b) hospital administrators and managers, (c) health personnel (doctors, nurses and assistants) who work 8-12 hours shifts and (d) health personnel who work during office hours. Nine in-depth interviews were conducted among six canteen operators and three managers. RESULTS The major factors for promoting healthy eating were identified as the availability of affordable healthy food options in the cafeterias, a commitment to such promotion by the cafeteria manager, operators, staff and hospital administration and the level of education of the employees. The most commonly reported barriers for healthy eating were the unavailability of healthy options, including the lack of food supply from local market, the higher cost of healthy foods, individual food preferences and limited human resources in the cafeteria. CONCLUSION The availability of affordable healthy foods, supply of healthy foods from the market, commitment from cafeteria managers, hospital administrators and health awareness among cafeteria operators may promote healthy eating among employees in a Nepali hospital setting.
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Affiliation(s)
- Dipesh Tamrakar
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Anjana Rai
- Family Health International 360, Kathmandu, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Vasanti Malik
- Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Donna Spiegelman
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
- Department of Biostatistics, Center on Methods for Implementation and Prevention Science, New Haven, Connecticut, USA
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