Foods and Beverages Available to Nurses in Hospital Cafeterias, Vending Machines, and Gift Shops

Impact of a nudge-based food environment intervention in a hospital convenience store on staff's food intake and Na/K

BACKGROUND

A food environment intervention using nudge tactics was implemented at a hospital convenience store (CVS) in Tokyo to improve employees' eating habits. The objective of this study was to evaluate its effects on the urinary sodium-to-potassium ratio (Na/K), food intake, eating attitude, and behavior.

METHODS

Using a pre-post design; the intervention incorporated nudge tactics, healthier options, easy-to-pick food placement, and eye-catching information. We also used price incentives. The primary outcomes included changes in Na/K and sodium and potassium excretion assessed using spot urine samples at health checkups. Secondary outcomes were changes in staff food intake, eating attitude, and behavior which were assessed using questionnaire surveys. All outcomes were evaluated statistically. Furthermore, we investigated how the intervention led to outcomes using path analysis.

RESULTS

A total of 140 participant (52men and 88women) were analyzed. Significant changes were observed in Na/K (3.16 to 2.98 in median, p = 0.02) and potassium excretion (43.4 to 45.2 mmol/day in mean, p = 0.03). However, sodium excretion did not change significantly. The intake of fruits and dairy products increased with improved self-efficacy. The most influential factor for lowering Na/K and increasing potassium excretion was information from the CVS; purchasing "balanced meals" to lower Na/K and salads to increase potassium excretion were second.

CONCLUSIONS

Food environment intervention using nudge tactics can improve staff's food intake and lower Na/K.

TRIAL REGISTRATION

Registration number: UMIN000049444 (UMIN-CTR). Date of registration: November. 7. 2022.

Characterizing food environments of hospitals and long-term care facilities in the Netherlands: a mixed methods approach

BACKGROUND

Hospitals and long-term care facilities, which are key institutions to serve health and well-being, have an important exemplary role in providing supportive food environments to encourage healthy and sustainable food choices. The objective of this study is to characterize the physical, socio-cultural, political and economic dimensions of the food environment for health care receivers, health workforce and visitors in healthcare settings, and make comparisons between the food environment of hospitals and long-term care facilities.

METHODS

To characterize the food environment in healthcare settings, two sub-studies were conducted. In sub-study 1, semi-structured interviews were held with staff members (n = 46) representing 11 hospitals and 26 long-term care facilities (rehabilitation centres, nursing homes, institutions for people with intellectual disabilities and mental healthcare institutions). In sub-study 2, staff members audited the food environment in hospitals (n = 28) and long-term care facilities (n = 36) using a predefined checklist.

RESULTS

The food environment in Dutch healthcare settings varies substantially between locations although noticeable differences between hospitals and long-term care facilities were identified. Hospitals and larger long-term care facilities featured more often restaurants and utilized central spaces for preparation of meals, while smaller long-term care facilities often operated as household-like settings. Type of healthcare shaped the socio-cultural food environment, with hospitals primarily emphasizing nutrition for fast recovery, while long-term care facilities more often as an instrument (i.e., to structure the day). Participants highlighted the importance of food policies and broad organizational support for realizing and regulating improvement of the food environment. Yet, long-term care facilities were less familiar with national guidelines for food environments compared to hospitals. Several economical aspects, like profit motives, strict budgets and contracts with external parties affected and shaped the food available within all healthcare settings.

CONCLUSIONS

This study characterized the food environment in Dutch healthcare settings. Disclosed differences between hospitals and long-term care facilities should be incorporated in strategies for a transition of the food environment. Future research should investigate the underlying mechanisms of the healthcare food environment attaining all healthcare stakeholders - health care receivers, staff and visitors - while prioritizing sustainability alongside healthiness.

Factors Generating the Willingness of Romanian Consumers to Buy Raw Milk from Vending Machines

The use of automatic raw milk dispensers for products obtained from Romanian farms can represent an effective method of encouraging the development of short supply chains and promoting sustainable production and consumption systems. There are very few studies in the literature, especially in emerging economies, that analyze consumer perception regarding the use of raw milk dispensers; most of the research is focused on technical aspects regarding how such machines function and food safety, and less on consumers' perceptions towards them or consumer satisfaction, loyalty, or intention to use them. Therefore, the objective of this research was to investigate the willingness of Romanian consumers to buy raw milk from vending machines. In this regard, the authors drew a conceptual model to assess the factors that trigger willingness to buy raw milk from vending machines and then implemented a quantitative-based survey among Romanian consumers who buy raw milk from vending machines. The data were analyzed by modeling structural equations with SmartPLS. The results reveal that the generation of consumer willingness to buy raw milk from vending machines depends on how consumers perceive raw milk but also on the product safety, reusability of the milk bottle, and the provenance of the raw milk, as well as the nutritional qualities of the unprocessed raw milk. The paper extends previous studies based on the stimulus-organism-response (SOR) and deepens the understanding of consumers' perception towards raw milk dispensers. Furthermore, the results also highlight possible managerial strategies that aim to improve the understanding of consumers.