Towards healthier food choices for hospital staff and visitors: impacts of a healthy food and drink policy implemented at scale in Australia

Abstract

Objective: To determine the impact of a healthy food and drink policy on hospital staff and visitors’ food purchasing behaviours, and their awareness and support for the changes introduced. Design: Two repeated cross-sectional surveys, consisting of intercept interviews and observations of food items purchased were conducted before (March-July 2018) and after (April-June 2019) the target date for implementation of 13 food and drink practices (31 December 2018). Food purchases were coded as ‘Everyday’ (healthy) or ‘Occasional’ (unhealthy). Setting: Ten randomly selected NSW public hospitals, collection sites including hospital entrances and 13 hospital cafés/cafeterias. Participants: 4,808 hospital staff and visitors completed the surveys (response rate 85%). The majority were female (63%), spoke English at home (85%), and just over half had completed tertiary education (55%). Results: Significant increases from before to after the implementation target date were found for policy awareness (23% to 42%; p<0.0001) and support (89% to 92%; p=0.01). The proportion of ‘Everyday’ food purchases increased, but not significantly (56% to 59%; p=0.22); with significant heterogeneity between outlets (p=0.0008). Overall, younger, non-tertiary-educated adults, visitors and those that spoke English at home were significantly less likely to purchase ‘Everyday’ food items. Support was also significantly lower in males. Conclusions: The findings provide evidence of strong policy support, an increasing awareness of related changes, and a trend towards increased ‘Everyday’ food purchasing. Given the relatively early phase of policy implementation, and the complexity of individual food purchasing decisions, longer-term follow-up of purchasing behaviour is recommended following ongoing implementation efforts.

Creating healthy hospital retail food environments: Multiple pathways to successful at scale policy implementation in Australia

“…10,29 Our study reveals factors central to interpreting outcomes found in related Framework evaluation studies. 14,19,20 Many retailers who adopted practices early – and even those whose contracts with the health service did not include conditions to achieve Framework practices – were motivated to succeed. This was prompted by aligned values, or anticipated opportunities within a dynamic market and the confidence or perceived leverage to change demand.…”

“…26 From the possible 18 LHDs, 11 were selected as the sampling frame from which stakeholders were identified. Nine LHDs had been randomly selected previously as part of a related larger evaluation study 19 and the remaining two were purposively selected to increase regional LHD representation.…”

“…However, a related Framework evaluation study has indicated that there is strong consumer support for the changes and consumers are not choosing to purchase less healthy products at other outlets nearby hospitals to any significant extent. 19…”

“…Examples included ‘Vending machines are stocked with at least 75% Everyday products’, ‘Sweet muffins meet the portion size limit of 80 g’ and ‘Foods and drinks placed at tills are Everyday foods and drinks only’. 15,19 There were high levels of support for these changes amongst hospital staff and visitors, and significant progress was made in achieving the 13 food- and drink-related targets in NSW hospital retail food outlets. 19,20…”

“…15,19 There were high levels of support for these changes amongst hospital staff and visitors, and significant progress was made in achieving the 13 food- and drink-related targets in NSW hospital retail food outlets. 19,20…”