“Just So You Know, It Has Been Hard”: Food Retailers’ Perspectives of Implementing a Food and Nutrition Policy in Public Healthcare Settings

Abstract

Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers’ experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy; (2) the Policy made it difficult for food retailers to operate successfully, and; (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success.

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

“…These include implementation toolkits or manuals, self-evaluation tools, scalable sample recipe ideas, training to improve staff culinary skills, newsletter and contract templates, access to nutrition analysis software, or a database listing healthy, compliant products. For example, participants in the Law et al study identified a “centralised provision of lists or databases of classified foods and drinks to reduce duplication of effort and the technical burden,” 41 because food providers noted, “You can’t go and find out this stuff yourself so easily.” 70 Importantly, such tools and resources need to be tested, user friendly, and up to date.…”

“…Although a positively framed policy and implementation plan are advantageous in lessening negative perceptions of change, accepting change requires building rapport with food providers, contingent on existing and new positive relationships in a workplace. As Law et al noted, “the trust built with the PHD [public health dietitian] meant [food providers] openly discussed their experiences, from a position of acceptance, not resistance.” 41 Studies frequently identified open and clear communication between stakeholders as facilitating the shift from food providers’ resistance to acceptance, for example, by “making sure that everybody knew all along the way what we were doing, what was expected of them and of their team.” 53 Regular communication efforts originating from governmental bodies, senior workplace management, or project champions demonstrate acceptance across organizational levels, and indicate to food providers the leadership’s willingness to work collaboratively to overcome barriers and achieve policy compliance. Green et al highlighted “that a positive relationship and open, frequent communication where both the city and vendor listened to each other’s concerns and worked together to address them was essential to successful implementation.” 52 Furthermore, shared responsibility and a collaborative approach to implementation can mitigate feelings of being disproportionately disadvantaged as a food provider and allows recognition of implementers’ fears, concerns, and barriers (both experienced and perceived) that can create negative perceptions of the policy.…”

“…These perceptions were often associated with the “cultural context that less healthy foods were a ‘treat,’ despite their ubiquity,…[and]…their provision was attributed to patrons wanting the less-healthy options.” 66 Customer resistance to change was a barrier to implementation in public sector workplaces, although the major source of customer complaints generally related to limitations on familiar, unhealthy comfort foods and drinks rather than additions of the healthier items. One food provider even described customers’ criticism as “abuse” 41 toward them or their front-of-house staff. As studies included in the review highlighted, dissatisfaction with removal of or restrictions on unhealthy items may be attributed to personal eating habits and purchasing patterns that are hard to change, particularly “if people have eaten this way their whole lives.” 56 The perceived customer resistance was taken, at times, as justification by food providers for noncompliance with policy guidelines.…”

“…Additional labor costs, staff training, and new cooking and storage equipment purchases, combined with the common belief that healthier foods and drinks have lower profit margins, further reiterate the likelihood of profit losses, which also has a ripple effect on workers fearing loss of jobs. Law et al pointed out that “although healthy food procurement policies are considered low-cost to governments, there is a cost of implementation borne by food retailers.” 41 Pressures to generate profits and run a commercially viable business may also stem from tight budgets, sponsorship arrangements, and revenue targets set out in contracts, contributing to the overall financial barriers. It can be “difficult for healthy food to be as profitable as unhealthy food, and doing so takes more resources and effort.” 32 Hence, the implementation team should work with food providers to identify ways to minimize operational costs, and leadership should allocate funding for any necessary new equipment or food service staff training.…”

Innovation in Healthy and Sustainable Food Product Development for Health and Aged Care: A Scoping Review

“…Previous authors have already established that innovation is a means to developing healthy and sustainable foods [ 11 ]. Accessing appropriate food products is an identified challenge for health service food retailers [ 12 ], highlighting the importance of understanding the current and potential food supply of healthy and sustainable food products that are safe and flavoursome.…”