Healthy meals at worksite canteens - Social shaping as a framework for understanding sustainable interventions

The challenge of public health nutrition in relation to worksite settings is to improve access to healthier meal options – especially for the groups with a lower educational level. Strategies changing the dietary environment such as increasing the availability of healthy food and reducing barriers towards healthy eating may help consumers change dietary behavior and meet the guidelines for a healthy diet.

The sustainability of interventions is found to be a central challenge in public health promotion not only related to the worksite setting, but in health promotion in general. Relatively few empirical studies are published in this area. Many health interventions fail to consider the interventions as complex systems that interact dynamically with the key stakeholders and the setting and the broader community.

The experiences regarding healthy eating interventions in Denmark and internationally are the point of departure of this research. The long term sustainability of these interventions has up till now only been analyzed to a limited extent. Furthermore health promotions at worksites have only had a limited focus on analyses of the organizational context‟s significance for the efficiency of the interventions.

Based on this background the overall purpose of this Ph. D. thesis is to make a contribution to promote healthy eating in worksite settings by developing a deeper understanding of the sustainability of healthy food interventions at worksite canteens. This thesis therefore analyses the 5 year sustainability of an F&V intervention at five worksites and uses a combination of social shaping and a worksites policy process perspective as a framework for understanding sustainable interventions.

The aims of this thesis were to: 1. Investigate if the meals served in the worksite canteens are healthy and easily available and what are the predictors of worksite canteens providing healthy meals. 2. Measure and analyze the sustained effect of a fruit and vegetable (F&V) promotion intervention in a worksite canteen setting. 3.

Evaluate the success factors concerning sustainability of a worksite F&V promotion intervention. The main findings of this research were as follows: Only 12% of the canteens applied to the healthy group combining hot meal, sandwich and salad. Worksites with more than 75% female employees served healthy menus on a frequent basis.

The size of the worksite was positively correlated with healthier meal options. Furthermore, this study suggests a positive relationship between corporate financial support and the availability of healthy meal options. Four out of five worksite canteens were able to either maintain the F&V intervention or even increase the F&V consumption from baseline to the 5 year follow-up with an average of 95 g per customer/meal/day.

One canteen didn‟t sustain the intervention and almost went back to the baseline. On average the five canteens at the 5 year follow-up had an average F&V consumption of 208 g per customer/meal/day. The analyses show a number of themes are important to sustainability of F&V worksite interventions. Contracting out the food service may challenge the sustainability but may also be a way of ensuring the necessary competences for a more F&V intensive food supply.

Structural changes of the worksite, like re-structuring, may also challenge the sustainability if this implies frequent changes of worksite employees and new employees question the F&V intensive food supply. The engagement of the canteen manager and the ability to develop strategies for integration of more F&V in the food supply and good cooperation with the F&V suppliers also play a crucial role.

The results of this thesis point to the need for a more widespread implementation of strategies that promote healthier eating at worksite canteens. The results indicate that a worksite intervention needs to be tailored to the needs of the particular worksite environment in which it is implemented. Furthermore this tailoring needs to be done in close partnership with the local stakeholders.

The results also indicate that worksite canteens are important change agents – intermediaries for developing intervention components. Healthier eating interventions are shaped and controlled by the involved local actors' ideas of health and nutrition and also by their concepts of how these ideas interrelate with the worksite’s working conditions and working performance.

A combination of a social shaping approach and a worksite policy process approach to the shaping and embedding of healthy worksite eating interventions is shown to be valuable in supporting a tailor-making of F&V interventions and make long-term sustainability more likely.