Magda Rosin

Background: Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. Objective: This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. Methods: The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the “Discover” (understanding of current gaps) and “Define” (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the “Develop” phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final “Deliver” phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. Results: A new digital tool, Healthy Kai (Food) Checker—a searchable database of packaged food and drink products that classifies items according to the Policy’s nutritional criteria—was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Conclusions: Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool’s acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool’s utility.

Background: In 2016, a voluntary National Healthy Food and Drink Policy was released to improve the healthiness of food and drinks for sale in New Zealand health sector organisations. The Policy aims to role model healthy eating and demonstrate commitment to health and well-being of hospital staff and visitors and the general public. This study aimed to understand the experiences of hospital food providers and public health dietitians/staff in implementing the Policy, and identify tools and resources needed to assist with the implementation. Methods: A maximum variation purposive sampling strategy (based on a health district’s population size and food outlet type) was used to recruit participants by email. Video conference or email semi-structured interviews included 15 open-ended questions that focused on awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. Data was analysed using a reflexive thematic analysis approach. Results: Twelve participants (eight food providers and four public health dietitians/staff) were interviewed; three from small (< 100,000 people), four from medium (100,000-300,000 people) and five from large (> 300,000 people) health districts. There was agreement that hospitals should role model healthy eating for the wider community. Three themes were identified relating to the implementation of the Policy: (1) Complexities of operating food outlets under a healthy food and drink policy in public health sector settings; (2) Adoption, implementation, and monitoring of the Policy as a series of incoherent ad-hoc actions; and (3) Policy is (currently) not achieving the desired impact. Concerns about increased food waste, loss of profits and an uneven playing field between food providers were related to the voluntary nature of the unsupported Policy. Three tools could enable implementation: a digital monitoring tool, a web-based database of compliant products, and customer communication materials. Conclusions: Adopting a single, mandatory Policy, provision of funding for implementation actions and supportive tools, and good communication with customers could facilitate implementation. Despite the relatively small sample size and views from only two stakeholder groups, strategies identified are relevant to policy makers, healthcare providers and public health professionals.

Background: In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, “the Policy”) was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors’ awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy. Methods: Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants. Results: Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that “Hospitals should be good role models.” Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options. Conclusions: The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces.

BACKGROUND Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. OBJECTIVE This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. METHODS The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the “Discover” (understanding of current gaps) and “Define” (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the “Develop” phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final “Deliver” phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. RESULTS A new digital tool, Healthy Kai (Food) Checker—a searchable database of packaged food and drink products that classifies items according to the Policy’s nutritional criteria—was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. CONCLUSIONS Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool’s acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool’s utility.

Aims: This study aimed to identify and evaluate tools and resources used to support the implementation of workplace healthy food and drink policies, primarily in Australia and New Zealand.Methods: A scoping grey literature review included searches of government agencies and non‐governmental organisations' websites in six English‐speaking countries, public health nutrition intervention databases and Google search engine queries. Paper‐based and digital tools were included if they were written in English, referred to within a policy or on a policy's website, and primarily targeting supply‐side stakeholders. Tools were evaluated on two domains: ‘Features’ (summarised descriptively) and ‘Usability and Quality’ (with inter‐rater reliability scores calculated using an intraclass correlation coefficient).Results: Twenty paper‐based tools were identified relating to Australian (n = 14) and New Zealand (n = 6) policies, and a further six digital tools were identified from Australia (n = 3) and Canada (n = 3). Target audiences included workplace managers, food providers and suppliers. The paper‐based tools focused on general implementation guidance. In contrast, digital tools tended to support specific elements of policy implementation. ‘Usability and Quality’ scores ranged from 2.9 to 4.5 (out of 5.0) for paper‐based tools, and 3.9 to 4.2 for digital tools, with a moderate agreement between reviewer scores (intraclass correlation coefficient 0.523, p = 0.010).Conclusions: A range of tools have been developed to support the implementation of workplace healthy food and drink policies. Understanding the strengths and limitations of current tools will assist in developing improved aids to support policy implementation.

Context: Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. Objective: The objective of this review was to systematically synthesize evidence on barriers and facilitators to implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces. Data Sources: Nine scientific databases, 9 grey literature sources, and government websites in key English-speaking countries along with reference lists. Data Extraction: All identified records (N = 8559) were assessed for eligibility. Studies reporting on barriers and facilitators were included irrespective of study design and methods used but were excluded if they were published before 2000 or in a non-English language. Data Analysis: Forty-one studies were eligible for inclusion, mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centers, and government agencies. Interviews and surveys were the predominant methods of data collection. Methodological aspects were assessed with the Critical Appraisal Skills Program Qualitative Studies Checklist. Generally, there was poor reporting of data collection and analysis methods. Thematic synthesis identified 4 themes: (1) a ratified policy as the foundation of a successful implementation plan; (2) food providers’ acceptance of implementation is rooted in positive stakeholder relationships, recognizing opportunities, and taking ownership; (3) creating customer demand for healthier options may relieve tension between policy objectives and business goals; and (4) food supply may limit the ability of food providers to implement the policy. Conclusions: Findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested or engaging in healthy food and drink policy development and implementation. Systematic Review Registration: PROSPERO registration no. CRD42021246340.

Aims: To examine the frequency of promotions on breakfast cereals and drinks in a major New Zealand supermarket chain, determine the healthiness of promoted versus non‐promoted products, and quantify the effects of promotions on sales.Methods: Weekly data on product promotions and sales were collected in six Auckland supermarkets for 198 breakfast products over 12 weeks. The healthiness of products was determined using the Health Star Rating system, and the effect of promotions on sales was estimated using linear mixed models.Results: On average, 47% of breakfast products in a given week were promoted using on‐shelf tickets, 12% in weekly mailers, and 9% via promotional displays. The healthiness of promoted and non‐promoted breakfast products was comparable. In relation to weekly sales of non‐promoted products, all three promotional strategies had substantial (2 to 2.5 times higher sales) and statistically significant (P < 0.001) effects on product sales.Conclusion: Promotions are frequently used and effective at increasing sales. Marketing strategies focusing solely on promoting healthier products could be an important nudging strategy to improve the healthiness of supermarket food purchases.

The National Healthy Food and Drink Policy (NHFDP) was developed to promote healthy food environments for the New Zealand District Health Board (DHB) staff and visitors. The policy classifies food and drinks as red, amber, or green and sets benchmarks for the proportions of red, amber, and green foods that should be available on-site. The HYPE (Healthy Policy Evaluation) study is the first national evaluation of the implementation and impact of the NHFDP. We designed an electronic audit tool to collect detailed food and drink data across a range of food settings (vending machines and all food outlets) at New Zealand DHBs and some government agencies. The electronic audit tool collects all the information required to classify food and drinks under the NHFDP (photographs of foods and drinks, item weight/volume, energy and nutrient content, ingredient composition, and Health Star Rating). The web-based tool was created using Drupal (web content management framework) and pilot tested. The tool is now in use by the HYPE team in DHBs across New Zealand. Data collection commenced in March 2021 and has been completed for nine DHBs (5700 products) so far. Audit results detailing the proportion of red, amber, and green food items available at all participating institutions will be available in late 2022. Ongoing stakeholder feedback and requirements have been incorporated throughout the design process and used to improve the audit tool. This feedback has informed key lessons such as agreeing the tool’s aims and objectives collectively with stakeholders/potential end users, pilot testing the tool prior to use, and ensuring the tool is simple and accessible for all end-users. This new electronic food setting audit tool has successfully facilitated comprehensive and standardised data collection across a range of retail settings.

Many countries and institutions have adopted policies to promote healthier food and drink availability in various settings, including public sector workplaces. However, studies reporting barriers and facilitators experienced by food vendors and caterers in providing healthy and nutritious foods and drinks have not been collated and synthesised, representing a significant gap in workplace health promotion knowledge. Our objective was to systematically synthesise evidence on barriers and facilitators relative to the implementation of and compliance with healthy food and drink policies aimed at the general adult population in public sector workplaces internationally. Nine scientific databases, nine grey literature sources, and government websites in key English-speaking countries were searched between April and June 2021. All identified records (n = 8559) were assessed for eligibility. Studies reporting barriers and facilitators were included irrespective of the study design and methods used, but they were excluded if they were published before the year 2000 or in a non-English language. Methodological strengths and limitations of the included studies were assessed with the CASP Qualitative Studies Checklist. Drawing on a thematic synthesis approach, primary findings were generated through research question-led coding and theme development. Forty-one studies were eligible for inclusion, and they were mainly from Australia, the United States, and Canada. The most common workplace settings were healthcare facilities, sports and recreation centres, and government agencies. Generally, poorly reported data collection and analysis methods were observed. Preliminary findings suggest that although vendors encounter challenges, there are also factors that support healthy food and drink policy implementation in public sector workplaces. Generated codes indicate that barriers and facilitators fall into five broad categories of financial ramifications, availability of healthier products, existence of supporting tools and resources, institutional leadership support, and communication between stakeholders. Understanding barriers and facilitators to successful policy implementation will significantly benefit stakeholders interested in or engaging in healthy food and drink policy development and implementation.