Adopting Sustainable Menu Practices in Healthcare Institutions: Perceived Barriers and Facilitators
Publication: Canadian Journal of Dietetic Practice and Research
3 May 2022
Abstract
Purpose: The healthcare sector is an important area for sustainable food initiatives, given its inherent mission to heal and its substantial impact on the food system. Foodservice managers can take part in these initiatives by using sustainable menu practices (SMPs). This study aimed to explore managerial perceptions of barriers and facilitators to adopting SMPs in Québec healthcare institutions.
Methods: Seventeen foodservice managers were recruited through purposeful sampling to participate in a qualitative semi-structured interview. The Diffusion of Innovations theory was used to assess the main determinants of the diffusion of an innovation (SMPs) through a complex social system (healthcare organization).
Results: Participants reported more barriers than facilitators. Lack of support at many levels was recognized as a major hindrance to SMP adoption, as were shortfalls in political directives. Increased collaboration between all food system actors and better communication in healthcare were perceived as needed for increased SMP adoption.
Conclusions: This research contributes to an in-depth understanding of managerial experiences in SMP adoption in various regional and healthcare settings. Findings suggest the need for support and strategies that would remove important barriers for foodservice managers and contributed to the development of a guide to support foodservice managers in implementing SMPs.
Résumé
Objectif. Le secteur des soins de santé est un domaine important pour les initiatives en alimentation durable étant donné sa mission inhérente de guérison et son effet substantiel sur le système alimentaire. Les gestionnaires de services alimentaires peuvent prendre part à ces initiatives en adoptant des pratiques de menus durables (PMD). Cette étude visait à explorer les perceptions des gestionnaires quant aux barrières et éléments facilitateurs en matière d’adoption de PMD dans les établissements de santé du Québec.
Méthodes. Dix-sept gestionnaires de services alimentaires ont été recrutés par échantillonnage intentionnel pour participer à une entrevue qualitative semi-structurée. La théorie de la diffusion des innovations a été utilisée pour évaluer les principaux déterminants de la diffusion d’une innovation (PMD) dans un système social complexe (organisation de soins de santé).
Résultats. Les participants ont relevé plus de barrières que d’éléments facilitateurs. Le manque de soutien à plusieurs niveaux a été reconnu comme un obstacle majeur à l’adoption de PMD, tout comme l’absence de politiques claires. Une collaboration accrue entre tous les acteurs du système alimentaire et une meilleure communication dans les soins de santé étaient perçues comme nécessaires pour une meilleure adoption des PMD.
Conclusions. Cette recherche contribue à une compréhension approfondie de l’expérience de gestion en matière d’adoption de PMD dans divers contextes régionaux et de soins de santé. Les résultats suggèrent la nécessité de mécanismes de soutien et de stratégies pour éliminer les principales barrières pour les gestionnaires de services alimentaires et ont contribué à l’élaboration d’un guide pour aider les gestionnaires de services alimentaires à mettre en œuvre des PMD.
Get full access to this article
View all available purchase options and get full access to this article.
REFERENCES
1
Fanzo J, Hawkes C. 2018 Global nutrition report: shining a light to spur action on nutrition. Bristol, UK: Development Initiatives Poverty Research Ltd; 2018 [cited 2020 Mar 1]. Available from: https://www.who.int/nutrition/globalnutritionreport/2018_Global_Nutrition_Report.pdf.
2
Global Panel on Agriculture and Food Systems for Nutrition. Food systems and diets: facing the challenges of the 21st century. London, UK: Global Panel on Agriculture and Food Systems for Nutrition; 2016 [cited 2020 Mar 1]. Available from: https://www.ifpri.org/publication/food-systems-and-diets-facing-challenges-21st-century.
3
Rocha C, Jacobs N. Unraveling the food-health Nexus: addressing practices, political economy, and power relations to build healthier food systems. Report commissioned by the Global Alliance for the Future of Food; 2017 [cited 2020 Mar 1]. Available from: http://www.ipes-food.org/_img/upload/files/Health_FullReport(1).pdf.
4
Rose D, Heller MC, and Roberto CA. Position of the society for nutrition education and behavior: the importance of including sustainability in dietary guidance. J Nutr Educ Behav. 2019;51(1):3–15.e1.
5
Willett W, Rockstrom J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet, 2019(393):447–92.
6
Burlingame B, Dernini S, Nutrition and Consumer Protection Division, FAO, editors. Sustainable diets and biodiversity: directions and solutions for policy, research and action. Proceedings of the International Scientific Symposium; 2010 Nov 3–5; FAO Headquarters, Rome, Italy [cited 2020 Mar 1]. Available from: http://www.fao.org/3/i3004e/i3004e.pdf.
7
Lang T, Dibb S, Reddy S. Looking forward, looking back. Sustainability and UK Food Policy 2000–2011 [Internet]. Sustainable Development Commission; 2011 [cited 2020 Mar 1] [Available from: http://www.sd-commission.org.uk/data/files/publications/FoodPolicy10_Report_final_w.pdf.
8
Mason P, Lang T. Sustainable diets: how ecological nutrition can transform consumption and the food system. Devon: Taylor & Francis Group; 2017.
9
Gussow JD and Clancy KL. Dietary guidelines for sustainability. J Nutr Educ Behav. 1986;18(1):1–5.
10
Alarcon B, Gerritsen E. On our plate today: healthy, sustainable food choices. LiveWell for LIFE: final recommendations. [Internet]. LiveWell for LIFE; 2014 [cited 2020 Mar 1] [Available from: http://livewellforlife.eu/wp-content/uploads/2014/12/LiveWell-for-LIFE_Rec-Report_English_Final.pdf.
11
Carino S, Porter J, Malekpour S, and Collins J. Environmental sustainability of hospital foodservices across the food supply chain: a systematic review. J Acad Nutr Diet, 2020;120(5):825–73.
12
Gray S, Orme J, Pitt H, and Jones M. Food for life: evaluation of the impact of the hospital food programme in England using a case study approach. JRSM Open, 2017;8(10):205427041771270–205427041771279.
13
Klein K, Thottathil S, Clinton S. Environmental nutrition. Redefining healthy food in the health care sector [Internet]. Health Care Without Harm; Reston: Health Care Without Harm; 2014 [cited 2020 Mar 1]. Available from: https://noharm-uscanada.org/sites/default/files/documents-files/2819/Environmental_Nutrition_HCWH_September_2014.pdf.
14
Reinhardt S and Salvador RJ. Health professionals as partners in values-based food procurement. AMA J Ethics, 2018;20(10):E974–8.
15
Gaspard A. Schools, universities, hospitals…cities’ new allies to change the food system. Urban Food Futures; 2019 Apr 4 [cited 2020 Mar 1]. [Available from: https://urbanfoodfutures.com/2019/04/04/institutions/.
16
Ranke TD, Mitchell CL, St.George DM, and D’Adamo CR. Evaluation of the balanced menus challenge: a healthy food and sustainability programme in hospitals in Maryland. Public Health Nutr. 2014;18(13):2341–9.
17
Guillaumie L, Boiral O, Baghdadli A, and Mercille G. Integrating sustainable nutrition into health-related institutions: a systematic review of the literature. Can J Public Health, 2020;111(6):845–61.
18
Carlsson L, Seed B, Yeudall F. The role of dietitians in sustainable food systems and sustainable diets. Toronto: Dietitians of Canada; 2020.
19
Équiterre. La recette clé pour un approvisionnement alimentaire local & écoresponsable. Fiche pratique pour le milieu de santé [Équiterre. The recipe for local and environmentally responsible food procurement in Quebec institutions. Healthcare sector fact sheet.] [Internet]. Québec: Équiterre; 2020 [cited 2020 Dec 1]. Available from: https://www.equiterre.org/sites/fichiers/fiche_milieu_de_la_sante.pdf. (French).
20
Health Care without Harm. Reston: healthy food in health care [Internet]. 2020 [cited 2020 Mar 1] [Available from: https://noharm-uscanada.org/issues/us-canada/healthy-food-health-care#initiatives.
21
Nourish. Nourish innovator program [Internet]. 2019 [cited 2020 Mar 1] [Available from: https://www.nourishhealthcare.ca/about-nourish.
22
Government of Québec. Politique bioalimentaire 2018–2025: Alimenter Notre Monde [Internet]. Government of Québec; 2018 [cited 2020 Mar 1]. Available from: https://cdn-contenu.quebec.ca/cdn-contenu/adm/min/agriculture-pecheries-alimentation/publications-adm/dossier/politique-bioalimentaire/PO_politiquebioalimentaire_MAPAQ.pdf?1552593128.
23
Dauner KN, Lacaille LJ, Schultz JF, Harvie J, Klingner J, Lacaille R, et al. Implementing healthy and sustainable food practices in a hospital cafeteria: a qualitative look at processes, barriers, and facilitators of implementation. J Hunger Environ Nutr. 2011;6(3):264–78.
24
Ducak K and Keller HH. Menu planning in long-term care: toward resident-centred menus. Can J Diet Pract Res. 2011;72(2):e126–33.
25
Linton E, Keller H, and Duizer L. Ingredients for success: strategies to support local food use in health care institutions. Can J Diet Pract Res. 2018;79(3):113–7.
26
Montague J, Wilcox J, and Harmon AH. Sustainable hospital food service: restoring health and prosperity to rural Montana. Austin J Nutri Food Sci. 2014;2(2):1014–22.
27
Perline A, Heuscher A, Sondag A, and Brown B. Perceptions of local hospitals and food producers on opportunities for and barriers to implementing farm-to-hospital programs. J Agric Food Syst Commun Dev. 2015;6(1):147–60.
28
Wilson ED and Garcia AC. Environmentally friendly health care food services: a survey of beliefs, behaviours, and attitudes. Can J Diet Pract Res. 2011;72(3):117–22.
29
Wilson ED and Garcia AC. ‘Going Green’ in food services: can health care adopt environmentally friendly practices? Can J Diet Pract Res. 2011;72(1):43–47.
30
Canadian Institutes of Health Research. Guide to knowledge translation planning at CIHR: integrated and end-of-grant approaches [Internet]. Government of Canada; 2012 [cited 2020 Mar 1]. Available from: http://www.cihr-irsc.gc.ca/e/45321.html.
31
Government of Québec. Le système de santé et de services sociaux au Québec. En bref [Health and social services system in Québec] [Internet]. Government of Québec; 2017 [cited 2020 Mar 1]. Available from: https://publications.msss.gouv.qc.ca/msss/fichiers/2017/17-731-01WF.pdf. (French).
32
Act to modify the organization and governance of the health and social services network in particular by abolishing the regional agencies. Pub. L. No. O-7.2; 2020 [cited 2020 Dec 10]. Available from: http://legisquebec.gouv.qc.ca/en/showdoc/cs/O-7.2.
33
Government of Québec. Miser sur une saine alimentation: une question de qualité [Internet]. Government of Québec; 2009 [cited 2020 Mar 1] [Available from: https://publications.msss.gouv.qc.ca/msss/fichiers/2009/09-289-02.pdf. (French).
34
Patton MQ. Enhancing the quality and credibility of qualitative analyses. Health Serv Res. 1999;34(5 Pt2):1189–208.
35
Government of Canada. Canada’s dietary guidelines. For health professionals and policy makers. In: Canada H, editor. 2019. p. 62. [cited 2020 Mar 1]. Available from: https://food-guide.canada.ca/en/guidelines/.
36
Greenhalgh T, Robert G, Macfarlane F, Bate P, and Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.
37
Patton MQ. Qualitative research & evaluation methods: integrating theory and practice. 4th ed. Thousand Oaks: SAGE Publications; 2015.
38
Elo S and Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107–15.
39
Hsieh HF and Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.
40
Sabatier PA. An advocacy coalition framework of policy change and the role of policy-oriented learning therein. Policy Sci. 1988;21:129–68.
41
Cutcliffe JR and McKenna HP. Establishing the credibility of qualitative research findings: the plot thickens. J Adv Nurs. 1999;30(2):374–80.
42
Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 2nd ed. USA: SAGE Publications; 2002.
43
Food Literacy for Life. A call to action for healthy eating: using a food literacy framework for public health program planning, policy, and evaluation [Internet]. Food Literacy for Life; 2017 [cited 2020 Mar 1]. Available from: https://www.publichealthontario.ca/-/media/documents/l/2017/ldcp-food-literacy-call-to-action.pdf?la=en.
44
Laur C, Valaitis R, Bell J, and Keller H. Changing nutrition care practices in hospital: a thematic analysis of hospital staff perspectives. BMC Health Serv Res. 2017;17:1–15.
45
Harris D, Lott M, Lakins V, Bowden B, and Kimmons J. Farm to institution: creating access to healthy local and regional foods. Adv Nutr. 2012;3(3):343–9.
46
Act respecting contracting by public bodies. Pub. L. No. C-65.1; 2020 [cited 2020 Dec 10]. Available from: http://legisquebec.gouv.qc.ca/en/ShowDoc/cs/C-65.1.
47
Harvie J, Mikkelsen L, and Shak L. A new health care prevention agenda: sustainable food procurement and agricultural policy. J Hunger Environ Nutr. 2009;4(3–4):409–29.
48
Balogun J, Hope Hailey V. Exploring strategic change. 3rd ed. London: Prentice Hall; 2004.
49
Landry R, Becheikh N, Amara N, Jbilou J, Halilem N, Mosconi E, et al. Innovation dans les services publics et parapublics à vocation sociale: rapport de la revue systématique des écrits. Université Laval, QC: Chaire FCRSS/IRSC sur le transfert de connaissances et l’innovation; 2007 [cited 2020 Mar 1]. Available from: http://www.frqsc.gouv.qc.ca/documents/11326/448958/PC_LandryR_rapport+2007_Proposition-cadre-conceptuel/0561c5f9-6ad8-4e2f-82a0-c1886b64f337. (French).
50
Callegaro M. Social desirability. In: Lavrakas PJ, editor. Encyclopedia of survey research methods. Thousand Oaks: SAGE Publications; 2011. p. 826–7.
51
Heidelberger L, Smith C, Robinson-O’Brien R, Earthman C, and Robien K. Registered dietitian nutritionists’ perspectives on integrating food and water system issues into professional practice. J Acad Nutr Diet, 2017;117(2).
52
Marquez A, Gacad A. A guide to sustainable menus. A step by step approach to sustainability [Internet]. Nourish; 2019 [cited 2021 Nov 1]. Available from: https://menudurable.ca/en/.
53
Riddell D, Moore M-L. Scaling out, scaling up, scaling deep: advancing systemic social innovation and the learning processes to support it [Internet]. The J.W. McConnell Family Foundation; 2015 [cited 2020 Mar 1]. Available from: https://mcconnellfoundation.ca/wp-content/uploads/2017/08/ScalingOut_Nov27A_AV_BrandedBleed.pdf, https://mcconnellfoundation.ca/wp-content/uploads/2017/08/ScalingOut_Nov27A_AV_BrandedBleed.pdf.
Supplementary Material
File (cjdpr-2022-007suppla.docx)
- Download
- 49.27 KB
Information & Authors
Information
Published In
Canadian Journal of Dietetic Practice and Research
Volume 83 • Number 3 • September 2022
Pages: 120 - 127
Editor: Naomi Cahill
History
Version of record online: 3 May 2022
Copyright
© 2022.
Key Words
Mots-clés
Authors
Metrics & Citations
Metrics
Other Metrics
Citations
Cite As
BéatriceDagenaisMSc, RD, AnnieMarquezRD, JoséeLavoieMSc, RD, BethHunter, and GenevièveMercillePhD, RD. 2022. Adopting Sustainable Menu Practices in Healthcare Institutions: Perceived Barriers and Facilitators. Canadian Journal of Dietetic Practice and Research.
83(3): 120-127. https://doi.org/10.3148/cjdpr-2022-007
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
There are no citations for this item
View Options
Login options
Check if you access through your login credentials or your institution to get full access on this article.
Subscribe
Click on the button below to subscribe to Canadian Journal of Dietetic Practice and Research
