This paper is only available as a PDF. To read, Please Download here.
Increasing obesity rates among US active duty military is considered a security threat to readiness, with $3.3 billion per year spent in attributable health care costs among active duty personnel and military families. Several Army food service venues have implemented behavioral design strategies to shift patrons’ food choices towards healthier options. However, little is known about implementation feasibility and sustainability.
To assess food service staff's perceptions on the feasibility of a behavioral design intervention promoting healthier food choices in a US Army hospital cafeteria.
Study Design, Settings, Participants
From August to December 2017, an Army hospital cafeteria implemented ten behavioral design strategies, including color-coded labeling, prominent placement of healthier items, provision of fruit baskets, and daily “performance” plates. Nine in-depth, semi-structured interviews were conducted with staff post-intervention.
Interviews were audio-recorded and transcribed verbatim. Braun & Clarke's Six Steps of Thematic Analysis was used to identify deductive and emergent themes of intervention feasibility in the transcripts.
Four a priori, deductive themes on feasibility were identified: acceptability, operability, sustainability, and effectiveness. Five themes emerged from the data: cafeteria ethos, buy-in, unintended consequences, food options, and factors influencing customers’ food decisions. Staff perceived the intervention as operable and slightly effective in improving food choices, but also perceived that the increase in healthier meal choices led to increased food waste and institutional financial loss. Staff expressed a desire for involvement in behavioral design strategy selection and for food production forecasts to reflect anticipated demand fluctuations.
Public health practitioners should consider diversifying staff representation when developing behavioral design interventions to increase buy-in and to accommodate venue-specific nuances.
© 2019 Published by Elsevier Inc.