Potential Public Health Impact
Reach: Changes in a hospital cafeteria have potential to reach all of the individuals purchasing food in the cafeteria. The intervention could have significant reach if it was implemented by many large companies throughout the country. If some of the larger food service companies decided to implement this systematically across their sites, the reach would be substantial. The data from this study do not address whether the population reached was representative of the population that works in the hospital.
Effectiveness: The data from this study support limited claims about the effects of the intervention on purchasing decisions. Respondents reported that the intervention affected their purchasing decisions, and cash register records indicated a significant increase in purchase of low calorie side dishes and snacks at the intervention hospital compared to control. However, the observation data does not indicate a change in purchasing following the intervention.
Adoption: The intervention was adopted by 5 of 6 hospital cafeterias and dissemination to additional sites within the KP system was initiated in 2009. As of June 2012 a total of 35 hospitals in three states had adopted the intervention.
IMPLEMENTATION — The intervention was implemented by 5 of 6 hospitals. The challenges to implementation were well described: One hospital was inconsistent in posting menus and one in serving sizes, but these obstacles were overcome. If a site uses a large food service company, then in theory, implementation should not be difficult. These companies have resources like recipes, nutrition data, and signage. They could easily decide to do what it takes to complete this intervention in all their cafeterias. However, the intervention may be less feasible for sites that work independent of a larger company and have to do their own menu development and nutrient analysis.
Maintenance: The restaurant culture is likely to change as calorie posting becomes normative, so there should be pressure to maintain cafeteria labeling as well.