Healthy Food Environments (HFE)

Prevention Partners

Overview

Healthy Food Environments (HFE) is a social marketing and PSE change intervention that aims to increase availability, visibility, and affordability of healthy foods and beverages for employees, volunteers, and visitors on hospital campuses.  The intervention includes a pricing policy incentive to encourage purchase of healthier items (through a price decrease) and discourage purchase of less healthier items (through a price increase). There are five principles in the overall Healthy Food Environment initiative:

  • Provide access to healthy foods
  • Use pricing to promote healthy foods
  • Use marketing techniques to promote healthy foods
  • Use benefit design & incentives to encourage behavior change, and
  • Educate staff and visitors about healthy foods.

Target Behavior: Healthy Eating

Intervention Type: Social Marketing, PSE Change

Intervention Reach and Adoption

HFE targets employees, volunteers, and visitors within hospital worksite settings to encourage the purchase of healthier items through a price decrease and discourage purchase of less healthier items through a price increase. In North Carolina, 95 hospitals have fully adopted the policy and 23 more have an action plan to reach full implementation.  These hospitals are all sizes and located in all parts of the state. HFPP reaches 200,000 hospital employees and millions of visitors. Additionally, hospitals in South Carolina have begun implementing the Healthy Food Environments Pricing Policy.

Setting: Health care, Worksite

Target Audience: Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults, Older Adults

Race/Ethnicity: All

Intervention Components

HFE includes the following main components:

  1. Stakeholder input and buy-in: Secure input and buy-in from upper management, food vendors, human resources/wellness, and other critical worksite staff.  In addition, form a wellness committee to conduct formative research to better understand preferences, potential barriers, and ownership of cafeteria changes (pricing, access, and marketing), and develop an implementation and compliance plan.
  2. Nutrition Criteria/Standards: Adopt and implement healthy food guidelines based on NCPP’s established criteria or adapt the criteria to be more stringent (NCPP guidelines are posted with the materials for this template).
  3. Procurement Specifications: Collaborate with vendors to offer healthy food and beverage items based on the established nutrition criteria.
  4. Training for Food Service Personnel: Provide training for food service personnel on implementation of nutrition criteria, including healthy food preparation methods and portion sizes.
  5. Pricing Incentives: Implement pricing incentives to encourage the purchase of healthier foods and decrease the purchase of less healthier foods.  This may take the form of increasing the cost of less healthy options while decreasing the cost of healthier options or bundling healthy food items together for a reduced price as “healthy value meals.”
  6. Marketing: Post nutrition information at the point of service, use a uniform icon for healthy items, and position healthy items to be more prominent and accessible.
  7. Equitable Access: Ensure that the same standards are implemented on site for all work shifts, i.e. that all shifts have access to healthy foods with a pricing incentive.

Intervention Materials

HFE has been carefully developed and implemented in North Carolina. In order for it to be as effective for others as it has been in NC with their community partners, it is important that the implementation guidelines are followed carefully and limit adaptation to just those things that can be adapted without sacrificing the quality of the intervention.

  • Conceptual Model– one-pager conveying Healthy Food Environments in its entirety with all five principles:  1)  provide access to healthy foods, 2) use pricing to promote healthy foods, 3) use marketing techniques to promote healthy foods, 4) use benefit design & incentives to encourage behavior change, and 5) educate staff and visitors about healthy foods
  • Nutrition Criteria– includes food item categories (e.g. beverage, fruit/vegetable) and the nutrition criteria in terms of calories, total fat, saturated fat, trans fat, sodium, etc.  informed by the USDA Dietary Guidelines, FDA requirements, and other key nutrition recommendations by nationally recognized organizations
  • Sample Action Plan– provides example of plan of action to take to implement this policy intervention in a worksite
  • Sample Recipe—PDF sample from our WorkHealthy America Recipe Database; includes cooking instructions and nutrition information
  • Sample Promotions– PDF sample from our WorkHealthy America Nutrition Toolbox;   snapshots and examples of nutrition labeling and icons in worksite cafeterias

Evidence Summary

At FirstHealth’s Moore Regional Hospital (the site submitted for review), overall sales increased after nine months of implementation of the pricing incentive.  However, it cannot be stated that this increase is due solely to the pricing incentive.  Increasing access, marketing, and/or other variables may play a role, as well. While not all data are displayed, here is an excerpt of sales data:

Grill item Status Old Employee Price New Employee Price ’06-’07 volume ’07-’08 volume % Difference
Hamburger Traditional (Iess healthy) $1.00 $1.75 4,725 2,583 -45%
Turkey Burger Healthy $1.75 $1.25 583 4,655 698%
Fried Chicken Sandwich Traditional (less healthy) $1.95 $2.50 2,223 1,127 -49%
Grilled Chicken Sandwich Healthy $2.25 $1.75 6,003 9,036 51%

Classification: Practice-tested

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Readiness and Capacity – Short Term (ST) Changes – Medium Term (MT) Effectiveness and Maintenance – Long Term (LT) Population Results (R)
Individual MT1
Environmental Settings MT5 LT5
Sectors of Influence

Evaluation Materials

Center TRT developed an evaluation logic model and evaluation plan for a program similar to the Healthy Food Environments (HFE) Pricing Initiative reviewed by the Center TRT. The logic model is intended to guide the evaluation process (as opposed to the planning process); the evaluation plan focuses on the implementation and effectiveness of an HFE pricing initiative at increasing availability, visibility, and affordability of healthy foods on hospital campuses. The evaluation addresses the reach, adoption, extent of implementation and effectiveness of an HFE pricing initiative at changing environments and behaviors related to healthy eating. The evaluation is a pre-post design. This evaluation plan provides guidance on evaluation questions and types and sources of data for both process and outcome evaluation. If you are interested in answering evaluation questions not listed in the evaluation plan, please refer to the list of additional evaluation questions here. We suggest a variety of data collection tools throughout the evaluation plan.

 

Additional Information

Website: More information on HFE can be found on Center TRT’s website (http://www.centertrt.org/?p=intervention&id=1099&section=1). Additionally, the website for NC Prevention Partners is http://forprevention.org/p2/.

Contact Person(s):
Prevention Partners
Email: http://forprevention.org/p2/