Kaiser Permanente (KP) Cafeteria Menu Labeling is a PSE change intervention developed collaboratively by KP National Nutrition Services Procurement & Supply and National Community Benefit Departments to help patrons make informed decisions about their purchases with the goal of shifting purchasing to lower calorie and healthier options. The KP Cafeteria Menu Labeling intervention provides cafeteria customers with detailed nutrient content information, including calories, at the point-of-decision-making. The intervention was developed to help inform food/beverage purchasing decisions in KP hospital sites for those visiting the cafeteria, including employees, health plan members, and visitors.

Target Behavior: Healthy Eating

Intervention Type: PSE Change

KP Cafeteria Menu Labeling has been adopted by and implemented in hospital cafeteria in three western states (California, Oregon, and Hawai’i) in a multi-ethnic, multi-racial population of hospital employees and visitors. The majority of respondents to the evaluation surveys during the pilot study were female, healthcare professionals, college graduates, and over the age of 30. The exact racial/ethnic breakdown of those reached by the intervention is not available.

Setting: Community, Health care

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

Race/Ethnicity: All

KP Cafeteria Menu Labeling includes the following main components:

• Stakeholder Input and Buy-in: Input and buy-in from upper management, food vendors, human resources/wellness, and cafeteria managers/staff is essential to understanding preferences and to problem-solving potential barriers to implementation.
• Standard Menus with Recipes: Cafeterias must have standard menus for foods offered; recipes for preparation of all food items on the menu; and, standard portion/serving sizes.
• Systematic Menu Analysis: Cafeterias must have a nutrition analysis completed on all menu items (recipes) to determine calories and nutrients per serving for each item on cafeteria menus. Calories and nutrient information for pre-packaged foods and beverages can be obtained from package labels or product specifications.
• Menu Labeling Display System: Menu boards are 8½ x 11 inch signs placed at countertop level at each food station in the cafeteria (i.e. grill, entrée/side dish station, soup station, salad bar, sandwich bar, and grab-and-go station). The information presented on the menu boards includes only the item name, calorie content, and price. Posters are 48 inches wide by 36 inches tall. The posters list all menu items along with their respective nutrient content including calories, fat, saturated fat, cholesterol, sodium, carbohydrate and protein.
• Training for Food Service Personnel: Training on implementation of the intervention must be provided to food service personnel in the kitchen and on the food service line. In addition to basic training on the goals of the intervention, training should address food preparation consistent with recipes/menus; correct placement of menu boards and posters; and appropriate and standardized portion/serving sizes.

The following materials are available for download from Center TRT:

• Evaluation Report: This evaluation report is of the pilot menu labeling intervention in KP cafeterias in summer 2008. The evaluation report summarizes the methods, the results, recommendations, and includes appendices such as the Patron Survey, Menu Board Examples, and Findings from Formative Assessment.
• Implementation Presentation: During roll-out of the program, KP provided the Food and Nutrition Services Directors at each facility with sample materials and then did a presentation of the KP Menu Labeling Pilot Study Overview that describes implementation and the results of the pilot study.
• Sample Menu Board: KP uses menu boards to provide item name, calorie content, and price for cafeteria offerings at the point of purchase.
• Sample Poster Board: KP uses large posters to list all menu items along with their respective nutrient content including calories, fat, saturated fat, cholesterol, sodium, carbohydrate and protein. Posters are placed in a central location in the cafeteria away from the point-of-decision.
• Healthy Picks Program (criteria and brochure): The Healthy Picks program aims to improve the health of KP’s members and employees by offering more nutritious options, educating people about healthy eating, and empowering individuals to make better food choices. The Healthy Picks logo indicates that a specific food item meets KP criteria for calories, fat, sugar, fiber, and portion size. Healthy Picks logos are placed on cafeteria foods as well as in vending machines outside of the cafeteria.

Cost information coming soon.

The intervention was evaluated in five cafeterias by comparing pre/post-intervention changes in purchasing. All five cafeterias implemented the Healthy Picks logo, one also had calorie labeling on a poster, and two had calorie labeling on a poster and at point of purchase. Purchasing was measured using cash register sales data in in two cafeterias and via observation in three cafeterias. Cash register sales showed that patrons significantly increased their purchase of low calorie side dishes and snacks in a cafeteria with both poster and point of purchase calorie labeling as compared to cafeteria with no calorie labeling. No differences were found for entrée purchases. For hospitals without cash register data, observers monitored sales and no differences in purchasing were noted across hospitals.

A survey was done to assess patrons’ attitude, awareness, and use of posted calorie information. More than 500 patrons completed cafeteria exit surveys, with significantly more noticing information at the sites that posted calories on both posters and at point of purchase than the poster only sites. Nearly a third who noticed the information reported that they altered their purchase as a result of the information. Nearly all respondents were positive about changes.

Classification: Practice-tested

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, LT7
Sectors of Influence

Center TRT developed an evaluation logic model and evaluation plan for a worksite cafeteria menu labeling initiative. 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 a cafeteria menu labeling initiative in changing purchasing habits of hospital employees and visitors. The evaluation addresses the reach, adoption, implementation and effectiveness of the intervention. The evaluation is a pre-post design with a comparison group. The evaluation plan provides guidance on evaluation questions and types and sources of data for both process and outcome evaluation. KP used several materials for its evaluation that are also available for your use. Some of these tools have been incorporated into the evaluation plan that Center TRT developed.

• Logic Model
• Evaluation Plan

Kaiser Permanente used several materials for its evaluation that are also available for your use: Patron Survey: From Evaluation Report (pgs. 20-22).

 

KP Staff is available to respond to questions about program implementation.

Contact Person:
Kathleen Reed
Sustainable Food Program Manager
National Nutrition Services – Procurement & Supply
Kaiser Permanente
1800 Harrison Street
18th Floor
Oakland, CA 94612
Phone: (510) 625-5821
Email: kathleen.m.reed@kp.org