Abstract
Background: Hospitals fulfill an important exemplary role in promoting health and well-being. It is therefore crucial to have a supportive food environment that stimulates healthy and sustainable food choices of patients, staff, and visitors. This qualitative study aimed to identify factors influencing the implementation of long-lasting actions to enhance the healthiness and sustainability of the food environment in the hospital setting in the Netherlands, from the perspective of different stakeholders. Methods: Semi-structured interviews were conducted in hospitals realizing a healthy and sustainable food environment. Verbatim transcripts were thematically analyzed, guided by the Consolidated Framework for Implementation Research. Data were organized and interpreted per theme as well as stakeholder group. Results: In three hospitals, 29 semi-structured interviews were conducted with 30 stakeholders from a wide spectrum of stakeholder groups (i.e., facility professionals, healthcare professionals, project coordinators, and board of directors). Identified themes and subthemes were: 1 the outer setting, with momentum for change, government-established policies and guidelines, collaboration and networks outside the hospital, and caterers’ and suppliers’ food offerings, interests, and contracts; 2 the innovation domain, with familiarity and compliance with the TEH program; 3 support at all levels, achieving organizational buy-in with communication as a strategy, and end user interests; 4 the inner setting, with key priority in policy and having a vision, available resources, infrastructure within the hospital, ambassadors, and gradual process with continuous effort; and 5 the individual domain with personal drive. Conclusions: The results revealed an interplay of perceived factors that influence the enhancement of a healthy and sustainable food environment and underscored the importance of addressing various facilitators and barriers across multiple domains within and outside the hospital setting. To ensure successful integration of a healthy and sustainable food environment in hospitals, throughout the entire organization it is crucial to engage diverse stakeholders at all levels and address their barriers with tailored implementation strategies. We suggest verification of our findings in more hospitals.
| Original language | English |
|---|---|
| Article number | 45 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | BMC Medicine |
| Volume | 23 |
| Issue number | 1 |
| Early online date | 27 Jan 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 27 Jan 2025 |
Bibliographical note
Publisher Copyright:© The Author(s) 2025.
Funding
This study was part of a project that was financially supported by a grant (grant number 162135) from the Regio Deal Foodvalley, a collaboration between the Dutch government and different regional governments, entrepreneurs, education, and knowledge institutions, including the Nutrition & Healthcare Alliance, a national expertise center that aims to realize health benefits by applying scientific findings on nutrition and exercise in prevention and healthcare. The TEH program is funded and supported by the Dutch government, following the National Prevention Agreement of 2018, which is an agreement aiming to achieve a healthier Netherlands, signed by the Dutch government and several public and private organizations []. One goal in the agreement focuses on the food environment in hospitals and states that by 2025, 50% of hospitals are expected to offer healthy foods to patients, staff, and visitors, with the goal of reaching full implementation in all hospitals in the Netherlands by 2030. The Nutrition & Healthcare Alliance and the TEH program started a learning network with 20 hospitals that committed to accelerating achieving the goal in the agreement: realizing a healthy hospital food environment by 2022. This group of 20 hospitals is called the frontrunner hospitals [, ]. A prerequisite to be a frontrunner hospital was to have a vision on healthy food for patients. The study was part of a project that was financially supported by a grant (grant number 162135) from the Regio Deal Foodvalley [], a collaboration between the Dutch government and different parties from the region to achieve healthy and sustainable food for everyone, including regional governments, entrepreneurs, education, and knowledge institutions, e.g., the Nutrition & Healthcare Alliance [].
| Funders | Funder number |
|---|---|
| Regio Deal Foodvalley | |
| Dutch Government | |
| Dutch government and several public | |
| Nutrition & Healthcare Alliance |
Keywords
- Food choices
- Food environment
- Health
- Healthy food environment
- Hospital
- Hospital staff
- Implementation evaluation
- Patients
- Prevention
- Sustainability