Drivers of healthy eating in a workplace in Nepal: a qualitative study

Dipesh Tamrakar, Archana Shrestha, Anjana Rai, Biraj Man Karmacharya, Vasanti Malik, Josiemer Mattei, Donna Spiegelman, Dipesh Tamrakar, Archana Shrestha, Anjana Rai, Biraj Man Karmacharya, Vasanti Malik, Josiemer Mattei, Donna Spiegelman

Abstract

Objective: To explore the perceptions, enablers and barriers to employees' healthy eating in a hospital site.

Design: A qualitative study including focus group discussion and in-depth interview, data were analysed using thematic analysis method.

Setting: The study was carried out among employees of Dhulikhel Hospital-Kathmandu University Hospital, located about 30 km east of Nepal's capital Kathmandu.

Participants: Focus group discussions were conducted among the 33 participants, who were divided into four groups: (a) support staff (drivers, cook, laundry, gardeners and ward boys), (b) hospital administrators and managers, (c) health personnel (doctors, nurses and assistants) who work 8-12 hours shifts and (d) health personnel who work during office hours. Nine in-depth interviews were conducted among six canteen operators and three managers.

Results: The major factors for promoting healthy eating were identified as the availability of affordable healthy food options in the cafeterias, a commitment to such promotion by the cafeteria manager, operators, staff and hospital administration and the level of education of the employees. The most commonly reported barriers for healthy eating were the unavailability of healthy options, including the lack of food supply from local market, the higher cost of healthy foods, individual food preferences and limited human resources in the cafeteria.

Conclusion: The availability of affordable healthy foods, supply of healthy foods from the market, commitment from cafeteria managers, hospital administrators and health awareness among cafeteria operators may promote healthy eating among employees in a Nepali hospital setting.

Keywords: barriers; diet; facilitators; qualitative study; workplace.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. National Research Council (US) Committee on Diet and Health Diet and health: implications for reducing chronic disease risk. Washington, DC: National Academies Press (US), 1989.
    1. Roberts CK, Barnard RJ. Effects of exercise and diet on chronic disease. J Appl Physiol 2005;98:3–30. 10.1152/japplphysiol.00852.2004
    1. Eckel RH, Jakicic JM, Ard JD, et al. . 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American heart association Task force on practice guidelines. J Am Coll Cardiol 2014;63:2960–84. 10.1016/j.jacc.2013.11.003
    1. George SM, Ballard-Barbash R, Manson JE, et al. . Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the women's health Initiative observational study: evidence to inform national dietary guidance. Am J Epidemiol 2014;180:616–25. 10.1093/aje/kwu173
    1. Bissonnette-Maheux V, Provencher V, Lapointe A, et al. . Exploring women's beliefs and perceptions about healthy eating blogs: a qualitative study. J Med Internet Res 2015;17:e87 10.2196/jmir.3504
    1. Nicholls R, Perry L, Duffield C, et al. . Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review. J Adv Nurs 2017;73:1051–65. 10.1111/jan.13185
    1. Thomas EL, Puig Ribera A, Senye-Mir A, et al. . Promoting healthy choices in workplace Cafeterias: a qualitative study. J Nutr Educ Behav 2016;48:138–45. 10.1016/j.jneb.2015.11.001
    1. Nepal Health Research Council Assessment of burden of disease in Nepal, 2009. Kathmandu, Nepal: Nepal Health Research Council, 2018.
    1. Aryal KK, Mehata S, Neupane S, et al. . The burden and determinants of non communicable diseases risk factors in Nepal: findings from a nationwide steps survey. PLoS One 2015;10:e0134834 10.1371/journal.pone.0134834
    1. Shrestha A, Koju RP, Beresford SAA, et al. . Food patterns measured by principal component analysis and obesity in the Nepalese adult. Heart Asia 2016;8:46–53. 10.1136/heartasia-2015-010666
    1. Vaidya A, Pathak RP, Pandey MR. Prevalence of hypertension in Nepalese community triples in 25 years: a repeat cross-sectional study in rural Kathmandu. Indian Heart J 2012;64:128–31. 10.1016/S0019-4832(12)60045-5
    1. Shrestha A, Koirala B, Koju RP, et al. . Dietary patterns, hypertension and diabetes in nepal–a community-based study. Int J Health Nutrition 2016;7:20–8.
    1. Quintiliani L, Poulsen S, Sorensen G. Healthy eating strategies in the workplace. Int J Workplace Health Manag 2010;3:182–96. 10.1108/17538351011078929
    1. Engbers LH, van Poppel MNM, Chin A Paw MJM, et al. . Worksite health promotion programs with environmental changes: a systematic review. Am J Prev Med 2005;29:61–70. 10.1016/j.amepre.2005.03.001
    1. Dodson EA, Hipp JA, Gao M, et al. . The impact of worksite supports for healthy eating on dietary behaviors. J Occup Environ Med 2016;58:e287–93. 10.1097/JOM.0000000000000813
    1. Anderson LM, Quinn TA, Glanz K, et al. . The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review. Am J Prev Med 2009;37:340–57. 10.1016/j.amepre.2009.07.003
    1. Mache S, Jensen S, Jahn R, et al. . Worksite health program promoting changes in eating behavior and health attitudes. Health Promot Pract 2015;16:826–36. 10.1177/1524839915596310
    1. Pridgeon A, Whitehead K. A qualitative study to investigate the drivers and barriers to healthy eating in two public sector workplaces. J Hum Nutr Diet 2013;26:85–95. 10.1111/j.1365-277X.2012.01281.x
    1. Devine CM, Nelson JA, Chin N, et al. . "Pizza is cheaper than salad": assessing workers' views for an environmental food intervention. Obesity 2007;15 Suppl 1:57S–68. 10.1038/oby.2007.388
    1. Faugier J, Lancaster J, Pickles D, et al. . Barriers to healthy eating in the nursing profession: Part 1. Nurs Stand 2001;15:33–6. 10.7748/ns2001.05.15.36.33.c3030
    1. Shrestha A, Pyakurel P, Shrestha A, et al. . Facilitators and barriers to healthy eating in a worksite cafeteria: a qualitative study from Nepal. Heart Asia 2017;9:e010956 10.1136/heartasia-2017-010956
    1. Swift JA, Tischler V. Qualitative research in nutrition and dietetics: getting started. J Hum Nutr Diet 2010;23:559–66. 10.1111/j.1365-277X.2010.01116.x
    1. Townsend N, Foster C. Developing and applying a socio-ecological model to the promotion of healthy eating in the school. Public Health Nutr 2013;16:1101–8. 10.1017/S1368980011002655
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 10.1191/1478088706qp063oa
    1. DOHS Annual Report 2072/73 : Department of health services, Ministry of health and population, eds. Kathmandu Nepal, 2017.
    1. Fitzgerald S, Geaney F, Kelly C, et al. . Barriers to and facilitators of implementing complex workplace dietary interventions: process evaluation results of a cluster controlled trial. BMC Health Serv Res 2016;16:139 10.1186/s12913-016-1413-7
    1. Burke K, Morris K, McGarrigle L, et al. . An introductory guide to implementation: terms, concepts and frameworks, 2012.
    1. Pollard J, Kirk SFL, Cade JE. Factors affecting food choice in relation to fruit and vegetable intake: a review. Nutr Res Rev 2002;15:373–87. 10.1079/NRR200244
    1. Krukowski RA, West DS, Harvey-Berino J, et al. . Neighborhood impact on healthy food availability and pricing in food stores. J Community Health 2010;35:315–20. 10.1007/s10900-010-9224-y
    1. Kahn-Marshall JL, Gallant MP. Making healthy behaviors the easy choice for employees: a review of the literature on environmental and policy changes in worksite health promotion. Health Educ Behav 2012;39:752–76. 10.1177/1090198111434153
    1. Gorman E, Ashe MC, Dunstan DW, et al. . Does an 'activity-permissive' workplace change office workers' sitting and activity time? PLoS One 2013;8:e76723 10.1371/journal.pone.0076723
    1. Ball K, Jeffery RW, Abbott G, et al. . Is healthy behavior contagious: associations of social norms with physical activity and healthy eating. Int J Behav Nutr Phys Act 2010;7:86 10.1186/1479-5868-7-86
    1. Muhihi AJ, Shemaghembe E, Njelekela MA, et al. . Perceptions, facilitators, and barriers to consumption of whole grain staple foods among overweight and obese Tanzanian adults: a focus group study. ISRN Public Health 2012;2012:1–7. 10.5402/2012/790602
    1. Cox DN, Anderson AS, Reynolds J, et al. . Take five, a nutrition education intervention to increase fruit and vegetable intakes: impact on consumer choice and nutrient intakes. Br J Nutr 1998;80:123–31. 10.1017/S0007114598001020
    1. An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Health Nutr 2013;16:1215–28. 10.1017/S1368980012004715
    1. Sforzo GA, Kaye MP, Calleri D, et al. . Free choice access to multipoint wellness education and related services positively impacts employee wellness: a randomized and controlled trial. J Occup Environ Med 2012;54:471–7. 10.1097/JOM.0b013e3182479f5c
    1. Glanz K, Basil M, Maibach E, et al. . Why Americans eat what they do: taste, nutrition, cost, convenience, and weight control concerns as influences on food consumption. J Am Diet Assoc 1998;98:1118–26. 10.1016/S0002-8223(98)00260-0
    1. Drewnowski A. Taste preferences and food intake. Annu Rev Nutr 1997;17:237–53. 10.1146/annurev.nutr.17.1.237
    1. Holdsworth M, Haslam C. A review of point-of-choice nutrition labelling schemes in the workplace, public eating places and universities. J Hum Nutr Diet 1998;11:423–45. 10.1046/j.1365-277X.1998.00124.x

Source: PubMed

3
Subscribe