Food Choice at Work Study: Effectiveness of Complex Workplace Dietary Interventions on Dietary Behaviours and Diet-Related Disease Risk. SARAH FITZGERALD HRB PHD SCHOLAR PRINCIPAL INVESTIGATOR: PROF IVAN J PERRY LEAD INVESTIGATOR: FIONA GEANEY DEPARTMENT OF EPIDEMIOLOGY AND PUBLIC HEALTH, UNIVERSITY COLLEGE CORK
Diet-related disease is a major public health concern, continuing to endanger population health and sustainability of healthcare systems. Complex dietary behaviour interventions have the potential to reduce diet-related disease. Ample opportunity exists to implement these interventions in the workplace. WHO supports the workplace as an effective and controlled setting for a healthy diet (WHO s 2004 Global Strategy on Diet, Physical Activity and Health + WHO s Global Plan of Action on Worker s Health 2008-2017).
Given the increasing prevalence of non-communicable diseases, there is an urgent need to develop effective behavioural change interventions to promote positive dietary change in the population. There is limited evidence that workplace dietary behaviour interventions improve dietary patterns in the workplace. The long-term impact is still unknown.
Objective: examine the impact of a structured catering intervention on food choices in a public sector workplace setting. Cross-sectional comparison study in 2 public sector hospitals in Cork. 100 participants (50 intervention, 50 non-intervention) Intervention hospital: foods high in sugar, salt and fat, fruit + vegetables. Non-intervention hospital - control. Results: total sugars (p<0.001), total fat (p<0.000), saturated fat (p<0.000) + salt (p<0.046) were lower in the intervention hospital (age + gender). Conclusion: suggests that nutrition interventions may influence dietary patterns at work. Need to extend preliminary findings in a large scale intervention study.
The overall aim is to assess the effectiveness and cost-effectiveness of complex dietary interventions focused on environmental modification alone or in combination nutrition education in large manufacturing workplace settings.
Study Objectives 1. Develop long-term complex dietary interventions in large manufacturing workplace settings. 2. Evaluate the impact on employees dietary behaviour, health status and nutrition knowledge. 3. Investigate employees food choice motives 4. Process evaluation 5. Cost-effectiveness evaluation
Food Choice at Work Study Study 1 Systematic review (Provide solid evidence base + inform intervention design) Study 2 Intervention study (Objective changes in health status + dietary behaviour)
Review to evaluate the effectiveness of workplace dietary modification interventions alone and in combination with nutrition education. Findings Ambiguity exists regarding the long-term effects on diet, health and economic cost. Complex dietary interventions should be designed with recommended guidelines for developing and evaluating complex interventions. Publication status: In press, Preventive Medicine
Study design: A clustered controlled trial in 4 large manufacturing workplaces over a 13-16 month period. Sample size and Power: A decrease in BMI by 1 kg/m² (1 unit) 2g average fall in dietary salt intake 80% power at the 5% significance level Baseline: 878 participants
Intervention design: The complex dietary intervention design is guided by the MRC framework for Developing and evaluating complex interventions: new guidance.
Workplace A Monitor employees eating behaviours (control) Workplace B Nutrition education Workplace C Environmental change + nutrition education Workplace D Environmental change
Clustered control trial Eligibility of workplaces assessed (n=107) Unit of delivery: workplaces Exclusions (n=103) Workplace A Control Workplace B Nutrition Education Non-randomised (n=4) Allocation Workplace C Environmental modification + nutrition education Workplace D Environmental modification Baseline: Physical Assessments BMI, waist circumference, blood pressure, urine analysis Two 24hr dietary recalls (within 1 week), Questionnaires Process evaluation Economic evaluation Follow-up: 3-4 months, 7-9 months and 13-16 months: Food and nutrient analysis -WISP, Statistical analysis using STATA (Pearson chi-square analysis, ANOVA, mixed effects modelling, latent class analysis. Cost-effectiveness.
Primary Outcomes Secondary Outcomes Dietary Behaviour Changes in dietary intake and dietary patterns (24-hour dietary recalls, FFQs, food sales data and food purchasing patterns). Health Status Improved health outcomes (changes in BMI, waist circumference, resting BP and urinary electrolytes (sodium and potassium). Nutrition Knowledge General Nutrition Knowledge Questionnaire Food Motives Food Motives Questionnaire Eating Behaviour Dutch Eating Behaviour Questionnaire Economic Cost Outcomes Economic cost evaluation and absenteeism trends
Influence nutritional policy in study workplace settings. Short Term Medium Term Inform food industry stakeholders and public health policy makers with dissemination of knowledge nationally and internationally. Food Choice at Work tool-box (post intervention): inform future researchers, relevant stakeholders + policy makers. Adopted by catering stakeholders as a best practice dietary modification intervention. Prevalence + economic burden of diet-related chronic disease may decrease in Ireland. Long Term
1. Study design Non- randomised controlled trial. Workplaces or participants not blinded. Reduce bias: participants randomly selected from total employee lists. 2. Comparable worksites Similar shift patterns, company-type (production + office based), skilled + educated workforces. Use demographic info. from HLFQ tool to determine further comparison between worksites. 3. Adequate response rate awareness (info. stand, emails, communication with workplace reps). 4. Feasibility to collect data Detailed pilot on 4 sites, Food Choice at Work steering committee will meet bi-monthly at each workplace: study logistics 5. Missing data Dietary assessments (24-hr dietary recalls): interviewer administered, physical assessments: research team.
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