BACKGROUND: Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry. METHODS: Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the 'best fit' framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR). RESULTS: Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs 'Consumer Needs & Resources' (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and 'Compatibility' with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs 'Relative Advantage' of menu labelling (e.g. improved business image/reputation) and 'Consumer Needs & Resources' (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains. CONCLUSION: This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration: Systematic review registration: PROSPERO CRD42017083306.
INTRODUÇÃO: Alimentos comprados de fontes preparados alimentares tornou-se uma parte importante da dieta americana e está ligada ao aumento das taxas de doenças crônicas. Muitas intervenções que visam as fontes preparados alimentares foram iniciados com o objetivo de promover opções saudáveis. O objetivo deste estudo foi o de fornecer uma revisão sistemática de intervenções em fontes preparados alimentares em ambientes comunitários.
MÉTODOS: Foram utilizados PubMed e Google Scholar e identificou 13 intervenções que atenderam a esses critérios: 1) com foco em fontes preparado alimentares em ambientes comunitários públicos, 2) utilizada uma avaliação de impacto, 3) tinha escrito documentação, e 4) ocorreram depois de 1990 . Realizamos entrevistas com pessoal de intervenção para obter informações adicionais. Revisores extraído e os dados reportados em formato de tabela para assegurar a comparabilidade.
RESULTADOS: As intervenções principalmente direcionada uma população urbana, predominantemente branca, em uma variedade de níveis de renda. O quadro mais comum utilizada foi a teoria de marketing social. A maioria das intervenções utilizou um desenho não experimental. Tudo feito uso de sinalização e menu de rotulagem para promover opções de alimentos saudáveis. Vários promovido métodos de cozimento mais saudáveis, apenas um apresentou novas opções de menu saudáveis. Níveis de viabilidade e sustentabilidade eram altos; resultados de vendas apresentaram aumento de compra de opções saudáveis. As medidas entre os consumidores eram limitados, mas em muitos casos apresentaram melhora da consciência e freqüência de compra de alimentos promovidos.
CONCLUSÃO: Intervenções em fontes preparados alimentares mostram resultados promissores iniciais no nível da loja. Futuros estudos devem se concentrar em melhorados desenhos de estudo, ampliando as estratégias de intervenção para além de sinalização e avaliação de impacto entre os consumidores.
Eating outside the home contributes to poor dietary habits worldwide and is associated with increased body fat and weight gain. Evidence shows menu labelling is effective in promoting healthier food choices; however, implementation issues have arisen. The purpose of this systematic review was to synthesise the evidence on the perceived barriers and facilitators to implementation of menu labelling interventions from the perspective of the food service industry.
METHODS:
Peer-reviewed and grey literature were searched using databases, specialised search engines and public health organisation websites. Screening reference lists, citation chaining and contacting authors of all included studies were undertaken. Primary research studies relevant to direct supply-side stakeholders were eligible for inclusion. There were no restrictions on menu labelling scheme or format, study methods, publication year or language. At least two independent reviewers performed study selection, data extraction and quality appraisal. The results were synthesised using the 'best fit' framework synthesis approach, with reference to the Consolidated Framework for Implementation Research (CFIR).
RESULTS:
Seventeen studies met the eligibility criteria, with the majority rated as average quality (n = 10). The most frequently cited barriers were coded to the CFIR constructs 'Consumer Needs & Resources' (e.g. lack of customer demand for/interest in menu labelling, risk of overwhelmed/confused customers) and 'Compatibility' with organisation work processes (e.g. lack of standardised recipes, limited space on menus). Frequently cited facilitators were coded to the CFIR constructs 'Relative Advantage' of menu labelling (e.g. improved business image/reputation) and 'Consumer Needs & Resources' (e.g. customer demand for/interest in menu labelling, providing nutrition information to customers). An adapted framework consisting of a priori and new constructs was developed, which illustrates the relationships between domains.
CONCLUSION:
This review generates an adapted CFIR framework for understanding implementation of menu labelling interventions. It highlights that implementation is influenced by multiple interdependent factors, particularly related to the external and internal context of food businesses, and features of the menu labelling intervention. The findings can be used by researchers and practitioners to develop or select strategies to address barriers that impede implementation and to leverage facilitators that assist with implementation effort. Trial registration: Systematic review registration: PROSPERO CRD42017083306.
