Li Ruoran, Wu You, Jing Limei, Jaacks Lindsay M
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
BMJ Open. 2018 Apr 12;8(4):e020529. doi: 10.1136/bmjopen-2017-020529.
To identify individual-level and organisation-level enablers and barriers to the provision and consumption of healthier foods at worksite canteens in China and to develop a theoretical framework and evidence-based, specific, practical intervention strategies.
Mixed-methods formative research, with in-depth interviews, focus group discussions and quantitative questionnaires.
Two community health centres (CHCs) in Pudong, Shanghai, China.
In-depth interviews with three CHC administrators and three canteen managers and staff. Six focus groups with a total of 19 male and 36 female employees, aged 25-67 years.
Three subthemes were identified as important for influencing individual food choice: the cultural perception of 'eating well', the need to balance taste preferences and nutrition, and the emphasis on food safety in healthfulness. At the organisation level, two related subthemes emerged: the balance of canteen budget and food safety with the variety and quality of offerings, and the interplay between key stakeholders. Key barriers included cost, poor communication between employees and management, individuals' emphasis on taste over healthfulness, variation in individual preferences and discordance between perceived and actual weight status, particularly among men. Key enablers included strong, positive food culture in China and trust in canteen food. An ecological framework to describe determinants of worksite food environment in Shanghai was developed and intervention strategies were mapped onto this framework.
A balancing act occurs at multiple levels and ultimately determines the worksite food environment and employee food choice at CHCs in Shanghai of China. There is a need to implement these findings and evaluate their impact on diet and health.
确定中国工作场所食堂提供和消费更健康食品的个人层面和组织层面的促进因素和障碍，并建立一个理论框架以及基于证据的、具体的、实用的干预策略。
采用混合方法进行形成性研究，包括深入访谈、焦点小组讨论和定量问卷调查。
中国上海浦东的两个社区卫生中心。
对三名社区卫生中心管理人员以及三名食堂经理和工作人员进行深入访谈。六个焦点小组，共有19名男性和36名女性员工，年龄在25至67岁之间。
确定了对影响个人食物选择重要的三个子主题：“吃得好”的文化认知、平衡口味偏好与营养的需求以及对健康食品中食品安全的重视。在组织层面，出现了两个相关子主题：食堂预算、食品安全与供应种类和质量之间的平衡，以及关键利益相关者之间的相互作用。主要障碍包括成本、员工与管理层之间沟通不畅、个人对口味而非健康的重视、个人偏好的差异以及感知体重状况与实际体重状况之间的不一致，尤其是在男性中。主要促进因素包括中国强大、积极的饮食文化以及对食堂食物的信任。开发了一个描述上海工作场所食物环境决定因素的生态框架，并将干预策略映射到该框架上。
在多个层面都需要进行权衡，最终决定了中国上海社区卫生中心的工作场所食物环境和员工食物选择。有必要实施这些研究结果并评估其对饮食和健康的影响。
