Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia.
Int J Environ Res Public Health. 2021 Sep 30;18(19):10346. doi: 10.3390/ijerph181910346.
Policies that support healthier food environments, including healthy retail food availability and promotion, are an important strategy for obesity prevention. The aim of this systematic review was to examine the evidence for barriers and enablers to successful implementation of healthy food and drink policies, delivered at scale.
MEDLINE, SCOPUS and INFORMIT were searched to May 2019 for peer-reviewed studies. Google and Google Scholar were searched for grey literature. Studies of any design relating to a healthy food and drink policy delivered at scale (≥10 sites) in non-commercial food settings, for specific retail outlets (e.g., vending machines, cafes, cafeterias, school canteens), and that reported on implementation barriers and/or enablers were included. Studies in commercial food retail environments (e.g., supermarkets) were excluded. Studies were appraised for quality and key information was extracted and summarised. Extracted information on barriers and enablers was further grouped into overarching themes relating to perceptions of the policy itself, organisational and contextual factors influencing policy implementation, stakeholder responses to the implemented policy and perceived policy impacts.
Of 19 studies, 16 related to policies implemented in schools, two in hospital/health facilities and one in a sport/recreation setting. Most studies were conducted in North America or Australia, and policy implementation occurred mainly at state/regional or federal levels. The most commonly cited barriers across overarching themes and intervention settings were: lack of stakeholder engagement or prioritisation of the policy (11 studies); resistance to change from school stakeholders or customers (8 studies); and concern over profitability, revenue and/or commercial viability (8 studies). Few studies reported on mitigation of barriers. Enablers most commonly raised were: stakeholder engagement, whole-school approach and/or prioritisation of the policy (9 studies); policy level or higher-level support in the form of information, guidance and/or training (5 studies); and leadership, school/policy champion, management commitment and/or organisational capacity (4 studies).
Key considerations for policy implementation ranged from building stakeholder support, prioritising policy implementation within organisations, to implementing strategies that address financial concerns and implementation barriers.
支持更健康食品环境的政策，包括健康零售食品的供应和推广，是预防肥胖的重要策略。本系统评价的目的是研究成功实施大规模实施的健康食品和饮料政策的障碍和促进因素的证据。
2019 年 5 月，通过 MEDLINE、SCOPUS 和 INFORMIT 搜索同行评议研究。通过 Google 和 Google Scholar 搜索灰色文献。纳入研究设计为在非商业食品环境中（例如，自动售货机、咖啡馆、自助餐厅）大规模实施（≥10 个地点）的特定零售场所（例如，自动售货机、咖啡馆、自助餐厅）的健康食品和饮料政策，且报告实施障碍和/或促进因素的研究。不包括商业食品零售环境（例如，超市）中的研究。对研究进行了质量评估，并提取和总结了关键信息。进一步将提取的关于障碍和促进因素的信息分组为与政策本身的看法、影响政策实施的组织和背景因素、利益相关者对实施政策的反应以及感知政策影响相关的总体主题。
在 19 项研究中，有 16 项与学校实施的政策有关，2 项与医院/卫生设施有关，1 项与体育/娱乐场所有关。大多数研究在美国或澳大利亚进行，政策实施主要在州/地区或联邦一级进行。在总体主题和干预环境中最常被引用的障碍是：缺乏利益相关者的参与或对政策的重视（11 项研究）；来自学校利益相关者或客户的对变革的抵制（8 项研究）；以及对盈利能力、收入和/或商业可行性的关注（8 项研究）。很少有研究报告缓解障碍的情况。最常提出的促进因素是：利益相关者的参与、全校方法和/或对政策的重视（9 项研究）；政策层面或以信息、指导和/或培训形式提供的更高层次的支持（5 项研究）；领导力、学校/政策拥护者、管理层承诺和/或组织能力（4 项研究）。
政策实施的关键考虑因素包括建立利益相关者的支持、在组织内优先实施政策、实施解决财务问题和实施障碍的策略。
