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      Parental perceptions of onsite hospital food outlets in a large hospital in the North East of England: A qualitative interview study

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          Abstract

          Background

          Addressing the increasing obesity rates in children living in the United Kingdom has become a priority. A public health level approach as opposed to an individual approach is potentially one way forward. The wider food environment should be designed so that the ‘healthier choice’ is the easiest choice; this includes public sector settings such as hospitals. Many hospital outlets sell and promote food and drinks high in sugar, fat and salt undermining health messages developed by the UK National Health Service. Financial incentives have been provided to encourage hospitals to promote healthier food choices; however, few outlets have complied with the targets.

          The aim of this qualitative interview study was to determine the dietary perceptions and needs of parents whose children attend a large children’s hospital in the North East of England and to identify potential barriers and facilitators to eating healthily in a hospital setting.

          Methods

          Eighteen parents whose children attended the hospital as an in- or out-patient were recruited through either ward research nurses, information posters or a parent hospital Facebook page to participate in a one-to-one in-depth interview.

          Results

          Parents reported a lack of affordable healthy options for sale both for themselves and visiting children. Although parents wanted to see more healthy options available for sale they did not feel it was appropriate to ban or restrict sales of any food types. Parents of frequent or long-term in-patients found it difficult to adequately feed themselves.

          Conclusions

          The ways in which visitors and staff can be encouraged to choose the healthier option in an NHS hospital setting warrants further investigation. The use of ‘nudge theory’, which has gained particular momentum in areas such as health promotion, may be a tool which can be utilised by hospitals to facilitate the promotion of healthy eating.

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          Most cited references15

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          Beyond nudges: Tools of a choice architecture

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            NUDGING FOR HEALTH: ON PUBLIC POLICY AND DESIGNING CHOICE ARCHITECTURE

            There have been recent policy moves aimed at encouraging individuals to lead healthier lives. The Cabinet Office has set up a ‘nudge unit’ with health as one of its priorities and behavioural approaches have started to be integrated into health-related domestic policy in a number of areas. Behavioural research has shown that that the way the environment is constructed can shape a person's choices within it. Thus, it is hoped that, by using insights from such research, people can be nudged towards making decisions which are better for their health. This article outlines how nudges can be conceived of as part of an expanding arsenal of health-affecting regulatory tools being used by the Government and addresses some concerns which have been expressed regarding behavioural research-driven regulation and policy. In particular, it makes the case that, regardless of new regulatory and policy strategies, we cannot escape the myriad of influences which surround us. As such, we can view our health-affecting decisions as already being in some sense shaped and constructed. Further, it argues we may in fact have reason to prefer sets of health-affecting options which have been intentionally designed by the state, rather than those that stem from other sources or result from random processes. Even so, in closing, this article draws attention to the largely unanswered questions about how behavioural research translates into policy and regulatory initiatives.
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              The food and beverage vending environment in health care facilities participating in the healthy eating, active communities program.

              Little has been done to ensure that the foods sold within health care facilities promote healthy lifestyles. Policies to improve school nutrition environments can serve as models for health care organizations. This study was designed to assess the healthfulness of foods sold in health care facility vending machines as well as how health care organizations are using policies to create healthy food environments. Food and beverage assessments were conducted in 19 California health care facilities that serve children in the Healthy Eating, Active Communities sites. Items sold in vending machines were inventoried at each facility and interviews conducted for information on vending policies. Analyses examined the types of products sold and the healthfulness of these products. Ninety-six vending machines were observed in 15 (79%) of the facilities. Hospitals averaged 9.3 vending machines per facility compared with 3 vending machines per health department and 1.4 per clinic. Sodas comprised the greatest percentage of all beverages offered for sale: 30% in hospital vending machines and 38% in clinic vending machines. Water (20%) was the most prevalent in health departments. Candy comprised the greatest percentage of all foods offered in vending machines: 31% in clinics, 24% in hospitals, and 20% in health department facilities. Across all facilities, 75% of beverages and 81% of foods sold in vending machines did not adhere to the California school nutrition standards (Senate Bill 12). Nine (47%) of the health care facilities had adopted, or were in the process of adopting, policies that set nutrition standards for vending machines. According to the California school nutrition standards, the majority of items found in the vending machines in participating health care facilities were unhealthy. Consumption of sweetened beverages and high-energy-density foods has been linked to increased prevalence of obesity. Some health care facilities are developing policies that set nutrition standards for vending machines. These policies could be effective in increasing access to healthy foods and beverages in institutional settings.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2 November 2018
                2018
                : 13
                : 11
                : e0205416
                Affiliations
                [1 ] The Human Nutrition Research Centre, William Leech Building, Newcastle University, Framlington Place, Newcastle upon Tyne, United Kingdom
                [2 ] Child Health Research Strategy, Children’s Services Clinical Research Centre, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
                [3 ] Social Work, Education & Community Wellbeing, Coach Lane Campus West, Northumbria University, Newcastle upon Tyne, United Kingdom
                Northwestern University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-1044-6201
                http://orcid.org/0000-0002-8061-0428
                Article
                PONE-D-18-16710
                10.1371/journal.pone.0205416
                6214497
                30388187
                7138181c-f84d-4b02-abf9-2b9a0a4c3cd2
                © 2018 McSweeney et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 June 2018
                : 25 September 2018
                Page count
                Figures: 0, Tables: 2, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: BH163208
                Award Recipient :
                Funded by Fuse The Centre for Translational Research on behalf of the Medical Research Council (UK) BH163208: LM.
                Categories
                Research Article
                Biology and Life Sciences
                Nutrition
                Diet
                Food
                Medicine and Health Sciences
                Nutrition
                Diet
                Food
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Eating
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Eating
                Biology and Life Sciences
                Nutrition
                Diet
                Medicine and Health Sciences
                Nutrition
                Diet
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Biology and Life Sciences
                Biochemistry
                Lipids
                Fats
                Biology and Life Sciences
                Nutrition
                Diet
                Food
                Chocolate
                Medicine and Health Sciences
                Nutrition
                Diet
                Food
                Chocolate
                Custom metadata
                Owing to the qualitative nature of our data and due to the type of consent obtained from participants, we are unable to make the data underlying this study publicly accessible. The participants have not consented to their data being publicly used and to do so may compromise participant privacy about their child’s medical conditions. Qualified researchers may contact Fuse@ 123456newcastle.ac.uk and the authors of this study ( lorraine.mcsweeney@ 123456ncl.ac.uk ) for inquiries regarding data access.

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