Making a healthy difference to menus: evaluation of a catering program in New Zealand.

Abstract

Objective: To determine the effect of the Heartbeat Catering Programme (HCP) on the provision of healthy menu items by measuring perceptions of caterers and dietitians involved in the program.

Study design: A multiple methods approach was used involving a postal questionnaire and telephone interviews with caterers, and telephone interviews with dietitians involved in the program.

Subjects: Caterers/food service managers n = 164, dietitians n = 15.

Setting: Food services in residential institutions (boarding schools, university hostels, prisons, aged care homes), workplace cafeterias, cafes and lunch bars.

Results: While not the sole source of information and motivation for menu development, it was clear that for most participants information learnt through contact with the Heart Foundation was incorporated into recipes and food preparation techniques. Program resources and services of particular value to caterers were the mailed information packs and food demonstrations. Dietitians reported a high level of satisfaction with the program and agreed that the program was assisting caterers to offer nutritious menus to customers. Both groups recommended changes to the program resources to improve their usefulness.

Conclusion: Caterers and dietitians perceived that the Hearbeat Catering Programme appeared to be improving the nutritional value of food served in food service outlets. Program resources required updating in line with comments from caterers and dietitians. The program should be expanded to increase influence.

Key words: food service, catering, menus, New Zealand, nutrition guidelines 

(Nutr Diet 2004;61:226-33)

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Introduction

Caterers are responsible for the nutrition of large numbers of New Zealanders in residential institutions, workplace cafeterias, cafes and lunch bars. New Zealanders are increasingly purchasing pre-prepared food and delegating the responsibility of food preparation and cooking. Catering services, as a market segment of sales within the food service industry, grew by 33% in 2000 with a further 25% growth predicted in 2001 (1).

Obesity, coronary heart disease and diabetes are three major health issues in New Zealand. These conditions are preventable, with lifestyle interventions such as a healthy diet. The 1997 National Nutrition Survey found 52% of New Zealanders overweight or obese, with higher rates of obesity among Maori and Pacific Islands peoples (2). Cardiovascular disease is the leading cause of death in New Zealand, accounting for 40% of all deaths (3). Diabetes affects 2% to 5% of New Zealanders, 5% to 10% of Maori and 4% to 8% of Pacific peoples (4). A further rise of type 2 diabetes is predicted due to the obesity epidemic (5).

As the food supply becomes more complex, with increasing consumption of pre-prepared foods, public health nutrition strategies are required to shift the food supply towards the recommendations of the New Zealand Food and Nutrition Guidelines (6). These guidelines recommend a reduction in total and saturated fat, increased consumption of fruit and vegetables, and establishment and maintenance of a healthy body weight. Strategies, that increase the availability of healthy food choices and target the food industry, have the potential to improve dietary patterns in New Zealand, in particular in relation to reductions of fat, salt and sugar in food products.

The Heartbeat Catering Programme (HCP) aims to create a supportive food environment within the food service industry where caterers make decisions about food selections. This program is part of a broad strategy which aims to work in partnership with the food industry to improve the formulation and availability of foods to consumers that are consistent with National Heart Foundation of New Zealand's nutrition policy. The HCP provides nutrition information and education opportunities that encourage caterers to develop their skills in providing healthy food choices for institutional residents and customers in food service outlets. The program strategy addresses food environmental factors and is significant because it recognises the multiple determinants of nutritional health status. It emphasises that prevention of obesity, heart disease and diabetes involves more than personal behaviour change and builds and strengthens partnerships between the food and health sector (7,8).

There have been many successful programs targeting the food service sector. These include the Heartbeat Wales Heartbeat Awards Scheme, Caterers in Hospitals Improvement Program (CHIP), Catering Improvement Program and the South Australian Healthy Food Services project (9,10). These programs have focused on improving the nutrition knowledge of food service staff and promoting healthy food choices.

Figure 1 outlines the development of the Heartbeat Catering Programme. It began in 1992 and aimed to encourage the provision of food and menus that met the Heart Foundation Catering Guidelines (Table 1). It initially targeted caterers in residential institutions such as aged care homes, boarding schools and hostels. The program activities involved nutrition education and information provision that encouraged caterers to make changes to menus in line with the supplied menu guidelines. There was a series of resources--Heartbeat Catering Guidelines, a quantity recipe book and video. The Heartbeat Catering Guidelines contain a menu assessment checklist. The checklist helps caterers assess their menus and guides them to develop targets for change that are realistic and achievable (Table 1). All of the resources follow the messages of the New Zealand Ministry of Health's Food and Nutrition Guidelines (6). Caterers joined the program when they ordered the Heartbeat Catering Guidelines. Partnerships were formed with community dietitians in Area Health Boards and other agencies. Community dietitians assessed menus in residential institutions using the Heart Foundation Catering Guidelines, and made appropriate changes to align the menu with the guidelines.

[FIGURE 1 OMITTED]

The program was piloted in 14 residential institutions in the central North Island and the lower half of South Island in New Zealand. Evaluation of the trial indicated the Heartbeat Menu Checklist was a useful and feasible method of menu assessment for caterers. The resources effectively initiated and supported changes in line with the Food and Nutrition Guidelines. The program and resources were modified as a result of the trial to increase their relevance to caterers prior to national implementation.

Further to the resources, caterers involved in the program received two mailed information packs per year (containing food product promotional flyers, healthy food preparation techniques and food ideas), nutrition newsletters (two per year), food demonstrations (five per year nationally) and promotional displays at regional hospitality trade shows (seven per year), and monthly articles in a commercial catering magazine. This ensured that contact was maintained with caterers every six months. The food industry supported the program by providing food product information brochures in the mailed information packs and in the presentation of food demonstrations. In 1994, further resources were developed, including Function Catering Guidelines, to encourage the availability of healthy food choices at conferences, seminars and functions, and the Recipe Development Guidelines followed in 1999 to provide a framework for recipe development. All resources were provided free of charge, apart from the quantity recipe book which was available for NZ$19.00.

Since inception, the program has expanded to provide services to a wider range of caterers including caterers in workplace cafeterias and commercial lunch bars and cafe settings. The program was predominantly promoted to caterers by the Heart Foundation, although dietitians and other health professionals also offer and utilise the program. At various stages of the program, as the need has arisen and funds allowed, evaluation has been performed to guide program development. In 1993 every tenth residential institution that requested a copy of the Heartbeat Catering Guidelines was randomly selected to participate in an internal evaluation to assess the short-term and medium-term impact of Heartbeat Catering Guidelines on the food service (11). Changes in 13 of the 22 target areas were monitored over the 12 months. Results showed that residential institutions had made small changes to menus, mainly in the first three months after receiving the guidelines. The most common changes were to introduce trim milk (1% fat or less), to use less cream, replace saturated fats with unsaturated fats in cooking and for spreading, and to remove skin from chicken. Caterers found it a useful resource that encouraged menu changes.

Food demonstrations and trade shows were also evaluated internally by the National Heart Foundation to see if they met the needs of the caterers, however the overall impact of the program on food services had not been evaluated. Given the longevity of the program and its expansion since 1992, an external evaluation of the program was considered timely.

The overall aim of this evaluation was to determine if caterers and dietitians involved in the HCP perceived that the program had influenced the provision of healthy menu choices (Table 1). The research also aimed to review program resources and services in order to plan future program directions.

Methods

Two research companies, independent of the Heart Foundation, designed, conducted and took ethical responsibility for the evaluation of the Heartbeat Catering Programme using a multiple methods approach. The methods were not specifically tested for validity and reliability. The evaluation included a postal questionnaire that was sent to 2200 caterers on the Heart Foundation national caterers' database. This questionnaire assessed the awareness, satisfaction and use of program resources and activities to measure the impact of the program on caterers' provision of healthy menu items. An incentive was offered to respondents to improve the response rate. No effort was made to re-contact caterers to improve the response rate due to restricted funding.

In order to gain greater in-depth information, a subsample of 107 caterers was randomly selected from 134 caterers on the Heart Foundation food demonstration database for a phone interview. This database is a subset of the national database and was used because this was a group known to be active participants in the program. It was considered important for this part of the evaluation that participants had some experience with the services offered by the HCP, including resources. To establish this, initial contact was made by phone, at which time a series of screener questions were asked. Those with limited or no awareness of the program were excluded at this time. Those to be invited to participate were sent an introductory letter outlining the evaluation. Due to budgetary constraints the majority of the interviews were descriptive, rather than in-depth interviews. Descriptive interviews are when a fully trained interviewer uses a questionnaire, with pre-determined questions rather than a discussion guide which is more flexible and responsive to individual contexts. The interviewer recorded manually what participants said during interviews as well as audiotaping them. Each interview was then reviewed using the audiotape so that notes could be clarified. Question areas covered issues similar to those included in the self-completion questionnaire but in greater depth. The in-depth interviews provided an opportunity for further exploration of ideas and issues identified during the descriptive interviews.

In addition, a random sample of 20 dietitians who cited food service and/or rest homes as their areas of interest in the New Zealand Dietetic Association database were contacted regarding their involvement in the Heartbeat Catering Programme. Dietitians who agreed to participate were interviewed on their use and satisfaction with specific HCP resources and the impact of the program on the provision of healthy menu items by caterers. The interview was done using a structured schedule with additional questions that were specific to four of the Heart Foundation resources in use. These dietitians were from private and publicly funded organisations including publicly funded health services, private health companies, sports bodies and the tertiary education sector.

Structured interviews were held with six food companies, three who used Heartbeat Catering Programme resources and three who had no previous involvement with this program. Responses from this group were too low for inclusion in the evaluation's results.

Results

Postal questionnaire

There were 2 200 questionnaires that were sent to caterers. Of these 164 were completed and returned (8% response rate). Past experience has shown caterers to be poor responders to postal surveys (11). While a response rate of 8% is not unusual for a mailed self-completion questionnaire, it does mean that findings need to be interpreted cautiously. Generalising the findings to the wider environment of caterers needs to be done with care. Despite this low response rate respondents represented a cross section of food service caterers. The respondents' roles within the food service included managers (34%), owner/operators (27%), head chefs (13%), general managers (9%) and others (16%). The respondents' sites of work within the food service industry were diverse and well represented. These included 25% from nursing homes, 23% from cafes and lunch bars and 14% workplace cafeterias. There was small representation from hostels, boarding schools and private caterers included in the sample.

Caterers indicated that the Heart Foundation's services and resources for the catering industry were viewed positively. A key role of the Heart Foundation within the food service industry was regarded as providing up-to-date, healthy food preparation techniques and healthy food alternatives. Information and resources needed by caterers centred on healthy recipes and food preparation techniques that were practical, up to date and relevant to the food service setting or sufficiently flexible to be adapted to different settings.

Surveyed respondents indicated a high awareness of (84%), access to (88%) and use of (83%) the mailed information pack (Edible Ideas) (Table 2). There was wide use of the nutrition newsletter (Caterers Corner), with high awareness of (73%), access to (73%) and use of it (70%). The awareness of other Heartbeat Catering Programme resources and services was much lower. Few participants (18%) received nutrition information from external sources such as the trade magazine. Catering Plus, which publishes articles from the Heart Foundation. Those who did access Catering Plus thought the articles were useful.

Almost half (48%) claimed to have used Heart Foundation resources or services to make healthy menu changes. Respondents perceived that information from the Heart Foundation had helped to increase their own knowledge of nutrition issues (89%) or that of their staff (71%). There were 44% of respondents who had attended a Heart Foundation food demonstration. Respondents wanted the resources to continue to be sent out but to include recipes and guidelines for specific groups including food for older people, younger people and preparing food for people with specific health needs such as diabetes and allergies.

Telephone interviews with caterers

Of the 107 caterers contacted, 49 were not able to be contacted by phone at the time of the call, six stated they had not attended Heart Foundation food demonstrations, one refused to participate, and 51 caterers agreed to participate in a telephone interview. However, 27 of these caterers were unavailable at the scheduled interview time. Twenty-four telephone interviews were completed, 17 descriptive and seven in-depth interviews. The results of the descriptive and in-depth interviews have been combined. Respondents thought the key role of the Heart Foundation was to be an up-to-date source of healthy food preparation techniques and healthy food alternatives. However, they thought this information needed to be more individualised for different food services or sufficiently flexible to be adapted to different settings.

Awareness of specific Heartbeat Catering Programme resources and services was mixed. Caterers were confused as to what specific resources were called, what they looked like, what information they contained and which ones they had. Resources that were mailed to caterers such as the information pack (Edible Ideas) and nutrition newsletter (Caterers Corner) had higher awareness and use compared with other available resources. Due to the feedback on specific resources being limited the results have been combined. Despite this confusion, when resources were obtained by individual caterers, they were used. Existing resources were seen to need updating in style and presentation, to include more illustrations of completed recipes, have increased relevance to a range of food settings and to include recipes of smaller quantities.

Additional general needs stated were: nutritional analysis of existing dishes and information on how to change ingredients and methods to make recipes healthier, provision of recipes in varying quantities and information on new products. It was considered necessary that resources for the catering industry should contain limited written information and specific requests were made for a card system for presenting and storing recipes, pictures of completed recipes, newsletter type of resources and an educational video.

Rather than the HCP resources being fundamental to menu development, they were used in a more informal way as needed. When used, they were considered informative. For many participants the resources had assisted in adapting existing ways of preparing food, were a source of new ideas and an information base from which recipe and menu ideas could be further developed.

Caterers indicated that the main influences on menu changes were feedback from customers, discussions with colleagues and company promotions. Additional motivators for menu changes included providing healthy food choices, ensuring that customers continue to have a choice of foods (healthy and not so healthy) and budgetary constraints. While not the sole source of information and motivation for menu development, it was clear that for most, information learnt through contact with the Heart Foundation was incorporated into recipes and food preparation techniques. Participants noted some of the following changes in discussing the Heart Foundation's influence on menus, 'low fat ideas like cutting the fat off meat and using low-fat or non-fat milk', 'use of fresh fruit for desserts', 'use of baking paper instead of fat', 'less margarine', 'use of the microwave for cooking fish and chicken', 'cooked desserts heavily laden with cream have given way to fruit desserts with yoghurt and cheeseboards with fruit', 'whereas cakes used to be doorstop size they are now bite size--a Heart Foundation idea'.

The Heart Foundation food demonstrations were regarded positively. Many caterers described them as a source of new and practical ideas that could be incorporated into menus. These demonstrations encouraged them to make changes in their food preparation and cooking techniques. Changes noted having been made to food preparation and cooking techniques included substitution of full fat milk with low fat milk, introduction of new vegetables, change of frying medium and use of evaporated milk instead of cream. Other benefits included the opportunity to network with caterers from similar food services, a chance to review their approach to food preparation, menu development, view new catering products and have access to a full range of Heart Foundation resources. For a few, the food demonstrations attended had not seemed relevant to their particular food setting. Caterers considered the Heart Foundation presence at hospitality trade shows as appropriate given their perceived role to educate and promote healthy food choices to caterers. However it was thought that the current promotional stand was too static, not interactive and offered predominantly reading material.

Dietitian interviews

Fifteen dietitians agreed to participate in the evaluation; three respondents were interviewed in person and 12 by telephone. Half of the dietitians indicated that the Heart Foundation resources had assisted their client organisations to provide healthier food choices on menus and prepare food using healthier cooking methods. Menuchanges included the introduction of 'unsweetened canned fruit, salad sandwiches, trim milk, low fat yoghurt, more fruit, salad and vegetables'. Changes to food preparation techniques included 'oven baking instead of frying, using low fat or no fat cooking methods, healthier fats, and less added salt'. Most dietitians thought their clients knew more about nutrition as a result of contact with the Heart Foundation (60%) and through its resources (93%).

Eighty-six percent of dietitians surveyed were aware and had access to the program resources relevant to them (Heartbeat Catering Guidelines, Heartbeat Function Catering Guidelines, Heartbeat Recipes and Food Ideas). Heartbeat Catering Guidelines was well used (80%) (Table 2) and there was a high degree of satisfaction reported for this resource. Approximately half the sample used the Function Catering Guidelines and recipe book (Table 2). Some respondents questioned the relevance of the recipe book for rest homes, stating some of the recipes were too low in fat and salt and too high in fibre. Since the book had been produced in 1993, the need for updating was noted. Less information and more illustrations were also requested by respondents as general comments about the resources.

The information gained from the postal survey overall provided feedback on the key HCP resources and services which was further investigated by the telephone interviews. Both techniques found the regularly mailed information and practical food demonstrations to be most valuable to caterers. While there was some confusion as to what some resources were and when resources were received, they were used and caterers perceived that their nutrition knowledge had increased as a result of involvement in the program. Participants reported that the program was also being used to make changes to menus in line with New Zealand Food and Nutrition Guidelines. The telephone interviews provided more detail about specific resource needs for the future including the need to be more visual and to increase the relevance to a range of food settings. Dietitians reported a high level of satisfaction with the program and agreed that the program was assisting caterers to offer nutritious menus to customers. They also suggested that the resources, in particular the recipe book, needed updating and increased specificity of information for key target groups such as older people.

Discussion

Health promotion programs based on modifying the food environment such as the Heartbeat Catering Programme are used to implement the Food and Nutrition Guidelines. They enable individuals to have access to healthier food choices. Caterers perceived their involvement with the HCP had improved the nutritional value of the food they provided to residents or customers. However, they required resource information to focus on recipes and food preparation techniques that were up to date, relevant and practical. This information needs to be individualised or sufficiently flexible to be adapted to different food service settings. Resources would better meet the needs of caterers if they were clearly branded as having a food service industry focus, were more visual and contained limited written information and were in a form that was easily accessible on a day-to-day basis.

This study had both quantitative and qualitative components. The methodology was chosen to enable the Heart Foundation to evaluate and then further develop the Heartbeat Catering Programme with limited funding. The low response rate in the quantitative questionnaire is a limitation of this study. Although a response rate of eight percent is not unusual for a mailed questionnaire, the ability to generalise these findings is limited. The participants represented a cross-section of food service caterers. Telephone interviews enabled the researcher to gather more in-depth information from caterers throughout New Zealand but telephone interviews were not ideal for reviewing printed resources. This limited the feedback on specific printed resources and resulted in more general information being collected. Despite these shortcomings, the results from the postal survey and the telephone interviews reported similar findings.

Similar benefits have been observed internationally. The Victorian Division of the Heart Foundation developed Healthy Catering Guidelines in 1993. An evaluation of these guidelines showed the majority of respondents found the guidelines useful in their food service setting and over half used it to assist with making menu changes that most claimed were easy to implement and to be successful (12). Reasons given by caterers for not using the guidelines document were 'it reinforces what they already do', 'they intend to use it in the future' and 'the information was not new'. Participants indicated they would like recipes, sample menus and a list of useful resources. The Heartbeat Catering Programme evaluation findings were similar to those in the evaluation by the Victorian Division of the Heart Foundation.

A wider evaluation of catering intervention programs in commercial food services in Australia identified a number of issues that need to be addressed. These included the need for research and development of competitive healthy food products and the lack of nutrition knowledge of caterers. This evaluation noted that programs needed to aim for small changes to behaviour, involve all key stakeholders and ensure commitment from senior management (10).

Some of the problems encountered with implementing nutrition programs in Australia are shared by the Heart-beat Catering Programme in New Zealand. These include overcoming caterers' doubts, reliance on the variable enthusiasm and understanding of managers, limited funds, food service outlets which do not see the need for improvement, lack of maintaining or making more changes after the initial introduction of a food service program, and staff turnover (10). A number of other variables impact on food service delivery, these include customer demand, seasonal availability, management priorities, and other public health accreditation and quality assurance programs such as food safety. Within these wider demands healthy food choices may not be seen as a priority by food caterers.

With increasing trends towards eating food prepared away from home, more people rely on the knowledge and skill of caterers and chefs to meet their nutritional needs. Community-based health promotion programs are recognised as effective mechanisms for intervention at the food environmental level (13). To improve the food prepared away from the home in New Zealand, nutrition interventions need to focus beyond the individual. In New Zealand 23 cents in every dollar is spent on food prepared out of the home (14). This food tends to be high in fat and salt and low in fibre (15). For health promotion programs such as Heartbeat Catering to have any effect on the food supply there is a need to work collaboratively with food manufacturers, the hospitality industry and food preparers. No one sector can be responsible for creating environmental and societal changes that are necessary in bringing about healthier food choices (7). For significant health benefits to occur these changes have to be sustained over many years (16).

Conclusions

The Heartbeat Catering Programme demonstrates the feasibility of influencing caterers in their role as the gatekeepers of nutrition to encourage the availability of healthy food choices in catering settings, which will impact on the health of New Zealanders. To improve the success of and expand the HCP the following recommendations should be implemented.

Review the current resources with the aim of:

* Creating a clear brand identity for the Heartbeat Catering Programme resources;

* Continuing to provide mailed recipe and food preparation information but consider a recipe card system or similar design for recipes to be added over time, with more pictorial representation of completed dishes and limited written information;

* Developing menu assessment guidelines suitable for the different target groups in preference to the current 'one size fits all' approach, for example, separate targets for young people in a hostel compared to older people in a nursing home;

* Increasing the relevance of food information to specific food services, for example, cafe style food;

* Continuing to offer food demonstrations, preferably more than currently delivered, but tailored to the different catering settings;

* Review and update content of stands at catering trade shows.

Future research should investigate the extent and type of menu changes made by caterers in the Heartbeat Catering Programme, however this research will require a robust evaluation design and methodology.

Table 1. Heartbeat menu checklist (a) from Heart Foundation Heartbeat
Catering Guidelines

Heartbeat target           Present menu  Target change  Items to include

Wholemeal bread            Yes/No                        Bread, bread
available daily                                          rolls, pita
                                                         bread, bagels
Cereals: rice/pasta etc.   Weekly total                  Rice, barley,
at least 5 meals weekly                                  spaghetti,
                                                         macaroni, sago,
                                                         noodles
Fruit                      Weekly total                  Raw, cooked,
at least twice daily       Average/day                   canned, frozen
Vegetables                 Weekly total                  Raw, cooked,
at least 3 times daily     Average/day                   canned, frozen
Meat                                                     Meat and meat
order lean                 A S N (b)                     dishes but not
remove excess fat          A S N (b)                     processed meats
Processed meats            Weekly total                  Sausages,
no more than twice                                       saveloys,
weekly                                                   sausage meat,
                                                         salami,
                                                         luncheon
Pastry items               Weekly total                  Short crust,
not more than twice                                      flaky, puff and
weekly                                                   choux pastry,
                                                         croissants
Food cooked in fat         Weekly total                  NF = no added
no more than 2 menu items                                fat cooking
weekly cooked in LF                                      method
                                                         SF = some added
                                                         fat cooking
                                                         method
                                                         LF = lots of
                                                         added fat
                                                         cooking method

Heartbeat target           Example

Wholemeal bread
available daily
Cereals: rice/pasta etc.   Spaghetti for breakfast + macaroni cheese for
at least 5 meals weekly    lunch + rice pudding for dessert = 3 counts
Fruit                      Canned plums for breakfast + apple for lunch
at least twice daily       + peach crumble for dessert = 3 counts
Vegetables                 Creamed corn for breakfast + coleslaw for
at least 3 times daily     lunch + potatoes, beans and carrots for
                           dinner = 5 counts
Meat                       Bacon for breakfast + cold meat for lunch +
order lean                 weiner schnitzel for dinner = 3 counts
remove excess fat
Processed meats            American hot dogs for lunch + savoury sausage
no more than twice         pie for dinner = 2 counts
weekly
Pastry items               Sausage rolls for morning tea + filled
not more than twice        croissants for lunch + chocolate eclairs for
weekly                     afternoon tea + apple shortcake for dinner =
                           4 counts
Food cooked in fat         Steam, boiled, grill, microwave, bake or
no more than 2 menu items  roast with no added fat.
weekly cooked in LF
                           Stir or pan fry, pot roast or roast with a
                           little added fat.
                           Deep fry, fry or roast with lots of added
                           fat.

(a) The checklist is a guide to assess current menus and develop targets
for change in line the Food and Nutrition Guidelines that are realistic
and achievable. Included are 8 out of the 22 Heartbeat targets.
(b) A (always), S (sometimes), N (never).

Table 2. Awareness, access and use of Heartbeat Catering Programme
resources and services by caterers and dietitians

Resource/service                                   Caterers
                                                   n = 164
                                        Awareness  Access    Used
                                           (%)      (%)       (%)

'Edible Ideas' information pack             84     88        83
'Caterers Corner' newsletter                73     73        70
Heartbeat recipes and food ideas            54     38        37
Heartbeat Catering Guidelines               44     34        30
Function Catering Guidelines                16      8         9
Heart Foundation nutrition articles in      25     18        10
trade catering magazine
Food demonstrations                         22     [dagger]  [dagger]
Heart Foundation display stands at          52     [dagger]  [dagger]
catering trade shows

Resource/service                                   Dietitians
                                                   n = 15 (a)
                                        Awareness  Access      Used
                                           (%)      (%)         (%)

'Edible Ideas' information pack             *        *           *
'Caterers Corner' newsletter                *        *           *
Heartbeat recipes and food ideas            86       86          40
Heartbeat Catering Guidelines               86       86          80
Function Catering Guidelines                86       86          46
Heart Foundation nutrition articles in      *        *           *
trade catering magazine
Food demonstrations                         *        *           *
Heart Foundation display stands at          *        *           *
catering trade shows

(a) Of the 15 dietitians interviewed two had not used the resources.
* Dietitians were not asked about the awareness, access and use of these
resources and services as they were not relevant to this group.
[dagger] Caterers were not asked the same questions about access and use
of food demonstrations and trade shows.

Acknowledgments 

This review was initiated and managed by the National Heart Foundation of New Zealand with funding support from the Ministry of Health. The evaluation research was conducted by independent research companies, Holibar-Fidler Research Associates and Evaluation Associates. The authors wish to acknowledge Dr Diana North and Heather Fear for assistance in the preparation of this paper.

References

1. Restaurant Association of New Zealand. 2001 Foodservice facts. Auckland: Restaurant Association of New Zealand; 2001.

2. Ministry of Health. NZ Food: NZ People: Key results of the 1997 national nutrition survey. Wellington: Ministry of Health; 1998.

3. Hay DR. Cardiovascular disease in New Zealand, 1999; A summary of recent statistical information. Auckland: National Heart Foundation; 1999.

4. Simmons D, Harry T, Gatland B. Prevalence of known diabetes in different ethnic groups in inner urban South Auckland. N Z Med J 1999;112:316-9.

5. Ministry of Health. Modelling diabetes: Forecasts to 2011. Wellington: Ministry of Health; 2002.

6. Ministry of Health. Food Fantastic: Nga kai tino pai rawa: NZ food and nutrition guidelines. Wellington: Ministry of Health; 1998.

7. Agencies for Nutrition Action. Healthy weight New Zealand. Auckland: Agencies for Nutrition Action; 2001.

8. World Health Organization. Obesity; Preventing and managing the global epidemic. Geneva: WHO; 1998.

9. Murphy S. Powell C, Smith C. A formative evaluation of the Welsh Heartbeat award scheme. Nutrition and Health 1994;9:317-27.

10. James C. Nutrition promotion in commercial foodservice--A review of current Australian programs and resources. Queensland: Queensland Health; 1996.

11. Mackay S. Evaluation of two nutrition promotion programs. Proceedings Nutrition Society of New Zealand 1995;20:143-6.

12. Cooper C, Engel H. Evaluation of the healthy catering guidelines document. Melbourne: Victorian Division, Heart Foundation of Australia; 1997.

13. Fear H. Mackay S. Influencing caterers--the gatekeepers to nutrition. Montreal: 16th International Congress of Nutrition; 1997.

14. Restaurant Association of New Zealand. 1999 Foodservice facts. Auckland: Restaurant Association of New Zealand; 1999.

15. Hughes RG, Harvey PWJ, Heywood PF. The food-service industry, dietary guidelines and change. Aust N Z J Public Health 1997;21:539-44.

16. Glanz K. Seewald-Klein T. Nutrition at the worksite, an overview. Journal of Nutrition Education and Behavior 1986;18(Suppl 1):1S-12S.

The Heart Foundation of New Zealand, Auckland

L. Young, BHSc, Post GradDipSci (Comm Nutr). MPH, NZRD, Public Health Dietitian, Hamilton 

A. Bidois, GradDipSci (Comm Nutr), National Catering Programme Manager

S. Mackay, MSc (Nutr). Public Health Nutritionist, Nelson

Correspondence: A. Bidois, The National Heart Foundation of New Zealand, P O Box 17160, Greenlane, Auckland 1130, New Zealand Email: [e-mail]

L. Young and A. Bidois contributed to the conception of the evaluation survey, managed the implementation, data interpretation and drafted the paper. S. Mackay contributed to data interpretation and drafted the paper.