Barriers to and facilitators of implementing complex workplace dietary interventions: Process evaluation results of a cluster controlled trial

Fitzgerald, Sarah; Geaney, Fiona; Kelly, Clare; McHugh, Sheena M.; Perry, Ivan J.

Barriers to and facilitators of implementing complex workplace dietary interventions: Process evaluation results of a cluster controlled trial

dc.contributor.author	Fitzgerald, Sarah
dc.contributor.author	Geaney, Fiona
dc.contributor.author	Kelly, Clare
dc.contributor.author	McHugh, Sheena M.
dc.contributor.author	Perry, Ivan J.
dc.contributor.funder	Health Research Board
dc.contributor.funder	Department of Agriculture, Food and the Marine
dc.contributor.funder	Irish Heart Foundation
dc.contributor.funder	Nederlandse Stichting Zuivel voor Voeding en Gezondheid
dc.date.accessioned	2017-06-21T11:01:25Z
dc.date.available	2017-06-21T11:01:25Z
dc.date.issued	2016-04-21
dc.description.abstract	Background: Ambiguity exists regarding the effectiveness of workplace dietary interventions. Rigorous process evaluation is vital to understand this uncertainty. This study was conducted as part of the Food Choice at Work trial which assessed the comparative effectiveness of a workplace environmental dietary modification intervention and an educational intervention both alone and in combination versus a control workplace. Effectiveness was assessed in terms of employees’ dietary intakes, nutrition knowledge and health status in four large manufacturing workplaces. The study aimed to examine barriers to and facilitators of implementing complex workplace interventions, from the perspectives of key workplace stakeholders and researchers involved in implementation. Methods: A detailed process evaluation monitored and evaluated intervention implementation. Interviews were conducted at baseline (27 interviews) and at 7–9 month follow-up (27 interviews) with a purposive sample of workplace stakeholders (managers and participating employees). Topic guides explored factors which facilitated or impeded implementation. Researchers involved in recruitment and data collection participated in focus groups at baseline and at 7–9 month follow-up to explore their perceptions of intervention implementation. Data were imported into NVivo software and analysed using a thematic framework approach. Results: Four major themes emerged; perceived benefits of participation, negotiation and flexibility of the implementation team, viability and intensity of interventions and workplace structures and cultures. The latter three themes either positively or negatively affected implementation, depending on context. The implementation team included managers involved in coordinating and delivering the interventions and the researchers who collected data and delivered intervention elements. Stakeholders’ perceptions of the benefits of participating, which facilitated implementation, included managers’ desire to improve company image and employees seeking health improvements. Other facilitators included stakeholder buy-in, organisational support and stakeholder cohesiveness with regards to the level of support provided to the intervention. Anticipation of employee resistance towards menu changes, workplace restructuring and target-driven workplace cultures impeded intervention implementation. Conclusions: Contextual factors such as workplace structures and cultures need to be considered in the implementation of future workplace dietary interventions. Negotiation and flexibility of key workplace stakeholders plays an integral role in overcoming the barriers of workplace cultures, structures and resistance to change.	en
dc.description.sponsorship	Health Research Board (Centre for Health & Diet Research grant HRC2007/13; Health Services Research Grant No. PHD/2007/16; Research Leader Award in Diabetes RL/2013/7)	en
dc.description.status	Peer reviewed	en
dc.description.version	Published Version	en
dc.format.mimetype	application/pdf	en
dc.identifier.articleid	139
dc.identifier.citation	Fitzgerald, S., Geaney, F., Kelly, C., McHugh, S. and Perry, I. J. (2016) ‘Barriers to and facilitators of implementing complex workplace dietary interventions: process evaluation results of a cluster controlled trial’, BMC Health Services Research, 16, 139 (13pp). doi: 10.1186/s12913-016-1413-7	en
dc.identifier.doi	10.1186/s12913-016-1413-7
dc.identifier.endpage	13
dc.identifier.issn	1472-6963
dc.identifier.journaltitle	BMC Health Services Research	en
dc.identifier.startpage	1
dc.identifier.uri	https://hdl.handle.net/10468/4128
dc.identifier.volume	16
dc.language.iso	en	en
dc.publisher	BioMed Central	en
dc.relation.uri	https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1413-7
dc.rights	© 2016, Fitzgerald et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.	en
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	en
dc.subject	Process evaluation	en
dc.subject	Implementation	en
dc.subject	Facilitators	en
dc.subject	Barriers	en
dc.subject	Workplace dietary intervention	en
dc.title	Barriers to and facilitators of implementing complex workplace dietary interventions: Process evaluation results of a cluster controlled trial	en
dc.type	Article (peer-reviewed)	en