Choosing Healthier Eating Options at Work and School

Recent national statistics revealed that the prevalence of lifestyle related diseases is increasing in Singapore. Much of this disease burden can be prevented using lifestyle strategies. A large proportion of Singaporeans consume foods prepared by outside vendors. These foods are typically high in refined-grains and saturated fat, and choices for healthier foods like brown-rice often do not exist. The Healthier Dining Program managed by the Health Promotion Board of Singapore, seeks to assess if increasing the availability of healthier food options increases consumer consumption of these foods. The investigators aim to evaluate this program implemented on the National University of Singapore campus. A major output of this evaluation will be the assessment of the barriers and enablers to programme implementation which will provide guidance for the widespread implementation of the programme. Additionally this evaluation can lead to detailed recommendations on policies and programmes relevant to non-home food environments. This is important as successful interventions have the potential of improving the eating behaviors of a vast majority of the population.

The evaluation will use a cluster randomized controlled design in 3 test NUS eateries with 3 control eateries that are matched on type (canteen or food court) and on similarity of students/staff that it typically serves (example: consumers from arts or sciences faculties). It will include both process evaluation and outcome evaluation components. The primary purpose of the process evaluation will be to understand the enablers or barriers to programme implementation which will help to adjust the programme as it is being implemented and to assess whether the intervention elements are being implemented as planned. The primary purpose of the outcome evaluation will be to assess if healthier options are available and if consumers are buying these healthier options. The investigators will triangulate data sources and use both quantitative and qualitative data to inform this evaluation.

Specific aims include

1. To conduct a process evaluation of the Healthier Dining Program (HDP) by assessing the reach, fidelity, dose delivered, dose received, and by examining the contextual barriers and facilitators towards the Healthier Dining Program implementation at NUS
2. To assess the effects of the HDP on the knowledge, attitudes, and behavior of hawkers and consumers regarding healthier food options
3. To conduct a cost effectiveness evaluation of the HDP
4. To model the impact of changes in dietary intakes ascribed to the HDP intervention, on the incidence of type-2 diabetes and cardiovascular diseases in Singapore using statistical modeling and computer simulation

A total of 408 consumers at baseline and 10 weeks after the intervention (68 persons per cluster, 34 staff and 34 students) will be interviewed. The sample size was computed based on a proportion difference of 40 % (5 % in the control centers and 45% in the intervention centers) of consumers who eat healthier foods at least once per week. Healthier foods include wholegrain foods, less sugar/ healthier choice symbol (HCS) beverage and reduced calorie meals, foods that are being targeted by the programme. A power of 0.8,a two-sided alpha of 0.05, an intra-cluster correlation of 0.15, and a drop-out rate of 25 % for consumers was assumed. Centers will be matched based on type (canteen or food court) and on similarity of students/staff that it typically serves (example; consumers from arts or sciences faculties) and will be randomized to either the intervention or control group. All eligible and consenting hawkers at the NUS canteens and food courts in the study will interviewed (approximately 15 per center, for a total of 90 hawkers).

Eligibility Criteria:
Inclusion Criteria:

* Food vendors:

  21 years or older Must be stall owner or decision maker
* Consumers 18 year or older (NUS students) or 21 years or older Frequent consumers of foods at NUS canteens or foodcourts

Exclusion criteria:

* Consumers:
* Persons unlikely to be on campus during the follow-up interviews