strategies and willingness of rural restaurateurs to promote healthy foods

Strategies and Willingness of Rural Restaurateurs to Promote Healthy FoodsAuthor(s): Wendy BensonSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 86, No.3 (MAY / JUNE 1995), pp. 181-184Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41991279 .

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Strategies and Willingness of Rural

Restaurateurs to Promote Healthy

Foods

Wendy Benson, MPH, RD

ABSTRACT

Nutritionists need to understand the willingness of restaurateurs to prepare and sell healthy foods, as Canadians frequently eat meals at food services. The lunch trade restaurants under the jurisdiction of a rural and semi-rural Alberta health unit were surveyed by telephone. Two thirds of the restaurants were family-style and had 100 seats or fewer. Five of 20 healthy foods were rated as difficult to serve, due to: lack of customer demand; lack of food availability; and the need to maintain the quality of fresh vegetables, fruits and milk products. Many restaurateurs are willing to change internally by training staff (88%) and by trying new recipes (84%). Staff education materials perceived to be helpful by 80% of restaurateurs included video/audio tapes, information sheets and posters. Restaurateurs were most willing to use menu inserts (76%), table tents (68%) and door decais (72%) to promote healthy foods. Nutrition services should focus on how restaurants can make changes to include healthy foods through food preparation and menu items.

ABRÉGÉ

Les restaurateurs veulent preparer et vendre de la nourriture saine étant donné que les Canadiens ont souvent recours aux services de restauration; les nutritionnistes doivent le com- prendre. Une enquête téléphonique a été réa- lisée auprès des restaurants servant les repas de midi sous la juridiction d'une unité de santé rurale et semi rurale en Alberta. Deux tiers des établissements étaient des restaurants de type familial pouvant accueillir au maximum 100 personnes. Sur 20 repas sains, cinq ont été jugés difficiles à préparer pour plusieurs raisons : pas de demande de la clientèle; problèmes d'appro- visionnement au niveau des ingrédients; néces- sité de maintenir la qualité des fruits et des légumes frais ainsi que des produits laitiers. Il existe chez les restaurateurs une grande volonté de changer les pratiques de restauration par la formation du personnel (88 p. 100) et par la préparation de nouvelles recettes (84 p. 100). Les matériels de formation du personnel jugés utiles par 80 p. 100 des restaurateurs compren- nent les bandes audio-visuelles, les affiches et les feuillets d'informations. Les restaurateurs étaient tout à fait prêts à glisser des encarts dans les menus (76 p. 100), à poser des dépliants rigides sur les tables (68 p. 100) et à mettre des autocollants sur leurs portes (72 p. 100) pour promouvoir une alimentation saine auprès de leur clientèle. Les services de nutrition devraient porter leur attention sur la façon dont les éta- blissements de restauration peuvent changer les choses en incluant des denrées alimentaires saines dans la préparation des repas qu'ils ser- vent ainsi que dans le choix» de leurs menus.

The frequency with which foods are eaten away from home appears to have been steady through the early 1990s, with 73% of Canadians having eaten out in the previous week and 33% within the previous 48 hours of being surveyed.1 The high frequency of meals eaten away from home can affect the nutritional status of an indi- vidual. As the number of meals women eat away from home increases, the total and saturated fat content of the diet increases and the amount of calcium, vitamin C, folacin and fibre decreases.2,3 This shift in nutrients is inconsistent with Nutrition Recommendations for Canadians i for lower- ing the risk for chronic diseases. Nutrition professionals need to determine the poten- tial for increasing healthy foods in restaurants in a public health context.

In marketing theory, the emphasis is on "beneficial exchanges" between restaurateurs and nutritionists.5 It is important to understand the wants and needs of the restaurateur to achieve the goal of wider availability of healthy foods. There has been some research on the perspective of urban restaurateurs on nutrition initiatives.6"8

The present descriptive research deter- mined what lunch trade restaurateurs under the jurisdiction of a rural and semi- urban Alberta Health Unit are willing and able to do to increase the sales of healthy foods, their priority for selling healthy foods, the healthy foods available in the restaurants, and the degree of difficulty in serving the foods.

Correspondence and reprint requests: Wendy Benson, Nutrition Division, Calgary Health Services, Box 4016, Station C, Calgary, AB, T2T 5T1, Tel. (403) 228-7420, Fax. (403) 229-1130

METHODS

The Licensed Food Premises List from the Environmental Health Program of the former Mount View Health Unit was used as a basis for sampling restaurateurs in the area. From the 600 licensed food service premises north and west of Calgary, Alberta, 67 were identified as restaurants with a strong lunch trade, open to the gen- eral public or club members more than two days a week. Fast food restaurants, bakeries and convenience stores were excluded from the sample.

Six restaurants were contacted to pilot the survey instrument. Of the 61 remain- ing restaurants, 31 were selected systemati- cally. Fifty percent of the restaurants were selected to ensure that restaurants were proportionally represented across the health unit while survey time was mini- mized.

For the purposes of this survey, healthy foods were defined as foods that are consistent with Canada's Guidelines for Healthy Eating.4 The specific healthy foods or methods for preparing healthy foods included in the survey were adapted from the Heart Smart Food Choices Program for Restaurants developed by the Heart Smart Committee, Heart and Stroke Foundation of Alberta (Figure 1).

The survey instrument was developed to achieve content and face validity. Two drafts were piloted with restaurant owners or managers by telephone. Questions were revised when respondents did not answer relevantly or when they had other suggestions for wording. There were few changes between the second draft and the final instrument, except to add "use menu inserts describing healthy foods" as a strategy to increase customer awareness.

MAY -JUNE 1995 CANADIAN JOURNAL OF PUBLIC HEALTH 181



HEALTHY FOOD PROMOTION BY RURAL RESTAURATEURS

The restaurant owner, manager or chef was telephoned between 1:30 and 3:30 p.m., Monday to Friday, over a three- week period in May and June, 1992. The intent was to talk to the person in the food service responsible for planning the menu and purchasing the foods. To foster consistency in data collection, the Community Nutritionist was the only person surveying restaurants. Three attempts were made to talk to each restaurateur before a non- response was recorded. The surveys were reviewed for missing information. If 33% or more of the questions were not answered, the survey was excluded from analysis.

The research is descriptive in nature and the data are reported by percentage.

RESULTS

There were 27 (73%) telephone surveys completed from the sample of 37 restaurants. Four of the surveys used the second pilot survey instrument. Twenty-five surveys provided complete data for analysis, for a response rate of 68%.

Restaurant characteristics are detailed in Figure 2.

In Table I the availability and degree of difficulty of serving the healthy foods are summarized. The reason for a restaurant not serving some menu items tended to be that they were sandwich, submarine and/or pizza restaurants without conventional ovens or deep fat fryers.

Overall, there were 42 comments indicating that a food was available on request. Half of these comments were for salad dressings on the side and half for milk as a substitute for cream in coffee or tea. Five of the 20 healthy foods were difficult to serve for 10% or more of the restaurateurs.

The restaurateurs were probed on why foods were easy or difficult to offer. For the four foods most frequently reported as difficult to serve the reasons were varied. For fresh fruit, the most common concern (n = 4) was maintaining quality while promoting adequate sales. For calorie-reduced salad dressings, nine (36%) respondents commented that they could carry different salad dressings if there was customer demand. Storage and increased inventory were frequently articulated reasons (n = 4)

Upon request, the restaurant will have available: - 2%, 1 % or skim milk as a beverage, or for adding to tea or coffee - fat-trimmed meats and skinned poultry - broiled, roasted, steamed or poached foods rather than sautéed or fried - foods prepared with vegetable oils and margarine made from sunflower,

safflower, corn, canola, soybean, peanut or olive oil - entrées or side dishes prepared without added salt or MSG (monosodium

glutamate) - smaller portions (i.e., 4-6 oz. or 1 20-1 80 g) of cooked meat, fish or poultry - gravies, sauces, salad dressings, butter or margarine on the side - margarine made from vegetable oils for table use (margarine should contain at

least 40-55% polyunsaturated fat) - salad, potatoes, rice or vegetables as a substitute for french fries - fat-reduced salad dressings instead of "regular" salad dressings - whole grain breads and cereals - lower-fat desserts such as angel food cake, sherbet and fruit

Figure 1. Heart Smart Food Choices Program.

TABLE I Healthy Foods Available and Difficulty in Serving Them

Number of Restaurants Restaurants Restaurants Offering Rating Item "a little" Deeming Item Food and ''very" Difficult Appropriate to Serve

Healthy Foods N % N % Milk for a beverage:

2% 25 23 92 Not 1% 25 1 4 Applicable skim milk 25 2 8

Milk substituted for cream for 25 21 84 3 12 coffee or tea

Soup, salads or vegetables 22 22 88 1 4 substituted for french fries

Sauces served on the side: gravies 20 1 8 72 0 0 salad dressing 25 25 100 1 4 other sauces 21 20 80 0 0

Butter or margarine on the side 25 25 100 0 0 Whole wheat breads or buns 25 21 84 2 8 Calorie-reduced salad dressings 25 6 24 4 16 Fresh fruit for desserts 24 16 64 7 28

4 to 6 oz. portions of meat, 25 20 80 3 12 fish or poultry

Fat removed from : poultry 22 21 84 1 4 meats 23 23 92 1 4

Broiled, roasted, steamed or poached: entrées 23 22 88 0 0 potatoes or vegetables 22 20 80 0 0

Entrées or side dishes prepared without: added salt 25 13 52 1 4 added MSG 25 15 60 1 4

Legumes offered as soups or casseroles 24 17 68 3 12

1 82 REVUE CANADIENNE DE SANTÉ PUBLIQUE VOLUME 86, NO. 3




Figure 2. Characteristics of restaurants surveyed on healthy food promotion, by number and percentage.

TABLE II Willingness of Restaurateurs to Use Strategies to Promote Healthy Foods

Strategy "Definitely" and "Might Consider" N %

Describe cooking methods on the menu 1 3 52 Use menu inserts describing healthy foods 16 76* Try new healthy recipes 21 84 Use placemats to advertise healthy foods 1 0 40 Use table tents to advertise healthy foods 1 7 68 Use door decais to say healthy foods are sold here 1 8 72 Use posters to advertise healthy foods 1 2 48 Train cooks and waiting staff to prepare and sell healthy foods 22 88 * There were 21 responses to this question, as it was added between the second draft and final

survey instrument.

for difficulty with calorie-reduced salad dressings. While only three restaurateurs (12%) described four to six ounces of meat, fish or poultry as difficult to serve, 16 comments were received about the difficulty of serving smaller portions. Limitations included the need to provide "a lot of food" for value (n = 4), customers' preferences for 8 oz. or more per serving

(n = 2) and use of pre-portioned meats (n = 1). Legumes included as soups or casseroles were the least difficult when served as a daily special (n = 6).

When a food was perceived as easy to serve, two themes became apparent: First, the food is available from the wholesaler or distributor. For example, offering skinless chicken was standard in seven restaurants

(28%) because it is shipped skinless. Second, the customer frequently orders the food or the substitute. All restaurants with french fries said a substitute was available, and five restaurateurs (20%) felt there were more requests for salads than fries.

In Table II the strategies that restaurateurs are willing to consider to increase the sales of healthy foods are summarized. The strategies restaurateurs are most receptive to are training cooks and staff, trying new healthy recipes and using menu inserts to describe healthy foods. Other strategies suggested by five restaurateurs included ongoing training of the restaurant staff by themselves.

Of the 22 restaurateurs (88%) who would consider staff training, 20 respond- ed to the questions. The data are summarized in Table III. Video or audio tape was a preferred format, 67% of respondents indicating a preference for borrowing the

MAY -JUNE 1995 CANADIAN JOURNAL OF PUBLIC HEALTH 183




materials. Group education, if conducted, was preferred either once or twice per year (46%) or three or more times per year (46%). A short presentation of one hour was preferred by eight (53%) of those interested in group education. Newsletters were not viewed as appropriate, and further analysis of the length and frequency of newsletters was not warranted because of the small numbers.

Subjects to be included in video or audio tapes, group education or information sheets or posters were as follows: • sources of calories, carbohydrates, pro-

teins, fats and cholesterol in foods; • healthy and unhealthy foods and the

alternatives; • incorporation of healthier foods on the

menu; • food preparation and storage recommen-

dations for healthy foods. Nineteen respondents (76%) indicated

that offering healthy foods was a medium or high priority to them. Eighteen (72%) indicated that they would like a nutritionist to provide services and help implement strategies to increase healthy food sales in restaurants.

DISCUSSION

This study has demonstrated the poten- tial for collaboration with rural and semi- rural Alberta restaurateurs to increase healthy food choices and has indicated what strategies to introduce for nutrition services. Restaurateurs stated that they would definitely consider trying new recipes (68%), training cooks and waiting staff (56%), and using door decais, table tents (36%) and menu inserts (33%).

Staff training is an important strategy in promoting successful changes in the restaurant industry. The Dine to your Heart's Content program found that 50% of restaurateurs and 82% of waiting staff thought more nutrition education was needed.6

Twenty-five percent of our sample vol- . unteered the suggestion that staff training was their responsibility. This strategy could be implemented through training at mandatory food handling classes, self- directed teaching packages, or restaurant chef or cooking courses. After training, the

key staff member could be supported in teaching consistent nutrition information with video or audio tapes, posters and/or information sheets.

The content of the training materials needs to be practical, with suggestions on how to incorporate healthy foods into the menu; what the healthy and unhealthy foods are; food preparation and storage recommendations; and sources of calories, carbohydrates, proteins, fats and cholesterol in food.

Public health nutrition professionals can collaborate with food commodity groups, the technical schools for cooks, the Canadian Federation of Chef de Cuisine, the Heart and Stroke Foundation and the Restaurant and Food service Associations to determine services, resources and information that might be helpful for program implementation.

The restaurant customer is perceived by the restaurateurs as an important link in the selling of healthy foods. There were 42 comments from 25 respondents indicating that a food was available if a restaurant customer requested it. In addition, one of the characteristics of healthy food that is easy to have available for restaurant customers was whether the demand for it by customers was high. To promote healthier foods to the restaurant customers, menu inserts were ranked highly. The To Your Heart's Delight program evaluation found there were difficulties with menu inserts, as they can fall off the menu cards.9 If promo- tional items such as menu inserts, door decais or table tents are used, they need to be flexible to meet the needs of a variety of restaurant decors and themes. Ways to motivate the restaurant customer to consis- tently order healthy food choices need to be researched.

In addition to increasing customer demand, the availability of certain foods from food manufacturers and wholesalers needs to be considered. Some healthy products are not yet routinely available in suitable package sizes for the commercial food services.

Further research is needed to identify barriers to and opportunities for promoting healthy foods as well as the roles and nutrition knowledge of food manufacturers, wholesalers, food distributors, restau-

TABLE III Preferred Training Formats

Training Format Restaurants in Favour N %

Video or audio tapes 1 6 80 Newsletters 8 40 Group Education 14 70 Information Sheets 16 80 Posters 1 6 80 Ongoing training by 5 25

the restaurant

rant cooks and chefs, the waiting staff and the restaurant customer. Future research should also assess the cost-effectiveness of selected restaurant strategies.

ACKNOWLEDGEMENTS

I thank Phyllis Hodges and Emily Alstad, both of whom contributed signifi- cantly to the development of the survey instrument.

REFERENCES

1. Garrett R (ed). 1993 Foodservice Facts. Toronto, ON: Canadian Restaurant and Foodservice Association, 1993.

2. Guenther P, Ricart G. Effects of eating at foodservice establishments on nutritional quality of women's diets. Top Clin Nutr 1989;4(2):4l-45.

3. Haines P, Hungerford D, Popkin B, Guilkey D. Eating patterns and energy and nutrient intakes of US women. J Am Diet Assoc 1992;92(6):698- 707.

4. Health and Welfare Canada. Nutrition Recommendations for Canadians. Ottawa, ON: Supply and Services Canada, 1990.

5. Kotler P, Andreasen A. Strategic Marketing for Nonprofit Organizations 4th Ed., Englewood Cliffs, NJ: Prentice-Hall, 1991;pe. 38.

6. Paul PM, Novascome MA, Ganern BC, Wimme PB. "Dine to Your Heart's Content": An assess- ment of the program in Virginia. J Am Diet Assoc 1989;89(6):817-20.

7. Petersen G, Elder J, Knisley P, et al. Developing strategies for food vendor intervention: The first step. J Am Diet Assoc 1986;86(5):659-61.

8. Sneed J, Burkhalter J. Marketing nutrition in restaurants: a survey of current practices and atti- tudes. J Am Diet Assoc 1991;91(4):459-62.

9. Forster-Coull L, Gillis D. A nutrition education for restaurant patrons. J Nutr Educ 1988;20:22B- 22C.

Received: September 28, 1994 Accepted: December 2, 1 994

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strategies and willingness of rural restaurateurs to promote healthy foods

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