Table 2

Overview of theory-based methods and practical strategies to be used in community health centre (CHC) canteen-based intervention

Level of the interventionTheory-based methodsPractical strategies informed by focus groups
IndividualEducationMany employees expressed the sentiment that as medical professionals, ‘we know what we should know’ (focus group, site A, female physicians). Further interventions targeting nutrition knowledge on effects of specific nutrients (eg, oil and salt) may not yield much effect.
However, when asked about whether weight control was important, one focus group member remarked: ‘No one here needs to lose weight; we need to gain weight ’ (focus group, site A, male physicians). Interestingly, for this group of male physicians, 50% were overweight, indicating a lack of awareness for risk of overweight. Additional information on the health effects of genetically modified foods and on added sugars may also be helpful in shaping food choices.
OrganisationFacilitationDietitian involved in menu planning. For example: ‘Things like calories, food composition, it’s impossible for me to look into these details. I’m not specialized in canteen management, nor am I a nutritionist; I wasn’t trained in this way’ (interview, site A, canteen manager). And: a dietitian ‘will supervise the use of oil, salt, and sugar’ (focus group, site A, male physicians), ‘enrich the variety’ (focus group, site A, female nurses) and ‘design a nutritional meal plan’ that employees ‘can even learn from’ (focus group, site A, female physicians).
Skilled chef involved in menu planning. For example: at site B, a chef with a level 2 culinary certificate cooks at the canteen. Both the CHC and canteen managers recognised that cooking skill of the chef was a main determinant for employee satisfaction, and in all focus groups, employees expressed their satisfaction with the taste of canteen food.
Increase subsidy for specific items, as has been done previously for non-genetically modified oil at site A. Target fruits, yoghurts and whole grains. For example: ‘Instead of increase the budget of 1 CNY to improve the dish, we would rather choose to have that for fruits or yogurts. If the budget goes directly to certain food, it’s more acceptable’ (interview, site A, CHC manager).
Media advocacyAdvertising changes to menu in terms of ‘eating well not ‘ healthfulness’.
Coalition formingCreate organisation-level coalition of canteen manager, CHC administrator and employee representatives to collect feedback on specific menus, leveraging social media and mobile technology. For example, employees argued that waste can be minimised if people’s preferences for specific choices could be predetermined: ‘If they have more type of dishes. I don’t mind of getting less quantity. It won’t be a waste like this. They should ask what people like roughly’ (focus group, site B, female physicians).