Combined environmental and educational intervention in hospital food service to increase patients attitude and intention about a healthy diet

Abstract Funding Acknowledgements Type of funding sources: None. Background The elimination of unhealthy risk behaviors such as unhealthy diet, smoking or physical inactivity can prevent at least 80% of cardiovascular disease.(1) Diet has been the number two in modifiable factors attributing to cardiovascular disease burden in the last thirty years.(2) In spite of this, adherence to dietary guidelines in The Netherlands is as low as 20-30%.(3) Clearly, more effective strategies towards healthier dietary behavior are needed.(1) According to the dual process theory, behavior can be influenced via the deliberate system and the intuitive system.(4) The food services on the cardiology ward were revised aiming to influence both systems in admitted patients to gear them towards healthier choices. Purpose To assess the impact of a combined environmental and rational intervention on patients’ attitude and intention towards a healthier diet. Methods A pre-post interventional study was conducted from June 2020 till November 2021 in patients admitted to the Cardiology ward. Patients’ attitude, self-efficacy and intention towards a healthy diet were evaluated through the validated Dietary Intention Evaluation Tool for In-hospitalized patients (DIETI). The intervention was aimed at intuitive and rational behavioral processes. The intuitive part consisted of posters, healthy standard options and a traffic light system on the menu. The rational part consisted of information about a healthy diet on the menu, emphasis on the importance of a healthy diet, a renewed website on lifestyle and an educational course on diet and nudging for nurses and food service employees. Also, at discharge, patients received two salt free spice mixes with healthy, easy and cheap recipes to prepare at home. Results A total of 512/853 (60%) complete responses were received. The intervention group reported to have learned significantly more during their admission than patients in the control group (4.58 vs. 4.80, p=0.009). However, our intervention does not influence patients’ attitude or intention regarding a healthy diet (p=0,41 and p=0,49 respectively). Conclusions A hospital admission of approximately 3 days is enough to make a significant impact on patients’ perceived learning. However, a combined environmental and educational intervention did not have an effect on patients’ attitude or intention regarding a healthy diet.