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BMC Public Health. 2012; 12: 376.
Published online May 25, 2012. doi:  10.1186/1471-2458-12-376
PMCID: PMC3490726
Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study
Dana Lee Olstad,1,2,3 Kim D Raine,1,3 and Linda J McCargarcorresponding author1,2
1Alberta Institute for Human Nutrition, 4-126 Li Ka Shing Centre, 8606 112 St, University of Alberta, Edmonton, AB T6G 2E1, Canada
2Department of Agricultural, Food and Nutritional Science, 4–10 Agriculture/Forestry Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
3Centre for Health Promotion Studies, 3–300 ECHA, 11405 87 Ave, University of Alberta, Edmonton, AB T6G 1C9, Canada
corresponding authorCorresponding author.
Dana Lee Olstad: dana.olstad/at/ualberta.ca; Kim D Raine: kim.raine/at/ualberta.ca; Linda J McCargar: linda.mccargar/at/ualberta.ca
Received March 6, 2012; Accepted May 2, 2012.
Abstract
Background
Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them.
Methods
We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools.
Results
The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY.
Conclusions
ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.
Keywords: Childhood obesity, Food environment, Recreational facility, Diffusion of Innovations, Mixed methods, Case study, Nutrition guidelines, Adoption, Implementation
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