Testing tools to support the A Better Choice Strategy Implementation: the CREATE study.

A multi-site pilot randomised controlled trial (RCT) to test implementation tools to support healthy food environments in commercial food outlets in public Queensland Hospitals. The primary aim of this pilot study is to assess the feasibility and acceptability of conducting a RCT to evaluate the ‘CREATE’ intervention in Queensland health services, and to inform the primary outcome measures and sample size for the full RCT. A 6-month, parallel-arm, 1:1 pilot RCT will be conducted in 7 Hospital and Health Services (HHS) in Queensland. The proposed intervention CREATE (Co-designed Retail Tools for healthier food Environments) will support food retail outlets in healthcare facilities in improve the healthiness of the food environment through targeting: (1) retailer capability to make changes that are feasible, acceptable to customers, and financially viable; and (2) specialised support from health promotion practitioners who understand the complexities of the retail business context. These capabilities are supported by the two key intervention components: A Retailer Toolkit and Practitioner Training which have been co-designed with end-users. The purpose of the intervention is to support the implementation of The A Better Choice Food and Drink Supply Strategy for Queensland Healthcare facilities (“A Better Choice” Strategy). A Better Choice Strategy aims to increase the provision of healthy food and drinks for staff, visitors, and patients within Queensland hospital and health services (HHS). A Better Choice Strategy uses a traffic light system to categorise food and drinks into ‘green’ (best nutritional value), ‘amber’ (some nutritional value) and ‘red’ (limited or no nutritional value). A Better Choice Strategy sets targets for the availability of each of these categories in order to create a healthier food environment. The target for food retail outlet drinks is having 0% red classified (as per the Queensland ‘A Better Choice Food and Drink Classification Guide’) drinks, a maximum of 20% amber classified drinks that are artificially sweetened, a minimum of 50% of drinks classified green and the remainder either amber (non-artificially sweetened) or green. Similarly, the targets for food are red classified foods being less than 20% of foods available, and a minimum of 50% of available foods being classified as green. The project will be conducted in collaboration with Health and Wellbeing Queensland (HWQld), an independent statutory body of the Queensland Government who are leading the implementation of the A Better Choice Strategy. Summary of CREATE intervention components to be delivered A) Introduction to the Toolkit- this is an introductory phase where the retailers and practitioners are familiarised with the retailer and toolkit. Who receives it: Retailers and Practitioners Rationale: To provide an overview of the project and the resources to be provided. Procedures including length of session and who will deliver: 1 hour, Research team. Delivery (format and location): Online real time via zoom. When and how much: Beginning of intervention (once). B) Introduction to the Practitioner training- - this step is where the participating practitioners are provided an online training understand the toolkit and support the ABC implementation strategy. The practitioner in our study is defined as a health promotion practitioner who could be a dietitian, health promotion officer, health promotion manager, or other staff member tasked with the roll out, implementation and /or support of the A Better Choice Strategy within a Hospital and Health Service. Who receives it: Practitioners Rationale: Have a shared practitioner training session for above. Or could be module 1 with helpline. Procedures including length of session and who will deliver: 1 hour, Research team. Delivery (format and location): Online real time via zoom. When and how much: Beginning of intervention (once). C) Environment audit and feedback to retailers – with practitioner- this is the photo audit of participating retail outlet where the information about the healthiness of the outlet is captured. This will be done by capturing their food display, advertising or campaigns, food menu etc. Who receives it: Retailers and Practitioners Rationale: Understand, communicate, and make an action plan. Material: FoodChecker Reports Procedures including length of session and who will deliver: 1 hour, Research team. Delivery (format and location): Over phone and FoodChecker Reports. When and how much: Beginning of intervention and during follow-up at 6 months. D) Retailer toolkit to retailers- This toolkit will guide retailers through the steps for success to roll out the Healthy choices’ guidelines in their food outlet, providing customers, staff, and managers with a unique food offering. Toolkit – it is an adaptation of the toolkit produced in Victoria* Who receives it: Retailers Rationale: Detailed step-by-step instructions tailored to retailers in QLD hospital settings on how to implement the policy. Material: PDF toolkit including rationale and 5 key steps for changes. Procedures including length of session and who will deliver: As required. Delivery (format and location): Online – email or website for download. When and how much: Beginning of intervention (once). *Source- M, Annois B, Johnson K, Livaditis C, Blake MR, Boelsen-Robinson T, Hedley J, Rosewarne E, Hobbs V. Healthy Retail Toolkit, February 2023. Nourish Network: Melbourne, 2023 E) Practitioner training- it is an interactive training specially designed for the study to support the practitioners in assisting the retailer to implement the A Better Choices (ABC) Strategy to be compliant. Who receives it: Practitioners Rationale: Match practitioner training to Toolkit – steps are mirrored. Training self-paced and in modules. Material: Teaching Practitioners how to support use of Toolkit. Procedures including length of session and who will deliver: 5-10 hours, as required. Delivery (format and location): Online – email or website for download. When and how much: NA F) Newsletter- Periodic updates on the study shared in form of an online newsletter. Who receives it: Retailers and Practitioners Rationale: Updates on what is happening to maintain engagement. Material: Online mail. Procedures including length of session and who will deliver: NA Delivery (format and location): Email update. When and how much: Every month.