Exploring the barriers and facilitators of continuous quality improvement for health promotion within healthcare food environments.

IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES
Laura J Kennedy, Meaghan Sim, Jeanna Parsons Leigh, Sara F L Kirk, Catherine L Mah
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Abstract

Continuous quality improvement (CQI) has become a widely accepted approach to optimize health services while lowering healthcare costs (Quintuple Aim) and has expanded from clinical interventions to health promotion. Retail food environments (e.g. hospital cafeterias, cafes) are of interest given the increased adoption of healthy eating policies and interventions to influence diet (e.g. price, promotion, placement and product). However, there is a lack of understanding of what organizational and policy processes are necessary to implement CQI for health promotion in healthcare. This research uses a qualitative multiple exploratory case study design to explore the barriers and facilitators of CQI for health promotion in healthcare retail food environments. This research occurred in a healthcare setting with an organizational Healthy Eating Policy applicable to staff, patients and visitors. We collected semi-structured interview data with 12 healthcare staff working in Nutrition & Food Services in a Canadian provincial health authority from January to June 2023. We used directed content analysis to analyze the data. We used the Inside out model to interpret cross-cutting organizational barriers and facilitators. Four cases of quality improvement interventions (Plan-Do-Study-Act (PDSA) cycles) were identified. Barriers included expertise to interpret nutrient criteria, lack of data, conflicting benchmarks (e.g. finance and health), third-party vendors, past negative experiences, and a lack of time to monitor and evaluate. Facilitators included an organizational Healthy Eating Policy, understanding community context, local knowledge, partnerships with researchers and leadership. This study revealed how overarching policies, accompanied by organizational support, facilitated quality improvement and engagement in CQI but also created barriers to routine practice and sustainability of health-promoting interventions.

探索在保健食品环境中促进健康的持续质量改进的障碍和促进因素。
持续质量改进(CQI)已成为一种广泛接受的方法,以优化卫生服务,同时降低医疗保健成本(五项目标),并已从临床干预扩大到健康促进。鉴于越来越多地采用健康饮食政策和干预措施来影响饮食(如价格、促销、位置和产品),零售食品环境(如医院自助餐厅、咖啡馆)值得关注。然而,对于在医疗保健领域实施CQI促进健康所必需的组织和政策流程,人们缺乏了解。本研究采用定性多元探索性案例研究设计,探讨CQI在医疗保健零售食品环境中促进健康的障碍和促进因素。本研究发生在一个医疗保健机构,该机构的健康饮食政策适用于工作人员、病人和访客。我们从2023年1月至6月收集了加拿大省级卫生当局营养与食品服务部门的12名卫生保健人员的半结构化访谈数据。我们使用定向内容分析来分析数据。我们使用Inside - out模型来解释跨部门的组织障碍和促进因素。确定了四个质量改进干预措施(计划-执行-研究-行动(PDSA)循环)。障碍包括解释营养标准的专门知识、缺乏数据、相互冲突的基准(例如财务和卫生)、第三方供应商、过去的负面经验以及缺乏监测和评估的时间。促进因素包括组织健康饮食政策、了解社区背景、当地知识、与研究人员和领导层的伙伴关系。这项研究揭示了总体政策在组织支持的陪同下如何促进CQI的质量改进和参与,但也为常规实践和健康促进干预的可持续性创造了障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health Promotion International
Health Promotion International Medicine-Public Health, Environmental and Occupational Health
CiteScore
4.70
自引率
7.40%
发文量
146
期刊介绍: Health Promotion International contains refereed original articles, reviews, and debate articles on major themes and innovations in the health promotion field. In line with the remits of the series of global conferences on health promotion the journal expressly invites contributions from sectors beyond health. These may include education, employment, government, the media, industry, environmental agencies, and community networks. As the thought journal of the international health promotion movement we seek in particular theoretical, methodological and activist advances to the field. Thus, the journal provides a unique focal point for articles of high quality that describe not only theories and concepts, research projects and policy formulation, but also planned and spontaneous activities, organizational change, as well as social and environmental development.
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