Stakeholder Perspectives on Implementing Menu Labeling in a Cafeteria Setting.

OBJECTIVES Mandatory and voluntary menu-labeling policies are increasingly common to support informed food choices among consumers. This study sought to examine stakeholder perspectives of developing, implementing, and maintaining a voluntary menu-labeling program in a hospital cafeteria setting. METHODS Semi-structured qualitative interviews were conducted with 9 key cafeteria stakeholders. Data were coded by 2 independent researchers. Themes were generated deductively around 4 key themes: (1) motivation for the program; (2) program and menu development; (3) program implementation process; and, (4) "lessons learned," and inductively as they emerged from interview transcripts. These themes were mapped onto Damschroder's Consolidated Framework for Implementation Research. RESULTS Motivations for the program were both internal and external to enable consumers to make educated food choices. Barriers to implementation included financial resources, digital menu board maintenance, and availability of healthy options from providers. Supports included availability of nutritional analysis software and nutritional information, and controlled food preparation. Ownership, program adaptation, a supportive collegial environment, a program champion and a culture valuing healthy eating were conducive to successful implementation. CONCLUSIONS Both internal and external factors can support the voluntary implementation of menu-labeling programs.