Choosing Healthier Eating Options at Work and School
Choosing Healthier Eating Options at Work and School
Recent national statistics revealed that the prevalence of lifestyle related diseases is
 increasing in Singapore. Much of this disease burden can be prevented using lifestyle
 strategies. A large proportion of Singaporeans consume foods prepared by outside vendors.
 These foods are typically high in refined-grains and saturated fat, and choices for healthier
 foods like brown-rice often do not exist. The Healthier Dining Program managed by the Health
 Promotion Board of Singapore, seeks to assess if increasing the availability of healthier
 food options increases consumer consumption of these foods. The investigators aim to evaluate
 this program implemented on the National University of Singapore campus. A major output of
 this evaluation will be the assessment of the barriers and enablers to programme
 implementation which will provide guidance for the widespread implementation of the
 programme. Additionally this evaluation can lead to detailed recommendations on policies and
 programmes relevant to non-home food environments. This is important as successful
 interventions have the potential of improving the eating behaviors of a vast majority of the
 population.
The evaluation will use a cluster randomized controlled design in 3 test NUS eateries with 3
 control eateries that are matched on type (canteen or food court) and on similarity of
 students/staff that it typically serves (example: consumers from arts or sciences faculties).
 It will include both process evaluation and outcome evaluation components. The primary
 purpose of the process evaluation will be to understand the enablers or barriers to programme
 implementation which will help to adjust the programme as it is being implemented and to
 assess whether the intervention elements are being implemented as planned. The primary
 purpose of the outcome evaluation will be to assess if healthier options are available and if
 consumers are buying these healthier options. The investigators will triangulate data sources
 and use both quantitative and qualitative data to inform this evaluation.

 Specific aims include

 1. To conduct a process evaluation of the Healthier Dining Program (HDP) by assessing the
 reach, fidelity, dose delivered, dose received, and by examining the contextual barriers
 and facilitators towards the Healthier Dining Program implementation at NUS

 2. To assess the effects of the HDP on the knowledge, attitudes, and behavior of hawkers
 and consumers regarding healthier food options

 3. To conduct a cost effectiveness evaluation of the HDP

 4. To model the impact of changes in dietary intakes ascribed to the HDP intervention, on
 the incidence of type-2 diabetes and cardiovascular diseases in Singapore using
 statistical modeling and computer simulation

 A total of 408 consumers at baseline and 10 weeks after the intervention (68 persons per
 cluster, 34 staff and 34 students) will be interviewed. The sample size was computed based on
 a proportion difference of 40 % (5 % in the control centers and 45% in the intervention
 centers) of consumers who eat healthier foods at least once per week. Healthier foods include
 wholegrain foods, less sugar/ healthier choice symbol (HCS) beverage and reduced calorie
 meals, foods that are being targeted by the programme. A power of 0.8,a two-sided alpha of
 0.05, an intra-cluster correlation of 0.15, and a drop-out rate of 25 % for consumers was
 assumed. Centers will be matched based on type (canteen or food court) and on similarity of
 students/staff that it typically serves (example; consumers from arts or sciences faculties)
 and will be randomized to either the intervention or control group. All eligible and
 consenting hawkers at the NUS canteens and food courts in the study will interviewed
 (approximately 15 per center, for a total of 90 hawkers).
Inclusion Criteria:

 -  Food vendors:

 21 years or older Must be stall owner or decision maker

 -  Consumers 18 year or older (NUS students) or 21 years or older Frequent consumers of
 foods at NUS canteens or foodcourts

 Exclusion criteria:

 -  Consumers:

 -  Persons unlikely to be on campus during the follow-up interviews