• Nicholes J Armstrong, Erik E Serrano, Renee E Cole, Asma S Bukhari, and Julianna M Jayne.
• Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.
• Mil Med. 2021 Nov 2; 186 (11-12): e1129-e1134.

IntroductionInterventions that encourage good nutrition-related behaviors in the dining environment can potentially influence the health of large numbers of military personnel. Thus, the Army has studied the effectiveness of implementing nutrition education and dining facility (DFAC) changes that included healthier recipes, revised menus, and population-specific point-of-choice labeling, but successful intervention implementation largely depends on the foodservice employees' understanding, knowledge, and desire to sustain changes. This phenomenological, qualitative study aimed to better understand common barriers to the implementation and sustainment of DFAC-based nutrition interventions at two U.S. Army DFACs.Materials And MethodsFocus group sessions (n = 168 participants) ranging from 60 to 90 minutes in length were conducted at two large DFACs on three separate occasions every 4 months from May 2015 to January 2016 among the foodservice staff during intervention implementation. Focus group transcripts were analyzed using NVivo 11 software. Researchers conducted multiple rounds of coding following an iterative process until four principal themes emerged.ResultsPrincipal themes related to the foodservice employees' experience during the nutrition intervention revealed barriers to a successful implementation related to (1) nutrition knowledge deficits, (2) inadequate culinary training, (3) poor management practices, and (4) low staff morale.ConclusionA lack of foodservice staff training and education is a significant contributor to implementation barriers. Future interventions should increase engagement with foodservice employees during intervention planning and implementation phases with a structured and tailored nutrition education and culinary skill training program. Addressing these barriers may enhance staff morale and promote intervention adherence.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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