Statewide dissemination of a rural, non-chain restaurant intervention: Adoption, implementation, and maintenance

Introduction: The restaurant setting offers an opportunity to encourage healthful choices. In previous work guided by the RE-AIM model, a simple intervention was tested in five non-chain restaurants. Table signs encouraged patrons to request healthy adjustments to their order such as smaller portions, and having meat broiled rather than fried. Results showed 70% of patrons noticed the signs (Reach), and 34% stated the signs affected their order (Effectiveness). The present study involved state-wide dissemination of this intervention to similar restaurants. Methods: Using a denominator of 100 restaurants identified from a state database, owners were recruited by mail and phone. Baseline telephone surveys were conducted with all adopters and 33 of the 72 non-adopters. Follow-up surveys using mixed methods were conducted with adopters at 3,6,12, and 18 months post-adoption to characterize implementation and maintenance issues. Results: A total of 28 restaurants adopted the program (Adoption rate = 28%). Adopters were more likely than non-adopters to agree that providing healthy options was important, to have tried to make healthy changes to their menu in the past, and to be confident they would be in business in 2 years (all p<.05). Reasons for non-adoption were time, no interest, and having no healthy options available. With some variations, signs remained in place for at least 12 months. Discussion: This intervention was successfully adopted where owners were already interested in providing healthy options. Other strategies are needed to encourage change by those who are not. Alternative strategies for dissemination of restaurant interventions should be tested.