A Qualitative Study on the Development and Adoption of the First State-Wide Comprehensive Food Service Guidelines for Improving the Health and Productivity of State Employees

Abstract

Introduction: In 2013, Washington State became the first to adopt state-wide comprehensive food service guidelines to increase the availability of healthy food and beverages sold to state employees and served to state institutionalized populations. The food service guidelines are a component of the worksite wellness policy titled Executive Order 13-06: “Improving the Health and Productivity of State Employees and Access to Healthy Foods in State Facilities” and impact an estimated 73,000 individuals in Washington State. The objective of this study is to examine the facilitators and constraints to Executive Order 13-06 development and passage to inform future food service guideline development and passage in other agencies, states, and municipalities. Methods: Data from 17 semi-structured interviews with key stakeholders involved in the development and/or passage of Executive Order 13-06 were collected and analyzed using the Advocacy Coalition Framework. Interviewees were from local and state public health departments, Washington State government, public agencies, academia, advocacy coalitions, and national organizations. Results: Two main coalitions (proponents and opponents) diverged in their support of the passage of Executive Order 13-06. Proponents supported Executive Order 13-06 given its potential to increase access to healthy food and beverage options. Opponents felt that it was not feasible to meet food service guidelines without affecting sales and profit. Conclusions: Study findings highlight the importance of early engagement with stakeholders most impacted by proposed food service guidelines; using existing guidelines rather than developing new guidelines; and creating a workgroup to discuss the feasibility of food service guideline implementation and compliance.