- Email: [email protected]
A Healthful Options Food Station Can Improve Satisfaction and Generate Gross Profit in a Worksite Cafeteria
RESEARCH Research and Professional Briefs
A Healthful Options Food Station Can Improve Satisfaction and Generate Gross Profit in a Worksite Cafeteria AMBER N. KIMATHI, MS, RD; MARY B. GREGOIRE, PhD, RD; REBECCA A. DOWLING, PhD, RD; MARCELLE K. STONE, MEd, RD
ABSTRACT The objectives of this study were to determine customer satisfaction with a healthful options food station offered in a worksite cafeteria and document the financial contribution of such a station. The healthful options station featured daily entrées with fewer than 500 calories and less than 30% of calories from fat. Questionnaires from 655 (24.5% response) employees and students provided data on satisfaction with and usage of the station. The majority of the respondents who had purchased from the healthful options station were female (77.3%), white (51.6%), aged 30 to 50 years (52.0%), and had annual incomes of $60,000 to $100,000 (29.3%) or $20,000 to $39,999 (22.2%). Sales and gross profit from the healthful options station were compared to those of the comfort station. Customers were satisfied with attributes of the healthful options station (means ⬎3 on a 5-point scale). Results of paired t tests suggested that customers who had purchased from the healthful options station rated the station significantly (P⬍0.001) higher for healthfulness of entrées, food presentation, food quality, overall quality of the cafeteria, length of line, and food choices available compared to their ratings for the cafeteria in general. The healthful options station generated average daily sales of $458 and gross profit of $306. However, the
A. N. Kimathi is a clinical dietitian, Emory University Hospital Midtown, Atlanta, GA; at the time of the study, she was a dietetics intern and graduate student at Rush University Medical Center, Chicago, IL. M. B. Gregoire is director, Food and Nutrition Services, professor and interim chair, Clinical Nutrition, and professor of health systems management, and M. K. Stone is assistant director, Food Service Operations, Rush University Medical Center, Chicago, IL. A. Dowling is currently retired; at the time of the study, she was vice president, Support Services, Rush University Medical Center, Chicago, IL. Address correspondence to: Amber N. Kimathi, MS, RD, 3317 Renaissance Way NE, Atlanta, GA 30308. E-mail: [email protected] Manuscript accepted: July 25, 2008. Copyright © 2009 by the American Dietetic Association. 0002-8223/09/10905-0016$36.00/0 doi: 10.1016/j.jada.2009.02.006
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Journal of the AMERICAN DIETETIC ASSOCIATION
sales and gross profit were significantly (P⬍0.05) less than the comparison comfort station. J Am Diet Assoc. 2009;109:914-917.
C
ustomers are requesting nutritional information and healthful food options in many types of foodservice operations, including worksite cafeterias (1). Healthful eating guidelines, based on research findings such as Healthy People 2010: Understanding and Improving Health (2) and the 2005 Dietary Guidelines for Americans (3), address health recommendations and promote behaviors to reduce diseases linked to diet and weight. A worksite cafeteria provides an effective environment for communicating nutrition information at the point-ofpurchase where food choices are made (4-6). Research by Buscher (7) concluded that customers are influenced to choose healthfully when they are aware of nutrition information about food choices. Previous researchers (8,9) have shown that sales of targeted healthful items increase when the items are promoted by nutrition education interventions. Results of previous studies (10-13) in an academic medical center employee cafeteria suggested that customers found nutrition information useful, and many used it on a daily basis when making food choices. Limited studies have been published that explore customer satisfaction with and gross profit of a targeted food station that features only healthful food items. The objectives of this study were to determine customer satisfaction with a healthful options food station offered in a worksite cafeteria and to document the financial contribution of such a station. METHODS Setting and Subjects The study was conducted at an academic medical center in the Midwest region of the United States. The academic medical center employs approximately 8,800 employees and has 1,400 undergraduate and graduate students. The worksite cafeteria is open from 6:30 AM to 3:30 PM Monday through Friday and serves 2,000 employees, students, and visitors each day. The cafeteria includes multiple serving stations that offer a variety of items including hot entrées, soups, sandwiches, salads, snacks, desserts, and beverages and has a food cost percentage goal of 35%. At this worksite cafeteria, medical center employees are not offered a discounted price. In April 2007, cafeteria personnel implemented a healthful options station featuring entrées that have
© 2009 by the American Dietetic Association
fewer than 500 kcal and side dishes that have fewer than 300 kcal. All items provided less than 30% of energy from total fat. Fish (including tilapia, cod, and salmon), highfiber foods (foods with more than 2 g per serving, such as red beans and black beans), entrée salads, and grain products (such as bulgur and barley) are featured daily. Recipes were standardized and nutrient analysis was conducted using the CBORD FSS Nutritional Accounting System (version 4.0.113, 1998-2004, CBORD Group, Inc, Ithaca, NY). Nutrient content of each item was posted daily at the station. Customer Satisfaction Data Survey methodology was used to collect customer satisfaction data for this study. A questionnaire was distributed via e-mail to a random sample of 2,087 employees and 501 students who had a medical center e-mail account. To help ensure representation of all employee groups, for employees without a worksite e-mail account, a paper version of the questionnaire was distributed at staff meetings to 124 employees. The university’s Human Investigation Committee approved this research prior to data collection. The 24-item questionnaire was developed based on previous research by Perlmutter and colleagues (4), Resnick and colleagues (12), and Jacobs (13) and used items validated by Resnick and colleagues (12). A pilot study was conducted via e-mail with a sample of 20 cafeteria patrons who were sent the online questionnaire link and asked to evaluate the questionnaire for its clarity and comprehension. Minor revisions were made based on suggestions received. Respondents were asked to use a 5-point scale (1⫽extremely dissatisfied to 5⫽extremely satisfied) to rate their satisfaction with nine attributes of the overall cafeteria and of the new healthful options station in the cafeteria. The attributes rated were healthfulness (perceived) of entrées, food presentation, food quality, overall quality of the cafeteria, length of line, availability of healthful food choices, entrée portion size, food choices available, and price. Demographic data about respondents, such as sex, race, age, job title, and length of employment were collected. In addition, frequency and use of the cafeteria and the healthful options station also were collected. Data were analyzed using the Statistical Package for the Social Sciences (version 13, 2006, SPSS Inc, Chicago, IL). Descriptive statistics were computed for all variables. A paired t test was used to compare ratings by respondents who had rated both their level of satisfaction with the healthful options station and the overall cafeteria. Sales Data Sales data for each of the entrées were collected from the electronic Micros cash register system database (MICROS Systems, Inc, Columbia, MO). Cost of food data were collected from the CBORD FSS System (v4.0.113, 19982004). Gross profit was calculated as sales minus food cost for each entrée from two cafeteria stations: the healthful options station and the comfort station. Gross profit was calculated for each entrée for each day of the
2-week cycle menu using data from two consecutive weeks in July 2007. Labor cost was not assessed because the preparation and serving time was assumed to be similar to other stations offering prepared food items in the cafeteria. The comfort station features fried chicken wings and a special entrée each day. This station was used as the comparison station because it, like the healthful options station, offered entrée items, although higher in calories and fat than the healthful options station. The healthful options station entrées included fish of the day, a wrap or salad, and a daily special. A pilot-test of sales data collection was conducted before the actual sales data collection. Sales data were analyzed using the Statistical Package for the Social Sciences (version 13). Descriptive statistics was computed for all variables. An independent t test was used to compare sales data from the two stations. RESULTS AND DISCUSSION A total of 655 (24.5% response) questionnaires (594 online, 61 paper) were returned and useable. Eighty-two respondents (12.5%) were students. Two hundred fiftyone respondents (39.3%) reported purchasing items from the healthful options station. The majority of respondents who purchased items from the healthful options station were female (77.3%), white (51.6%), age 30 to 50 years (52.0%). Most patrons (59.4%) had been at the medical center for more than 5 years and were in positions as managers/administrators (19.2%) or administrative/clerical (16.6%), and had annual incomes of $60,000 to $100,000 (29.3%) or $20,000 to $39,999 (22.2%). The majority of the respondents who reported purchasing from the healthful options station (n⫽233, 94.9%) indicated that they had used the cafeteria before the introduction of the healthful options station; 76 (31.3%) reported visiting the cafeteria more often because of the station. A total of 70 people (28.8%) who had used the cafeteria prior to the healthful options station reported visiting the cafeteria more often, and 6 (2.5%) who did not use the cafeteria prior to implementation reported patronizing the cafeteria because of the station. Some patrons (n⫽57, 23.5%) reported going to the cafeteria specifically to purchase from the healthful options station most or all of the time. Customer Satisfaction Customer satisfaction ratings for the nine attributes of the healthful options station are shown in Table 1. Highest satisfaction ratings were found for perceived healthfulness of entrées (3.75⫾0.83), food presentation (3.53⫾ 0.84), and food quality (3.47⫾0.91). The least satisfaction, or lowest mean ratings, were: price (2.93⫾1.0), food choices available (3.09⫾1.0), and entrée portion size (3.28⫾0.96). Respondents reported spending $4.00 to $4.99 (n⫽93, 38.3%) or more than $5.00 (n⫽90, 37.0%) for lunch. This may be perceived as high by employees and students. Portion sizes of entrées such as fish were 3 oz, which may have been smaller than some customers were accustomed to eating. More than half of the questionnaire respondents were “very satisfied” or “satisfied” with the healthfulness of entrées (n⫽158, 65.0%), food presentation
May 2009 ● Journal of the AMERICAN DIETETIC ASSOCIATION
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Table 1. Comparison of medical center cafeteria customer a ratingsb of a healthful options station c and the overall cafeteriad
Attribute Healthfulness of entrees*** Food presentation*** Food quality*** Overall quality*** Length of line*** Availability of healthful food choices*** Entree portion size Food choices available Price
Healthful options stationc mean bⴞSD e
Cafeteria overalld mean bⴞSD
3.75⫾0.83 3.53⫾0.84 3.47⫾0.91 3.40⫾0.86 3.37⫾0.91
3.23⫾0.99 3.28⫾0.84 3.27⫾0.95 3.07⫾0.98 2.74⫾1.11
3.31⫾0.98 3.28⫾0.96 3.09⫾1.0 2.93⫾1.0
3.09⫾1.14 3.37⫾0.96 2.98⫾1.13 2.80⫾1.12
a
n⫽243 customers who had purchased from the healthful options station. Scale: 1⫽very dissatisfied to 5⫽very satisfied. c The healthful options station was one of eight stations in the worksite cafeteria. It featured entrées that have fewer than 500 calories per serving and less than 30% of energy from fat. d Overall cafeteria refers to ratings for the entire cafeteria. e SD⫽standard deviation. ***Pⱕ0.001; t test comparison of healthful options station and overall cafeteria ratings. b
Table 2. Comparison of sales data for two medical center cafeteria food stations: the healthful options stationa and comfort stationb Financial attribute
Healthful options mean cⴞSD d
Comfort mean cⴞSD
Sales ($)* Gross Profit ($)*
458.06⫾123.61 305.83⫾91.11
604.05⫾144.65 404.70⫾109.36
a The healthful options station was one of eight stations in the worksite cafeteria. It featured entrées that have fewer than 500 kcal per serving and less than 30% of energy from fat. b The comfort station was one of eight stations in the same cafeteria. It was used as the comparison station and featured a daily special entrée and fried chicken wings. c Based on 2 weeks of sales data. d SD⫽standard deviation. *Pⱕ0.05.
(n⫽226, 51.8%), and food quality (n⫽124, 51.0%). Previous research by Resnick and colleagues in 1998 (12) and Jacobs in 2001 (13) in the same medical center found that cafeteria customers were most satisfied with food presentation and food quality. Customers were least satisfied with price in Resnick’s study, and length of line in Jacobs’ study. Sales Total sales and gross profit are illustrated in Table 2. Independent t test results from the two stations indicated sales ($604 vs $458 per day) and gross profit ($405 vs $306 per day) were significantly higher (P⬍0.05) for the comfort station compared with the healthful options station. Limited published data exist on sales of healthful items from one targeted station in a cafeteria vs having such
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items dispersed throughout a cafeteria. HaueisenCasarez (8) discovered that total sales of lower-calorie and lower-sodium entrées did not significantly increase when labeled with nutrition information. Several researchers (5,7,8,14) reported that total sales of low-fat items did increase significantly when labeled and promoted. The lower sales at the healthful options station could have been because of patrons’ food preferences or might have been related to price sensitivity because entrées on the healthful options station were higher in price than some of the entrées on the comfort station. This study contained several limitations that should be addressed before conclusions are made. One limitation of this study is that it was conducted within one university medical center cafeteria, and although results are valid for this site, generalizations to other academic medical center cafeterias need to be made with caution. The limited response rate (24.5%), a potential consequence of the online distribution of the questionnaires, could have resulted in nonrespondent error. CONCLUSIONS The results of this research suggest that developing and showcasing healthful menu items at a separate, specific station in a worksite cafeteria can increase customer satisfaction with the worksite cafeteria. Serving healthful food options that meet set nutritional parameters can be profitable for foodservice organizations as well. In this study, customers who purchased from the healthful options food station were satisfied with the food items offered at that station and were more satisfied with the overall cafeteria. The healthful options station attracted customers to the cafeteria and contributed positively to the financial performance of the cafeteria. Additional ways to convey the “healthful options” message should be explored. Only 39% of questionnaire respondents indicated they had actually purchased from the healthful options station, which may suggest that additional marketing and/or customer education is needed to better attract customers to make healthful food choices in a worksite cafeteria. There is no funding disclosure for this research. References 1. Lefebvre J. Making nutrition a business proposition. Food Management. 2007;42:36-44. 2. US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: US Government Printing Office; 2000. 3. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans. 6th Edition. Washington, DC: US Government Printing Office; 2005. 4. Perlmutter CA, Canter DD, Gregoire MB. Profitability and acceptability of fat- and sodium-modified hot entrees in a worksite cafeteria. J Am Diet Assoc. 1997;97:391-395. 5. Levin S. Pilot study of a cafeteria program relying primarily on symbols to promote healthy choices. J Nutr Educ. 1996;28:282285. 6. Sproul AD, Canter DD, Schmidt JB. Does point-of-purchase nutrition labeling influence meal selections? A test in an Army cafeteria. Mil Med. 2003;168:556-560.
7. Buscher L, Martin K, Crocker S. Point-of-purchase messages framed in terms of cost, convenience, taste, and energy improve healthful snack selection in a college foodservice setting. J Am Diet Assoc. 2001;101:909-913. 8. Haueisen-Casarez A. The effect of nutritional information on selcetion of low fat menu items at the point-of-purchase [master’s thesis]. Long Beach, CA: California State University, Long Beach; 1994. 9. Hannan P, French SA, Story M, Fulkerson JA. A pricing strategy to promote sales of lower fat foods in high school cafeterias: Acceptability and sensitivity analysis. Am J Health Promot. 2002;17:1-6. 10. Brown H. The Impact of Point-of-Choice Nutrient Information on Entree Sales in the Rush-Presbyterian-St Luke’s Medical Center Cafeteria [master’s thesis]. Chicago, IL: Rush University; 1993.
11. Brown ML. The impact of nutrient information on food selection behavior in the cafeteria at Rush-Presbyterian-St Luke’s Medical Center [master’s thesis]. Chicago, IL: Rush University; 1997. 12. Resnick MP, Gregoire MB, Lafferty LJ, Lipson S. Marketing can change consumers’ perceptions of healthfulness of items served in a worksite cafeteria. J Am Diet Assoc. 1999;99:1265-1267. 13. Jacobs K. The impact of the Pocket Guide to Nutrition on customer satisfaction and menu selection in the Rush-Presbyterian-St Luke’s Medical Center Cafeteria [master’s thesis]. Chicago, IL: Rush University; 2001. 14. Steenhuis I, Van Assema P, Van Breukelen G, Glanz K, Kok G, De Vries H. The impact of educational and environmental interventions in Dutch worksite cafeterias. Health Promot Int. 2004;19:335-343.
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A Healthful Options Food Station Can Improve Satisfaction and Generate Gross Profit in a Worksite Cafeteria AMBER N. KIMATHI, MS, RD; MARY B. GREGOIRE, PhD, RD; REBECCA A. DOWLING, PhD, RD; MARCELLE K. STONE, MEd, RD
ABSTRACT The objectives of this study were to determine customer satisfaction with a healthful options food station offered in a worksite cafeteria and document the financial contribution of such a station. The healthful options station featured daily entrées with fewer than 500 calories and less than 30% of calories from fat. Questionnaires from 655 (24.5% response) employees and students provided data on satisfaction with and usage of the station. The majority of the respondents who had purchased from the healthful options station were female (77.3%), white (51.6%), aged 30 to 50 years (52.0%), and had annual incomes of $60,000 to $100,000 (29.3%) or $20,000 to $39,999 (22.2%). Sales and gross profit from the healthful options station were compared to those of the comfort station. Customers were satisfied with attributes of the healthful options station (means ⬎3 on a 5-point scale). Results of paired t tests suggested that customers who had purchased from the healthful options station rated the station significantly (P⬍0.001) higher for healthfulness of entrées, food presentation, food quality, overall quality of the cafeteria, length of line, and food choices available compared to their ratings for the cafeteria in general. The healthful options station generated average daily sales of $458 and gross profit of $306. However, the
A. N. Kimathi is a clinical dietitian, Emory University Hospital Midtown, Atlanta, GA; at the time of the study, she was a dietetics intern and graduate student at Rush University Medical Center, Chicago, IL. M. B. Gregoire is director, Food and Nutrition Services, professor and interim chair, Clinical Nutrition, and professor of health systems management, and M. K. Stone is assistant director, Food Service Operations, Rush University Medical Center, Chicago, IL. A. Dowling is currently retired; at the time of the study, she was vice president, Support Services, Rush University Medical Center, Chicago, IL. Address correspondence to: Amber N. Kimathi, MS, RD, 3317 Renaissance Way NE, Atlanta, GA 30308. E-mail: [email protected] Manuscript accepted: July 25, 2008. Copyright © 2009 by the American Dietetic Association. 0002-8223/09/10905-0016$36.00/0 doi: 10.1016/j.jada.2009.02.006
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Journal of the AMERICAN DIETETIC ASSOCIATION
sales and gross profit were significantly (P⬍0.05) less than the comparison comfort station. J Am Diet Assoc. 2009;109:914-917.
C
ustomers are requesting nutritional information and healthful food options in many types of foodservice operations, including worksite cafeterias (1). Healthful eating guidelines, based on research findings such as Healthy People 2010: Understanding and Improving Health (2) and the 2005 Dietary Guidelines for Americans (3), address health recommendations and promote behaviors to reduce diseases linked to diet and weight. A worksite cafeteria provides an effective environment for communicating nutrition information at the point-ofpurchase where food choices are made (4-6). Research by Buscher (7) concluded that customers are influenced to choose healthfully when they are aware of nutrition information about food choices. Previous researchers (8,9) have shown that sales of targeted healthful items increase when the items are promoted by nutrition education interventions. Results of previous studies (10-13) in an academic medical center employee cafeteria suggested that customers found nutrition information useful, and many used it on a daily basis when making food choices. Limited studies have been published that explore customer satisfaction with and gross profit of a targeted food station that features only healthful food items. The objectives of this study were to determine customer satisfaction with a healthful options food station offered in a worksite cafeteria and to document the financial contribution of such a station. METHODS Setting and Subjects The study was conducted at an academic medical center in the Midwest region of the United States. The academic medical center employs approximately 8,800 employees and has 1,400 undergraduate and graduate students. The worksite cafeteria is open from 6:30 AM to 3:30 PM Monday through Friday and serves 2,000 employees, students, and visitors each day. The cafeteria includes multiple serving stations that offer a variety of items including hot entrées, soups, sandwiches, salads, snacks, desserts, and beverages and has a food cost percentage goal of 35%. At this worksite cafeteria, medical center employees are not offered a discounted price. In April 2007, cafeteria personnel implemented a healthful options station featuring entrées that have
© 2009 by the American Dietetic Association
fewer than 500 kcal and side dishes that have fewer than 300 kcal. All items provided less than 30% of energy from total fat. Fish (including tilapia, cod, and salmon), highfiber foods (foods with more than 2 g per serving, such as red beans and black beans), entrée salads, and grain products (such as bulgur and barley) are featured daily. Recipes were standardized and nutrient analysis was conducted using the CBORD FSS Nutritional Accounting System (version 4.0.113, 1998-2004, CBORD Group, Inc, Ithaca, NY). Nutrient content of each item was posted daily at the station. Customer Satisfaction Data Survey methodology was used to collect customer satisfaction data for this study. A questionnaire was distributed via e-mail to a random sample of 2,087 employees and 501 students who had a medical center e-mail account. To help ensure representation of all employee groups, for employees without a worksite e-mail account, a paper version of the questionnaire was distributed at staff meetings to 124 employees. The university’s Human Investigation Committee approved this research prior to data collection. The 24-item questionnaire was developed based on previous research by Perlmutter and colleagues (4), Resnick and colleagues (12), and Jacobs (13) and used items validated by Resnick and colleagues (12). A pilot study was conducted via e-mail with a sample of 20 cafeteria patrons who were sent the online questionnaire link and asked to evaluate the questionnaire for its clarity and comprehension. Minor revisions were made based on suggestions received. Respondents were asked to use a 5-point scale (1⫽extremely dissatisfied to 5⫽extremely satisfied) to rate their satisfaction with nine attributes of the overall cafeteria and of the new healthful options station in the cafeteria. The attributes rated were healthfulness (perceived) of entrées, food presentation, food quality, overall quality of the cafeteria, length of line, availability of healthful food choices, entrée portion size, food choices available, and price. Demographic data about respondents, such as sex, race, age, job title, and length of employment were collected. In addition, frequency and use of the cafeteria and the healthful options station also were collected. Data were analyzed using the Statistical Package for the Social Sciences (version 13, 2006, SPSS Inc, Chicago, IL). Descriptive statistics were computed for all variables. A paired t test was used to compare ratings by respondents who had rated both their level of satisfaction with the healthful options station and the overall cafeteria. Sales Data Sales data for each of the entrées were collected from the electronic Micros cash register system database (MICROS Systems, Inc, Columbia, MO). Cost of food data were collected from the CBORD FSS System (v4.0.113, 19982004). Gross profit was calculated as sales minus food cost for each entrée from two cafeteria stations: the healthful options station and the comfort station. Gross profit was calculated for each entrée for each day of the
2-week cycle menu using data from two consecutive weeks in July 2007. Labor cost was not assessed because the preparation and serving time was assumed to be similar to other stations offering prepared food items in the cafeteria. The comfort station features fried chicken wings and a special entrée each day. This station was used as the comparison station because it, like the healthful options station, offered entrée items, although higher in calories and fat than the healthful options station. The healthful options station entrées included fish of the day, a wrap or salad, and a daily special. A pilot-test of sales data collection was conducted before the actual sales data collection. Sales data were analyzed using the Statistical Package for the Social Sciences (version 13). Descriptive statistics was computed for all variables. An independent t test was used to compare sales data from the two stations. RESULTS AND DISCUSSION A total of 655 (24.5% response) questionnaires (594 online, 61 paper) were returned and useable. Eighty-two respondents (12.5%) were students. Two hundred fiftyone respondents (39.3%) reported purchasing items from the healthful options station. The majority of respondents who purchased items from the healthful options station were female (77.3%), white (51.6%), age 30 to 50 years (52.0%). Most patrons (59.4%) had been at the medical center for more than 5 years and were in positions as managers/administrators (19.2%) or administrative/clerical (16.6%), and had annual incomes of $60,000 to $100,000 (29.3%) or $20,000 to $39,999 (22.2%). The majority of the respondents who reported purchasing from the healthful options station (n⫽233, 94.9%) indicated that they had used the cafeteria before the introduction of the healthful options station; 76 (31.3%) reported visiting the cafeteria more often because of the station. A total of 70 people (28.8%) who had used the cafeteria prior to the healthful options station reported visiting the cafeteria more often, and 6 (2.5%) who did not use the cafeteria prior to implementation reported patronizing the cafeteria because of the station. Some patrons (n⫽57, 23.5%) reported going to the cafeteria specifically to purchase from the healthful options station most or all of the time. Customer Satisfaction Customer satisfaction ratings for the nine attributes of the healthful options station are shown in Table 1. Highest satisfaction ratings were found for perceived healthfulness of entrées (3.75⫾0.83), food presentation (3.53⫾ 0.84), and food quality (3.47⫾0.91). The least satisfaction, or lowest mean ratings, were: price (2.93⫾1.0), food choices available (3.09⫾1.0), and entrée portion size (3.28⫾0.96). Respondents reported spending $4.00 to $4.99 (n⫽93, 38.3%) or more than $5.00 (n⫽90, 37.0%) for lunch. This may be perceived as high by employees and students. Portion sizes of entrées such as fish were 3 oz, which may have been smaller than some customers were accustomed to eating. More than half of the questionnaire respondents were “very satisfied” or “satisfied” with the healthfulness of entrées (n⫽158, 65.0%), food presentation
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Table 1. Comparison of medical center cafeteria customer a ratingsb of a healthful options station c and the overall cafeteriad
Attribute Healthfulness of entrees*** Food presentation*** Food quality*** Overall quality*** Length of line*** Availability of healthful food choices*** Entree portion size Food choices available Price
Healthful options stationc mean bⴞSD e
Cafeteria overalld mean bⴞSD
3.75⫾0.83 3.53⫾0.84 3.47⫾0.91 3.40⫾0.86 3.37⫾0.91
3.23⫾0.99 3.28⫾0.84 3.27⫾0.95 3.07⫾0.98 2.74⫾1.11
3.31⫾0.98 3.28⫾0.96 3.09⫾1.0 2.93⫾1.0
3.09⫾1.14 3.37⫾0.96 2.98⫾1.13 2.80⫾1.12
a
n⫽243 customers who had purchased from the healthful options station. Scale: 1⫽very dissatisfied to 5⫽very satisfied. c The healthful options station was one of eight stations in the worksite cafeteria. It featured entrées that have fewer than 500 calories per serving and less than 30% of energy from fat. d Overall cafeteria refers to ratings for the entire cafeteria. e SD⫽standard deviation. ***Pⱕ0.001; t test comparison of healthful options station and overall cafeteria ratings. b
Table 2. Comparison of sales data for two medical center cafeteria food stations: the healthful options stationa and comfort stationb Financial attribute
Healthful options mean cⴞSD d
Comfort mean cⴞSD
Sales ($)* Gross Profit ($)*
458.06⫾123.61 305.83⫾91.11
604.05⫾144.65 404.70⫾109.36
a The healthful options station was one of eight stations in the worksite cafeteria. It featured entrées that have fewer than 500 kcal per serving and less than 30% of energy from fat. b The comfort station was one of eight stations in the same cafeteria. It was used as the comparison station and featured a daily special entrée and fried chicken wings. c Based on 2 weeks of sales data. d SD⫽standard deviation. *Pⱕ0.05.
(n⫽226, 51.8%), and food quality (n⫽124, 51.0%). Previous research by Resnick and colleagues in 1998 (12) and Jacobs in 2001 (13) in the same medical center found that cafeteria customers were most satisfied with food presentation and food quality. Customers were least satisfied with price in Resnick’s study, and length of line in Jacobs’ study. Sales Total sales and gross profit are illustrated in Table 2. Independent t test results from the two stations indicated sales ($604 vs $458 per day) and gross profit ($405 vs $306 per day) were significantly higher (P⬍0.05) for the comfort station compared with the healthful options station. Limited published data exist on sales of healthful items from one targeted station in a cafeteria vs having such
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items dispersed throughout a cafeteria. HaueisenCasarez (8) discovered that total sales of lower-calorie and lower-sodium entrées did not significantly increase when labeled with nutrition information. Several researchers (5,7,8,14) reported that total sales of low-fat items did increase significantly when labeled and promoted. The lower sales at the healthful options station could have been because of patrons’ food preferences or might have been related to price sensitivity because entrées on the healthful options station were higher in price than some of the entrées on the comfort station. This study contained several limitations that should be addressed before conclusions are made. One limitation of this study is that it was conducted within one university medical center cafeteria, and although results are valid for this site, generalizations to other academic medical center cafeterias need to be made with caution. The limited response rate (24.5%), a potential consequence of the online distribution of the questionnaires, could have resulted in nonrespondent error. CONCLUSIONS The results of this research suggest that developing and showcasing healthful menu items at a separate, specific station in a worksite cafeteria can increase customer satisfaction with the worksite cafeteria. Serving healthful food options that meet set nutritional parameters can be profitable for foodservice organizations as well. In this study, customers who purchased from the healthful options food station were satisfied with the food items offered at that station and were more satisfied with the overall cafeteria. The healthful options station attracted customers to the cafeteria and contributed positively to the financial performance of the cafeteria. Additional ways to convey the “healthful options” message should be explored. Only 39% of questionnaire respondents indicated they had actually purchased from the healthful options station, which may suggest that additional marketing and/or customer education is needed to better attract customers to make healthful food choices in a worksite cafeteria. There is no funding disclosure for this research. References 1. Lefebvre J. Making nutrition a business proposition. Food Management. 2007;42:36-44. 2. US Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd Edition. Washington, DC: US Government Printing Office; 2000. 3. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans. 6th Edition. Washington, DC: US Government Printing Office; 2005. 4. Perlmutter CA, Canter DD, Gregoire MB. Profitability and acceptability of fat- and sodium-modified hot entrees in a worksite cafeteria. J Am Diet Assoc. 1997;97:391-395. 5. Levin S. Pilot study of a cafeteria program relying primarily on symbols to promote healthy choices. J Nutr Educ. 1996;28:282285. 6. Sproul AD, Canter DD, Schmidt JB. Does point-of-purchase nutrition labeling influence meal selections? A test in an Army cafeteria. Mil Med. 2003;168:556-560.
7. Buscher L, Martin K, Crocker S. Point-of-purchase messages framed in terms of cost, convenience, taste, and energy improve healthful snack selection in a college foodservice setting. J Am Diet Assoc. 2001;101:909-913. 8. Haueisen-Casarez A. The effect of nutritional information on selcetion of low fat menu items at the point-of-purchase [master’s thesis]. Long Beach, CA: California State University, Long Beach; 1994. 9. Hannan P, French SA, Story M, Fulkerson JA. A pricing strategy to promote sales of lower fat foods in high school cafeterias: Acceptability and sensitivity analysis. Am J Health Promot. 2002;17:1-6. 10. Brown H. The Impact of Point-of-Choice Nutrient Information on Entree Sales in the Rush-Presbyterian-St Luke’s Medical Center Cafeteria [master’s thesis]. Chicago, IL: Rush University; 1993.
11. Brown ML. The impact of nutrient information on food selection behavior in the cafeteria at Rush-Presbyterian-St Luke’s Medical Center [master’s thesis]. Chicago, IL: Rush University; 1997. 12. Resnick MP, Gregoire MB, Lafferty LJ, Lipson S. Marketing can change consumers’ perceptions of healthfulness of items served in a worksite cafeteria. J Am Diet Assoc. 1999;99:1265-1267. 13. Jacobs K. The impact of the Pocket Guide to Nutrition on customer satisfaction and menu selection in the Rush-Presbyterian-St Luke’s Medical Center Cafeteria [master’s thesis]. Chicago, IL: Rush University; 2001. 14. Steenhuis I, Van Assema P, Van Breukelen G, Glanz K, Kok G, De Vries H. The impact of educational and environmental interventions in Dutch worksite cafeterias. Health Promot Int. 2004;19:335-343.
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