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Table 7 Propositions regarding factors from Greenhalgh et al’s Diffusion of Innovations framework[27]that were not common across all cases

From: Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

Theoretical domain Proposition
Food environment analysis Profit-oriented food services are incompatible with healthy environmental defaults (ie. > 50% CMO items), regardless of whether they are municipally or privately operated.
Sales analysis Patrons insufficiently choose healthy options when the environmental defaults are unhealthy (ie. < 50% CMO items).
Adopters and the adoption process
Meaning of the ANGCY to managers 1) Adoption and implementation of nutrition guidelines is greatest when the personal beliefs of managers, the organizational mandate and the aims of nutrition guidelines are all aligned.
2) The personal beliefs of managers are highly influential and may motivate adoption when a window of opportunity arises.
Attributes of the ANGCY
Complexity Guidelines that are easily understood may be more readily adopted.
Relative advantage 1) Profitability is the most important barrier to adopting nutrition guidelines because managers perceive that selling healthy foods is unprofitable.
2) A choice-based format may assist facilities to balance wellness and revenue concerns associated with nutrition guidelines, but may not support greater purchase of healthy items by patrons.
3) Nutrition guidelines are perceived to provide a relative advantage insofar as they assist recreational facilities to achieve their wellness mandate in a financially sustainable manner. Small financial losses may be accepted if implementation supports achievement of other important priorities.
Organizational antecedents for the ANGCY
Formalization Short-term food service agreements provide greater flexibility to address emerging priorities.
Professionalism 1) Managers who correctly perceive their food environment as unhealthy are more likely to adopt nutrition guidelines.
2) Registered Dietitians are a source of critical expertise to support implementation of nutrition guidelines.
Size of operation, technical capacity Large recreational facilities may have greater technical capacity to implement the ANGCY.
Absorptive capacity for new knowledge 1) Use of nutrition guidelines in schools can create a favourable climate and increase capacity for adopting nutrition guidelines in other contexts.
2) Health promoting partnerships with industry can provide capacity to implement nutrition guidelines that recreational facilities lack.
Risk-taking climate Tolerance for financial risk is essential for adoption and implementation of nutrition guidelines.
Managerial relations Where private industry is present, adoption and implementation of nutrition guidelines requires their full cooperation. When industry is committed to implementation, the stipulations of policies and contracts may be less important.
Organizational readiness for the ANGCY
Power balances Choice-based nutrition policies are better accepted by most stakeholders and may therefore facilitate adoption of nutrition guidelines.
Fit of the ANGCY with the recreational facility context When food service is managed as a separate entity and is not under the direct purview of the general manager, its goals may not support adoption of nutrition guidelines.
Tension for change Adoption of nutrition guidelines is more likely when management perceives a high tension for health-related change.
Communication and influence
Champion Managers act as gatekeepers of the food environment, and therefore an influential manager must champion adoption and implementation of nutrition guidelines.
Diffusion and dissemination Use of nutrition guidelines in schools may facilitate spread to other contexts where diffusion networks are not yet active.
Outer context
Competitive environment Facilities that perceive fewer competitive pressures may be more likely to adopt nutrition guidelines.
Interorganizational norm-setting 1) Early adopters must be willing to accept the risks inherent in contravening industry norms.
2) Diffusion of nutrition guidelines may be slow to occur because of the association of unhealthy foods with sport spectatorship.
Implementation process The absence of clear goals and priorities for implementation and failure to monitor its progress can impede the implementation process.
  1. ANGCY: Alberta Nutrition Guidelines for Children and Youth; CMO: “choose most often”.