Preliminary Evaluation Findings of the Informed Dining Program June 2013 Background The Informed Dining program is a voluntary nutrition information program for restaurants in Canada with at least one outlet located in British Columbia. The development of the program took place over a two year period and involved several consultations with the food industry and public health stakeholders. The current program design is the result of negotiated decisions aimed at meeting the needs of both industry and public health and is endorsed by the Canadian and Restaurant Foodservices Association, the BC Restaurant and Foodservices Association and the Heart and Stroke Foundation of Canada (BC & Yukon). Participating restaurants are required to: Display the program logo and directional statement on the menu or menu board advising guests that nutrition information is available Provide nutrition information for all standard menu items upon request before or at the point of ordering (calorie and sodium content of standard menu items must be highlighted), and Provide information regarding daily calorie and sodium requirements The Informed Dining program was announced on August 10, 2011. The Ministry of Health partnered with the Heart and Stroke Foundation of Canada (BC & Yukon) to implement and evaluate the Informed Dining program (Refer to Appendix A for a timeline of program milestones). The goal of the Informed Dining program is to improve the health of British Columbians by helping consumers make informed food choices when dining out, thereby contributing to the promotion of healthy weights and reducing the risk of chronic disease. The objectives of the Informed Dining program are to: Assist consumers to identify restaurants that disclose nutrition information Assist consumers to understand the calorie and sodium value of menu items in relation to their daily calorie and sodium requirements Support restaurants to provide consumers with nutrition information before or at the point of ordering The Ministry of Health provides a variety of implementation supports for participating restaurants (Refer Appendix B for a full chart detailing all program implementation supports). In addition to these supports, small business operators with fewer than five outlets in Canada and fewer than 50 employees per outlet were eligible for small business support until March 31, 2013 to offset the costs of program implementation. Small business operators accepted into the program benefited from nutrient analysis, support to reformulate recipes, graphic design assistance to create a nutrition menu/brochure/poster, and a $300 printing grant to offset costs to reprint menus. Purpose The purpose of this report is to provide a snapshot of early program impact and to identify potential areas for improvement. Since several of the data collecting activities referred to in this report were conducted soon after program implementation (approximately 6 months) with relatively few participating restaurants, a full 1 evaluation is being planned for 2014/2015 once the program is more established with a greater number of participating restaurants. Data Collection Activities The Ministry of Health and the Heart and Stroke Foundation of Canada (BC & Yukon) collected both process and outcome data through a number of activities aimed to evaluate program implementation and impact. The Heart and Stroke Foundation of Canada (BC & Yukon): Point of Purchase Surveys (POP): Point of purchase surveys were conducted with 531 consumers in November and December 2012 in 4 different restaurants actively participating in the Informed Dining program. Restaurant Response Surveys (RRS): A web-based survey was completed anonymously by 7 restaurants actively participating in the Informed Dining program in January 2013. Web analytics from the We Want It Campaign: A petition-style campaign that invited British Columbians to identify restaurants they would like to see provide nutrition information. The campaign was launched on January 24, 2013 and ran until April 8, 2013. The Ministry of Health: Public Opinion Research (POR): Web-based quantitative surveys were conducted with 803 British Columbians in January 2012 and with 810 residents in February 2013. The aim of these surveys was to gauge the public interest and support for nutrition information in restaurants. Informed Dining Promotional Campaign Survey: Ipsos Reid conducted a web-based survey with 400 British Columbia residents in May and June 2012 to assess the impact of the Informed Dining promotional campaign which was launched on May 14, 2012. This included Global TV promotional spots, print and out-of-home advertisements, online contesting and social media. Restaurant Tracker: The Ministry of Health tracks expressions of interest in joining the Informed Dining program by restaurants and participation through an excel database. Restaurant Verification Reports: Environmental Health Officers monitor restaurant compliance through restaurant verification reports, which are tracked by the Ministry of Health. Refer to Appendix C for further details on evaluation data. Key Preliminary Findings 1. 2. 3. 4. 5. Consumers want nutrition information in restaurants. Consumers want nutrition information to be visible and accessible at the point of ordering. There is a lack of awareness of the Informed Dining program amongst consumers. Consumers have limited knowledge regarding calories and sodium. A growing number of restaurants are informed and successfully participating in the program. 2 Key Preliminary Finding 1. Consumers want nutrition information in restaurants. 77% of consumers surveyed in BC said it was very important or important to have nutrition information when selecting their meals (POP). Full nutrition information (e.g. calories and 13 core nutrients) on a supplemental brochure, pamphlet or nutrition menu at point of ordering is the preferred choice for visitors to full and quick service restaurants (38% and 42%)—with select nutrition information (e.g. calories and sodium on the menu or menu board) a distant second (26% and 23% in the respective full and quick service establishments) (POR, 2013). A large majority of British Columbians are more likely to visit a restaurant that provides nutrition information about its menu items. Both women and men report equally that they prefer restaurants that provide nutrition information (74% and 67%, respectively) (POR, 2013). “I want to make educated choices for myself and my children when eating out!” Amanda, We Want It Campaign website - March 2013 “I care about what I put into my body, and I’m less likely to go back to a restaurant that doesn’t publish its nutrition info”. Taylor, We Want It Campaign website - March 2013 The nutrition information made available with Informed Dining has a focus on calories and sodium. Consumers rated calories (70%) and sodium (69%) as the most useful nutrition information to them when making an ordering decision at a restaurant (POR, 2013). See Figure 1. 44% of parents reported that nutrition information would be useful to them when making an ordering decision for their children (POR, 2013). See Figure 1. % of British Columbians Figure 1. British Columbians who reported calories and sodium as useful nutrition information when ordering at a restaurant: 100% 70% 44% 0% find calories useful 69% find sodium useful would use nutrition information to make an ordering decision for their children From January to April 2013, more than 2,200 British Columbians requested nutrition information be provided at their favourite restaurants through the Heart and Stroke Foundation of Canada’s (BC & Yukon) We Want It campaign. There were 8,373 unique website visits during that time. 3 Key Preliminary Finding 2. Consumers want nutrition information to be visible and accessible at the point of ordering. 79% of British Columbians desire to have nutrition information automatically provided to them in a restaurant as opposed to having it available only on an “upon request” basis (POR, 2012). Only 2% of 531 consumers surveyed indicated they asked to see nutrition information before purchasing their food (POP). 30% of the 520 consumers who did not ask to see nutrition information reported they did not know nutrition information was available (POP). Most British Columbians do not think that nutrition information is readily available in restaurants (POR, 2013) (Figure 2). % of British Columbians 100% Figure 2. British Columbians who reported that nutrition information is NOT readily available in BC restaurants 83% 61% 0% full service restaurant quick service restaurant Key Preliminary Finding 3. There is a lack of awareness of the Informed Dining program amongst consumers. 1 in 10 BC residents were aware of the Informed Dining program following the May 2012 promotional campaign (Ipsos Reid). 21% of consumers surveyed reported that they had seen the Informed Dining program logo before (POP). 56% reported that they had not seen the logo in the participating restaurant that day (POP). Only 2% could correctly identify other Informed Dining participating restaurants (POP). Key Preliminary Finding 4. Consumers have limited knowledge regarding calories and sodium. The majority of POP survey respondents did not know the calorie (66 %) or sodium (87%) content of the meal they had just ordered (POP). 74% of surveyed customers could not accurately report daily calorie requirements for a healthy adult (POP). 95% of surveyed customers could not accurately report daily sodium requirements for a healthy adult (POP). 4 in 5 British Columbia residents stated that sodium is a concern to them when they dine out (POR, 2013). 2 in 3 British Columbians would use nutrition information inside a restaurant to select a lower-sodium alternative in their meal (POR, 2013). 4 Key Preliminary Finding 5. A growing number of restaurants are informed and successfully participating in the program. As of June 1, 2013, 21 restaurants with 341 outlets were participating in the Informed Dining program across the province. This includes 16 independent operators, one BC chain, and three national chains. 100% of the restaurants participating in the Informed Dining program indicated they would continue to participate. 100% would recommend the program to other restaurants (RRS). The Informed Dining program has received an increasing number of expressions of interests (EOIs), from restaurants, with a total of 146 as of June 1, 2013 (Figure 3). Interest in the program has been received from a variety of restaurants including: quick service, full service, small businesses, university retail food services, and buffet-style establishments. On April 3, 2013, 22 national chain restaurants representing over 1,800 outlets in BC committed to participate in the program by the end of 2013 year. Figure 3. Total Expressions of Interest (EOIs) in the Informed Dining program # of EOIs 200 146 150 111 100 50 38 0 2011 2012 2013 Environmental Health Officers (EHOs) have been monitoring the compliance of participating restaurants since December 2012. Restaurant compliance to program requirements is reported to be greater than 79% (Restaurant Verification Reports). All non-compliance issues are being addressed on a case-by-case basis with the restaurant and Ministry staff. 91% of customers who asked for nutrition information indicated that the restaurant provided the nutrition information as requested (POP). As of March 31, 2013, a total of 36 small business operators received small business support. "We would have never been able to afford the nutritional analysis otherwise." –Small Business Operator (RRS, January 2013) 5 Summary The preliminary evaluation findings in this report were collected early in program implementation with few participating restaurants so they have been used to describe initial program impact and to identify opportunities for improving program design and support. These findings indicate the program is supporting restaurants to provide consumers with nutrition information before or at the point of ordering. The program constitutes a foundation for meeting public demand for nutrition information at restaurants, and—ultimately-- enabling British Columbians to be able to make informed food choices when dining out. Here, the evaluation findings identify opportunities to improve the program so that over time, it can meet its overall goal of contributing to the promotion of healthy weights and reducing the risk of chronic disease in BC. Multiple types of restaurants in BC have shown interest in the Informed Dining program to date. Small business operators have been able to participate through government support for menu nutrient analysis that was offered over the last two years. Currently, the vast majority of participating restaurants are meeting all program standards. Participating restaurants have been supported through the implementation process, and plan to both continue to participate and to inform other restaurateurs about the program. The recent commitment by 22 national chains in April 2013 indicates that interest and participation in the program is growing, and this alone is expected to increase program awareness amongst the public. Nutrition information in restaurants is strongly supported by British Columbians and is predicted to be a useful tool in helping them to make informed food choices when dining out, especially with respect to sodium and calorie content in meals. Among a sample of consumers in Informed Dining restaurants, however, few reported asking for the available nutrition information before making their food choices that day. Many surveyed were also not aware of the program, the calorie and sodium content of their meals, nor of their respective daily requirements. While findings suggest the current program design of providing full nutrition information meets the needs of consumers, program modifications are needed to considerably increase the visibility and access of nutrition information in restaurants so that consumers know nutrition information is available and they use it. Overall, further and more comprehensive program evaluation is needed to understand how well Informed Dining is meeting program goals and objectives, in particular its impact on population health in BC. Based on these findings, the following recommendations are made: 1. Increase visibility, prominence and access to nutrition information in restaurants by implementing program modifications to remove “upon request” and increase store-level signage. Explore new tools such as mobile apps to increase access to nutrition information. 2. Increase public awareness of the Informed Dining program and participating restaurants through activities such as campaigns, events, presentations. 3. Continue to educate the public and raise awareness around healthy eating in restaurants, with a focus on calories and sodium. This could be done through campaigns and public information resources. 4. Increase restaurant participation in the program by continuing to offer restaurant implementation supports and addressing barriers such as resource needs for small business operators. 5. Continue to evaluate the program, contribute to the evidence, and assess/monitor emerging research on an ongoing basis. 6 Appendix A: Program Milestones 7 Appendix B Informed Dining Program Implementation Supports Resources Description Informed Dining Website (www.informeddining.ca) The Informed Dining website provides information for restaurants, consumers, small businesses and health care facilities. The Restaurant Participation Guide outlines all the program standards and steps to participate in the program. Available in hard copy print or pdf download from www.informeddining.ca Restaurant Participation Guide Guide to Nutrient Analysis The Guide to Nutrient Analysis is a “how to” document on standardizing recipes and conducting a nutrient analysis. Included in the guide is a list of labs, consultants and software options. Available in hard copy print or pdf download from www.informeddining.ca Rack Card The Rack Card is a restaurant recruitment tool for conferences and tradeshows. The rack card is predominantly distributed by Environmental Health Officers during routine food safety inspections. The rack card is available in hard copy in 6 languages (English, Farsi, Korean, Traditional Chinese and Punjabi) from program staff. 8 Staff Training Poster & Guide The staff training poster and guide are available to restaurant operators to help train their food service staff to understand the program in order to assist customers and answer basic questions. Available in hard copy print or pdf download from www.informeddining.ca Dietitian Services at HealthLink BC Registered Dietitians available at HealthLink BC assist with nutrient analysis, recipe reformulation and answer program questions from the public and restaurants. Graphic Design Templates InDesign graphic templates available in menu, brochure or poster style that incorporate program standards for nutrition information. Available from program staff. Danglers Informed Dining logo and directional statement danglers that can be affixed to menu boards. Available from program staff. Window Decals Informed Dining window decals that identify designated restaurants. Available from program staff. 9 Appendix C Evaluation Data from the Heart of Stroke Foundation of Canada (BC & Yukon) and the Ministry of Health The Heart and Stroke Foundation of Canada (BC & Yukon) Evaluation Data Data source Time Sampling Point of Purchase survey (POP) November & December 2012 531 consumers (ages 19-64 yrs) interviewed in 4 different restaurants actively participating in the Informed Dining program Restaurant Response survey (RRS) January 2013 7 restaurants actively participating in the Informed Dining program completed a web-based survey We Want It campaign web analytics January-April, 2013 Unknown The Ministry of Health Evaluation Data Data source Time Sampling Public Opinion Research (POR) January 2012 803 randomly selected British Columbians – web-based survey February 2013 810 randomly selected British Columbians – web-based survey Promotional Campaign online survey conducted by Ipsos Reid May- June 2012 400 British Columbians (between ages 18-70) Restaurant verification reports by Environmental Health Officers (EHO’s) December 2012 – June 2013 62 reports by EHOs Program Restaurant Tracker 2011 – June 2013 N/A 10