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CITY OF MELBOURNE Sports and recreation centre healthy food retail case study Professor Anna Peeters & Oliver Huse

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Contents 1. List of Abbreviations .............................................................................................................. 4

2. List of Figures ......................................................................................................................... 5

3. Executive Summary ................................................................................................................ 6

Overview ................................................................................................................................ 6

Objectives ............................................................................................................................... 6

Methods ................................................................................................................................. 6

Findings .................................................................................................................................. 7

Conclusions ............................................................................................................................ 8

4. Background ............................................................................................................................ 9

4.1. Context ............................................................................................................................ 9

4.2. Organisational structure ............................................................................................... 10

4.3. Aims ............................................................................................................................... 11

5. Methods ............................................................................................................................... 12

5.1. Study Design .................................................................................................................. 12

5.1.1. Analysis of NMRC café sales and product data ..................................................... 12

5.1.2. Key informant interviews ....................................................................................... 12

6. Analysis of sales data ........................................................................................................... 15

6.1. Product offerings .......................................................................................................... 15

6.2. Sales data ...................................................................................................................... 16

7. Enablers and challenges to the implementation of GLER at NMRC .................................... 19

7.1. Initial Enablers ............................................................................................................... 19

7.1.1. Practical support from the Health Projects team .................................................. 19

7.1.2. Champions ............................................................................................................. 20

7.1.3. Making healthy eating a priority ............................................................................ 20

7.2. Ongoing challenges ....................................................................................................... 21

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7.2.1. Issues with supply .................................................................................................. 21

7.2.2. Staff understanding and engagement ................................................................... 22

7.3. Ongoing Strategies ........................................................................................................ 23

7.3.1. Champions of GLER ................................................................................................ 23

7.3.2. Supportive strategies from the City of Melbourne ............................................... 24

8. Discussion and recommendations ....................................................................................... 26

9. Acknowledgements .............................................................................................................. 29

10. References ......................................................................................................................... 30

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1. List of Abbreviations

Term Abbreviation

Green Light Eat Right GLER

North Melbourne Recreation Centre NMRC

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2. List of Figures Table 1: Progression of the GLER program and rationale for these changes .......................... 10

Table 2: Interview participants ................................................................................................ 13

Figure 1: NMRC café product selection, number of green, amber and red products, by season.................................................................................................................................................. 15

Figure 2: NMRC café product selection, proportion of green, amber and red products, by season ...................................................................................................................................... 16

Figure 3: NMRC cafe item sales, per 100 visitors, of green, amber, red and total products, by season ...................................................................................................................................... 17

Figure 4: NMRC café top-ten selling products, number of green, amber, red items sold, by season ...................................................................................................................................... 18

Figure 5: NMRC café sales revenue, per 100 visitors, from green, amber, red and total products, by season ................................................................................................................. 19

Table 3: Key enablers to initial implementation of the ‘No Red’ Trial and the GLER program at NMRC ....................................................................................................................................... 21

Table 4: Key challenges to the ongoing implementation of the GLER program ..................... 23

Table 5: Key strategies to support the ongoing implementation of the GLER program ......... 25

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3. Executive Summary

Overview There is increasing recognition of the role of the environment in supporting healthy eating. Knowing this, the City of Melbourne developed the Green Light Eat Right (GLER) program, in 2008, for initial use at catering events. The GLER program aims to encourage healthy eating and classifies food and drinks as ‘green’ (best choices), ‘amber’ (choose carefully) and ‘red’ (limit) based on nutrient composition and serving size. In 2010, it adopted the GLER branding at the seasonal café at its North Melbourne Recreation Centre (NMRC). The NMRC is comprised of a pool, a café and a fitness facility, with the pool and café both being seasonal and only open from October to April. Over the 2014 off-season period, key stakeholders at the City of Melbourne and the NMRC worked to extend this program by significantly reducing the quantity of ‘red’ food and drinks on sale and providing ‘green’ and ‘amber’ options instead. They aimed to remove all soft drinks and diet soft drinks (an ‘amber’ type drink) from sale. It was agreed to maintain a small selection of sports drinks (a ‘red’ drink type) on offer. Subsequently, the October 2014 to April 2015 season was treated as a ‘No Red’ trial period for this new strategy. Based on the success of this trial, the City of Melbourne and the NMRC have worked to implement ongoing changes to the products offered at the café over the October 2015 to April 2016 season. In this report we capitalise on the policy directive and the opportunities that have occurred as a result of the implementation of the GLER trial at NMRC.

Objectives We aimed to explore the implementation of the ‘No Red’ trial and to understand some of the enablers, challenges and strategies surrounding its initial and ongoing implementation. In addition we aimed to explore the impact of the ‘No Red’ trial on availability and sales of unhealthy food and drinks, and total food and drink sales, at the NMRC. Specifically, this evaluation asked:

I. What changes were made as part of this initiative? II. What worked well?

III. What were barriers to change? IV. How did the change affect business perceptions of viability? V. What were some unique successful actions arising from this initiative? VI. What recommendations could be made to the City of Melbourne and other

organisations looking to implement healthy food policies to enhance implementation and effectiveness of the initiatives?

Methods Data collection and analysis for this study involved:

I. Analysis of the NMRC café sales and product data to understand the potential health and financial outcomes of the ‘No Red’ trial and the ongoing GLER program.

II. Semi-structured interviews with key stakeholders from the City of Melbourne and NMRC to understand the challenges and opportunities presented by the ‘No Red’ trial.

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NMRC café data was analysed as dollar sales and items sold per season. Where relevant, the data was adjusted for the number of centre visitations per season. Specifically, data is presented here as; items available by GLER classification (‘red’, ‘amber’ or ‘green’), NMRC café total item sales and item sales by GLER classification, the proportion of items in the top-ten best-selling products by GLER classification and NMRC café total sales revenue and sales revenue from each GLER category. Semi-structured, in-depth interviews were selected as the primary method of data collection. All interviews, except one, were conducted by the same two researchers and lasted approximately 1 hour. Qualitative description was used as the primary approach to exploring factors perceived to be associated with the implementation of the ‘No Red’ trial and thematic analysis was used to analyse the qualitative data obtained from interviews.

Findings After the reduction in ‘red’ food and drinks at the NMRC, there is a clear decrease in the number of ‘red’ items on offer, decreasing from around 15 items to around 5 items, and a clear increase in the number of ‘amber’ and ‘green’ items on offer. The introduction of the ’No Red’ trial appears to have had the desired effect of reducing the quantity of ‘red’ item sales while increasing the quantities of ‘amber’ and ‘green’ item sales. ‘Red’ item sales appear to have decreased by around 60%. As a consequence of the removal of ‘red’ products, there was a small decrease in total sales revenue over following seasons at the NMRC café. Key factors enabling the successful implementation and continuation of the ‘No Red’ trial at the NMRC included having strong champions of the program, who led and supported its implementation; the City of Melbourne making healthy eating an organisational priority; providing the champions with a supportive environment in which to work; and a range of practical supports from the City of Melbourne’s Health Projects department. Key challenges to the ongoing implementation of the policy were difficulties with supply, and with staff understanding and engagement. Several participants identified that issues with supply surrounded both the availability of healthy products, and the availability of suppliers to provide existing products. Areas of staff understanding and engagement identified for future focus included improving staff skills and confidence in working with GLER, and increasing communication between the NMRC and the City of Melbourne. Interviewees identified some innovative strategies that the City of Melbourne has introduced to respond to these challenges and embed the GLER approach, including introducing Champions of GLER and the development of an official council policy to support ongoing implementation.

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Conclusions The City of Melbourne North Melbourne Recreation Centre was an early adopter of strategies to improve the availability of healthy food and drinks. The trial and subsequent ongoing implementation of healthier food provision has led to large decreases in the availability and sales of unhealthy food and drink items. At the same time it has led to increases in sales of healthier food and drink items. The small decrease in overall food and drink sales is likely to be due, at least in part, to difficulties associated with supply and this potential loss in revenue is likely to be ameliorated if these challenges can be resolved. The overall process of introducing healthier food and beverages to the NMRC has been highly iterative and consultative, commencing with the implementation and evaluation of the GLER ‘No Red’ trial, with feedback to key stakeholders, followed by reflection on how to progress the approach with increased engagement and effectiveness. The innovative organisational strategies that the City of Melbourne and NMRC are now implementing to improve supply and multiple stakeholder engagement are likely to lead to further benefits to the community in future. We recommend that the key enablers, the innovative strategies used by City of Melbourne and NMRC, and the key findings be communicated broadly to support other similar organisations to make similar changes.

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4. Background

4.1. Context To reduce the burden of obesity, there is increased emphasis on improving food environments in order to improve population-wide diet quality (1, 2). However, comparatively less emphasis has been placed on the role of food retailers in altering consumer choices and improving diet-quality and it is possible that concern for business viability is one factor preventing retailers from embracing healthier business options. In Victoria, Australia, we are starting to see a move towards supporting businesses in their provision of a healthy food environment. The City of Melbourne is one council that has been a forerunner in the shift to providing healthy food to its community. The steps that the City of Melbourne has taken on this pathway have been summarised in Table 1. In 2008, the City of Melbourne, engaged the services of Nutrition Australia, to develop the Green Light Eat Right (GLER) program and criteria in an effort to increase organisational focus on healthy eating and physical activity, which was a new area of interest for the City of Melbourne. The GLER program classifies food and drinks as ‘green’ (best choices), ‘amber’ (choose carefully) and ‘red’ (limit). Foods are classified as ‘green’, ‘amber’ or ‘red’ based on saturated fat, fibre, sodium and energy content per 100g, as well as serving size. Drinks are classified as ‘green’, ‘amber’ or ‘red’ based on sugar and nutrient content, as well as serving size. This classification guideline was based on the Victorian State Government’s Healthy Choices: Food and Drink Hospital Guidelines (3). The GLER program was initially introduced to some sports and recreation centres within the municipality, as well as a food court. Over the 2009/10 season, the City of Melbourne adopted the GLER branding at the seasonal café at its North Melbourne Recreation Centre (NMRC), which is a metropolitan sports and recreation centre. It incorporates an outdoor pool and a café. The aim of this program was to educate the community to make more informed choices by improving the range and access to nutritious foods and drinks. In conjunction with the GLER branding, the City of Melbourne also began to gradually reduce the number of ‘red’ products available at the NMRC café. Over the 2014 off-season period, key stakeholders at the City of Melbourne and the NMRC worked to extend this program by significantly reducing the quantity of ‘red’ food and drink on sale and providing ‘green’ and ‘amber’ options instead, such that the only remaining ‘red’ products were sports drinks. They also removed all diet soft-drinks (an ‘amber’ drink type) from sale. Subsequently, the October 2014 to April 2015 season was treated as a trial period for this new strategy. These changes had the potential to impact on staff and customers, and therefore sales and customer feedback were monitored over this period and new suppliers and innovative food and drink offerings were selected.

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Table 1: Progression of the GLER program and rationale for these changes

Year Change Rationale

2008/09 GLER program developed through collaboration with Nutrition Australia. GLER branding introduced at some sports and recreation centres and at a public market

Healthy eating was a new, and developing, area of interest for the City of Melbourne.

2009/10 GLER Branding introduced at the NMRC café.

The Libraries and Recreation Branch were interested in participating, as they felt the goals of the program aligned with their service offering.

2010 Annual ‘stepped’ approach to removal of ‘red’ items introduced at the NMRC café.

The decision was made to continue rolling out the GLER program and provide healthier food and drink options to consumers.

2014/15 The ‘No Red’ trial, whereby most ‘red’ products were removed from sale, was introduced at the NMRC café.

This was treated as a trial period for other centres. As the NMRC café is a seasonal café, the risk associated with the program was perceived as minimal.

Based on the success of the ‘No Red’ trial in decreasing the sales of ‘red’ products and increasing the sales of ‘green’ and ‘amber’ products, the City of Melbourne and the NMRC have worked to implement ongoing changes to the products offered at the café over the October 2015 to April 2016 season, and there are plans to continue to extend line of work in coming café seasons. Recently, the Healthy Eating Policy for Libraries and Recreation has been endorsed by members of the City of Melbourne Leadership group. This will provide a platform to continue and expand this work for some years. In this report we capitalise on the policy directive and the opportunities that have occurred as a result of the implementation of the ‘No Red’ trial at NMRC. More specifically, this report aims to explore the implementation of the ‘No Red’ trial and to understand some of the enablers and challenges for its initial and ongoing implementation. In addition it aims to explore the impact of the ‘No Red’ trial on availability and sales of unhealthy and healthy food and drinks, and total food and drink sales, at the NMRC.

4.2. Organisational structure The City of Melbourne is comprised of numerous branches, one of these being Libraries and Recreation. This branch is responsible for the maintenance of several sports and recreation centres including the NMRC, in addition to five library sites. In brief, this branch is broadly overseen by a manager, with each subsequent library and recreation centre being overseen by a leisure facilities manager. The NMRC centre shares its leisure facilities manager with the Melbourne City Baths, another facility. Health and Wellbeing, a second branch at the City of Melbourne, is responsible for the management of City of Melbourne’s health and food-focused programs. The Health Projects team is part of the Health and Wellbeing

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branch, overseen by a Team Leader, with project coordinators being responsible for the specifics of program implementation. The Health Projects team was responsible for the development of the GLER program. The Libraries and Recreation branch were then interested to implement the ‘No Red’ trial at the NMRC, with support from the Health Projects team. The North Melbourne Recreation Centre itself is comprised of a full-time gym facility and a seasonal pool facility. The Pool is open from early October to the end of April, with a high season from November to February. The gym and the pool facilities are located in separate buildings. The café is connected with the pool facility and is subsequently a seasonal retailer as well. It is owned by the City of Melbourne and managed by staff at the NMRC. Revenue from the café contributes to overall revenue from the NMRC. During the on-season, attendees of the NMRC gym are able to access the café. Attendees of the NMRC have access to four drinking water fountains. Staff at the NMRC are either casual staff, employed on a per-season basis, or management staff, employed on a full or part-time basis. Casual staff are, in part, responsible for customer service at the café while management staff are additionally responsible for product ordering, service coordination and facility budget targets.

4.3. Aims In this report we capitalise on the opportunity provided by the implementation of the ‘No Red’ trial and the GLER program at the City of Melbourne’s NMRC. We aimed to explore the implementation of the ‘No Red' trial and to understand some of the enablers, challenges and strategies surrounding its initial and ongoing implementation. In addition we aimed to explore the impact of the ‘No Red' trial on availability and sales of unhealthy food and drinks, and total food and drink sales, at the NMRC. Specifically, this evaluation asked:

I. What changes were made as part of this initiative? II. What worked well?

III. What were barriers to change? IV. How did the change affect business perceptions of viability? V. What were some unique successful actions arising from this initiative? VI. What recommendations could be made to the City of Melbourne and other

organisations looking to implement healthy food policies to enhance implementation and effectiveness of the initiatives?

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5. Methods

5.1. Study Design Data collection and analysis for this study was divided into two distinct stages; analysis of sales and product data to understand the potential health outcomes (stage 1) and qualitative interviews to understand the challenges and opportunities (stage 2).

5.1.1. Analysis of NMRC café sales and product data The first stage of this study was analysis of café sales data.

Data collection The City of Melbourne provided aggregate, seasonal data detailing sales and product offering data for the NMRC café over five seasons; three seasons pre-implementation of the ‘No Red’ trial (Oct 2011 - April 2012, Oct 2012 - April 2013 and October 2013 - April 2014) and two seasons post-GLER program implementation (Oct 2014 - April 2015 and Oct 2015 - April 2016). Data was available for entire seasons and was not available on a monthly or weekly basis. This data was used to inform for future interviews and provide context to the changes made at the NMRC café. Prior to analysis, the available product data was coded into GLER classifications by City of Melbourne staff. Changes to the GLER classification standards resulted in some products, specifically certain ice-creams, which were ‘amber’ at the time of the ‘No Red’ trial becoming reclassified to ‘red’ and being removed from the café for future seasons.

Data description NMRC café data was analysed as total dollar sales and number of items sold per season. Where relevant, the data was adjusted for the number of centre visitations per season. Specifically, data is presented here as; number of items available by GLER classification (‘red’, ‘amber’ or ‘green’), NMRC café total number of items sold and number of items sold by GLER classification (per visitation) and NMRC café total sales revenue and sales revenue from each GLER category (per visitation). We also present the proportion of the top-ten best-selling products, according to number of items sold, in each ‘green’, ‘amber’ and ‘red’ category.

5.1.2. Key informant interviews The second stage in this study involved qualitative interviews with key staff from the City of Melbourne and the NMRC. These interviews aimed to describe the perceptions of different stakeholders regarding the implementation of the GLER program at the NMRC.

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Participant recruitment Interviewees were selected based on their position as a stakeholder in the implementation of the GLER program at the NMRC café. These stakeholders included senior staff from the NMRC involved with product selection, product ordering and customer service, along with management and staff from the City of Melbourne who were involved in the establishment of the GLER program and the selection of products for the NMRC café. These interviewees were recruited through communication with the City of Melbourne’s Libraries and Recreation branch and Health Projects team. Interview participants are shown in Table 1 below.

Table 2: Interview participants

Stakeholder Department

Team Leader Health Projects team

Senior Project Coordinator Health Projects team

Project Coordinator Health Projects team

Leisure Services Officer and GLER program manager

Health Projects team & Libraries and Recreation branches

Leisure Facilities Manager Libraries and Recreation branch

(Former) Leisure Facilities Manager Libraries and Recreation branch

Leisure Services Manager NMRC

Leisure Services Officer NMRC

Data collection Semi-structured, in-depth interviews were selected as the primary method of data collection as inductive methods such as this have enabled new information to the elicited from participants in past studies (4). A semi-structured interview schedule was used to direct these key-informant interviews and the following themes were explored: 1. Knowledge and experience of the City of Melbourne’s GLER program. 2. The stakeholder’s perspective on the new food program (benefits and disadvantages, barriers and facilitators). 3. Enablers and strategies important for initial and ongoing implementation of the GLER program. 4. Challenges to the initial and ongoing implementation of the GLER program. All interviews, except one, were conducted by the same two researchers (AP and OH) and lasted approximately 1 hour. The differing interview was conducted by OH and another researcher. Interviews were conducted in private at the NMRC or the City of Melbourne and were audio-recorded and transcribed using a professional transcription company. Supporting hand-written notes were also recorded by both interviewers. Immediately following the interview, the researchers privately discussed key themes coming from the interview, to aid future interviews, as well as to record subjective interpretations. These discussions were also audio-recorded.

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Data Analysis Qualitative description was used as the primary approach to exploring factors perceived to be associated with the implementation of the GLER-based healthy food and drink program. Qualitative descriptive research provides a comprehensive summary of events and allows results to be systematically compared and validated (5). Thematic analysis (6) was used to analyse the qualitative data obtained from interviews and additional researchers performed their own analyses of part of the data to enable cross-checking of the main themes. All themes described in this report were identified by at least four interviewees and all subthemes were identified by at least two interviewees.

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6. Analysis of sales data

6.1. Product offerings Figure 1 shows the number of items on offer at the NMRC café in each category (‘red’, ‘amber’ and ‘green’) over time. The reduction of ‘red’ food and drinks commenced over the April 2014 to October 2014 off-season, as shown by the dotted line on Figure 1. There is a clear decrease in the number of ‘red’ items on offer after the introduction of the ’No Red’ trial, decreasing from around 15 items to around 5. There is an associated increase in the number of ‘amber’ items on offer, with the number of items available rising from around 10 to 18 and then to 27 in response to the introduction of the ‘No Red’ trial. The number of available ‘green’ items was rising steadily prior to the ‘No Red’ trial, but increased substantially, to 26 and then to 30 ‘green’ items, post-trial. Similarly, Figure 2, depicts a substantial decrease in the proportion of ‘red’ products available, relative to ‘green’ and ‘amber’ options, in response to the implementation of the ‘No Red’ trial. The introduction of the GLER program combined with the ‘No Red’ trial appears to have had the desired effect, in improving the number and proportion of healthy options available at the NMRC café. Figure 1: NMRC café product selection, number of green, amber and red products, by season

Dashed line shows the time of implementation of the ‘No Red’ trial.

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Figure 2: NMRC café product selection, proportion of green, amber and red products, by season

Dashed line shows the time of implementation of the ‘No Red’ trial.

6.2. Sales data Analysis of itemised product sales data, provided by the NMRC, is presented through the following section. In brief, it appears that the introduction of both the GLER branding over the 2009/10 season, and the introduction of the ‘No Red’ trial has had the desired effect of reducing the number of ‘red’ products purchased by consumers. The number of ‘green’ and ‘amber’ products purchased increased after the implementation of the ‘No Red’ trial. While total number of products sold decreased in response to the reduction of ‘red’ products, this decrease was not as large as the decrease in the number of ‘red’ products sold, due to the aforementioned increase in the sales of ‘amber’ and ‘green’ products. As detailed in the analysis of challenges, lack of available supply of alternatives to the commonly purchased ‘red’ products appears to be one of the key factors behind the observed overall decrease in number of products sold. Figure 3 shows number of items sold at the NMRC café over five seasons, adjusted for the number of centre visitations each season. Prior to the reduction in the availability of ‘red’ food and drinks in 2014, item sales of ‘red’ products and total products were declining from 27 to 16 items per 100 visitors and 51 to 40 items per 100 visitors over three seasons, respectively. It is not possible to determine whether these changes were due to underlying community trends or due to the introduction of the GLER branding and the gradual removal of some unhealthy products from the NMRC café since 2009 (Table 1). ‘Green’ and ‘amber’ sales were relatively stable at around 6 items and 17 items per 100 visitors, respectively. Following the ‘No Red’ trial, there was a decline in the number of ‘red’ products sold to around 8 and then 3 items per 100 visitors, one and two seasons after the ‘No Red’ trial. Accompanying this decrease in the number of ‘red’ items sold, was an increase in the number of ‘amber’ and ‘green’ products sold per visitation, to around 8 and 24 items per 100 visitors, respectively. The total number of products sold per visitor remained relatively stable at around 35 items per 100 visitors between the October 2014-April 2015 and the October 2015-April 2016 seasons. Conclusions were similar when not accounting for

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changes in visitation numbers. The introduction of the GLER program combined with the ‘no red’ trial appears to have had the desired effect of reducing the quantity of ‘red’ items purchased by customers while increasing the quantities of ‘amber’ and ‘green’ items purchased. Figure 3: NMRC cafe item sales, per 100 visitors, of green, amber, red and total products, by season

Dashed line shows the time of implementation of the ‘No Red’ trial. Analysis of changes to the top-ten highest selling products at the NMRC café over time revealed that, for the three seasons prior to the ‘No Red’ trial, five out of the ten highest selling products were ‘red’, with four ‘amber’ and one ‘green’. Following the introduction of GLER, and the removal of most ‘red’ products, the number of ‘red’ items in the top-ten reduced to two to three. Of the remaining top-ten selling items; six to seven were ‘amber’ and one-two were ‘green’, in the seasons following the ‘No Red’ trial. Prior to the reduction in ‘red’ products, hot chips and several (‘red’) ice-cream varieties were amongst the top-ten highest sellers. Following the removal of these ‘red’ products, popcorn and ‘amber’ ice-cream varieties entered the list of the top-ten bestselling products. Figure 4 shows the combined number of items sold for all top-ten selling products at the NMRC café, over five seasons. The removal of many unhealthy products appears to have had the desired effect, with ‘red’ sales making up a smaller quantity of the top-ten selling products’ item sales.

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Figure 4: NMRC café top-ten selling products, number of green, amber, red items sold, by season

Dashed line shows the time of implementation of the ‘No Red’ trial. Figure 5 shows sales revenue, in Australian dollars, at the NMRC café over five seasons, adjusted for centre visitations. Prior to the reduction in ‘red’ food and drink, sales revenue from ‘red’ products was declining. It is not possible to determine whether these changes were due to underlying community trends or due to the introduction of the GLER branding and the gradual removal of some unhealthy products from the NMRC café since 2009 (Table 1). As a result, total sales revenue per visitation declined between 2011/12-2013/14 (Figure 5). Sales revenue per visitation from ‘amber’ and ‘green’ products was relatively stable over this period. Following the reduction in ‘red’ products from the café, there was a sharp decline in the sales revenue from ‘red’ products with an accompanying increase in the sales revenue from ‘green’ and ‘amber’ products. Total sales revenue per visitation declined immediately after the ‘No Red’ trial by around 15%, and then was stable between 2014/15-2015/16 (Figure 5). Conclusions were similar when not accounting for changes in visitation numbers.

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Figure 5: NMRC café sales revenue, per 100 visitors, from green, amber, red and total products, by season

Dashed line shows the time of implementation of the ‘No Red’ trial.

7. Enablers and challenges to the implementation of GLER at NMRC Key informant interviews with stakeholders from the NMRC and the City of Melbourne were conducted and enablers, challenges and ongoing strategies surrounding the implementation of the ‘No Red’ trial and the GLER program (specifically the removal of products) were identified. The following sections discuss the initial enablers to the implementation of the trial and the ongoing challenges and strategies that have emerged following this implementation.

7.1. Initial Enablers A number of enablers were identified by interviewees as contributing to the successful implementation of the GLER program and the ‘no-red’ trial. The key enablers that were identified in the implementation of the GLER program are outlined in Table 2 and described in detail below. Specifically, these early enablers included; practical support strategies from the Health Projects Department; making healthy eating a City of Melbourne priority; and champions of the GLER program.

7.1.1. Practical support from the Health Projects team Interviewees identified a number of examples of practical support from the Health Projects team that were critical for implementation and relied heavily on the nutrition expertise from within the team. Practical support from the Health Projects team took the form of assistance with finding suppliers, assistance with finding new products, assistance with training staff and assistance with nutritional expertise. Specifically, the Health and Wellbeing branch had “the expertise in [the] team to be able to make that happen … [they]

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have that kind of nutrition background.” Given the innovation of the ‘No Red’ trial, this assistance was instrumental in bridging the early gaps in expertise and knowledge available at the NMRC.

7.1.2. Champions Another significant enabler to the success of the GLER program was the campaigning of champions. These early supporters of the GLER program who were eager to implement and progress it were seen by several interviewees as the initial catalysts of the program implementation. A number of respondents identified that key individuals (‘champions’) were instrumental in taking initial risks and campaigning for the implementation of a trial at the NMRC café. Specifically, one informant noted: “…was quite driven around this notion of really trying to get more green products on the menu to replace red ... we were more than willing to support them”. These champions were perceived to have been important communicators of the importance of the ‘No Red’ trial and the GLER program and were significant in their capacity to communicate this across different sites, branches and levels of management.

7.1.3. Making healthy eating a priority Finally, a broad theme that came up in most interviews was the importance to the early implementation of the GLER program of the City of Melbourne’s willingness to make healthy eating a priority. This was apparent through; top-down acceptance of a potential budget impact, general acceptance of the importance of encouraging healthy eating, alignment of the GLER program with the City of Melbourne’s goals and the willingness of the City of Melbourne to conduct a trial for the GLER program and collect feedback. The acceptance of a potential budget impact was noted by several informants, with one saying “it was just taking a kind of leap really, and saying at the time - you know, hold on, the health and wellbeing of people who are accessing the centre and that sort of stuff is more important at the end of the day than money that can be made from them purchasing items from the canteen.” It was through this supportive environment that champions of the GLER program were able to focus on the process of implementation. Multiple informants identified that the GLER program continued and progressed based on the feedback of the outcomes obtained from the trial season. Based on the success of the ‘No Red’ trial in decreasing the sales of ‘red’ products and increasing the sales of ‘green’ and ‘amber’ products, with minimal impact on overall sales the GLER program was extended to future seasons.

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Table 3: Key enablers to initial implementation of the ‘No Red’ Trial and the GLER

program at NMRC

Broad enablers Specific themes

Practical support from the Health and Wellbeing branch

Assistance with finding suppliers

Assistance with finding new products

Assistance with training staff

Assistance with nutrition expertise

Making healthy eating a Priority

Top-down acceptance of a potential budget impact

General acceptance of the importance of encouraging healthy eating

Alignment with City of Melbourne goals

Willingness to undertake a trial and collect feedback

Champions Champions were early supporters of the GLER program who were eager to implement and progress it

7.2. Ongoing challenges A few key challenges were identified by interviewees during the ongoing implementation of the GLER program. The two major challenges that key informants identified were issues with supply, and with staff understanding and engagement. Difficulties with supply were identified in some form by all informants and it was recognised by all that these challenges were significant and ongoing. These issues with supply took the form of both gaps in available and appropriate products and gaps in the availability of suppliers to supply existing products. As a result of these, the City of Melbourne and the NMRC have developed specific strategies aimed at improving supply (discussed in a later section). Another broad challenge that arose in response to the ‘No Red’ trial was differences in staff understanding and engagement. More specifically, there were issues surrounding; staff skills and confidence in working with GLER, staff turnover and role changes, communication between the NMRC and the City of Melbourne and staff attitudes to the changes. These challenges are shown in Table 4 and the following sections discuss these difficulties associated with supply and staff understanding and engagement in more detail.

7.2.1. Issues with supply One challenge that was consistently mentioned as being not yet fully resolved was difficulties surrounding the supply of healthy food. Further, it is likely that the small

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decrease in total sales, identified in section 6.2, can be attributed, at least partially, to these gaps in supply. Within this broad challenge, several underlying themes were identified through key informant interviews. First, ‘Gaps in available suppliers’ was a theme that was identified by all informants and it was expressed by all that “a particular barrier that exists today is suppliers and their abilities to offer the foods we need at the frequency we need, and the amounts we need.” Second, there was a perception of a lack of appropriate healthy products in general, such that acceptable replacements are not available for the removed ‘red’ items. In particular, it was noted that there were “very limited lunch options, so to speak, so for example, sandwiches are limited to one or two ranges, which aren't family friendly. We have no hot food options…” Third, and more specifically to the NMRC café, there was identified to be a further lack of healthy options that do not require on-site preparation and this was recognised to have limited the available healthy choices. Fourth, minimal food storage options, the perishable nature of healthy food options and the unpredictable nature of service at the NMRC café resulted in many interviewees identifying food wastage as an ongoing challenge that was rooted in issues with supply.

7.2.2. Staff understanding and engagement A number of interviewees identified a number of differences in staff understanding and engagement as challenges to the ongoing implementation of the GLER program, some of which were also linked to those presented by supply. First, some informants raised concerns surrounding a lack of staff skills and confidence when working with GLER, with some believing that staff at the front desk had not yet been fully provided with the tools needed to meet customer queries; “…didn’t really have any answers to the questions that they [the customers] had as to why the Council were doing it or what the purpose [was] or why we weren’t selling this and weren’t selling that”. Second, some interviewees identified communication between the City of Melbourne and the NMRC as a potential area for improvement. Some identified areas of discordance in understanding of implementation between NMRC-based and City of Melbourne-based staff. For example, one participant noted “…there's quite a disjoint between what we do and what the facilities do on the ground.” Some gaps in communication were identified regarding the City of Melbourne’s acceptance of financial implications from the ‘No Red’ trial and the GLER program. The interviews identified that some staff did not appear to have received this message, while others felt reassured that the trial could progress without budgetary concerns. Two more minor issues were identified, related to staff communication and engagement. Staff turnover represented a small challenge, with some informants identifying that a combination of staff turnover and changes in roles resulted in a loss of relationships and skills. Finally, it was recognised that there were a variety of staff attitudes to the changes that suggested different levels of understanding of the goals and process of the GLER program. For example, one informant said “The people who use the facility should be made to have choices, and make their own choices as well. I'm not sure that we should be forcing the choices…” while another informant said “…people want to make the healthy choice. The

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whole notion of the Green Light, Eat Right program was that people needed something to help them make that choice.”

Table 4: Key challenges to the ongoing implementation of the GLER program

Broad challenges Specific themes

Issues with supply Gaps in available suppliers

Gaps in appropriate products

Limited healthy options that don’t require on site preparation

Perceptions that customers do not like the options

Wastage

Staff understanding and engagement Staff skills and confidence in working with GLER

Communication between the NMRC and the City of Melbourne

Staff turnover and role changes

Staff attitudes to the changes

7.3. Ongoing Strategies In the ongoing implementation of the GLER program, the City of Melbourne and the NMRC have worked together to introduce several strategies aimed at increasing the impact of the program and overcoming some of the identified challenges. Two key strategies are the introduction of ‘Champions of GLER’ and enhanced, continuing support from the City of Melbourne.

7.3.1. Champions of GLER ‘Champions of GLER’ represents a relatively new official role, tasked with increasing NMRC staff understanding, engagement and support for the GLER program and acting as a line of communication between the NMRC and the City of Melbourne. To this extent, one such role adopted by these individuals was visiting a number of sports and recreation centres and working with and collecting feedback from staff on difficulties with GLER that had emerged. The potential benefit of this role was recognised by all interviewees, with one saying “ideally you would have a champion in each site”. As one informant noted, another overarching role of the ‘Champions of GLER’ has been “to really own it (the GLER program) and drive it, and come up with some creative initiatives”. In part, ‘Champions of GLER’ have encouraged NMRC staff to engage further with GLER through providing a source of experience, enthusiasm and support when working with the

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GLER program. Further, these champions are in a position to come up with new, creative initiatives for encouraging customers and staff to be enthused with healthy eating and for identifying new supply options. It will be important to continue to define the ‘Champions of GLER’ role with one interviewee, noting the potential benefit of “…a very clear document that says ‘you are the champion and these are your roles. This is the kind of training you’ll have and these are the expectations and these are the outcomes we expect’”.

7.3.2. Supportive strategies from the City of Melbourne Beyond the introduction of the ‘Champions of GLER’, the City of Melbourne has continued to support the implementation of GLER at the NMRC through assistance with finding new suppliers, creation of an overarching policy outlining the GLER program, continued acceptance of any budgetary impacts and through the inclusion of staff training about GLER in the NMRC induction process. In order to address the ongoing issues with supply, the City of Melbourne has worked closely with a consultant in an effort to identify both new suppliers and new healthy food and drink products relevant to the NMRC. It will be important to evaluate whether this strategy is achieving the intended goal of improving the availability of acceptable healthy options. Beyond this, members of the Health Projects Department have worked, following the ‘No Red’ trial, to create a ‘Healthy Eating Policy’, outlining the expectations and goals of healthy eating in the recreation and libraries spaces. The introduction of this policy will provide concrete guidelines for NMRC staff, and will support ongoing communication regarding the reasons for and processes involved in the implementation of GLER and the traffic light classification system. Further, the City of Melbourne has continued to support the GLER program, making it clear that the health goals of the program outweigh any potential financial impacts. These clear messages have continued from those in leadership positions across both of the aforementioned City of Melbourne branches. In order to address some staff concerns regarding understanding about and confidence with GLER, along with the issues of a changing workforce, staff training for GLER has been made a fixed part of the seasonal staff induction process. The aim of this consistent training has been to educate staff on the benefits of healthy eating and the coding process by which healthy foods are selected for use at the NMRC café. Informants identified that increasing the frequency and amount of this training may represent an opportunity to increase staff confidence and skills when working with GLER.

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Table 5: Key strategies to support the ongoing implementation of the GLER program

Broad strategies Specific themes

Introduction of the ‘Champions of GLER’

Increased lines of communication between the NMRC and the City of Melbourne

Increased consultation and collaboration, by the City of Melbourne, with staff from the NMRC through the introduction of a ‘GLER Taskforce’

Ongoing supportive strategies from the City of Melbourne

Search for suppliers through a consultant

Creation of an overarching ’Healthy Eating Policy’

Maintained budget flexibility

Inclusion of GLER training in the NMRC staff induction

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8. Discussion and recommendations The key factors leading to the initial implementation of the ‘No Red’ trial season were champions of the program, who led the way in its implementation, the City of Melbourne making healthy eating an organisational priority, providing these champions with a supportive environment in which to work, and practical support from the Health Projects department, which filled the knowledge gaps present in the Libraries and Recreation department. The trial had its intended impact. The removal of unhealthy products further reduced the number of ‘red’ items sold at the NMRC café and also increased the sales of ‘amber’ and ‘green’ items. As a result of this reduction in ‘red’ products, there was a small decrease in total sales revenue, which stabilised over following seasons. Key-informant interviews indicated that it is likely that this small decrease in total sales was due, at least in part, to the limitations in what ‘green’ and ‘amber’ products could reliably be sourced to replace the removed ‘red’ items. Based on the perceived success of this initial trial, the decision was made to continue with the implementation of the GLER program and make further changes to the offerings at the NMRC café while continuing to try and find a greater variety of ‘green’ and ‘amber’ supply options. It is important to recognise that, while this evaluation uses the total number of products sold and the revenue gained from the sale of these products as indicators of the impact of the ‘No Red’ trial on the NMRC café’s income, these factors are simple indicators. For a full understanding of this impact it will be critical to look at the other components of the café profit such as expenses and other resources. With the removal of preparation and storage facilities for hot food and a reduction in the range of products purchased it is possible that expenses also changed following the ‘No Red’ trial, but we have not been able to capture that here. We recommend that future evaluations of this and other interventions conduct more in-depth financial analysis so as to fully capture the financial implications of such interventions. As the GLER program progressed, ongoing challenges to its implementation included; difficulties with supply and challenges with staff understanding and engagement. Informants noted that appropriate healthy products and suppliers were lacking, and this was contributing to food wastage and issues with staff engagement. The City of Melbourne has introduced some innovative strategies to embed the GLER approach and deal with some of these challenges, including introducing Champions of GLER and an official ‘Healthy Eating Policy’ to support ongoing implementation. Over the following section, we make several recommendations to the City of Melbourne to address these key challenges to the ongoing implementation of the GLER program. These recommendations are also relevant to other organisations introducing similar programs in similar contexts. First, we recommend further support and strengthening of current communication strategies by the City of Melbourne. One of the overriding themes identified through interviews was the potential for greater communication between the City of Melbourne and

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NMRC staff in their efforts to implement GLER. We identified an opportunity to more systematically communicate key information, such as the successful changes to sales of healthy and unhealthy products, a continued acceptance of potential financial impact, customer feedback information, and ideas on improving supply. As a result, we would recommend that the existing, innovative ‘Champions of GLER’ be further invested in, such that their role is clearly defined and they have the capacity to act as a key communicant between each of the recreation centres and the City of Melbourne. Further, these communication pathways could be incorporated into the ‘Healthy Eating Policy’ document, so that they become a consistent component of organisational management. Second, while there is a component of staff training included in the NMRC staff induction, we identified an opportunity to expand this training, possible in connection with the Champions of GLER initiative. Due to the staff turnover experienced at the NMRC and the significant changes included in the GLER program, we recommend that this staff training become more comprehensive and frequent so as to ensure that gaps in NMRC staff knowledge and confidence are consistently filled. It will be critical to deal with the issues surrounding supply. Without a supplier that is able to provide healthy food at the price, quantity and timeliness required by the NMRC, it will be difficult for staff to continue to make changes and provide consumers with attractive healthy eating and drinking options. Therefore, a third recommendation is for the City of Melbourne to continue to work closely with other councils and organisations who have implemented similar strategies, in an effort to share knowledge and experience in this new but developing field, through a mutually beneficial relationship. Fourth, we also recommend that the City of Melbourne work closely with staff at the NMRC to address issues with supply. This could potentially be achieved through the inclusion of more taste testing, an idea raised by some informants, as well as through the Champions of GLER initiative discussed above. The overall process of introducing healthier food and beverages to the NMRC has been highly iterative and consultative, commencing with the implementation and evaluation of the GLER ‘No Red’ trial, with feedback to key stakeholders, followed by reflection on how to progress the approach with increased engagement and effectiveness. The innovative organisational strategies that the City of Melbourne and NMRC are now implementing to improve supply and multiple stakeholder engagement are likely to lead to further benefits to the community in future.

The City of Melbourne North Melbourne Recreation Centre was an early adopter of strategies to improve the availability of healthy food and drinks. The trial and subsequent ongoing implementation of healthier food provision has led to large decreases in the availability and sales of unhealthy food and drink items. At the same time it has led to increases in sales of healthier food and drink items. The small decrease in overall food and drink sales is likely to be ameliorated if challenges with supply can be resolved. We recommend that the key enablers, the innovative strategies used by City of Melbourne and NMRC, and the key findings be communicated broadly to support other similar organisations to make similar changes.

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9. Acknowledgements Funding This project was supported through funds from VicHealth. Professor Anna Peeters is supported by an NHMRC Career Development Fellowship and Deakin University. Participants We would like to extend our thanks to the City of Melbourne and its NMRC for their part in this evaluation, and in particular all of the individuals that participated in the interviews. Research group We would like to acknowledge Miranda Blake and Tara Boelsen-Robinson for their contribution to the results of this report, and to thank the Obesity and Population Health Unit at Deakin University for their feedback and support.

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10. References 1. Hawkes C, Smith TG, Jewell J, Wardle J, Hammond RA, Friel S, et al. Smart food policies for obesity prevention. The Lancet. 2015;385(9985):2410-21. 2. Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, et al. The global obesity pandemic: shaped by global drivers and local environments. The Lancet.378(9793):804-14. 3. State Government of Victoria. Healthy choices: food and drink guidelines for Victorian public hospitals. Melbourne: 2010. 4. Li S, Collins J, Lawson S, Thomas J, Truby H, Whelan K, et al. A preliminary qualitative exploration of dietitians' engagement with genetics and nutritional genomics: perspectives from international leaders. J Allied Health. 2014;43(4):221-8. 5. Sandelowski M. Whatever happened to qualitative description? Research in Nursing & Health. 2000;23(4):334-40. 6. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006;3(2):77-101.