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Evaluation of the "fresh choice" restaurant-based nutrition program Fitzpatrick, M. Patricia 1995

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EVALUATION OF THE "FRESH CHOICE" RESTAURANT-BASED NUTRITION PROGRAM M. PATRICIA FITZPATRICK B.Sc, The University of Prince Edward Island, 1990 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCES in THE FACULTY OF GRADUATE STUDIES (School of Family and Nutritional Sciences) We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA April 1995 © M. Patricia Fitzpatrick, 1995 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. egpartment of family a\^cK / V M T H boval Sciences The University of British Columbia Vancouver, Canada DE-6 (2/88) \ ABSTRACT ABSTRACT Nutrition programs in restaurants, designed to influence food selection behaviour at the point of purchase, are becoming a popular form of nutrition intervention. The "Fresh Choice" restaurant-based nutrition intervention program, developed from a partnership between the Vancouver Health Department, the Restaurateur and Foodservices Association of Greater Vancouver and the B.C. Chefs' Association, was designed to increase the availability and accessibility of good-tasting, lower fat menu items and to enable restaurateurs and customers to make informed choices about nutrition. Through the collaborative efforts of chefs and dietitians menu items prepared with little or no added fat were produced. These items and participating restaurants were promoted during the intervention month of June, 1993. The objective of this research was to evaluate the "Fresh Choice" program by first assessing customer satisfaction with restaurant menu items and second, assessing the acceptance of and response to the "Fresh Choice" program. In the first component, the restaurant population in eight Vancouver restaurants was surveyed during the fourth week of the intervention. A total of 686 patrons responded to a one page questionnaire and rated their satisfaction with 1127 menu items. Statistical tests indicated significantly greater overall satisfaction with "Fresh Choice" menu items than regular items. Satisfaction did not vary by the type of menu item (soup, salad, entree, dessert), meal type, or respondent's frequency of eating out, reason for eating out, eating pattern, gender or age. The most frequent reason for selecting all menu items, whether "Fresh Choice" or regular, was that they were favorites or preferences. In the second component of the study nine restaurant patrons who were recruited from participating restaurants during the intervention were interviewed. Interviewees indicated that eating out was a reward and an indulgence if done for the self and if there was freedom of selection. Also conveyed was that restaurants fulfilled many needs, both ii ABSTRACT emotional and physical, that arose from living and work situations which in turn affected the frequency of and reason for eating out. Restaurant and menu item selections were influenced by frequency of and reason for eating out as well as previous satisfying experiences with restaurants and menu items. Patrons identified similar determinants of satisfaction and reasons for menu item selection as the questionnaire respondents. Determinants of satisfaction were preparation, presentation, taste, freshness, portion size, lack of fat, temperature, value for price. They interpreted the "Fresh Choice" logo and name as denoting healthy, fresh and fun menu item choices. "Fresh Choice" added to the indulgent experience of eating out because it increased menu variety and selection of desired foods. However, when it was perceived that "Fresh Choice" reduced freedom of choice by advocating vegetarian and diet dishes over regular dishes, that meat dishes or substantial meals were not available, or that "Fresh Choice" meant less food, patrons were less interested in "Fresh Choice". Patrons also wanted healthier choices to be identified on the menu but did not want nutrition information anywhere near the menu. Nutrition information in general, excepting the "Fresh Choice" pamphlet, which was non-obtrusive and easy to read, was perceived by restaurant patrons to detract from the eating out experience by advocating what patrons should choose. "Lower fat" was a more acceptable descriptor of "Fresh Choice" dishes than "lighter fare" because the latter indicated less food to interviewees. The research indicated that customers were more satisfied with "Fresh Choice" versus regular menu items, implying that "Fresh Choice" and other nutrition intervention programs can be successful in providing healthier choices that are satisfying as well. Customers were receptive to "Fresh Choice" except when it was perceived that "Fresh Choice" was a vegetarian program which did not meet their needs and therefore iii ABSTRACT "Fresh Choice" program planners should promote all food groups equally to make it a program for all patrons. Results also indicated that patrons liked the "Fresh Choice" promotional materials which conveyed messages df fun, taste and health. Other nutrition interventions also could benefit by focusing on the pleasurable aspects of eating out and downplaying the factual aspects of nutrition. iv TABLE OF CONTENTS TABLE OF CONTENTS ABSTRACT ii T A B L E OF CONTENTS v LIST OF TABLES viii A C K N O W L E D G M E N T x 1. INTRODUCTION 1 2. BACKGROUND and LITERATURE REVIEW 4 2.1. Nutrition Programs in Restaurants 4 2.1.1. Rationale for Restaurant-Based Nutrition Programs 4 2.1.1.1. Prevalence of Eating Out 6 2.1.1.2. Public's Interest in Nutrition 8 2.1.1.3. Theoretical Justification for Nutrition Point-of-Purchase Programs 10 2.1.2 Evaluation of Restaurant and Cafeteria-Based Nutrition Programs 10 2.1.2.1. Evaluation of Restaurant-Based Nutrition Programs 11 2.1.2.2. Evaluation of Nutrition Information in Restaurants 15 2.1.2.3. Evaluation of Cafeteria-Based Programs 16 2.1.2.4. Conclusions 18 2.2. Understanding Customers' Restaurant Choices and the Importance of Satisfaction 19 2.2.1. Customers' Satisfaction with Meals in Foodservice Operations 20 2.3. "Fresh Choice" Nutrition Program 21 2.3.1. History and Process 22 2.3.2. Menu Items and Program Promotion 24 2.3.3. Study Objectives 25 3. DESIGN AND METHODS 27 3.1. Design Overview 27 3.2. Quantitative Evaluation of Customer Satisfaction with "Fresh Choice" Menu Items 27 3.2.1. Questionnaire Development and Pre-Testing 28 3.2.2. Questionnaire Implementation 29 3.2.3. Data Analysis 29 T A B L E O F C O N T E N T S 3.3. Qualitative Evaluation of Customer Attitudes to "Fresh Choice" Program 30 3.3.1. Interview Guide Development 31 3.3.2. Pilot Testing and Interviewer Training 31 3.3.3. Recruitment of Interviewees 31 3.3.4. Data Collection 32 3.3.5. Data Analysis 32 4. RESULTS 34 4.1. Satisfaction Questionnaires 34 4.1.1. Descriptive Results 36 4.1.2. Customers' Satisfaction with Characteristics of "Fresh Choice" and Regular Menu Items 41 4.1.3. Intercorrelations Among Satisfaction Descriptors and Overall Satisfaction Scale 46 4.1.4. Satisfaction with "Fresh Choice" and Regular Menu Items by Meal and Demographic Categories 48 4.2. Interviews 53 4.2.1. The Interviewees 5 3 4.2.2. The Role of Eating Out in Participants' Lives 57 4.2.2.1. The Meaning of Eating Out 57 4.2.2.2. Eating Out in Relation to Work and Home Contexts 64 4.2.3. Customers' Restaurant and Menu Selections and Satisfaction with Selections 68 4.2.3.1. Influences on Restaurant Selections 68 4.2.3.2. Influences on Menu Item Selections 71 4.2.4. Opinions on "Fresh Choice" and Nutrition Information in Restaurants 72 4.2.4.1. "Fresh Choice" Concepts 76 4.2.4.2. Nutrition Information Pamphlet 78 4.2.4.3. Response to the Use of "Lighter Fare" and "Lower Fat" 79 4.2.4.4. Promotion of the "Fresh Choice" Program 82 5. DISCUSSION 83 5.1. Satisfaction with Restaurant Dining 83 5.2. The Context of Restaurant Dining 85 5.3. Response to "Fresh Choice" and Nutrition in Restaurants 91 5.4. Limitations 94 6. CONCLUSION and RECOMMENDATIONS 95 7. BIBLIOGRAPHY 98 vi T A B L E O F C O N T E N T S 8. APPENDICES APPENDIX A "Fresh Choice" Participation Agreement, Logo and Pamphlet, Table Talker Insert, "Fresh" Special Sheet and Consumer Information Sheet 104 APPENDIX B Qualitative Questionnaire and Results 112 APPENDLX C "Customer Satisfaction with Menu Items" Pretest Questionnaire and Questionnaire Evaluation 115 APPENDIX D "Customer Satisfaction with Menu Items" Questionnaire 117 APPENDIX E Waitstaff Tip Sheet on Research Requirements 118 APPENDLX F Interview Guide 119 APPENDLX G Interviewee Recruitment Form 122 APPENDIX H Interviewee Consent Form 123 APPENDIX I Waitstaff Questionnaire for Response Rate 124 APPENDIX J Correlation Matrices and Two-Way A N O V A Tables 125 vii LIST O F T A B L E S LIST O F T A B L E S Table 2.1 Seating Capacity and Average Number of Customers per Day at Participating "Fresh Choice" Restaurants. 24 Table 4.1 Menu Items Rated in Satisfaction Questionnaires. 37 Table 4.2 Reasons for Choosing "Fresh Choice" and Regular Menu Items. 38 Table 4.3 Descriptions of Dining Occasions in Which Questionnaires Were Completed. 39 Table 4.4 Description of Diners Who Completed Questionnaires. 40 Table 4.5 Satisfaction with "Fresh Choice" Versus Regular Menu Items. 41 Table 4.6 Satisfaction with Menu Items Correctly and Incorrectly Classified as "Fresh Choice" by Customers. 43 Table 4.7 Satisfaction with Regular Menu Items Correctly and Incorrectly Classified by Customers 44 Table 4.8 Satisfaction with Menu Items Classified Correctly by Customers 45 Table 4.9 Correlation Coefficients Among Components of Satisfaction Scales within all Menu Items. 47 Table 4.10 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Menu Item Type. 49 Table 4.11 Customer Satisfaction with Menu Items Grouped Menu Item Classification and Meal Type. 49 Table 4.12 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Frequency of Eating Out. 50 Table 4.13 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Reason for Eating Out. 50 Table 4.14 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Eating Pattern. 51 viii LIST OF TABLES Table 4.15 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Specific Diet. 51 Table 4.16 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Gender. 52 Table 4.17 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Age. 52 Table 4.18 Profiles of the Nine Interviewees and the Restaurants Where Recruited. 54 Table 4.19 Patterns of Interviewees' Eating Habits, Nutrition, Exercise and Health. 56 Table 4.20 Comparison of the Characteristics of Eating Out and "Grabbing Some Food". 63 Table 4.21 Determinants of Restaurant Selection. 70 Table 4.22 Determinants of Menu Item Selection. 71 Table 4.23 Awareness of and Willingness to Try "Fresh Choice" Menu Items. 74 Table 4.24 Influence of Availability of "Lighter Fare" and "Lower Fat" Items on Menu Item and Restaurant Selections. 81 ix A C K N O W L E D G M E N T A C K N O W L E D G M E N T This research project was accomplished under the supervision of Dr. Gwen Chapman, Division of Human Nutrition, University of British Columbia, whose excellent guidance, good humour, and unfailing support and encouragement contributed greatly to the successful completion of my degree. It was a pleasure to work with her and an honour to have been her first graduate student. Many thanks to my other committee members Dr. Susan Barr, Division of Human Nutrition, University of British Columbia, and Dr. Susan Crawford for their generous assistance and direction. As well, a special thanks to Lynne Sawchuk for her infectious enthusiasm and support during the initial stages of the research with the "Fresh Choice" program and in the final stages as a research committee member. I also extend gratitude to Dr. Linda McCargar, Division of Human Nutrition, University of British Columbia, and to Deb Jones for serving as my members of the examining committee. I wish to acknowledge the contributions of the Vancouver Health Department and the Restaurant and Foodservices Association of Greater Vancouver who partially funded the research. I would also like to thank the "Fresh Choice" committee members, especially Lezlie Wagman, for their understanding, patience and encouragement throughout the past two years. This research could not have been completed without the cooperation of the restaurants' waitstaff and management, and the questionnaire and interview participants. I am extremely grateful to these individuals for the time spent in contributing toward this research. To my fellow graduate students at Family and Nutritional Sciences thank you for your support, wisdom and friendship during these challenging years. Special thanks to Charitini, Lynn (and her wonderful family!), Elle, and Dorcas for welcoming me into their homes on countless occasions, and to Eileen and Sabina for their positive perspectives and good advice. Finally, gratitude is expressed to my two families, in Prince Edward Island and in Vancouver Island, for their love and support. Very special thanks to Mark whose understanding, gentle wisdom, and frequent advice to "just get the job done" encouraged me to persevere and accomplish my goals. x INTRODUCTION 1. INTRODUCTION Current dietary recommendations suggest that the Canadian diet should be comprised of no more than 30% energy from fat and no more than 10% from saturated fat (Nutrition Recommendations for Canadians, 1990). Lowering the average Canadian's fat intake from the current 37% to the recommended level is a challenge faced by nutrition educators (Action Towards Healthy Eating, 1990). Part of the challenge is to reach large numbers of individuals in cost effective ways (Glanz, 1992; Mullis, 1990; Mayer, 1989). Point-of-purchase programs in locations where people choose what they will eat such as restaurants, cafeterias and grocery stores have shown success in influencing customers' choices (Glanz, 1992; Zifferblatt, 1980). Nutrition programs in restaurants have been suggested as an area of great potential to influence the eating habits of the restaurant population (Glanz, 1992; Mayer, 1989). National survey data indicate a growing trend for consumers to spend a larger share of the food dollar in restaurants (The Consumer Price Index, 1992). This increased importance of eating out is believed to be a result of the combined effects of greater numbers of women in the work force, decreased size of households, increased numbers of restaurants and marketing pressure to eat out, especially from the fast food industry (The Consumer Price Index, 1992; Reiter, 1991; Zifferblatt, 1980). At the same time, consumer nutrition awareness is high leading to consumer demand for restaurants to make available more healthy alternatives (Tefft, 1995; Sneed, 1988). Finally, there is theoretical support from the nutrition education, health promotion, and social marketing literature for the effectiveness of point-of-purchase nutrition programs (Anderson, 1990; Dean, 1990; Mullis, 1990; Glanz, 1989; Mayer, 1989; Granzin, 1988). 1 I N T R O D U C T I O N Fresh Choice Program "Fresh Choice" was a restaurant-based nutrition intervention and health promotion program designed and developed through a partnership of the Vancouver Health Department, the Restaurant and Foodservices Association of Greater Vancouver and the British Columbia Chefs' Association. The aims of the program were to increase the availability and accessibility of good-tasting, lower fat menu items in the Vancouver area and to provide restaurateurs and consumers with information to make informed choices. Chefs from participating restaurants, in consultation with dietitians, identified menu items that would fit the criteria of the "Fresh Choice" program. These menu items were made available and promoted during the "Fresh Choice" month which took place in June, 1993. Study Aims Evaluation research is a necessary component of a nutrition intervention or health promotion program as it provides feedback from the targeted population to assess the effectiveness or success of the program. The feedback provides program planners and other stakeholders with information that will affect the continuation and future directions of the program. The purpose of this study was therefore to evaluate some indicators of the effectiveness of the "Fresh Choice" restaurant-based nutrition intervention program. The evaluation was comprised of two components: a) measuring customer satisfaction with selected menu items and b) assessing restaurant patrons' acceptance of and attitude toward the "Fresh Choice" program. Customer satisfaction with menu items was selected as a predictor of effectiveness for several reasons. First, customer satisfaction with a product, such as a menu item, translates into a willingness to try that product again (Carsky, 1991; Johnston, 1991). 2 I N T R O D U C T I O N Second, restaurant businesses that depend on return and regular customers will probably be willing to continue with promotions that have been shown to satisfy customers (Johnston, 1991; Beasley, 1990). Third, consumption of satisfying and available menu items that provide continual, positive reinforcements of healthier eating may influence customers' attitudes towards nutrition and effect a health behaviour change (Westbrook, 1991) . Therefore, use of customer satisfaction with menu items as a predictor of program effectiveness was relevant to all "Fresh Choice" stakeholders: the restaurateurs, the program planners, and other supporters of the program. Customer satisfaction with "Fresh Choice" and regular menu items was assessed using a self-administered questionnaire. Customers' response to the "Fresh Choice" program and their receptivity to nutrition information when eating out were assessed in the second component of the evaluation. Customers' acceptance of "Fresh Choice" and attitudes towards nutrition and nutrition information when eating out were important factors in evaluating the success and effectiveness of the program. In contrast to the first component, which was employed to determine if the program did or did not work, the second component was employed to gain some insight into how and why the program did or did not work. Qualitative interviews allowed the customers' perspectives on nutrition in restaurants to be noted and insight into customers' ideas, opinions, and perceptions about eating out and how it fit into their lives was gained. Historically, evaluation research has used quantitative measures and techniques to obtain factual, reliable data on respondent awareness or behavioural change (Steckler, 1992) . How and why changes in awareness and behaviour occur, however, cannot be adequately described using quantitative data alone. Thus there is a need for qualitative research in evaluation measures (Steckler, 1992; Achterberg, 1988; Edwards, 1986). 3 BACKGROUND and LITERATURE REVIEW 2. BACKGROUND AND LITERATURE REVIEW Because restaurant-based nutrition interventions are a relatively new approach to nutrition education, the literature describing and evaluating such programs is not extensive. The available reports are discussed in the first section of this chapter where the rationale for nutrition programming is described, followed by a review of published evaluations of nutrition interventions. The second section of the chapter focuses on the rationale for using customer satisfaction as a measure of program effectiveness. The "Fresh Choice" program is then described. The chapter concludes with a statement of the study objectives. 2.1. Nutrition Programs in Restaurants The central goal of nutrition education and nutrition programs is to promote healthful eating patterns by giving the consumer information needed to make informed choices about nutrition and by creating environments where this can be more easily achieved (Glanz, 1992). Nutrition education in restaurants is a relatively new field of public health interest (Granzin, 1988). It focuses on increasing the availability of healthful foods that meet nutrition guidelines and on offering nutrition information through labeling and promotional materials (Anderson, 1990; Mayer, 1989; Carlson, 1986). Nutrition programs may also promote the restaurant as a location where more healthful foods can be requested (Green, 1993). 2.1.1. Rationale for Restaurant-Based Nutrition Programs The current nutrition recommendations for Canadians suggest that the Canadian diet should include no more than 30% of energy as fat and no more than 10% as saturated fat (Nutrition Recommendations for Canadians, 1990). A high fat diet is thought to be 4 B A C K G R O U N D and L I T E R A T U R E R E V I E W associated with increased risk for chronic diseases such as diabetes, coronary heart disease, obesity and cancer (Mullis, 1990). Lowering fat intake from the average North American consumption of approximately 37% (Kristal, 1990; Action Towards Healthy Eating, 1990) to the recommended maximum intake of 30%, is thought to decrease morbidity and mortality due to disease and increase health in general. Therefore, reduction of fat intake is a common objective of many nutrition programs (Kristal, 1990; Mullis, 1990). Canada's "Guidelines for Healthy Eating" recommends that to reduce fat intake Canadians should: enjoy a variety of foods but emphasize breads, cereals, vegetables and fruits; choose lower fat dairy products, leaner meats, and foods prepared with little or no added fat; and achieve and maintain a healthy body weight by exercising regularly and eating wisely (Using the Food Guide, 1992; Action Towards Healthy Eating, 1990). For nutrition educators' recommendations to have an effect on fat intake and the health of Canadians, large numbers of individuals need to be reached in cost-effective ways (Glanz, 1992; Mullis, 1990; Mayer, 1989). Nutrition interventions in locations where people choose what they will eat such as grocery stores, cafeterias, and restaurants, have been reported to influence many individuals at the same time, in a potentially cost-effective manner (Glanz, 1992; Zifferblatt, 1980). Three justifications for the use of restaurant-based nutrition intervention programs are: the prevalence of eating out (Green, 1993; Granzin, 1992; Sneed, 1991; Regan, 1987); the public's increasing interest in nutrition (Granzin, 1992; Sneed, 1991; Anderson, 1990); and the body of theory and research supporting programs in nutrition education (Granzin, 1992; Mullis, 1990; Glanz, 1989; Mayer, 1989). As consumers simultaneously become more aware of the relationship between nutrition and health and increase food consumption away from home, nutrition educators feel there is a need to provide healthier choices and more nutrition information in restaurants (Bronner, 1991). 5 BACKGROUND and LITERATURE REVIEW 2.1.1.1. Prevalence of Eating Out The frequency with which North Americans eat out has risen substantially over the past two decades (Green, 1993; Weisbrod, 1991; Regan, 1987; Ries, 1987). Increasingly, fewer foods are purchased from grocery stores and fewer meals are prepared at home (The Consumer Price Index, 1992; Weisbrod, 1991). In Canada, expenditures on restaurant meals as a proportion of the total food budget have increased two-fold from 12% in 1957 to 28% in 1986 (The Consumer Price Index, 1992). By 1992, expenditures on restaurant meals had risen to 32% (Visions, 1994). A report from the Canadian Restaurant and Foodservices Association suggests that the proportion of the food dollar being spent in restaurants is even higher, stating that in 1988 Canadians spent approximately 39% of their food dollar on meals eaten away from home, an increase from 35.5% in 1986 (Action Towards Healthy Eating, 1990). Americans show greater tendencies for eating out in restaurants than Canadians. In 1988, 43% of their food dollar was spent on meals away from home, an increase from 25% in 1955 (ADA Reports, 1991(b); Weisbrod, 1991). In 1991 Americans ate an average of 3.8 meals per week away from home and in 1993, spent 236.5 billion dollars in commercial food service establishments (Warshaw, 1993). By the turn of the century the share of the food budget being spent on meals away from home is predicted to increase to two-thirds (Finkelstein, 1989; Ries, 1987). In 1992 it was estimated that the Canadian foodservice industry served an average of three million meals per day to a potential eating out population of 19.8 million adults which suggests an average of just over one meal a week eaten out by Canadians (Eating Out Quarterly, 1992). The same survey showed that men ate out more frequently than women, respondents in the 18-24 age group ate out more than those in other age groups, and respondents of higher socioeconomic status ate out more often than those in 6 B A C K G R O U N D and L I T E R A T U R E R E V I E W lower income groups. An earlier survey in 1985, however, reported that the average Canadian ate out 130 times a year, or two and a half times a week, suggesting a decreasing trend in the prevalence of eating out (Forster-Coull, 1986). The earlier study, however, surveyed "average" Canadians and the latter included all adults which may explain the differences in the findings. In 1992 a Gallup Poll commissioned by the Canadian Restaurant and Food Service Association reported that 67% of surveyed adults had eaten out the week prior to the data collection. The majority of adults, (51%), mentioned dinner as the last meal eaten away from home, while 42% had lunch, 6% had breakfast and 5% had a snack (Eating Out Quarterly, 1992). In the same year, however, the Consumer Price Index (1992) reported lunch as the meal most often eaten away from home. The increased food expenditure on commercial eating has caused concern about the impact on the general public's nutrition and health status and thus increasing concern from nutrition educators (Ries, 1987; Axelson, 1983). The United States Surgeon General's report on nutrition and health noted the prevalence of eating away from home and recommended that foodservice establishments make changes to improve nutritional balance on their menus (ADA Reports, 1991(b)). Along the same lines, a National Academy of Sciences'Tnstitute of Medicine panel suggested restaurants should be required to provide nutrition information about the foods served (Skolnick, 1990). However, a survey of restaurateurs' opinions (Sneed, 1991) about healthier foods in restaurants showed they did not believe it was their responsibility to improve patrons' health or that the availability of healthier foods would be a factor in a patron's restaurant selection. The restaurateurs did believe, however, that they could provide healthier, more tasty menu alternatives for customers (Sneed, 1991). 7 BACKGROUND and LITERATURE REVIEW The increased expenditure on restaurant meals has been linked to increased numbers of women in the labour force, increased family income, decreased family size, and the associated rise in the number of one person households (Family Food Expenditures in Canada, 1992; Shields, 1992; Ries, 1987). The Consumer Price Index Report of 1992 stated that the, proportion of the food dollar spent on food away from home varied quite distinctly with the employment status of the woman in the household. The proportion was highest in homes with women who worked full time in the labour force and lower for part time and unemployed women. When both spouses had full-time jobs, greater value was placed on free time and leisure activities, such as eating out (Consumer Price Index Report, 1992). In addition, one person households in all income classes spent a significantly greater proportion of the food dollar on restaurant meals compared to households composed of two or more people. The number of children in a family appeared to limit eating out (Family Food Expenditures, 1992). 2.1.1.2. Public's Interest in Nutrition Consumer awareness of and concern about nutrition has risen dramatically over the past decade. A nationwide survey in 1989, "Tracking Nutrition Trends", reported that 59% of Canadian adults considered nutrition to be extremely or very important when choosing their food, while 71% were very to somewhat concerned about the amount of fat in their diet (Beggs, 1993). To decrease fat intake, these respondents chose lower fat products (29%), removed visible fat when preparing foods (22%) and ate less high fat content foods (21%)(Beggs, 1993). More recently a National Institute of Nutrition study (April, 1994) reported that nutrition was important to 87% of Canadians who indicated concern about dietary fat 50% of the time when selecting food (Tefft, 1995). In the United States, an American Dietetic Association poll (1990) reported that 95% of adult 8 B A C K G R O U N D and L I T E R A T U R E R E V I E W Americans saw balance, moderation and variety as important for a healthy diet (ADA Reports, 1991(b)). A 1989 National Restaurant Association (NRA) survey found that 60% of respondents claimed to have improved eating habits at home while 39% were committed to healthier eating away from home (ADA Reports, 1991(b)). The latter figure was an increase from 35% in an earlier NRA survey (1986)(ADA Reports, 1991(b)). The 1986 survey also reported that 42% of adults responded that they had tried, or were likely to try, restaurants that offered healthful menus, a 2% increase from 1985 (ADA Reports, 1991(b)). Restaurateurs and nutrition educators are becoming increasingly aware of consumer interest in nutrition and the need to work together to satisfy restaurant patrons' food and nutrition needs (Welland, 1993; ADA Reports, 1991(a)(b); Sneed, 1991). A variety of restaurants are responding to consumer interest by having nutritious alternatives available and by incorporating lower fat menu items and nutrition programs into their foodservice (Tefft, 1995; Sneed, 1991; Eating Out Quarterly, 1992; Anderson, 1990; Regan, 1987; Carlson, 1986). Consumer interest, however, does not necessarily lead to healthier items being ordered. Warshaw (1993) stated that "Americans talk thin and eat fat", indicating a vast difference between nutrition interest and eating behaviour. Eating out in restaurants may mitigate against dietary improvement (Weisbrod, 1991) because along with the increasing interest in "lighter fare" and healthier alternatives, has been an increase in "all you can eat" and "dessert" bars (Regan, 1987). As well, consumers may face barriers to healthier choices by associating them with tasteless diet foods, higher prices, smaller sizes, and the inconvenience or lack of availability of these items (Hendricks, 1993; Weisbrod, 1991). 9 BACKGROUND and LITERATURE REVIEW 2.1.1.3. Theoretical Justification for Nutrition Foint-of-Furchase Programs Point-of-purchase programs are based on the marketing concept that the greatest opportunity to influence a sale or to influence consumer behaviour is directly before the decision is made to buy the product (Glanz, 1992; Carsky, 1991; Zifferblatt, 1980). Application of this marketing strategy to a nutrition intervention program involves providing the consumer with the necessary information at the point-of-purchase that is easy to use to make an informed, confident decision on nutrition ( Hendricks, 1993; Glanz, 1992; Anderson, 1990; Glanz, 1989; Carlson, 1986). In such promotions, nutrition information is communicated with the use of on-site promotional materials (table tents, window decals, posters and menu labeling) in combination with media coverage in the community (Albright, 1990; Anderson, 1990; Forster-Coull, 1989). The social marketing of nutrition in restaurants creates an environment that is conducive to enjoyable, healthy eating (Hendricks, 1993; A D A Reports, 1991(a)). Positive, upbeat messages that minimize guilt and present food in the context of good tasting, attractive nutrition address the motivators and barriers to healthful change (Hendricks, 1993; A D A Reports, 1991(a); Colby, 1987; Regan, 1987). Successful nutrition promotions have focused on variety, quality, taste, enjoyment of food, and moderation, rather than deprivation and food avoidance (Hendricks, 1993; Granzin, 1988). 2.1.2. Evaluation of Restaurant and Cafeteria-Based Nutrition Programs Evaluation research is essential to all facets of nutrition intervention programs, including their development and implementation (Achterberg, 1988). It provides feedback to program stakeholders who can then determine program progress and worth. Ultimately, 10 BACKGROUND and LITERATURE REVIEW evaluation research may contribute to policy developments that influence lifestyle change and advance the field of nutrition education (Achterberg, 1988). Evaluations have been conducted for a number of nutrition programs in the United States and in Canada that have targeted cafeteria patrons and restaurant diners (Green, 1993; Albright, 1990; Anderson, 1990; Mayer, 1989; Forster-Coull, 1988; Schmitz and Fielding, 1986). Approaches to these evaluations have varied widely, including the use of pre/post sales tracking, surveys, and observation and withdrawal designs. The following section reviews a number of such evaluations, highlighting the methods used, the findings, and the strengths and weaknesses of the evaluation approach. 2.1.2.1. Evaluation of Restaurant-Based Nutrition Programs A restaurant-based nutrition program was conducted in four family style restaurants as a part of the Stanford Five City community-based cardiovascular risk reduction study (Albright, 1990). The restaurant intervention employed heart symbols that identified healthier items on posted menus, signs indicating that heart labeled items were low fat and low cholesterol, and tip sheets identifying healthier offerings. A pre/post test evaluation design was used to track sales during the intervention. In addition, restaurant patrons' awareness of the program and selection of labeled entrees were assessed through a one page survey administered on one day during the fourth week of the program. Results showed that during the intervention period, two of the four restaurants had significantly increased sales of lower fat foods, relative to baseline sales (p<0.05). There were significant differences in the reasons for selecting menu items by customers who chose the labeled items compared to those who did not (p< 0.001). Taste and wanting a healthy meal were listed most frequently by patrons who chose a lower fat item (37% and 35%, respectively), while taste and wanting to try something different were the 11 B A C K G R O U N D and L I T E R A T U R E R E V I E W most frequent responses from those who did not choose a labeled item (50% and 20%, respectively). Overall strengths of the evaluation procedures used in the study included the accuracy of sales tracking through computerized sales and careful monitoring of cashiers by management. Limitations included administering the customer survey on only one day, and lack of control in the experimental setting, including the unauthorized implementation of the program in a control restaurant. In addition, lack of education for managers about research requirements was a limitation. "Dine to Your Heart's Delight" was a similar, four week restaurant-based intervention. Heart decals on menus informed restaurant patrons about available low fat/low cholesterol alternatives (Anderson, 1990). A total of 53 restaurants participated, including 12 table service restaurants, 37 fast food outlets, and four cafeterias. A pre/post test design tracked sales during the intervention and an opinion survey assessed restaurateurs' receptivity to the program. Results showed that sales of ninety percent of labeled menu items increased during the four weeks. As well, all 53 managers responded positively to the program and reported that customers' comments were very favorable. Strengths of the design included a testing period adequate to note changes in sales and to control for novelty (and possibly seasonality) affects, and an open-ended opinion survey that discovered weak areas of the program such as inadequate waitstaff education. Limitations included the inability of 83% of restaurants to provide pre/post test data due to sales confidentiality, insufficient time for record keeping, and evaluation delays caused by new menus, staff turnover, management change. In addition, the lack of adequate training for waitstaff and managers was a limitation. Dining room success of the program was found to depend on waitstaff involvement, and managers' attitudes were important to motivating staff. A recommendation for future research was to evaluate customer satisfaction with restaurant-based nutrition intervention programs. 12 B A C K G R O U N D and L I T E R A T U R E R E V I E W Two research studies used surveys to evaluate restaurant programs (Forster-Coull, 1988; Green, 1993). "To Your Heart's Delight", a six week nutrition program promoting heart-healthy eating (foods low in fat, sugar and salt), was offered at twenty-one downtown Halifax restaurants. Heart decals on menus and menu inserts identified targeted items, table tents provided information on ways to reduce fat in restaurant meals, and tip sheets helped staff answer questions about the program. Customers were surveyed as they left two restaurants after lunch, pre/post nutrition intervention (Forster-Coull, 1988). They were asked about selections and if they asked for sauces on the side. In addition, post intervention customers were asked to identify heart healthy foods and recall labeled menu items. Managers and waitstaff were also surveyed to determine their response to the intervention material. The results showed a significant increase (pre/post intervention) in the percentage of patrons having "heart healthy" foods for lunch (7% versus 22%) and a significant increase in the number of patrons who asked for sauces on the side (18% versus 32%). In addition, 70% of the post intervention respondents could identify one heart healthy characteristic and 69% could recall one labeled item. Areas of concern were identified by managers and waitstaff but overall, restaurant personnel and patrons responded favorably to the program. A limitation of the evaluation included the inability to analyze sales tracking data due to incomplete collection. The Saskatchewan "Heart Smart" restaurant program is an on-going consumer-driven restaurant promotion that identifies restaurants offering "Heart Smart" menu items (Green, 1993). The goals of the program are to increase healthful, affordable choices in tableservice restaurants and to encourage restaurant patrons to make those choices. At the time of the evaluation, (after twenty-two months of program promotion in Saskatoon and eight months in Regina), 56% and 68% of the eligible restaurants, in Regina and Saskatoon respectively, were Heart Smart restaurants. A telephone survey was conducted 13 B A C K G R O U N D and L I T E R A T U R E R E V I E W to assess restaurant compliance to the program, and consumer awareness, understanding, and utilization of the program. Frequency of eating out and demographic information were obtained as well. Results showed that 41% (Regina) and 22% (Saskatoon) of respondents were aware of the "Heart Smart" program . One third of these knew how the program worked in each city, but only 16% had made requests for "Heart Smart" items. The availability of more healthful food choices was mentioned as important to restaurant selection by only 4% of the respondents. The strengths of this evaluation were that areas of weakness within the promotion such as the widespread misunderstanding of how the program operates and lack of restaurant compliance to "Heart Smart" objectives were illuminated. "Dine to Your Heart's Content", a Virginia "Eating Away from Home" program, was designed to enable restaurateurs to modify, develop, and promote menu items that meet the American Heart Association's guidelines (Paul, 1989). The purpose of the evaluation was to assess program development and obtain baseline data. Sixteen of the 26 eligible restaurants participated in the evaluation. Mailed-out questionnaires measured patrons' frequency of eating out, reasons for choices when eating out, wants and needs concerning menu items, knowledge of food composition, and opinions about the program. In addition, restaurateurs' perspectives of the program were assessed by interview and their knowledge of fats and oils assessed with a questionnaire. Results indicated that 57% of patrons were aware of the program, 88% were interested in following a heart healthy diet, and 55% were motivated by nutrition when making selections. A positive correlation was found between frequency of eating out at heart healthy restaurants and awareness of the program (p<0.001). Availability of the program appeared to increase restaurant selection. A strength of the evaluation was the identification of program development 14 BACKGROUND and LITERATURE REVIEW directions, including assistance for restaurateurs, program promotion in the community to increase awareness, and waitstaff training. Two smaller evaluations of restaurant-based nutrition programs focused on change in sales of menu items. Incorporation of a "Help your Heart" menu did not result in a significant change in total sales from the special menu over twelve months (Scott, 1979). In contrast, use of a poster promoting a low fat/high fibre selection in a fast food restaurant was associated with increased sales of the targeted item (Wagner, 1988). 2.1.2.2. Evaluation of Nutrition Information in Restaurants Other evaluations of nutrition interventions in restaurants were concerned with the effect of the nutrition messages used. The Pawtucket Heart Health Program's Four Heart System (Colby et al, 1987) used three types of prompting messages to promote sales of three daily specials. The messages used were: "healthful", (low in fat, sodium and cholesterol); "flavourful, as well as healthy"; and finally, "daily special". During the 27 day intervention 90% of patrons who chose the targeted daily specials responded to two statements in a brief, self administered questionnaire. The first statement sought to determine the main reason the special was selected and if the message influenced it. The second statement determined whether the patron remembered the specific details of the promotional message. Results indicated that taste had the strongest influence on selection and the message combining flavour and health was most likely to be remembered by the participants. Almanza et al (1993) evaluated consumer preferences for the presentation of nutrient information on menus. Three formats were used during different periods. An apple symbolized that items met nutrition guideline standards; colored dots identified choices low in fat, calories, and sodium; and numeric values were given for certain 15 B A C K G R O U N D and L I T E R A T U R E R E V I E W nutrients (fat, cholesterol, sodium, and fibre) in pamphlet form. A brief, self-administered questionnaire was completed after menu selections. The questionnaire sought demographic information, and included nutrition knowledge questions that tested the customer's recall of the information. It was found that nutrition information was read more often when associated with colored dots and that healthier choices increased significantly with pamphlet use (P=0.000). A follow-up study to assess customers' interest in nutrition and opinions about the attractiveness, ease of use, clarity, and overall preference for the three formats indicated that the apple and pamphlet formats were the most attractive and clearest, thus the easiest to use (Almanza, 1995). Attractiveness was the most important attribute for overall preference of any format. 2.1.2.3. Evaluation of Cafeteria-Based Programs Programs in cafeterias differ from restaurant-based programs due to several factors: first, cafeterias generally have a more stable population, especially those located in the worksite (Schmitz, 1986); second, menus in cafeterias may be more limited than restaurants (Albright, 1990), prices are lower, and customers serve themselves (Mayer, 1989); and third, management seems more amenable to promotions that increase customers' health (Sneed, 1991). Evaluation research is therefore different in cafeterias and usually more easily undertaken. Six published evaluations of nutrition programs in cafeteria settings assessed the use of food labels, nutritional information or incentives to cue healthier food selections. Five of these studies used observation techniques (Mayer 1987; Mayer, 1986; Schmitz, 1986; Cincirpini, 1984; Dubbert, 1984) and the sixth used an inventory cash register (Zifferblatt, 1980) to record foods selected during different phases. Dubbert et al (1984), 16 BACKGROUND and LITERATURE REVIEW examined the additive effects of labeling the three lowest calorie choices in an attempt to decrease caloric intake of foods selected. Zifferblatt (1980) used a nutrition game that carried specific nutritional messages designed to decrease caloric content of foods chosen. Both evaluations found significant increases in sales of some food items (p<0.05 and p<0.001 respectively) but not of entrees. Only Zifferblatt found a significant decrease in calories (p<0.001). Schmitz et al (1986), on the other hand, used cards to compare low calorie and high calorie foods at the point-of-choice. In a pre/post test design, she found a significant decrease (p<0.01) in calories per tray relative to baseline data. Mayer et al (1986), found that using posters and food labels significantly increased sales of low fat entrees during two phases of program intervention relative to baseline sales (p<0.001 and p <0.005). Cincirpini (1984) observed the effects of listing caloric values, labeling healthier foods, and offering rebates for purchases of healthier foods to individuals classified as obese, lean and normal. Mayer et al (1987) listed foods' caloric values, introduced specific nutritional messages with a nutrition awareness game, and offered incentive raffles for the selection of targeted foods. Both studies found that a combination of incentives and labeling was associated with increased sales of targeted items, but labeling alone was not. Davis-Chervin et al (1985) evaluated the effectiveness of a point-of-choice program that offered only intangible incentives, such as the promise of better health. Two dormitory cafeterias hosted the program for an academic year. One dorm displayed posters which recommended healthy food changes and ways to make changes and cards which provided caloric, fat and cholesterol values. The second cafeteria used only the nutrient display cards. Patrons did not differ in food selection practices prior to intervention but the additional information provided in the first dorm was associated with enhanced behaviour change. 17 B A C K G R O U N D and L I T E R A T U R E R E V I E W 2.1.2.4. Conclusions Most evaluations of point-of-purchase nutrition programs in restaurants and cafeterias have used change in sales to assess effectiveness. This approach can be accurate and reliable and does not intrude upon the patrons' dining experience. The test period must be long enough to note changes in sales and to control for seasonal and novelty effects. Limitations of this form of evaluation include restaurateurs' difficulties in collecting data and their reluctance to share records, and the problems encountered due to frequent management and staff turnover. In addition, this type of design does not provide information about why the observed behaviour changes occurred. Other evaluation designs have used opinion surveys to identify restaurateurs' and patrons' perceptions and responses to nutrition programs. Such studies indicate areas of weakness and strength in the program and can direct program improvement. Surveys may also test program effectiveness by assessing patrons' awareness of nutrition. Overall, however, there is a need to understand not only what does and does not work, as shown by the increase in sales of nutritious menu items or increased awareness of available items, but also how programs are received and interpreted by the customer. Patrons' attitudes to nutrition when eating out, their acceptance of nutrition information in restaurants and their acceptance of modified menu items are factors necessary to understand program success. Two ways to determine how and why a nutrition program is effective are by employing qualitative data and by understanding customer satisfaction with various menu items. Qualitative research can give valuable information about the group under study, particularly how people perceive a program and why they reacted the way they did (Steckler, 1992; Achterberg, 1988; Edwards, 1986). The use of both qualitative and quantitative methodologies to investigate the same program can be a solution to the problem of relying on any one data source or method in research (DeVries, 1990; Patton, 18 BACKGROUND and LITERATURE REVIEW 1990) and is a technique that is being encouraged (Achterberg, 1988). The importance of customer satisfaction is addressed in the next section. 2.2. Understanding Customer's Restaurant Choices and the Importance of Satisfaction The main goal of a nutrition intervention is to effect healthful eating behaviours (Glanz, 1992). Food selection behaviours are learned behaviours deeply rooted in culture and linked to the social, emotional and mythical meanings of foods (Parraga, 1990; Lewis, 1989). They also can be influenced by the environments in which individuals work and live (Hendricks, 1993; Parraga, 1990; Anon, 1990; Colby, 1987; Cincirpini, 1984; Hochbaum, 1981). Learned behaviours, while difficult to change, can be influenced by a change in attitude, which is in turn affected by a satisfying or dissatisfying experience (Dube, 1991). Attitudes, or feelings of favorableness or unfavorableness toward something, can predispose consumers toward certain food choices in restaurants or wherever food selections are made ( Parraga, 1990; Granzin, 1988; Sims, 1981). Therefore satisfaction with menu items offered by a nutrition program in a restaurant setting may affect attitudes about nutrition in restaurants and thus could be a measure of effectiveness for a nutrition program whose goal is to influence food selection behaviours. Satisfaction is a broad concept, involving both the object or product and the total experience. It is viewed as an evaluative, post choice judgment, or affective outcome, where consumers compare the experience to some internal standard (Dube, 1991; Johnston, 1991; Cadotte, 1987). Most of the empirical research to date has measured behaviour change and awareness to gauge nutrition intervention effectiveness in dining establishments (Mayer, 1989; Forster-Coull, 1988). There are two concerns with the measurement of program effectiveness in this way. First, behaviour change occurs slowly. 19 BACKGROUND and LITERATURE REVIEW As shown by the hierarchy-of-effects model, it occurs in stages from awareness of a problem or situation, to understanding, then attitude change, intention to change, and finally behaviour change (Westbrook, 1991). Tracking pre/post sales will indicate how customers chose over a period of time but may not be the best predictor of future behaviour. Second, the factors that are involved in, or contribute to, consumer food selection are varied (Anon, 1990; Parraga, 1990; Lewis, 1989). Knowledge or awareness about nutrition alone has not been a good predictor of behaviour (Kar, 1993; Lewis, 1989). Satisfaction, on the other hand, has been established as an important causal component for experience-based change because it provides feedback to the individual, affecting post-purchase attitudes and an intention to repurchase (Westbrook, 1991). 2.2.1. Customers' Satisfaction with Meals in Foodservice Operations Although assessment of customer satisfaction has not been a central component of the evaluation of restaurant-based nutrition programs, three studies have evaluated cafeteria patrons' or patients' satisfaction with hospital foodservices (Dube, 1994; Johnston, 1991; DeLuco, 1990). Johnston et al (1991) and Dube et al (1990) employed self-administered questionnaires to rate satisfaction with various aspects of the foodservice operations as well as overall satisfaction as the main outcome measure. DeLuco et al (1990) conducted randomly selected interviews by telephone to determine cafeteria patrons' perceptions and importance of quality of hospital food. Johnston, et al (1991) assessed patrons' satisfaction with food, service, environment and accessibility in twelve hospital cafeterias in Canada and New Zealand. Results indicated that food quality was most strongly associated with overall satisfaction, followed by service. Environment and accessibility were twenty times less important than food quality (p<0.01). 20 B A C K G R O U N D and L I T E R A T U R E R E V I E W Dube et al (1994), found that overall satisfaction with meals and foodservices was strongly associated with satisfaction with food quality, customization, attitude of staff, promptness and reliability (p<0.001) (Dube, 1994). Dube noted that patients' perceptions of food service and meals seemed interwoven with social, physical and emotional aspects and that satisfaction of basic human needs, such as recognition, reassurance, and status, were considered crucial to understanding a patient's satisfaction with the overall experience. These determinants are usually absent on surveys because they are difficult to quantify but they are none the less important. DeLuco et al, (1990) found that components of food quality were associated with patients' overall satisfaction with foodservice and hospital stay. All studies supported previous evidence that food was the primary source of satisfaction in a foodservice setting (Paul, 1989). 2.3. "Fresh Choice" Nutrition Program "Fresh Choice" is a Vancouver restaurant-based nutrition intervention program designed to support and promote restaurateurs who wish to cater to the increasing demand of consumers who want more nutritious menu items when eating out. This nutrition intervention health promotion program is a development of Project FIND (For Informed Decision Making), a Vancouver Health Department initiative. The Health Department, in cooperation with the B.C. Chefs' Association and the Restaurant and Foodservices Association of Greater Vancouver, created "Fresh Choice" to answer to the needs of consumers who are increasingly demanding more nutritious foods when eating out. 21 B A C K G R O U N D and L I T E R A T U R E R E V I E W The program's objectives were: • to increase the availability and accessibility (i.e. public awareness) of tasty, lower fat menu items in restaurants; • to provide restaurateurs and consumers with information about lower fat menu items to enable them to make informed choices; • to promote restaurants that participate in the program; • to evaluate the program by exploring customer satisfaction with menu items, and restaurateurs' and customers' attitudes toward "Fresh Choice". 2.3.1. History and Process Formative research for "Fresh Choice" was done in the Kitsilano area of Vancouver in 1991. In this survey, restaurant patrons indicated a preference for lower fat menu items, including having sauces (47%) and salad dressings (62%) served on the side (Vancouver Health Department, 1991). The following year, a survey of 22 food industry representatives and 17 owner/proprietors in the same area indicated a trend towards interest in more healthful menu items and making lower fat menu choices available to the public (Farrel and Associates, 1992). This market survey noted that restaurateurs believed the word "healthy" connoted bland, boring, diet food, that a stigma may be attached to healthier fare, and that these connotations would decrease the appeal of nutrition promotions in the restaurant setting. Restaurateurs felt that reassuring, positive terms such as "fresh" and "delicious" would be preferred over "healthy". The "Fresh Choice" program was thus designed to make available to restaurant patrons lower fat, but fiavourful, menu items prepared with little or no added fat. The nutrition intervention program was based on strategies and techniques from the fields of 22 B A C K G R O U N D and L I T E R A T U R E R E V I E W health promotion and social marketing. Health promotion involves the use of a systems approach to investigate, inform and change lifestyles to improve health and prevent disease and is based on understanding the forces that can promote or damage health in the social and physical environments in which people work and live (Dean, 1990). Social marketing involves the application of marketing techniques to sell health ideas (Dean, 1990). In May 1992, restaurateurs and the media were introduced to the "Fresh Choice" concept and in February 1993, a training workshop was held to encourage restaurant participation and teach restaurateurs and chefs how to incorporate lower fat ingredients into existing recipes. A restaurant's acceptance into the program was contingent upon certain criteria, one of which involved willingness to participate in the evaluation of the program (see Appendix A). In June 1993, the "Fresh Choice" month began in nine Vancouver restaurants. The participating restaurants are described in Table 2.1. Restaurants were contacted prior to and following the evaluation to obtain information on seating capacity and number of customers. The number of customers per lunch and dinner was generally three times the seating capacity for each restaurant. The primary target populations of the "Fresh Choice" campaign were restaurateurs and restaurant patrons, defined as non-diet restricted, regular (eat out at least two to three times a week) (Forster-Coull, 1988) and routine (eat out for non-celebratory reasons) diners (Ries, 1987). 23 BACKGROUND and LITERATURE REVIEW Table 2.1 Seating Capacity and Average Number of Customers per Day at Participating "Fresh Choice" Restaurants. Restaurant Seating Capacity Average Number of Customers / Day (lunch/dinner) Avenue Grill 40 120 Fettucini's 25 75 Herons 80 240 Inlets 100 300 Isadora's 120 360 Picasso's 65 200 Sierra Grill 110 330 Tomato's 65 200 Vistas 144 300 2.3.2. Menu Items and Program Promotion The "Fresh Choice" program provided restaurants with pamphlets, table talker inserts, window decals and "Fresh" special sheets to highlight "Fresh Choice" menu items (see Appendix A). Restaurateurs were then free to decide how to promote the items. All changed some pre-existing menu items to meet the "Fresh Choice" criteria of preparing food with little or no added fat. Some also tried new recipes. They announced menu items with "Fresh" special sheets (Avenue Grill, Herons, Inlets, Isadora's, Tomato's ), promoted them with table talkers (Avenue Grill, Fettucini's, Picasso's, Sierra Grill, Tomato's) or on the menu (Fettucini's) or used a special menu with the restaurant's logo (Picasso's, Vistas) 2 4 B A C K G R O U N D and L I T E R A T U R E R E V I E W and some used window decals (Avenue Grill, Inlets, Picasso's, Tomato's). All restaurants were supplied with "Fresh Choice" pamphlets which were generally placed near the entrance to the restaurant. Because staff training and willingness to participate have been shown to be extremely important to the success of a restaurant-based nutrition program (Sneed, 1991; Anderson, 1990; Regan, 1987) the "Fresh Choice" program incorporated staff training sessions. Meetings with waitstaff were conducted by nutritionists from the "Fresh Choice" committee to inform them about the program concept and objectives and about administration of the questionnaire. Waitstaff were asked to provide information on the macronutrient content (a stipulation of Consumer and Corporate Affairs) of the menu items to patrons upon request (see Appendix A). Nutrition pamphlets providing information on "Fresh Choice" menu items and the rationale for the program were delivered to businesses and community centres in areas where the program's restaurants were located. The "Fresh Choice" program included health promotion strategies such as providing a positive upbeat approach to cue and reinforce the message that healthier foods can be flavourful and tasty, hopefully to reduce barriers to behaviour change. The desired effect of the message was to combine consumer interest in enjoyable foods with their demand for more nutritious selections when eating out. 2.3.3. Study Objectives The broad purpose of this thesis project was to evaluate indicators of the effectiveness of the "Fresh Choice" program. The specific objectives were to a) measure consumer satisfaction with "Fresh Choice" (lower fat) menu items and to 25 B A C K G R O U N D and L I T E R A T U R E R E V I E W b) assess consumer interest in and perception of the "Fresh Choice" restaurant-based nutrition intervention program. Satisfaction with the "Fresh Choice" menu items was chosen as a measure of effectiveness of the program because satisfaction has been shown to be pivotal toward making an attitude change, and an attitude change is necessary to an intention to repurchase or to change food behaviour. Although both restaurateurs and customers were targeted by this program, it was felt that an evaluation of customer satisfaction in the restaurant setting was pertinent to acceptance of the "Fresh Choice" program by the restaurateurs and of value to program planners who want to sell the idea that lower fat can be good-tasting and good for health. The null hypotheses for this component were: 1. There is no difference in customer satisfaction between "Fresh Choice" and non "Fresh Choice" items and 2. There is no association between satisfaction with menu items and menu item type, meal type, frequency of eating out, reason for eating out, eating pattern, specific diet, gender and age. The assessment of restaurant patrons' reactions to "Fresh Choice" and eating out was important because their perspective on the program had not been previously obtained. The program planners did not know if the developed program would suit the needs and answer the concerns of consumers. The assessment would also provide insight about restaurant patronage and nutrition in restaurants, and about the factors influencing eating out, choice of restaurants and menu items, and satisfaction with menu items. 26 DESIGN AND METHODS 3. DESIGN AND METHODS 3.1 Design Overview The research design included three phases. Preliminary qualitative data were collected to identify the components of customer satisfaction with restaurant meals. A questionnaire designed to measure customer satisfaction with "Fresh Choice" menu items was developed from these findings, pretested, then implemented during the intervention month, in June 1993. Semi-structured interviews with selected restaurant patrons were completed following the intervention to assess acceptance and perception of the "Fresh Choice" program and nutrition programs in restaurants. 3.2 Quantitative Evaluation of Customer Satisfaction with "Fresh Choice" Menu Items Qualitative research was conducted to identify those factors which determine customer satisfaction with a meal and to develop the satisfaction scale for the questionnaire. Individuals were approached at a downtown Vancouver university campus during evening winter session courses in 1993 and asked to complete a brief, self-administered, open-ended questionnaire about the determinants of their satisfaction with menu items when eating out. Forty-six individuals responded over a two hour period. The questionnaire and results are in Appendix B. Factors that were named by respondents were presentation (17), taste (16), doneness (12), freshness (11), portion size (10) temperature (9), low-fat (8) and price-value (6). These factors were included on the final version of the satisfaction scale. 27 DESIGN A N D M E T H O D S 3.2.1. Questionnaire Development and Pre-Testing A copy of the pretest questionnaire is given in Appendix C. The questionnaire included questions about specific menu items ordered that day, awareness of whether the item was a "Fresh Choice" or not, and an open-ended question about reasons for choosing those items. A five point Likert scale was used to assess customers' degree of satisfaction with each menu item according to each of the satisfaction descriptors. As well, a global question on overall satisfaction with menu items and an open-ended question about overall satisfaction with the meal were included. Other questions characterized respondents according to frequency of eating out, the reason for eating out at this time, special diet restrictions, gender, age and income. All questions were included in one page to intrude upon the diners as little as possible. The questionnaire was pretested in two of the participating restaurants, during lunch and dinner periods, on June 15th and 16th. One of these restaurants was a larger, fine dining establishment and the second was a smaller, casual style restaurant. For the purposes of the pretest, questions were included concerning difficulties in understanding the questionnaire and the length of time taken to do it (see Appendix C). Waitstaff were instructed by their managers or by the researcher to give one questionnaire to every customer with their bill whether they had a "Fresh Choice" or not. Incomplete and complete questionnaires were to be placed together in a sealed envelope to be counted later by the researcher. Any difficulties encountered by the staff in the delivering and collection of the questionnaires were to be reported to the researcher. Thirty-three restaurant patrons responded to the pretest. No problems with the questionnaire or its administration were evident except for some patrons' objections to the question of income, which was subsequently excluded. The evaluation proceeded as scheduled during the fourth week of the "Fresh Choice" promotion. 28 DESIGN AND METHODS 3.2.2. Questionnaire Implementation A total of 2,400 questionnaires (see sample in Appendix D) was distributed to the nine participating restaurants. Questionnaires were distributed according to seating number and average number of customers during lunch and dinner periods. A "Fresh Choice" committee nutritionist and the researcher met with waitstaff to explain evaluation procedures. In addition, tip sheets (Appendix E) reminding waitstaff of their role in the evaluation and a contact number in case of problems were also made available. Dated envelopes, to collect the used questionnaires, were provided for each day of the implementation and pens were available for customer use. One restaurant (a pretest restaurant) decided not to implement the survey because the questionnaire was found to be unsuitable for their clientele. The remaining eight restaurants were visited on a daily basis throughout the evaluation to count and collect questionnaires and consult with the waitstaff and management about implementation progress. The head waitress of one participating restaurant was interviewed following the intervention to gain feedback about waitstaff s reaction to "Fresh Choice" and their participation in the evaluation research. 3.2.3. Data Analysis The questionnaires were coded by individual restaurant, day of week and number. Menu items were coded by type (for example 1= soup) and were then identified by the researcher as either a "Fresh Choice" or a regular item using menus from the restaurants during the time of the promotion. Each variable in the satisfaction scale was coded. Coded values for the descriptors of the scale ranged from one to five, "extremely dissatisfied" to "extremely satisfied", equivalent to the range on the scale itself. Coding was completed for all independent variables including whether the item was a "Fresh Choice" or not, meal type, and demographic data (frequency of eating out, reason for eating out, on a particular 29 DESIGN AND METHODS diet, diet specification, gender and age) and the dependent variables of the satisfaction scale. Means, medians, standard deviations, frequencies and percentages of the independent variables (menu item classification, meal and menu item type, and respondent data) and dependent variables (satisfaction scale descriptors) were determined. Two-tailed independent samples t tests were used to compare respondents' satisfaction with "Fresh Choice" menu items with their satisfaction with regular items. Intercorrelations between the degree of satisfaction with different components of the satisfaction scales were calculated using Spearman's correlation matrices. Finally, two-way A N O V A tests were completed using four of the satisfaction descriptors (overall satisfaction, lack of fat or grease, freshness, and taste) as dependent variables, "Fresh Choice" versus regular classification, and each of the other eight variables as independent variables. All statistical analyses were conducted using the SPSS ( Statistical Packages for Software Systems) for Windows 5.0, (Chicago: 1992). A probability of <0.05 was used to determine statistical significance. Responses to the open-ended question, asking for reasons for menu item choice, were analyzed by the frequency with which reasons were mentioned. Similar responses were grouped together. 3.3. Qualitative Evaluation of Customer Attitudes to "Fresh Choice" Program The purpose of the qualitative interview was to obtain insight into restaurant patrons' eating out habits, menu item selections and perspectives on "Fresh Choice" and nutrition information in restaurants. Nine semi-structured interviews were conducted, transcribed verbatim and analyzed using cross-case analysis as described by Patton (1990). 30 DESIGN AND METHODS 3.3.1. Interview Guide Development The interviews were semi-structured; therefore, the main topics to be discussed in the interview were developed in advance, but the order and exact wording of the questions were decided during the interview. This format allows participants to raise issues they see as important and permits the interviewer to follow up these areas. A prototype of the interview guide is in Appendix F. Specific questions included: the customer's eating out habits and beliefs on nutrition and health; the customer's perception of the "Fresh Choice" concept, including the "Fresh Choice" name and promotional materials; the program's value to the restaurant patron; and the consumer's view of the importance of nutrition intervention in restaurants in general. 3.3.2. Pilot Testing and Interviewer Training The interview guide was pilot tested with two individuals who eat out regularly. They were recruited at the Burrard Health Unit in Vancouver and were not known to the interviewer. Each interview was tape recorded. The thesis supervisor observed the two interviews behind a two-way mirror and consulted with the interviewer following each session to provide advice on interviewing techniques. The length of time needed to conduct the interview and structural problems within the interview guide were determined at this time. 3.3.3. Recruitment of Interviewees Draws to win a dinner for two (donated by "Fresh Choice" participating restaurants) were used to recruit restaurant diners. The entry forms were pretested with the questionnaire at two restaurants, one of which later discontinued the evaluation. Fortunately, because of the pretest held there, entrants for the draw (and therefore 31 DESIGN A N D M E T H O D S potential interviewees) were available from this restaurant. The final entry forms (Appendix G) were made available to the restaurants before the intervention. During evaluation, the forms were delivered with, but separate from, the "customer satisfaction with menu items" questionnaire. The forms asked for entrants' names and phone numbers, described the requirements and responsibilities of the entrant and explained that participants would be interviewed on their perceptions of and interest in the "Fresh Choice" program and nutrition information in restaurants. Only questionnaire respondents were invited to enter the draw. When completed, the participants were asked to deliver their entry to a collection box, provided by the researcher, near the entrance. Nine participants, one from each restaurant, were selected for the interviews. The voucher for the dinner-for two was given at the conclusion of each interview. 3.3.4. Data Collection Data collection for the qualitative component of the research began in July and concluded in October, 1993. Interviews were arranged at the participant's convenience and most were held in the Family and Nutritional Sciences building at the University of British Columbia. All interviews were tape recorded and verbatim transcripts were prepared. Interviews ranged in length from thirty to sixty minutes. An informed consent form (Appendix H) was signed prior to each interview. Before and after each interview, notes were kept which were later used to develop summaries about the interviewees. 3.3.5. Data Analysis Analysis of the interviews followed standard procedures for cross-case analysis which involves grouping together the answers to common questions from different people 32 DESIGN A N D M E T H O D S (Patton, 1990). The semi-structured interview guide approach allowed for answers to be grouped in this manner. To ensure integrity, accuracy, validity and reliability in the analysis, rigorous methods and techniques were employed. Transcripts were reviewed three times to achieve familiarity with the data. Throughout the transcribing, coding, and analysis, reflective and analytic notes were written (Patton, 1990). Then the data were coded in a "top down" or deductive analytic approach according to interview guide questions (Patton, 1990). This method, which presupposes areas of interest, was necessary as certain areas were important to the evaluation. Next, reflective notes were made on the passages, responses, coded segments and summaries of the interviewees. The data were then reread to identify areas of interest not previously detected with the "top down" method of analysis. The second method of coding was "bottom up" or inductive where the data were read with no preconceived ideas or questions of what might be found (Patton, 1990). Emergent themes or patterns were identified in this manner, the data were recoded and reflective notes were written. The data were then aggregated according to the codes, interpreted and analyzed. Techniques such as negative case analysis in which a case that does not fit within the pattern is analyzed, and cross-classification matrices, in which responses to questions and emergent themes can be viewed in order, helped in the analysis (Patton, 1990). Finally, reflective and analytic notes on the progress of the interpretive analysis were completed. 33 R E S U L T S 4. R E S U L T S 4.1 Satisfaction Questionnaires A total of 2000 questionnaires was distributed to the eight restaurants participating in the evaluation. Not all 2000 questionnaires, however, were distributed to customers. Overall, an estimated 892 questionnaires were distributed. Of this number 694 questionnaires were completed, 149 were not, and 49 were missing. Therefore, a total of 1108 questionnaires were never distributed. Of the 694 questionnaires completed, eight were incomplete and unusable. The response rate was estimated by dividing the number of usable questionnaires by the approximate number of restaurant patrons who would have been at the restaurants during the promotion. Based on information provided by the restaurants on seating capacity and the number of individuals usually served during the lunch and dinner periods it was estimated that approximately 7,000 restaurant patrons could have received a questionnaire. Included in this figure, however, are a certain percentage of non-English-speaking tourists who were not given a questionnaire. The 686 questionnaires that were collected would thus represent a minimum response rate of approximately 10%. The approximate number of customers who received a questionnaire, is believed to be 892. Therefore, a response rate of 77% can be calculated to represent the percentage of customers who received and completed a questionnaire. Questionnaire results from one restaurant, Picasso Cafe, represent approximately 30% of total data (which may have skewed the overall results). Only Picasso's, of all eight restaurants, was able to carry out the research requirements as requested. Response rate from Picasso Cafe was 84%. Unfortunately, the pretest failed to uncover the difficulties most waitstaff would encounter with distributing and collecting questionnaires. The total number of questionnaires placed in collection envelopes was much lower than expected, given the 34 R E S U L T S total number of patrons served. As well, there were complete lunch and dinner periods or complete days at some restaurants when the waitstaff failed to distribute the questionnaires. The research supervisor, who visited a restaurant during the promotion, was not given a "Fresh Choice" menu or questionnaire. As well, when the researcher was present at another participating restaurant, no "Fresh Choice" promotion was visible at the table. To compensate for the inability to obtain an accurate response rate, a short questionnaire was given to the waitstaff of each restaurant to determine to the best of their recollection how many customers they served during the intervention, how many questionnaires they distributed, and how many were filled out (Appendix I). A total of twenty-four responded for the eight restaurants. Response rate was found to be highly variable using this method and therefore was estimated. Waitstaff s reasons given for their inability to deliver questionnaires were: they had no time; they forgot; and they did not distribute to non-English speaking customers. Another problem with questionnaire implementation was that one restaurateur, for convenience, stapled the dinner-for-two entry forms to the questionnaires. Efforts were made to persuade against this strategy but the management was firm about keeping them together. A waitress from a participating restaurant was subsequently interviewed about difficulties with questionnaire administration. The waitress reported that the questionnaires made her work more difficult, were inconvenient, got in the way, and were not liked by staff or customers. She collected most of them even though she repeatedly told staff to do so but the staff, she felt, did not have enough knowledge or respect for them. Some questionnaires were even tossed out by mistake by the busperson. The customers, she felt, had enough paperwork to do doing during the day and did not need more when eating out. She also stated that her restaurant was a "going to" restaurant where people were on 35 R E S U L T S their way to something else. The questionnaire might be better suited, she stated, in a restaurant where people were there to lunch. She liked the name "Fresh Choice" but felt healthy customers (those without diseases like diabetes) were not interested in knowing about grams of fat in restaurants: only two customers had asked her for the available information concerning macronutrient content. 4.1.1. Descriptive Results From the 686 completed questionnaires, 1127 menu items were rated for satisfaction. Respondents were asked to identify their menu items which were later classified as "Fresh Choice" or regular according to the restaurant menus. Table 4.1 shows the number of "Fresh Choice" and regular menu items rated and the types of menu items chosen. Regular items were chosen four times as often as "Fresh Choice" items and entrees were chosen most often. Unclassified items were those that could not be identified as either "Fresh Choice" or a regular. Appetizers and beverages are included in the category of "other". 36 RESULTS Table 4.1 Menu Items Rated in Satisfaction Questionnaires (n=1127)* Number % "Fresh Choice" Items Yes No Unknown Menu Item Type Soup Entree Salad Dessert Other 205 878 44 106 595 128 104 190 18.2 77.9 3.9 9.4 52.8 11.4 9.2 16.9 * Totals may not add up to 1127 due to missing data In Table 4.2 answers to the open-ended question about the reason for menu item choice are given. In all, 274 reasons were given for choosing the 205 "Fresh Choices" while 729 reasons were given for choosing the 878 regular items. Both menu item types were chosen most frequently because they were "favorites or preferences" indicating previous satisfaction. "Nutrition/health", "low fat/low cal/light" and "appealed/were craved" were the next most important reasons to choose a "Fresh Choice" at approximately 14% each. In contrast, the second most common reason for choosing regular items was because they "appealed/ were craved". "Nutritious" reasons for 37 RESULTS choosing these menu items were low in comparison. The frequencies of remaining reasons for choosing either type of menu item were similar. Table 4.2 Reasons for Choosing "Fresh Choice" and Regular Menu Items Type of Menu Item Reasons for Selection "Fresh Choice" Regular n % n % Favorite/Preference 67 24 217 30 Nutrition/Health 39 14 53 7 Low Fat/Low Cal/Light 37 14 48 7 Appealed/were Craved 35 13 179 25 New Experience 23 8 38 5 Special/Value 18 7 32 4 Taste/Spicy/Flavorful 17 5 45 6 Hungry/Filling/Thirsty 13 5 37 5 Vegetarian/Dairy free 9 3 22 3 Fresh 8 3 14 2 Appropriate for Day/Time 5 2 14 2 "Fresh Choice" 3 1 Recommended/Limited Choice — — 30 4 Total 274 99% 729 100% 38 RESULTS The dining occasions at which questionnaires were completed are described in Table 4.3. Most dining occasions were lunch, and most were not special occasions. The "other" category includes breakfast and snack meal types. Table 4.3 Description of Dining Occasions in Which Questionnaires Were Completed (N=686)* Dining Occasion Number % Meal Type Lunch 482 70.3 Dinner 141 20.0 Other 52 7.6 Special Occasion Yes 102 14.9 No 567 82.7 * Totals may not add up to 686 due to missing data The restaurant patrons who completed the questionnaires are described in Table 4.4. Over 60% of respondents ate out at least twice weekly, and few reported being on a diet. Over half were women and 34% were in the 35-49 age group. 39 RESULTS Table 4.4 Description of Diners Who Completed Questionnaires (n=686) Number % Frequency of Eating Out <2x/week 241 35.1 2-3x/week 264 38.5 >3x/week 156 22.7 No Response 25 3.7 On a Particular Diet Yes 129 18.8 No 525 76.5 No Response 32 4.6 Gender Male 234 34.1 Female 402 58.6 No Response 50 7.3 Age <24 76 11.1 25-34 202 29.4 35-49 233 34.0 > 50 157 22.9 No Response 18 2J5 40 RESULTS 4.1.2. Customers' Satisfaction with Characteristics of "Fresh Choice" and Regular Menu Items As shown in Table 4.5, diners' satisfaction with "Fresh Choice" menu items was significantly higher than their satisfaction with regular items for all satisfaction descriptors. The difference was highly significant (p < 0.001) for the descriptors "not over or undercooked", "lack of fat and grease", "freshness", "taste" and "overall satisfaction". Table 4.5 Satisfaction with "Fresh Choice" Versus Regular Menu Items "Fresh Choice" Regular Satisfaction Descriptors Total X 1 ±SD n X 1 ±SD n P2 Not over/undercooked 803 4.55 .70 152 4.28 .81 651 .000 Lack of fat/grease 890 4.53 .76 176 4.17 .89 714 .000 Freshness 991 4.64 .68 188 4.40 .75 803 .000 Portion Size 999 4.49 .83 195 4.32 .83 804 .011 Presentation 1003 4.39 .81 195 4.28 .78 808 .023 Taste 1020 4.50 .83 196 4.26 .82 824 .000 Temperature 924 4.40 .87 183 4.18 .84 741 .002 Value for Price 990 4.30 .85 194 4.12 .88 796 .007 Overall Satisfaction 989 4.47 .76 192 4.27 .81 797 .001 ' Mean satisfaction scores as measured on 5 point scale where 1 =extremely dissatisfied and 5=extremely satisfied 2 "Fresh Choice" versus regular as determined by independent samples t test. 41 R E S U L T S Because the customers' identification of menu items as "Fresh Choice" did not always agree with the restaurant's classification, further means comparison tests were conducted to assess whether there was a difference in satisfaction with menu items which customers correctly and incorrectly identified as "Fresh Choice" or regular. In Table 4.6, satisfaction with "Fresh Choice" menu items correctly identified as such is compared with satisfaction with regular menu items which customers identified as "Fresh Choice". For all satisfaction descriptors, satisfaction with true "Fresh Choice" items was higher than satisfaction with regular items which customers believed to be "Fresh Choice" selections. The difference was statistically significant for the descriptors "not over or undercooked", "freshness" and "taste". 42 RESULTS Table 4.6 Satisfaction with Menu Items Correctly and Incorrectly Classified as "Fresh Choice" by Customers. "Fresh Choice" Regular1 Satisfaction Scale Total X 1 ±SD n X 1 ±SD n PJ Not over/undercooked 280 4.56 .71 119 4.31 .74 161 .006 Lack of fat or grease 310 4.56 .76 136 4.39 .86 174 .065 Freshness 350 4.66 .70 148 4.49 .71 202 .021 Portion Size 347 4.49 .74 153 4.34 .83 194 .082 Presentation 348 4.43 .82 152 4.37 .76 196 .469 Taste 357 4.56 .80 153 4.38 .78 204 .041 Temperature 325 4.45 .85 144 4.30 .77 181 .091 Value for price 344 4.33 .83 151 4.19 .91 193 .148 Overall satisfaction 341 4.50 .74 150 4.42 .72 191 .340 1 Mean satisfaction scores as measured on 5point scale where 1 ^ extremely dissatisfied and 5=extremely satisfied 1 Incorrectly classified by customer as "Fresh Choice" 3 "Fresh Choice" versus regular as determined by independent samples t test. 43 RESULTS Table 4.7 compares the satisfaction with regular menu items which customers incorrectly identified as "Fresh Choice" with those items that were correctly classified as regular. In most cases, the incorrectly identified "Fresh Choice" items had a higher mean ranking than the regular items. These differences were significant in the categories of "lack of fat or grease", "temperature" and "overall satisfaction". Table 4.7 Satisfaction with Regular Menu Items Correctly and Incorrectly Classified by Customers. "Fresh Choice"1 Regular Satisfaction Scale Total X 1 +SD n X 1 +SD n PJ Not over/undercooked 428 4.31 .74 161 4.33 .80 267 .844 Lack of fat or grease 463 4.39 .86 174 4.12 .93 289 .002 Freshness 522 4.49 .71 202 4.45 .71 320 .583 Portion Size 517 4.43 .83 194 4.37 .79 323 .732 Presentation 519 4.37 .76 196 4.24 .77 323 .060 Taste 531 4.38 .78 204 4.27 .80 327 .110 Temperature 477 4.30 .77 181 4.14 .88 296 .040 Value for price 514 4.19 .91 193 4.09 .90 321 .242 Overall satisfaction 511 4.42 .72 191 4.28 .78 320 .035 1 Mean satisfaction scores as measured on 5 point scale where 1 =extremely dissatisfied and 5=extremely satisfied 2 Regular menu items incorrectly classified as "Fresh Choice" 3 "Fresh Choice" versus regular as determined by independent samples t test. 44 RESULTS The menu items correctly classified as "Fresh Choice" and correctly classified as regular by the customers are compared in Table 4.8. "Portion size" was the only category where there was not a significantly greater satisfaction with "Fresh Choice" than with "Regular" items. The difference in satisfaction was highly significant for "lack of fat and grease", "taste" and "temperature" (p<0.001). Table 4.8 Satisfaction with Menu Items Classified Correctly by Customers. "Fresh Choice" Regular Satisfaction Scale Total X 1 ±SD n X 1 ±SD n P2 Not over/undercooked 386 4.56 .71 119 4.33 .80 267 .007 Lack of fat or grease 425 4.56 .76 136 4.12 .93 289 .000 Freshness 468 4.66 .70 148 4.45 .71 320 .003 Portion Size 476 4.49 .74 153 4.37 .79 323 .102 Presentation 475 4.43 .82 152 4.24 .77 323 .013 Taste 480 4.56 .80 153 4.27 .80 327 .000 Temperature 440 4.45 .85 144 4.14 .88 296 .000 Value for price 472 4.33 .83 151 4.09 .90 321 .007 Overall satisfaction 470 4.50 .74 150 4.28 .78 320 .004 'Mean satisfaction scores as measured on 5point scale where l=extremely dissatisfied and 5=extremely satisfied 2 "Fresh Choice" versus regular as determined by independent samples t test. 45 RESULTS In summary, whether an item was classified by restaurant identification or customer identification, "Fresh Choices" were found to be ranked higher than regular items. In Tables 4.5 and 4.8 (restaurant and customer classification respectively) where all items were correctly identified as "Fresh Choice" and regular the results were highly significant for "overall satisfaction", "lack of fat and grease", "freshness" and "taste", the most important satisfaction descriptors to the "Fresh Choice" program. 4.1.3. Intercorrelations Among Satisfaction Descriptors and Overall Satisfaction Scale Spearman's correlation analysis was used to test for correlations amongst the satisfaction descriptors. As shown in table 4.9, "overall satisfaction" was highly correlated with other descriptors and was therefore used as a proxy for the others in further statistical analyses. "Lack of fat", "freshness" and "taste", were considered important to the goals of the "Fresh Choice" program, and were also tested as dependent variables in the A N O V A tests. 46 RESULTS Table 4.9 Correlation Coefficients Among Components of the Satisfaction Scale within all Menu Items. Satisfaction Not over Lack of Fresh. Portion Present Taste Temp. Value Overall Descriptors or fat or size for satisfaction under grease price cooked Not over or 1.00 undercooked Lack of fat or .45 1.00 grease Freshness .69 .48 1.00 Portion size .44 .36 .39 1.00 Presentation .47 .38 .52 .49 1.00 Taste .62 .46 .62 .44 .55 1.00 Temperature .54 .40 .55 .48 .52 . 61 1.00 Value for .43 .40 .49 .52 .52 .52 .53 1.00 price Overall .59 .49 . 65 . 51 .58 . 71 .62 . 67 1.00 satisfaction . • All correlations highly significant, p=0.000. Correlation coefficients as determined by Spearman's. 47 RESULTS Intercorrelations among components of the satisfaction scale within "Fresh Choice" items alone and within regular items alone were also examined with similar results. The information is given in Appendix J. 4.1.4. Satisfaction with "Fresh Choice" and Regular Menu Items by Meal and Demographic Categories Two-way A N O V A tests were completed to compare satisfaction with "Fresh Choice" versus regular items in the different meal and demographic categories. Results of these tables are summarized in Tables 4.10 to 4.17. Complete results are found in Appendix J. In most instances, no significant differences were found between the various meal and demographic categories. The only exception was that regular diners rated their satisfaction with the "freshness" of menu items higher than special occasion diners rated their satisfaction. Otherwise, satisfaction did not vary according to menu item type, meal type, frequency with which the respondent ate out, the dining occasion, the respondent's eating pattern, diet, gender and age. Within each category, "Fresh Choices" continued to be rated significantly higher than regular menu items in most instances. The exceptions were of classification by "specific diet", "menu item type" and "dining occasion". The findings of these analyses again indicate that customers who selected "Fresh Choices" were more satisfied than those who chose regular items. 48 RESULTS Two-way ANOVA Summary Tables Table 4.10 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Menu Item Type Satisfaction Descriptor Classification Menu Item Type "Fresh Choice"/Regular Soup/Salad/Entree/Dessert Overall Satisfaction .088' .199 Lack of Fat/Grease .001 .086 Freshness .009 .638 Taste .061 .384 1 p values determined by 2x4 ANOVA tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J. Table 4.11 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Meal Type Satisfaction Descriptor Classification "Fresh Choice"/Regular Meal Type Lunch/Dinner Overall Satisfaction .009' .411 Lack of Fat/Grease .000 .788 Freshness .001 .440 Taste .001 .083 1 p values determined by 2x2 ANOVA tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J. 49 RESULTS Table 4.12 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Frequency of Eating Out Satisfaction Descriptor Classification "Fresh Choice" / Regular Frequency of Eating Out <2x/wk, 2-3x/wk, >3x/wk Overall Satisfaction .0021 .280 Lack of Fat/Grease .000 .936 Freshness .000 .730 Taste .001 .062 1 p values determined by 2x3 A N O V A tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J. Table 4.13 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Reason for Eating Out Satisfaction Descriptor Classification "Fresh Choice" / Regular Reason for Eating Out Occasion, Regular Dining Overall Satisfaction .049' .994 Lack of Fat/Grease .011 .238 Freshness .163 .016 Taste .081 .810 1 p values determined by 2x2 A N O V A tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J. 50 RESULTS Table 4.14 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Eating Pattern Satisfaction Descriptor Classification "Fresh Choice" / Regular Eating Pattern On Diet, Not On Diet Overall Satisfaction .029' .518 Lack of Fat/Grease .001 .897 Freshness .009 .341 Taste .024 .242 ' p values determined by 2x2 A N O V A tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J . Table 4.15 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Specific Diet Satisfaction Descriptor Classification "Fresh Choice"/Regular Specific Diet Veget., Low Fat, Other Overall Satisfaction .575' .605 Lack of Fat/Grease .413 .329 Freshness .546 .947 Taste .713 .469 1 p values determined by 2x3 A N O V A tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J . 51 RESULTS Table 4.16 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Gender Satisfaction Descriptor Classification "Fresh Choice" / Regular Gender Male/Female Overall Satisfaction .002' .099 Lack of Fat/Grease .000 .584 Freshness .000 .446 Taste .001 .078 1 p values determined by 2x2 A N O V A tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J. Table 4.17 Customer Satisfaction with Menu Items Grouped by Menu Item Classification and Age Satisfaction Descriptor Classification "Fresh Choice"/Regular Age <25, 25-34, 35-49, >50 Overall Satisfaction .019' .268 Lack of Fat/Grease .000 .442 Freshness .001 .460 Taste .002 .226 1 p values determined by 2x4 A N O V A tests where Satisfaction Descriptors were the dependent variables and menu item classification and type were the independent variables: Complete data are found in Appendix J. 52 R E S U L T S 4.2. Interviews The second phase of the "Fresh Choice" evaluation employed qualitative research techniques to assess restaurant patrons' ideas, perceptions and opinions on "eating out" in restaurants and their acceptance of and attitude towards the "Fresh Choice" program. Semi-structured interviews were conducted with nine subjects recruited during a ten day period in the "Fresh Choice" promotion month of June, 1993. The findings from the interviews are presented in three sections. The first section briefly introduces and describes the nine interview participants. Their general views on eating out will be presented in the second section. The third section focuses on their specific reactions to the "Fresh Choice" program. 4.2.1. The Interviewees Five women and four men ranging in age from mid-twenties to over fifty participated in semi-structured interviews. Interviewees were selected from an estimated amount between 500 to 750 entrants. Research requirements stipulated that each customer receive a questionnaire and an entry form delivered by the waitstaff. The estimation of entry forms, therefore, is based on the number of questionnaires that were distributed and filled out. When entrants were selected as potential interviewees and contacted it was discovered that some had filled out the form only. As shown in Table 4.18, the participants had varied backgrounds, careers (many service-oriented) and living situations. Eight were born in Canada and appeared Caucasian; the ninth was from a visible minority group and had moved to Canada from Hong Kong when she was a teenager. Seven individuals ate out at least 2-3 times a week while two ate out at least once a month. The three participants who ate out regularly for lunch were older, had well paying jobs, and worked in locations with a selection of restaurants nearby. Participants in the 25-34 year old age group usually ate out for lunch 53 RESULTS on days off or for dinner. Two women and two men of the group were married, and one single woman was in a long term relationship with a man. Two single women lived with family and two single men lived alone. Table 4.18 Profiles of the Nine Interviewees and the Restaurants Where Recruited Interviewees Age (approx) Gender Occupation Frequency of Eating Out Usual Time of Eating Out Status Living Situation Carol * Sierra Grill >50 F Civil Servant / Retail sales >7x/week Lunch Work days Single Lives with mother Darren Fettucini's 25-34 M Aerobics Instructor > 2-3x/week Dinner Single Lives alone Eldon Heron's >50 M Insurance Agent > 2-3x/week Lunch Work Days Married Lives with wife Kelley Inlet's 2-34 F Waitress / Caterer < 2-3x/week Lunch/Dinner Days off Married Lives with husband Larry Tomato's 25-34 M Unemployed Waiter >2-3x/week Lunch/Dinner Days off Single Lives alone LauraLee (visible minority) Vistas 25-34 F Program Assistant >2-3x/week Lunch/Dinner Days off Single Lives with daughter Melanie Avenue Grill >50 F Psychiatrist >7x/week Lunch Work days Married Lives with husband Rory Isadora's 35-49 M Engineer < 2-3x/week Dinner Days off Married Lives with family Suzanne Picasso's <25 F Student/ Waitress >3-5x/week Dinner Days Off Single Lives with boyfriend * Subjects' names are pseudonyms 54 RESULTS Table 4.19 summarizes interviewees' descriptions of their eating patterns and the roles of nutrition, exercise and health in their lives. "Eating Habits" refers to eating patterns and diets followed when "eating out". All but one of the interviewees specified some area of diet restriction, usually weight watching or a type of vegetarianism. When asked during the interview whether they were on a particular diet or not most interviewees stated they were not. However, in the context of the interview they indicated that they restricted food intake. The individual with no diet restrictions (except for diet foods) preferred a "fatty steak" on the infrequent occasions when he ate out. He said he felt healthy and must therefore be eating healthily. Interviewees who identified themselves as semi-vegetarians ate little or no red meat when eating out; their preferred foods were chicken, seafood, pasta, salads and fruits and vegetables. Desserts, red meat dishes and fatty foods were avoided by those who ate out frequently because eating less of these foods was considered healthy. Interviewees were asked how nutrition and health fit into their lives. Those who ate out frequently said an everyday standard of sensible eating and nutritional balance was important. For those who ate out infrequently, good nutrition meant good physical health and appearance. Both nutrition and exercise were seen as important in contributing to overall health (which was described as a state of well-being). 55 RESULTS Table 4.19 Patterns of Interviewees' Eating Habits, Nutrition, Exercise and Health Eating Habits Foods Preferred Foods Avoided The Meaning ofNutrition Exercise The Meaning Habits ofHealth Vegetarian Stir fries Seafood Chemically treated foods Vital, organic foods Everyday standard Physical >mental Good nutrition D Watches weight Chicken Pasta Watches weight Lamb Fish Desserts Large portions Maintaining caloric Aerobics Physically active intake, Partner with exercise for health Sensible eating Cycles Keeping in shape, Healthy attitude Happy well and satisfied K Bland diet (Diet restricted) Fruit/Veg Chicken Fried, spicy foods Cheesecake Chemically treated foods High carb low fat Pasta Red meat Semi-vegetarian Seafood Grilled foods Fruits/veg Physical health and appearance Limiting fat intake Part of healthy lifestyle, balance Cycles Cycles swims weights Physical appearance Mental, physical emotional spiritual LL Follows food guide Semi-vegetarian Salad Pasta Seafood Red Meat Fried foods MSG Balance of foods Energy, Promotes health Exercise Physical > mental class and emotional M Iridologist's Salad recommendations Chicken Semi-vegetarian Dairy R Not on diet, likes Steak food S Watches weight Salads Semi-vegetarian Thai food Dairy, red meats seafood, desserts Diet foods Fatty foods sauces, red meat Important to health Walks State of well-being No diseases (so must eat nutritionally) 4 on a Scale of 5 "Eating out", a 3 Cycles runs soccer Nutrition>physical Physically active in shape 56 RESULTS 4.2.2. The Role of Eating Out in Participants' Lives The interviews included questions about the significance of restaurant eating for the participants. The descriptions and explanations that ensued are discussed below in three sections: the meaning of "eating out"; "eating out" patterns in relation to the context of individuals' lives; and selection of and satisfaction with restaurants and menu items. 4.2.2.1 The Meaning of Eating Out Interviewees were asked to define "eating out" in restaurants and describe the place of "eating out" in their lives. One replied, "I adore eating out, I just love it. I love sitting there and having people serve me...I guess it's partly because when I get home from work and I've had a heavy day I don't feel like setting out to cook. And on the weekends also I like eating out because again ... I've worked all week and I just want to relax and take things easy". There were a number of commonalities in participants' descriptions of "eating out". "Eating out" was described as having a meal, usually dinner, at a table service restaurant. It was a planned event that provided the customer with relaxation, social entertainment and some choice in selections. "Eating out" was viewed as a reward or treat to oneself that provided "emotional satisfaction" by catering to individual's wants and needs and "tummy satisfaction" by providing enough food to feel replenished. Fulfilled needs led to overall satisfaction with the "eating out" experience. When asked about "eating out" and how it fit into their lives, individuals would invariably talk about "going out to eat". The term "eating out" was used by frequent diners to describe eating out alone, with a client for business reasons, eating out routinely everyday, or when already away from home. 57 R E S U L T S "Going out to eat" usually implied movement away from the home environment, a social and/or special occasion, and eating out on days off or for dinner. When "going out to eat" interviewees were inclined to be more indulgent with food and money but when "eating out", they tried to be frugal. Interviewees who ate out infrequently used "going out to eat" exclusively to describe "eating out" because everytime they ate out was special. One interviewee used "going out to eat" to describe having dinner alone when out of town and associated it with a break from the routine. Only in this situation were his choices unrestricted by others and could he exercise freedom of choice of restaurants and menu items. Eating Out as an Indulgence. The interviewees talked about eating out as being an indulgence, in contrast to other eating away from home practices which they described as obtaining needed sustenance. There were two ways that eating out was viewed as indulgent. First, the eating out experience was indulgent in itself and second, the food chosen could be indulgent. Indulgence, or pleasing and pampering the self, was an integral part of eating out and an essential component of desired "emotional satisfaction" with the eating out experience. Eating out as an indulgence meant having others provide for you. Interviewees who worked in service-oriented positions and/or were meal providers at home described eating out as a deserved reward for the work they had done during the day or week. At the end of a day of serving others, they wanted and needed to be served. Restaurants fulfilled this need to be provided for and catered to with food and attention. The following quote shows the importance of eating out to the interviewee not because of the food but because someone else provided it. 58 R E S U L T S "...working as a waiter ...a lot of times serving the public, I would want to go out and be waited on... somebody to look after me for a while." For this waiter, being served in a restaurant was a change in status and recognition, a reversal of his position during the day. Someone would now look after his needs. Four interviewees described eating out as having "everything" - meal preparation, serving, and clean-up - done by someone else. " / would much rather just go in there (a restaurant) and relax and have someone else worry...about it, doing everything." These interviewees were responsible for the meal tasks at home. The frequency of eating out did not affect the need to be indulged by others. One interviewee ate out more than seven times a week and defined eating out for lunch as "my time to myself where she enjoyed " the service, the people and the food'. Some participants indicated that restaurants should care for the customer's well-being, accommodate one's needs, and give individualized, specialized attention. When restaurants provided this kind of service, they were warm, caring and giving and not so much a business. One interviewee felt that when a restaurant gives special attention to its clientele, " ...(it) shows that they are thinking about people ... their needs rather than just how much money they can make on a given dish." 59 RESULTS Another individual indicated when eating out she placed her trust in restaurants to stay within certain criteria of nutrition to safe-guard her health. An interviewee who did not eat out frequently mentioned that being comfortable and cozy, indicating a home-like atmosphere, was important and part of eating out for her. The individuals who did not talk of restaurants as caring for their emotional needs were married men. This may have had relevance to their living situation. Eating out was an indulgent experience but certain foods, such as fried or fatty foods, junk food and desserts were described as indulgent and unhealthy because they carried unneeded extras that interviewees could not always afford: extra calories, extra fat, and if desserts, extra expense. Participants who ate out frequently usually tried to maintain a standard of nutritious eating that restricted their intake of these unhealthy, luxury items. However, occasional consumption of these items was not perceived as damaging to their health as long as they followed their nutrition standards and lifestyle practices most of the time. "...eating out doesn't mean you eat things that aren't goodfor you ...you might indulge now and eat an ice-cream, shouldn't, but you do... (you should) go on a basic everyday standard of good eating habits so that the odd time you might incorporate something, or something (might) not be quite right it's not going to ....rock the boat." Indulgence of cravings for foods like ice-cream, cheesecake, or bacon and eggs was usually justified as a special occasion or for a reward. The more special the occasion, the more the frequent restaurant diners felt they could indulge themselves with high fat, high calorie or expensive foods. One interviewee said selection of a dessert that he called "decadent" or "obscene" depends on: 60 R E S U L T S "...how I'm feeling...IfI haven't been working out for a while... I'll consciously watch myself.. if I've been really good, I'll reward myself." Interviewees who rarely ate out tended to indulge themselves with foods they considered unhealthy but desirable. These were usually dessert foods, but also included fatty items such as fried foods, fattening sauces, and steaks. One interviewee ordered steak the majority of times he ate out and said: "...ifyou feel like eating something gross and non-nutrition(al), go for it. You know because we do it so infrequently...it's not really a factor." Although eating out was usually viewed as a deserved indulgence, it could also become an overindulgence if indulgent foods were eaten excessively and frequently, and if more money was spent on eating out than was affordable. One interviewee felt he ate out more than he "should". The stated reason was the expense, but he also told of overindulging in smoking, drinking and eating out while living in Japan and as a result, "...(I) gained a lot of weight and Ifelt extremely unhealthy.. .1felt really terrible about myself ...Now, I'm so into health I wouldn't want to be succumbing to that." Threat of weight gain, feeling terrible and the cost of excessive eating out were the reasons he restricted eating out and food indulgences. In summary, frequent, regular dining was seen as indulging in the need to be cared for, and was associated with conscious restriction of unhealthy, expensive foods. "Going out to eat" for special occasions and celebratory events was linked with more indulgent eating behaviours but was not considered overindulgence. However, frequent 61 RESULTS consumption of luxury foods was seen as overindulgent, leading to weight gain and cash shortage. Comparison of Eating Out with "Grabbing and Picking up Some Food" "...eating out to me is more of a relaxed...not formal necessarily, but a relaxed type of... planned event... I'll stop at Benny's Bagel or something on the way home quite frequently and grab something or sit down there but that's not eating out to me. Eating out..I consider more of a treat as opposed to something that's necessary to fuel my body." In defining eating out, interviewees often contrasted eating out with "grabbing some food" and "picking up some food". The main differences between the two types of eating away from home are summarized in Table 4.20. Restaurant dining provided the elements necessary for interviewees' "emotional satisfaction", the endpoint for the self-indulgent eating out experience: a comfortable atmosphere and accoutrements for dining, including table and settings which joined people together and permitted a shared social activity to occur; personal service that catered to the customer and encouraged social interaction; and variety of selection, including preparation methods and dishes that provided "tummy satisfaction". Eating out in restaurants also required more planning, time and money. "Grabbing and picking up food" were terms used by younger interviewees and were activities distinct from eating out because emotional needs were not met and the experience was not considered indulgent. There was no prolonged personal service, no comfortable atmosphere, no sharing of a well prepared, well presented meal with others around a common table and no permanence in the throw-away utensils and containers. 62 RESULTS Table 4.20 Comparison of the Characteristics of Eating Out and "Grabbing Some Food" "Eating Out" or "Going Out to Eat" "Grabbing and Picking up Some Food" (ages 25-34) Eat in restaurant Take-away / eat elsewhere "Emotional satisfaction" Self-indulgent / treat "Tummy satisfaction" Necessary /sustenance / fuel Prolonged service encounter Brief service encounter Social occasion Solitary experience Joined with others at table Eat wherever Cutlery and plates Plastic utensils / containers/finger foods Meal /1-3 courses (i.e. salad and entree) Typically one food item / snack (i.e. "hot dog") Healthier food "Fast food" / not as healthy Selection important Selection not as important Time / relaxed Lack of time / hurried Planned ahead / organized No set plan, organization More expensive Less expensive 63 RESULTS The food was "fast", unhealthy and sometimes lacking in taste or flavour and thus selection was not as important. "Grabbing and picking up some food" were necessary activities for sustenance and prevailed because of lack of time, organization, and money. These activities contrast sharply to eating out. There are few similarities between the two other than that both are forms of eating away from home where food that someone else has prepared is purchased. 4.2.2.2. Eating Out in Relation to Work and Home Contexts The following section discusses interviewees' descriptions of their eating out habits in the context of their specific home and work situations. Lunch time eating out patterns appeared to be affected more by interviewees' work situations, while eating out for dinner and on days off related more to individuals' living situations. Eating Out for Lunch on Work Days. Three interviewees ate out for lunch almost every day of the week as their professions allowed for and required a definite lunch hour. One ate out for business and the others ate out for personal reasons. What these three had in common was that they were older, did not go out for a social outing at lunch time, could afford to not prepare their own food and had enough time to go out for a lunch at a tableservice restaurant. All three structured eating out into their days. The two women had highly organized eating out patterns. They stayed with familiar restaurants close to work, usually ate alone and controlled how they spent their lunch time. The man did not have the same organized lunch as he had little choice in where he ate, when he ate and sometimes what he ate, as choices depended on his clients. 64 RESULTS In comparison, the four individuals who ate out infrequently for lunch were younger, had less time for lunch and therefore less control or choice over how they spent it. They purchased ready-to-eat foods or brought a lunch to eat at the workplace, were under more time and location constraints, and on the infrequent occasions when they did eat out for lunch on a work day, it was for a celebratory event. The following quote is from an interviewee who seldom ate out for lunch, "...eating out for lunch would mean completely removing myselffrom the environment that I'm in and doing something for an hour that's really relaxing, which seldom happens, but when it does, it's nice." The interviewees who did not or could not organize eating into a structured pattern and were at the mercy of their schedules, often "grabbed something to eat" or "picked up something". Eating Out for Lunch on Days Off and Eating Out for Dinner. Eating out for lunch on days off and for dinner seemed easier to organize into interviewees' days although two had work schedules that interfered. Eating out for lunch on days off was enjoyed by all but one interviewee who avoided it because he associated it with work. On days off, friends, partners or family tended to be sharing the eating out experience, and therefore it was a social outing. In comparison to eating out for lunch, eating out for dinner tended to be more formal and planned, depending on the reason for eating out. "...every once in a while my boyfriend and I will go out for, you know, a nice dinner and we'll put some money into it but...usually it's just kind of going out casually (for lunch) with friends..." 65 R E S U L T S The most predominant reasons for eating out for dinner or lunch on days off were: to be catered to; for a social outing; to get out of meal planning and preparation work; for convenience; for a new taste experience; or for a special occasion. Two individuals did not eat out frequently at these times for financial reasons and lack of time. One participant who ate out rarely said that she could not eat out as often as she likes (due to finances). The other individual and his wife were too busy to eat out regularly, but would go out to eat whenever they could get some time together. When eating out, these infrequent diners were usually with their partners; they would rarely go out to eat with friends. Patterns of eating out outside of the work day seemed profoundly affected by living situation. Of the nine subjects interviewed, three women and two men were in long term, heterosexual, living situations while two single males lived alone and two women lived with one other family member. None of the interviewees had small children under six. All but one lived in single or two person households. The one individual who lived in a nuclear family situation with his wife and teen-aged children ate out infrequently, because it was rare that he and his wife would have the time to go out for dinner. When they did, it was a either spontaneous treat for the two of them or a planned event with another couple. Cooking dinner at home on the weekdays was a responsibility shared by all five members of his family. The other married man was the eldest male in the group. When not working, he avoided eating out for lunch because he did it so often for his job. He and his wife did, however, eat out for brunch or dinner on weekends to save work at home and to see friends. The three women in long term relationships did not like to cook but they were responsible for the provision of household food. Getting out of preparing a meal, being 66 RESULTS catered to by others, and trying foods they did not cook at home were reasons for them to eat out. These women talked about the restaurant as something that would take over the responsibility of planning and cooking meals from them. One ate out infrequently due to financial reasons but said, / like it (eating out) because I do not enjoy cooking...I enjoy different foods, ones that I would not think to cook up." The two individuals who lived alone were single, gay men. Although one loved to cook for himself and for friends, his friends preferred to eat out and he would eat out to see them. The other man never cooked, and at most, would prepare sandwiches or have take-out food. He considered the latter to be eating in or at home. Both of these individuals ate out frequently and a predominant reason for eating out was to see their friends on a social outing and for convenience. One said that eating out was, "...a fairly major part of my life especially on a social standpoint, getting together with friends..." The last two interviewees lived with family members who were not partners. One lived with her mother while the other lived with her six year old daughter. The daughter interviewee ate out seven days a week for lunch because she did not like preparing sandwiches, and would have dinner at home cooked by her mother. When eating out for dinner she was often with her mother. The mother interviewee ate out at least two to three times a week. She and her daughter would eat out for dinner when she did not want to cook for them. In both of these situations, the mother and daughter were close 67 RESULTS companions. For the mother who cooked, eating out was a social outing and convenient; for the daughter who did not cook it was a celebratory occasion and convenient. All five of the women interviewed worked outside the home. Four were responsible for cooking in the home though three stated that they did not want that responsibility. A predominant reason for eating out for those women was to abandon their food related roles. 4.2.3. Customers' Restaurant and Menu Selections and Satisfaction with Selections The interview participants were asked specific questions about the determinants of their restaurant and menu item selections and their satisfaction with menu items. The decision of where and what to eat was a many faceted process. Selections were influenced by previous restaurant and menu experience and the extent of choices available. Selections were also influenced by the reason for eating out: when eating out for a new taste experience, previous satisfaction with restaurant and menu items was a less important factor. 4.2.3.1. Influences on Restaurant Selections Participants who had a satisfying experience in a restaurant were likely to choose that restaurant again. Table 4.21 lists the factors from previous experience which influenced restaurant selection, including service, atmosphere and satisfaction with the food served. Participants who avoided meat also looked for menu flexibility and variety. Several participants indicated that reasons for eating out would have a strong influence on the type of restaurant chosen. For instance, a different type of restaurant would be chosen for a social outing, as opposed to a special occasion which might warrant a three course meal, spending more money, and being more indulgent with selections. This distinction 68 R E S U L T S was particularly noted by a participant who ate out every Friday night with her husband to celebrate the end of the week. She said, " ..a Friday evening meal ...I want a more special, you know, a special environment and not feeling crowded in with everybody. " Restaurant selections of participants who ate out infrequently were not influenced by special occasions because every time they ate out was considered a treat. Sometimes interviewees looked for new taste experiences and selected restaurants to meet this goal. Some who mentioned this were responsible for providing and preparing meals at home. Individuals also would select a restaurant for the house specialties for which it was known. In this ease the menu item would take precedence when selection was being made such as going to "The Keg" (a restaurant that specializes in steak) for a steak. Other factors were familiarity with choices, recommendations from friends or restaurant, and coupons offered. As well, food cravings for specific ethnic dishes or form of preparation were discussed as factors in restaurant selection. 69 RESULTS Table 4.21 Determinants of Restaurant Selection Satisfaction with Previous Experience with the Restaurant Other Factors Factors Limiting Selection Service Low fat Reason eating out Amount of time Atmosphere Temperature Frequency eating out Price range Food preparation Texture New taste experience Convenience Presentation Value for price Familiarity Diet needs Food freshness Menu flexibility / variety Recommendations Company Portion size Company Coupons Awareness of nutrition programs Taste Food craving Factors that limited interviewees' choice of restaurants were usually beyond their control. These included the amount of time available (especially at lunch), the amount of money available in relation to restaurant prices, convenience of restaurant location, dietary requirements including food sensitivities and health beliefs, preferences of dining companions, and previous satisfaction. Lack of knowledge about restaurants that carry programs like "Fresh Choice" was also mentioned as a limitation to those interested in lower fat fare. "Emotional satisfaction" with the eating out experience was dependent upon the crucial effects of atmosphere and service. One interviewee said, "...more than anything what determines eating at a restaurants is... the people there. You go in right away they see you, they know what you want and they bring it to you." 70 RESULTS 4.2.3.2. Influences on Menu Item Selection After selecting the restaurant, perhaps with a predetermined menu selection in mind, certain factors might influence an individual's final choice. Items that had previously been experienced as prepared with attention and cooked to the expected degree, well presented, appealing in taste and flavour, fresh, presented in portions that were neither too large or too small, low in fat, pleasing in texture and well priced were more likely to be selected again. Determinants of menu item selection were closely related to the components of satisfaction with menu items described in more detail in the interviews than in the preliminary qualitative data for questionnaire development. Presentation, for instance, was defined as attractiveness or balanced look of food in relation to plate size, freshness was associated with food quality, and preparation meant either cooked to expected degree or cooked with expected method. Table 4.22 Determinants of Menu Item Selection Satisfaction with Previous Experience with the Menu Items Other Factors Factors Changing Selection Food preparation Temperature Reason eating out Hunger Presentation Texture Frequency eating out Food appeal / craving Taste Low fat New taste experience Meal type Portion size Value for price Familiarity Don't make at home Food freshness /quality Recommendations Diet restrictions Coupons Nutrition Company 71 RESULTS The previous eating out choice affected menu selections of those who ate out frequently. One interviewee chose more healthily if she ate out frequently while another, who rarely ate out, indulged himself fully. Other factors that influenced an interviewee's final choice included: how hungry the individual was; the degree to which a certain dish appealed; time of day (i.e. lunch or dinner); if the selection was a dish they would not make at home; the reason for eating out; the nutritional value of the dish; the mood the interviewee was in and choices such as daily specials that give perceived value for price. The choice of whether or not to have a dessert was influenced by other factors. Individuals would select a dessert if they did not feel too full after their meal, if they were inclined to indulge or reward themselves, or if they were prepared to do extra exercise to burn off the calories dessert would provide. Otherwise they would restrict this choice. One interviewee would have a dessert if it was shared with someone: a whole dessert she felt was too "piggy". Six of the interviewees responded that they would be interested in hearing about the daily special and might order it if it sounded or looked appealing. The two who ate out for lunch most frequently, however, were not interested in what the daily special was because they ordered what they were familiar with or what they were in the mood for. If it was a special, then that was considered a bonus. 4.2.4. Opinions on "Fresh Choice" and Nutrition Information in Restaurants This section focuses on the customers' specific reactions to the "Fresh Choice" logo, name, concept, nutrition information pamphlet and the use of "lighter fare", "lower fat" terminology. One interviewee summed up the significance of eating out, nutrition, and programs like "Fresh Choice" by saying that 72 RESULTS "... eating out is here to stay because of our whole social structure... ("Fresh Choice" is) recognizing the need to satisfy, (and) at the same time support peoples needs and requirements towards health..." The "Fresh Choice" Logo. The interviewees were asked a series of questions about their opinions on the "Fresh Choice" design and name. When shown the "Fresh Choice" logo, three interviewees said they recognized it from the restaurant from which they had been recruited for the interview. Five others commented that the design looked somewhat familiar, but that they had difficulty in placing its significance. The logo was unfamiliar to only one interviewee. The general response to the design was that it was fun-looking and inspired the idea of fresh foods. One respondent said: ..it's pleasant, bubbly, well-spaced...if food gets served as well as this logo I think I would have a good time". Another called it "simple and very effective" while others' comments were that the design reminded them of grocery shopping: "a market type thing....foods put together to make a meal...or picnic" Table 4. 23 compares customers' awareness of the "Fresh Choice" design with the selection of "Fresh Choice" menu items. Two of the individuals who remembered the design were the only respondents who knew they had ordered had a "Fresh Choice" menu item. Both individuals eat out frequently and are concerned with maintaining their nutrition standards when they eat out. The menu items that they chose were familiar ones that they had had before at the same restaurant. 73 RESULTS Table 4.23 Awareness of and Willingness to Try "Fresh Choice" Menu Items Awareness of "Fresh Choice" Selection of "Fresh Choice " Item Interviewee / Restaurant Recalled Looked Didn't Design Familiar Look Familiar Tried F.C. Will Try Again. Did Not Try Will Not Try F.C. Did Not Try F.C. But Would C Sierra Grill 0 0 D Fettucini's 0 0 E Herons 0 0 K Inlets 0 0 L Tomato's 0 0 L L Vistas 0 0 M Avenue Grill 0 0 R Isadora's 0 0 S Picasso's 0 0 The one individual who remembered reading the pamphlet but chose a regular menu item said that it was the first time she had been at the restaurant and thought she might try a "Fresh Choice" some other time, as did four other interviewees who had not selected "Fresh Choice" items. Review of the menu selections of the two participants who did not know if they tried a "Fresh Choice" item showed that both had selected a regular 74 R E S U L T S item. Both said they would probably not try a "Fresh Choice" item at any time because they want quantity and not diet food when they eat out. They appeared to associate "Fresh Choice" with dieting. Response to the "Fresh Choice" Name. Interviewees were asked to describe what the name "Fresh Choice" meant to them. The goals of the program were then described to them and they were again asked to respond to the name. A typical response was that the name meant: "fresh food prepared with freshness, taste and healthiness in mind." "Healthy" was used by four of the interviewees to describe how they felt about "Fresh Choice". "Fresh" meant fresh "healthy" foods, fruits and vegetables, and salads made from recently picked produce or something new. Most did not associate foods from other food groups with "Fresh Choice". This connotation with fruits and vegetables led to a perception that "Fresh Choice" was more or less a vegetarian program, despite the program planners' focus on offering lower fat alternatives from all food groups. It is interesting to note that the two individuals who chose "Fresh Choice" menu items were vegetarian or semi-vegetarian. One interviewee responded unfavorably towards the "Fresh Choice name. He said it: "seems a bit tacky to me... is everything else stale?... if you don't eat this you feel bad, you feel guilty?....it's just a couple of words that don't tell you anything." 75 R E S U L T S Interviewees then responded to the name following the explanation of the "Fresh Choice" concept. "Fresh", some replied, did not necessarily mean lower fat. Food could have a high fat or high caloric content and still be considered fresh. Without lower fat and good-tasting being prominently displayed somewhere, it was difficult for individuals to make the connection between the "Fresh Choice" name and the intended message behind it. Another interviewee stated, "I don't see (it) as completely low fat but what I do see is your focusing more on other food items, the green - tossed salad, carrots, radish, pasta. I'm not even thinking how many calories. It's a matter that it's healthy, it looks very healthy... the connotation of fresh, you know, it makes people stop and think, catch(es) the attention, gives people a sense of optimism." Overall, they associated "Fresh Choice" with "healthy" rather than lower fat and indicated that the logo conveyed a message of fun and health. 4.2.4.1. "Fresh Choice" Concepts Interviewees were asked if they thought the "Fresh Choice" program was worthwhile. All concluded that there was a need for programs like "Fresh Choice" in restaurants. Some participants felt that the program would benefit them personally. Others said they could already make nutritious menu choices but the program might be needed for other people. Having the option to choose or not to choose a "Fresh Choice" seemed very important to the interviewees. If individuals wanted a lower fat menu item, the "Fresh Choice" program would give them the option to choose it. Also, when more options were presented, a wider variety of people could be satisfied. 76 R E S U L T S "They can satisfy more people...my eating habits are totally different from my wife's so if they have the option she can have her "Fresh Choice" and I can have my steak." One individual concluded that a program like "Fresh Choice" is good because it allows people to "...have your cake and eat it. If you can ..satisfy yourself and eat more healthy then you 're going to do that or you 're not very bright...." In contrast, he said he would not choose "Heart Smart" menu items "...unless I'm desperate ..if you're on a strict diet then you might have to. " The "Fresh Choice" program thus seemed to fit with the interviewees' desire to indulge themselves in restaurants that allowed them to choose good-tasting items without feelings of guilt. Ethnic restaurants were not targeted by the "Fresh Choice" program, but one interviewee felt they should be included. This interviewee, the only non-Caucasian participant said that while the premise of "Fresh Choice" and the use of the term "lighter fare" was very Western, the idea of offering healthier alternatives for customers should be available to "ethnic" restaurants. "... "lighter fare", I would be eating this in an English restaurant. I can't see it in a Japanese restaurant, I cannot see it in a Chinese restaurant,...not even in a European restaurant. I can see it in the English restaurant because of the idea of meat and potato..." 11 R E S U L T S Caucasian individuals who frequented ethnic restaurants chose those restaurants for their house specialties and said they would not choose a "Fresh Choice" if it was available. 4.2.4.2. Nutrition Information Pamphlet The participants were asked a series of questions concerning nutrition information and its place in restaurant dining. Views on relevance of nutrition information in restaurants varied but five participants thought it relevant to others but not to themselves. Two of the five felt that the information should be left as an option for people and that it should be placed where it was not obtrusive, perhaps at the door where people enter and leave. Those who wanted it could then pick it up to read before or after their meal. Other participants said to be careful that the message not be too "preachy". Two interviewees were concerned that the information be presented in a non-technical format customers could read in a short time. Some individuals were then asked what they thought of the nutrition information in the "Fresh Choice" pamphlet (see Appendix A). The five who responded approved of the type and quality of the information . " ...it's bold and big enough that it's not asking the reader to make too much of an effort." Two interviewees remembered looking through the pamphlet at the restaurant. When asked whether nutrition information would influence their restaurant or menu selection, six participants said it would not, while the remaining three felt that it would help them make their decision. 78 R E S U L T S Overall, although the "Fresh Choice" pamphlet was seen as an acceptable vehicle of nutrition information, the interviewees felt that there was a need to tread very lightly around the issue of nutrition information itself. They seemed somewhat overwhelmed by the words "nutrition information" and felt that it would be obtrusive to their dining enjoyment, force them to feel guilty by interfering with the choices they wanted to make, and be too technical and therefore hard to read. They did not want to be told what they could and could not eat and felt that a nutrition intervention or health promotion program like "Fresh Choice" might give them information they did not want to hear at a restaurant. 4.2.4.3. Response to the Use of "Lighter Fare" and "Lower fat" "Lighter fare" was a term used on the cover of the "Fresh Choice" pamphlet, so was the first introduction of "Fresh Choice" program to some customers. The interviewees were shown the pamphlet and asked to define the term "lighter fare". All but one had heard the term before. "Lighter fare" was associated with salads for two of the interviewees. Another said foods that had heavy ingredients or were heavy were not lighter fare. Meat, potatoes and bread pudding were given as examples of heavy foods. Five of the interviewees replied that lighter fare meant that there were less calories and two others said it meant less fat. Three interviewees felt that lighter fare meant smaller quantities. This was seen as positive by one individual but undesirable by the other two, who defined a "good" meal as being substantial enough to fill you. These two interviewees, who participated in physical exercise more regularly than the others, compared lighter fare to diet food. One said lighter fare was: 79 R E S U L T S " something not greasy, like less in calories.... not as big... in the back of your mind, 'lighter fare, diet food not as good' seems to go together, yeah, don't want that today." The definition for "lower fat" was straightforward; most interviewees said it meant less fat, whether by preparation, (not deep fried or fried), or by using substitutions and reducing high fat ingredients to decrease fat content. To two individuals, the term "lower fat" also meant lower in cholesterol and another said she would rather see "lower fat" than "lighter fare" on the menu because it has a better connotation. When eating out, individuals did not want to be faced with "diet" foods; this was not seen as a part of the indulgent experience. Dieting is not fun and, above all, in a restaurant situation food must taste good and be fun. Response from the nine interview participants suggests that replacing the emphasis on "lighter fare" with an emphasis on "lower fat" would be more acceptable. Table 4.24 shows the summary of the respondents' answers as to whether the availability of "lighter fare" or "lower fat" menu items would influence their restaurant and menu item selection. Six responded that the availability of these items would influence their restaurant and menu item selections, while two would not be influenced. These two individuals had previously mentioned that they would not order diet food in a restaurant. One interviewee said that although his restaurant selection would be affected by availability of these menu items, his menu item selection would depend on what else was on the menu. 80 RESULTS Table 4.24 Influence of Availability of "Lighter Fare" and "Lower fat" Items on Menu Item and Restaurant Selections Menu Selections Restaurant Selections Interviewee /Restaurant Yes No Yes No C Sierra Grill 0 0 D Fettucini's 0 0 £ Herons 0 0 K Inlets 0 0 L Tomato's 0 LL Vistas 0 0 M Avenue Grill 0 0 R Isadora's 0 0 S Picasso's 0 0 Finally, interviewees were asked what they would emphasize if they had input into designing a restaurant-based nutrition program that focused on offering lower fat menu items. The three themes discussed most often were variety or choice, taste and health. 81 R E S U L T S Participants wanted to choose from a variety of vegetable, fruit and lower fat selections which would be tasty, healthy and fun. 4.2.4.4. Promotion of the "Fresh Choice" Program None of the interview participants wanted an information pamphlet promoting the "Fresh Choice" program near the menu. Two individuals thought a separate sheet promoting the menu items would be appropriate. Six of the interviewees, however, felt that the best way to draw attention to the menu items was to have the lower fat selections incorporated right on the menu in conjunction with a notation explaining what a "Fresh Choice" was, with symbols highlighting the choices. Three interviewees also mentioned that the waitstaff need to know about the program in order for the program to be properly promoted or be successful. Six interviewees found that the pamphlet was a good way to promote the program as long as it was not too technical or "preachy". They commented that a pamphlet allows customers the choice to read the information or not. They felt the program should be promoted right on the menu. Advertising in the restaurant was seen as important, but it should be subtle, visual and light in tone. Advertising in the community was also mentioned as important to make people aware of what is being offered within the restaurant. 82 DISCUSSION 5. DISCUSSION The two-fold objectives of the evaluation research reported herein were to assess customer satisfaction with "Fresh Choice" menu items and to assess consumer interest in and response to a restaurant-based nutrition program. The findings are relevant to the "Fresh Choice" program planners as well as others interested in developing nutrition programs in restaurants. More specifically, the results provide information about customer satisfaction with lower fat and regular menu items, the context of restaurant dining, and consumer response to various aspects of the "Fresh Choice" program. In addition to these issues implications of the study for future evaluations of restaurant nutrition programs are discussed in this chapter. 5.1. Satisfaction with Restaurant Dining Satisfaction with a menu item can predispose the restaurant patron toward future food choices because it affects post-purchase attitudes and intentions to repurchase (Westbrook, 1991; Parraga, 1990; Granzin, 1988; Kar, 1983). Therefore, satisfaction can be an important determinant of repeat business for the restaurant. As well, satisfaction has been established as an important causal component of experienced-based change (Westbrook, 1991) and could be a determinant of increased healthy behaviour. Both outcomes are of importance to restaurateurs and program planners. The information on satisfaction obtained from this study included the components of customer satisfaction with menu items and customer satisfaction with lower fat menu items. Preliminary qualitative research in questionnaire development indicated that the predominant components of satisfaction with menu items when eating out were, in descending order of times mentioned, presentation, taste, doneness, freshness, portion 83 DISCUSSION size, temperature, low-fat, and price/value. Similarly, qualitative interview data evinced the same determinants of interviewees' satisfaction with menu items indicating preparation, presentation, taste, portion size, freshness or quality, temperature, low-fat, texture and value for price. In the interview data definitions of the components of satisfaction were elaborated on. For instance, preparation was described as either cooked to expected degree or cooked with expected method, and freshness was associated with food quality. Other predominant aspects of restaurant dining that provided satisfaction for the customer were service and atmosphere. The determinants of satisfaction with menu items identified in this study can be compared with those from studies of customer satisfaction with hospital foodservices. The three studies conducted in this area agreed that food had the greatest impact on overall satisfaction with foodservice operations. Johnston and Upton (1991) identified the components as food variety, food quality, nutrition, portion size and price; Dube et al (1994) indicated the components were flavour, presentation, freshness, and temperature and DeLuco et al (1990) reported that taste, aroma, appearance, tenderness, temperature, freshness, and nutrition were relevant. Preparation and not over or undercooked, however, were new descriptors found in this research. "Texture", another component of satisfaction, was also mentioned in both "Fresh Choice" qualitative data sets but infrequently. Statistical tests indicated significantly greater overall satisfaction with "Fresh Choice" menu items than with regular menu items and this did not vary according to menu item type, dining experience or respondent's characteristics. It is possible, however, that results are skewed in favour of the 30% of respondents from Picasso Cafe. Customer satisfaction with regular and lower fat menu items in restaurants had not been previously evaluated; therefore these findings in the present study are new. This method of evaluation in restaurants appears sufficient to detect differences in satisfaction between lower fat and 84 DISCUSSION regular menu items. Results from the questionnaires are important to "Fresh Choice" program planners as they inspire confidence in customer acceptance of the lower fat menu items promoted. Because satisfaction has been identified as a causal component for post-evaluative change "Fresh Choice" program planners and others can believe that satisfaction with lower fat menu items can contribute to the success of nutrition programs in restaurants. All satisfaction scale descriptors were highly intercorrelated with overall satisfaction and therefore overall satisfaction was used as a proxy for other descriptors. Because interview data identified "cooking method" and "food quality" as relating to "not over or undercooked" and "freshness", respectively, other program evaluators interested in using a similar satisfaction scale might consider the inclusion of "cooking method" and "food quality" descriptors on the scale. 5.2. The Context of Restaurant Dining The qualitative portion of this evaluation provided valuable information about the context of restaurant-based nutrition programs as perceived by restaurant customers. When interviewees were asked about the role of restaurant dining in their lives, the themes that were discussed included: eating out as an indulgence that satisfied emotional and physical needs; differentiation between the relationship of eating out and grabbing something to eat; different working and living situations and frequency and reasons for eating out; and the influence of frequency of eating out, reason for eating out and previous satisfying experiences on restaurant and menu item selections. 85 DISCUSSION Eating Out as an Indulgence. From the interview data it appeared that eating out, when done for the self and when there was freedom of choice, was a relaxing reward and an indulgence. When eating out certain emotional and physical needs were met. Physical needs were described as obtaining sustenance and pleasure from eating while emotional needs were defined in the context of being served by others and being in the company of others. Tableservice meals provided recognition for and increased the status of the customer, allowed for social interactions, and reassurance through meal rituals. And when restaurants gave individualized attention to customers they were described as caring and giving and less of a business. Although no other research has defined eating out as an indulgence, several authors have identified that restaurant-based nutrition programs need to create environments conducive to enjoyable, healthy eating (Hendricks, 1993; A D A Reports, 1991(a)). Also important are positive, upbeat messages that minimize guilt and present food in the context of good tasting, attractive nutrition (Hendricks, 1993; A D A Reports, 1991(a); Colby, 1987; Regan, 1987) and that focus on variety and quality rather than on deprivation and food avoidance (Hendricks, 1993; Granzin, 1988). All of these point towards providing an indulgent experience. The suggestion that eating out meets basic emotional and physical needs was corroborated by DeVault (1991) who described the eating experience as an emotional, social and biological one and stated that through the social arrangements of serving and eating, people were nurtured. Dube et al (1994) in a study of patients' satisfaction with hospital foodservices found that while overall satisfaction was predominantly affected by food aspects, status, recognition and reassurance relating to the patient's social, physical, and emotional environments were other important factors. Both authors appeared to substantiate interview data that found 86 DISCUSSION that the service of food provided both physical and emotional nourishment which contributed to eating out as an indulgent experience. To develop successful nutrition programs in tableservice restaurants program planners must understand how the eating out experience is perceived by restaurant patrons. A nutrition program that fits with the indulgent concept of eating out, and that satisfies emotional and physical needs would be more successful than one that did not take this view into consideration. To satisfy physical needs, menu items need to provide enough sustenance and appeal to the senses. To satisfy emotional needs the program should convey itself as a service for the customer and assure a degree of familiarity or safety with program menu items. Healthier foods such as "Fresh Choices" could be considered indulgent because of the choice of good-tasting foods that satisfy without feelings of guilt or as one interviewee stated "have your cake and eat it". Eating Out and Grabbing Something to Eat. When eating out was compared to grabbing some food several distinctions became apparent. The most important of these seemed to be that grabbing something to eat was not an indulgent experience as emotional needs were unfulfilled, meal rituals were not observed and it was not a planned and relaxed social occasion. Interviewees implied that grabbing something to eat, especially "fast food", meant that food choice was less important. Food was chosen for sustenance and taste, "to fill the hunger void", and was considered a snack, not a meal. Food choice was also considered less healthy in comparison to menu selection in tableservice restaurants; however, this may have been an effect of the unavailability of healthier selections in fast food locations, not preferred choice. DeVault in Feeding the Family (1991) discusses modern industrial society as a "grazing society" in which individuals grab quick snacks here and there during the day 87 DISCUSSION instead of getting together to share meals. She also discusses "a proper meal" as comprised of and prepared with certain criteria under which grabbing something to eat does not fit. A "proper meal" was defined as a protein, a starch and vegetables prepared with methods other than frying. Because grabbing something to eat implies snacking there may be less concern when choosing healthy foods than when in a meal situation. A study by Axelson et al (1983) found that those who ate fast food infrequently believed that fast food locations had limited selections of lower quality foods that were not nutritious or tasty. This points to individuals selecting other restaurants to have a greater selection of more nutritious and tastier foods prepared with different methods. Emotional satisfaction seemed associated with eating out in restaurants but not with grabbing some food. Cadotte et al (1987), however, indicated that the evaluation standards of satisfaction may vary from situation to situation. For instance, satisfaction with the time-based benefits of fast food and with the social interaction situation of atmosphere restaurant dining might be evaluated by different norms. Therefore, fast food dining could provide emotional satisfaction with service but this could not be compared with emotional satisfaction with the service of tableservice dining. This comparison has relevance to developing nutrition programs to suit restaurant types. A nutrition program with accessible and available healthier menu items might be more acceptable at a tableservice restaurant than other restaurants because of the concepts of a "proper meal" and snacking as described by DeVault (1991). Selections when eating out did appear healthier for those who ate out frequently on non-special occasions. As well, a nutrition program modeled for a tableservice restaurant would not be transferable to a fast food type establishment because different needs were being met in both locations. 88 DISCUSSION Different Living and Working Situations. Living and working situations affected interviewees' frequency of and reasons for eating out. Lunch time eating out patterns appeared to be more affected by interviewees' work situations but eating out for dinner and on days off was influenced by individuals' living situations. Older more established professionals ate out frequently for lunch while younger workers grabbed something to eat at this time. Available time, money, flexible work schedule and location distinguished the two groups and were reasons interviewees did or did not eat out. Living situation seemed to affect the frequency of and reason for eating out for dinner. Among this group, those in one or two person households ate out most frequently but this is not a strong conclusion as only one interviewee lived in a different situation. Emotional needs, satisfied in restaurants, arose from living and working situations. Those who worked in service oriented positions and/or who prepared meals at home liked to eat out to get away from meal work and to be served by others. The predominant reasons married women ate out were to save on meal work and to be catered to. Single individuals ate out to socialize and for convenience. All interviewees ate out to celebrate an occasion. Some documentation exists on the effect of living and work situations on eating out in restaurants. The Consumer Price Index (1992), reports that the factors that contributed to increased prevalence of eating out centred on the increase in smaller households and the increased prevalence of women in the work force. Women today have more money, less time and less reason to prepare meals at home because of work outside the home. Eating out has become a leisure activity for those who can afford it (Consumer Price Index, 1992) and a way for those who live alone to socially interact with others. Family Food Expenditure in Canada (1992) reported on living situation and eating out. In 1992 tableservice restaurant meals accounted for 53% of eating away from home meals 89 DISCUSSION for persons who lived alone while 27% of such meals were from fast food restaurants. Married couples with children had different proportions at 40% ands 38%, respectively. The present research indicates the myriad of needs individuals bring to the restaurant. Understanding how different living and work situations affect these needs permits a better understanding of the reasons for and the frequency with which individuals eat out and allows insight into the characteristics of those who eat out. Information of this kind allows program planners to develop programs suited to these needs and expectations. Influences on Restaurant and Menu Item Selection. Frequency of eating out, reason for eating out and previous satisfaction with the eating out experience affected restaurant and menu item selections. Healthy menu item choice seemed dependent on frequency of eating out which indicated that interviewees carried everyday standards of nutrition into the restaurant. Indulgent foods were chosen on infrequent eating out occasions and special occasions. Nutrition at these times was not something to be concerned about. Satisfaction with a previous selection was a predominant reason for restaurant and menu item selection and menu items were chosen most often because they were favorites or preferences. Questionnaire results indicated that the predominant reasons for selecting a "Fresh Choice" menu item was that it was a favorite or preferred food. The second reason was nutrition. The interview results supported the quantitative data. Reasons for not choosing a "Fresh Choice" were: the perception of a lighter, less substantial menu item; something else appealed at the time; and the dining occasion was a special one. The processes of selecting restaurants and menu items were complex and variable. However, the research has indicated that reasons for selection were centred in previous 90 DISCUSSION satisfying experiences. "Fresh Choices" have been found in the questionnaire data to be more satisfying than regular items which infers that customers would be willing to try a "Fresh Choice" again. Other nutrition program planners should take customer satisfaction into consideration when developing menu items for programs as some individuals were not willing to risk being dissatisfied with less familiar items. Others who chose healthier items felt safe in experimenting because of familiarity with the dish. Obviously a favorite or preference of customers changed to fit the criterion of being lower in fat would be selected more readily than unfamiliar items. 5.3. Response to "Fresh Choice" and Nutrition in Restaurants The qualitative interviews also provided valuable feedback on customers' receptivity to and opinions of "Fresh Choice" and about nutrition information in general. The "Fresh Choice" logo was familiar to eight of the nine individuals interviewed. Overall, the impression of the logo and name was one of fun and health. All interviewees responded that "Fresh Choice" was a worthwhile program, for themselves or for others, because the option to choose a "Fresh Choice", not necessarily the choice itself, was important. Two male interviewees, however, did not and felt they would not select "Fresh Choice" menu items because they associated them with diet food which meant less in quantity, less in taste, and less in value. Other evaluations used surveys to inquire about recall of available selections and awareness of restaurant-based nutrition programs (Albright, 1990; Forster-Coull, 1988; Green, 1993; Paul, 1989). In the present study, interviewees were randomly recruited from a select sample of restaurant patrons. The high degree of awareness of the logo should then be judged on that context. A definite impression, however, was made by the logo. 91 DISCUSSION Responses to the logo and name reflected the objectives of program planners to present an image that meant fun and attractive menu items. Colby et al (1987) and Regan (1987) suggested that programs that use positive upbeat messages that minimize guilt and present food in the context of good tasting, attractive nutrition are programs that succeed in motivating individuals to change behaviour . Program planners, who were not previously aware how the name and logo were received by customers, now have feedback that suggests that customers are receptive to both because they fit with the definition of eating out as an indulgent, non-restricted experience. Some interviewees, however, felt that "Fresh Choice" detracted from the indulgent experience because it was not designed for them. They perceived "Fresh Choice" to advocate a vegetarian diet. Although many "Fresh Choice" entrees did contain meat, "Fresh Choice" was not perceived as having a varied menu. Promotion of all food groups must be done to ensure that customers perceive that "Fresh Choice" can be a program for all. Nutrition Information. The "Fresh Choice" pamphlet was an acceptable vehicle of nutrition information for the interviewees because the contained information was non-technical and the style was easy to read. The pamphlet, however, needed to be unobtrusively placed in the restaurant so as not to intrude upon patrons' enjoyment of the meal by interfering with what patrons wanted to order. Menu item promotions for "Fresh Choice", however, were thought better placed on the menu and not on a separate sheet. The term "lower fat" was better understood than "lighter fare", as the latter conveyed a meaning of less food or less value. There have been many studies concerning the acceptance and use of nutrition information in restaurant-based nutrition programs. Glanz et al (1992) and Carlson et al 9 2 DISCUSSION (1986) summarized the research by indicating that information for restaurant nutrition programs needs to be easily accessible, easily processed and friendly so that decisions concerning the use of such information can be more easily made. Program planners for "Fresh Choice" should be less concerned with specific nutrient information and focus on the broad nutritional principles in the pamphlet. Similarly, other programs would benefit from understanding that restaurant patrons want to eat healthy foods but do not want to be aware of intake of nutrients in restaurants. The less nutrient information, it appears, the better. Emphasis should be taken off "lighter fare" because of its negative connotations. In summary, even though eating out was an indulgent experience for the interviewees it did not mitigate against a nutrition intervention program like "Fresh Choice". In fact, freedom of selection was enhanced with "Fresh Choice" because of the increased menu variety and restaurant flexibility. As eating out was a treat, a reward and a time to relax and socialize, a nutrition program that reflected fun and health could be part of the indulgent experience. Some implications for "Fresh Choice" program planners and others interested developing a nutrition intervention, health promotion program in restaurants would be: awareness that the idea of fun, good taste and health might only be part of a successful concept; that understanding indulgence as a part of food and eating out is an important component; knowing that customers want the option of healthier foods for themselves or their company when eating out but do not want or need a lot of nutrient information; and that evaluations can be conducted in a restaurant situation. 93 DISCUSSION Limitations The limitations of the study include: the estimated 10% response rate; the use of a convenience sample, the lack of foresight surrounding the waitstaff s inability to satisfy research requirements and the small sample size of the interview group. Only 13%, or 892, of the restaurant population received a questionnaire. Therefore the results are not representative of the total population. There also may be systematic bias in the results as respondents from Picasso's restaurant represented 30% of the total who were surveyed; therefore results may be skewed in favour of Picasso clientele. As well, patrons were less likely to receive a questionnaire at busy times than at quiet times which also would may have biased the results. The implications of these limitations are that the results are representative of a select few and thus do not present an accurate account of restaurant patrons who ate in "Fresh Choice" restaurants during the evaluation. Previous studies have indicated the importance of the commitment of management and waitstaff to the success of restaurant-based nutrition interventions. Efforts were made to ensure management and waitstaff compliance to the research requirements of the "Fresh Choice" evaluation but ultimately they seemed not to have incentive to carry the requirements out successfully. A reward system that acknowledged and valued the waitstaffs efforts is a suggestion for the future evaluations. The inclusion of management and waitstaff in the development and implementation process of restaurant-based nutrition interventions is also seen as necessary for the success of the intervention. An interview group of nine was not large enough to achieve saturation of the data which means that after progressive interviewing no new revelations become apparent. Because the "Fresh Choice" study was designed to recruit one patron to represent one restaurant, nine was the end number for the study. The small number and non-saturation of data have implications for transferring, or generalizing, the results to similar populations. 94 CONCLUSIONS and R E C O M M E N D A T I O N S 6. CONCLUSIONS and R E C O M M E N D A T I O N S Conclusions Both components of the research indicated that "Fresh Choice" was an acceptable program to restaurant patrons. The questionnaire results showed that customers were significantly more satisfied with "Fresh Choice" than regular menu items which encourages all stakeholders, including restaurateurs and program planners, to continue with the "Fresh Choice" program. The null hypotheses were: 1. There was no difference in customer satisfaction between "Fresh Choice" and non "Fresh Choice" items and 2. There was no association between satisfaction with menu items and menu item type, meal type, frequency of eating out, reason for eating out, eating pattern, specific diet, gender and age. Hypothesis one can be rejected but hypothesis two cannot be rejected. Interviewees responded favorably to the program indicating that they appreciated having "Fresh Choice" items available. Customers were in favour of having healthier alternatives so that the needs of most people could be satisfied and because the option of having the healthier choice was important. Both components of the research indicated that a favorite or preferred menu item, indicating a previous satisfaction, largely determined selection. The "Fresh Choice" items that were chosen by interviewees were chosen because they were favorites. Eating out was defined by interviewees as a reward and as an indulgent experience if done for the self and if there was freedom of selection. Eating out satisfied both emotional and physical needs that arose from interviewees' living and working situations. It appeared that "Fresh Choice" contributed to the indulgent experience because the 95 CONCLUSIONS and R E C O M M E N D A T I O N S program increased menu flexibility and variety for most diners, thus increasing emotional satisfaction. The "Fresh Choice" logo and name were well liked but it appeared they indicated to restaurant patrons that "Fresh Choice" was a vegetarian program. The pamphlet was an acceptable vehicle for nutrition information because interviewees found it easy to read and non-technical. Interviewees thought promotion of "Fresh Choice" items could be done on the menu itself but nutrition information should not be near the menu. "Lighter fare" was not well understood as some interviewees perceived it to mean less food. "Lower fat" as a term for healthier alternatives had better connotations for individuals but in terms of promotion use of this term, may have regulatory implications. "Lower fat" implies the modified food has been reduced at least 25% in fat compared to regular food which could make the identification of some items difficult. Waitstaff were, to a large degree, unable or unwilling to cooperate with the research requirements of the evaluation but their participation was most needed as they interacted with the customers. Recommendations • The "Fresh Choice" program should be continued as it has shown promise as a successful program and because restaurant patrons want the choice of healthier food. • Favorites or preferences of customers should be changed to fit the criterion of being lower in fat as they would be selected more readily than unfamiliar items. • All food groups should be promoted equally to decrease the perception of "Fresh Choice" as a vegetarian program. This will make the program more available to those who are not vegetarians. 96 CONCLUSIONS and R E C O M M E N D A T I O N S • The focus should be removed from "lighter fare" as it appears detrimental to acceptance of the program by everyone. • Promotional focus for "Fresh Choice" items should be on the regular menu rather than on a separate sheet that can be easily overlooked by customers or forgotten by waitstaff. Nutrient information need not be a focus. Broad nutritional principles that are consistent and easy to assimilate are needed. • Waitstaff participation is needed for the success of the program. An incentive for the individual, not just for the restaurant, needs to be considered. 97 BIBLIOGRAPHY 7. BIBLIOGRAPHY Achterberg,C. Qualitative Methods in Nutrition Education Evaluation Research. Journal of Nutrition Education. 20:5;244-50, 1988. A D A Reports. President's Page: Resetting the American Table - Creating a New Alliance of Taste and Health. Journal of the American Dietetic Association. 91:2;228-30, 1991. A D A Reports. Position of the American Dietetic Association: Nutrition in Foodservice Establishments. Journal of the American Dietetic Association. 91:4;480-2, 1991. Almanza,B.A., Mason. A.C. , Widdows,R., Girard,F.I. Consumer Responses to Nutrition Guidelines Labeling in a University Restaurant. Journal of the American Dietetic Association. 93:5;580-l, 1993. Almanza,B., Hsieh,H.M.-Y. Consumer Preferences Among Nutritional Labeling Formats in a Restaurant. Journal of the American Dietetic Association. 95: l;83-5, 1995. Albright,C, Flora, and J.A., Fortmann,S.P. Restaurant Menu Labeling: Impact of Nutrition Information on Entree Sales and Patron Attitudes. Health Education Quarterly. 17:2;157-67, 1990. Anderson, J. Haas,M. Impact of Nutrition Education Program on Food Sales in Restaurants. Journal of Nutrition Education. 22:5;232-8, 1990. Anon. Factors Influencing Food Choice in Humans. Nutrition Reviews. 48:12;442-4, 1990. Axelson, M L . , Brinberg,D., Durand,J.H. Eating at a Fast Food Restaurant - A Social-Psychological Analysis. Journal of Nutrition Education. 15:3;94-8, 1983. Beasley, M . Determining Customer Satisfaction. Food Management. 25:3;48, 1990. Beggs,L., Hendricks,S., Schwartz,N.E., Biro,K. Tracking Nutrition Trends: Canadians Attitudes, Knowledge, and Behaviour Regarding Fat, Fibre, and Cholesterol. Journal of the Canadian Dietetic Association. 54:l;21-5, 1993. Bronner, Y. Healthy People 2000: A Call to Action for A D A Members. Journal of American Dietetic Association. 91:12;1520-1, 1991. 98 B I B L I O G R A P H Y Cadotte,E., Woodruff,R.B., Jenkins,R.L. Expectations and Norms in Models of Consumer Satisfaction. Journal ofMarketing Research. 25:305-14, 1987. Canada. Agriculture and Agri-Food. Visions. Ottawa: Food Bureau, Market and Industry Services Branch. 5:1, 1-16, 1994. Canada. Statistics Canada. The Consumer Price Index. Ottawa: Minister of Supply and Services. 62-001, July, 1992. Canada. Statistics Canada. Family FoodExpendicture in Canada. Ottawa: Minister of Supply and Services. 62-554: 11-14, 1992. Canada. Health and Wefare Canada. Action Towards Healthy Eating. Ottawa: Minister of Supply and Services, 1990. Canada. Health and Welfare Canada. Nutrition Recommendations for Canadians. Ottawa: Minister of Supply and Services, 1990. Canada. Health and Welfare Canada. Using the Food Guide. Ottawa: Ministry of Supply and Services, 1992. Carlson,B. and Tabacchi,M. Meeting Consumer Nutrition Information Needs in Restaurants. Journal of Nutrition Education. 18:5 ;211-14, 1986. Carsky,M.L. An Investigation of the Relationship Between Consumer Information and Satisfaction with Food Marketing Services. Advances in Consumer Research 18:78-86, 1991. Cinciripini,P. Changing Food Selections in a Public Cafeteria. Behavior Modification. 8:4;520-39, 1984. ColbyJ.J., Elder,J.P., Peterson,G., Knisley,P.M., Carleton,R.A. Promoting the Selection of Healthy Food Through Menu Item Descriptions in a Family-Style Restaurant. American Journal of Preventive Medicine. 3:3;171-77, 1987. Davis-Chervin, D. Rogers,T. Clark,M. Influencing Food Selection with Point-of-Choice Nutrition Information. Journal of Nutrition Education. 17:l;18-22, 1985. Dean,K. Nutrition Education Research in Health Promotion. Journal of the Canadian Dietetic Association. 51:4;481-4, 1990. DeLuco,D. and Cremer,M. Consumers' Perceptions of Hospital Food and Dietery Services. Journal of the American Dietetic Association. 90:12;1711-15, 1990. 99 B I B L I O G R A P H Y DeVault,M.L. Feeding the Family: The Social Organization of Caring as Gendered Work. Chicago: University of Cicago Press, 1991. De Vries,H.et al The Utilization of Qualitative and Quantitative data for Health Education Program Planning, Implementation, and Evaluation: A Spiral Approach. Health Education Quarterly. 19:1;101-15, 1990. Dube,L. and SchmittJB.H. The Processing of Emotional and Cognitive Aspects of Product Usage in Satisfaction Judgements. Advances in Consumer Research. 18:52-6, 1991. Dube, L . , Trudeau,E., Belanger,M-C. Determining the Complexity of Patient Satisfaction with Foodservices. Journal of the American Dietetic Association. 94:4;394-401, 1994. Dubbert,P. The Influence of Caloric Information on Cafeteria Food Choices. Journal of Applied Behavioural Analysis. 17: l;85-92, 1984. Eating Out Quarterly. "Trends in Dining Out"'.Canadian Restaurant and Foodservices Association. Robin Garret, ed. 8-12, 1992. Edwards,P.K., Mullis,R.M., Clarke,B. A Comprehensive Model For Evaluating Innovative Nutrition Education Programs. Journal of Nutrition Education. 18:1;10-15, 1986. Farrel and Associates. Kitsilano Restaurateur Interviews. Vancouver Health Department Report, 1992. FinkelsteinJ. Dining Out: A Sociology of Modern Manners. New York: New York University Press, 1989. Forster-Coull,L. and Gillis, D. E . Report on "To Your Heart's Delight" - A Nutrition Education Program to Promote Heart Healthy Eating Among Lunchtime Restaurant Clientele. Nova Scotia Heart Foundation. October, 1986. Forster-Coull,L. Gillis,D. E . Nutrition Education Program For Restaurant Patrons. Journal of Nutriton Education. 20:22B-C, 1988. Glanz,K. Point-of-Choice Nutrition Information, Federal Regulations and Consumer Health Education: A Critical View. Journal of Nutrition Education. 21:2;95-100, 1989. Glanz,K., Rudd,J., Mullis,R.M., Snyder,P. Consumer Behavior and Nutrition Education: An Integrative Review. Journal of Nutrition Education. 24:5;267-77, 1992. 100 B I B L I O G R A P H Y Granzin,K.L. and Bahn,K.D. The Role of Consumers' Attitudes Toward Nutrition in Restaurant Patronage. Journal of Nutrition Education. 20:2;56-62, 1988. Green,K.L., Steer,S.L., Mahaffey,S.M., Muhajarine,N. Evaluation of the Heart Smart Restaurant Program in Saskatoon and Regina, Saskatchewan. Canadian Journal of Public Health. 84:6; 399-402, 1993. Hendricks, S. Nutrition Education - Beyond the Facts. Canadian Journal of Public Health. 84:6;367-8, 1993. Hochbaum, G. Strategies and Their Rationale for Changing People's Eating Habits Journal of Nutrition Education. 13:1; S59-S65, 1981. Johnston,C.M. Upton,E.M. Managers' Perceptions of Customers' Satisfaction with their Hospital Cafeteria Services. Journal of the Canadian Dietetic Association. 52:1;11-14, 1991. Kar, et al. A Psychosocial Model of Health Behaviour: Implications for Nutrition Education Research Policy. Health Behaviour and Education. 7:2;29-37, 1983. Kristal, A. Patterns of Dietary Behaviour Associated with Selecting Diets Low in Fat: Reliability and Validity of a Behavioural Approach to Dietary Assessment. Journal of the American Dietetic Association. 90:2;214-20, 1990. Lewis,C.J., Shannon,B. Examination of Specific Nutrition/Health Behaviors Using a Social Cognitive Model. Journal of the American Dietetic Association. 89:2;194-202, 1989. MayerJ.A., HeinsJ.M., VogelJ.M., Morrison,D.C, Lankester,L.D., Jacobs,A.L. Prompting Low-Fat Entrees Choices in a Public Cafeteria. Journal of Applied Behaviour Analysis. 19:4;397-402, 1986. Mayer,J.A., Brown,T.P., HeinsJ.M., Bishop,D.B. A Multi-Component Intervention for Modifying Food Selections in a Worksite Cafeteria. Journal of Nutrition Education. 19:6;277-80, 1987. Mayer,J.APromoting Nutrition at the Point-of-Choice:A Review. Health Education Quarterly 16:1; 31-43, 1989. Mullis,R. Snyder,M.P., Hunt,M.K. Developing Nutrient Criteria for Food-Specific Dietary Guidelines For the General Public. Journal of the American Dietetic Association 90:6;847-851, 1990. 101 B I B L I O G R A P H Y Paul, P. Novascone,MA., Ganem,B.C, Wimme,P.B. "Dine to Your Heart's Content": An Assessment of the Program in Virginia. Journal of the American Dietetic Association. 89:6;817-20, 1989. Parraga,I.M., Determinants of Food Consumption. Journal of the American Dietetic Association. 90:5;660-63, 1990. Patton, M.Q. , Qualitative Evaluation and Research Methods (Second edition). Newbury Park: Sage Publications, 1990. Regan,C. Promoting Nutrition in Commercial Foodservices Establishments: A Realistic Approach. Journal of the American Dietetic Association. 87:4;486-8, 1987. Reiter,E. Making Fast Food: From the Frying Pan into the Fryer. Montreal and Kingston: McGill-Queen's University Press. 1991. Ries, C P . , Kline,K. Weaver,S.O. Impact of Commercial Eating on Nutrient Adequacy. Journal of American Dietetic Association. 87:4;463-8, 1987. Sawchuck,L. Final Report (unpublished) "Fresh Choice" - A New Vancouver Restaurant Program. Vancouver Health Department, September, 1993. Schmitz,M.F and Fielding,J.E. Point-of-Choice Nutritional Labeling: Evaluation in a Worksite Cafeteria. Journal of Nutrition Education. 18:l;s65-s68, 1986. Scott, L.W., Foreyt,J.P., Manis,E., 0'Malley,M.P., Gotto,A.M., A Low Cholesterol Menu in a Steak Restaurant. Journal of the American Dietetic Association. 74:54-6, 1979. Sims,L.S. Toward and Understanding of Attitude Assessment in Nutrition Research. Journal of American Dietetic Association. 78:460-66, 1981. Shields, J.E., and Young,E. Fat in Fast Foods - Evolving Changes. Nutrition (Annual Editions). 25:2;18-20, 1991-92. Skolnick, A. Institute of Medicine to Restaurants: Serving up Nutrition Information. Journal of the American Medical Association.264:23; 2975, 1990. Sneed, J. Marketing Nutrition in Restaurants: A Survey of Current Practices and Attitudes. Journal of the American Dietetic Association. 91:4; 459-62, 1991. Steckler,A., BurkhalterJ.D. Toward Integrating Qualitative and Quantitative Methods: An Introduction. Health Education Quarterly. 19:l;l-8, 1992. 102 B I B L I O G R A P H Y Tefft,M. The Healthy Menu. Foodservice and Hospitality. February, 18-25, 1995. Vancouver Health Department. Healthy Kitsilano Survey, 1991. Wagner.J.L., and Winnet, R.A. Promoting One Low-Fat, High-Fibre Selection in a Fast-Food Restaurant. Journal of Applied Behavior Analysis. 21:2;179-85, 1988. Warshaw,H.S. America Eats Out: Nutrition in the Chain and Family Restaurant Industry. Journal of the American Dietetic Association. 93:1; 17-20, 1993. Weisbrod,R.R., Pirie,P.L., Mullis,R.M., Snyder,P. Healthy Menu Choices in Midwest Restaurants. Journal of Nutrition Education. 23:6;303-7, 1991. Welland, D., RDs and Restaurants: Recipe for Success. Journal of the American Dietetic Association. 93:10;1105-8, 1993. Westbrook,R., and 01iver,R. The Dimensionality of Consumption Emotion Patterns and Consumer Satisfaction. Journal of Consumer Research.l&:84-91, 1991. Zifferblatt, S. Changing Cafeteria Eating Habits. Journal of the American Dietetic Association 76:15-20, 1980. 103 APPENDICES 8. APPENDICES A P P E N D K A "Fresh Choice" Participation Agreement C H O I C E ' A NEW V A N C O U V E R R E S T A U R A N T P R O G R A M A Vancouver Health Department initiative in cooperation with the Restaurant & Foodservices Association ot Greater Vancouver and the B.C. Chets' Association PARTICIPATION AGREEMENT The Vancouver Health Department will do the following for restaurateurs participating in the FRESH CHOICE program: • Market the FRESH CHOICE program through a local med ia campa ign . • Assist in market ing your FRESH CHOICE menu items by providing FRESH CHOICE w indow deca ls a n d menu inserts or table tents or menu decals or menu stamps. • Offer FRESH CHOICE Workshops to chefs and restaurateurs to provide new ideas for prepar ing FRESH CHOICES. • Discuss the purpose and implementat ion of the FRESH CHOICE program or a presentation to your restaurant staff. • Identify at least three FRESH CHOICE menu items rhat meet the FRESH CHOICE Guidel ines. Suggest ways to modify current menu items, if necessary to meet the minimum of three FRESH CHOICES. • Analyze FRESH CHOICE recipes for carbohydrate , fat. protein and energy (ie. nutrient analysis). • Provide written nutrition information on the FRESH CHOICE program. • Evaluate consumer a n d restaurateur satisfaction with the program and analyze sales d a t a . 104 APPENDICES "Fresh Choice" Participation Agreement The restaurateur will do the following as a participant in the FRESH CHOICE program: • You and/or your chef will attend a FRESH CHOICE Workshop. • Participate in FRESH CHOICE Month by offering at least three FRESH CHOICES daily during the month of June. 1993. • Provide accurate recipes for analysis. Recipes are to include method of preparation, ingredients, portion sizes, and name and description of item as given to the consumer. • Notify a FRESH CHOICE representative (Vancouver Health Department) before any changes are made in approved FRESH CHOICE recipes or menu names. • Choose a marketing strategy for FRESH CHOICES in your restaurant and do all necessary printing. (Blank FRESH CHOICE menu inserts or table tents are available from the Vancouver Health Department). • Will only use FRESH CHOICE logo on approved FRESH CHOICE menu items. • Assist in the evaluation of the program by providing sales data, completing a short survey following the evaluation, and being receptive to on-site customer interviews and incentives. • Make available to customers, upon request, written nutrition information about FRESH CHOICE and the nutrient analyses of FRESH CHOICES offered. • Ensure that staff are informed about FRESH CHOICE and receive an information sheet on FRESH CHOICE. Restaurant Owner/Manager Fresh Choice Representative Name of Restaurant Date 105 APPENDICES "Fresh Choice" Logo and Pamphlet LOOK FOR FRESH CHOICES IN THESE PARTICIPATING RESTAURANTS: A v e n u e Grill 2114 West 41st Avenue 266-8183 Fettucini's C a f e 1179 C o m m e r c i a l Drive 255-7771 Herons Restaurant & Lounge Waterfront Cent re Hotel 900 C a n a d a P l a c e W a y 691-1818 Inlets Bistro & Lounge Blue Horizon Hotel 1225 Robson Street 688-1411 Isadora's Granvi l le Island 1540 O l d Bridge 681-8816 P icasso C a f e 1626 W. Broadway 732-3290 Sierra Grill Pac i f i c Cent re 5 6 G - 701 W. G e o r g i a 683-4140 Tomato Fresh Food C a f e 3305 C a m b i e Street 874-6020 Vistas Rena issance Hotel 1133W. Hastings St. 691-2787 For more FRESH C H O I C E information ca l l the V a n c o u v e r Heal th Depar tment : 736-2033 For more nutrition information cal l Dial-A-Dierit ian: 732-9191 INTERESTED [No ' LIGHTER o FARE? ; F R E S H C H O I C E J f O V i 106 APPENDICES Fresh Choice" Logo and Pamphlet 1 ENJOY A FRESH CHOICE! W H Y FRESH CHOICE? • FRESH CHOICE has b e e n d e v e l o p e d in response to the growing trend for lighter, lower fat fare that doesn ' t sacrif ice flavour. • If restaurants are a regular part of your O lifestyle — FRESH CHOICE is a new food adventure for you to enjoy. W H O IS FRESH CHOICE? • FRESH CHOICE is a partnership program of V a n c o u v e r restaurateurs a n d chefs , the Greater Vancouve r Branch of the Restaurant a n d Foodservices Associat ion of B.C. , the Vancouver Heal th Depar tment a n d the B.C. Che fs ' Associat ion. • N e w restaurants part ic ipat ing in the FRESH CHOICE program are be ing a d d e d all the time. W H A T ISA FRESH CHOICE? • Fresh Cho ices are soups, salads, appetizers, entrees or desserts.prepared with 'little or no fat: • leaner meats, fish or skinless poultry • lower fat dairy products, such as skim, 1 % a n d 2% milk • lower fat cook ing methods, such as broiling a n d roasting • salads with oil-free dressings • desserts p repared without a d d e d fats like oil, butter or margarine. a • Deta i led nutrition information on Fresh Cho ices is ava i lab le upon request. Ask your server. • Part icipating restaurants offer a minimum of three Fresh Cho ices e a c h day . C H O I C E M A K E TODAYS CHOICE A FRESH CHOICE! A N E W FOOD ADVENTURE 107 APPENDICES 'Fresh Choice" Table Talker Insert A N E W F O O D i A D V E N T U R E In te res ted , in l ighter f a r e ? e . o > En joy a FRESH C H O I C E ! ^ Fresh C h o i c e s a r e t a s t y , l o w e r f a t |r m e n u s e l e c t i o n s t h a t g i v e y o u t h e o p t i o n o f c u t t i n g f a t w i t h o u t s a c r i f i c i n g f l a v o u r . If r e s t a u r a n t s a r e a r e g u l a r p a r t o f y o u r l i f e s t y l e , 0 n o w y o u h a v e a F R E S H C H O I C E ! Ask y o u r s e r v e r f o r m o r e i n f o r m a t i o n . / o / / \ \v - (/ o \\ i o F R E S H ! C H O I C E A program of the Resiouront the Vancouver Heolih Decor e n d Poodservic ssociction o; es.v_. CheiS' A s S O C i O i i Q " 108 APPENDICES Fresh" Special Sheet o 1 o 0 o o o 4 ^ o °/Af\V 0 F R E S H ; 0 C H O I C E A program ol the Greater Vancouve r Branch of the Restaurant one: ^codserv iess Asscc io i i cn of B.C ih-2 Vancouve r H'_-ci:n Depar i rnenf . a n d the B.C. Chefs ' Associa i ion. 109 APPENDICES "Fresh Choice" Consumer Information Sheet Your Chef is following these guidelines for Fresh Choices --Entrees & Appet izers • U s e leaner meats, fish or skin less poultry s u c h as lean beef, pork, l amb, veal , fish, ch icken, turkey, pheasant, venison, rabbit. • Serve smaller portions (6 oz. or less) of m e a t , f ish or sk in less poultry. • Trim off all visible fat and skim off any excess fat when cooking. v U s e lower fat cook ing methods such as bro i l ing, roast ing, s t e a m i n g , poaching, baking, microwaving, pansearing or sauteeing. • Use non-stick pans , broth, cooking oil sprays or a very limited a m o u n t of oii (just enough to prevent sticking) when pansear ing or sau tee ing . • U s e lower fat dairy products such as sk im, 1% or 2% mi lk, co t t age cheese and yogurt with 2% or less milkfat, and c h e e s e s with l ess than 20% milkfat. P a r m e s a n is acceptable as a garn ish or served on the s ide . (Parmesan is higher in fat.) • U s e low fat breads that do not leave a greasy feel on your hands . (H igh fat breads include cro issants, danishes, butter rolls, etc.) • U s e nuts and s e e d s a s a garnish or minor ingredient only. (Nuts and seeds are high in tat.) • Prepare combinat ion d ishes such as vegetar ian d ishes , pas ta d i s h e s , p izza or sandwiches following the above guidel ines. • P repare s a n d w i c h e s without added fat s u c h a s butter, m a r g a r i n e , mayonnaise or peanut butter. (Please see reverse side.) F R E S H CHOICE is a program oi ihe Greater Vancouver Branch of the Restaurant and Foods. Association of B . C . Ihe Vancouver HeaJlh Department and the B.C. Chefs' Associate 110 APPENDICES "Fresh Choice" Consumer Information Sheet F R ( •> H , CHOICE' Your Chef is following these guidelines for Fresh Cho ices --Soups & Salads • Use clear soups, vegetable based soups and soups prepared with lower fat dairy products instead of cream. • Use no salad dressing or prepare lower fat dressings and dips without adding oil or other fats such as peanut butter, mayonnaise or cream. • Fruit juice and yogurt may be used as the base for dressings and dips. Desserts • Prepare all desserts without adding any fat such as oil, margarine, butter, shortening, cream, sour cream, peanut butter. • Make fruit a major ingredient (eg. fruit salads, fruit sorbets) and/or offer a baked product such as Angel food cake. Fresh Choices are soups, salads, appetizers, entrees and desserts prepared with little or no fat. The carbohydrate, protein, fat and energy content "of Fresh Choices is available upon request. F R E S H C H O I C E is a program of the Greater Vancouver Branch ot the Restaurant and Foodservices Association of B.C. . the Vancouver Health Department and the B.C. Chefs' Association. For more F R E S H C H O I C E information call the Vancouver Health Department" 735-2033 For more nutrition iniormation call Dial-A-Oietitiarv 732-9191 111 APPENDICES A P P E N D K B Qualitative Questionnaire and Results Customer Satisfaction with Restaurant Menu Items We request one to two minutes of your time to complete this questionnaire. Your information is needed for a survey on customer satisfaction with selected menu items in restaurants. Participation is voluntary and by completing the questionnaire we assume you are giving your consent. Your name and address are not required, thus ensuring confidentiality. 1. When eating out, what are the characteristics of restaurant foods that determine whether you are satisfied or dissatisfied with your meal? It may help to think of a time when you were particularly satisfied or dissatisfied with the food you had when eating out. (Please refer only to foods and do not include comments on restaurant atmosphere or service). 2. Please indicate: Less than 18 0 4.0n average, how often do you eat out? 18-24 0 < once a month ( 25-34 0 l-2x/month ( 35-49 0 3-4x/month ( 50-64 0 2-3x/week ( 65+ 0 4-5x/week ( > 5x/week ( Thanks for your participation! For information contact: Trish Fitzpatrick or Gwen Chapman, Family and Nutritional Sciences, University of British Columbia, 822-6874. 112 APPENDICES Satisfaction Scale Survey Results Total respondants = 46 1. Gender 2. Age 3. Frequency of Eating out Female = 28 Less than 18 = 0 < once/month = 5 Male = 14 18-24 = 21 l-2x/month = 7 No response = 4 25-34 = 10 3-4x/month = 18 35-49 = 11 2-3x/week = 9 50-64 = 4 4-5x/week = 4 65 + = 0 5x/week = 3 Total 46 4.Characteristics of restaurant foods that determine satisfaction Aggregated Number of times Aggregated Number of times mentioned mentioned 1. Taste Taste 16 Flavour 6 Spicy 4 Salty 1 Balanced items 1 Compatability of dishes 1 Freshness I i Total 40 2. Quality Food quality 2 Quality of ingredients 1 Substance of food 1 Consistency of food 1 Comparisons to other places 1 Same as previous time 1 Preparation 3 Doneness 12 Texture 3 Crispness 1 Correct temperature 9 Good coffee 1 Total 36 113 APPENDICES 3. Presentation 4. Nutrition and Health Presentation 17 Healthy food 5 Artistic arrangement 1 Nutritional preparation 1 Color 4 Low-fat 8 Food arrangement 1 Dressing on side 1 Garnishes 1 Fits allergv requirements 2 Total 24 Total r 5. Portion size 6. Unusual Quantity 2 Unusual or ethnic 2 Portion size 10 Does not cook at home 3 Total 12 Variety 2 Creative 1 Unusual desserts 1 Total 9 7. Price . 8. Others Price 4 Tastes like home 2 Portion size relative to price 1 Sanitary 1 Value for price 1 Food demos 1 Total 6 Service 3 Order is right 1 Promptness of server 1 Personality of server 1 Choice on menu 3 Atmosphere 3 Location 1 Total 17 114 APPENDICES APPENDK C 'Customer Satisfaction with Menu Items" Pretest Questionnaire T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A Schoo l .of Family a n d Nutr i t ional Sciences 2205 East M a l l Vancouver , B . C . C a n a d a V 6 T IW5 "Customer Satisfaction with Menu Items" We request a few minutes of your time to fil! out this questionnaire. We are measuring customer satisfaction with menu items and your information will help us to assess the "Fresh Choice" program. Participation is voluntary and by.completing the questionnaire we assume you are giving your consent. Your name and address arc not required, thus ensuring confidentiality. Please leave the questionnaire to be collected by your server. 1 Menu item 1 M e n u item 2 M e n u item 3 j 1. Name the food items you had. Please be I specific, Le., French onion soup instead of | "soup". 1 2. Was this item a "Fresh Choice"? (please circle) Yes No Dont Know . Yes No D o n ! Know Yes No D o n t K n o w 3. Why did you order the item(s) you ordered? 4. For each of the categories listed below, evaluate | your satisfaction with the menu items using the following scale. 1 = extremely dissatisfied; 2 = dissatisfied; 3= neutral; 4= satisfied; 5= ertremely satisfied; n/a= not applicable, (plcatc drde) Menu item 1 M e n u item 2 M e n u item 3 Not over or undercooked 1 2 .1 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a Freshness - 1 2 3 4 5 n/a I 2 3 4 S n/a 1 2 3 4 5 n/a Lack of fat or grease 1 2 3 4 . 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a Portion size 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 .n/a Presentation 1 2 3 4 5 n/a 1 2 3 4 5 n/a I 2 3 4 5 n/a Taste 1 2 3 4 5 n/a , 1 2 3 4 5 n/a 1 2 3 4 5 n/a Temperature 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a Value for price 1 2 3 4 5 n/a ' 1 2 3 4 5 >n/a 1 2 3 4 5 n/a Overall satisfaction with menu items. 1 2 3 4 5 n/a 1 2 3 4 5 n/a 1 2 3 4 5 n/a 5. Was this meal: ( ) lunch , ( ) d inner; ( ) breakfast or ( ) a snack ? 6. O n average, how often do you eat out? o>Uu» i n d i c u ) < once/month ( ) l-2x/month ( ) 3-4x/monlh ( ) 2-3x/week ( ) 4-5x/week ( ) > 5xAveek ( ) 7. A r e you eating out today to celebrate a special occasion? Yes ( ) No ( ) 8. Are you on a particular diet? Yes ( ) No { ). (f yes. please specify 10. Age. Less than 1 H ) 11. Household Income Level: Under 20,000 18-24 ( ) . 20,000-39,999 25-34 ( ) 40,000-59,999 35^9 < > 60,000-79,999 50-64 ( ) 80,000-99,999 65+ ( ) 100,000+ Thanks for your participation! For informaiioo c o n i a d : T i i s t i FitzpaLrick or Gwcn C h a p m a n , F a m i l y and Numuona l Sc iences . U . G . C 822-6874. SEE OTHER S[DE 115 APPENDICES Questionnaire Evaluation We are conducting a pretest of a questionnaire that will measure customer satisfaction with menu items. The formal questionnaire will be implemented the next week and your comments will help us determine whether the questionnaire is complete and ready to be distributed. Thank you for your assistance. 1. How long did it take to complete the questionnaire? 2. Were any of the questions, or was the wording, unclear? (Please specify) 3. Were there any questions you did not wish to answer? (Please specify) 4. Any comments about the questionnaire? (SEE OTHER SIDE) 116 APPENDICES APPENDDX D 'Customer Satisfaction with Menu Items" Questionnaire T H E U N I V E R S I T Y O F B R I T I S H C O L L I M B I A S c h o o l o f F a m i l y a n d N u t r i t i o n a l S c i e n c e s 3 2 0 5 E a s t M a i ! V a n c o u v e r . B C C a n a d a V 6 T IW5 "Customer Satisfaction with Menu items" We request a few minutes of your time to fill out this questionnaire. We are measuring customer satisfaction with menu items and your information will help us to assess the "Fresh Choice" program. Participation is voluntary and by completing the questionnaire we assume you are giving your consent. Your name and address are not required, thus ensuring confidentiality. Please leave the questionnaire to be collected by your server. Menu item J Menu item 2 ..Menu item 3 I. Name the food items you had. Please be specific, Le., French onion soup instead of "soup ". 2. Was this item a "Fresh Choice"? (please cirde) Yes No Don 7 Know Yes No Don 7 Know-Yes No Don't Know 3. Why did you order the item(s) you ordered? 4. For each of the categories listed below, evaluate your satisfaction with the menu items using the following scale. 1 = extremely dissatisfied; 2= dissatisfied; 3 — neutral; 4 — satisfied; 5 = extremely satisfied; n/a = not applicable, (pitas* cirtt*) Menu item I Menu item 2 Menu item 3 Not over or undercooked 2 3 4 5 n/a 2 3 4 5 n/a 1 2 3 4 5 n/a Freshness 2 3 4 5 n/a 2 3 4 5 n/a 5 n/a Lack of fat or grease 2 3 4 5 n/a 2 3 4 5 n/a I 2 3 4 5 n/a Portion size 2 3 4 5 n/a 3 4 5 n/a I 2 3 4 5 n/a Presentation 2 3 4 5 n/a 2 3 4 5 n/a 1 2 3 4 5 n/a Taste 2 3 4 5 n/a 2 3 4 5 n/a 1 2 3 4 5 n/a Temperature 2 3 4 5 n/a 2 3 4 5 n/a 1 2 3 4 5 n/a Value for price 2 3 4 5. n/a 3 4 5 n/a 1 2 3 4 5 n/a Overall satisfaction with menu items. 2 3 4 5 n/a 2 3 4 5 n/a I 2 3 4 5 nli Comments on satisfaction ? 5. Was this meal: ( ) lunch ; () dinner ; ( ) breakfast or ( ) a snack 6. On average, how often do you eat out? (please indiaue) < once/month ( ) I-2x/month ( } 3-4x/month ( ) 2-Sx/week ( ) 4-Sx/wcek ( ) > 5x/week () Yes () 7. Are you eating out today to celebrate a special occasion? 8. Are you on a particular diet ? Yes ( ) No ( ). If yes, please specify-. 9. Gender: M () F ( ) 10. Age: Less than 18 ( ); 18-24 { ); 25-34 ( ); 35-49 ( ); 50-64 ( ); 65+ ( ). For information contact: Trish Fiapatrick or Gwen Chapmen. Family end SittritUmal Sciences. If.B.C. 822-6874 N o ( ) Tlianks for your participation! 117 APPENDICES APPENDK E Waitstaff Tip Sheet on Research Requirements Evaluation Questionnaire and Gift Certificate The waitstaff is an important part of the week long evaluation process. You will be asked to: *Deliver the questionnaires to every customer (with coffee or bill) explaining that the restaurant is involved in a study to evaluate the "Fresh Choice" program. The questionnaires should be made available to all customers but during the lunch and dinner periods only. *Collect all of the questionnaires completed or not and place them in a box in a safe and easily accessible area. •Deliver the entry form for a gift certificate for a dinner-for-two, to all customers at the same time as the questionnaire is delivered. These will be placed by the customer in a specially marked box near the exit. *Pens will be made available for the customers' convenience. *Large envelopes will be made available to collect all questionnaires at the end of the day. These should be secured to avoid any mix ups. *For the findings to have any statistical significance and be relevant to your restaurant, these directions need to be followed. This process will require the cooperation of a very flexible waitstaff. We realize that this may be difficult to carry out along with your many other duties but without your assistance we would not be able to evaluate this program. Thank you very much ! Trish Fitzpatrick Any questions? (224-8954) 118 APPENDICES APPENDLX F Interview Guide CUSTOMERS' OPINIONS ON EATING OUT IN RESTAURANTS AND A C C E P T A N C E OF "FRESH CHOICE" AND RESTAURANT-BASED NUTRITION PROGRAMS. Interview Guide for Semi-Structured Interview Opening statement: You may be wondering what today's interview will involve and what will be done with the information once it's collected. I'm going to ask you to give me your ideas, perceptions and opinions of eating out in restaurants, what factors influence what you choose to eat and how satisfied you are with what you get. The purpose of collecting the information is to get some feedback, from the consumer's perspective, about programs like "Fresh Choice". The information will be used by the Vancouver Health Department and the Foodservice Industry to develop programs to better meet consumers' needs. 1. Before we focus in on your perceptions and opinions of eating out, I would like to get to know you a little. Tell me a bit about yourself. probes: Where do you live? Who do you live with? What do they do? What do you do? 2. How does "eating out" fit into your life? probes: What does "eating out" mean to you? What determines if you will eat out? How often do you eat out? What time of the day do you normally eat out? How many days a week would you do this? How typical is what you've just described? Does eating out differ for you on weekends? Who are you usually with? Where did you last eat out? Why did you choose that restaurant? 119 APPENDICES 3. What determines your menu selection? probes: How do you decide what you are going to have? Would you decide differently on special occasions? Would you decide differently on the weekend? Do you tend to look for daily specials? What did you have the last time you ate out? Why did you choose what you did? 4. What determines your satisfaction with the menu items you've had? probes: Tell me about a time when you were very satisfied with the food you had when you were eating out. What did you have? Why were you satisfied? Tell me about a time when you were very dissatisfied with the food you had. What did you have? Why were you satisfied? 5. Do you recognize this design? (If no, explain it is the "Fresh Choice" design.) probes: Have you heard of "Fresh Choice"? What does the name "Fresh Choice" bring to mind? Do you know what "Fresh Choice" is? How did you learn about "Fresh Choice"? Have you tried a "Fresh Choice" menu item? More than once? Where would this have been? Why did you try a "Fresh Choice"? (If they know about "Fresh Choice" but did not try...) Why did you not try a "Fresh Choice"? What is your response to the name "Fresh Choice" for this program? What does the term "lighter fare" mean to you? What does "lower fat" mean to you? Does the availability of lower fat menu items and lighter fare influence your choice of restaurant? Does the availability of lower fat menu items and lighter fare influence what you order when you're in the restaurant? 120 APPENDICES 6. What does nutrition mean in your life? probes: What does "nutrition" mean to you? How relevant is nutrition in your life? How relevant is nutrition when you are eating out? 7. What does health mean to you? probes: What does the word "health" mean to you? Do you think much about your health? Why? Why Not? What is your biggest health concern? Are you on a particular diet? 8. What are your opinions on having nutrition information available in restaurants? probes: Would having nutrition information available influence your choice of restaurant? Would it influence your menu selection? Do you think it is relevant to have nutrition information available when eating out? Are you aware of any nutrition programs in restaurants? Have you tried menu items promoted by nutrition programs? Have you or would you choose them again? 9 Imagine that your input as a consumer is needed to help plan a nutrition program for you favorite restaurant. The program will focus on offering lower fat menu selections. probes: What are some things you think should be emphasized? What do you think the program should be called? How do you think the program should be promoted? How do you think the menu selections should be promoted? Do you think such a program would be worthwhile? Why or why not? 121 APPENDICES APPENDIX G Interviewee Recruitment Form DINNER-FOR-TWO (front) Enter to win: The opportunity to be interviewed about your opinions and perceptions of eating out in restaurants and to receive a complimentary Dinner-for-Two at this restaurant valued at $50.00! You are eligible to enter if: * you have participated in the "menu items satisfaction" questionnaire; * you eat out 2 or more times a week (at any restaurant); * and you are not celebrating a special occasion (birthday, etc.) by eating out today, name . phone number (w) If your name is drawn, you will be contacted by July 7, 1993 to schedule the interview at a time convenient for you. Please place your completed form in the specially marked box near the exit. (See other side for more information.) DINNER-FOR-TWO (back) If you wish to participate further in our study, we are now recruiting people. To be eligible you must eat out at least 2 to 3 times a week and have not celebrated an occasion (birthday, etc.) by eating out today We will select names at random from entrants who have completed this form and placed it in a specially marked box near the exit. If you are selected, you will be asked to participate in a thirty minute interview that will focus on your opinions and perceptions of eating in restaurants. The interviews will be held during July and August at the Family and Nutritional Sciences Building at the University of British Columbia. All names will be held in confidence and will be used for no other purpose than as stated above. Participation in the interview is voluntary. The dinner-for-two voucher will be awarded upon completion of the interview. 122 APPENDICES A P P E N D K H Interviewee Consent Form T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A School of Fam.ly and Nutrit ional Sciences 1305 E a « Mal l Vancouver. B . C . C a n a d a V6T IW5 CUSTOMER SATISFACTION WITH "FRESH CHOICE" MENU ITEMS A N D ACCEPTANCE OF RESTAURANT-BASED NUTRITION PROGRAMS I agree to participate in. a study about customers' opinions and perceptions o f eating out, satisfaction with menu items and acceptance of nutrition-based programs in restaurants. I understand that I will be interviewed by Trish Fitzpatrick at the Family and Nutritional Sciences building at U.B.C. I understand that the interview will last approximately 45 minutes and will involve a discussion about my perceptions of the "Fresh Choice" nutrition program and my interest in and opinions of nutrition programs in restaurants. I understand that the interview will be tape recorded and that I can turn the tape recorder off at any time. I am aware that I can have any portion of the tape erased if I wish and that I can refuse to answer questions that I do not wish to answer. I understand that all recorded information will be kept in confidence and my name will not be identified with any reports of the findings. I understand my participation is voluntary and that my decision to participate is not binding; I am free to withdraw at any time I am aware that I will receive a dinner-for-two as compensation for my involvement. If I have any questions concerning the procedures used in this project, ! can contact Trish Fitzpatrick, graduate student (224-8954) or Gwen Chapman, thesis supervisor, (822-6874). I consent to participate in this project and acknowledge that-1 have received a copy o f the consent form. Date Signature 123 APPENDICES APPENDDXI Waitstaff Questionnaire for Response Rate "Fresh Choice" Re: Validation of Response Rate Dear Waitstaff: Your help is needed to check the response rate for the evaluation questionnaire. Please respond to the following questions to the best of your knowledge. For the time period of the evaluation (June 21st to June 30th): 1. Approximately, how many customers would you have served during the lunch hour? and during the dinner hour? 2. Of the total number of lunch and dinner customers you served, approximately how many would have received a questionnaire? 3. What factors determined whether a customer received a questionnaire or not? 4. In your opinion, what percentage of the total number of lunch and dinner customers would have filled out the questionnaire? Thanks once again for all your efforts! 124 APPENDICES APPENDIX J Correlation Matrices and Two-Way ANOVA Tables Table 8.1 Correlation Coefficients Among Components of the Satisfaction Scale Within "Fresh Choice" Menu Items. Satisfaction Not over Lack of Fresh. Portion Present Descriptors or fat or size under grease cooked Taste Temp. Value Overall for satisfaction price Not over or undercooked 1.00 Lack of fat or .38 grease 1.00 Freshness .77 .51 1.00 Portion size .37 .43 .40 1.00 Presentation .42 .45 .53 .60 1.00 Taste .65 .49 .53 .47 .56 1.00 Temp. .55 .50 .51 .45 .55 .61 1.00 Value for .36 price .43 . 50 .43 .51 .50 .53 1.00 Overall satisfaction .63 .49 .64 .53 .63 .75 .64 .67 1.00 All correlations highly significant,p=0.000 Correlation coefficients as determined by Spearman's. 125 APPENDICES Table 8.2 Correlation Coefficients Among Components of the Satisfaction Scale Within Regular Menu Items Satisfaction Not over Lack of Fresh. Portion Present. Descriptors or fat or size under grease cooked Taste Temp. Value Overall for satisfaction price Not over or 1.00 undercooked Lack of fat or grease .44 1.00 Freshness .68 .45 1.00 Portion size .45 .34 .38 1.00 Presentation .49 .35 .51 .47 1.00 Taste .61 .44 .64 .43 .55 1.00 Temp. .52 .37 .55 .48 .52 .60 1.00 Value for price .44 .39 .49 .54 .52 .51 .53 1.00 Overall satisfaction .58 .47 .65 .50 .57 .69 .59 .67 1.00 All correlations highly significant, p =0.000 Correlation coefficients as determined by Spearman's. 126 APPENDICES Table 8.3 Overall Satisfaction with Menu Items According to Menu Item Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Menu Item Type Total X ±SD n X ±SD n Soup 94 4.59 -.65 58 4.33 .76 36 Entree 542 4.42 .79 102 4.21 .80 440 Salad 111 4.42 .90 12 4.22 .79 99 Dessert 94 4.50 .86 14 4.53 .62 80 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Type) ANOVA F Significance ofF Main Effect 2.085 .081 Classification 2.916 .088 Menu Type 1.556 .199 Interactions .384 .764 127 APPENDICES Table 8.4 Satisfaction with the Lack of Fat or Grease of Menu Items According to Menu Item Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Menu Item Type Total X ±SD n X ±SD n Soup 90 4.61 .69 54 4.47 .74 36 Entree 523 4.47 .81 96 4.13 .87 427 Salad 95 4.67 .65 12 4.11 .96 83 Dessert 75 4.78 .67 9 4.26 .87 66 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Type) ANOVA F Significance ofF Main Effect 5.705 .000 Classification 11.937 .001 Menu Type 2.209 .086 Interactions .751 .522 128 APPENDICES Table 8.5 Satisfaction with the Freshness of Menu Items According to Menu ItemType. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Menu Item Type Total X ±SD n X ±SD n Soup 92 4.66 .58 56 4.36 .72 36 Entree 544 4.64 .71 98 4.36 .75 446 Salad 113 4.46 1.13 13 4.37 .79 100 Dessert 95 4.73 .46 15 4.49 .76 80 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Type) ANOVA F Significance ofF Main Effect 2.902 .021 Classification 6.865 .009 Menu Type .566 .638 Interactions .249 .862 129 APPENDICES Table 8.6 Satisfaction with the Taste of Menu Items According to Menu Item Type Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Menu Item Type Total ±SD n X ±SD n Soup 96 4.50 .82 58 4.16 .82 38 Entree 556 4.56 .71 103 4.21 .83 453 Salad 114 4.21 1.42 14 4.19 .85 100 Dessert 98 4.47 .92 15 4.47 .75 83 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Type) ANOVA F Significance ofF Main Effect 2.261 .061 Classification 3.528 .061 Menu Type 1.018 .384 Interactions 1.174 .318 130 APPENDICES Table 8.7 Overall Satisfaction with Menu Items According to Meal Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Meal Type Total x ±SD n x ±SD n Lunch 679 4.45 .74 140 4.25 .81 539 Dinner 229 4.51 .85 39 4.31 .72 190 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Type) ANOVA F Significance ofF Main Effect 3.417 .033 Classification 6.803 .009 Meal Type .676 .411 Interactions .000 .986 131 APPENDICES Table 8.8 Satisfaction with Lack of Fat or Grease of Menu Items According to Meal Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Meal Type Total x ±SD n x ±SD n Lunch 617 4.56 .78 126 4.17 .90 491 Dinner 207 4.49 .69 37 4.19 .86 170 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Type) ANOVA F Significance ofF Main Effect 8.580 .000 Classification 14.199 .000 Meal Type .072 .788 Interactions .253 .615 132 APPENDICES Table 8.9 Satisfaction with the Freshness of Menu Items According to Meal Type. Classification of Menu Items11. "Fresh Choice" Items Regular Menu Items Meal Type Total x ±SD n x ±SD n Lunch 679 4.65 .65 136 4.36 .78 543 Dinner 228 4.66 .63 38 4.47 .67 190 1 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Type) ANOVA ofF Main Effect 5.276 .005 Classification 10.313 .001 Meal Type .596 .440 Interactions .525 .469 133 APPENDICES Table 8.10 Satisfaction with the Taste of Menu Items According to Meal Type. Classification of Menu Items1 "Fresh Choice" Items Regular Menu Items Meal Type Total x SD n x ± SD n Lunch 703 4.47 .84 144 4.21 .83 559 Dinner 233 4.62 .78 39 4.34 .78 194 1 Nunhers are according to ratings of satisfaction scale 2x2 (Classification x Type) ANOVA F Significance ofF Main Effect 5.490 .004 Classification 10.723 .001 Meal Type 3.019 .083 Interactions .011 .915 134 APPENDICES Table 8.11 Overall Satisfaction with Menu Items According to Respondents' Frequency of Eating Out Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Frequency _ _ Eating Out Total . x ± SD n x ± SD n <2x/week 343 4.53 .77 60 4.35 .75 283 2-3x/week 404 4.51 .74 81 4.23 .80 323 >3x/week 219 4.38 .80 47 4.23 .81 172 1 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Eat Out) ANOVA F Significance ofF Main Effect 4.220 .006 Classification 9.701 .002 Frequency Eat Out 1.275 .280 Interactions .353 .703 135 APPENDICES Table 8.12 Satisfaction with Lack of Fat or Grease of Menu Items According to Respondents' Frequency of Eating Out. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Frequency _ _ Eating Out Total x ± SD n x ± SD n <2x/week 313 4.53 .73 57 4.19 .86 256 2-3x/week 352 4.49 .86 71 4.22 .87 281 >3x/week 205 4.60 .65 45 4.05 .99 160 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Eat Out) ANOVA F Significance ofF Main Effect 9.028 .000 Classification 26.398 .000 Frequency Eat Out .066 .936 Interactions 1.107 .331 136 APPENDICES Table 8.13 Satisfaction with Freshness of Menu Items According to Respondents' Frequency of Eating Out Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Frequency _ _ Eating Out Total x ± SD n x ± SD n <2x/week 346 4.62 .59 58 4.48 .67 288 2-3x/week 405 4.68 .65 79 4.39 .75 326 >3x/week 213 4.64 .68 45 4.33 .87 168 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Eat Out) ANOVA F Significance ofF Main Effect 5.854 .001 Classification 16.135 .000 Frequency Eat Out .314 .730 Interactions .760 .468 137 APPENDICES Table 8.14 Satisfaction with Taste of Menu Items According to Respondents' Frequency of Eating Out. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Frequency Eating Out Total X ±SD n X ±SD n < 2 x/week 3 5 8 4 . 5 8 . 77 6 0 4 . 3 2 .78 2 9 8 2-3x/week 4 1 3 4 . 5 2 .81 81 4 .28 .82 3 3 2 > 3x/week 2 2 3 4 .33 .94 4 9 4 . 1 7 . 8 7 174 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Eat Out) ANOVA F Significance ofF Main Effect 5.771 .001 Classification 10.785 .001 Frequency Eat Out 2 . 7 8 7 . 062 Interactions . 1 9 9 .820 138 APPENDICES Table 8.15 Overall Satisfaction with Menu Items According to Reason forEating Out. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Reason _ _ Eating Out Total x ± SD n x ± SD n Special 136 4.46 .78 24 4.29 .79 112 Occasion Regular 837 4.47 .76 166 4.27 .78 671 Dining Nunbers are according to ratings of satisfaction scale 2%2 (Classification x Reason) ANOVA F Significance ofF Main Effect 2.539 .080 Classification 3.896 .049 Reason Eat Out .000 .994 Interactions .017 .896 139 APPENDICES Table 8.16 Satisfaction with Lack of Fat or Grease of Menu Items According to Reason for Eating Out. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Reason _ _ Eating Out Total x ± SD n x ± SD n Special 121 4.33 .86 21 4.14 .88 100 Occasion Regular 754 4.56 .75 153 4.18 .90 601 Dining Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Reason) ANOVA F Significance ofF Main Effect 7.203 .001 Classification 6.461 .011 Reason 1.394 .238 Interactions .656 .418 140 APPENDICES Table 8.18 Satisfaction with Freshness of Menu Items According to Reason for Eating Out. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Reason _ _ Eating Out Total x ± SD n x ± SD n Special 139 4.33 1.09 24 4.35 .71 115 Occasion Regular 832 4.68 .60 161 4.42 .75 671 Dining Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Type) ANOVA F Significance ofF Main Effect 7.246 .001 Classification 1.945 .163 Reason 5.838 .016 Interactions 2.431 .119 141 APPENDICES Table 8.19 Satisfaction withTaste of Menu Items According to Reason for Eating Out. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Reason _ _ Eating Out Total x ± SD n x ± SD n Special 144 4.40 .91 25 4.32 .76 119 Occasion Regular 857 4.51 .82 168 4.25 .83 689 Dining Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Reason) ANOVA F Significance ofF Main Effect 2.303 .100 Classification 3.055 .081 Reason .058 .810 Interactions .837 .360 142 APPENDICES Table 8.20 Overall Satisfaction with Menu Items According to Respondents' Eating Pattern. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Eating Pattern Total x ± SD n x ± SD n Diet 198 4.38 .90 50 4.29 .84 148 No Diet 700 4.50 .71 137 4.27 .76 623 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Eating Pattern) ANOVA F Significance of F Main Effect 3.035 .049 Classification 4.783 .029 Eating Pattern .417 .518 Interactions .913 .340 143 APPENDICES Table 8.21 Satisfaction with Menu Items' Lack of Fat or Grease According to Respondents' Eating Pattern. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Eating Pattern Total x ± SD n x ± SD n Diet 176 4.42 .92 45 4.28 .89 131 No Diet 683 4.58 .68 125 4.14 .89 558 1 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Eating Pattern) ANOVA F Significance ofF Main Effect 6.038 .002 Classification 11.334 .001 Eating Pattern .017 .897 Interactions 2.740 .098 144 APPENDICES Table 8.22 Satisfaction with Menu Items' Freshness According to Respondents' Eating Pattern Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Eating _ _ Pattern Total x ± SD n x ± SD n Diet 199 4.51 .82 49 4.43 .75 150 No Diet 755 4.68 .63 133 4.39 .75 622 1 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Eating Pattern) ANOVA F Significance ofF Main Effect 4.618 .010 Classification 6.818 .009 Eating Pattern .908 .341 Interactions 2.017 .156 145 APPENDICES Table 8.23 Satisfaction with Taste of Menu Items According to Respondents' Eating Pattern. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Eating Pattern Total x ± SD n x ± SD n Diet 204 4.33 1.07 51 4.29 .83 153 No Diet 779 4.55 .73 138 4.25 .82 641 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Eating Pattern) ANOVA F Significance ofF Main Effect 3.979 .019 Classification 5.115 .024 Eating Pattern 1.369 .242 Interactions 2.772 .096 146 APPENDICES Table 8.24 Overall Satisfaction with Menu Items According to Respondents' Diet Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Diet Type Total x ± SD n x ± SD n Vegetarian 76 4.24 .83 17 4.25 .73 59 Low Fat 68 4.44 .86 18 4.24 .92 50 Other 62 4.44 1.03 16 4.39 .86 46 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Diet) ANOVA F Significance ofF Main Effect .445 .721 Classification .315 .575 Diet Type .504 .605 Interactions .240 .787 147 APPENDICES Table 8.25 Satisfaction with Lack of Fat or Grease of Menu Items According to Respondents' Diet Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Diet Type Total x ± SD n x ± SD n Vegetarian 66 4.64 .63 14 4.08 .88 52 Low Fat 63 4.18 1.13 17 4.24 1.015 46 Other 54 - 4.43 .85 14 4.55 .75 40 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Diet) ANOVA F Significance ofF Main Effect .933 .426 Classification .674 .413-Diet Type 1.118 .329 Interactions 1.986 .140 148 APPENDICES Table 8.26 Satisfaction with Freshness of Menu Items According to Respondents' Diet Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Diet Type Total x ± SD n x ± SD n Vegetarian 79 4.56 .71 18 4.43 .67 61 Low Fat 66 4.50 1.03 16 4.50 .76 50 Other 63 4.50 .73 16 4.40 .80 47 1 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Diet) ANOVA F Significance ofF Main Effect .158 .924 Classification .367 .546 Diet Type .054 .947 Interactions .098 .906 149 APPENDICES Table 8.27 Satisfaction with Taste of Menu Items According to Respondents' Diet Type. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Diet Type Total x ± SD n x ± SD n Vegetarian 79 4.11 1.08 18 4.31 .70 61 Low Fat 68 4.65 .70 17 4.20 1.00 51 Other 66 4.29 1.31 17 4.39 .79 49 Nunbers are according to ratings of satisfaction scale 2x3 (Classification x Diet) ANOVA F Significance ofF Main Effect .552 .647 Classification .136 .713 Diet Type .761 .469 Interactions 2.008 .137 150 APPENDICES Table 8.28 Overall Satisfaction with Menu Items According to Respondents' Gender. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Gender Total X ±SD n X ±SD n Male 338 4.41 .80 71 4.23 .77 267 Female 569 4.55 .72 104 4.31 .77 465 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Gender) ANOVA F Significance ofF Main Effect 6.900 .001 Classification 9.936 .002 Gender 2.724 .099 Interactions .223 .637 151 APPENDICES Table 8.29 Satisfaction with the Lack of Fat or Grease of Menu Items According to Respondents' Gender. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Gender Total x ± SD n x ± SD n Male 305 4.57 .66 67 4.17 .92 238 Female 510 4.48 .86 94 4.17 .88 416 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Gender) ANOVA F Significance ofF Main Effect 10.218 .000 Classification 20.397 .000 Gender .301 .584 Interactions .338 .561 152 APPENDICES Table 8.30 Satisfaction with Freshness of Menu Item According to Respondents' Gender. Classification of Menu Items. "Fresh Choice" Items Regular Menu Items Gender Total x ± SD n x ± SD n Male 338 4.64 .57 70 4.35 .80 268 Female 564 4.62 .79 101 4.46 .67 463 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Gender) ANOVA F Significance ofF Main Effect 7.260 .001 Classification 13.290 .000 Gender .582 .446 Interactions 1.148 .284 153 APPENDICES Table 8.31 Satisfaction with the Taste of Menu Items According to Respondents' Gender. Classification of Menu Items1. "Fresh Choice " Items Regular Menu Items Gender Total x ±SD n x ±SD n Male 349 4.40 .88 72 4.24 .83 277 Female 584 4.59 .72 106 4.30 .79 478 Nunbers are according to ratings of satisfaction scale 2x2 (Classification x Gender) ANOVA F Significance ofF Main Effect 7.502 .001 Classification 10.569 .001 Gender 3.119 .078 Interactions .806 .370 154 APPENDICES Table 8.32 Overall Satisfaction with Menu Items According to Age. Classification of Menu Items.1 "Fresh Choice" Items Regular Menu Items Age Total X ±SD n X ±SD n <25 119 4.21 1.10 24 4.27 .79 95 25-34 301 4.60 .49 48 4.26 .75 253 35-49 322 4.51 .77 73 4.21 •* .85 249 >50 221 4.46 .68 39 4.40 .72 182 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Age) ANOVA F Significance ofF Main Effect 2.665 .031 Classification 5.521 .019 Age 1.316 .268 Interactions 1.900 .128 155 APPENDICES Table 8.33 Satisfaction with Lack of Fat or Grease Menu Items According to Age. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Age Total X ±SD n X ±SD n <25 104 4.38 .92 21 4.11 .98 83 25-34 271 4.56 .70 43 4.17 .89 228 35-49 291 4.55 .81 65 4.08 .94 226 >50 197 4.54 .72 39 4.35 .78 158 1 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Age) ANOVA F Significance ofF Main Effect 5.273 .000 Classification 16.575 .000 Age .898 .442 Interactions .733 .532 156 APPENDICES Table 8.34 Satisfaction with Freshness of Menu Items According to Age. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Age Total X ±SD n X ±SD n <25 115 ' 4.67 .73 21 4.46 .70 94 25-34 308 4.74 .44 46 4.43 .76 262 35-49 321 4.60 .76 74 4.34 .78 247 >50 215 4.57 .80 37 4.49 .67 178 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Type) ANOVA F Significance ofF Main Effect 2.921 .020 Classification 10.195 .001 Age .863 .460 Interactions .625 .599 157 APPENDICES Table 8.35 Satisfaction with Taste of Menu Items According to Age. Classification of Menu Items1. "Fresh Choice" Items Regular Menu Items Age Total X ±SD n X ±SD n <25 119 4.50 1.10 22 4.23 .87 97 25-34 311 4.43 .74 47 4.26 .81 264 35-49 332 4.49 .81 76 4.19 .84 256 >50 228 4.59 .77 41 4.43 .73 187 Nunbers are according to ratings of satisfaction scale 2x4 (Classification x Type) ANOVA F Significance ofF Main Effect 3.367 .010 Classification 9.308 .002 Age 1.452 .226 Interactions .333 .802 158 

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