Meat Free Mondays in Hospital Cafés in Aotearoa: Exploring Enablers and Barriers

Abstract

Introduction: Despite the overwhelming scientific consensus that reducing meat intake is necessary to reduce environmental degradation and rates of non-communicable diseases, meat reduction policy interventions are limited, and globally, meat intake remains high. Meat Free Mondays (MFM) is a global campaign to reduce meat consumption by 15% to improve human and planetary health. In 2020, Nelson Marlborough DHB introduced an MFM policy at their staff and guest cafés, and Northland DHB trialled an MFM policy for two months. Methods: This mixed methods study investigated the attitudes of staff and managers towards MFMs and the implementation barriers and enablers at Nelson Marlborough DHB, Northland DHB, and Auckland DHB (who were not considering an MFM policy). Online staff surveys were conducted at Auckland and Nelson Marlborough DHBs, but not Northland as they had previously evaluated MFMs. Eleven semi-structured interviews were held with food service managers, café managers and sustainability managers in all three DHBs. Results: The online survey received 194 responses (105 from Auckland DHB and 89 from Nelson Marlborough DHB). Of those surveyed, 50.8% were actively reducing meat intake, mainly for health reasons, environmental concerns and enjoyment of plant-based dishes. A total of 59.0% were positive towards MFMs, and 31.0% were negative. Qualitative analysis of the interviews and open-ended questions of the survey identified four key themes: 1) change and choice – MFMs impact on personal choice and resistance to changing eating habits; 2) getting it right – product and price, food quality, appearance, nutritional balance, and the impact of an MFM policy on café customer retention and sales; 3) human and planetary health – the co-benefits of MFMs and hospitals as leaders of healthy and sustainable diets; and 4) implementation success – consultation, communications, and education, for a successful MFM policy and maintaining staff wellbeing. Conclusion: This study identified barriers to MFMs; however, most staff were already reducing their meat intake and were aware and supportive of MFM policies. Recommendations for successful implementation of MFMs included wide consultation with food service, management, DHB staff, and cultural advisors; providing clear aims and alternatives; considering the wider food environment; and providing training and dietitian support for the food service.