In the first initiative of its kind in the UK, social marketing techniques have been used to promote the sustained improvement of nutrition and healthy eating among hospital employees.

Piloted by the cardiovascular disease prevention charity, Heart of Mersey, and ten participating trusts, The Cheshire and Merseyside Hospital Food Project worked with 10 trusts in this region over an initial three month pilot project, to positively impact upon the health of more than 35,000 employees, with far-reaching implications. 

Key learning:

  • Hospital catering services can have a key role in changing people’s diets for the better, and healthy eating interventions within hospitals can make a positive difference to staff health and wellbeing.
  • Taking a collaborative approach is vital to success and networking between hospitals also encourages the sharing of best practice.
  • Listening to hospital staff, testing assumptions and tailoring interventions that help to overcome their barriers to adopting a healthier diet are all essential.

The initial step was to conduct a baseline audit of over 1,700 staff across six different hospitals in the region, to help inform the development of the project. Robin Ireland, chief executive of Heart of Mersey explains;

“The key to effective social marketing is to talk and listen to the audience you’re trying to reach. Our 2007/2008 audit revealed relatively poor dietary habits among hospital staff, and helped to highlight some of the main factors influencing employee food purchasing decisions such as cost and convenience.”

The research also revealed a wide lack of understanding of the term ‘healthy eating option’, with many staff saying that would not choose a healthy eating option because they were ‘not on a diet’, and identified the need for further training as many hospital catering staff were simply not equipped to promote healthy eating properly.

“Trusts up and down the country are facing similar challenges and I believe a collaborative approach is vital to tackle these issues. In our case, we brought together representatives from each participating trust, the Heart of Mersey, and our specialist partner in social marketing, ICE marketing & communications, to form a steering group which enabled everyone involved to discuss progress, share learning and voice any issues, concerns and barriers they faced throughout the course of the project.”


Recognising that a ‘one size fits all’ solution wouldn’t meet the differing needs of each hospital, this insight was used to closely inform a range of tailored interventions under the ‘Nourish’ umbrella brand which was developed and tested, to help provide a consistent identity for all participating trusts to promote their healthier eating messages throughout a three month focused campaign period.

A systematic, two-pronged approach was adopted, which included extensive training on nutrition for catering staff, as well as social marketing training to equip catering staff with the skills to carry out the Nourish campaign and promote the benefits of healthier food to their customers. Communications teams were also invited to take part in training sessions, to help ‘sell in’ the campaign’s messages to key influencers in the trust such as chief executives, and to all staff through internal communications.

On-site training around updating catering policies and training sessions on social marketing techniques were also delivered to hospital catering and communications staff  in order to help them understand how to effectively market healthy food options to staff.

Voluntary behaviour change

One of the key premises of social marketing is that behaviour change is voluntary and audiences must be persuaded that they are receiving something worthwhile ‘in exchange’ for making that change to their behaviour.

As a result, the Cheshire & Merseyside Hospital Food Project identified and piloted a range of creative interventions to help staff overcome a range of the identified barriers to eating healthily such as competition from big chain stores on or nearby hospital sites, and the perceived convenience and lower cost of unhealthy snacks and junk food.

Modi Mwatsama, food and health programme manager for Heart of Mersey, said; “The economic climate has certainly had an impact on spending power. However, we were able to develop lots of interventions such as healthy option ‘grab and go’ meal deals and the offer of a free piece of fruit with every purchase, healthy budget hot meals, loyalty card schemes and menu overhauls - all of which were positioned as equally convenient, cost-effective and crucially, healthier.”

A ‘Nourish’ website was also created to help hospital catering teams to share best practice and lessons learned with each other throughout the project period. Each participating hospital was provided with their own web page where they could supply information on current promotions, menu options and forthcoming events.

As part of the project, each participating hospital was asked to monitor and evaluate the effectiveness of these new intervention and healthy eating promotions, and findings from the project’s Evaluation reveal a significant increase in the uptake of healthier meals and snacks among each the participating Trusts.

Some of the Hospital Food Project’s key achievements over the twelve week Nourish awareness campaign included:

  • All participating hospitals saw an increase in the purchase of healthy eating options such as fruit and salads, ranging between a 17–50 per cent increase across the differing hospitals.
  • Two hospitals switched to healthier baked beans, resulting in almost 4kg less salt and just over 3kg less sugar consumed.
  • One hospital reformulated the cheese sauce recipe used in a number of daily meals such as lasagnes and cauliflower cheese, reducing the saturated fat by an average of 4g per portion.
  • New healthier fish dishes introduced onto the menu in one hospital resulted in 1,800 portions sold.
  • One hospital sold an extra 12,000 healthy sandwich options, and reported a 40 per cent increase in fresh fruit sales after introducing two large branded fruit stands into their restaurant.
  • Each hospital used more wholemeal bread for sandwiches and soup meals, and introduced new alternative healthy snack options such as healthy range crisps and alternative snack bars such as multi-grain bars.

Mr Ireland added; “This project hasn’t been without its challenges, but all participating trusts have certainly seen some improvements in the dietary habits of their employees, and it’s hoped this initiative will bring more widespread, long-term changes over the coming months as each of the Trusts continue to build upon this learning. There’s also no reason why this success can’t be replicated across the country: using social marketing as a practical tool to reshape attitudes to public health and change people’s diets for the better.”