Perceived Facilitators and Barriers to Implementing Culturally Inclusive Diets into Hospitals and Long-Term Care Facilities

Objectives: To identify perceived facilitators and barriers to implementing culturally inclusive foods into hospitals and long-term care (LTC) from the perspectives of registered dietitians and food service directors. Design: Cross-sectional survey. Setting and Participants: Online nationwide survey of registered dietitians and food service directors working in hospitals or LTC. Methods: We analyzed and compared participants’ perceived barriers to implementing culturally inclusive foods in hospitals and LTC, assessed through a question in which we provided respondents with 13 different barriers and asked them to report the top 3. Then, we conducted a qualitative analysis of perceived facilitators, which respondents described in open-ended comments. Results: The most common perceived barriers to implementing culturally inclusive foods were cost of ingredients (44%) and staff cultural knowledge and competence (44%). LTC respondents perceived barriers including (1) willingness of staff to adopt new practices, (2) time, (3) staff burnout, and (4) local/facility-level regulatory barriers more frequently than hospital respondents. Administrative buy-in, staff diversity, and patient considerations (eg, feedback and demand) were perceived facilitators to implementing culturally inclusive foods. Conclusions and Implications: Implementing culturally inclusive foods into hospitals and LTC requires administrative buy-in, willingness to change, and resources including staff diversity and cultural knowledge and awareness. Incorporating patient feedback and preferences into decisions related to dietary offerings could further motivate menu modifications. Further examination of organizational and state policies regulating diet, particularly in LTC settings, is necessary to understand both how to implement culturally inclusive foods and further, to inform investigation of health outcomes (physical and mental) associated with increasing culturally inclusive food offerings in these facilities.