A total of 27 respondents completed the screening survey, and all were invited to participate in the discussions. Of those, 20 participated in the study, representing 13 restaurants (Table 1). Most study participants self-identified as Hispanic (n = 17) and more than half of the participants (n = 13) had 10 years or more of experience on the industry. Close to half of the participants were restaurant owners (n = 9), with the rest closely split between chefs (n = 6) and servers (n = 5) (Table 1). Only three participants were not currently working at a restaurant at the time of the interview, having left their positions as chefs for reasons related to COVID-19. Among the 7 that signed up and did not participate, all identified as Hispanic, including three owners and five servers, and all were working in the industry at the time. While we followed up with these participants, we were unable to ascertain the individual reasons for the no-shows.
Most of the restaurants were in New York City (NYC, n = 10) and were classified as full-service (n = 10). More than half of the restaurants served Mexican food (n = 7), whereas the rest served Latin Caribbean foods (one Cuban and three Puerto Rican) or South American (n = 2, Peruvian and Uruguayan). The price range per customer at these restaurants varied, with most restaurants (n = 9) in the $11–30 price range, as reported by participants (Table 1). Most of the restaurants had a single location, except for two (one with two locations and a second, family-owned restaurant, with 14 locations, as of June 2021).
Healthy Eating Promotion Strategies (HEPS): acceptability, barriers, and facilitators
HEPS used in this research are summarized in Table 2. They are ordered by the mean acceptability sentiment rating and discussed here in that order. For each strategy, we present an overview of the strategy, followed by factors associated with levels of acceptability. The next section compiles the resource needs to engage in the strategies.
Menu highlights encompassed the use of special markers on menus (e.g., “V” for vegetarian), the grouping of healthy options in particular sections, or the use of a separate menu for healthy options. This strategy was largely viewed as acceptable across respondents. Acceptance was driven by two main factors: customer convenience by simplifying food choices and marketing potential to satisfy a perceived demand for healthier options, with the potential to expand the customer base (Table 2). Low acceptability came from chefs. One argued that labeling or marking certain offerings as healthy may imply that the rest of the menu is not healthy, while another noted that healthy menu sections might add a feeling of exclusion for customers interested in healthier offerings, as being relegated to the corner of a menu. Healthy sections are regularly included at the end of menus, diminishing their importance within the rest of the offerings and potentially decreasing their effectiveness in promoting healthier choices, as customers may be enticed by the less healthy options presented early in a menu.
Promotion of healthier options
The promotion of existing healthier options (Table 2) was discussed mainly as promotion via social media, as the primary medium for marketing, with increased importance after the onset of COVID-19. In addition, we also inquired about the promotion of healthier items by servers recommending these items to customers. The relatively high acceptability of this strategy was associated with the potential to better market the restaurant and because it offered an alternative to menu highlights, not requiring menu redesigns or the need to develop online menus, thus reducing menu production costs. Low acceptability was found among chefs and servers, who expressed concerns about customer reaction. For example, customers might react poorly to staff or the restaurant if server recommendations of healthy items triggered negative emotions among customers or otherwise offended them. Additionally, as noted by one chef, promotion efforts tended to focus on top sellers, not seeing healthier items in this category (Table 2).
Providing healthier food options
All the respondents came from restaurants that offered some potentially healthful options (Table 2), including green salads, vegetarian alternatives, and seafood options. This strategy was discussed based on their experience with current offerings and the potential for expanding these options. COVID-19 forced the restaurants to adapt their menus, temporarily taking out both healthier (e.g., green salads) and less healthy offerings (e.g., fried snacks). The adaptations were in response to shifts to takeout and delivery, issues with the food supply, and reduced staff due to capacity restrictions, concerns for staff health, and the inability to keep the payroll. The shift to take out and delivery forced some restaurants to experiment with this service mode for the first time, pushing them to rethink menus and packaging to retain food quality. These experiences with menu changes served as a starting point to discuss potential increases in healthier offerings.
Acceptability for this strategy was associated with factors that could increase profit, including wanting to satisfy rising demand and reduce cost. Some participants, notably chefs, were motivated to provide more vegetable-forward dishes due to concerns over environmental sustainability due to animal product consumption. Study participants indicated that the demand for healthier offerings came largely from white (non-Hispanic) clients, but some recognized a growing market among young Hispanics. Cost-saving was discussed by chefs expressing interest in increasing vegetarian alternatives, noting the creative potential and the lower cost of vegetables compared to meats, along with the greater profit, as these were often sold at comparative prices. Additionally, one waitstaff mentioned the potential for up-selling healthier additions, such as side vegetables, as a potential to increase profit.
On the other hand, low acceptability for this strategy mainly came from concerns about demand, exacerbated by the uncertainty of COVID-19, pushing restaurants to focus on top sellers regardless of their relative healthfulness, or their own, personal interest in offering these items. The importance of perceived demand and notions about which offerings are perceived as “authentic” was also a reason that prevented some LARs from offering cuisines closer to contemporary healthier offerings in Latin America. For example, Mexico-born chefs discussed wanting to create dishes devoid of the cheese or sour cream typically found in Mexican-American (or “Tex-Mex”) cuisine but received pushback from the restaurant owners about the types of foods that should be offered in their restaurants. Some owners felt forced to include less healthy offerings due to perceived customer demand. Lastly, participants also discussed logistical issues regarding the storage and space requirements to accommodate healthier offerings. This included space for refrigeration and kitchen space and equipment capacity to diversify food preparation methods. Items such as salads or dishes containing seafood are perishable. They require high turnover or demand to avoid food waste – a concern that became more salient during the initial onset of COVID-19.
Providing nutrition information
Respondents were familiar with the provision of nutrition information in menus (Table 2) as a strategy associated with large corporate restaurants, especially fast-food restaurants. Only two respondents, coming from the same multi-location restaurant, had experience with this strategy, as one required by law. Acceptance of this strategy was associated with recognizing an increased interest in nutrition information. A few owners saw this as a possible way to make their restaurants stand out from the competition. Some were curious as to the nutrition content of the foods they served, expressing an openness for the analysis. However, some participants expressing high acceptability discussed the information as something to offer upon request instead of having it on full display. Participants also expressed not wanting to “rub that [nutrition information] in people’s faces” to avoid customers “feeling guilty about what they are eating” (waitstaff, Puerto Rican restaurant). While recognizing the benefit of the information was the main motivator driving some level of acceptance for this strategy, there was some pushback, particularly when the strategy did not fit with the restaurant concept or when additional resources were needed to provide the information. In these restaurants, recipes change frequently, and offerings were highly customized, factors that could make nutrient calculations inaccurate or require ongoing revisions, adding to the cost. Lastly, participants also expressed skepticism of whether the nutrition information made any difference in customer choice or, as expressed by one owner, whether such information might even trigger eating disorders.
Changing portion size
Portion size changes (Table 2) were discussed in two main ways – either a general decrease in the size of offerings or the offering of specific portion options, such as half-portions – the latter being the least accepted. Acceptability was found among those with experience with the strategy, seeing the benefit of offering half or smaller portions for business and customers. One respondent shared that the Mexican establishment he worked at experimented with smaller portions as part of their adjustments in response to COVID-19. The shift to a takeout mode of service created a motivation to create menu items that consisted of “small bite-sized things that [one could] just grab and go as quickly as possible.” In making this change, he noted, “We sell way more of the smaller stuff than we do the bigger orders.”
Low acceptability was primarily due to economic concerns. Some respondents argued that portions sizes resulted from estimations based on ingredient costs, potential profit, and perceived client expectations for larger portions. Thus, offering half-portions was seen as potentially detrimental for profit. Participants discussed expectations of check amounts per diner, particularly in full-service establishments, which might decrease if diners opted for half portions. The general sense was that the customer could always take the left-over home if they wished to do so. Additionally, the core ingredients in these dishes (e.g., white rice, beans, tortillas) were seen as largely inexpensive, and, hence, not really motivating for restaurateurs to decrease portion sizes to save money. Some also expressed concerns over challenging logistics and additional costs related to this HEPS, particularly in the pricing calculation for the half-portion and the need for menu re-design.
Resource needs for engaging in HEPS
The discussions revealed a high level of operational burden affecting LAR owners that could prevent them from making innovations in support of healthier eating. They shared several resource needs, notably help with restaurant promotion and assistance in accessing information about local regulations and complying with them (should certain HEPS become law). Table 3 summarizes the perceived resources needed in relation to the HEPS discussed. Nutrition knowledge as a resource was seen as common across all HEPS, except for portion size change. The knowledge can help in the identification of offerings to highlight or promote and in the development of new, healthier offerings. Design expertise was identified as a need to facilitate menu design and promotion activities to convey new offerings in a clear and appealing fashion.
The strategies with the most identified resource needs were the increase of healthier offerings and the promotion of these items. Respondents noted the need for social media expertise, including an expert to craft messaging and create appealing imagery for highly visual and popular platforms, like Instagram. They also noted the need for general promotion concerning Latin cuisines. Respondents discussed a lack of general knowledge among clients, including notions that LARs were generally unhealthy or inaccurate views concerning the healthfulness of specific offerings, for example, negative views about vegetarian options, including the perception that “meat is really good for you, and if you don’t eat meat, you’re going to get sick.” (Waitstaff, full-service Mexican restaurant, NYC). Related to this, some mentioned the need for community nutrition education, in general, and at schools to make children aware of healthier eating, as well as greater dissemination or promotion of healthier eating trends, such as vegetarian and pescatarian diets.
When asked about resource needs for the provision of healthier menu offerings, these included additional culinary training or tips to develop new, palatable, healthy choices, including assistance in recipe development. In our sample, chefs who already actively engaged in cooking healthier dishes took the initiative to research the ingredients and cuisines, including travels to Latin America. However, this is not accessible to most chefs or cooks, necessitating alternative ways to access the information. As described by one of these chefs, this could include a list of traditional produce and condiments for other chefs to experiment with. At the same time, others mentioned the need for creativity and an open mind about the cuisines – which were key characteristics among the chefs already engaged in developing innovative, healthier dishes in LARs. In addition, some participants noted the need to increase awareness among owners and chefs about the need to provide healthier foods and how this change could lead to better business outcomes. Another important resource needed was assistance with food sourcing. For example, one owner mentioned wanting assistance with food supplier research to facilitate the identification of local food suppliers that offered competitive pricing for healthier ingredients. Some also mentioned interest in developing connections with local food producers, which could result in fresher produce and new dishes based on producers’ perspectives. Lastly, participants also mentioned policy factors. While the participants shared the perception that the sector was over-regulated, they discussed the need to provide policy-level incentives to increase healthier offerings. These included monetary incentives for restaurants to incorporate local produce or producers to work with restaurants. One chef mentioned the idea of creating an incentive tied to certifications or permits or providing a tax incentive for restaurants that offer training on local produce to their staff.
While the least accepted, reducing portion size was associated with fewer resource needs. Counter-style restaurants would likely require new packaging for smaller portions. A second less pressing resource was the need for design expertise to assist with menu re-design to accommodate the half-portion offering in a visually appealing and understandable format.