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(PTFS18-07-26) Lessons Learned From Phase 1 of FRESH: A Systems-Level Nutrition Intervention With Independently-Owned Restaurants in Urban Low-Income Neighborhoods

Monday, July 27, 2026
2:54 PM - 2:58 PM ET
Location: Prince George's Hall B-E (The Hub) - Poster Theater 2 / Poster Board Number: PT2-7
Disclosure(s):
Jessica J. Cruz, BA, MPH: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: Diet-related chronic diseases disproportionately affect lower-income ethnic minority communities, where independent restaurants serve as a main source of prepared food. Focus on Restaurant Engagement to Strengthen Health (FRESH) is a randomized controlled trial intervention working with independent restaurants in predominantly African American and Latino neighborhoods of Baltimore and the DC metro area to incorporate additional healthy menu options. We aim to report lessons learned from Phase 1 in which restaurants received subsidies for the development and addition of 3 FRESH-approved beverages.

Methods: Based on data from a sample of 15 intervention restaurants (7 in DC, 8 in Baltimore), we employed a qualitative thematic analysis of the barriers and facilitators to Phase 1 implementation. After 7 months, and 186 visits, 80% of restaurants have successfully incorporated 3 FRESH-approved beverages to their menus. Intervention visit forms captured each visit's focus, progress, and challenges that arose. Contextual factors were systematically recorded during weekly meetings with interventionists. Four FRESH team members closely involved with the intervention, reviewed and coded these data to identify recurring factors affecting intervention progress.

Results: Common barriers included owners’ limited time, technical issues with subsidies, restaurant staffing instability, financial strain, and reduced customer traffic linked to the sociopolitical context. Facilitators included owner motivation, staff engagement, and customer interest and demand for healthier options. To ensure progress, our team adjusted visit schedules, tackled administrative errors, worked with owners to develop beverages aligned with restaurant interest and capacity, and supported restaurants’ promotional efforts. These adjustments strengthened our partnerships and our ongoing collaboration.

Conclusions: This evaluation addresses a gap in restaurant intervention literature by documenting the factors affecting real-world interventions. Interventions of this sort are important, but resource-intensive, and those working closely with restaurants must understand owners’ time constraints and the impact of external stressors on restaurant function. Owners’ limited time should not be presumed as a lack of interest.

Funding Sources: NIH, NIMHD