Implementation Assessment of the Eat Right Campus Policy in a Tertiary Care Healthcare Institution in North India: A Descriptive Cross-Sectional Mixed-Methods Study

Abstract

Background: Institutional food environments in tertiary healthcare settings pose risks to vulnerable populations. India's Eat Right Campus (ERC) initiative promotes hygiene, nutrition, and sustainability, yet evidence of implementation remains limited. Objectives: To assess ERC implementation status and identify determinants of compliance in a tertiary care institution. Methods: A six-month descriptive cross-sectional mixed-methods study audited all 30 registered food outlets using the FSSAI Hygiene Rating Checklist. Food-handler knowledge, attitudes and practices (KAP) were assessed via a questionnaire adapted from the WHO Five Keys to Safer Food Manual. Focus group discussions and in-depth interviews were thematically analysed and synthesised through a SWOT framework. Results: All outlets met minimum standards; 13.3% achieved Good/Very Good ratings, 60.0% were Fair, and 26.7% required improvement. Documentation and monitoring were weakest. Positive attitudes coexisted with lower knowledge; compliance was largely enforcement-driven. Conclusion: ERC implementation achieved foundational compliance but revealed gaps in documentation, monitoring and food-handler knowledge, highlighting the need for continuous training and strengthened oversight.