title: What does it take to get a healthy diet at sea? A maritime study of the challenges of promoting a healthy lifestyle at the workplace at sea.
abstract: OBJECTIVE
  Prevalence of obesity is high among Danish seafarers and appropriate health promotion interventions are required within the maritime setting. The aim of this study was to examine whether a training intervention for ship cooks could improve seafarers' diet on board and, in particular, to identify possible challenges in practice on board of vessels from 2 Danish shipping companies.
  
  
  METHODS
  Interviews and participant observations were conducted during a 2-day cooking course. Interviews were repeated 1 year after (N:35) the course in order to assess self-perceived changes in preparing meals and ordering supplies, as well as perceived challenges in implementing changes and maintaining them. In addition, changes in self-reported eating behaviour before the cooking course and 1 year after were assessed based on a 1-year follow-up quantitative questionnaire survey (N:193).
  
  
  RESULTS
  Participants reported positive opinions about the course and subsequent changes in promoting a nutritious and healthy diet at sea by way of health education. Also a significant change was found in these afarers' self-reported eating behaviour from T1 to T2. However several challenges were identified during the transfer and maintenance phase such as many cooks having received little or no prior training which limited their cooking abilities. Confined physical capacities on board, restricted space for storage and lack of proper equipment were other barriers and so were low frequency of supply options and high prices for fresh fruit and vegetables.
  
  
  CONCLUSIONS
  To fully realise the benefits of the changes, these challenges related to the specific maritime workplace setting need to be acknowledged and addressed at management level.
authors.affiliation: Centre of Maritime Health and Society, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark. lhjarnoe@sdu.dk.
authors.forename: Lulu
authors.initials: L
authors.lastname: Hjarnoe
authors.forename: Anja
authors.initials: A
authors.lastname: Leppin
mesh_terms: D001294:Attitude to Health; D003296:Cooking; D003718:Denmark; D004032:Diet; D005500:Follow-Up Studies; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D009326:Naval Medicine; D016272:Occupational Health; D036301:Qualitative Research; D057566:Self Report; D017132:Workplace