Sustainable Eating for a Healthy Tomorrow - Effectiveness of Digital Nutrition Workshops to Implement the Planetary Health Diet for Hospital Employees

Changes in heathy eating habits are measured using a generally recognized Food Frequency Questionnaire (FFQ) in the validated German DEGS-Version from the Robert Koch Institute, Germany. The DEGS comprises 53 questions and records the frequency of consumption of various food groups and drinks over a certain period of time. The following habits are assessed: healthy plant-based foods, less healthy plant-based foods and animal-based foods. The Helathy Plant-based Diet Index (hPDI) is calculated from the DEGS questionnaire. The score of the hPDI can range from 18 to 90, with a higher index reflecting a more plant-based and less animal-based diet.

Changes in heathy eating habits are measured using a generally recognized Food Frequency Questionnaire (FFQ) in the validated German DEGS-Version from the Robert Koch Institute, Germany. The DEGS comprises 53 questions and records the frequency of consumption of various food groups and drinks over a certain period of time. The following habits are assessed: healthy plant-based foods, less healthy plant-based foods and animal-based foods. The Helathy Plant-based Diet Index (hPDI) is calculated from the DEGS questionnaire. The score of the hPDI can range from 18 to 90, with a higher index reflecting a more plant-based and less animal-based diet.

The questionnaire PIAC (Perception, intention and ability for change) questionnaire relates to the ability to change health behavior, habits and living conditions. The statements are based on respondents' experiences and cover various factors such as substance use, dietary habits, lack of exercise and disease-promoting behaviors. The PIAC contains 13 questions that can be answered at a scale from "strongly disagree" (0 points) to "strongly agree" (4 points). A higher score (0-52 range) shows a positive attitude, strong intent, and ability to adopt healthier behaviors.

The questionnaire PIAC (Perception, intention and ability for change) questionnaire relates to the ability to change health behavior, habits and living conditions. The statements are based on respondents' experiences and cover various factors such as substance use, dietary habits, lack of exercise and disease-promoting behaviors. The PIAC contains 13 questions that can be answered at a scale from "strongly disagree" (0 points) to "strongly agree" (4 points). A higher score (0-52 range) shows a positive attitude, strong intent, and ability to adopt healthier behaviors.

The questionnaire AKU (AKU is an acronym of the German translation of "Adaptive Coping with Disease") meassures active and adaptive behaviors to maintain health. It offers the opportunity to record and quantify the implementation of strategies to promote health in different contexts, taking into account both external influences and individual, internal convictions. We used one subsclae of the AKU (Conscious way of living), which consists of 5 questions and ranges from "Does not apply at all" (0 points) to "Applies exactly" (4 points). Therefore, the sum score ranges from 0-20. A high score indicates strong adaptive health behavior and good implementation of health-promoting strategies.

The questionnaire AKU (AKU is an acronym of the German translation of "Adaptive Coping with Disease") meassures active and adaptive behaviors to maintain health. It offers the opportunity to record and quantify the implementation of strategies to promote health in different contexts, taking into account both external influences and individual, internal convictions. We used one subsclae of the AKU (Conscious way of living), which consists of 5 questions and ranges from "Does not apply at all" (0 points) to "Applies exactly" (4 points). Therefore, the sum score ranges from 0-20. A high score indicates strong adaptive health behavior and good implementation of health-promoting strategies.

Health-specific self-efficacy scale (HSSES) meassures the confidence in the ability to accomplish certain health tasks, even if they are challenging. In the area of nutrition, self-efficacy can positively influence an intervention. HSSES is a set of 5 questions to be answered on a scale of 0-4: (0) very uncertain, (1) somewhat uncertain, (2) I cannot say, (3) somewhat certain, and (4) very certain. Therefore, the sum ranges between 0-20. A higher score on the HSSES indicates strong confidence in one's ability to change their diet, which can positively influence behavior.

Health-specific self-efficacy scale (HSSES) meassures the confidence in the ability to accomplish certain health tasks, even if they are challenging. In the area of nutrition, self-efficacy can positively influence an intervention. HSSES is a set of 5 questions to be answered on a scale of 0-4: (0) very uncertain, (1) somewhat uncertain, (2) I cannot say, (3) somewhat certain, and (4) very certain. Therefore, the sum ranges between 0-20. A higher score on the HSSES indicates strong confidence in one's ability to change their diet, which can positively influence behavior.

The WHO-5 Index (Well-being index of the WHO) is a self-assessment method for measuring quality of life. Participants answers 5 questions on a six-point Likert scale (from 0 = "At no time" to 5 = "All the time"). The sum score is calculated by adding up the 5 item values, with higher values indicating better quality of life. Therefore, a score to be achieved is between 0-25.

The WHO-5 Index (Well-being index of the WHO) is a self-assessment method for measuring quality of life. Participants answers 5 questions on a six-point Likert scale (from 0 = "At no time" to 5 = "All the time"). The sum score is calculated by adding up the 5 item values, with higher values indicating better quality of life. Therefore, a score to be achieved is between 0-25.

The YCSCB (Young Consumers' Sustainable Consumption Behavior) scale is used to meassure the respondent's sustainable consumption behavior. The questionnaire contains 14 short questions that can be answered in four categories: "never" (0 points), "sometimes" (1 points), "often" (2 points) and "always" (3 points). Therefore, a score between 0-51 points can be achieved. A higher score on the YCSCB indicates a strong sustainable behavior.

The YCSCB (Young Consumers' Sustainable Consumption Behavior) scale is used to meassure the respondent's sustainable consumption behavior. The questionnaire contains 14 short questions that can be answered in four categories: "never" (0 points), "sometimes" (1 points), "often" (2 points) and "always" (3 points). Therefore, a score between 0-51 points can be achieved. A higher score on the YCSCB indicates a strong sustainable behavior.

The measurement of body weight is a fundamental indicator of overall health and can provide insights into potential health risks. Increased body weight and therefore Body Mass Index (BMI) may indicate overweight or obesity, which is associated with a higher risk of various diseases, including cardiovascular diseases, diabetes, and metabolic syndrome. Regular weight monitoring allows for the early detection of changes in body weight, enabling the implementation of preventive measures if necessary. Body weight is therefore measured on a calibrated and validated scale, while wearing only underwear. BMI ranges are categorized as follows: underweight: <18.5, normal weight: 18.5-24.9, overweight: 25-29.9, obesity: ≥30.

The measurement of body weight is a fundamental indicator of overall health and can provide insights into potential health risks. Increased body weight and therefore Body Mass Index (BMI) may indicate overweight or obesity, which is associated with a higher risk of various diseases, including cardiovascular diseases, diabetes, and metabolic syndrome. Regular weight monitoring allows for the early detection of changes in body weight, enabling the implementation of preventive measures if necessary. Body weight is therefore measured on a calibrated and validated scale, while wearing only underwear. BMI ranges are categorized as follows: underweight: <18.5, normal weight: 18.5-24.9, overweight: 25-29.9, obesity: ≥30.

Body weight measurement is a fundamental indicator of overall health and can provide valuable insights into potential health risks. A persistent increase in body weight can indicate overweight or obesity, which are associated with an elevated risk of various diseases, including cardiovascular diseases, diabetes, and metabolic disorders. Conversely, unintended weight loss may point to underlying health issues such as malnutrition or chronic illness. Regular monitoring of body weight allows for early detection of such changes, supporting timely preventive or therapeutic interventions. Body weight is measured using a calibrated and validated scale, while the participant wears only underwear.

Body weight measurement is a fundamental indicator of overall health and can provide valuable insights into potential health risks. A persistent increase in body weight can indicate overweight or obesity, which are associated with an elevated risk of various diseases, including cardiovascular diseases, diabetes, and metabolic disorders. Conversely, unintended weight loss may point to underlying health issues such as malnutrition or chronic illness. Regular monitoring of body weight allows for early detection of such changes, supporting timely preventive or therapeutic interventions. Body weight is measured using a calibrated and validated scale, while the participant wears only underwear

The measurement of waist circumference plays a crucial role in assessing the risk of metabolic syndrome and current health status. By determining waist circumference, the distribution of body fat and the mass of visceral fat (abdominal fat) can be evaluated, enabling an individual risk assessment of concomitant diseases. Abdominal obesity, characterized by an increased proportion of visceral fat, is associated with a higher risk of metabolic and cardiovascular health issues. Waist measurement is independent of body size and offers insights into intra-abdominal fat mass and total body fat. Women: low risk: <80 cm, increased risk: 80-88 cm, highly increased risk: >88 cm. Men: low risk: <94 cm, increased risk: 94-102 cm, highly increased risk.

The measurement of waist circumference plays a crucial role in assessing the risk of metabolic syndrome and current health status. By determining waist circumference, the distribution of body fat and the mass of visceral fat (abdominal fat) can be evaluated, enabling an individual risk assessment of concomitant diseases. Abdominal obesity, characterized by an increased proportion of visceral fat, is associated with a higher risk of metabolic and cardiovascular health issues. Waist measurement is independent of body size and offers insights into intra-abdominal fat mass and total body fat. Women: low risk: <80 cm, increased risk: 80-88 cm, highly increased risk: >88 cm. Men: low risk: <94 cm, increased risk: 94-102 cm, highly increased risk.

Safety was operationalized as the number of (participants with) adverse events (AE) or study withdrawals due to AEs. AEs were defined as any untoward medical occurrence in a participant, which did not have to have a defined causal relationship with the treatment being studied. Cases of any untoward medical occurrence that, at any dose, resulted in death, were life-threatening, required inpatient hospitalization, or caused persistent or significant disability were assessed as serious AEs.

Work engagement is collected through the questionnaire UWES (Utrecht Work Engagement Scale). Work engagement is considered to be the supposed opposite of burnout. This is because, unlike people who suffer from burnout, engaged employees have a sense of energized and effective connection to their work activities and see themselves as being able to cope well with the demands of their job. The questionnaire contains nine questions to be answered on a scale of 0-6. This means that you can achieve a score between 0-54. A high score (40-54) on the UWES indicates strong work energy, commitment and effectiveness, which indicates a low risk of burnout. Low scores (0-18) indicate low engagement and potential burnout.

Work engagement is collected through the UWES (Utrecht Work Engagement Scale). Work engagement is considered to be the supposed opposite of burnout. This is because, unlike people who suffer from burnout, engaged employees have a sense of energized and effective connection to their work activities and see themselves as being able to cope well with the demands of their job. The questionnaire contains nine questions to be answered on a scale of 0-6. Therefore, a score between 0-54 can be achieved. A high score on the UWES indicates strong work energy, commitment and effectiveness, which indicates a low risk of burnout.

Work engagement is collected through the UWES (Utrecht Work Engagement Scale). Work engagement is considered to be the supposed opposite of burnout. This is because, unlike people who suffer from burnout, engaged employees have a sense of energized and effective connection to their work activities and see themselves as being able to cope well with the demands of their job. The questionnaire contains nine questions to be answered on a scale of 0-6. Therefore, a score between 0-54 can be achieved. A high score on the UWES indicates strong work energy, commitment and effectiveness, which indicates a low risk of burnout.

Workload is measured using an NRS (Numeric Rating Scale). A high workload can reduce adherence to the intervention and lead to stress or burnout. Therefore, it is important to ensure that the intervention can be realistically integrated into participants' daily lives and that appropriate support is provided. Therefore, the following question is asked: Please use the scale to indicate how much stress you currently feel as a result of your work. The scale ranges from 0% (0 points) to 100% (10 points) in eleven steps. A high score on the NRS indicates a heavy workload and increased risk of stress.

Workload is measured using an NRS (Numeric Rating Scale). A high workload can reduce adherence to the intervention and lead to stress or burnout. Therefore, it is important to ensure that the intervention can be realistically integrated into participants' daily lives and that appropriate support is provided. Therefore, the following question is asked: Please use the scale to indicate how much stress you currently feel as a result of your work. The scale ranges from 0% (0 points) to 100% (10 points) in eleven steps. A high score on the NRS indicates a heavy workload and increased risk of stress.

Workload is measured using an NRS (Numeric Rating Scale). A high workload can reduce adherence to the intervention and lead to stress or burnout. Therefore, it is important to ensure that the intervention can be realistically integrated into participants' daily lives and that appropriate support is provided. Therefore, the following question is asked: Please use the scale to indicate how much stress you currently feel as a result of your work. The scale ranges from 0% (0 points) to 100% (10 points) in eleven steps. A high score on the NRS indicates a heavy workload and increased risk of stress.

The PHQ-4 questionnaire (Patient Health Questionaire) is used to assess mental well-being.The questionnaire consists of four questions and a four-point scale from 0 till 3. The PHQ-4 can achieve a score between 0-12. A higher score on the PHQ-4 indicates significant mental stress, which could make it difficult to implement an intervention.

The PHQ-4 questionnaire (Patient Health Questionaire) is used to assess mental well-being.The questionnaire consists of four questions and a four-point scale from 0 till 3. The PHQ-4 can achieve a score between 0-12. A higher score on the PHQ-4 indicates significant mental stress, which could make it difficult to implement an intervention.

The PHQ-4 questionnaire (Patient Health Questionaire) is used to assess mental well-being.The questionnaire consists of four questions and a four-point scale from 0 till 3. The PHQ-4 can achieve a score between 0-12. A higher score on the PHQ-4 indicates significant mental stress, which could make it difficult to implement an intervention.

Satisfaction with the intervention is meassured directly after completion of the intervention. The CSQ (Client Satisfaction Questionnaire) uses eight items to measure general satisfaction with various aspects of the treatment received. The items are scored from 1 (most unfavorable) to 4 (most positive) according to their polarity and added up to an overall score ranged 8-32 with higher scores indicate higher satisfaction. .

The expectation of treatment effectiveness is meassured by an NRS using two questions. The first question: "At this point in time, how successful do you think this course will be in improving the quality of your functioning?" ranges from not at all (0) to very useful (10) and the second question: "At the end of the course, how much improvement in your functioning do you think you will actually experience?" ranges from 0% (0) to 100% (10). A higher score indicates optimistic expectations of treatment success.

Two questions are integrated into the study diary to record the daily dietary behavior of the test subjects using a Likert scale: "Please indicate to what extent you managed to eat the 5 recommended servings of fruits and vegetables today" and: "Please indicate to what extent you managed to eat servings of fruits and vegetables today, specifically the 1 recommended serving of legumes."