Page 119 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

the development process [58, 60]. The “Measurement Instrument for Determinants of Innovation” (MIDI) was used, amongst others, to assess and order relevant determinants related to implementation [95], and the Saunders framework was used to define process evaluation concepts [101]. Besides using these theoretical approaches, practice was also involved during the whole research process. This involvement was a convenient process, facilitated by continuous collaboration with the Netherlands Nutrition Centre and involved stakeholders of school canteens.
The needs identified in our study were comparable to needs identified in other school health promotion studies, where the importance of creating ownership, good collaboration and communication, support of management and sufficient time and staff was also recognised [50, 69, 71]. As in other studies, the involvement of parents was mentioned as important, but also as challenging [204]. In our study, examples of successful parental involvements were shared and intervention schools were advised to collaborate with parents who were already involved, or were interested in being involved.
The developed tools are a mix of (improved) existing and newly developed tools. As there
were multiple tools offered, this allowed users to choose a tool suited to their needs,
their stage in the process, and their available time with regard to changing their canteen.
While such a recommended combination of tools can strengthen the implementation plan, implementation remains a complex interplay related to multiple contextual conditions
[56, 68]. So, gaining insight into the contextual conditions in and around each school is important for the formulation of tailored advice. Consequently, the first actions of our implementation plan were to gain insight into the current situation in the specific school
and of the stakeholders and canteen via questionnaires and the Canteen Scan. In the subsequent advisory meeting, these insights were combined into tailored and stakeholder- supported advices. 7
To our knowledge, the Canteen Scan is still the only available online tool that automatically scores entered products as healthier or less healthy options and combines that with the number of products offered and their accessibility. This automatically results in one score, indicating the health level of the canteen with reference to the guidelines. In comparison, in Canada and the United States of America similar validated tools like FoodMats, NEMS- V/S/R and (VEND)ing Audit were developed. These tools also combine the assessment of food availability and accessibility in recreational facilities, restaurants, stores or vending machines, although in these tools users have to check manually whether products are in accordance with the nutritional guidelines [28, 158-160, 205, 206].
An important step in the development of a measurement instrument is to evaluate the quality of a tool through the assessment of its validity and reliability [162]. The Canteen Scan is used in practice to support and monitor the implementation of a healthy school canteen. Therefore, it was necessary to study the inter-rater reliability and criterium validity of the Canteen Scan. The results of this study were published in a report and in a fact sheet (both in Dutch). Appendix I includes the Dutch fact sheet with the study’s summary of objectives, methods, results, conclusions and recommendations. Textbox 7.1 summarises this study in English. As this textbox shows, judged by the criteria of Landis and Koch, the scan had a substantial to good reliability and validity for the measurement of the food availability
117