Page 125 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

other. Consequently, we were only able to follow schools between four to six months, a relatively short period of time for applying the implementation tools and for making actual adaptations in the canteen. Schools usually plan per school year, which allows them adequate time to work on a healthy canteen through setting up a working group and an anchor policy, and adapting the cafeteria and vending machines.
The limited period of time also influenced when we could measure students’ purchase behaviour. The most important limitation was that we measured the purchase behaviour of students around the same time as measuring the health level of the canteen. During the post-intervention investigations, we noticed that the adaptations in the canteens had been recently performed. It appeared that it is difficult for schools to allocate the time required to make a canteen healthier, despite our reminders during the intervention period. A planned moment, like the post-intervention measurement, and the potential reward with a “healthy school canteen award” encouraged them to make changes prior to the measurement. As a consequence, students may not have been able to get used to the adapted offering and presentation of healthier products, and to adapt their purchase behaviour accordingly. This may be why we were unable to detect changes in purchase behaviour, as it is known that it takes a while for students to get used to a new offering and to adapt their behaviour.
The developed online Canteen Scan, which was an implementation and measurement tool
in our studies, was launched just before the baseline measurements. On the one hand,
this is a limitation, as the scan was still in a development phase and users such as school
canteen advisors and canteen employees had to get used to it. On the other hand, it is
a strength that we had access to an easy, online tool to score the level of the canteen according to the Guidelines for Healthier Canteens. At a later stage, the scan showed a
good validity and reliability particularly when filled out by a school canteen advisor, as 7 shown in previously presented textbox 7.1 and the accompanying fact sheet I.
How to describe and assess an implementation plan properly?
A strength of our study is the clear description of the development and content of the implementation plan, including the aims, strategies and tools [58]. Although such descriptions have been acknowledged by others, implementation plans have generally been described poorly, making it difficult to compare study results and to integrate insights in practice [54, 213]. Since each country has its own system and regulations, this extensive explanation is even more important in the field of school food environment [214].
Another strength is the fact that we performed an effect and process evaluation that included multiple outcomes. As the effect evaluation included measures on canteen and student level, and the process evaluation included stakeholders’ determinants affecting implementation, and the quality of each tool, these outcomes complemented each other. The results on effect and process level contributed to broad insights into the relevance and feasibility of our plan.
With regard to the process evaluation, there were several strengths and limitations. One strength was that we aligned the process outcomes to the identified determinants in the needs assessment, which formed the basis of the selected implementation strategies
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