Page 60 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis
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Chapter 4. Development of the Canteen Scan
and changes over time regarding availability and accessibility of food/beverages, and iii) that provides tailored feedback and advises how to make the canteen healthier [15, 151]. In addition to the Netherlands, also in several other countries efforts have been made to create school food policies, such as guidelines, procedures or rules to enable a healthier school food environment [149, 152]. However, often the actual implementation of these policies can be improved and surveillance is recommended to monitor implementation over time [39, 149, 153]. Therefore, tools to monitor the implementation of these policies are required [39, 152, 154, 155].
Various measurement tools are available to assess product availability/accessibility in the consumer food environment [28, 148, 156, 157]. For example, in the United States the Nutrition Environment Measurement Survey for Stores (NEMS-S) and Restaurants (NEMS-R) are regularly used to assess the food environment and have also been tested on reliability and validity [158, 159]. The NEMS started as a tool to assess the availability, price and quality of products in stores, and to assess the availability, facilitators, barriers, pricing and signage/promotion in restaurants. Meanwhile, a version for vending machines is also available [160]. Unfortunately, none of the available tools were suitable to monitor Dutch canteens due to differences in nutritional guidelines and definitions of accessibility [28, 157]. Also, Dutch canteens differ from other countries regarding the products sold because in the Netherlands, most children bring their lunch from home, so in school canteens snacks are the main purchase. Moreover, the psychometric properties of these instruments have not always been properly evaluated [28, 157].
One of the first properties that should be assessed is the degree to which the content of the instrument is an adequate reflection of the construct to be measured (content validity) [161]. In addition, to facilitate the use of the tool by different stakeholders and to ensure clear and usable feedback is provided by the tool, it is recommended to develop it in a close collaboration between science and practice [162, 163]. Therefore, this paper describes the development (in close collaboration between practice and research) and assessment of the content validity and usability of the “Canteen Scan”.
METHODS
Guidelines for Healthier Canteens as a conceptual framework
The Guidelines for Healthier Canteens consist of three predefined ambition levels bronze, silver, gold; these correspond to an increasingly healthy range of foods and drinks being available and accessible [78]. The levels are awarded based on four constructs: A) a set of basic conditions. This is a mix of availability, accessibility and policy items, all of which need to be present in a healthier canteen. B/C) the percentage of healthier products on display and in vending machine, i.e. healthier products that are available in the total range of products. D) a score on the accessibility of healthier products (see Figure 4.1). Healthier and less healthy products are classified according to the Dutch Food-Based Dietary guidelines, based on five food groups known as the Wheel of Five [79]. In the Guidelines for Healthier Canteens, healthier products are defined as foods that are included in the Wheel of Five such as whole wheat bread, fruits and vegetables, semi-skimmed milk, and low fat cheese, and small portions of less healthy foods with limited calories, saturated and
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