Page 61 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

trans-fat, sodium and added sugar [78, 79]. These four constructs formed the conceptual framework of the tool to be developed. Further, as no additional criteria to assess the four constructs were defined in the guidelines, further operationalisation was necessary to measure adherence to the guidelines.
CONSTRUCTS
A. Basic conditions
B/C. Availability of healthier food and drinks on display and in vending machines
D. Accessibility of healthier food and drinks
ITEMS
A.1. In each offered food group a healthier product is offered
A.2. Healthier products are placed at the most eye-catching spots
A.3. Encouragement to drink water A.4. Policy is anchored
B/C.1. Classification of products B/C.2. Number of products
D.1. The majority of the canteen shows a healthy environment
and healthier products are easily accessible; healthier products are placed visibly; mostly healthy items on the menu and promotions
no level
Less than four items met
AMBITION LEVELS
bronze silver gold
All four basic conditions met
60-79% healthier products available +
At least fruit or vegeta- bles
60-79% score on accessi- bility of healthier products
≥80%
healthier 4 products
available
+ Fruit and vegeta- bles
≥80% score on accessi- bility of healthier products
Figure 4.1. Conceptual framework for the Canteen Scan based on the Guidelines for Healthier Canteens.
Study design and setting
The study was conducted between December 2014 and January 2016. We used a 3-step iterative process of drafting, and continuous evaluation and revision. This design was based on recommendations for developing and evaluating measurement instruments [161-164]. They emphasize to develop a measurement instrument in an iterative process based on a clear definition of the construct to be measured, with people who have expertise in the field and to keep the practical application in mind [162-164]. The tool was therefore developed in multiple cycles of development, evaluation and adaptations and each cycle was properly evaluated based on input of different experts (representing research, policy and practice) and end-users. End-users of the Canteen Scan are experienced school canteen advisors, representatives of caterers (who provide the foods and designs of the canteens in several schools) and canteen managers/employees. Both qualitative and quantitative methods were used to provide complementary information and to improve the rigour of the study [163]. After each step, research results were discussed in the project team and the Canteen Scan was further improved.
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