Page 71 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

the future [155]. Taking all this together, the Canteen Scan appears to be a useful tool for practice.
A limitation of the tool and a possible barrier for implementation [90] is that the use of the Canteen Scan was perceived to be time-consuming. Other comparable tools assess a more limited range of food groups, which can decrease entry time [158, 180]. However, we chose to assess all food groups and products in order to obtain more comprehensive insight into the assortment, to be able to observe changes in the assortment, and to provide insight to users on whether replacement of certain foods actually improves their score. In addition, pilot tests showed that the investment of time was worthwhile and improvements in the database can decrease the amount of time required. Moreover, the second and subsequent uses of the scan will be less time-consuming because a previously entered scan can be copied and simply adapted.
Another limitation is that some of the items used to score accessibility are difficult to 4 quantify and, therefore, to measure. For example, the item “healthier products are placed
at an eye-catching spot” is liable to bias because “eye-catching spot” can be interpreted
in different ways. Therefore, to reduce possible bias, additional explanation by text and
pictures to each item might be a solution.
To increase usability in practice, collaboration of science and practice is recommended for the development of such a tool [162, 163]. However, one of the challenges was to balance the needs and wishes from practice and the scientific evidence and to be able to align this with the technical possibilities. Consequently, certain compromises had to be made. For example, although price- and portions sizes strategies are effective [168-170] they were not included as accessibility item in the tool. By practice, this was considered not yet feasible since the buying-in costs are higher for healthier options. As solution, these strategies were added as a suggestion in the general feedback. The limited number of participating stakeholders that were consulted could have influenced the results. However, we included a wide range of stakeholders (researchers, school canteen advisors, professionals representing caterers and schools) to receive a broad range of information.
The development of the Canteen Scan is a continuous process and the tool will be adapted based on input from experts and end-users. This study showed the first refinements of the measurement methods and items of the Canteen Scan based on the input of the experts and end-users. In a follow-up (quantitative) study, the criterion validity and reliability of the Canteen Scan will be investigated in a larger sample, which should lead to further improvements.
The Guidelines for Healthier Canteens are applicable in school/sports canteens and worksite cafeterias. During the expert meeting in the first step of the development of the Canteen Scan, experts advised us to focus on school canteens. Based on the noticed differences between the settings, e.g. different products, more meals on offer, and a different organisational structure (i.e. more volunteers in sports canteens). However, currently the Canteen Scan is already used in sport and worksite canteens. Based on these experiences, future refinements will be made to increase the Canteen Scan’s usability also in other settings than the school setting, such as sports canteens and worksite cafeterias.
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