Page 90 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis
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Chapter 5. Effect evaluation
planned [50, 90, 101]. In our case, the core elements of the intervention have been described in the study design [130]. In addition to the effect evaluation, we also evaluated the quality of implementation to assess whether schools received each implementation tool [132].
A final limitation includes the fact that, due to the skewness of our purchase data and the non-linearity of some of the relations under study, we decided to dichotomize our data. This negatively influenced the power, and led to some loss of information.
Based on our results, we recommend that future studies investigate the sustainability of supportive implementation of food environment policy. In addition, we recommend longer-term studies that assess changes in students’ purchases inside, and in shops around, school, that appear after an adaptation period.
Our results confirm that adolescents in the Netherlands bring most food and drinks from home and additionally buy their food inside as well as outside school. Attention to the home environment and the environment around school is therefore needed. The complexity of the food environment at schools within this broader food environment makes the use of whole system-based approaches important [19, 41]. Different relevant stakeholders such as parents, shopkeepers, and local policy makers should be actively involved in this approach. Moreover, a healthy school environment not only consists of a healthy canteen, including vending machines, but also includes food education, and integration with other health promotion school policies [196]. This is important, as schools contribute to the personal development of youth, wherein learning about making choices with regard to a healthy lifestyle in an obesogenic environment is an essential part.
Conclusions
This study investigated the changes in Dutch school canteens and self-reported student purchase behaviour after support to implement the Guidelines for Healthier Canteens compared to no support. We conclude that such support appears to contribute to healthier canteens. Our results did not show an effect of the implementation on healthier students’ purchase behaviour, perhaps due to the short time between the changes made in the canteen and our follow-up measurements. Due to the fact that this study was performed in collaboration with the Netherlands Nutrition Centre and involved stakeholders, our research results are likely to lead to implementation in daily practice. More system-based approaches are warranted to be able to influence students’ dietary behaviour. Additionally, long-term research to investigate the effects of healthier school canteens are needed.
List of abbreviations
CS Control schools
IS Intervention schools
Acknowledgements
We thank all schools, coordinators, school canteen advisors, students and other involved stakeholders who participated in this study. We also thank Renate van Zoonen and our Health Sciences students (Tamara Coppenhagen, Samantha Holt, Katelyn Sadee and Andrea Thoonsen) who supported us in the gathering of data.
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