Page 106 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Chapter 6. Process evaluation
lead to better implementation [96]. Only a few other studies evaluated the process of supportive implementation of school health policy, and they showed mixed effects on individual factors, such as the relation between being interested and (not) implementing a health related school based intervention [51].
The results with regard to the second research question showed that the personalization and combination of tools particularly supported stakeholders in the implementation of healthier canteen guidelines. Stakeholders considered it helpful to receive personal advice and to use the tool suitable to their specific situation. For example, during the advisory meeting, the given personal advice was helpful to draft aims, supported by stakeholders of school and caterer. Hence, the newsletter reminded them to remain active and to keep the canteen on the agenda. In addition, the students’ opinions, summarised in the fact sheet, supported stakeholders to discuss the healthy canteen topic with colleagues. These results are in line with Australian studies showing that implementation of healthy canteen policies can be achieved in most schools with multi-strategic support, including personalized support, monitoring, and feedback [89, 153].
Although the satisfaction with the advisory meeting and communication materials could be influenced by their high use [202], the qualitative results also indicated that the personal contact, tailored advise, examples of healthier products/accessibility, and information about the guidelines given by these tools inspired them. In contrast, the online community scored low on satisfaction. The choice to use Facebook as medium could have influenced these results. Stakeholders indicated they only wanted to use Facebook in personal life. In addition, a supportive community will only be reached if enough people actively contribute. Due to the research setting in which only a limited number of schools and stakeholders participated, we were only able to set up a limited community. The number of subscribed stakeholders (n = 21) may be too few to realize an active community. Outside the research setting, more people could subscribe and interact, which may result in higher use and support.
In contrast to the high use of the advisory meeting and communication materials, only four stakeholders used the Canteen Scan themselves. This could be explained by the delayed development of the tool, which made it difficult for stakeholders to fill out the scan by themselves. However, in all schools, school canteen advisors filled out the Canteen Scan and discussed the results in the advisory meeting. Stakeholders indicated that insight into the level of their canteen and tailored advices to improve the canteen as generated by Canteen scan helped them to define aims and actions. Our results agree with earlier research, in which tailoring programmes to schools’ needs and context, ownership, and providing support and examples were found to be effective to implement school based interventions [70]. These findings could be explained by the different characteristics and diverse and dynamic social, physical, and organisational context of schools and their canteens, which make general advice less applicable.
Strengths and limitations
A strength of this study is the involvement of stakeholders from schools, community health services, caterers, and the Netherlands Nutrition Centre during the process of development and evaluation. This enabled identification of a wide range of factors
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