Page 117 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

The studies included in this thesis concern the implementation of healthier canteen guidelines in secondary schools in the Netherlands. They address the central research question: Is support for the implementation of the Guidelines for Healthier Canteens helpful in creating healthier school canteens? In order to be able to answer this question, first implementation tools were developed, based on the needs for support of practice, insight from theory and scientific evidence (Part I). Second, the effectiveness of these developed implementation tools was evaluated and a process evaluation was performed (Part II). This general discussion presents the main findings of both parts of this thesis and reflects on them, followed by methodological considerations and implications for research, practice and policy, leading to an overall conclusion.
Main findings
Part I: Development of the support to implement healthier school canteen guidelines Summary of part one
Chapter 2 of this thesis describes the design of the study: how the implementation plan, including different tools, was developed to support implementation of healthier school canteen guidelines in secondary schools. It further describes the design of a quasi- experimental controlled study involving 20 secondary schools. The first aim of this study was to evaluate the effect of the implementation plan by determining changes 1) in the health level of canteens, and 2) in self-reported purchase behaviour of students. Second, a process evaluation was designed to gain insight into the process of implementation via 1) the factors affecting implementation, and 2) the quality of each tool, both according to stakeholders.
Chapter 3 provides a more extensive description of the development and content of the implementation plan. The plan was developed through three steps: 1) interviews with 7 stakeholders to identify impeding and facilitating factors to create a healthier school
canteen; 2) an expert meeting to discuss and prioritise these factors; 3) translating these
factors into implementation tools using behaviour change methods and implementation strategies. Stakeholders indicated individual determinants as being most important: being motivated and enthusiastic, having a positive attitude and being able to apply knowledge,
all regarding creating a healthier canteen. Collaboration with multiple stakeholders
such as students, parents and teachers and the feeling of ownership among involved stakeholders were also mentioned as important. Furthermore, stakeholders emphasised
the need to have commitment and receive support throughout the whole process from the management of the school and other stakeholders inside and outside the school. Other
factors identified as important were insight into the current canteen and organisational
situation, being able to create a financial plan and the challenge of maintaining canteen-
related activities over time.
Based on these factors and using behavioural change methods and implementation strategies, several implementation tools were specified (Table 7.1). A tool that provides insight into the health level of a canteen is essential to support the implementation of guidelines. Therefore, a digital tool, the “Canteen Scan”, was developed. This tool not only assesses the health level of the canteen, it also provides tailored directions for improvements. Chapter 4 describes how this tool was developed and assessed on content validity and
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