Page 130 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Chapter 7. General Discussion
the investigation into the previously mentioned financial sustainability for schools and
caterers.
Increase insights about school-based implementation
Over the last decade, there has been a growing interest in implementation science, although not all results are applicable to the implementation of school-based health programmes [221]. More insight into school specific implementation is therefore needed. First, as the contextual factors related to school-based implementation differ from, for example, care-based implementation settings, more insight into them is needed. Such factors include both inside school factors, like the support of management, nutritional education and student involvement, and factors outside school, like shops close to schools, regional factors and the support of Community Health Services. In particular, the influence of factors related to the school organisation like educational level, involvement of teachers, and nutritional working groups is limited [41].
Second, a new school specific implementation strategy compilation (SISTER) that has been recently published should be used in future research on school-based implementation [67]. During the development of our implementation plan, we used the general ERIC strategy compilation [65]. These strategies have meanwhile been adapted to more specific strategies for school-based health programmes, i.e. the SISTER strategy compilation [67, 222]. Specifically, of the 74 ERIC strategies, 11 remain; 57 were changed, with mostly terminology adaptations; 5 have been deleted, for example “other payment schemes”; and 7 strategies have been added. These new strategies included “develop local policy that supports implementation”. Such school specific strategies are likely to facilitate implementation of health programmes in schools.
Third, feasible, reliable and valid process evaluation measures that are also adaptable to the specific implementation situation in schools need to be developed [51]. During our process evaluation, we found that translating general process evaluation concepts, such as fidelity, into research specific questions while taking into account the comparability and feasibility was challenging. While existing online databases with measurement instruments may already support researchers choosing appropriate instruments [223], increased knowledge about school specific instruments is likely to support researchers even more.
Implications for practice
The studies performed also revealed multiple practical implications related to individual factors and the social and physical environment (Figure 7.1). These involve: 1) facilitating the collaboration between research, policy and practice; 2) strengthening the collaboration inside schools; and 3) aligning food related interventions inside and outside school.
The collaboration between research, policy and practice should be facilitated
I recommend that scientists, practitioners and policymakers collaborate in research projects from the outset, in order to enable joint creation of relevant, feasible research questions. This is likely to result in a sense of ownership among all involved stakeholders, commitment and support to perform the study, and broad dissemination of the study results. Honesty, appreciation, knowledge of each other’s strengths and the intention to put effort in the collaboration are some factors needed for a successful collaboration [113].
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