Page 166 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Summary
Implementation of Change Model”. These steps combined a theory-based approach with a practice-based approach involving different stakeholders, including caterers, school management, canteen employees and school canteen advisors. The resulting plan was studied in practice on effectiveness and using a process evaluation in a quasi-experimental trial (as explained in part II).
A more detailed explanation of the development and content of the implementation plan is provided in Chapter 3. This plan was developed in three steps: 1) performing interviews with stakeholders to identify impeding and facilitating factors to create a healthier school canteen; 2) facilitating an expert meeting to discuss and prioritise these factors; 3) using behaviour change methods and implementation strategies to translate these factors into implementation tools. The interviews revealed the most important factors affecting implementation, identifying the individual factors motivation and enthusiasm, a positive attitude and applying knowledge, all towards creating a healthier canteen. Next, factors related to the multitude of involved stakeholders (inside and outside schools) were identified, including collaboration, ownership, commitment and receiving support. Finally, insights into the level of the canteen and the organisational situation, including the financial situation, and the challenge to maintain canteen-related activities were identified as related factors. Based on these factors, behavioural change methods, evidence-based implementation strategies and accompanied tools were selected. These tools are partly derived from the existing Healthy School Canteen Programme and partly newly developed. The tools included the questionnaires for schools and stakeholders, the “Canteen Scan” (an online tool to assess product availability/accessibility), a tailored advisory meeting and report, communication materials, an online community, newsletters, and a fact sheet with students’ wishes and needs.
Chapter 4 reports on the development, content validity and usability of one of the novel tools, the online “Canteen Scan”. This tool was developed through an iterative theory- based process, again involving multiple stakeholders from research, policy and practice, aiming to support the implementation of the guidelines. It assesses the availability and accessibility of healthier food and drinks, including the offer of water, and the presence of a healthy school canteen policy according the Guidelines for Healthier Canteens. Resulting to insight into the health level of a canteen, and a tailored advice about how to improve the canteen. This scan was favourably rated by stakeholders like the school canteen advisors, canteen managers and representatives of caterers.
An additional study, summarised in Chapter 7 and reported in Dutch in Appendix I, investigated the quality of this scan by measuring the inter-rater reliability and criterium validity for two assessors: an expert (school canteen advisor) and a canteen employee. This study showed a substantial to good reliability and validity for measuring the food availability in the cafeteria for school canteen advisors and canteen employees, and for measuring food availability in vending machines and accessibility when measured by a school canteen advisor.
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