Page 167 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Part II: Evaluation of the support to implement healthier school canteen guidelines
The second part of this thesis covers the effect and process evaluation based on a 6-month quasi-experimental controlled study in 10 intervention and 10 matched control schools which included their involved stakeholders and 100 students per school. The schools were matched on different characteristics, including how the catering was provided (by the school itself, or by a catering company), school size (<1000 or ≥1000 students) and educational level (vocational, senior general, or pre-university). Intervention schools received support in implementation with the developed tools, while control schools only received general information about the guidelines.
Chapter 5 reports on the effect of the implementation plan on both the health level of the canteen and self-reported purchase behaviour of 13 to 15 years old students. The intervention schools made more changes in their canteen compared to control schools. More specifically, the availability of healthier food and drinks in the cafeteria and the number of fulfilled accessibility of healthier food and drinks criteria increased more often in the intervention schools, but the effect on vending machines was limited. The large majority of the students reported that they usually bring food or drinks from home and buy food or drinks in school only once a week or less. With regard to the students’ self- reported purchase behaviour, no changes resulting from the support in implementation or a healthier availability or accessibility in the canteen were detected.
Chapter 6 reports on the process of the supportive implementation of healthier canteen guidelines in schools. The results show that, compared to the control condition, stake- holders (like canteen employees, caterers, school management) who received the support perceived an increase in their knowledge (“I have all information I need”) and their motiva- tion, and a decrease in their need for support. These small effects agreed with the qualita- tive results. For example, stakeholders mentioned that the different tools complemented each other, and that the tools together supported them in creating a healthier canteen. In addition, the quality of the implementation tools was evaluated by the stakeholders on dose delivered, dose received and satisfaction. They particularly liked the advisory meeting and report, the students’ fact sheet, the communication materials and the Canteen Scan.
Conclusion
The final chapter of this thesis (Chapter 7) summarises the main findings and reflects on
them. It also discusses methodological considerations and implications for future studies, S practice and policy.
This thesis describes how a plan to support implementation of the Guidelines for Healthier Canteens in schools was developed and thereafter evaluated on effect and process level. It shows how stakeholders with a diverse background in research, policy and practice engaged in all studies, throughout the whole process from the research design, to intervention development, and evaluation. Their practical experience, combined with theoretical frameworks and methods were used to guide the development and evaluation of the implementation tools. The aim of the implementation plan was to facilitate the process to create a healthier school canteen, thus stimulating Dutch adolescents to purchase healthier food and beverages in school.
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