Page 24 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Chapter 2. Study protocol
implementation plan, the use of behaviour change models to translate the need of practice into implementation strategies and the use of a combination of implementation tools [58, 92]. The collaboration with practice in combination with the use of theory will increase the likelihood of a feasible and effective implementation. To succeed over time, implementation of new guidelines should allow adaptations to local circumstances but, nonetheless, be conducted with rigor and consistency. This article describes: 1) how we developed a plan to support implementation of canteen guidelines in Dutch secondary schools; and 2) how we will evaluate this implementation plan on process and effect level. The process will be evaluated on factors affecting implementation perceived by stakeholders and the quality of implementation. The effect will be evaluated by determining changes in the health level of canteens and in the self-reported purchase behaviour of adolescents.
The input of practice during the development and evaluation of our implementation plan will give insights to researchers about working elements. We hypothesize that this approach will increase future uptake and effect of the implementation plan. With our implementation plan we aim to facilitate the process to create a healthier school canteen, and thereby to stimulate Dutch adolescents to purchase healthier foods and beverages during school time.
METHODS
Many approaches to support the development and evaluation of implementation interventions exist and have corresponding steps [57, 58, 92]. In this study the “Grol and Wensing Implementation of Change Model” (2006, updated in 2016) was used to develop and evaluate the implementation plan to disseminate the Guidelines for Healthier Canteens in secondary schools [92]. A strength of this model is that it combines several approaches and has been improved over time. It consists of six steps from developing a proposal for change when new guidelines are developed to continuous evaluation and adaptation of the implementation plan. The first two steps are not applicable as the guidelines already exist. The last step falls outside the scope of this research but will be aimed to perform in the future. Hence, this paper describes the application of the three middle steps: 3) the needs assessment of the target group and setting, 4) the selection of corresponding implementation strategies, and 5) the development, testing and executing of the implementation plan. In the selection of implementation strategies, characteristics of the Intervention Mapping approach are used [58]. We divided our study into two phases: first the development, which has already been performed, and second the evaluation of the implementation plan. These phases and a timeline are presented in Figure 2.1 and explained below. To report this study design, the SPIRIT 2013 Statement was used, if applicable [93]. As a full description of an implementation plan makes it possible to use it in practice, to compare results and to enhance reproducibility [54], this article explains how we developed and will evaluate the implementation plan, while a separate article will describe the content of the implementation plan. Namely, by describing the factors aimed to change with the plan, the behavioural change methods, implementation strategies and an explanation of the implementation tools.
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