Page 26 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Chapter 2. Study protocol
while others were already experienced to create a healthier canteen. To get more insight into these differences, we included participants spread among the Rogers’ diffusion of innovation theory [94]. The included participants were spread among innovators (n=5), the majority (n=7) and laggards (n=2). The Guidelines for Healthier Canteens were sent to the participants and informed consent was signed before the interview. A researcher (IE) trained in qualitative interview methods conducted the interviews and a second researcher was present to make notes. After the interviews, a member check was conducted. As the last interviews did not reveal any new information, we concluded that data-saturation was reached.
Interview topics: The fourteen interviews were structured around open-ended questions. The topic list was compiled using the most important determinants of the Measurement Instrument for Determinants of Innovation (MIDI) and the Behaviour Change Wheel (BCW) [95, 96]. The MIDI includes 29 determinants of innovation categorised into determinants of users, organisation, innovation, and social political environment. The BCW describes capability, opportunity and motivation (all of which interact with each other) as most important determinants that are needed for behavioural change. The topic list consisted of the main-topics: context, experience, opinion about the guidelines, desired support and solutions and completion. After each interview the topic list was optimised, based on experience with the earlier interviews.
Data analysis: All interviews were audio-taped and transcribed verbatim. The thematic content approach was used for data collection and data analysis [97]. Three steps were undertaken to analyse the interviews; open, axial and selective coding. Coding process was performed by two researchers, in alignment with each other and with a third researcher (IE). Thereafter, results were discussed with the project team.
1.2. Expert meeting to prioritise barriers and facilitators
Design and participants: As many factors were identified from the interviews, it was needed to discuss together with different stakeholders which factors should be affected at least by the intervention. To prioritise the identified barriers and facilitators an expert meeting was organised with attendees from research, policy and practice. A total of 30 experts were invited, e.g. managers at school/caterers, health promoters from the Community Health Services and the Healthy School Concept, school canteen advisors, and researchers in the field of implementation, nutrition and behaviour. A total of 25 experts participated, divided over research (n=10), policy (n=4), and practice (n=11).
Data collection: The expert meeting consisted of two parts. First, the 41 barriers and facilitators retrieved from the interviews were prioritised to create focus which factors needed to be changed with the implementation plan. Each participant first ranked all barriers and facilitators individually, thereafter plenary all factors were discussed and consensus about the prioritisation was reached. Second, solutions to strengthen facilitators and reduce barriers were identified and discussed in in six subgroups, based on the World Café Method [98]. To provide participants already with ideas, all groups received a list with current implementation tools, and solutions suggested by participants of the interviews. The results of the expert meeting were multiple ideas to influence the highest-ranked facilitating and impeding factors.
24