Page 27 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

1.3. Translation of identified and prioritised barriers/facilitators into implementation
tools
The prioritised barriers and facilitating factors were translated into corresponding implementation tools through behaviour change methods (techniques) and implementation
strategies [62, 64, 65]. This theory-based translation was needed as it is important to choose
strategies that – from a theoretical perspective – are likely to change the prioritised factors. 2 The implementation plan consists of a mix of activities and tools, so called implementation
tools, aiming to change the crucial and most important impeding and facilitating factors that affects implementation [92]. The choices made for implementation tools were grounded in evidence-based theory, existing (and previously used) tools and activities of the Netherlands Nutrition Centre, and by balancing the expected effect and investment (financial, time-consuming, effort, commotion) [62, 64]. The tools were developed in collaboration with the project team, and organisations which will support implementation in the future (e.g. the Netherlands Nutrition Centre, the Amsterdam Community Health Service, and “Young People at a Healthy Weight (JOGG)”).
2. Evaluation of the implementation plan on process and effect level Setting and study design
To evaluate both the process and effect of the developed implementation plan, a 6-month quasi-experimental controlled design will be used with 10 intervention and 10 matched control schools (See Figure 2.2). The included schools will have a variety of characteristics, so the results can be translated to other Dutch schools. Control schools will be matched by the main characteristics: how the catering is provided (i.e. by a catering company, or the school itself), school size (<1000 and ≥1000 students), level of secondary education (vocational, senior general and pre-university), availability of (many) shops near the school, and whether or not the school has a policy for students to stay on the schoolyard during breaks. Intervention schools will receive the developed implementation plan to support implementation of the Guidelines for Healthier Canteens, whereas the control schools will receive the guidelines only. Control schools will receive these guidelines in a short meeting and on paper after the baseline measurements. After the intervention period, control schools will receive the intervention. This quasi-experimental study will be carried out according to: 1) the project application (Nr: 50-53100-98-043, date: 2 December 2014) approved by funding organisation ZonMw, 2) the study protocol approved by the VU University Medical Centre (WC2015-008 and 2015.331), and iii) registration in the Dutch Trial Register (NTR5922).
Study population and recruitment
Schools: We will recruit schools that are situated in the western and middle part of the Netherlands, via the Netherlands Nutrition Centre and caterers by email and telephone. The inclusion criteria are: a) presence of a canteen, b) willingness to make their school canteen healthier, c) and willingness to provide time and space for the investigators to measure outcomes in students, employees and canteen workers. The exclusion criteria are: a) the school had already started to implement the recent developed Guidelines for Healthier Canteens, and b) in 2015, the school canteen had already been advised about how to reach a healthier canteen, by school canteen advisors. After 6 months of participation in all measurements, all schools will receive a small financial incentive.
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