Page 35 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

advisors of the Netherlands Nutrition Centre have already built robust partnerships with relevant stakeholders regarding healthier canteens. On the one hand, our research project will benefit from the competencies, experiences and partnerships of the advisors. On the other hand, the existing school canteen programme will be improved based on the insights and results of this study.
In addition to stakeholders involvement, each school will be advised to include students 2 in their implementation process. This because involvement of the target group facilitates implementation [70] and most students appreciate such involvement [17]. We can recommend, but not prescribe how schools should involve their students, as each school
has its own culture and organizational structure. The fact sheet with students’ needs and wishes will offer the schools insight into the opinion of their students and how they want to be involved. Our process evaluation will provide insight whether the school involved students in the implementation process.
Another strength is that we will evaluate the implementation plan using both effect and process outcomes. The effect of implementation will be measured at two levels, i) at the student level by assessing self-reported purchase behaviour and ii) at the school level by using the Canteen Scan to measure the availability and accessibility of food and drinks in the canteen. In the process evaluation, frequently used concepts of process evaluation (dose delivered, dose received, including use and satisfaction) will be used [101, 102]. In addition, changes in factors affecting implementation will be assessed, in accordance with the demand for this knowledge [51]. By this process evaluation we will be able to get some insight into which tools seem to contribute most to the implementation process. Although these conclusions should be interpreted carefully, as the tools are offered together and will probably also create a reinforcing effect.
Some limitations also need to be addressed. Measurement of the purchase behaviour of students will be based on self-reporting. Alternative methods to measure purchase behaviour (e.g. sales data, food measurement via observation and weighting of foods, or photographing the selected foods) have been investigated in previous studies [38, 114]. However, they were considered infeasible in our study because of the time and people involved, and the differences in registration yielding incomparable sales data. Moreover, questionnaires to measure purchase behaviour are commonly used in relation to consumption [88]. Nevertheless, sales data and purchase behaviour can be incongruent [38]. The second outcome, the level of the canteen will be measured with the Canteen Scan. This tool is able to measure the level of the canteen and to give tailored feedback how to improve this level. All intervention schools will receive the feedback as an implementation tool. It can be a limitation that the same tool is used as measurement and implementation tool. However, in this study the school canteen advisors will fill out the scan, and only the intervention schools will receive the results and tailored feedback.
This study provides an example how the identified needs of stakeholders can be combined with evidence-based theory to develop an implementation plan. This study will show the impact of implementing guidelines to create healthier canteens in Dutch secondary schools, with support of the developed implementation plan, on the canteen’s health level and on the purchase behaviour of students. Also, the evaluation will show the appreciation, use
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