Page 41 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

INTRODUCTION
Despite the known benefits of healthy nutrition, most people including adolescents do not
comply with dietary recommendations [8, 115]. It is known that early recommendations,
including in adolescence, play an important role in developing and maintaining healthy
eating habits that track into adulthood [10, 14]. Healthy school food environments encourage adolescents to make healthier choices and thereby improving their dietary behaviour [27, 38]. In this context, school food policy has been shown promising to
positively influence adolescent dietary behaviour [37]. Since many students purchase and
consume multiple drinks, snacks and meals during their school day, a healthier school 3 canteen plays a role [116]. Studies in the Netherlands found that youth (aged 9-18) eat 15%
of their total food and drink intake per day at school [4] and that, even though most Dutch students (aged 12-18 year) bring their own lunches from home, they buy complementary foods (snacks and drinks) in the school canteen [32].
The Dutch Healthy School Canteen Programme supports secondary schools in the creation of healthier school canteens [73]. In the programme, school canteen advisors (nutritionists) from the Netherlands Nutrition Centre visit schools to provide information and advice, send regular newsletters and maintain a website with information and examples about a healthier canteen. This programme has been evaluated positively [73, 74]. As the government increased their focus on healthier canteens [75, 76], the Netherlands Nutrition Centre developed the “Guidelines for Healthier Canteens” in 2014 [78]. These guidelines, applicable to school canteens, canteens of sports clubs and worksite cafeterias, aim to improve the availability and accessibility of healthier food and drink products [78]. However, it is known that insufficient implementation results in meagre use and effectiveness of policy/guidelines [36, 39, 74, 117]. Besides, until now, the specific support needed to implement the guidelines in Dutch secondary schools remains unknown.
Research suggests that practical and feasible implementation support plans can improve the uptake, implementation, maintenance and effectiveness of school canteen policy [50, 89, 118, 119]. While numerous partly overlapping theories and frameworks can be used to guide and improve this process [59-61], a theory-based implementation plan needs to take into account schools’ contextual factors, as well as the needs of different involved stakeholders [120-122]. An effective implementation plan therefore consists of a combination of a range of implementation tools, based on evidence-based implementation strategies affecting these identified changeable factors [56, 58, 60]. Although studies have shown that tailored implementation strategies can support schools in improving their food environment, for example through education, modelling, training, monitoring and feedback [50, 51, 89, 123], knowledge about which specific strategies are needed to support Dutch schools in implementing the Guidelines for Healthier Canteens remains unknown. To enhance reproducibility, allow for comparison with other studies, and to increase use in practice a full description of the development and content of an implementation plan is necessary [54, 56, 65]. The purpose of this paper is to describe the development of and tools for such an implementation plan to facilitate implementation of the Guidelines for Healthier Canteens in Dutch secondary schools.
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