Page 44 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Chapter 3. Development of the implementation plan
basis of the interviews. The main topics were context, experiences, opinions about the guidelines, desired support and solutions and completion. The interviews were performed by a trained researcher (Blinded for review), with a second researcher taking notes during the interviews. The audio-taped interviews were between 59 and 88 minutes, and took place between March and May 2015. As the last two interviews did not reveal any new information, it was decided that data-saturation was reached. The interviews were transcribed verbatim, and the summary was validated by each participant.
Data analysis
The thematic content approach was used to analyse the data in three steps: open (label excerpts of the transcripts with descriptive codes), axial (create codes that reflects multiple text fragments and create interpretative codes) and selective coding (compare codes between interviews, to look for correlations) [97, 124]. This coding process was performed by two researchers, in alignment with each other and with a third researcher (Blinded for review), and discussed in the project team.
Step 2: Prioritization of factors
Participants
To prioritize all identified factors and to generate potential solutions, an expert meeting was organized. Of the 30 experts invited, 5 were not able to attend. Of the 25 experts who did, experts worked in research (n=10), in policy (n=4), and in practice (n=11). Attendees included researchers in the field of implementation science and nutrition, school canteen advisors from the Netherlands Nutrition Centre, school facility managers, and representatives of caterers. The expert meeting was led by an external chair and minutes were taken by a fellow researcher.
Instrumentation and procedure
In preparation for the expert meeting, we organized the identified factors that may impede or facilitate creating a healthier canteen into three stages derived from the Stage Theory of Organizational Change [125]: 1) awareness; 2) preparation; and 3) action. During the expert meeting, for each of these three stages of change consensus was achieved about which factors were most important and modifiable and should be addressed with the implementation plan [60]. This was performed by first individually ranking. In addition, missing factors were added by each stakeholder. Next, consensus about the factors was reached during a plenary discussion. Thereafter, a World Café Method [98] was used to reveal and discuss potential actions. This method involved that six subgroups came up with activities to change one of the six highest ranked factors. Subsequently, each subgroup provided their feedback, before finally presenting their proposed actions.
Step 3: Development of implementation strategies and tools
Procedure and data analysis
To translate the prioritized factors into implementation tools, we performed three sub- tasks [58, 60]. First, the identified factors were translated into behaviour change methods, which are methods that can influence determinants of behaviour and environmental conditions of the target population [58]. For example, to increase the determinant attitude, the method Elaboration was selected [62]. To select a behaviour change method which really addresses the identified factors, behaviour change taxonomies were used [62, 64].
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