Page 45 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

So, guided by these taxonomies and in discussion with three researchers, the prioritised
factors were linked to behaviour change methods. Second, the behaviour change methods
were linked to corresponding and effective implementation strategies, techniques to
enhance the adoption, implementation and sustainability of a programme/guideline [54].
n our study, we selected strategies as defined by Powell et al (2015) [65]. Third, the chosen
strategies were specified into implementation tools by defining the mode of delivery, actor,
dose, and the target group [54, 126]; using the input from the step 2 expert meeting; and reviewing evidence-based implementation strategies and plans and the current materials
of the Healthy School Canteen Programme [52, 73, 117, 127, 128]. To select strategies and specification of tools, one researcher made a proposal, which was then discussed in the 3 project team. During the selection of strategies and tools, the effectiveness and investment
for practice were taken into account (e.g. financial, time consumption, alignment with stakeholders’ work processes) [52, 60]. To ensure that all prioritized factors are part of the implementation plan, a variety of strategies were chosen. We also aimed for inclusion of a mixture of dose (e.g. once, 6-weekly, or if needed), mode of delivery (e.g. real life, paper-based, internet-based or email) and users (e.g. management, coordinator of school, canteen employee) [60, 126, 129]. Final decisions about the chosen strategies and tools were made during discussions with the researchers, organizations and stakeholders in the field; the Netherlands Nutrition Centre, the Community Health Service Amsterdam, “Young People at a Healthy Weight (JOGG)”, caterers and schools. All tools were then bundled into the implementation plan.
RESULTS
Step 1: Identification of factors that impede or facilitate implementation
As Table 3.1 shows, the interviews resulted in four themes related to creating a healthy school canteen: (1) individual determinants, e.g. lack of knowledge about the canteen guidelines and healthier food options, and insight into the current level in the canteen; (2) commitment of and collaboration with involved stakeholders, both inside and outside the school, including canteen employees, school management, parents, students, caterer and school canteen advisors; (3) school conditions, such as maintaining the initiated policy, keeping the management involved and receiving enough support, financial and time; and (4) environmental conditions, such as the tension between the school canteen and suppliers outside the school.
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