Page 52 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

Chapter 3. Development of the implementation plan
meeting, in order to create aims and actions together, based on the insight received into their characteristics, the school’s context and the level of the canteen.
Our implementation plan uses implementation strategies that have shown positive results in support implementation in previous studies, such as audit, feedback, monitoring, education, information, incentives and sharing knowledge and experiences [50, 89]. McIsaac (2016) also emphasized the importance of tailoring tools to the individual needs of schools to support implementation [50], as it is easier for schools to perform and maintain actions aligned to their system, organizational culture and circumstances [50, 70, 129]. Whether our plan will indeed support implementation needs investigation through the planned effect and process evaluation [132].
A strength of our study is that we developed implementation tools that can be tailored to the needs of a specific school, to the school’s context and to the implementation phase, as some schools are just starting with implementing a healthy school canteen while others have been involved in the healthy school canteen for years. One example of an implementation tool that can be tailored is the advisory meeting. This meeting aims to align the actions to the school by discussing common aims, actions and actors for implementation with the involved stakeholders, such as school managers, caterers, school canteen employees and involved teachers.
Another strength of our study is its use of existing theoretical frameworks to guide the development of implementation tools. To be able to perform our study systematically and to integrate this with practical experiences, we used a combination of two intervention development frameworks in the development of the tools: “Grol and Wensing Implementation of Change Model” and the Intervention Mapping approach [58, 60].
In addition, we used the “Measurement Instrument of Determinants in Innovations” (MIDI) and the “Behaviour Change Wheel” (BCW) to guide the interviews. Using these frameworks, enabled identification of factors that hinder or facilitate implementation on multiple levels: individual, organizational, innovation and environmental. To improve proper implementation, we addressed all these factors in the implementation plan [133].
A third strength of our study is the detailed description of the development of our implementation plan. Such a comprehensive description enables comparison of results between studies, and gaining further knowledge about selection of implementation strategies [54, 65, 66, 122]. A clear description of the development and content of the implementation tools can also increase its use in practice [122]. A review of effective strategies to improve implementation of school-based health programmes recommends performing high quality studies to improve the evidence of effective implementation of school canteen policy [51]. This study contributes to this area of knowledge.
Although it is widely recommended and has proven to be effective, collaboration with practice during the development of an implementation plan is not always applied , [52, 56, 70]. Therefore, another strength of our study is the intensive collaboration with stakeholders with a diverse background in research, policy and practice throughout each step of our development process [56, 58]. This breadth revealed factors that varied across stakeholders’ function and stage of change. This comprehensive insight led
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