Page 53 - ON THE WAY TO HEALTHIER SCHOOL CANTEENS - Irma Evenhuis

to an implementation plan that is usable and feasible for a wide range of schools and stakeholders [129]. Besides, the implementation plan is aligned with the existing Healthy School Canteen Programme, in which school canteen advisors support schools towards a healthier canteen [73, 127]. Connecting to daily practice facilitates more sustainable implementation [70, 129].
Limitations
One limitation of our study is that we did not involve students as stakeholders during the development of our implementation plan. Since involvement of students in creating a
healthier canteen was identified as a need in our study, and also in previous research [70], 3 and valuing their input is found to be important [17], we advise schools to take into account
students’ opinions and needs in the process of creating a healthier canteen. We facilitate
this by offering the student fact sheet with school-specific information about students’
needs and wishes. In addition, during the advisory meeting, schools are encouraged to
involve students, although how to do this is not specified to allow for local tailoring. While
this freedom for schools to choose how they want to involve students can be regarded as
a strength, as schools can align this to their own cultural and organizational habits, it could
also be a potential limitation, as schools are not supported in this process.
Another possible limitation is that our implementation plan does not consider the outside school environment, such as supermarkets and cafeterias, which may encourage students to consume unhealthy foods and drinks during or around school time. As interviews with stakeholders identified concerns about this outside school environment, in the advisory meeting we encourage schools to address this topic. One example of a solution was to create policy to oblige students to stay in the school yard during breaks. Another identified point of concern, and possible limitation was the influence of parents, who have a major influence on and are also responsible for their children’s nutritional behaviour [134]. Good collaboration with and involvement of parents is therefore important. Although our implementation plan advises schools to involve parents, they indicate that they perceive this as difficult. Future studies should investigate how parents can be reached and how they can be involved in creating a healthier canteen [70].
Implications for policy and practice
School canteen guidelines can support schools to make such changes in a canteen. However, it is well known that support of implementation tools is required to ensure that the guidelines are properly applied in practice [39]. This article describes how we combined identified needs of stakeholders with evidence-based theory to develop stepwise an implementation plan. This development serves as a good example for other researchers, policymakers, and school health practitioners how create an implementation plan aligned to the needs of various stakeholders.
The described implementation plan consists of multiple tools, which together aims to support stakeholders in creating a healthier canteen. The tools can be tailored, so it is possible to deliver each school the support they need. Also, each stakeholder can choose to use the tool that fits their practice. Although some tools described in this manuscript will be translatable to other regions and settings, we advise users also to include their local
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