Implementation of Guidelines for Healthier Canteens in Dutch Secondary Schools: A Process Evaluation

Abstract

The Netherlands Nutrition Centre has developed ‘Guidelines for Healthier Canteens’. To facilitate their implementation, implementation tools were developed: stakeholders’ questionnaires, the ‘Canteen Scan’ (an online tool to assess product availability/accessibility), a tailored advisory meeting/report, communication materials, establishment of an online community, newsletters, and a fact sheet with students’ wishes/needs. In this quasi-experimental study, we investigated the effect of these tools in secondary schools on (a) factors perceived by stakeholders as affecting implementation; (b) the quality of implementation. For six months, ten intervention schools implemented the guidelines, supported by the developed implementation tools. Ten control schools received the guidelines without support. School managers, caterers, and canteen employees (n = 33) reported on individual and environmental factors affecting implementation. Implementation quality was determined by dose delivered, dose received, and satisfaction. Stakeholders (n = 24) in intervention schools scored higher on the determinants’ knowledge and motivation and lower on need for support (p < 0.05). Dose received (received and read) and satisfaction was highest for the advisory meeting/report (67.9%, 64.3%, 4.17), communication materials (60.7%, 50.0%, 3.98), and fact sheet (80%, 60%, 4.31). Qualitative analyses confirmed these quantitative results. In conclusion, a combination of implementation tools that includes students’ wishes, tailored information/feedback, reminders and examples of healthier products/accessibility supports stakeholders in creating a healthier school canteen.

The Effect of Supportive Implementation of Healthier Canteen Guidelines on Changes in Dutch School Canteens and Student Purchase Behaviour

“…The support we offered was targeted at different stakeholder-identified impeding factors related to implementation of the guidelines, such as knowledge and motivation. The process evaluation already showed that our implementation plan favourably influenced these factors [38].…”

“…In our case, the core elements of the intervention have been described in the study design [34]. In addition to the effect evaluation, we also evaluated the quality of implementation to assess whether schools received each implementation tool [38].…”

Development of the ‘Canteen Scan’: an online tool to monitor implementation of healthy canteen guidelines

“…The Guidelines for Healthier Canteens consist of three predefined ambition levels bronze, silver, gold; these correspond to an increasingly healthy range of foods and drinks being available and accessible [ 33 ]. The levels are awarded based on four constructs: A) a set of basic conditions.…”

“…Healthier and less healthy products are classified according to the Dutch Food-Based Dietary guidelines, based on five food groups known as the Wheel of Five [ 34 ]. In the Guidelines for Healthier Canteens, healthier products are defined as foods that are included in the Wheel of Five such as whole wheat bread, fruits and vegetables, semi-skimmed milk, and low fat cheese, and small portions of less healthy foods with limited calories, saturated and trans-fat, sodium and added sugar [ 33 , 34 ]. These four constructs formed the conceptual framework of the tool to be developed.…”

“…Availability is defined as the presence of products that can be bought. Accessibility is defined as product promotion and placement [ 33 ]. The next step is to implement these guidelines throughout the Netherlands.…”