Development and Evaluation of the Implementation of Guidelines for Healthier Canteens in Dutch Secondary Schools: Study Protocol of a Quasi-Experimental Trial

Abstract

Introduction: To encourage healthier food/drink choices, the “Guidelines for Healthier Canteens” were developed by the Netherlands Nutrition Centre. This paper describes (1) how we developed a plan to support implementation of the “Guidelines for Healthier Canteens” in Dutch secondary schools, and (2) how we will evaluate this plan on process and effect level.Materials and Methods: The implementation plan (consisting of several tools) was developed in cooperation with stakeholders. Barriers/facilitators to implement the guidelines were identified by 14 interviews and prioritized during one expert meeting. Thereafter, these barriers were translated into implementation tools using behavioral change methods and implementation strategies. The implementation plan consists of the tools: tailored advice provided via an advisory meeting and report, based on a questionnaire about the stakeholders'/school's context and the “Canteen Scan,” an online tool to assess the product availability and accessibility; communication materials; an online community; newsletters; a factsheet with students' wishes/needs. This implementation plan will be evaluated on process and effect in a 6-month quasi-experimental controlled design with 10 intervention and 10 matched control schools. Process outcomes will be measured: (1) factors affecting implementation and (2) the quality of implementation, both collected via a questionnaire among involved stakeholders. Effect outcomes will be collected pre/post-intervention with: (1) self-reported purchase behavior among around 100 students per school; (2) the “health level” of the school canteen. Linear and linear/logistic two-level regression analyses will be performed.Discussion: The implementation tools are developed by combining a theory and practice-based approach, with input from different stakeholders. If these tools are evaluated positive, it will support schools/stakeholders to create a healthier school canteen.Trial Registration: Dutch Trial register no.: NTR5922, date of registration June 20, 2016; METC no.: 2015.331; EMGO+ project number: WC2015-008.

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

“…Therefore, it is important to (1) describe the core intervention functions of each tool of the implementation plan to be able to support schools with the same support and (2) to measure if the tools has been delivered and used as planned [12,56,57]. 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].…”

“…The sample size was calculated based on the outcome purchase behaviour, an expected 10% drop out, 80% power and 5% significance level [34]. The calculation showed that 20 schools and 100 students per school were necessary to be able to detect a 10% difference in purchase behaviour of students (continuous variable), with the expected multi-level structure (students within schools, intra-class correlation of 0.05).…”

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

“…This calculation was based on the effect outcome: students’ purchase behaviour, with a multi-level structure of students within schools (with a correlation of 0.05 between schools), an expected 10% drop-out, 80% power, and 5% significance level. Detailed information about the study design, intervention, and effect evaluation has been described previously [13]. The study protocol was approved by the Medical Ethical Committee of the VU University Amsterdam (Nr.…”

“…Table 1 summarizes each intervention tool. A more detailed explanation is available separately [13]. The tools were offered by a school canteen advisor of the Netherlands Nutrition Centre, in collaboration with the Vrije Universiteit Amsterdam.…”

“…As stakeholders need support to increase compliance with guidelines [10,11], an implementation plan based on their perceived factors that hamper or enable implementation is needed [12]. The implementation plan to support implementation of the Guidelines for Healthier Canteens was developed in collaboration with stakeholders and based on behaviour change models and implementation strategies [13,14,15,16]. Stakeholders gave their input about their experienced or expected barriers or facilitators regarding implementation of school canteen guidelines.…”