‘Everything is Health’ in the school canteen. Implementation and evaluation of the Dutch Guidelines for Healthier Canteens in secondary schools.

To tackle the growing obesity problem and stimulate healthy eating and physical activity behaviour in adolescents, environmental interventions aimed at making the healthy choice easier are recommended. Schools are an opportune setting to encourage a healthy lifestyle in adolescents because of their pedagogical task and potential to reach youth. To stimulate healthy dietary behaviour during school time a healthy school canteen is a promising intervention. Therefore, the Netherlands Nutrition Centre together with experts in the field of policy, practice and research has developed Guidelines for Healthier Canteens. According to these Guidelines a school canteen is considered as healthy when it offers healthy products and has a healthy appearance. For school canteens two healthy levels are distinguished; Silver if 60-80 %and Gold if 80 % or more of the product offer and appearance is healthy (Source: Wolvers, Mensink, Peters. 2014. Richtlijnen Gezondere Kantine).

The first objective of this study is to evaluate the guidelines in daily practice on process level by exploring barriers and facilitators of implementing the Guidelines experienced by different stakeholders of caterers and schools. In addition the effect of the guidelines on purchase behaviour of students in secondary school was determined.



Prior to this study implementation strategies were systematically developed based on the Intervention Mapping Protocol (Bartholomew, 2006). By interviewing 17 relevant stakeholders (e.g caterers, canteen manager, school director) insights in barriers and facilitators for creating a healthy school canteen were gained. These interviews were supplemented by a review of the literature. During an expert meeting 25 experts in the field of implementation and dietary behaviour and stakeholders from practice and policy were asked to prioritize the identified barriers and facilitators and provide ideas for implementation strategies and materials. Finally, the results of the expert meeting and literature were translated into implementation strategies and subsequently supporting materials were developed.



Derived from the interviews, literature and expert meeting implementation strategies like tailoring, individualization, feedback, reinforcement, community development and peer education proved to be important. Subsequently these strategies were translated into the following materials: A visit of the School Canteen Brigade to provide the school with tailored advice how to achieve a healthy school canteen; an exchange and collaboration facebook group; healthy school canteen leaflets; newsletters; a factsheet per school of (determinants) of purchases of the school’s students.
Consequently, in this study the developed implementation materials will be tested in practice. A quasi-experimental design with 10 intervention and 10 control schools will be carried out. The intervention schools will implement the Dutch Guidelines Healthier Canteens for 4-6 months aiming to achieve a healthy school canteen. The process is measured with a logbook, an online and telephone questionnaire, consisting of process evaluation questions for each implementation method.



The effect on purchase behaviour and determinants of purchase behaviour of adolescents will be measured with an online questionnaire measured by 100 second or third years’ student s of each participating school. The level of the canteen is measured with the Canteen Scan, a tool to measure to what extent the canteen meets the Guidelines for Healthier Canteens.

The main objective is to evaluate the Dutch Guidelines for Healthier Canteens in daily practice in secondary schools.



Therefore on process level we will explore among different stakeholders (from caterers and school) how they experience implementation of the Guidelines.



The second objective of the study is to study the effect of implementation of the Dutch Guidelines for Healthier Canteens in secondary schools on purchase behaviour of adolescents in the school setting and to study which determinants of purchase behaviour are related with purchase behaviour.



It is hypothesized that implementation of the Guidelines for Healthier Canteens will lead to more healthy and less unhealthy purchase behaviour of adolescents in the school setting.

T0 = at/before the start of the intervention

T1 = at maximum 6 months after the start of the intervention

The schools in the intervention group will implement the Guidelines for Healthier Canteens aiming to reach a healthy canteen. According to these Guidelines a school canteen is healthy when it offers healthy products and has a healthy appearance. For school canteens two healthy levels are distinguished; ‘Silver’ if 60-80 percentage and ‘Gold’ if 80 or more percentage of the product offer and appearance is healthy (Source: Wolvers, Mensink, Peters. 2014. Richtlijnen Gezondere Kantine).



The developed implementation materials to support implementation of the Guidelines for Healthier Canteens are:

- A visit and a written advice of the School Canteen Brigade (dieticians of the Netherlands Nutrition Centre who visit and advice schools how to achieve a healthy school canteen) to provide the school with tailored advice.

- Access to a closed Facebook page, to ask questions, exchange information and idea’s between schools

- Written information about of the Dutch Guidelines for Healthier Canteens and a short leaflet about step to take to achieve a healthy school canteen

- Newsletter with news, facts, examples, advices about the healthy school canteen

- Results of purchase behaviour and determinants of purchase behaviour of the schools questioned second years students.

The control schools will only receive an explanation of the Guidelines for Healthier Canteens.

10 intervention schools and 10 control schools will be included. Per school 100 students are participating with the questionaire, so 2000 students in total.