title: Design, testing and validation of an innovative web-based instrument to evaluate school meal quality.
abstract: OBJECTIVE
  To develop a feasible, valid, reliable web-based instrument to objectively evaluate school meal quality in Swedish primary schools.
  
  
  METHODS
  The construct 'school meal quality' was operationalized by an expert panel into six domains, one of which was nutritional quality. An instrument was drafted and pilot-tested. Face validity was evaluated by the panel. Feasibility was established via a large national study. Food-based criteria to predict the nutritional adequacy of school meals in terms of fat quality, iron, vitamin D and fibre content were developed. Predictive validity was evaluated by comparing the nutritional adequacy of school menus based on these criteria with the results from a nutritional analysis. Inter-rater reliability was also assessed.
  
  
  METHODS
  The instrument was developed between 2010 and 2012. It is designed for use in all primary schools by school catering and/or management representatives.
  
  
  METHODS
  A pilot-test of eighty schools in Stockholm (autumn 2010) and a further test of feasibility in 191 schools nationally (spring 2011).
  
  
  RESULTS
  The four nutrient-specific food-based criteria predicted nutritional adequacy with sensitivity ranging from 0.85 to 1.0, specificity from 0.45 to 1.0 and accuracy from 0.67 to 1.0. The sample in the national study was statistically representative and the majority of users rated the questionnaire positively, suggesting the instrument is feasible. The inter-rater reliability was fair to almost perfect for continuous variables and agreement was ≥ 67 % for categorical variables.
  
  
  CONCLUSIONS
  An innovative web-based system to comprehensively monitor school meal quality across several domains, with validated questions in the nutritional domain, is available in Sweden for the first time.
authors.affiliation: Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Norrbacka, level 3, 17176 Stockholm, Sweden. emma.patterson@ki.se
authors.forename: Emma
authors.initials: E
authors.lastname: Patterson
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Quetel
authors.forename: Karin
authors.initials: K
authors.lastname: Lilja
authors.forename: Marit
authors.initials: M
authors.lastname: Simma
authors.forename: Linnea
authors.initials: L
authors.lastname: Olsson
authors.forename: Liselotte Schäfer
authors.initials: LS
authors.lastname: Elinder
mesh_terms: D002648:Child; D003258:Consumer Behavior; D004032:Diet / Q000592:standards*; D005069:Evaluation Studies as Topic; D005522:Food Services / Q000592:standards*; D005523:Food Supply; D006801:Humans; D020407:Internet; D062407:Meals; D009753:Nutritive Value; D015203:Reproducibility of Results; D012574:Schools; D011795:Surveys and Questionnaires / Q000592:standards*; D013548:Sweden