Abstract
BackgroundEcological intervention programs are recommended to prevent overweight and obesity in children. The National Institute of Public Health (INSP) in Mexico implemented a successful ecological intervention program to promote healthy lifestyle behaviors in school age children. This study assessed the integration of ecological principles and Social Cognitive Theory (SCT) constructs in this effective school-based obesity prevention program implemented in 15 elementary schools in Mexico City.MethodsTwo coders applied the Intervention Analysis Procedure (IAP) to “map” the program’s integration of ecological principles. A checklist gauged the use of SCT theory in program activities.ResultsThirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains.ConclusionsFindings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement and were most commonly underpinned by Reciprocal Determinism for both Nutrition and Physical Activity.
Highlights
The rate of overweight and obesity in Mexican children is growing at an alarming pace
The checklist used to assess Social Cognitive Theory (SCT) construct use only captured four of the SCT constructs; a more exhaustive list may have yielded a different theoretical picture. To our knowledge, this is the first research to document the integration of ecological principles and theoretical constructs in a school-based obesity prevention program in Mexico
There may be a variety of successful combinations of ecological strategies and theoretical constructs, our findings provide one version that can be used as a starting point to develop even more effective combinations
Summary
The rate of overweight and obesity in Mexican children is growing at an alarming pace. In 2006, the National Institute of Public health (INSP) designed and implemented an innovative and successful intervention program to modify the school environment to promote healthy lifestyle behaviors in 4th, 5th, and 6th grade students [10]. This intervention program was designed according to ecological principles that recognize the reciprocal relationship between individuals and their environment [11], based on formative research [4,5,6], and informed by Social Cognitive Theory [12]. The National Institute of Public Health (INSP) in Mexico implemented a successful ecological intervention program to promote healthy lifestyle behaviors in school age children. There is a lack of guidance about combinations of intervention activities to replicate successful intervention efforts, especially in the obesity prevention area
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