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Open Access Research

An ecological and theoretical deconstruction of a school-based obesity prevention program in Mexico

Margarita Safdie12, Margaret Cargo3, Lucie Richard4 and Lucie Lévesque2*

Author Affiliations

1 Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad 655, Sta. Ma. Ahuacatitlán, Cuernavaca 62508, Morelos, México

2 School of Kinesiology and Health Studies, Queen’s University, 28 Division Street, Kingston, Ontario, Canada

3 School of Population Health, University of South Australia, 160 Currie Street, Adelaide 5000, South Australia, Australia

4 Faculty of Nursing and IRSPUM, Université de Montréal, Station Centre-ville, Montréal, H3C3J7, Quebec, Canada

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:103  doi:10.1186/s12966-014-0103-2

Published: 10 August 2014

Abstract

Background

Ecological 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.

Methods

Two 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.

Results

Thirty-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.

Conclusions

Findings 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.

Keywords:
Children; Physical activity; Nutrition policy; Social cognitive theory