Thesis (MBA.) -- University of Limpopo, 2016 / The National School Nutrition Programme (NSNP) is a poverty alleviation strategy, which was introduced in 1994 by the Government of South Africa as part of the Reconstruction and Development Programme (RDP). Studies of the Food and Agriculture Organisation, United Nations Educational, Scientific and Cultural Organisation (UNESCO) and the World Health Organisation (WHO), show that hunger, nutrition, and poverty, are strongly correlated. The same studies note that in the world as a whole, hunger impacts negatively on the Millennium Development Goals, such as universal primary education, gender equality, child mortality, maternal health, management of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), tuberculosis (TB) and malaria, and environmental stability. Hunger, specifically, has been shown to contribute to reduced school attendance, impaired cognitive capacity, high child mortality rates, high maternal death rates, increased migratory labour that increases the spread of HIV, and the unsustainable use of forest lands and resources. The National School Nutrition Programme aims at providing meals to mostly needy learners, who come from poor families. Healthy food provides energy for the brain. The meals that are provided at schools are, therefore, intended to give energy for mental and physical activities for the body, for the brain to function, to make learners alert and receptive during lessons. Initially, meals in South African Schools were provided to all learners in Quintile 1, 2 and 3 public primary schools from Grades R to 7. The programme was extended to Quintile 1 secondary schools in April 2009. All Quintile 2 and 3 public secondary schools were included in 2010 and 2011, respectively. To collect information for research purposes, the researcher used an interview questionnaire. This approach, which is used by the researcher, seeks to identify the impediments that pose challenges to effective and efficient implementation and management of the NSNP in the Bakenberg North Circuit of the Department of Education in the Limpopo Province. The sample covered three secondary schools participating in the NSNP in the Bakenberg Circuits. In each school, the principal, the heads of departments and the teacher, formed part of the sample of the study. The empirical findings were analysed and interpreted, and in presenting the findings, special reference to the research questions was made, namely: “An assessment of theimplementation and management of NSNP in the Bakenberg North Circuit secondary schools.” The study shows that the Department of Education in the Limpopo Province has not managed the NSNP efficiently and effectively. The findings of this study reflect that there are still challenges that continue to plague the NSNP after so many years since inception of the programme by the Department of Education. The empirical findings of this study have revealed that the challenges confronting the implementation of the NSNP could be attributed to poor governance and corruption by the Department of Education officials. Some pockets of excellence of the NSNP are noted in the study. Recommendations are made to mitigate the problem situation. The study therefore recommends the:  Menu supplied by the department to be followed,  Monitoring to be done at schools,  Storage facilities to be improved,  Issues of myth to be cleared among learners regarding the programme.

A Food Behavior Checklist (FBC) was developed, validated, and pilot-tested with homemakers in Virginia's Expanded Food and Nutrition Education Program (EFNEP). The FBC was designed to measure nutrition-related practices that are taught in EFNEP, but cannot be measured by the 24-hour recall. During development, 20 EFNEP paraprofessionals in Virginia and 20 randomly selected state EFNEP coordinators helped to identify items that are most important in evaluating the overall effectiveness of EFNEP, and which could be used to establish content, face, and construct validity of a behavior assessment instrument. The Food Behavior Checklist contained 30 items, and responses were recorded on a Likert scale with four response levels: 0 = "never or seldom", 1 = "sometimes",2 = "usually", and 3 = "almost always". Cronbach-alpha revealed a reliability coefficient of 0.86. During the field test phase of this study, the FBC was used before and after EFNEP intervention to collect data on the nutrition-related practices of 147 low-income homemakers in three rural counties and one urban area in Virginia. In this phase, the experimental group, which consisted of 79 homemakers, received computer-aided feedback on their dietary practices, via a Diagnostic Report, which was used as a teaching tool. Paraprofessionals thoroughly explained the content of the diagnostic report to the homemaker at program entry and program exit. The control group, which consisted of 68 homemakers, did not receive computer-aided feedback on their dietary intakes, in that no mention was made of the computer print out to them. Results indicated that this instrument (FBC) may be useful in evaluating the overall effectiveness of EFNEP nationwide and may be useful in other nutrition programs. No significant differences were observed in the nutrient intake or Food Behavior Checklist practice change scores between the group who received computer-aided feedback and the group who did not received computer-aided feedback. The author concluded that the dietary analysis contained in the computer generated Diagnostic Report needs to be simplified if it is to become an effective tool with EFNEP homemakers. More research is needed on the use of computerized diet analysis as a teaching tool with low-income homemakers. / Ph. D.

This thesis is composed of two essays that study behavioral economics to motivate health-promoting behaviors. The first paper, "Does Nutrition Education Reduce Delay Discounting?," studies delay discounting, or delayed gratification, which is an important research topic because it plays a role in producing numerous health outcomes, such as obesity. It is important to understand how the delay discounting process relates to unhealthy diets. People who discount the value of future outcomes prefer immediate rewards (e.g., enjoyment/taste) even though a larger reward from delaying exists (e.g., good health status). In this paper, we aim to provide evidence over whether nutrition education reduces delay discounting. Our analysis, therefore, provides guidance for designing more effective interventions to help increase overall health. The second paper, "Are We Reaching Those Most In Need?: Motivation Profiles and Willingness-to-Participate," explores the potentially negative psychological spillover effects (i.e., "crowding out" effects), which can complicate incentives' effectiveness because it can make targeted behavior (i.e., the aim to improve one's health) less desirable. To understand this "crowding out" effect, our paper examines how different types of motivations (i.e., intrinsic and extrinsic motivations) influence people's willingness-to-participate in a weight control program with and without incentives. This analysis provides further guidance for designing more effective interventions by considering different recruitment strategies to target different individuals, which can minimize the negative spillover of incentives. / Master of Science / This thesis is composed of two essays that study the behavioral economics to motivate health-promoting behaviors. The first paper, “Does Nutrition Education Reduce Delay Discounting?,” studies delay discounting, or delayed gratification, which is an important research topic because it plays a role in producing numerous health outcomes, such as obesity. It is important to understand how the delay discounting process relates to unhealthy diets. People who discount the value of future outcomes prefer immediate rewards (e.g., enjoyment/taste) even though a larger reward from delaying exists (e.g., good health status). In this paper, we aim to provide evidence over whether nutrition education reduces delay discounting. Our analysis, therefore, provides guidance for designing more effective interventions to help increase overall health. The second paper, “Are We Reaching Those Most In Need?: Motivation Profiles and Willingness-to-Participate,” explores the potentially negative psychological spillover effects (i.e., ‘crowding out’ effects), which can complicate incentives’ effectiveness because it can make targeted behavior (i.e., the aim to improve one’s health) less desirable. To understand this ‘crowding out’ effect, our paper examines how different types of motivations (i.e., intrinsic and extrinsic motivations) influence people’s willingness-to-participate in a weight control program with and without incentives. This analysis provides further guidance for designing more effective interventions by considering different recruitment strategies to target different individuals, which can minimize the negative spillover of incentives.

Objective: Evaluate how a social marketing approach compares to traditional nutrition education curriculum for promoting behavioral changes related to eating and food. Design: Nonequivalent comparison group, entry-exit design. Participants from 12 Kentucky counties assigned either comparison or pilot group. Comparison group received traditional nutrition education curriculum and pilot group received the social marketing program, Cook Together, Eat Together (CTET) curriculum. EFNEP’s Behavior Checklist and 24-Hour Dietary Recall were administered at entry and exit of the 8-week programs. Participants: Females (18-72 years of age) from families eligible to receive SNAP benefits (n=64 comparison group participants, n=60 pilot group participants). Intervention: Comparison group completed an 8-week standard lesson and pilot group completed CTET program in varying time frames (1-8 weeks). Main Outcome Measures: Eating behavior changes between entry and exit for comparison versus pilot. Analysis: Quantitative data were analyzed using independent and paired t-tests with significance of P≤ 0.05 and 0.10. Results: Groups were demographically similar. Both had significant differences in entry and exit scores for Behavior Checklist and 24-Hour Recall (P≤ 0.05). Conclusion and Implications: Positive behavior change was observed in both comparison and pilot groups. A social marketing program proves to be a promising approach to nutrition education.

Cette étude vise à évaluer les éléments facilitants et les barrières à l’implantation du programme d’éducation à la nutrition Camille, Antoine et l’archipel Ôlait, développé par les Producteurs laitiers du Canada (PLC), auprès d’enseignants du préscolaire provenant de six régions du Québec et ayant reçu un atelier de formation animé par une diététiste des PLC. Elle vise également à connaître le degré d’implantation et la fidélité du programme ainsi que son appréciation, son utilisation et sa pertinence. Après une moyenne de 5 mois d’implantation, un questionnaire auto-administré a été complété par 37 enseignants (N = 86, 43 %), dont 10 utilisateurs (27 %) et 27 non-utilisateurs (73 %). Puis, des groupes de discussion ont eu lieu avec 13 enseignants (N = 170, 8 %). En moyenne, 11,4 activités sur 30 ont été réalisées (38 %), dont 6,3 telles quelles (55 %) et 5,1 modifiées (45 %), et les enseignants ont rapporté avoir l’intention de refaire 6,1 activités (54 %). L’implantation du programme a été facilitée ou limitée par différentes caractéristiques des enseignants, par l’appréciation de son contenu et son format, par sa pertinence concernant les exigences pédagogiques au préscolaire, la réalité des élèves et des parents et les objectifs d’apprentissages en nutrition, par le milieu scolaire, familial et communautaire ainsi que par la crédibilité et le support des PLC. Plusieurs de ces facteurs sont à la fois des éléments facilitants et des barrières. Les résultats obtenus aideront à ajuster ce programme et guider le développement et l’évaluation de programmes similaires. / This study aims to assess the facilitating conditions and barriers to the implementation of Camille, Antoine et l’archipel Ôlait nutrition education program, develop by the Dairy Farmers of Canada (DFC), with preschool teachers, from six regions of Québec, who assisted a workshop delivered by a dietitian from DFC. It also seeks to know the degree of implementation and fidelity of the program and its assessment, its use and relevance. Following an average of five months of implementation, a self-administered questionnaire was completed by 37 teachers (N = 86, 43 %), 10 users (27 %) and 27 non-users (73 %). Then, focus groups were held with 13 teachers (N = 170, 8 %). On average, 11.4 out of 30 activities have been carried out (38 %), including 6.3 as planned (55 %) and 5.1 modified (45 %), and teachers reported that it intends to repeat 6.1 activities (54 %). Implementation of the program was facilitated or limited by various characteristics of teachers, the assessment of its content and its format, its relevance to the educational requirements for preschool, the reality of pupils and their parents and objectives in nutrition learning, at school, in their family and community as well as the credibility and support of the DFC. Many of those factors are both facilitating conditions and barriers. The results will help to adjust the program and guide the development and evaluation of similar programs.

Políticas de governo, nos seus vários níveis, abordam o tema da alimentação e nutrição ressaltando sua importância para a melhora da qualidade da saúde da população. Nas últimas décadas as Doenças Crônicas Não Transmissíveis (DCNT) passaram a liderar as causas de óbito no Brasil, ultrapassando as taxas de mortalidade por doenças infecciosas e parasitárias da década de 80. As DCNTs se caracterizam por ter uma etiologia incerta, múltiplos fatores de risco, longos períodos de latência, curso prolongado, origem não infecciosa e por estar associadas a deficiências e incapacidades funcionais. A experiência de diversos países mostra que o sucesso das intervenções de saúde pública, no que se refere aos fatores de risco e à redução da prevalência das DCNTs, tem sido atribuído ao enfoque na vigilância de fatores comuns de risco e na promoção de modos de viver favoráveis à saúde e à qualidade de vida, tendo um custo menor do que as abordagens para as doenças específicas. Em 2005, o Ministério da Saúde apresentou como uma de suas prioridades, implementar políticas promotoras de modos de viver saudáveis, enfatizando as diretrizes da Estratégia Global de Alimentação Saudável, Atividade Física e Saúde (EG) proposta pela Organização Mundial da Saúde (OMS) e a prevenção do tabagismo. Essas prioridades foram abordadas na Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 que objetiva especificamente contribuir para a mudança do modelo de atenção do sistema de maneira a ampliar e qualificar as ações de promoção da saúde. O presente trabalho apresenta uma proposta de intervenção nutricional para uma amostra de funcionários não docentes da USP, que foram previamente avaliados e apresentaram alta incidência de sobrepeso e obesidade. Esse modelo baseia-se nas diretrizes propostas pela PNPS e usa a educação nutricional como principal instrumento de intervenção. / Government policies, in its levels, addressing the topic of food and nutrition emphasizing its importance to improving the quality of health. In recent decades the Chronic Noncommunicable Diseases (NCDs) are now leading causes of death in Brazil, surpassing the rates of mortality from infectious and parasitic diseases of the 80s. The NCDs are characterized by an uncertain etiology, multiple risk factors, long latency periods, a prolonged, non-infectious origin and be associated with functional impairment and disability. Experience in several countries shows that the success of public health interventions, with regard to risk factors and reduce the prevalence of NCCD, has been assigned to focus on surveillance of common risk factors and promote ways of living favorable to health and quality of life, having a lower cost than the approaches to specific diseases. In 2005, the Ministry of Health (MS) presented as one of their priorities, implementing policies that promote healthy ways of living, emphasizing the guidelines of the Global Strategy on Diet, Physical Activity and Health (GS) proposed by the World Health Organization (WHO) and smoking prevention. These priorities have been addressed in the National Policy for Health Promotion (PNPS), published in 2006 that aims specifically to bring about change in the attention system in order to widen and improve the actions of health promotion. This paper presents a proposal for nutritional intervention for a sample of non-teaching staff of the University of São Paulo (USP), which were previously evaluated and showed a high incidence of overweight and obesity. This model is based on the guidelines proposed by PNPS and use nutrition education as the main instrument of intervention.

Intervenção nutricional educativa em pacientes submetidos à angioplastia transluminal coronária: ensaio clínico randomizado [Tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2016. INTRODUÇÃO: Mudanças no estilo de vida são estimuladas na prevenção primária e secundária da doença arterial coronária. A educação para promoção de saúde requer uma atividade capaz de problematizar a realidade do indivíduo e capacitá-lo para escolhas conscientes. Considerando os aspectos pluridimensionais da alimentação e a dificuldade de mudanças no comportamento alimentar, o objetivo deste estudo foi analisar a efetividade de uma intervenção nutricional educativa em pacientes submetidos à angioplastia transluminal coronária (ATC) quanto à mortalidade e recorrência de eventos como infarto agudo do miocárdio (IAM), revascularização cirúrgica do miocárdio (RM) ou nova ATC em até um ano de acompanhamento. Os objetivos secundários incluíram consumo alimentar; medidas antropométricas e bioquímicas; estágios de mudança do comportamento alimentar e a ocorrência de eventos cardiovasculares em até quatro anos de seguimento, além de uma análise qualitativa dos fatores socioculturais e atitudinais que influenciaram as práticas alimentares dessa população. MÉTODOS: Foi realizado um ensaio clínico controlado, randomizado e pragmático, com duração de um ano, relativo aos cuidados clínico-nutricionais nos grupos controle e intervenção, sendo neste adicionadas oficinas educativas de nutrição com abordagem construtivista. O ensaio foi complementado com um estudo de coorte para observar eventos cardiovasculares em até quatro anos. Foram alocados 200 pacientes, sendo 101 no grupo intervenção. Ao final do primeiro ano e depois de quatro anos, foram calculadas a redução do risco absoluto e o risco relativo como medidas de incidência cumulativa, respectivamente. RESULTADOS: Ao final de um ano de seguimento, nos grupos intervenção e controle, respectivamente, houve cinco e sete óbitos (p = 0,53); cinco e seis IAM (p = 0,73); quatro e seis re-ATC (p = 0,50); e quatro e quatro RMs (p = 0,98). Após quatro anos, os RR entre os grupos de intervenção e controle foram 0,75 (IC95% 0,35-1,58) para óbito; 0,89 (IC95% 0,34-2,28) para IAM; 0,86 (IC95% 0,40-1,84) para re-ATC e 1,14 (IC95% 0,38-3,40) para RM. Quanto à ingestão alimentar, observou-se redução de gordura saturada (p=0,04) e aumento de fibras (p=0,03) e potássio (p=0,01) no grupo intervenção comparado ao controle. As medidas antropométricas e bioquímicas não apresentaram diferença entre os grupos. A análise estratificada mostrou um efeito protetor para a circunferência da cintura nos subgrupos de idosos [-2.6 cm (IC95% -4,7; -0.6)] e até quatro anos de estudo [-2.5 cm (IC95% -4,9; -0,1)], com interação entre eles (p=0,02). Quanto à mudança de comportamento, houve um aumento no número de indivíduos nos estágios de ação/manutenção de 2,2 vezes (IC95%1,0;5,2) no grupo intervenção, porém sem diferença entre os grupos. Foram identificados fatores socioculturais relacionados ao prazer, hábito, cultura e medo, bem como fatores atitudinais como mudanças declaradas, ambivalência e resistência que permearam as práticas alimentares independente do estágio de mudança, além do conhecimento adquirido, explícito ou ausente. CONCLUSÕES: A intervenção educativa pareceu vantajosa, embora a amostra não tenha sido suficiente para ser conclusiva quanto à ocorrência de eventos cardiovasculares. Houve redução de gordura saturada e aumento no consumo de fibras e potássio, porém sem melhora nas medidas antropométricas e bioquímicas, exceto um menor acúmulo de gordura abdominal em idosos e sujeitos com baixa escolaridade. Há de se fortalecer o debate dos aspectos culturais que constituem o espaço social alimentar e repensar a orientação valorizando as mudanças positivas e escolhas alimentares dentro de um contexto de padrão alimentar saudável / INTRODUCTION: Changes in lifestyle are encouraged in primary and secondary prevention of coronary artery disease. The education for health promotion requires an activity capable of problematizing the individual\'s reality and enabling him to make conscious choices. Considering the multidimensional aspects of feeding and the difficulty of changes in eating behavior, the objective of this study was to analyze the effectiveness of a nutrition education intervention program on mortality and recurrence of events as acute myocardial infarction (AMI), revascularization with re-percutaneous coronary intervention (re-PCI), or coronary artery bypass graft (CABG) surgery after one year of follow-up in patients who previously underwent elective PCI. The secondary objectives included food consumption, anthropometric and biochemical parameters, stages of dietary change, and recurrence of cardiovascular events after four years of follow-up, besides a qualitative analysis of the cultural and attitudinal factors that influenced the dietary practices of this population. METHODS: A controlled, randomized, and pragmatic clinical trial was performed during one-year, related to the clinical and nutritional care in the control and intervention groups, and nutrition education workshops that adopted a constructivist approach were additionally applied to the intervention group. The trial was complemented with a cohort study to observe cardiovascular events up to four years of follow-up. Two hundred patients were allocated, 101 in the intervention group. The absolute risk reduction and the risk ratio were calculated as measures of the cumulative incidence after one and four years, respectively. RESULTS: After one year of follow-up, in the intervention and control groups, respectively, there were five and seven deaths (p=0,53); five and six AMIs (p=0,73); four and six re-PCIs (p=0,50); and four and four CABGs (p=0,98). After four years, the risk ratios between intervention and control groups were 0,75 (95%CI 0,35-1,58) for death, 0.89 (95%CI 0,34-2,28) for AMI, 0,86 (95%CI 0,40-1,84) for re-PCI, and 1,14 (95%CI 0,38-3,40) for CABG. Regarding food consumption, a decrease in saturated fat (p = 0.04) and increase in fiber (p = 0.03) and potassium (p = 0.01) intakes were observed in the intervention group compared to the control group. Anthropometric and biochemical measurements did not show any difference between groups. The stratified analysis showed a protective effect for waist circumference in the elderly [-2.6 cm (95%CI-4,7; -0,6)] and individuals up to four years of study [-2.5 cm (95%CI -4,9 ;-0,1)] subgroups, with interaction between them (p = 0,02). Regarding the change in dietary behaviour, there was an increase in the number of individuals in the action/maintenance stages of 2.2 times (95%CI 1,0; 5,2) in the intervention group, but with no difference between the groups. Factors related to pleasure, habit, culture and fear were identified, as well as attitudinal factors such as stated changes, ambivalence and resistance that permeated eating practices regardless of the stage of change, as well as acquired, explicit or absent knowledge. CONCLUSION: The educational intervention seemed advantageous, although the sample was not enough to be conclusive about the occurrence of cardiovascular events. There was a reduction in saturated fat and an increase in fiber and potassium consumption, but there was no improvement in anthropometric and biochemical measurements, except for a lower accumulation of abdominal fat in the elderly and subjects with low schooling. There is a need to strengthen the debate on the cultural aspects that constitute the food social space and rethink the orientation by valuing positive changes and food choices within a healthy eating pattern

Políticas de governo, nos seus vários níveis, abordam o tema da alimentação e nutrição ressaltando sua importância para a melhora da qualidade da saúde da população. Nas últimas décadas as Doenças Crônicas Não Transmissíveis (DCNT) passaram a liderar as causas de óbito no Brasil, ultrapassando as taxas de mortalidade por doenças infecciosas e parasitárias da década de 80. As DCNTs se caracterizam por ter uma etiologia incerta, múltiplos fatores de risco, longos períodos de latência, curso prolongado, origem não infecciosa e por estar associadas a deficiências e incapacidades funcionais. A experiência de diversos países mostra que o sucesso das intervenções de saúde pública, no que se refere aos fatores de risco e à redução da prevalência das DCNTs, tem sido atribuído ao enfoque na vigilância de fatores comuns de risco e na promoção de modos de viver favoráveis à saúde e à qualidade de vida, tendo um custo menor do que as abordagens para as doenças específicas. Em 2005, o Ministério da Saúde apresentou como uma de suas prioridades, implementar políticas promotoras de modos de viver saudáveis, enfatizando as diretrizes da Estratégia Global de Alimentação Saudável, Atividade Física e Saúde (EG) proposta pela Organização Mundial da Saúde (OMS) e a prevenção do tabagismo. Essas prioridades foram abordadas na Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 que objetiva especificamente contribuir para a mudança do modelo de atenção do sistema de maneira a ampliar e qualificar as ações de promoção da saúde. O presente trabalho apresenta uma proposta de intervenção nutricional para uma amostra de funcionários não docentes da USP, que foram previamente avaliados e apresentaram alta incidência de sobrepeso e obesidade. Esse modelo baseia-se nas diretrizes propostas pela PNPS e usa a educação nutricional como principal instrumento de intervenção. / Government policies, in its levels, addressing the topic of food and nutrition emphasizing its importance to improving the quality of health. In recent decades the Chronic Noncommunicable Diseases (NCDs) are now leading causes of death in Brazil, surpassing the rates of mortality from infectious and parasitic diseases of the 80s. The NCDs are characterized by an uncertain etiology, multiple risk factors, long latency periods, a prolonged, non-infectious origin and be associated with functional impairment and disability. Experience in several countries shows that the success of public health interventions, with regard to risk factors and reduce the prevalence of NCCD, has been assigned to focus on surveillance of common risk factors and promote ways of living favorable to health and quality of life, having a lower cost than the approaches to specific diseases. In 2005, the Ministry of Health (MS) presented as one of their priorities, implementing policies that promote healthy ways of living, emphasizing the guidelines of the Global Strategy on Diet, Physical Activity and Health (GS) proposed by the World Health Organization (WHO) and smoking prevention. These priorities have been addressed in the National Policy for Health Promotion (PNPS), published in 2006 that aims specifically to bring about change in the attention system in order to widen and improve the actions of health promotion. This paper presents a proposal for nutritional intervention for a sample of non-teaching staff of the University of São Paulo (USP), which were previously evaluated and showed a high incidence of overweight and obesity. This model is based on the guidelines proposed by PNPS and use nutrition education as the main instrument of intervention.

Cette étude vise à évaluer les éléments facilitants et les barrières à l’implantation du programme d’éducation à la nutrition Camille, Antoine et l’archipel Ôlait, développé par les Producteurs laitiers du Canada (PLC), auprès d’enseignants du préscolaire provenant de six régions du Québec et ayant reçu un atelier de formation animé par une diététiste des PLC. Elle vise également à connaître le degré d’implantation et la fidélité du programme ainsi que son appréciation, son utilisation et sa pertinence. Après une moyenne de 5 mois d’implantation, un questionnaire auto-administré a été complété par 37 enseignants (N = 86, 43 %), dont 10 utilisateurs (27 %) et 27 non-utilisateurs (73 %). Puis, des groupes de discussion ont eu lieu avec 13 enseignants (N = 170, 8 %). En moyenne, 11,4 activités sur 30 ont été réalisées (38 %), dont 6,3 telles quelles (55 %) et 5,1 modifiées (45 %), et les enseignants ont rapporté avoir l’intention de refaire 6,1 activités (54 %). L’implantation du programme a été facilitée ou limitée par différentes caractéristiques des enseignants, par l’appréciation de son contenu et son format, par sa pertinence concernant les exigences pédagogiques au préscolaire, la réalité des élèves et des parents et les objectifs d’apprentissages en nutrition, par le milieu scolaire, familial et communautaire ainsi que par la crédibilité et le support des PLC. Plusieurs de ces facteurs sont à la fois des éléments facilitants et des barrières. Les résultats obtenus aideront à ajuster ce programme et guider le développement et l’évaluation de programmes similaires. / This study aims to assess the facilitating conditions and barriers to the implementation of Camille, Antoine et l’archipel Ôlait nutrition education program, develop by the Dairy Farmers of Canada (DFC), with preschool teachers, from six regions of Québec, who assisted a workshop delivered by a dietitian from DFC. It also seeks to know the degree of implementation and fidelity of the program and its assessment, its use and relevance. Following an average of five months of implementation, a self-administered questionnaire was completed by 37 teachers (N = 86, 43 %), 10 users (27 %) and 27 non-users (73 %). Then, focus groups were held with 13 teachers (N = 170, 8 %). On average, 11.4 out of 30 activities have been carried out (38 %), including 6.3 as planned (55 %) and 5.1 modified (45 %), and teachers reported that it intends to repeat 6.1 activities (54 %). Implementation of the program was facilitated or limited by various characteristics of teachers, the assessment of its content and its format, its relevance to the educational requirements for preschool, the reality of pupils and their parents and objectives in nutrition learning, at school, in their family and community as well as the credibility and support of the DFC. Many of those factors are both facilitating conditions and barriers. The results will help to adjust the program and guide the development and evaluation of similar programs.

Introdução: a prevalência de obesidade infantil tem aumentado rapidamente no Brasil nas últimas décadas. Por isso, há uma necessidade urgente de desenvolver estratégias efetivas na prevenção e controle da obesidade infantil. Neste contexto, foi desenvolvido um programa de intervenção com educação nutricional e atividade física no âmbito escolar, com o objetivo de prevenção e controle da obesidade, denominado TriAtiva: educação, alimentação e atividade física. Métodos: trata-se de um estudo controlado randomizado por conglomerado, conduzido em 12 escolas municipais da cidade de Porto Alegre/RS (6 escolas intervenção e 6 escolas controle), do primeiro ao quarto ano do ensino fundamental, durante um ano letivo. O Programa TriAtiva foi implementado nas escolas de intervenção, através de práticas educativas relacionadas à alimentação saudável e à atividade física, visando ao desenvolvimento da saúde do aluno em um ambiente favorável, com o envolvimento da comunidade escolar e dos familiares. Foi considerado desfecho primário o índice de massa corporal e como desfechos secundários o percentual de gordura corporal, circunferência da cintura, além da prevalência, incidência e remissão do excesso de peso e obesidade. Resultados: foram avaliados 600 escolares, com uma perda de 10,3% até o final do estudo. Comparados ao grupo controle, escolares do grupo intervenção apresentaram redução no índice de massa corporal (IMC), com diferença de média padronizada (DMP) de -0,18 (IC95%: -0,27 a -0,08; P=0,002), no peso com DMP de -0,10 (IC95%: - 0,16 a -0,04; P=0,004) e no escore Z do IMC com DMP de -0,19 (IC95%: -0,29 a -0,09; P=0,002), todos com significância estatística. Também houve redução, mas não estatisticamente significativa, na circunferência da cintura com DMP de -0,07 (IC95%: -0,13 a 0,02; P=0,06) e no percentual de gordura corporal com DMP de -0,07 (IC95%: -0,28 a 0,14; P=0,47). O grupo intervenção apresentou mudança com a redução na prevalência de excesso de peso e obesidade com odds ratio (OR) de 0,77 (IC95%:0,61 a 0,97; P=0,02) e OR de 0,54 (IC95%: 0,44 a 0,67; P<0,001), respectivamente. Também houve aumento na remissão do excesso de peso e obesidade, com OR de 3,57 (IC95%: 1,39 a 9,09; P=0,008) e OR de 7,69 (IC95%: 3,94 a 14,28; P<0,001), respectivamente. Mas não houve mudanças na incidência do excesso de peso com OR de 0,57 (IC95%: 0,20 a 1,62; P= 0,29) e na obesidade com OR de 0,89 (IC95%: 0,18 a 4,28; P=0,88). Conclusão: o Programa TriAtiva apresentou efeitos positivos no IMC e mudanças favoráveis na prevalência e remissão da obesidade, após o término do programa, tornando-se um aliado na prevenção e controle da obesidade, no âmbito escolar. Registro Brasileiro de Ensaios Clínicos: RBR- 2xx2z4. / Introduction: The prevalence of childhood obesity has increased rapidly in Brazil in the last decades. Therefore, there is an urgent necessity to develop effective strategies for the prevention and control of childhood obesity. In this context, it was developed an intervention program with nutrition education and physical activity at schools, with objectives to prevent and control obesity, called TriAtiva: education, nutrition and physical activity. Methods: This is a cluster randomized controlled trial, conducted in 12 public schools in Porto Alegre/RS (6 intervention schools and 6 control schools), from first to fourth grade from elementary school during one school year. The TriAtiva Program was implemented in the intervention schools through educational practices associated to healthy eating and physical activity, aimed the development of the health for student in a favorable environment, with the involvement of the school community and family. The body mass index was considered the primary outcome and the secondary outcomes were the percentage of body fat, waist circumference, beyond the prevalence, incidence and remission of overweight and obesity. Results: 600 students were assessed, the loss was 10.3% until the end of the study. Compared to the control group, students in the intervention group showed a reduction in body mass index (BMI), the standardized mean difference (SMD) was -0.18 (95% CI: -0.27 to -0.08; P = 0.002 ), SMD for the weight was -0.10 (95% CI: - 0.16 to -0.04; P = 0.004) and for BMI z-score was -0.19 (95% CI: -0.29 to -0.09; P = 0.002), all with statistical significance. There was a reduction, but not statistically significant, in waist circumference, where SMD was -0.07 (95% CI: -0.13 to 0.02; P = 0.06) and SMD for percentage of body fat was -0.07 (95% CI: -0.28 to 0.14; P = 0.47). The intervention group showed a change with a reduction in the prevalence of overweight and obesity, odds ratio (OR) was 0.77 (95% CI: 0.61 to 0.97; P = 0.02) and 0.54 (95% CI: 0.44 to 0.67; P < 0.001), respectively. Also there was an increase in the remission of overweight and obesity, where OR was 3.57 (95% CI: 1.39 to 9.09; P = 0.008) and 7.69 (95% CI: 3.94 to 14.28; P < 0.001), respectively. Although there were no changes in the incidence of overweight where OR was 0.57 (95% CI: 0.20 to 1.62; P = 0.29) and for obesity OR was 0.89 (95% CI: 0.18 to 4.28; P = 0.88). Conclusion: TriAtiva program showed positive effects on BMI and favorable changes in the prevalence and remission of obesity, after the program ends, becoming an allied in the prevention and control of obesity at schools. Brazilian Clinical Trials Registry (ReBec): RBR- 2xx2z4.