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OBJECTIVE: To explore the needs, motivations, and limitations related to healthy eating and digital materials, as well as to identify patterns for their design as a strategy aimed at Mexican families. DESIGN: A qualitative observational study of the phenomenon through focus group sessions. LOCATION: A public primary education center in the city of Querétaro, Mexico. PARTICIPANTS: Children aged 9 to 11 years and parents, mothers, or caregivers with children in primary education. METHOD: Twelve sessions were conducted with three groups of students and two sessions with parents, mothers, or caregivers using an interview guide. Various digital materials, developed based on social cognitive theory, were presented during the sessions. The sessions were recorded with the participants' or their guardians' prior consent and transcribed for analysis. Coding was performed for key points of analysis, and information saturation was confirmed. RESULTS: Students expressed motivation towards digital material that promotes play and experimentation, especially within the family context. The main perceived barrier was the caregivers' resistance to change. Parents expressed motivation and a need for explanatory material on diseases, with economic and time-related barriers. CONCLUSIONS: Digital material based on social cognitive theory, designed to improve nutrition, can be an effective strategy in nutritional education if it considers the circumstances of the target population. It is advisable to include affective and behavioral elements to achieve meaningful learning within households.
Assuntos
Dieta Saudável , Motivação , Pesquisa Qualitativa , Humanos , México , Criança , Feminino , Masculino , Adulto , Avaliação das Necessidades , Grupos Focais , Pais/psicologia , Pais/educação , Cuidadores/educação , Cuidadores/psicologia , Educação em Saúde/métodosRESUMO
Background: Dietary energy density (DED) is associated with chronic disease markers in adults. However, results in children are still controversial. Objective: To evaluate the DED of children and its association with obesity and biomarkers of chronic disease. Methods: In this cross-sectional study, we recruited 284 children (6-10 y) from rural Mexico. Dietary intake was assessed using three 24-h recalls. DED was calculated for "foods only" (DEDfo) and for "foods and beverages" (DEDfb). Weight, height, and body fat percent (dual-energy X-ray absorptiometry) were measured. Inflammatory cytokines, lipid profile, leptin, and insulin resistance were determined from a fasting blood sample. Results: DEDfo was 1.91 ± 0.36 kcal/g and DEDfb was 1.36 ± 0.31 kcal/g. Higher DEDfo and DEDfb were associated with higher risk to have insulin resistance [odds ratio (OR) = 3.92, 95% confidence interval (CI): 1.66, 9.22, P < 0.01; OR = 3.51, 95% CI: 1.25, 9.87, P = 0.02, respectively]. Higher DEDfo was associated with higher risk of higher leptin levels (OR = 3.17, 95% CI: 1.01, 10.23). Also, DEDfo and DEDfb were associated with higher concentrations of cholesterol (ß = 11.67, 95% CI: 1.81, 19.53, P = 0.03; and ß = 11.74, 95% CI: 2.69, 20.74 P = 0.01, respectively) and higher odds of having high insulin concentrations (OR = 2.52, 95% CI: 1.26, 5.06, P = 0.01; and OR = 2.95, 95% CI: 1.30, 6.70, P = 0.01). DEDfo and DEDfb were not associated with any measure of obesity and inflammatory cytokines in the adjusted models. Conclusions: DED was associated with higher leptin and cholesterol concentrations, and having insulin resistance, but not with any measure of obesity or inflammation. Reducing DED may reduce risk of cardiovascular disease and improve insulin sensitivity in school-aged children.
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INTRODUCTION: The burden of multimorbidity is recognised increasingly in low- and middle-income countries (LMICs), creating a strong emphasis on the need for effective evidence-based interventions. Core outcome sets (COS) appropriate for the study of multimorbidity in LMICs do not presently exist. These are required to standardise reporting and contribute to a consistent and cohesive evidence-base to inform policy and practice. We describe the development of two COS for intervention trials aimed at preventing and treating multimorbidity in adults in LMICs. METHODS: To generate a comprehensive list of relevant prevention and treatment outcomes, we conducted a systematic review and qualitative interviews with people with multimorbidity and their caregivers living in LMICs. We then used a modified two-round Delphi process to identify outcomes most important to four stakeholder groups (people with multimorbidity/caregivers, multimorbidity researchers, healthcare professionals and policymakers) with representation from 33 countries. Consensus meetings were used to reach agreement on the two final COS. REGISTRATION: https://www.comet-initiative.org/Studies/Details/1580. RESULTS: The systematic review and qualitative interviews identified 24 outcomes for prevention and 49 for treatment of multimorbidity. An additional 12 prevention and 6 treatment outcomes were added from Delphi round 1. Delphi round 2 surveys were completed by 95 of 132 round 1 participants (72.0%) for prevention and 95 of 133 (71.4%) participants for treatment outcomes. Consensus meetings agreed four outcomes for the prevention COS: (1) adverse events, (2) development of new comorbidity, (3) health risk behaviour and (4) quality of life; and four for the treatment COS: (1) adherence to treatment, (2) adverse events, (3) out-of-pocket expenditure and (4) quality of life. CONCLUSION: Following established guidelines, we developed two COS for trials of interventions for multimorbidity prevention and treatment, specific to adults in LMIC contexts. We recommend their inclusion in future trials to meaningfully advance the field of multimorbidity research in LMICs. PROSPERO REGISTRATION NUMBER: CRD42020197293.
Assuntos
Técnica Delphi , Países em Desenvolvimento , Multimorbidade , Humanos , Adulto , Avaliação de Resultados em Cuidados de Saúde , Pesquisa Qualitativa , FemininoRESUMO
La sobrevaloración de la alimentación y de la saciedad en familias que viven en un medio influenciado por la globalización y desarrollo de la industria alimentaria, puede estar teniendo un efecto sinérgico en el desarrollo de la obesidad y sus comorbilidades en países de ingreso medio. El objetivo de este trabajo fue desarrollar y validar escalas para medir el valor otorgado a la alimentación y la saciedad en mujeres. Se desarrolló un instrumento y se aplicó en querétaro, México (n=243), se midieron variables socioeconómicas y de percepción de peso corporal. Se realizó análisis factorial explorato- rio, confirmatorio y ANOVA. Las escalas del valor que las mujeres dan a la alimentación como base del bienestar, a la saciedad y a la alimentación como base del bienestar del hijo, se validaron (α-Cronbach>0.66) y se confirmaron (CFI>0.98;RMSEA<0.05). Los puntajes de valor de la alimentación y de la saciedad se asociaron con un menor nivel socioeconómico y educativo, inseguridad alimentaria en el pasado, menor intención de perder peso y con percepción bajo peso en los hijos. En conclusión, las es- calas para medir el valor de la alimentación y la saciedad tienen validez para ser utilizadas en futuros estudios; su utilización puede contribuir a desarrollar estrategias que consideren la verdadera motivación de la alimentación en los segmentos poblacionales más desfavorecidos(AU)
The overvaluation of eating and satiation in families whose environment has been influenced by globalization and the food industry, could be inducing obesity and its co-morbidities in midd- le income countries. The objective was to develop and validate scales to measure women's eating and satiation values. A measurement instrument was developed and ad- ministered to women from querétaro, Mexico (n=243), it also measured socioeconomic (SE) and body weight per- ception variables. Analyses included exploratory and con- firmatory factorial analyses and ANOVA. The scales that represented the value of feeding as basis of wealth, the va- lue of satiation and the value of feeding a child as the basis of the child's wealth, were validated (Cronbach-α>0.66) and confirmed (CFI >0.98; RMSEA<0.05).The scores were associated with a lower SE status, lower education level, childhood food insecurity, low intention to lose weight and with an underweighted child perception. In conclusion, the scales that measure the value of eating and satiation have the validity to be used in future studies; its utilization can contribute to develop strategies to improve eating behavior of underprivileged population segments, that take into consideration the real motives of eating(AU)