Analysis of the Chilean health promotion policy "Choose a Healthy Lifestyle".

BACKGROUND: Intersectoral health promotion initiatives in Chile to address obesity and non- communicable diseases have had a long history in Chile, but also a high degree of changes in their design, implementation, and financing. AIM: To analyze the "Choose a Healthy Lifestyle" enacted by Law 20,670 under Sabatier's "Advocacy Coalition Framework" (ACF), addressing the political discussion and its execution in the subsequent governing coalitions (2011-2022). MATERIAL AND METHODS: The ACF components are the following: external events, coalitions, policy subsystem (health promotion), and policy brokers. Policy change and learning occurs when a certain level of conflict exists between coalitions. We carried out a bibliographic and literature review, including history of the Law and notes in the media. RESULTS: We identified two coalitions. The first is pro-individual freedom and aims to solve the problem with education and health promotion. The second one defines the problem as structural and related to social determinants and health inequity. The first coalition launched the "Choose Healthy Liferstyle" program in 2011 when they were in executive power. After criticism from the opposition and the participation of policy brokers, the Program was institutionalized with an intersectoral vision. The lack of permanent financing affected the continuity of the policy, especially after a change in the governing coalition. CONCLUSIONS: Law 20,670 falls within the ACF. However, policy learning slowed down because the problem involved social aspects, conflict between deep beliefs of both coalitions, and lack of permanent funding, thus affecting the continuity of the policy.

Analysis of the Chilean health promotion policy "Choose a Healthy Lifestyle" / Análisis de la política de promoción de salud chilena "Elige Vivir Sano"

BACKGROUND: Intersectoral health promotion initiatives in Chile to address obesity and non- communicable diseases have had a long history in Chile, but also a high degree of changes in their design, implementation, and financing. AIM: To analyze the "Choose a Healthy Lifestyle" enacted by Law 20,670 under Sabatier's "Advocacy Coalition Framework" (ACF), addressing the political discussion and its execution in the subsequent governing coalitions (2011-2022). MATERIAL AND METHODS: The ACF components are the following: external events, coalitions, policy subsystem (health promotion), and policy brokers. Policy change and learning occurs when a certain level of conflict exists between coalitions. We carried out a bibliographic and literature review, including history of the Law and notes in the media. RESULTS: We identified two coalitions. The first is pro-individual freedom and aims to solve the problem with education and health promotion. The second one defines the problem as structural and related to social determinants and health inequity. The first coalition launched the "Choose Healthy Liferstyle" program in 2011 when they were in executive power. After criticism from the opposition and the participation of policy brokers, the Program was institutionalized with an intersectoral vision. The lack of permanent financing affected the continuity of the policy, especially after a change in the governing coalition. CONCLUSIONS: Law 20,670 falls within the ACF. However, policy learning slowed down because the problem involved social aspects, conflict between deep beliefs of both coalitions, and lack of permanent funding, thus affecting the continuity of the policy.

ANECEDENTES: Las iniciativas intersectoriales de promoción de salud en Chile han tenido una larga historia en el país, pero también un alto grado de cambios en su diseño, implementación y financiamiento. OBJETIVOS: Analizar el "Sistema Elige Vivir Sano" (Ley 20.670) bajo el marco de "Coaliciones de Causa" (ACF), abordando la discusión política y su ejecución durante cambios de coaliciones gobernantes (2011-2022). MATERIAL Y MÉTODOS: Los componentes de ACF incluyen eventos externos, coaliciones, subsistema de políticas (promoción de salud) e intermediarios de políticas. El cambio y aprendizaje de políticas ocurre cuando existe cierto nivel de conflicto entre coaliciones. Realizamos una revisión de literatura, incluyendo historia de la Ley y notas en los medios de comunicación. RESULTADOS: Identificamos dos coaliciones. La primera es pro-libertad individual y pretende resolver el problema con educación y promoción de la salud. La segunda es pro-determinantes sociales y define el problema como estructural. La primera coalición lanzó el programa "Elige Vivir Sano" en 2011 cuando estaban en el poder ejecutivo. Luego de las críticas de la oposición y la participación de intermediarios de políticas, el Programa se institucionalizó con una visión intersectorial. La falta de financiamiento permanente afecta la continuidad de la política, especialmente luego de un cambio en la coalición gobernante. CONCLUSIONES: La Ley 20.670 se enmarca dentro de la ACF. Sin embargo, el aprendizaje de políticas se ralentizó porque el problema involucra aspectos sociales, conflicto entre creencias profundas de ambas coaliciones y falta de financiamiento permanente, afectando la continuidad de la política.

Evaluación de cursos en línea, masivos y abiertos de educación en salud y nutrición para prevenir la obesidad / Assessment of massive open online courses for teaching nutrition and preventing obesity

Background: A massive open online course (MOOC) is an online course aimed at unlimited participation and open access via the Web. Aim: To assess the MOOC experience for teaching nutrition, healthy food consumption, physical activity and health promotion to prevent obesity. Material and Methods: Two MOOC courses, (one with two versions), are described with the registration and evaluation instruments such as surveys carried out at the beginning and at the end of the courses. Effective participants in the three versions were 17.456, 11.121 in MOOC1, 2.351 in MOOC1 second version and 3.984 in MOOC2. Their median age was 31 years, 82% were women, 60% were professionals and 12% were foreigners. Results: In the final evaluation of the three courses, 85% to 99% qualified as "very good" or "good" all the surveyed topics. Thirty five percent of participants reported having lack of time, 11% reported problems with internet connectivity and 3.9%, personal or work problems. Conclusions: This is the first experience with MOOC in health and nutrition to prevent obesity in Chile. Considering the good results and positive evaluation of these courses, we estimate that they are an important tool to prevent obesity and chronic diseases in Chile, Latin America and other regions of the world.

[Assessment of massive open online courses for teaching nutrition and preventing obesity]. / Evaluación de cursos en línea, masivos y abiertos de educación en salud y nutrición para prevenir la obesidad.

BACKGROUND: A massive open online course (MOOC) is an online course aimed at unlimited participation and open access via the Web. AIM: To assess the MOOC experience for teaching nutrition, healthy food consumption, physical activity and health promotion to prevent obesity. MATERIAL AND METHODS: Two MOOC courses, (one with two versions), are described with the registration and evaluation instruments such as surveys carried out at the beginning and at the end of the courses. Effective participants in the three versions were 17.456, 11.121 in MOOC1, 2.351 in MOOC1 second version and 3.984 in MOOC2. Their median age was 31 years, 82% were women, 60% were professionals and 12% were foreigners. RESULTS: In the final evaluation of the three courses, 85% to 99% qualified as "very good" or "good" all the surveyed topics. Thirty five percent of participants reported having lack of time, 11% reported problems with internet connectivity and 3.9%, personal or work problems. CONCLUSIONS: This is the first experience with MOOC in health and nutrition to prevent obesity in Chile. Considering the good results and positive evaluation of these courses, we estimate that they are an important tool to prevent obesity and chronic diseases in Chile, Latin America and other regions of the world.

The contribution of distance education to health promotion in Chile.

The objective of this paper is to present the distance education's contribution to developing health promotion in Chile, through evaluation of a postgraduate certificate program for professionals, and a training course for nurse technicians working in primary healthcare, with an 8-month follow-up after program completion. The program methodology was participatory, interactive and reflective, with mentoring support, exercises, group work and discussions as well as content pertinent to the needs of practice. The evaluation was quali-quantitative with an analysis of the student profile, the implementation process, outcomes at the end of the training and impacts on workplace changes. The results showed a high rate of student approval (87 and 76%), good academic performance and a high level of satisfaction with the methodology and knowledge delivered. The participants' final projects were adapted to local work places realities and were implemented by 62.6% of technicians and 43% of professionals, in addition to changes in work practices that favor health promotion. The level of fulfillment of participants' expectations was very high and the most frequent barriers to implementing the final project were lack of time and personnel, along with minimal support from management and low prioritization of health promotion. This study shows the effectiveness of a distance training model for professionals and technicians that can reach the most remote parts of the country, where there is no access to presencial training, with an educational program centered on work activities and current health challenges.

[Assessment of a nutrition education intervention among construction workers]. / Evaluación de una intervención educativa nutricional en trabajadores de la construcción para prevenir enfermedades crónicas no transmisibles en Chile.

BACKGROUND: Unhealthy lifestyles and overweight are common among blue collar workers. AIM: To evaluate a nutrition education intervention in construction workers to prevent chronic diseases. MATERIAL AND METHODS: One hundred forty two participants were randomly assigned to an experimental group (n = 69) and or a control group (n = 73). The experimental group received nutrition education consisting in individual lifestyle counseling, group workshop, group counseling in healthy lifestyles, and environmental intervention. At baseline and after one year of intervention, clinical evaluations consisting in laboratory determinations, anthropometry and nutritional assessment evaluation were carried out. RESULTS: The experimental group experienced a significant decrease in waist circumference, total cholesterol, triglycerides, and an increase in HDL cholesterol. A significant reduction in total calorie intake, especially at the evening snack was observed during week-days. The same reduction in total calories occurred at dinner during the week-end. A significant increase was observed in the consumption of fruits, vegetables and fish. In the control group there was a significant increase in weight, waist circumference, body mass index, glucose and insulin, without changes in total calorie intake or healthy food consumption. High soft drink consumption did not change in both groups. CONCLUSIONS: In construction workers, integral nutrition intervention at the individual, group and environmental level had an impact in nutritional and biochemical indicators.

Evaluación de una intervención educativa nutricional en trabajadores de la construcción para prevenir enfermedades crónicas no transmisibles en Chile / Assessment of a nutrition education intervention among construction workers

Background: Unhealthy lifestyles and overweight are common among blue collar workers. Aim: To evaluate a nutrition education intervention in construction workers to prevent chronic diseases. Material and Methods: One hundred forty two participants were randomly assigned to an experimental group (n = 69) and or a control group (n = 73). The experimental group received nutrition education consisting in individual lifestyle counseling, group workshop, group counseling in healthy lifestyles, and environmental intervention. At baseline and after one year of intervention, clinical evaluations consisting in laboratory determinations, anthropometry and nutritional assessment evaluation were carried out. Results: The experimental group experienced a significant decrease in waist circumference, total cholesterol, triglycerides, and an increase in HDL cholesterol. A significant reduction in total calorie intake, especially at the evening snack was observed during week-days. The same reduction in total calories occurred at dinner during the week-end. A significant increase was observed in the consumption of fruits, vegetables and fish. In the control group there was a significant increase in weight, waist circumference, body mass index, glucose and insulin, without changes in total calorie intake or healthy food consumption. High soft drink consumption did not change in both groups. Conclusions: In construction workers, integral nutrition intervention at the individual, group and environmental level had an impact in nutritional and biochemical indicators.

ENERGY EXPENDITURE AND INTAKE COMPARISONS IN CHILEAN CHILDREN 4-5 YEARS ATTENDING DAY-CARE CENTRES.

INTRODUCTION: the doubly labelled water (DLW) method has an accuracy of 1% and within-subject precision of 5-8%, depending on subject's age and environments issues. Energy intake assessment is prone to errors (>15- 20%) depending in the method utilized. OBJECTIVE: to quantify DLW methodology errors in four to five year olds that could affect the comparison with energy intake. METHODS: energy expenditure (TEE, by DLW), was assessed during 14 days in 18 preschool children, who attended eight hours daily to day-care centres. Energy intake was determined by a combined method: food weighing during weekdays and recall after leaving the Centre (17h to sleep time) plus 24 h recall, during the weekend. Several assumptions affecting DLW total error were assessed to determine their influence in the comparison to energy intake (i.e. background variability, space ratio, proportion of water subject to fractionation, food quotient value). RESULTS: the individual mean energy expenditure was 1 373 ± 177 kcal and the energy intake (1 409 ± 161 kcal). The overall difference between intake and expenditure was 42.9 kcal/day (limits of agreement + 259.1 to -112.3 kcal/day). TEE measurement error only explained a minor quantity (2.4%), between both measurements, and the observed mean isotope dilution space was 1.030 ± 0.010 confirming the value utilized in adults studies. CONCLUSIONS: energy expenditure data is similar to other studies in preschool children. The small difference found between energy intake and expenditure may be attributed to the applied energy intake methodology, the homogeneous diet at care centres during the week-days and the lower DLW methodology error.

Introducción: el método del agua doblemente marcada (ADM) tiene una precisión del 1% y en un mismo sujeto es de 5-8%, dependiendo de la edad y el entorno del sujeto. La evaluación de la ingesta energética es propensa a errores (> 15-20%), dependiendo del método utilizado. Objetivo: cuantificar los errores metodológicos del ADM en niños de 4-5 años que podrían afectar la comparación con la ingesta de energía. Métodos: el gasto de energía (GTE, por ADM), se evaluó durante 14 días en 18 preescolares, asistentes a guarderías infantiles. La ingesta energética se determinó mediante un método combinado: pesaje de alimentos durante los días de la semana y registro después de salir del centro (17 horas en adelante), además de un recordatorio de 24 horas, durante un día del fin de semana. Resultados: el promedio individual del gasto energético total fue 1373 ± 177 kcal y la ingesta de energía (1409 ± 161 kcal). La diferencia global entre la ingesta y el gasto fue 42,9 kcal/día. El error de medición del GET explicó una variación del 2,4%, entre ambas mediciones, y el espacio de dilución de isótopos fue 1030 ± 0.010, confirmando el valor utilizado en los estudios de adultos. Conclusiones: los datos de GET fueron similares a otros estudios realizados en niños en edad preescolar. La pequeña diferencia encontrada entre la ingesta y el gasto energético se puede atribuir a la metodología de la ingesta de energía aplicada, la dieta homogénea en los centros de atención, durante los días de la semana, y el bajo error metodológico del ADM.

[Evaluation of an online health promotion Diploma]. / Evaluación de un programa de educación a distancia en Promoción de Salud para la Atención Primaria en Chile.

BACKGROUND: Health promotion in Chile is essential, considering its current epidemiologic status where chronic diseases are predominant. AIM: To report the evaluation of an on-line Diploma in health promotion for Primary Health Care professionals. MATERIAL AND METHODS: Two hundred sixty four professionals from all regions of the country (40% rural and 60% urban) took the Diploma. It lasted 8 months with 248 academic hours distributed in 5 modules with a total of 15 units. The program was evaluated with four surveys answered by the students (general description of participants, mid-term, final and follow-up). RESULTS: Students were highly satisfied with the program and especially with its interactive methodology which included tutorials, individual and group assignments, online discussions and a final project. The drawbacks were time restrictions and limited internet access. Ninety percent of students completed the course with an overall mean grade of 5.57 (out of a 1-7 scale). The follow-up survey showed that students implemented the new health promotion knowledge acquired, and put in practice their final assignment in their local counties. Also, most students improved their working conditions. CONCLUSIONS: The on-line interactive and participative methodology applied in this Diploma had positive results and the evaluation model can be applied in other health promotion on-line education programs.

Evaluación de un programa de educación a distancia en Promoción de Salud para la Atención Primaria en Chile / Evaluation of an online health promotion Diploma

Background: Health promotion in Chile is essential, considering its current epidemiologic status where chronic diseases are predominant. Aim: To report the evaluation of an on-line Diploma in health promotion for Primary Health Care professionals. Material and Methods: Two hundred sixty four professionals from all regions of the country (40% rural and 60% urban) took the Diploma. It lasted 8 months with 248 academic hours distributed in 5 modules with a total of 15 units. The program was evaluated with four surveys answered by the students (general description of participants, mid-term, final and follow-up). Results: Students were highly satisfied with the program and especially with its interactive methodology which included tutorials, individual and group assignments, online discussions and a final project. The drawbacks were time restrictions and limited internet access. Ninety percent of students completed the course with an overall mean grade of 5.57 (out of a 1-7 scale). The follow-up survey showed that students implemented the new health promotion knowledge acquired, and put in practice their final assignment in their local counties. Also, most students improved their working conditions. Conclusions: The on-line interactive and participative methodology applied in this Diploma had positive results and the evaluation model can be applied in other health promotion on-line education programs.

Evaluación de un programa de intervención nutricional y de actividad física dirigido a mujeres chilenas de bajo nivel socioeconómico

El objetivo del estudio fue evaluar un programa de intervención en educación nutricional y actividad física para disminuir la obesidad, cambiar hábitos alimentarios y aumentar la actividad física en mujeres de nivel socioeconómico bajo. Para ello se seleccionaron cuatro grupos seguidos por seis meses: uno intervenido en educación nutricional y actividad física (grupo A); otro con educación nutricional (grupo B); un tercero con actividad física (grupo C), y un grupo control. Se realizaron tres talleres de alimentación por líderes de la comunidad y nutricionistas, y tres sesiones semanales de actividad física. Se efectuaron evaluaciones antropométricas y encuestas de compra, consumo de alimentos y actividad física, antes y después de la intervención. En el grupo A se incrementó la obesidad, pero en los otros dos grupos intervenidos (B y C), bajó en un 10% y en el grupo B disminuyó la grasa corporal total. En el grupo control se mantuvo el porcentaje de obesidad y aumentó la grasa corporal total. La adherencia a sesiones de actividad física fue baja, lo que repercutió en los resultados de evaluación nutricional en los dos grupos intervenidos con actividad física (B y C). Los tres grupos intervenidos tuvieron cambios saludables en sus hábitos de compra y consumo de alimentos. Se concluye que la obesidad bajó en un 10% en los grupos intervenidos B y C, y en el B disminuyó la grasa corporal total. En los tres grupos intervenidos mejoraron los hábitos alimentarios y de actividad física. Los resultados permiten contar con un programa de intervención comunitaria en educación nutricional y actividad física para mujeres de nivel socioeconómico bajo.

Evaluation of a nutrition education and physical activity intervention in Chilean low socioeconomic women The objective of the study was to assess a nutrition education and physical activity intervention to decrease obesity changing food habits and increasing physical activity in low socioeconomic women. Four groups were selected and followed-up during six months: one was intervened with food education and physical activity (group A); another with food education (group B); a third with physical activity (group C), and a control group. Three nutrition education workshops were carried out with community leaders and nutritionists, and three times per week physical activity sessions were performed. Anthropometric measurements and food and physical activity surveys were carried out before and after the intervention. Obesity increased in group A, but decreased 10% in the other two intervened groups (B and C), and total fatty mass decreased in group B. In the control group, obesity did not change but total fatty mass increased. Attendance to physical activity sessions was poor, with negative results in the nutritional impact in the physical activity intervened groups (B and C). We conclude that obesity was reduced in 10% in groups B and C; total fatty mass was reduced in group B and increased in the control group. Healthy diet and physical activity habits improved in the three intervened groups. With these results, an intervention program in nutrition education and physical activity can be available for future community interventions in low socioeconomic women.

[Evaluation of a nutrition education and physical activity intervention in Chilean low socioeconomic women]. / Evaluación de un programa de intervención nutricional y de actividad física dirigido a mujeres chilenas de bajo nivel socioeconómico.

The objective of the study was to assess a nutrition education and physical activity intervention to decrease obesity changing food habits and increasing physical activity in low socioeconomic women. Four groups were selected and followed-up during six months: one was intervened with food education and physical activity (group A); another with food education (group B); a third with physical activity (group C), and a control group. Three nutrition education workshops were carried out with community leaders and nutritionists, and three times per week physical activity sessions were performed. Anthropometric measurements and food and physical activity surveys were carried out before and after the intervention. Obesity increased in group A, but decreased 10% in the other two intervened groups (B and C), and total fatty mass decreased in group B. In the control group, obesity did not change but total fatty mass increased. Attendance to physical activity sessions was poor, with negative results in the nutritional impact in the physical activity intervened groups (B and C). We conclude that obesity was reduced in 10% in groups B and C; total fatty mass was reduced in group B and increased in the control group. Healthy diet and physical activity habits improved in the three intervened groups. With these results, an intervention program in nutrition education and physical activity can be available for future community interventions in low socioeconomic women.

Promoción de salud y actividad física en Chile: política prioritaria / Promoting health and physical activity in Chile: a policy priority

This piece describes and analyzes the situation with respect to physical activity in Chile and the policies and strategies that have been developed in order to combat sedentary lifestyles. The level of sedentary lifestyles in the Chilean population is very high, with 91 percent performing less than 30 minutes of physical activity three times per week. This predicament has worsened as a result of increased urbanization and economic growth over the past decade, with a resulting increase in the number of cars and televisions, along with a rise in the number of hours that workers are on the job each day. In order to deal with this situation a policy to develop physical activity was implemented as a part of the country's general health promotion policy. This policy is overseen by the CHILE LIFE Council (Consejo VIDA CHILE), which is made up of 28 Chilean institutions. The policy encompasses various strategies, such as preparing guides to active living for the Chilean population, conducting educational activities and human resources training for kindergartens and other schools, establishing regulatory measures, performing research, carrying out media campaigns, reclaiming public spaces for recreation, and creating incentives for physical activity in the workplace. These strategies have been well received by the general population, academicians, professionals, and technicians. This makes it possible to foresee achieving in the medium and long term the objectives that have been set: more active lives and a better state of health for the Chilean population