Design of an educational strategy based on Intervention Mapping for nutritional health promotion in Child Care Centers.

Early childhood is a critical period for instilling healthy habits to prevent overweight and obesity. This paper describes the development of an educational intervention for the promotion of healthy eating and physical activity among two-to-four-year-old children in public child care centers (CCCs) in Mexico City. Following the Intervention Mapping (IM) protocol, we developed the Bright Futures multidisciplinary intervention. First, a formative research process to identify the personal and environmental determinants of childhood overweight and obesity, behavioral outcomes and performance objectives was conducted. Then, a matrix of change objectives by intersecting the performance objectives with the determinants was integrated. Bright Futures lasted six months and included 24 weekly sessions, each composed of five phases: warm-up, theory, active movements, relaxation, and hydration. Ad hoc interactive teaching materials focused on recreational activities, and formulated plans for the adoption, implementation and process/impact evaluation of the intervention was developed. IM successfully guided the design of a theory-driven and evidence-based intervention for children in CCCs within a socio-ecological and participatory planning framework. This is one of the first studies in Mexico to use IM in the context of CCCs.

Knowledge about food classification systems and value attributes provides insight for understanding complementary food choices in Mexican working mothers.

Knowledge about mothers' perceptions of food classification and values about complementary feeding is necessary for designing educational and food supply interventions targeted to young children. To determine classification, attributes, and consumption/preparation routines of key complementary foods, 44 mothers of children < 2 y of age in 14 manufacturing businesses were studied. Using 31 key foods, we conducted free-listings, pile-sort, and food attributes exercises. Hierarchical clustering showed that mothers identified nine classes of key foods, including milk derivatives, complements, junk food, infant products, chicken parts, and other meats. From multidimensional scaling, mothers used three primary classification systems: food groups, food introduction stages, and food processing. Secondary classification systems were healthy-junk, heavy-light, hot-cold, good-bad fat, and main dish-complement. Child health and nutrition, particularly vitamin content, were salient attributes. Fruits and vegetables were preferred for initiating complementary feeding on the second month of age. Consumption of guava, mango, and legumes, however, was associated with digestive problems (empacho). Red meats were viewed as cold-type, heavy, and hard, not suitable for young children, but right for toddlers. Chicken liver was considered nutritious but dirty and bitter. Egg and fish were viewed as a vitamin source but potentially allergenic. Mothers valued vitamin content, flavor, and convenience of processed foods, but some were suspicious about expiration date, chemical and excessive sugar content and overall safety of these foods. Mothers' perceptions and values may differ from those of nutritionists and program designers, and should be addressed when promoting opportune introduction of complementary foods in social programs.