Promoción de la alimentación saludable en escolares desde la perspectiva comunitariaaportaciones del ámbito familiar, educativo y enfermero

Abstract

This doctoral thesis analyzes the improvement of pupils´ nutrition in the school context at primary level. The objectives aim to analyze and propose improvements in students´ eating habits and physical activity; to identify teaching strategies based on innovation and a collaborative approach; and, to enhance food literacy and participation of students´ families. The methodology consist of a "case study" approach based on a collaborative action-research structured into two parallel teaching and learning processes: the classroom experimentation of a healthy eating habit project based on inquiry-based learning; and the development of a literacy program aimed at improving families� knowledge on nutrition, using the triangulation of observations, written records, diaries, surveys and interviews. The results initially show that the group of pupils follows a similar pattern to other studies. The analysis of the families´ statements evidences the need to improve children´s eating habits and physical activity, while they minimize nutritional errors and undesirable situations regarding breakfast and confectionery intake. The implementation of the teaching project How can we improve our diet?, based on experiences and the protagonists´ collaboration -pupils, teachers, families and the researcher- has been measured through the KIDMED test. The Quality Index Diet (ICD) at the beginning of the project determines that the majority of students is at a medium level of adaptation to the Mediterranean diet pattern and a minority at the highest level. It is found that a daily breakfast at the beginning of the project is a widespread practice, reaching the highest level in the post -test. After the project, more than half of the students obtains the highest level of ICD primarily due to the increased consumption of fruit, vegetables and fish, in addition to the reduction of confectionary, disappearing at the lowest level in the ICD. Physical activity data has been obtained through the Krece Plus test both before and after the implementation of the teaching proposal, evidencing that the worse classified students at the beginning are highly reduced, growing to more than two thirds the group classified in the medium level. With regard to the family nutritional literacy process, the analysis of the situation determined the need for further training in this field. Previous knowledge consists of disjointed and vague ideas about the concepts discussed. Food myths proliferate, a finding consistent with those found in the Spanish population. Knowledge gained by the participants during the training process influences the improvement of personal and family food practices. It was revealed that the school context is an appropriate environment to carry out training activities for families. Some difficulties identified are related to the low proportion of families participating in the workshop. However, it is significant that a large number of mothers participated in all the scheduled tasks. They assumed an active role in the school activities as health agents. This is evidenced by the distribution of healthy recommendations in their environment, giving signs of nutritional autonomy and empowerment. Among the conclusions of the research it is evidenced the improvement of healthy eating habits in children, especially in the breakfast and the school snack, being the physical activity increased. It is confirmed that experiencial activities and collaborative actions between teachers and families enable successful results; and, finally that families´ nutritional literacy processes promote significative and stable changes, making a positive impact on eating habits at personal and family levels. Healthy habits acquisition can be a reality by means of the implementation of complex and integrated proposals, going beyond those approaches based on campaigns, events and experts talks which largely promote illusions.