Policy windows for school-based health education about nutrition in Ecuador

Effective health promoting school for better health of children and adolescents: indicators for success

BACKGROUND

Improvement of health literacy, health behavioural change, creating a supportive physical and social environment to be more conducive to health should be the focus of child and adolescent public health. The concept of Health Promoting School initiated by World Health Organization aims to move beyond individual behavioural change and to consider organisational structure change such as improvement of the school's physical and social environment. The aim of this study is identification of the key indicators for successful implementation of Health Promoting School by analysing the findings of the school health profile based on the structured framework of Hong Kong Healthy School Award Scheme and the health status of students investigated by the Hong Kong Student Health Survey.

METHODS

This is a retrospective correlation study. Analysis of variance (ANOVA) was utilised to analyse for significant improvement of school health profile measured at baseline (n = 104) and among those schools implemented the Hong Kong Healthy School Award Scheme (n = 54). Those indicators showing statistical significance were chosen to be part of the core indicators reflecting effective Health Promoting School. Each of those selected core indicators was then correlated with the related student health outcomes measured by the Hong Kong Student Health Survey Questionnaire to further identify the core indicators.

RESULTS

A total of 20 core indicators among all the six Key Areas of Health Promoting School (6 indicators under action competencies, 2 under community link, 2 under physical environment, 2 under social environment, 4 under healthy school policies, 1 under services of school health protection) have been identified with the method mentioned above.

CONCLUSIONS

This study has identified the indicators with most significant impact on a wide range of health related outcomes. Those are key indicators for motivating positive change of the schools and students. They can be considered as school performance indicators to help schools embarking their Health Promoting School journey as another key education objective.

Impact of two policy interventions on dietary diversity in Ecuador

Objective

To differentiate the effects of food vouchers and training in health and nutrition on consumption and dietary diversity in Ecuador by using an experimental design.

Design

Interventions involved enrolling three groups of approximately 200 randomly selected households per group in three provinces in Ecuador. Power estimates and sample size were computed using the Optimal Design software, with a power of 80 %, at 5 % of significance and with a minimum detectable effect of 0·25 (sd). The first group was assigned to receive a monthly food voucher of $US 40. The second group was assigned to receive the same $US 40 voucher, plus training on health and nutrition issues. The third group served as the control. Weekly household values of food consumption were converted into energy intake per person per day. A simple proxy indicator was constructed for dietary diversity, based on the Food Consumption Score. Finally, an econometric model with three specifications was used for analysing the differential effect of the interventions.

Setting

Three provinces in Ecuador, two from the Sierra region (Carchi and Chimborazo) and one from the Coastal region (Santa Elena).

Subjects

Members of 773 households randomly selected (n4343).

Results

No significant impact on consumption for any of the interventions was found. However, there was evidence that voucher systems had a positive impact on dietary diversity. No differentiated effects were found for the training intervention.

Conclusions

The most cost-effective intervention to improve dietary diversity in Ecuador is the use of vouchers to support family choice in food options.

Community participation in rural Ecuador’s school feeding programme

Purpose

The purpose of this paper is to contribute to the debate concerning community participation in school-based health education and health promotion, with regard to food and nutrition.

Design/methodology/approach

Based on empirical data generated over the course of one year of fieldwork in three rural communities and schools in Ecuador, the study examines community participation related to the implementation of the school feeding programme (SFP) in rural schools in Ecuador. The conceptual framework for the study is shaped by the concepts of student and community participation within the health promoting school (HPS) paradigm.

Findings

The findings help identify and portray different forms of community participation, ranging from a total absence of meaningful participation, though very limited, to consequential participation determined as community influence on the SFP practices to meet the community needs, priorities and systems of meanings.

Research limitations/implications

The study shows that the meaningful participation of the parents and community members in small rural schools in a low- to middle-income country such as Ecuador can be linked to an empowered stance towards the SFP so that it is better tuned to local conditions, priorities and systems of meaning. School leadership, geographical characteristics and internal community organization seem to influence how participation is valued and enacted. Challenges remain in the interpretations of community participation, including counter- and non-participation of members.

Originality/value

The study contributes to an understanding of policy implementation and the implications of a HPS approach to health education and health promotion in small rural schools.