ABSTRACT

Introduction: Evidence-based and culturally acceptable educational materials have proven to be effective tools for promoting healthy eating. Objective: To design printed educational material depicting healthy eating using Intervention Mapping for use in a Lifestyle Medicine Clinic. Methodology: Intervention Mapping methodology was implemented in proceeding order: 1) Establishing needs assessment, 2) Matrix of objectives, 3) Theoretical methods, and 4) Design. Results:The PRECEDE Logic Model was followed along with the matrix of change objectives based on the determinants of knowledge, identification, availability, support, and information processing was used as a theoretical method. A 22-page magazine with content, images, and text was obtained based on the Intervention Mapping steps. Conclusions: The Intervention Mapping process provided evidence-based and participatory inputs for the design of educational material for a Lifestyle Medicine Clinic in this particular study.

Keywords:Health promotion, public health, education (MeSH).

RESUMEN

Introducción: Los materiales educativos basados en evidencia y culturalmente aceptables han demostrado ser una herramienta efectiva en el fomento de la alimentación saludable. Objetivo: Diseñar un material educativo impreso en alimentación saludable usando Intervention Mapping para una Clínica del Estilo de Vida. Metodología: Se utilizó la metodología de Intervention Mapping con los pasos 1) evaluación de necesidades, 2) Matrices de objetivos, 3) Métodos teóricos y 4) Diseño. Resultados: Se construyó el Modelo Lógico PRECEDE, la matriz de objetivos de cambio basado en los determinantes conocimiento, identificación, disponibilidad y apoyo y se utilizó el procesamiento de la información como método teórico. Se obtuvo una revista de 22 páginas con contenido, imágenes, texto y redacción basado en los pasos de Intervention Mapping. Conclusiones: El proceso de Intervention Mapping proporcionó insumos basados en evidencia y participativos para el diseño del material educativo de la Clínica del Estilo de Vida en estudio.

Palabras Clave: Promoción de la Salud; Salud Pública; Educación. (fuente: DeCS BIREME).

INTRODUCTION

The lifestyles of the Mexican population ⁽¹⁾ are characterized by a diet high in saturated fats, added sugars, salt, meat, low levels of physical activity, and sedentary behavior, which are factors related to the high prevalence of morbidity, mortality, and micronutrient deficiencies ^(2-3). The Lifestyle Clinic (CEV) ⁽⁴⁾ is an institution in northern Mexico that implements intervention programs in behavior change, lifestyle, and healthy plant-based eating which seeks to systematize its educational materials since these have proven to be an effective tool in promoting healthy eating when they are evidence-based and culturally acceptable ^(5-7).

In this sense, we propose evidence-based processes and methodologies in health promotion and education to follow in the construction of materials and interventions. Intervention Mapping (IM) is a systematic process that guides planning and practice in health promotion and education (HP) ⁽⁸⁾. Encouraging access to information and developing skills and abilities that allow people to have control of their health ⁽⁹⁾, is a principle proposed by HP in which healthy eating is included. Therefore, the objective of this research was to design printed educational material about healthy eating using Intervention Mapping for a Lifestyle Medicine Clinic.

METHODS

Design and study area

The present study utilized a methodological design in which IM was used for the design process of the educational material from January to August 2021, taking into account four of the six steps contained in IM ⁽¹⁰⁾. The scientific rigor and the quality of the content of materials or tools allow for greater effectiveness in health education. In this sense, a methodological process such as IM allows for the development of materials for health promotion and education. A methodological process is the fulfillment of minimum standards for the achievement of an objective ⁽¹¹⁾.

Procedure

Step 1: Needs assessment.

As a first step, a multidisciplinary work team is established to diagnose and prioritize evidence-based health needs and review the dietary patterns and health profiles of the patients who attend the clinic. Based on this, the PRECEDE Logic Model is generated, which establishes the main health needs of the population, the quality of life of patients who have specific health issues (sypmtoms or signs of a present chronic condition), as well as the behavioral and environmental factors that precede it, and its determinants.

Step 2: Objectives.

From the construction of the first step, the main objective of the study is defined and a matrix is proposed which identifies and establishes behavioral and environmental determinants to propose specific objectives for change.

Methods.

Based on the change objectives, a suitable method is selected to modify the behavioral and environmental determinants previously identified in step two.

Step 4: Design.

With this information, the team designs and tests for comprehension, attractiveness, and motivation of the structure, content, themes, messages, images, and colors of the educational material it designed.

Ethical aspects

The Ethics and Research Committee of Montemorelos University approved the research protocol with reference 2021-012-CI72.

RESULTS

Step 1. Needs assessment.

A multidisciplinary work team was established consisting of two dietitians, one physician, one diabetes specialist, one physiotherapist, one health professional, and a graphic designer. 57% of the team were women (n=4), the average age was 32 years and all members were involved in Lifestyle Medicine practice. To define the central health problem, the dietary records of people attending the CEV during the last year were analyzed and a lack of a healthy diet was identified and prioritized. The team reviewed the scientific literature on the problem and constructed the PRECEDE Logic Model, which establishes the affectation in the quality of life derived from the problem as well as the analysis of the behavioral and environmental factors and their respective determinants that precede the lack of a healthy diet (Figure 1).

Step 2. Objective matrixes.

As the main objective of the study, the design of printed educational material on healthy eating for people attending the programs offered at the CEV was established. For this purpose, actions to achieve the objective, behavioral and environmental determinants were identified, according to Table 1.

Step 3. Theoretical methods.

Information Processing Theory was selected as the theoretical method to address the determinants of step two. This theory is characterized by using a pattern as a stimulus in understanding the subject. It can be applied in printed educational materials through images or messages since these support memorization and information processing ^(12-13).

Step 4. Design.

A magazine-type printed educational material was developed, entitled "Revista de educación en alimentación saludable", with a cover page, CEV logo, table of contents, foreword, and contents including nine topics: 1) fiber, 2) how to increase fiber intake, 3) fruits, 4) glycemic index and load, 5) vegetables, 6) legumes, 7) cereals and tubers, 8) seeds and fats, and 9) foods without fiber. For each topic, images of foods known among the Mexican population were attached, as well as values of some nutrients. It was written in Spanish and calorimetry was used according to the proposed objective. The digital design was tasked to the graphic designer who used the program InDesign Adobe cc version 2018, in order to generate the first version. This first draft proposal received observations from the work team, which were addressed and a second version was produced. The latter went through a process of evaluation of the subject matter, comprehension, colors and images, font type and size, as well as the motivation for action among the members of the working group (Table 2). Finally, the magazine was printed on glossy Couche paper with a size of 8x10 inches (Figure 2).

DISCUSSION

The present research was developed under the IM methodology, which is an evidence-based process that integrates participation, the ecological model, behavioral theories, and systems thinking ⁽¹⁴⁾, which allowed the design of printed educational material for healthy eating. Using this process responds to the recommendations for developing HP ⁽¹⁵⁾, since those educational materials are based on theory and evidence and have been reported to have a higher probability of effectiveness ⁽¹⁶⁾.

Although IM consists of six steps, in this research only step four is presented. This process has been used for different health topics including the development of materials for food and nutrition health promotion and education programs ^(17-19). Although there is little evidence of the use of IM in Mexico ⁽²⁰⁾, the development of actions in HP requires methodological processes that provide the scientific quality, evaluation, and attention to behavioral and environmental changes needed to promote health and reduce inequities ⁽²¹⁾.

CONCLUSIONS

The design of a printed educational material was developed through the Intervention Mapping process, which provided evidence-based inputs to be used in actions aimed at health promotion and education for the Lifestyle Medicine Clinic in this study.

ACKNOWLEDGEMENTS

To the Lifestyle Clinic and the Master of Public Health from the University of Montemorelos.