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Revista de la Facultad de Medicina Humana
versión impresa ISSN 1814-5469versión On-line ISSN 2308-0531
Rev. Fac. Med. Hum. vol.22 no.3 Lima jul./set. 2022 Epub 09-Jul-2022
http://dx.doi.org/10.25176/rfmh.v22i3.4835
Special Article
Using Intervention Mapping protocol to design a nutrition education material
1University of Montemorelos, Montemorelos, Mexico.
2Mexican College of Lifestyle Medicine, Montemorelos, Montemorelos, México.
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.
Methods:
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).
INTRODUCTION
The lifestyles of the Mexican population1are 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 deficiencies2-3. The Lifestyle Clinic (CEV)4is 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 acceptable5-7.
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 health9, 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 área
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 IM10. 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 objective11.
Process
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: Matrices of 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.
Step 3: Theoretical Methods.
Based on the change objectives, a suitable method is selected to modify the behavioral and environmental determinants previously identified in step two.
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. Matrices of objectives.
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 toTable 1.
Table 1. Matrix of Action objectives, determinants, and changes in objectives.
| Action objectives | Behavioral determinants | Environmental determinants | |||
| Knowledge | Understanding and identification | Availability | Support | ||
| 1.The work team conducts a bibliographic review of fiber consumption. | The team knows the recommendation in grams of fiber intake and the food groups that contain it. | The team comes to understand the relevance of fiber consumption as part of dietary management through culturally acceptable foods in people attending CEV. | The team has access to scientific databases to carry out the literature review | The work team is supported during the bibliographic review. | |
| 2. The work team delimits and organizes the themes | The team knows the order and content of each topic in the material. | The team understands that the topics and the order in which they are presented are relevant to the people who come to the CEV | The team has the tools available to carry out the delimitation and arrangement of issues. | The team relies on the delimitation and arrangement of topics for the material. | |
| 3. The work team designs the printed material. | The team is familiar with the material design process | The team designs the material based on a structure and making use of images, language and colorimetry with which the population with DM that attends the CEV can identify. | The team has available design personnel and the necessary technological tools for the purpose. | Team is supported with feedback during material design | |
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 processing12-13.
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).
Table 2. Evaluation Scores.
| Theme of the magazine | Comprehension | Colors and images | Typeface and font size | Motivation to action | |
| 1 | 5 | 5 | 5 | 5 | 4 |
| 2 | 5 | 4 | 4 | 5 | 5 |
| 3 | 5 | 4 | 5 | 4 | 5 |
| 4 | 5 | 5 | 5 | 4 | 5 |
| 5 | 5 | 5 | 5 | 5 | 5 |
| 6 | 5 | 5 | 5 | 5 | 5 |
| 7 | 5 | 5 | 5 | 5 | 5 |
| Average | 5 | 4.7 | 4.9 | 4.7 | 4.9 |
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 thinking14, which allowed the design of printed educational material for healthy eating. Using this process responds to the recommendations for developing HP15, since those educational materials are based on theory and evidence and have been reported to have a higher probability of effectiveness16.
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 programs17-19. Although there is little evidence of the use of IM in Mexico20, 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 inequities21.
ACKNOWLEDGEMENTS:
To the Lifestyle Clinic and the Master of Public Health from the University of Montemorelos
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8Article published by the Journal of the faculty of Human Medicine of the Ricardo Palma University. It is an open access article, distributed under the terms of the Creatvie Commons license: Creative Commons Attribution 4.0 International, CC BY 4.0(https://creativecommons.org/licenses/by/1.0/), that allows non-commercial use, distribution and reproduction in any medium, provided that the original work is duly cited. For commercial use, please contact revista.medicina@urp.edu.pe.
Received: April 04, 2022; Accepted: June 29, 2022
Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons
