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The promotion of healthy diet in childhood from an intercultural perspective

Mª de los Angeles Merino Godoy1
1Hospital Juan Ramón Jiménez, Huelva, España

Mail delivery: C/ Miguel de Unamuno, 12, 2ºI 21004 Huelva, España

Manuscript received by 7.03.2006
Manuscript accepted by 22.08.2006

Index de Enfermería [Index Enferm] 2006; 55: 54-58








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Merino Godoy MA. The promotion of healthy diet in childhood from an intercultural perspective. Index de Enfermería [Index Enferm] (digital edition) 2006; 55. In </index-enfermeria/55/e6270.php> Consulted





The final end of this investigation is to develop the school-children's and their parent's responsibility about feeding. It has been used a nature description mix model, which is based in the combination of qualitative and quantitative techniques. This research has carried out on the childhood, also has considered the diversity cultural that is living together nowadays at the classroom.
After analyse the educational context in all its fields (school dinning room, health centre, health and educational administrations, town halls, families, etc) it has been design and educational proposal. These programmes have been elaborated from the detected needs and try to raise and train at the educational community in relation with the importance of the healthy feeding at the childhood. In any case, we have to respect and enrich ourselves, at the same time, from what others cultures offers to us.
It is due to a common project that owe came from the administrations, from it is needed a constant cooperation between the institutions mentioned before. It is based in an integral education deep in all the fields (advertising, food establishment, families, etc.) and that include the realization of an educational programme through the television.









    Health and education are the motor forces that guide our lives. Such statement lead us to choose the topic Health Promotion at the school (SHP) for the current research, focussing on food habits since, after the theoretical analyses, we were successful in detecting the impact1 that inadequate diet habits are causing at all levels (social, economic and political) among child population. The cases of obesity in children are getting more frequent. In Spain, 16 out of 100 children are obese.2 Chronic cardiovascular diseases that formerly were usually detected only in adult people are affecting childhood.
    Besides that, the current research has been undertaken considering the cultural diversity that can be found in classrooms nowadays. The Spanish province of Huelva, one of the first regions
3 in Andalusia in immigrant population, is also putting aside its food habits and adopting the new ones imposed by developed countries, based on fast food and a fat-rich diet.
    Our objective consists of boosting self-responsibilities in schoolchildren and their families as far as a healthy diet is concerned. In order to get it, we have focussed on the following specific goals: (1) to know about previous ideas, (2) to detect educational needs, (3) to describe the treatment of this area in the teaching-learning process, (4) to discover whether diet habits of schoolchildren coming from other cultures are taken into account in their own educational context, especially in the school dining-hall, and (5) to outline an educational intervention program, paying attention to the intercultural approach.


    In order to reach the abovementioned objectives, we have decided to undertake a working process organized in three stages. The first one, when the theoretical frame was elaborated, let us arouse our interest for the importance of diet in physical, psychic and social development of schoolchildren,4 reason why we opted for a detailed analysis of this concrete aspect of school HP in a second stage, where we evaluated the context aiming to outline an educational proposal, shaping up the third and last stage.
    For our research we have used a mixed descriptive model, based on the design of two kinds of instruments: qualitative and quantitative.

Stage 1. Theoretical frame

    SHP and diet habits are influenced by a great many physical, psychic, social and cultural factors in constant evolution and change.6 In order to get to understand this starting situation, we have taken into account most of the perspectives that converge around this subject matter, that is at the same time a topical, controversial one and constitutes a real social problem.

Stage 2. Assessment of the context

    The initial phase of second stage, in which we evaluated environment, has been a central one for making an outline of the researching techniques: questionnaires, children debates and observation. In this stage, known as roaming, we intended fundamentally to explore the people and places with whom we were sharing our work and to obtain data on the reality subject of study. Following up, we will summarize some of the main conclusions we got, starting from the data obtained during this roaming stage:
- Firstly, our studies reveal a change in the eating habits,
7 for example skipping breakfast and the consumption of fats, sweets, industrial pastry and fast food to excess, and a decrease in the ingestion of fruit, vegetables, legume and fish, principally.
- With regards to the educational curriculum of pre-school
8,9 and primary education10,11 in Andalusia, this healthy diet and interculturality are only envisaged from transversality, that is, from the education in values.12 In pre-school education, besides transversality, these factors are included in two out of the four contents that make up the field of "Identity and personal Autonomy".
    At a national level, in the new normative that establishes the curriculum in pre-school education (Real Decreto 114/2004, 23 January),
13 a well-balanced diet and elemental guidelines of coexistence are regarded as two of the key goals. We hope they will be developed and carried out in the autonomous region of Andalusia, enjoying enough and effective resources. It is also necessary that such objectives will be prime objectives at all educative levels, not only in pre-school education. In this sense, as far as LOE is concerned, we are referring to the new Educative Law;14 in pre-school education we go on working bearing globality in mind, but in Primary education, these contents become part of a subject called Education for Civic Responsibility.
- However, these contents hardly have a reflection on teachers' continuous education
15 neither in initial education, because it is not a core or compulsory education, only optional, and leaves the teacher the responsibility of being educated in that field. We hope LOE will come along with the incorporation of this new subject also in the teacher's formation and not only in the school curriculum.
- Regarding the role of institutions (Townhall, Spanish Office of Health and Education), they offer programs with healthy diet and intercultural education as their main goals, although their subject matters have never been mixed. We will describe some of the assessments about these programs: they are only put into practice if the educative centre requires them; this assessment is insufficient, results will be influenced by the pedagogical approach applied; they barely devote a part of their concrete actions to families or to the school dining hall.
- We think it necessary to incorporate, through these programs, a proposal of activities coordinated with health centres, since they can make up a union link between the school and families, in order to warrant the efficiency of Health Education programs.
- Regarding intercultural education, we have to point out that immigrant students are growing increasingly in the Andalusian region of Huelva, what has caused educative programs to pay attention to priority needs required by schools, that is, communication, so taking part by using Spanish-learning programs exclusively. So human and didactic resources intended to develop a comprehensive education for students coming from other cultures are necessary.
- Finally, we would like to highlight the Instructions issued by the Regional Government of Andalusia (2004)
16 regarding the implementation of a normative regulating the organization and functioning of school dining halls, that consider the dining hall as an educative service that completes the educational institution work, that is why it should be integrated in the educational project of the teaching center and care should be taken trying not to turn it into a food service.
    Well, once this roaming stage was finished, we got enough data to go into the context assessment in greater depth through the implementation of questionnaires, children debates and the observation techniques.
    The selection of the study population responds to two main justifications. Firstly, an adequate diet is essential for everyone, but especially for children due to two basic reasons: on the one hand, because of the increase of caloric, protein and some micronutrient needs indispensable for this growth period, and on the other hand, childhood is the period that shapes the base for habit-acquisition. Secondly, inside school, the dining hall is the educational space par excellence for the praxis and habit-acquisition. Moreover, it favours social relationships, as it is the best means to know the diet habits of every culture that coexist in the educational center.

Central Techniques of the research. Questionnaires. The abovementioned aspects motivated our decision of projecting the research into public schools that offer a dining hall service, focussing in the level of pre-school and the two first years of primary education. We also had into account that these schools had children coming from other cultures among their students and that they were relatively close to each other. So we decided to select the public schools of the city of Huelva and its surrounding area, and we took in addition to this population three more schools in the coastal area, since they are the public schools in the province of Huelva that receive the highest number of students coming from other cultures. So, during the academic year 2004/2005, the dining hall service was offered by 85 educational centers in the province of Huelva, and we have selected 29 out of them for the application of this technique, carrying out a trial test previous to the delivery of questionnaires. Three questionnaires were delivered, one intended for pre-school and first two years of primary education teaching staff, the second one for the people responsible for the dining hall in these centers and the last one for the students' fathers and mothers.

Children debates. These debates have been organized following the methodology of the discussion group, although we do not dare to call them so regarding the age of the participating subjects. Four groups of debate were established in two educational centers of the selected schools for the implementation of questionnaires; so two study groups were carried out in each school, one for pre-school and a second one for primary school (first two years). For this purpose, we chose a school in town and other in the surrounding area, in such a way that both centers would have a good number of students coming from different cultures.

Observation. We consider it necessary to explore diet habits in the life of the educational center, mainly in the hidden curriculum of the school, because values have as much or even more representation in what is transmitted through a real coexistence in school; the observation instruments used for this purpose where the following ones: taking field notes, photographs and the analysis of the documents, in this case, textbooks and the dining hall menus.
    These observation techniques have also been taken into practice in all the 29 public schools in the town of Huelva and its surrounding area that offer a dining hall service. We include here two schools that were excluded for the implementation of questionnaires, because they showed certain limitations in the development of such instrument. However, there was no problem in integrating them in the context assessment by means of the observation techniques. So, the selection of schools for observation increased to the number of 31 schools in all.

Conclusion: Once we have evaluated all the data results, we will show some of the main conclusions reached regarding the different aspects on study.

School dining halls
- There has been an increase in the students having lunch in the school dining hall, and many of them have also breakfast in the school morning class. As a consequence, more services like this are being created in schools, sometimes rather quickly by request of families, using for this purpose, the scarce economic funding they had.
    - Some families claim for an improvement in dining hall services, such as serving less fried food and "elaborated" food in menus and a stronger watchfulness of students' eating habits. It is also necessary to train the instructors and to increase the number of collaborators, to inform families about the eating behaviour of the children, to elaborate balanced and varied menus in the design of which nutritionists will have to take part, to go through cooking techniques, to supply these services with ventilated spaces far from the toilets and next to basins in order to make hand-washing easier, to foster a Mediterranean diet and a higher involvement of the people responsible for the dining hall. In short, we are talking about aspects already regulated in the Plan de Calidad de Comedores
17 (quality dining-hall plan), el Plan de Apoyo a las Familias18 (Family support plan) and all the legislation controlling the organization and functioning of the dining-hall services, but they are not taken into practice.
    - In this sense, some of the people responsible for this service do not agree with the educative labour carried out in the dining-hall, they put forward reasons such us the lack of training in collaborators and an excessive number of three-years-old children having lunch, that claim all the attention for themselves.
    - It is also necessary to have into account the cultural diversity in the dining-hall, not only in the classroom, reason why they have to foster knowledge, respect and tolerance for the eating habits of those students belonging to other cultures and not to limit themselves to serve an alternative kind of meat to the Muslim students who demand so.
    - Other service that has to be submitted to further watchfulness is the Morning Classroom, where breakfast is served to students; most of them also have lunch in the school dining-hall, so there is a great number of students who have the main daily meals in school, so it is important to control the functioning of these services.

- The education at home is essential
19 for the acquisition and maintenance of healthy eating habits.
    - Mothers are normally those who take care of the nutrition of children and it can be said that more than half of the mothers in the population on study have a job, so many of them take the lack of time as one of the main problems in making difficult the implementation of these eating habits.
    - Only some mothers and fathers (36,6%) prepare the rest of the meals of the day according to the lunch the children have taken in the school dining-hall in order to offer them a balanced and varied diet. With regard to those who fail to do so, most of the cases are due to the lack of time, some others do not know how to do it, and the rest is a matter of ignorance of what their children are eating in the dining-hall.
    - Most of the students do not take a complete breakfast,
20 something that should be taken seriously. It would be advisable to get up a little earlier and to have breakfast together with the family, something that it is normally done only during the weekend.
    - With regard to the students, they have a rather scarce knowledge about healthy nutrition.
    - On the other hand, almost half of fathers and mothers (40,2%) consider they need information on how to educate their children in order to acquire the right eating habits.

  - Publicity
21 exerts a deep influence on this population. However, we observe a great enthusiasm when they talk about the pizzas and hamburgers their own mums cook for them, and the same occurs with other meals.
    - This fact demonstrates that it is possible to fight against commercial brands, fostering homemade meals and even more if they are allowed to participate in the elaboration of meals, they will enjoy them much more, so they will learn more and at the same time they will get a great deal of autonomy.

What schools are especially worried about is breakfast, so in many centers only the food that makes up a healthy breakfast is allowed. Some teachers do not find a support in families, saying that they only tend to comfort, they attach very little value to diet and they only follow the advice during the first days, being forgotten shortly after, so they have to insist constantly on it.
    - Moreover, the existing resources and methodology to deal with a healthy diet in school seem to cause difficulties.
    - Most of educative activities refer to detailed activities, not from transversality; Mediterranean diet is not promoted, and the intervention involving families is a scarce one.
    - A part of the teaching staff (34,1%) admits they need information and specific training on how to educate students in order to acquire healthy diet habits. They demand more information on certain aspects, such as family participation, diet habits in other cultures, the modification of eating habits, nutrition and dietetics, diseases related with nutrition and the didactics of this topic.
    In conclusion, in the schools selected, no comprehensive education including our subject of study is performed. It seems that an especial emphasis is placed on the ground of nutrition including school hours, that is, midmorning breakfast. All in all, teachers know about the importance of nutrition for health, but they consider that health workers, management and families must also collaborate; at the same time, these latter groups think it is also teachers' responsibility.

Health-centers. In most of Primary Health Care Centers no collaboration initiatives exist, and the scarce collaboration (8%) consists of specific and isolated actions that will probably have little result if coherence and coordination with the school pursuing a common goal is not transmitted.22

Intercultural dimension
- As far as an intercultural perspective is concerned,
23 both students of Spanish origin and those coming from other countries do not know about the eating habits of their own culture and those of the rest of their schoolmates, so no problems have been detected regarding the respect for these customs among students.
    - Most fathers and mothers (90,1%) assess the necessity of coexistence among children and the relationship of their kids with schoolmates born in other countries from an early age, favouring this way their personal enrichment in different fields.
    - On the other hand, however, it is worrying the fact that in some cases (12,1%) xenophobia, lack of solidarity or intolerance, especially towards Muslim culture have been detected.
    - Many of the individuals polled (77,3%) also believe that knowing the eating habits of schoolmates coming from other cultures would be beneficiary for their children.
    - As in students, in the rest of the educational community we can observe how families and teachers show ignorance about these traditions, and some of them show some interest to know them, probably because they come from neighbourhoods with higher cultural diversity.
    Well, coinciding with most of the authors, we consider that one of the most relevant conclusions we have reached is that the participation of the community, trying to get them involved in the educational projects on healthy diet is the most difficult point to achieve, but it is completely necessary in order to get satisfactory results in the long term. The performances of school SHP must be multidisciplinary and starting from all fields, implying the whole society, especially families in their participation.

Stage 3. Design of the educational program

    Finally, we reach the third stage, in which we pretend to show the internal structure of the educational proposal on healthy diet from an intercultural approach so it can include the most representative requests posed by the population on study during the former stage. There are quite interesting materials24,25 that have been drawn up by the management containing a series of teaching units devoted to healthy nutrition, so these already designed resources can serve as a complement to the educational performance program we are introducing in the current article.

Working process. We have designed a common project that should be started by the management, so constant cooperation is needed among the different institutions (Town halls, provincial health office and provincial education office). This project includes the execution of an educational program using television. With regard to the recipients of this project, it is intended to promote healthy nutrition among childhood in the province of Huelva and among the rest of the educational community. The actions integrating the project are listed following up: (1) diagnosis and treatment in cases of malnutrition in children,26 (2) advice and supervision of school dining-halls, (3) formation of teachers, (4) marketing campaign, and (5) TV programming.
    To sum up, our interest is mainly placed on the possibility of raising awareness and formation among the educational community, so childhood can enjoy healthy and amusing nutrition habits, starting from tolerance and taking advantage of the cultural diversity
27 we are living with.


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