Educação Alimentar e Nutricional no âmbito do Programa Saúde na Escola da cidade do Rio de Janeiro: análise de contexto e desenvolvimento de estratégia de implementação da série de materiais educativos para Promoção da Alimentação Adequada e Saudável

Abstract

The implementation of Food and Nutrition Education (FNE) materials based on the dialogue between food and nutrition topics and basic education curricula has not been studied. This study aimed to develop strategy for implementing a series of educational materials focused on the Promotion of Adequate and Healthy Eating (PAHE) within the scope of the Health in School Program (HSP), based on the context of the city of Rio de Janeiro. This is a qualitative study guided by Implementation Science. The Consolidated Framework for Implementation Research (CFIR) was used to identify barriers and facilitators and support the development of the implementation strategies, and the Expert Recommendations for Implementing Change (ERIC) was used to systematize and categorize the strategies. To understand the context of the HSP Carioca, including social representations and perceptions of key stakeholders, the following techniques were employed: Free Word Association Technique with educators from the municipal school system; semi-structured interviews with PSE coordinators; Focus groups were conducted with representatives of the School and Daycare Health Centers (SDHC) and local professionals, as well as an electronic questionnaire administered to SDHC representatives. Evoc 2005® and QSR Nvivo version 14 software were used to analyze and systematize these data, the latter being used to code and categorize the information. A workshop was developed for key HSP stakeholders to raise awareness of PAHE among professionals, present the series of materials, and collectively develop the strategies for its implementation. Detailed workshop steps were included in the "Technical Manual for Implementing the PAHE Series of Materials within the HSP." Both the workshop program and the manual were evaluated by a panel of experts. The content, writing, layout, and slides of the manual, as well as the syllabus, objectives, schedule, and duration of the workshop, were evaluated. The workshop was piloted with representatives from the SDHC and general coordinators of the HSP. The professionals noted a lack of coordination between the HSP sectors (Social Assistance, Education, and Health) and a lack of joint planning. Although they recognized the cross-cutting nature of the FNE, they pointed out practical difficulties in implementing it. Local-level professionals reported feeling unprepared, approaching the topics with little theoretical basis, despite seeing themselves as multipliers in their fields. Motivation, while high, contrasted with gaps in theoretical and practical training, as well as challenges such as lack of time, work overload, and lack of continuing education, factors that favor specific actions over more dialogic and transformative educational practices. During the workshop testing, eight actions were structured, distributed across seven of the nine ERIC categories. Implementation was assessed as relevant and timely. Professionals demonstrated motivation but also reported insecurity regarding conducting FNE actions. The conclusion is that the implementation strategy of the series of materials demonstrates feasibility for application in different regions and the potential to strengthen sustainable FNE practices in the HSP. To achieve this, it is necessary to invest in training processes and in overcoming weaknesses in the implementation of the HSP.