Health promotion at schools has evolved during the past few years from practices centered on health education in class to adoption of comprehensive approach aiming attitudes, skills, and behaviors of youth and their environment. Various studies suggested the need for action by developing nutrition strategies and policies based on comprehensive approaches, reinforcing environments, and consolidating actions joining youth in the most favorable environments for nutrition and physical activity interventions including residence, schools, and communities.
The purpose of this study is to explore the determinants of an eventual School Nutrition Policy (SNP) development by studying the perceptions of different Lebanese key stakeholders.
This qualitative exploratory study proposed an innovative conceptual framework based on social marketing approach and using several theories and models to approach the SNP development at different levels of action. Purposive sampling was used to recruit 32 multidisciplinary key stakeholders active in various communities and sectors, especially in health promotion in Lebanon (governmental parties, municipalities, non-governmental organizations, UN agencies, dietitians, pediatricians, food industry, school health advisers, journalists, health experts, and academic researchers). Directed and semi-structured individual interviews were conducted for a maximum duration of 60 min. Interviews were audiorecorded and analyzed using a thematic qualitative analysis.
The comprehensive conceptual framework amalgamates several variables involved in the process of health promotion under various categories (community/individual/organizational) to facilitate SNP development and evaluation. Variables are interconnected altogether to gain an insight of perceived barriers and facilitators to SNP development. Collaboration, coordination, public participation, partnership, advocacy, and leadership are identified as the main facilitating factors. However, the major barriers are the socioeconomic instability, the social structure diversity, and the political and religious divisions.
By combining social, behavioral, organizational, and communication theories and models, this study offered opportunities to comment on how a SNP is intended to work to achieve the desired health goals. This study explored several determinants envisaged in the SNP development that helps the decision- and policy-makers in their promotion and communication practices.
Health promotion, key stakeholders, Lebanon, nutrition, perceptions, physical activity, school nutrition policies, schools