ABSTRACT
Objectives: Mexico, as many developing countries, is undergoing a nutrition transition characterized by the coexistence of undernutrition (stunting and micronutrient deficiencies) alongside obesity and chronic diseases. Training of health workers needs to build and reinforce the essential competences, skills, and attitudes adapted to this changing context. The objective of this paper is two-fold: 1) to describe the process of development of a national training system at the primary care level to address nutrition transition in Mexico, and 2) to identify the factors, processes, and strategies conducive to the establishment of an effective national training system. Methods: This paper is a case study that uses participant observation and document review as primary methods for data collection. Results: Based on formative research, we developed an in-person cascade training for primary care physicians, nurses, and community health workers. We tested and evaluated the training in four states in Mexico. Results showed that it was not successful in reaching the lower levels of the cascade. We redesigned the training system by: 1) developing monitoring and supervision components, 2) reducing the number of levels of the cascade, and 3) developing virtual (online and offline) training modules. In addition, instructional designers adopted a competence-based approach to redesign the training, and structured new and interactive activities to enhance learning. Conclusions: Training systems should have monitoring and supervision components to ensure adequate adoption and implementation. The use of technology and instructional design has the potential to improve the effectiveness of the training system.