ABSTRACT
There is an increasing interest in having validated instruments that can classify food environments due to their influence on eating behavior and nutritional status. In Chile, it is not known how people perceive food environments and only a few studies have adapted instruments to the Chilean context, all of which use objective measures. The aim of this study is to present the adaptation and validation of the Perceived Nutrition Environment Measures Survey (NEMS-P-Ch) for Chile using a cross-sectional, non-probability study. First, the NEMS-P was adapted in 3 stages: cultural translation and adaptation, expert judgment (focus groups), and cognitive interviews with a population similar to the target audience. Then, the adapted questionnaire (NEMS-P for Chile, NEMS-P-Ch) was tested on people responsible for buying food in their homes in the Metropolitan Region, Chile, for statistical validation. After 200 people completed the questionnaire a final version of the NEMS-P-Ch was generated with 48 questions and seven sections that measure food environments: home, food supply, restaurants and street. NEMS-P-Ch had acceptable reliability in more than half of the questions analyzed, with Cronbach's alpha values between 0.44 and 0.82. Acceptable values were also obtained for most of the questions when the consistency of the instrument was evaluated after applying it for the second time (n= 167). The NEMS-P-Ch adapted to the Chilean context showed acceptable validity and reliability. Having instruments adapted and validated to the national reality will promote their use and adaptation in other countries of the region and thus deepen the study of food environments in various territories and populations.
El creciente interés por contar con instrumentos validados que clasifiquen los ambientes alimentarios se debe a la influencia que estos tienen en la conducta alimentaria y el estado nutricional. En Chile, se desconoce cómo las personas perciben los ambientes alimentarios y son pocos los estudios que han adaptado instrumentos al contexto chileno, todos utilizando medidas objetivas. En este estudio se presenta la adaptación y validación para Chile de la Encuesta de Medición del Entorno Nutricional Percibido (NEMS-P-Ch). Estudio transversal, no probabilístico. Inicialmente, NEMS-P fue adaptado siguiendo 3 etapas: traducción y adaptación cultural, juicio de expertos (grupos focales) y entrevistas cognitivas con población similar a la audiencia objetivo. Luego, el cuestionario adaptado (NEMS-P-Ch) fue testeado en personas responsables de la compra de alimentos del hogar, Región Metropolitana, Chile, para finalmente validarlo estadísticamente. Tras su aplicación a 200 personas, se generó la última versión de NEMS-PCh, instrumento con 48 preguntas y 7 secciones que mide los ambientes alimentarios: doméstico, de abastecimiento, restauración y vía pública. NEMS-P-Ch mostró una confiabilidad aceptable en más de la mitad de las preguntas analizadas, con valores alfa de Cronbach entre 0,44 y 0,82. También se obtuvieron valores aceptables en la mayoría de las preguntas cuando se evaluó su consistencia al aplicarlo por segunda vez (n= 167). NEMS-P-Ch adaptado al contexto chileno mostró una validez y confiabilidad aceptables. Contar con instrumentos validados a la realidad nacional promoverá su uso, su adaptación en otros países de la región y la profundización del estudio de los ambientes alimentarios en diversos territorios y poblaciones.
ABSTRACT
OBJETIVO: Explorar las perspectivas de tomadores de decisiones y miembros de la comunidad en atención primaria en salud (APS) en torno a la conceptualización de la participación social (PS). DISEÑO: Estudio transversal de carácter exploratorio con metodología cualitativas. Emplazamiento: Centros de Salud de la Región Metropolitana (RM), Santiago, Chile. PARTICIPANTES: Ocho informantes del nivel directivo (grupo 1), 13 del nivel de ejecución en APS (grupo 2) y 28 miembros de la comunidad y cuatro agentes comunitarios de salud (grupo 3). MÉTODO: Se realizaron entrevistas y grupos de discusión, que fueron grabados y transcritos. La organización y análisis se realizó con Atlas.ti 8.1. Las narrativas fueron sistematizadas mediante un análisis temático. Se codificó la totalidad de los documentos a través de reuniones periódicas para revisar los códigos existentes y para discutir la inclusión de nuevos códigos. RESULTADOS: El grupo 1 remite concepciones más teóricas acerca de la PS. El grupo 2 expresa dimensiones más concretas y operativas. El grupo 3 indica que la PS se encarna en experiencias particulares, vividas cercanamente por quienes las relatan. Los grupos 1 y 3 poseen más de una noción de la participación social en salud. CONCLUSIONES: Predomina transversalmente una concepción institucional de la participación, arraigada desde la década de 1990. En el nivel de la comunidad, las narrativas adquieren la forma de prácticas colectivas vividas en torno al mejoramiento de la calidad de vida comunitaria mediadas por el nivel de ejecución
OBJECTIVE: To explore the perspectives of the decision makers and community members in primary health care (PHC) around the conceptualization of social participation (PS). DESIGN: An exploratory cross-sectional study with qualitative methodology. LOCATION: Health Centers of the Metropolitan Region (RM), Santiago, Chile. PARTICIPANTS: Eight informants from the management level (group 1), 13 from execution level in PHC (group 2), 28 community members and four community agents of health (group 3). METHOD: Interviews and discussion groups were conducted, which were recorded and transcribed. The organization and analysis of the data was done with Atlas.ti 8.1. The narratives were systematized using a thematic analysis. All the documents were codified, and we hold periodic meetings to review the existing codes, as well as discussing the inclusion of new codes. RESULTS: Group 1 refers to a more theoretical conception of PS. Group 2 expresses more concrete and operative dimensions. Group 3 indicates that PS is embodied in particular personal experiences. Groups 1 and 3 have more than one notion of social participation in health. CONCLUSIONS: An institutional conception of participation prevails transversally, rooted since the 1990s. At the community level, the narratives take the form of collective practices lived around the improvement of the quality of community life mediated by the level of execution
Subject(s)
Humans , Social Participation , Primary Health Care/organization & administration , Cross-Sectional Studies , Qualitative Research , Interviews as Topic , Community Health Workers , 57923 , ChileABSTRACT
OBJECTIVE: To explore the perspectives of the decision makers and community members in primary health care (PHC) around the conceptualization of social participation (PS). DESIGN: An exploratory cross-sectional study with qualitative methodology. LOCATION: Health Centers of the Metropolitan Region (RM), Santiago, Chile. PARTICIPANTS: Eight informants from the management level (group 1), 13 from execution level in PHC (group 2), 28 community members and four community agents of health (group 3). METHOD: Interviews and discussion groups were conducted, which were recorded and transcribed. The organization and analysis of the data was done with Atlas.ti 8.1. The narratives were systematized using a thematic analysis. All the documents were codified, and we hold periodic meetings to review the existing codes, as well as discussing the inclusion of new codes. RESULTS: Group 1 refers to a more theoretical conception of PS. Group 2 expresses more concrete and operative dimensions. Group 3 indicates that PS is embodied in particular personal experiences. Groups 1 and 3 have more than one notion of social participation in health. CONCLUSIONS: An institutional conception of participation prevails transversally, rooted since the 1990s. At the community level, the narratives take the form of collective practices lived around the improvement of the quality of community life mediated by the level of execution.
