Sintra Cresce Saudável Project

Within the scope of the principles of health promotion and health education, schools are regarded as key players. The principles of health-promoting schools are based on the Ottawa Charter (WHO, 1986) and the Convention on the Rights of the Child (1989). Therefore, schools play a key role in the development of behaviours that promote a healthy lifestyle, which include nutrition and physical activity. The school is where children spend most of their day and where they eat at least three meals every day. Childhood is when we can achieve better results with regard to the development of knowledge, attitudes and behaviours that prevail in adult life.

Scientific evidence shows us the need to intervene in order to change eating habits and recommends a multidisciplinary approach with a view to obtaining better results. Thus, getting all the stakeholders involved is more effective when it comes to achieving health promotion goals. Therefore, in an educational context, the action group should be composed of representatives of schools, teachers, non-teaching staff, parents, children and health professionals.

In addition to these elements, the intervention should be multicentric, acting in different domains in an integrative way: academic curriculum, educational environment, school feeding, the school community, and the health services. However, depending on the specific context and reality, the interests and concerns of the community in question should be defined.

With regard to the educational curriculum, food education is a crucial element in the development of healthy lifestyles in children, and it is important that the school’s messages are consistent, mutually reinforcing, and reflected throughout the entire curriculum – “formal, non-formal and hidden”. However, teaching these subjects requires suitably qualified professionals and appropriate resources. Within the scope of food skills, the educational curriculum should cover several categories: nutrition and health; food preparation, preservation, and storage; consumer awareness, consumer rights, and media literacy; food production, processing, and distribution; sustainability and food ecology. By being taught these subjects, children become more aware of the importance of following a healthy diet, they learn how to prepare food economically and ecologically, develop preparation and cooking skills and become empowered to make more informed choices about the food they should eat, by understanding food labels, the nutritional value of food, as well as their own daily needs.

The current relevance of this area and the legal responsibilities of the local authorities within the scope of the promotion of health gave rise to the Sintra Cresce Saudável Project (SCS) | Promotion of Healthy Lifestyles in an Educational Context, promoted by the Sintra City Council, in synergy with the academic community. This is an intervention project to promote healthy lifestyles, aimed at children from the 1st cycle of basic education, supported by a community-based participatory research methodology, which integrates evaluation-planning-intervention cycles. This project relies on the collaboration of academic partners in different areas of knowledge (Health and nutrition, physical activity, communication), and the Faculty of Medicine of the University of Lisbon (FMUL) takes the technical-scientific leadership of the project, ensured by a researcher in charge of that responsibility – Dr. Telma Nogueira. We should also note that there is an Advisory Board consisting of national reference entities in the main areas of activity of the project.

The major objectives of the project are developing an intervention model to promote healthy lifestyles in educational contexts, evaluating the impact of the intervention and fostering the definition and dissemination of the intervention model.

The intervention of the SCS is focused on the players in the school community: students, families, teachers, and non-teaching staff, and prioritizes 3 axes:

1. Development and implementation of Curriculum Enrichment Activity (AEC) or Complementary Offer
2. Intervention in the School Food Environment – definition and implementation of the School Food Policy
3. Intervention in the Educational Curriculum – integration of healthy eating principles into curricular activities

The interaction between these axes and the participatory intervention promote an innovative approach, fostering the development of the dimensions of empowerment for health promotion (behaviours that promote healthy eating and physical activity) and the development of competences such as self-regulation, problem solving, communication, and creative and critical thinking, foreseen in the Profile of the Students who are leaving compulsory education.

This project, in addition to its innovative nature, is scientifically robust and may have the ability to change behaviours, aiming at short- and long-term health gains, based on the school-family-local authorities triad, fostered by the academic community.

The pilot project was implemented in the 2017/2018 school year in a school group where about 500 children were involved in the intervention group. A control group with a similar number of children (from another school group in the municipality) was created for evaluation purposes.

Several activities were developed over the last year: diagnosis of needs; involvement of the school community; creation of a network of partnerships; planning of the intervention with the school community; engagement of all the players, making them responsible for the implementation and evaluation of the project.

The activities are currently being disseminated in 2 other school groups (nearly 1300 children).

In the context of the axis of intervention in the school food environment, the instruments and methodology for evaluating snacks consumed in educational contexts were developed and are currently being analysed and qualitatively and quantitatively evaluated. The school’s food policy is defined and implemented according to the results obtained.

The FMUL is proud of this partnership and of contributing with its scientific know how to such a relevant Public Health project whose health gains and long-term results will surely be very positive for the children of the municipality of Sintra