Participatory Intervention to Improve Nutrition and Physical Activity in Schoolchildren From Acatlán de Juárez, Jalisco
Phase: NA
Conditions: Sedentary Behavior, Adipose Tissue, Child Obesity
Sponsor: Iberoamerican Institute of Sports Science and Human Movement

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
STUDY PROTOCOL:  
Participatory intervention to improve the nutrition and physical 
activity of school children in Acatlan de Juarez, Jalisco 
 
Summary 
Introduction 
 
This is a community project carried out in partnership between the Technologic Institute of 
Higher education in the West (ITESO, in Spanish: Instituto Tecnológico de Estudios 
Superiores de Occidente), the Tonala University Center of the University of Guadalajara 
(CUTonala, in Spanish: Centro Universitario de Tonalá de la Universidad de Guadalajara) 
and the University center of health science from Guadalajara University (CUCS, in Spanish: 
Centro Universitario de Ciencias de la Salud de la Universidad de Guadalajara) with 
consultancy of the National Institute of public health (INSP, in Spanish: Instituto Nacional de 
Salud Pública), financed by the company Tresmontes Lucchetti and endorsed by the Jalisco 
Association of Nutritionists, A.C. (AJANUT, in Spanish: Asociación Jalisciense de 
Nutriólogos). The present Project complies with the “National Strategy for the Prevention 
and control of Overweight, obesity and diabetes” (In Spanish: “Estrategia Nacional para la 
Prevención y el control del Sobrepeso, la Obesidad y la Diabetes”) signed by the Federal 
Government executive. It also follows the accords that establishes the general guidelines 
for sale and distribution of processed and cooked food and beverage in Schools from the 
National Education System, suggested by the national ministries of health and public 
education. The references mentioned before have the objective of protecting and improve 
health in Mexican kids. 
General Objetive 
 
Assess the functionality and effect of a participatory intervention to improve nutrition and 
physical activity within the school environment in kids between 6 and 10 years old from 
public elementary schools in Acatlan de Juarez, Jalisco, Mexico. 
Proposed Methods 
The project is a community trial with a three-year duration that includes an intervention group 
and a control group of 3 different schools each. Acatlan de Juarez has a total of 11 
elementary schools. 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
The strategies will be implemented in collaboration with local authorities from Acatlan de 
Juarez, school campus authorities, personnel from ITESO, CUTonala, CUCS, and AJANUT. 
Key actors will be included in all study stages from both school and community settings, with 
the goal to adapt the strategies to be social and culturally acceptable and promote 
community ownership of the project. There will be an initial study of the project’s viability 
and the actual conditions of food intake and physical activity in schools, including a 
community perception. The research team will design the contents and materials for the 
intervention, considering the intakes of opinion and suggestions of the community and the 
initial study results. The schools from the control group will be selected from the municipality 
of Villa Corona, Jalisco, which is similar to the Acatlan de Juarez municipality. 
The strategies proposed for intervention from the research team, that will be consensed with 
the community, goes as follow: 
• 
Vigilance in the compliance with the regulation of food sales on the school ground in 
accordance with official guidelines. 
• 
Sensibilization of children, parents, teachers (especially the ones in charge of Physical 
Education), and food supply staff (in the school food store) to improve acceptance and 
compromise to food sales regulation. 
• 
Training on hygiene and nutritious food preparations for personnel in charge of the 
school’s food store. 
• 
Promotion of consumption of simple water and healthy food. 
• 
Rescue and promotion of consumption of local foods 
• 
Refurbishment of infrastructure for the consumption of simple water for free and healthy 
foods, as well as the realization of physical activities. 
• 
Event organization and support on group coordination that promotes physical activity at 
the community level. 
• 
Optimization of Physical Education Classes at school. 
• 
Implementation of health promotion and care actions in the school context. 
• 
Skill development in school community for health care and the generation of healthy 
school environments. 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
• 
Creation and/or strengthening of health and nutritional committees in school, with 
principals, teachers, and parents’ participation to generate primary and permanent 
conditions that favor healthy contexts. 
A member of the research team will be in charge of implementing and monitoring each of 
the schools’ strategies from the intervention community during the study. 
Monitoring and evaluation of the impact of the intervention will be assessed through a 
community trial. There will be three schools as a study group and three as a control. There 
will be three different periods of measurements: 
• 
a baseline measurement in the 2015-2016 school year 
• 
an intermediate measurement in the 2016-2017 school year 
• 
a final measurement in the 2017-2018 school year 
The measurement periods will have an estimated duration of two months each. 
During the measurement periods, the body composition of children from 1st to 4th grade will 
be obtained, and they will be followed up during the next two years; the dynamics of water 
and food consumption, physical activity, functional physical capacities, as well as availability 
and accessibility of food in school will be identified. In addition, a sub-sample of study 
subjects will provide questionnaires on food consumption frequency, additional 
anthropometric measures, and blood samples to determine blood glucose and lipid levels. 
To obtain a bigger approach with the population, instruments of qualitative nature will be 
implemented prior to the intervention, such as focus groups and in-depth interviews, that will 
identify barriers and possible solutions to improve food habits and encourage the physical 
activity of the population. During the periods of intermediate and final measurements, there 
will be similar qualitative strategies applied to procure successes and find possible 
improvement points of the intervention. 
During the implementation of the strategies, there will be a thorough monitoring of the 
locations that will allow identifying the critical changes that can affect eating and physical 
activity habits in any of the two groups (intervention and control) 
 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Introduction 
For 20 years, in Mexico, a growing problem of overweight and obesity has been observed 
in all life stages, including children. Jalisco is one of the states with the highest prevalence 
of overweight/obesity in the school population, surpassing the national average (Instituto 
Nacional de Salud Pública, 2013). Excess body weight (from body fat) is a risk factor for 
many chronic diseases; it is also associated with emotional, psychological, economic, and 
social problems, both for the individual, their families, and the community. The sooner in life 
this condition of excessive wight occur, the greater the risk of developing concomitant 
diseases and the difficulty in reversing these conditions (Reilly & Kelly, 2011) 
The most successful interventions in modifying behaviors and environments that promote 
the development of childhood overweight are those that have within their strategies the 
empowerment of the actors involved, from the planning of the intervention, monitoring, and 
follow-up once the research team is withdrawing from the scenario (Hawkes et al., 2015; 
Hung et al., 2015; Vasques et al., 2014). Also, they seek to modify factors related to 
individual food consumption and the availability of food and beverages, policies, knowledge, 
beliefs, and others (Roberto et al., 2015; Swinburn et al., 2015). 
A conceptual framework has recently been proposed to study overweight/obesity 
development and strategy planning, which has three levels of influence on which various 
risk factors are grouped (Figure 1).  The following describes each of the levels; this study 
will base its strategies on these: 
The basic causes are the most “distant” to the individual; that is, they have more relation 
with the epidemiological and nutritional transition than the individual’s decisions. Within this 
group of causes, we find industrialization, urbanization, globalization, technological changes 
for food production and processing, as well as modifications in transportation, media, work, 
and recreational activities. In addition, here are the regulations surrounding the food and 
physical activity issued by the state. 
The underlying causes refer to the environment’s characteristics closest to the subject; 
these are determined by the basic causes. The availability and accessibility to food and 
beverage with high amounts of energy intake and low micronutrients are the causes within 
this group that have the most significant relationship with the development of overweight 
and obesity. Another causal factor within this group is the change in eating patterns, where 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
local dietary habits have been modified to adopt new ones. This has its origin in lifestyle 
modifications since there is a diminution in the time dedicated to the selection, preparation, 
and consumption of food. Therefore, it relates to the preferences of acquiring processed and 
energy-dense food, which results more convenient, and has advertising and marketing with 
a bigger social penetration. 
At last, the Immediate causes are directly related to the subjects’ behavior and are primarily 
influenced by the underlying causes and, consequently, are also influenced by the basic 
causes. This group of causes, specifically for the development of obesity, results in a positive 
balance of energy, which means higher consumption of energy in comparison to the energy 
utilized by the body, which leads to energy storage, mainly as body fat. The two factors 
responsible for energy balance are diet and physical activity.  The higher the intake of high 
energy food/beverage and less time spent on physical activity, the imbalance energy will be 
more pronounced, and the fat tissue gain will be more significant. On the other hand, the 
genetic and epigenetic factors can contribute to make the energy balance of each individual 
more complicated (or simple) to maintain. 
 
 
 
 
 
 
 
 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
 
Figure 1 Conceptual framework of obesity causes 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
In Mexico, efforts have been made to fight the increasing prevalence of overweight/obesity 
and its consequences on the population through regulations (sale, formulation of products, 
taxes, advertising) and public awareness (media campaigns) (Roberto et al., 2015). 
Currently, the documents containing guidelines to fight and prevent overweight/obesity are 
the "National Strategy for the Prevention and control Overweight, Obesity and Diabetes" (In 
Spanish: "Estrategia Nacional para la Prevención y el control del Sobrepeso, la Obesidad y 
la Diabetes") (Gobierno de la República de México, 2013a) and the "National Plan of 
development 2013-2018" (in Spanish: "Plan Nacional de Desarrollo 2013 – 2018") 
(Gobierno de la República de México, 2013b). In the school environment, specifically, 
guidelines were developed for the sale of food inside the schools of the National Education 
System (Secretaría de Educación Pública de México & Secretaria de Salud de México, 
2014). The present study proposes to evaluate the functionality and effect of a participatory 
intervention to improve nutrition and physical activity within the school environment for 
children 6-10 years of age from public elementary schools. The current project aims to apply 
the general guidelines for sale and distribution of prepared and processed foods and 
beverages in schools from the national education system, including the promotion of 
physical activity in school hours and the implementation of an educational component, 
among other actions at the community level, planed in conjunction with key actors, in Acatlan 
de Juarez, Jalisco, Mexico. Acatlan de Juarez has eleven elementary schools (including 
public, private, rural, and urban). 
 
 
Background 
Obesity is a public health problem in Mexico. Results of representative surveys at a national 
level in 1999, 2006, and 2012 show high increases in the prevalence of overweight and 
obesity in children, teenagers, and adults (Gutiérrez et al., 2012). The prevalence of 
overweight and the combined obesity rate is 34.3% among school children (ages 5-11) 
nationally. In the State of Jalisco, this number has increased and raises to 39.6% (in 2006 it 
was 37.4% in boys and 34.9% in girls) (Instituto Nacional de Salud Pública, 2013). 
Weight gain from the early stages of life is detrimental to individuals' physical and 
psychological health. Developing obesity in childhood significantly increases the risk of 
remaining overweight in adulthood, the risk of presenting chronic diseases, fewer job 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
opportunities, self-esteem conflicts, lower overall quality of life, and higher cost for both the 
individual and the health care system (Lobstein et al., 2015; Paulis, Silva, Koes, & van 
Middelkoop, 2014). 
Over the last decade, there has been increased public and private interest in preventing 
childhood overweight and obesity. Interventions based on individual behavior change have 
been implemented, such as increased physical activity and dietary changes and 
environmental issues that promote healthier lifestyles. Similarly, a significant number of 
studies have been developed to identify risk factors for obesity. In Mexico, there have been 
efforts to improve the health of the population, including the children (Roberto et al., 2015). 
In September of 2013, the federal government and the health ministry issued the National 
Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes, a document 
that establishes action plans to fight these diseases from different approaches. The 
objectives of the strategies are: 
• 
Promote the consolidation of a culture that facilitates the adoption of lifestyles that 
maintain people's health. 
• 
To detect timely and massively the universe of overweight, obesity, and diabetes 
cases to guarantee its proper control and management. 
• 
Generate a platform that allows for trained human resources and inputs sufficient 
to make adequate access to health services. 
• 
Increase the number of patients in metabolic control with type 2 diabetes. 
In addition, within the strategy, there are established axes to achieve the objectives mention 
above, one of which is the Health Promotion. This axis, in turn, includes four groups of 
specific actions for its application. 
1. Promotion of correct nutrition on an individual and collective level (family, school, 
place of work, and community) 
2. Promotion of physical activity on an individual and collective level (family, school, 
place of work, and community) 
3. Educational communication 
4. Generate social participation processes with emphasis on community participation 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
On the other hand, in May 2014, was published in the Official Federal Diary the “Agreements 
to stablish the general guidelines for the sale and distribution of food and beverage made 
and processed in schools of the national education system” (Secretaría de Educación 
Pública de México & Secretaría de Salud México, 2014) for all schools, public and private, 
in which prepared and processed foods and beverages are sold and distributed (Appendix 
1). The main objective of the accord is to promote the health of students in terms of 
nutritional content and hygienic conditions of food and drinks. It is important to mention that 
the guidelines should be implemented from the second semester of 2014. 
The interventions within the school settings that are most successful against overweight and 
obesity in children are the ones that take into account both individual and environmental 
issues, without neglecting the politicians and procure the involvement of the school 
community (Lobelo et al., 2013). It has been observed that interventions that only include 
one component from the listed above have less impact and probability of success than the 
programs with an effort to cover the majority of causes (immediate, subjacent, and basics) 
(Aguilar Cordero et al., 2014; Anuradha et al., 2015; Rocha-Silva, Martiń -Matillas, 
Carbonell-Baeza, Aparicio, & DelgadoFernandez, 2014; Williams et al., 2013). 
To achieve a decrease in overweight and obesity within Mexican childhood, and its wide 
range of consequences, it is required to design and implement interventions that take into 
account a variety of factors involved in its development. The current project proposes 
following the actions signaled by the National Strategy for the Prevention and Control of 
Overweight, Obesity, and Diabetes, which include diet-related strategies (also based on the 
guidelines for the food sale and beverages), promotion and increase of physical activity, 
scholarly communication and community involvement in decision making. 
General objective 
Assess the effect and functionality of a participatory intervention to improve nutrition and 
physical activity within the school environment in children from six to ten-year-old’s from 
public elementary schools in Acatlan de Juarez, Jalisco, Mexico 
Specific objectives 
1. Determine the viability, restrictions, and possible solutions from locals to improve 
nutrition and physical activity on school-aged children 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
2. Implement and monitor strategies for the promotion of adequate diet and physical 
activity of children between six and ten years old at the community and school level 
3. Evaluate the effect of the strategies implemented to promote an adequate diet and 
physical activity for children between six and ten. 
Proposed methods 
The project will have a total duration of 3 years (figure 2). The outcome variables will be the 
change in consumption and availability of food and drinks, time spent on physical activity 
within school settings, knowledge, and attitudes regarding the consumption of healthy food, 
water, and realization of physical activity, as well as the empowerment of community actors 
involved about their health. On the other hand, it is expected to find serum lipids and glucose 
modifications in the prevalence of children's overweight and obesity and physical abilities 
(endurance, strength, and speed). Finally, it is intended that the present project establishes 
a background of the need to maintain a permanent health promoter in all schools of primary 
education. 
The strategies will be carried out on a community and school level. The proposed actions 
will be developed at three local elementary public schools during the morning shift; 
meanwhile, the other three, belonging to the municipality of Villa Corona, Jalisco, will only 
be evaluated (control group). Table 1 presents the general characteristics of the intervention 
and control schools. 
 
Figure 2 Study design in Acatlan de Juarez, Jalisco 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Table 1. General characteristics of elementary schools in the intervention and control group 
School 
Municipality 
Type 
schedule 
students 
teachers 
groups 
David G. Berlanga 
Acatlan 
Intervention 
8:00 to 12:30 
571 
19 
18 
Cuauhtémoc 
Acatlan 
Intervention 
8:00 to 12:30 
238 
9 
9 
Justo Sierra 
Acatlan 
Intervention 
8:00 to 12:30 
353 
12 
12 
Benito Juarez 
Villa Corona 
Control 
8:00 to 12:30 
380 
12 
12 
Roberto Quiroz Guerra 
Villa Corona 
Control 
8:00 to 12:30 
277 
9 
9 
Manuel López Cotilla 
Villa Corona 
Control 
8:00 to 12:30 
251 
9 
9 
 
The study will have three moments of evaluation: baseline, intermediate, and final, and an 
initial evaluation of viability and formative research (Figure 3). In the measurement periods, 
simple instruments will be used in the school setting to obtain information on the dynamics 
of water and food consumption within the school ground, the dynamics, and infrastructure 
for realizing physical activity, quality of physical education classes, and the availability of 
food in schools. In each measurement period, anthropometric measurements will also be 
taken on all children from 1st to 4th year of elementary (six to ten years of age). Qualitative 
methodologies will be applied to obtain information on the community's satisfaction level and 
the benefits and restrictions observed to that point. In addition,  at the request of the 
municipal president of Acatlan de Juarez, a diagnosis of the nutritional status of children in 
the eight elementary schools that will not have intervention through the measurement of 
height and weight. 
Figure 3 Measurement moments during the project 
PA: physical activity, endurance, strength and speed evaluation 
SOFIT: System for Observing Fitness Instruction Time 
 
 
School 
meassurements 
outside of study 
april 2015
• Height, weight
Formative and 
viability 
research jun-jul 
2015
• Qualitative 
component
• Availability and 
accessibility of 
food/drinks
• Diagnosis of 
facilities, policies
Baseline 
evaluation sept-
oct 2015
• Anthropometry
• Diet
• PA, SOFIT
• Knowledge, 
beliefs, attitudes
• Biochemicals
• Blood preassure
Intermediate 
evaluation Oct-
nov 2016
• Anthropometry
• Diet
• PA, SOFIT
• Knowledge, 
beliefs, attitudes
• Biochemicals
• Blood preassure
• Qualitative 
component
Final evaluation 
May-jun 2018
• Anthropometry
• Diet
• PA, SOFIT
• Knowledge, 
beliefs, attitudes
• Biochemicals
• Blood preassure
• Qualitative 
component

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Table 2 Description of GENERAL evaluation instruments 
Instrument 
Description 
Information to obtain 
To whom it is 
addressed 
Place of 
application 
Application period 
Focus groups 
Group technique 
with the support of 
audio and video 
recorders for its 
registration and 
transcription. 
Opinions, prejudices and 
beliefs. Restrictions and 
possible solutions to improve 
their eating habits and 
encourage physical activity. 
Improvement points during the 
implementation of the project. 
Impact perception of the 
intervention 
Sample of children 
selected by 
convenience and 
separated by age. 
Sample of key 
actors selected by 
convenience 
(Parents, teachers, 
principals, health 
authorities) 
Intervention 
and control 
schools 
Viability study (prior to 
baseline measurements) 
Intermediate evaluation 
period 
Final evaluation period 
For convenience until 
information saturation is 
reached. 
In-depth 
interviews 
Individual interviews 
Opinions, prejudices and 
beliefs. Restrictions and 
possible solutions to improve 
their eating habits and 
encourage physical activity in 
the population. 
Improvement points during the 
implementation of the project. 
Impact perception of the 
intervention 
Sample of key 
actors selected by 
convenience 
(Parents, teachers, 
principals, health 
authorities) 
Place selected 
for 
convenience of 
the interviewee 
Viability study (prior to 
baseline measurements) 
Intermediate evaluation 
period 
Final evaluation period 
For convenience until 
information saturation is 
reached. 
Inventory of 
food and drinks 
Format of availability 
of water 
Availability of pure free water 
in school grounds 
- 
Intervention 
and control 
schools 
Baseline, intermediate and 
final measurements. 
Evaluations will be performed 
twice in not consecutive days 
in each measurement period 
Inventory of 
food and drinks 
Registration form of 
available food. 
Support material: 
Food scale 
Availability of food and 
beverages in schools; 
quantities, ingredients or 
brand, portion size and prices. 
All food stores in 
schools 
Intervention 
and control 
schools 
Baseline, intermediate and 
final measurements. 
Evaluations will be performed 
twice in not consecutive days 
in each measurement period 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Instrument 
Description 
Information to obtain 
To whom it is 
addressed 
Place of 
application 
Application period 
Observation of 
the food sales 
at entering and 
exiting the 
school ground 
Direct observation 
registration form. 
Availability of food and 
beverages outside the schools, 
as well as the most demanded 
foods. 
- 
Surroundings 
of the 
intervention 
and control 
schools 
Baseline, intermediate and 
final measurements. 
Observation of 
food 
consumption 
within the 
school 
Survey of food 
consumption in 
classrooms 
Classroom food consumption 
and teachers´ attitudes 
towards it 
Teachers 
Classrooms 
(all groups 
from 1st to 4th) 
Baseline, intermediate and 
final measurements. 
Observation during 
recess 
Activities generally performed 
by most children during recess 
Information 
regarding schedules, 
duration and 
implementation of 
phased recess 
Intervention 
and control 
schools 
Baseline, intermediate and 
final measurements. 
SOFIT 
Registration forms 
recording children´s 
and teacher´s 
activities during 
physical education 
classes 
Quality of the physical 
education class and teacher's 
behavior. 
Follow-up groups of 
the study schools 
Intervention 
and control 
schools 
Baseline, intermediate and 
final measurements. 
Anthropometry 
OMS and ISAK 
methodology with 
plicometers, metallic 
anthropometric 
tapes, electronic 
scales and portable 
stadiometers. 
Weight, size, folds 
(tricipital, abdominal and calf) 
and 
perimeters (neck, relaxed arm, 
flexed arm, waist, calf) 
Follow-up groups of 
the study schools 
Intervention 
and control 
schools 
Baseline, intermediate and 
final measurements. 
 
Table 2 describes the assessment instruments to be used per measurement period, the information to be obtained with each one of 
them, the target population of each one, and the periods of application. 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
For the project’s logistic and financial considerations, a random sub-sample of children will 
have additional measurements taken to complement the information (Table 3). The 
additional measurements include: 
• 
Household socio-economic characteristics questionnaire. 
• 
Questionnaires (semi-quantitative) of the child’s food consumption frequency, 
applied to his mother. 
• 
Questionnaire and observation of the consumption of school lunch/refreshments 
applied to the child in school. 
• 
Breakfast questionnaire and observation of school breakfast consumption (if the 
school counts with the service). 
• 
Blood pressure 
• 
A blood sample to determine glucose and lipid levels 
• 
Evaluation of physical endurance capacities with the application of Eurofit Battery 
and the realization of endurance and speed1 tests. 
• 
Twenty-two detailed anthropometric measurements according to ISAK methodology, 
to obtain body composition. 
Prior to applying the test, the informed consent of the children’s parents will be requested. 
Table 3 Measurements to be applied in the sub-sample 
Instrument 
Description 
Information to 
obtain 
To whom it is 
addressed 
Place of 
application 
Application 
period 
Household 
questionnaire 
Validated 
questionnaire of 
family and 
housing 
characteristics 
Household and 
child identification 
data. 
Socioeconomic 
information of the 
family 
Mother or 
person in 
charge of the 
care of selected 
children  
Home 
Baseline, 
intermediate 
and final 
measurements 
Food 
consumption 
frequency 
questionnaire 
Semi-
quantitative 
questionnaire of 
the 
consumption of 
one week 
Characterization 
of the usual diet 
of the child 
Mother or 
person in 
charge of the 
care of selected 
children 
Home 
Baseline, 
intermediate 
and final 
measurements 
 
1 By performing the 6-minute walking test and the maximum speed test. 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Instrument 
Description 
Information to 
obtain 
To whom it is 
addressed 
Place of 
application 
Application 
period 
Breakfast 
questionnaire 
Semi-
quantitative 
record of the 
consumption of 
one mealtime 
Accurate 
information on 
the breakfast 
consumed by the 
child at home or 
at school on the 
day of the 
interview. 
Children from 
the sub-sample 
Intervention 
and control 
schools 
Baseline, 
intermediate 
and final 
measurements 
School lunch 
questionnaire 
Semi-
quantitative 
record of 
habitual 
consumption at 
lunch break 
Food 
consumption 
preferences and 
average spending 
on food during 
lunch break 
Children from 
the sub-sample 
Intervention 
and control 
schools 
Baseline, 
intermediate 
and final 
measurements 
Observation of 
school breakfast 
and lunch 
Direct 
observation of 
the food 
consumed 
Semi-quantitative 
registration. 
Precise 
observation of the 
food consumption 
of the selected 
children in the 
school cafeteria 
Children from 
the sub-sample 
Schoolyard 
of 
Intervention 
and control 
schools 
Baseline, 
intermediate 
and final 
measurements 
Blood pressure 
Automatic 
baumanometers 
Recordings of 
systolic and 
diastolic blood 
pressure 
Children from 
the sub-sample 
Intervention 
and control 
schools 
Baseline, 
intermediate 
and final 
measurements 
Blood sample 
Technical 
description in 
appendixes 
Blood glucose 
and lipid levels 
Children from 
the sub-sample 
Intervention 
and control 
schools 
Baseline, 
intermediate 
and final 
measurements 
Physical 
evaluation 
6-minute 
pediatric 
walking test 
Tolerance level to 
exercise and 
subjective feeling 
of fatigue 
Children from 
the sub-sample 
Intervention 
and control 
schools 
Baseline, 
intermediate 
and final 
measurements 
Flexibility test 
“Back-saber sit 
& reach” 
Trunk and hip 
mobility 
(representative of 
global flexibility) 
Children from 
the sub-sample 
Intervention 
and control 
schools 
1 Evaluation 
period per year 
(Baseline, 
intermediate 
and final 
measurements) 
Explosive force 
test for lower 
body (standing 
broad jump) 
Maximum power 
reached by the 
lower body 
Children from 
the sub-sample 
Intervention 
and control 
schools 
1 Evaluation 
period per year 
(Baseline, 
intermediate 
and final 
measurements) 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Instrument 
Description 
Information to 
obtain 
To whom it is 
addressed 
Place of 
application 
Application 
period 
Endurance test 
“Course-
Navette 
20m shuttle run 
test” to estimate 
the maximum 
oxygen 
consumption 
<VO2max> 
Maximum oxygen 
consumption 
(VO2max), 
maximum 
cardiorespiratory 
capacity 
Children from 
the sub-sample 
Intervention 
and control 
schools 
1 Evaluation 
period per year 
(Baseline, 
intermediate 
and final 
measurements) 
Maximum 
speed test 
Subjective feeling 
of fatigue using 
the modified Borg 
scale 
Children from 
the sub-sample 
Intervention 
and control 
schools 
1 Evaluation 
period per year 
(Baseline, 
intermediate 
and final 
measurements) 
Step 
registration for 
one day 
Number of steps 
during the day 
(The pedometer 
will be placed at 
the entrance of 
the classroom 
and will be 
removed the next 
day at the same 
time, making an 
observation at the 
end of the day) 
Children from 
the sub-sample 
Intervention 
and control 
schools 
1 Evaluation 
period per year 
(Baseline, 
intermediate 
and final 
measurements) 
Anthropometry 
ISAK 
methodology 
with 
plicometers, 
anthropometric 
metal strips, 
electronic 
scales, portable 
stadiometers 
and 
anthropometers 
for long and 
short limbs 
22 
measurements of 
which: 
Basic (3 
measurements) 
Folds (6 
measurements) 
Perimeters (9 
measurements) 
Diameters (4 
measurements) 
 
Children from 
the sub-sample 
Intervention 
and control 
schools 
1 Evaluation 
period per year 
(Baseline, 
intermediate 
and final 
measurements) 
 
Each test will be realized on a different day during school hours before lunch break. Each 
child's results will be compared with the standard parameters, and they will be given to the 
children's parents confidentially. 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
In order to achieve a greater approach to the population, qualitative tools will also be 
implemented, such as non-participating observation, focus groups, and semi-structured 
interviews, that will aim to generate new strategies suggested by the population, as well as 
to identify barriers and possible solutions to improve eating habits and encourage physical 
activity in the community. The aim is to carry out three qualitative measurements, one before 
the baseline, as part of the feasibility study, one in the intermediate period to acknowledge 
the population's perception of the intervention and improvement areas, and at the end of the 
study to gather the satisfaction level among the community and the perceived impact of the 
intervention. The qualitative component will be implemented by specialized personnel in 
qualitative methodologies. 
Questionnaires, formats, and interview guides are presented in full as appendixes in this 
protocol, in separate documents. 
In addition, close and careful observation of the events will be maintained inside the 
communities during the project that could affect the results (Table 4) 
Table 4 Description of evaluation instruments at the LOCAL LEVEL 
Instrument 
Description 
Information to 
obtain 
To whom it 
is 
addressed 
Place of 
application 
Application 
period 
Observation log 
Detailed 
registration of 
events, without 
specific format 
Relevant related 
events that may 
affect the dynamics 
of food and 
physical education 
in schools and 
communities 
- 
Schools and 
communities 
Constant 
recording of 
relevant 
events 
Registry of 
process 
indicators of 
activities at the 
community level 
Indicator 
registry format 
according to 
the 
implemented 
actions 
proposed by 
the locality 
Number of effective 
events carried out, 
attendance, 
duration, etc. 
- 
Schools and 
communities 
Depending 
on the 
regularity of 
the actions 
proposed by 
the 
community 
 
 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Population description and sample selection 
 
Study location:  
Acatlan de Juarez is a small town and municipality in the central region of the state of Jalisco 
state, Mexico. Its located approximately 45.7 km south of Guadalajara, in the Lagunas 
region. It has an area of 176.85 km². According to the 2010 census, it has a population of 
23,241 inhabitants, of which 9.88% are children between 6 and 10 years old. The main 
economic activities are agriculture of cane, corn, beans, peanuts, sunflower, and tomatoes. 
Within the cattle raising, the main breeding is from dairy and beef cattle, pigs, sheep, goats, 
horses, and various birds, beehives, and rabbits; the main branches of the Acatlan de Juarez 
industry are sugar and alcohol. For commerce, the municipality counts with various 
commercial establishments, where one can find basic necessities. There are five medical 
units and 11 elementary schools (Gobierno del Estado de Jalisco, 2015; Instituto Nacional 
de Estadística y Geografía, 2010). 
 
Selection of study schools:  
The strategies will be implemented in all three intervention schools. A nutrition diagnosis will 
be offered as a community service to the rest of the schools in Acatlan de Juarez in a 
previous stage of the study; none of the described strategies will be implemented. The 
schools were chosen at the convenience of the size of the student body. In addition to having 
a sufficient population, each school’s authorities needed to be willing to participate. 
 
Selection of control schools:  
There were three elementary schools selected from the municipality of comparison (Villa 
Corona, Jalisco). The schools were chosen for their similarities in social, economic, and 
geographic contexts to the intervention municipality. These schools were selected for the 
similarity in the student body size for the intervention schools. 
 
Subjects of study:  
Depending on the different strategies, is pretended to incorporate: 
• 
Children from six to ten years of age (completed at the beginning of the study) who 
attend public schools from the intervention community 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
• 
Mothers and fathers from families with kids of school-age 
• 
Personnel in charge of school cooperatives 
• 
Key actors and members of different groups involved in the implementation of the 
strategies. 
 
Sample size:  
All schools and retail outlets of food in and around the schools will be evaluated. The 
anthropometric measures (height, weight, waist, and three basic folds) will be taken from 
students from 1st to 4th year of elementary schools. 
 
For the calculation of the sample size, data of a similar study realized by Li and Col. were 
used. In 2014 (Li et al., 2014), a total sample size of 288 children among the six schools 
(three control and three intervention) took into account a loss in the follow-up of 30%. It was 
considered a type I error of .05, power of 80%, and six clusters. 
 
Selection of the sub-sample 
One cluster will be randomly selected from each grade level of the schools chosen, listed in 
Table 1, and within each cluster chosen, 12 children will be randomly selected per cluster 
(48 children total per school) 
 
The exclusion criteria are: 
• 
Chronic disease with confirmed diagnosis (Cancer, diabetes type 1 or type 2) 
• 
Physical limitations that could affect the development and standard nutritional 
patterns. 
• 
Use of medications that may influence energy consumption and expenditure 
(antidepressant drugs, antipsychotics, and steroids). 
• 
Children who are or have been in a weight reduction program in the past year. 
• 
Use of medications or confirmed diagnosis of illnesses that could alter laboratory 
values. 
 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Fieldwork logistics in evaluation periods 
The field strategy for information gathering in the three evaluation periods will be organized 
with a single brigade of six people (during the evaluation periods, there will be two more 
people to complement the 6-member brigade and facilitate the collection of information; 
while four members will stay in the project during the implementation of strategies). In 
addition, some of the project’s researchers and undergraduate nutritionists will participate 
as support in the measurement period. The brigade will work in each of the schools for 
approximately one week, starting with the intervention schools. It is expected that in 2 
months, all the required information will be completed. The responsibilities will be distributed 
inside the brigade to optimize the time. The qualitative component will be implemented by 
different brigade personnel to ensure their specialization in qualitative methodologies. The 
project will count with one general field supervisor to ensure that the brigade personnel is 
advised and supported at all times. 
Field staff will receive the appropriate training in interviewing techniques, ethical 
considerations, filling out specific questionnaires, training in the anthropometric measures, 
and blood pressure. One researcher will be trained in the SOFIT method. Only the 
standardized personnel with the specific techniques will be responsible for gathering the 
information. 
 
Blood sampling 
Glucose and lipid determinations on blood will be made by the laboratory of clinical analysis 
of the University Center of Exact Sciences and Engineering (CUCEI; in Spanish Centro 
Universitario de Ciencias Exactas e Ingeniería) of the University of Guadalajara, who will be 
going to the schools, take the samples, analyze them and deliver the results. The 
determination of blood chemistry analytes is done by spectrophotometry in liquid chemistry. 
The hematic biometry is done with the SISMEX equipment by impedance. The laboratory is 
registered on the external quality control PACAL (Quality Assurance Program) company 
certified in ISO 9001:2008 and certified by System ISO 9001. In addition, it has Notice of 
Laboratory Operation at the Jalisco Ministry of Health and the University of Guadalajara. 
They are also registered with the Ministry of Environment and Natural Resources 
(SEMARNAT. In Spanish: Secretaria de Medio Ambiente y Recursos Naturales) and have 
transportation and reception of biologically hazardous waste with the company Corporate 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Techno Ambienta. For the collection of blood samples, children and their parents will be 
asked to have fasting of food and caloric beverages for 12 hours before intake (usually the 
night before), which must be suspended as soon as the measurement is made. The blood 
samples collection will be conducted on school premises by qualified CUCEI staff (described 
at the beginning of this section) at the end of the baseline, intermediate, and final 
measurement period. It is estimated that the measurements are taken during the first hours 
of the school day (between 8:00 and 10:00 hours), and approximately 10 ml of blood will be 
taken per child. 
 
Action strategies 
Strategy implementation 
The strategies of the project are aimed to improve nutrition and increase the physical activity 
of the children. They are mainly based on the implementation of the guidelines of the 
“National Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes” in 
a guided and supervised way by the research team of this project; In addition, it is intended 
to incorporate strategies suggested by the own community of intervention. In the control 
community, as in the rest of the country, it is expected that the actions of the “National 
Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes” are gradually 
implemented under the capacities of local authorities in education and health. 
In both intervention and control communities, results will be presented by the school after 
each measurement period, and parents will be given the results of their child’s nutritional 
status. 
To achieve a better acceptance of the strategies by the population in the intervention locality, 
these will be implemented in collaboration with municipal authorities, schools, parents, and 
staff from ITESO, UdeG, and AJANUT. The aim is to involve the key actors of both the 
school environment and community, from early stages of the project, in order to adapt the 
strategies to be cultural and socially acceptable, generating strategies that could contribute 
to the achievement of the goals and promote the appropriation of the project from the 
community. Key actors include parents, school principals, teachers, food service 
concessionaires within the school grounds, and municipal authorities of Acatlan de Juarez 
in contact with the school-age children from six to ten years old. 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Initially, the strategies to be implemented will include the following: 
• 
Regulation of food sales within school grounds 
• 
Awareness of children, parents, teachers, and staff in charge of the food supply to 
improve acceptance and commitment to food sales regulation. 
• 
Training of staff in charge of food supply within the school, to help support the 
preparation of healthy foods. 
• 
Promotion of the consumption of water.  
• 
Organization of events and support in the coordination of groups that promote 
physical activity at the community level. 
• 
Implementation of healthy spaces inside the school 
• 
Improve the quality of the physical education classes within schools 
• 
Physical activities outside school hours and during vacations to promote physical 
activity all year round. 
• 
Offering different types of support for the implementation and promotion of health 
care actions within the school context. 
• 
Development of skills in the educational community for health care and the 
generation of healthy school environments. 
• 
Creation and/or strengthening of health and nutrition committees in schools, with 
school principals, teachers, and parents to generate primary conditions that favor 
healthy environments. 
 
Table 5 lists possible intervention strategies taken from the study realized before in 
Tlaltizapan, Morelos; however, in the current project, some strategies may be modified once 
the result of the formative investigation and viability are known. 
For the implementation of the strategies, the population will be actively involved; it will be 
established on a common agreement the times, responsibilities, and activities for the 
organization and convening of courses and events. The research team will design the 
contents and didactic materials for the courses and workshops, considering the community’s 
opinions and suggestions. 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Table 5 Description of strategies proposed in the previous project carried out in Tlaltizapan, Morelos 
Strategy 
Implementation 
Regulation of food sales on school grounds 
Compliance with food sales guidelines in schools will be 
monitored. Non-compliance will be reported to school principals 
and they will be encouraged to limit sales to permitted products, 
advising those in charge to do so. 
Awareness of children, parents, teachers and staff in charge of 
food offering to improve the acceptance and commitment to the 
regulations 
There will be an opening event at the beginning of the project 
activities, which will include the community and various 
recreational activities that promote healthy food and physical 
activity. 
Meetings will be held with parents and teachers to explain in 
detail the purpose of the regulation, the process of elaboration 
of the guidelines, to make known the benefits of good nutrition, 
the risks of consuming food that is dense in calories and high fat 
content, and answer questions about it. 
Similar guidance will be provided to food sales staff but during 
the time of the school day, with the help of the teachers. They 
will be informed that they will be able to access workshops and 
training to adapt their food supply to the guidelines. 
Children will have an explanation during classes, 
complementing the nutrition content marked by SEP. Each 
group will be asked for a space to explain the new regulations 
and to answer their questions about them. 
Training of the staff in charge of the food offer in the schools, to 
support the preparation of healthy food 
Free workshops will be provided to adapt the food supply to the 
guidelines. The main topics to be discussed will be portion 
sizes, healthy cooking methods, hygiene in the preparation and 
healthy ingredients. It is aimed to offer the workshops for each 
school, on campus, and at times that result convenient to 
vendors. To integrate food vendors from around the schools, the 
support of the Municipal President will be sought. 
Organization of events and support in the coordination of groups 
that promote the physical activity at the community level. 
In coordination with the key actors, support will be given to the 
organization of sports tournaments, walks, dance competitions, 
etc. (depending on children´s preferences). Schools will be 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
supported in the purchase of some games that encourage 
physical activity that can be used by all children during recess. 
Improve the quality of physical education classes on school 
campuses 
Physical education teachers will be provided with manuals for 
class development of physical education adapted to the 
Mexican context. As an additional tool to existing classroom 
programs. 
Each group will be monitored to take at least 2 physical 
education classes per week and the effective time of each class. 
Principals will be encouraged to comply with the regarding 
physical education classes. 
Implementation of healthy spaces on school campuses 
In coordination with local key actors, actions such as food fairs, 
healthy lunch contests, gastronomic exhibitions or conferences, 
nutrition week, etc. will be organized. 
Physical activation outside of class and outside of the school 
calendar (Not applicable in Tlaltizapan) 
Activities will be planned so that children can go to their schools 
(or community centers) outside of their school hours and during 
vacations to stay active even at times outside of their school 
hours. For the above, the support of social service providers of 
the Bachelor of Physical Culture and Sport (or similar) will be 
sought. 
To offer diverse support for the implementation of health 
promotion and care actions in the school context 
Courses will be developed for teachers to give them useful tools 
in the health and nutrition sessions that they must give to their 
students as part of the modifications to the school curriculum 
that SEP has made. These courses will be based on the 
contents of the official textbooks. It will be coordinated with the 
school zone supervisor and with the principals of each school 
on the schedules and duration of the courses; and if possible, 
incentives or recognition to the teachers. 
Creation and/or strengthening of health and nutrition 
committees in schools, with the participation of principals, 
teachers and parents to generate basic conditions that favor 
healthy environments. 
The formation of committees will be encouraged in schools 
where they have not been previously integrated. The support of 
the principals of each school will be requested for the 
invitations. A member of the project team will join each school´s 
committee and participate in the meetings. 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
During the periods of strategy implementation, the project will have four people who will stay 
permanently in the locality for the duration of the intervention. A member of the project will 
be permanently in charge of implementing and monitoring the strategies at one of the 
community interventions schools, keeping direct contact with key actors. The same person 
will be a member of the health and nutrition committee of the school. In addition, monitoring 
activities will be carried out in the comparison schools, which will be systemized into 
indicators for the evaluation process. On the other hand, it is contemplated the support of 
nutritionists and other undergraduate professionals to support the elaboration of material, 
application of interventions, events, workshops, and measurements, with previous training 
and standardization. 
Additionally, formative research will enrich the proposed strategies. This will be carried out 
with the support of personnel specialized in qualitative methodologies. Two people will be in 
charge of implementing the qualitative component, which will consist of non-participating 
observation, focus groups, and semi-structured interviews with children and key actors 
(parents, teachers, school principals, municipal authorities, and community leaders); to 
inquire about opinions, prejudices, and beliefs regarding the implementation of the 
guidelines that regulate food sales within school grounds. The same staff will be responsible 
for analyzing the information and determining the barriers and possible solutions to improve 
eating habits and encourage physical activity in the population (during the qualitative 
instruments' application, one more person will be supporting the research team). The focus 
group among children will be held inside the schools, working mainly with fifth and sixth-
grade students. In addition, all teachers at each school will be invited to participate in a focus 
group that will be held at the school campus with the support of the principals. Semi-
structured interviews will be conducted with children, parents, and teachers. The specialized 
staff in qualitative methodologies will personally arrange with each of the interviewees the 
day, time, and place where interviews will be held, supporting the interviewees' convenience. 
 
Monitoring and evaluation 
Table 6 describes the outcome variables. The conceptual framework of obesity causes 
(Figure 1) specifies a wide variety of factors that influence this pathology's immediate 
causes. To modify these factors, it is necessary to implement strategies that will impact the 
outcome variables, but whose impact is not direct. These strategies are mainly oriented 
towards modifying the food supply, increasing opportunities to make physical activity, 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
creating healthy environments, and community participation, among others; not precisely 
modifying the body composition. Many of the strategies proposed for the project will reflect 
on the outcome variables; however, their monitoring during the intervention will be given 
through process indicators, among which stand out: 
• 
Number of parent’s reunions, for each topic of health and nutrition 
• 
Number and percentage of parents that assist the reunions about topics of health 
and nutrition (total of parents per group/number of parents that assist per group) 
• 
Number of events outside school hours realized with health and nutrition topics 
• 
Number of sports events realized 
• 
Number of assistants and participants on sports events and health and nutrition 
topics 
• 
Effective classes of physical education per group (physical education classes 
programmed per group / physical education classes realized per group) 
• 
Duration pf physical education classes (minutes) 
• 
Application grade of the guidelines 
• 
Number of non-recommended foods present at the school campus 
These are some of the indicators proposed; however, with the formative and viability 
investigation results, it will be possible to propose various actions for which indicators of the 
specific process will be designed. 
During the implementation of the strategies, detailed records will be kept of relevant related 
events that may affect food and physical education dynamics in the schools and the locality 
(Table 4), both in the intervention and control localities. Similarly, a detailed registry will be 
kept of the agreements reached in meetings with key actors and the support given by the 
municipality and school authorities. 
 
Table 6 Outcome variables 
Category 
Basic causes 
Underlying causes 
Diet 
Physical activity 
Interpersonal factors 
Environment 
Energy 
consumption 
Number of steps 
Beliefs 
Availability and 
accessibility of food 
and beverages 
Fat consumption 
Speed 
Knowledge 
Quality of 
infrastructure for 
physical activity and 
meals 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Recommended and 
non-recommended 
food consumption 
Resilience 
Attitudes 
Length and quality 
of physical 
education classes 
Beverage 
consumption 
Strength 
Motivation, intention 
to change 
Policies to regulate 
the sale and 
consumption of food 
Local foods 
consumption 
 
Social 
empowerment 
 
 
Information analysis plan 
It is pretended to analyze the information in 3 different sections. One section with impact 
results, one section with process results, and one section with qualitative results. 
The section with impact results will present central tendency measures and dispersion of 
the information obtained during the measurement periods, having as main outcome 
variables: 
• 
Score in beliefs, attitudes, and knowledge questionnaires. 
• 
The average consumption of energy and fat 
• 
Consumption of healthy foods (recommended) 
• 
Consumption of non-healthy foods (Not recommended) 
• 
Number of steps during the day 
• 
Availability of healthy foods and non-healthy foods at school 
• 
Availability of drinking water at schools 
• 
Number and quality of spaces to develop physical activity 
• 
Score in endurance, speed, and strength test 
As for the process results section, six-month reports will be elaborated and delivered to the 
financing company, presenting information on the process indicators mentioned in the 
previous section; as well as the summary of the activities and relevant events that have 
taken place in the community and the agreements reached with the key actors. 
The section on qualitative results will be presented once the formative research has 
concluded, and after each measurement phase. This section will present the barriers and 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
possible solutions to improve eating habits and encourage physical activity in the population 
provided by the key actors and elements of the actors’ perception of the intervention’s 
progress and satisfaction. 
Ethical aspects 
Parent meetings will be held at the intervention and comparison sites for each grade at each 
school to explain the project and request oral consent from children’s parents who have not 
been selected in the sub-sample, to obtain measurements of weight, waist, neck, basic folds, 
and height. Copies of the designed informed consent letter will be made available upon 
request. Different informed consent letters will be read to parents of children in the 
intervention community and the control locality. In addition, a written informed consent letter 
will be requested from the parents of the children selected to take the additional 
measurements (Appendix 1). The signing of the consent letters will be realized at smaller 
meetings and/or home visits to obtain their contentment regarding the collection of blood 
samples and questionnaires of diet and physical activity in children, blood pressure 
measurements, and step counts. The assent of all children over 7 years of age will be 
obtained with an informed assent letter (Appendix 2). Both letters of consent and assent will 
be read and explained to participants to ensure that they have understood their content. 
These letters are written specifically for the intervention and comparison locality. 
Participating key actors will be asked for informed consent to participate in interviews and 
will be provided with a copy of the contact information from the researchers responsible for 
the project (Appendix 3). 
Reunions will be carried out with different community groups, the school community, and 
the decision-makers separately to present the results after each measurement period. The 
reunion will help maintain the community involved in the process, as well as receive 
feedback. Parents will be given the results of their children’s nutritional state, blood pressure, 
glucose, cholesterol, triglyceride levels, and the results of the physical abilities test. In the 
case of detecting that any child requires medical attention, it will be referred to Acatlan 
Health Services for treatment. If the found condition is severe, the kid will have a secured 
place for its special treatment at the New Civilian Hospital of Guadalajara “Juan I. Menchaca” 
in Guadalajara Jalisco. 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Schedule 
The intervention is scheduled to begin in September 2015; however, in June and July of 
2015, the formative research and the viability study will be carried out within the schools. It 
is contemplated a training period for staff before each of the 3 periods of evaluation. The 
total duration is 3 years (2015-2018), with the last field evaluation scheduled at the end of 
the 2017-2018 school year. There is also a 6-month period for data analysis and the 
elaboration of the final report at the end of the project. Table 7 describes the estimated times 
on which each of the project periods will be developed. 
Year 
Month 
Activities 
School year 
2015 
April 
Measurement of non-participating schools in the intervention 
location 
2014-2015 
June-July 
Formative research and viability study 
July- August 
Analysis of formative research and staff training 
August 
Planning of intervention strategies 
September 
Presentation of strategies before a group of experts and 
corrections.  
Preparation of material for initial evaluation 
2015-2016 
October – November 
Baseline evaluation 
November 
Opening event 
December 
Formative research article 
School vacations 
2016 
January – July 
Baseline measurement article 
Strategy implementation 
Easter 
School vacation 
July – August 
School vacation 
July – August 
Staff training 
September – October 
Intermediate measurement 
2016-2017 
November – December 
Strategy implementation 
December 
School vacation 
2017 
January – March 
Intermediate measurement article 
Implementation of strategies 
Easter 
School vacation 
April – July 
Implementation of strategies 
July – August 
School vacation 
September – December 
Implementation of strategies 
2017-2018 
December 
School vacation 
2018 
January – April 
Implementation of strategies 
Easter 
School vacation 
March – April 
Implementation of strategies 
Staff training 
May – June 
Final evaluation 
July - December 
Analysis of information 
2019 
January 
Final report evaluation 
Final evaluation article 
2019 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Budget 
Table 8 describes the different items considered for the budget per year, which considers 
the necessary costs for developing all the stages of the project, including from staff training, 
to the end of the collection and analysis of the information. The work team includes a project 
coordinator, who will be in charge, along with the operative responsible for the quality of the 
information and the development of the fieldwork. A coordinator for the qualitative 
component is also included. There will be an additional person who will support the 
qualitative research. The team will have 2 social service providers in charge of collecting 
quantitative information during the different stages, as well as implementing and evaluating 
the intervention. 
Due to the type of methodology used in this study, the totality of strategies to be implemented 
during the intervention is unknown; however, previous experience of INSP groups in similar 
interventions indicate that it will be necessary to develop materials and campaigns to 
promote the consumption of fruits and vegetables, as well as the creation of healthy spaces 
within the school. All materials and equipment for the design of an educational campaign 
are included, including the ones that will need reproduction and the materials for its 
implementations. 
On the other hand, expenses for transportation (gasoline) and travel of personnel in charge 
of collecting information and implementing strategies are included in the items of 
transportation and travel expenses, respectively. Finally, the administrative cost of the 
projects is included in the budget, which represents 15% of the total cost of the intervention, 
requested by ITESO´s administration. 
 
2015 
2016 
2017 
2018 
 
 
May 
January 
July 
January 
July 
January 
TOTAL 
PERSONNEL/STAFF 
$132,000.00 
$237,000.00 
$222,000.00 
$174,000.00 
$174,000.00 
$249,000.00 
$1,188,000.00 
TRANSPORTATION 
$7,000.00 
$12,500.00 
$9,000.00 
$9,000.00 
$9,000.00 
$7,500.00 
$54,000.00 
TRAVEL EXPENSES 
$6,000.00 
 
 
 
 
 
$6,000.00 
BIOCHEMICAL 
DETERMINATIONS 
$105,000.00 
 
$105,000.00 
 
 
$105,000.00 
$315,000.00 
MATERIAL & EQUIPMENT 
$16,200.00 
$88,420.00 
$3,600.00 
$15,000.00 
$3,600.00 
$15,000.00 
$141,820.00 
OTHER EXPENSES 
 
$15,000.00 
 
 
 
$15,000.00 
$30,000.00 
STATIONERY AND OTHERS 
 
$10,000.00 
$10,000.00 
$10,000.00 
$10,000.00 
$10,000.00 
$50,000.00 
EVENTS 
$15,000.00 
 
 
 
 
$10,000.00 
$25,000.00 
 
 
 
 
 
 
 
 
SUBTOTAL 
$281,200.00 
$362,920.00 
$349,600.00 
$208,000.00 
$196,600.00 
$411,500.00 
$1,809,820.00 
ADMINISTRATIVES ITESO 
15% 
(OVERHEAD) 
$49,623.53 
$64,044.71 
$61,694.12 
$36,705.88 
$34,694.12 
$72,617.65 
$319,380.00 
TOTAL IN PESOS 
$330,823.53 
$426,964.71 
$411,294.12 
$244,705.88 
$231,294.12 
$484,117.65 
$2,129,200.00 
TOTAL IN DOLLARS 
$21,505.23 
$27,754.90 
$26,736.23 
$15,907.14 
$15,035.31 
$31,470.13 
$138,408.93 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Appendixes 
October 2015 
 
CONSENT LETTER: Parent's consent for their child to participate in an interview 
and Acceptance of the child to participate. 
PARTICIPATORY INTERVENTION TO IMPROVE THE NUTRITION AND PHYSICAL 
ACTIVITY OF SCHOOL CHILDREN IN ACATLAN DE JUAREZ, JALISCO 
Dear Sir / Mrs.: 
On behalf of the Technological Institute of Higher Studies of the West (ITESO), the 
University of Guadalajara (UdeG), and the Ministry of Public Education (SEP), we extend a 
warm invitation to you and your child to participate in a study that has as its purpose the 
implementation and evaluation of a strategy to modify the environment of school-aged 
children and promote adequate physical activity and healthy eating, thus improving their 
body composition and physical fitness. 
Procedure: 
In case you agree to participate in the study, your child will be asked a series of questions 
related to feeding, observations about the foods your child eats at school, body 
measurements (weight, height, folds, waist, hip, and neck), physical fitness tests: flexibility, 
aerobic capacity (the child is asked to walk for 6 minutes, as far as he or she can walk) 
strength (the child is asked to do horizontal jumps) and a venous blood sample to check 
glucose levels, and blood lipids. Observations, interviews, and measurements will be 
conducted by ITESO and UdeG trained staff within the school facilities. 
It will take approximately half an hour to ask your child these questions. The body 
measurements are estimated to take 25 minutes, and the physical fitness test will take 
approximately 15 minutes. For blood sampling, about 10 ml (equivalent to 2 teaspoons) of 
blood from an arm vein, under controlled circumstances. The blood collection will be 
performed by experts in the area, within the school facilities, with new and sterile material 
and under rigorous quality control. These measurements will be performed on 3 occasions 
throughout the project (from 2015 to 2018). 
Benefits: 
The main benefit for you and your child will be to know the child's nutritional and physical 
status and blood test results free of charge for three years. If you agree to participate, you 
will be collaborating with ITESO, UdeG, and SEP in a mission to research and find solutions 
for the promotion of adequate physical activity and healthy eating in schools. This study can 
help us better understand how to improve the school environment and our children's health 
in the future. 
In addition, we are committed to sending regular reports on your child's nutritional status 
and overall progress of the study and working throughout the three years to improve 
children's nutrition and physical activity. 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
Possible risks: 
The study does not pose any risk to your child's health since the amount of blood drawn will 
be the same as that required for a regular blood test. Drawing the blood sample may cause 
a burning sensation at the point where the needle is inserted into the skin and may result in 
a small bruise that disappears within a few days. On rare occasions, it can cause temporary 
dizziness. 
Fitness tests are low impact; however, medical care will be available at all times. 
Participation / Voluntary Withdrawal: 
Children participating in this study will be those in grades 1-4. Participation in this study is 
entirely voluntary. You have the right to refuse to participate and to withdraw from the study 
at any time. Whether or not you participate will not affect your child's benefits from the school 
or any future services. 
You do not give up any of your legal rights by signing this informed consent document. 
Cost of Participation: 
There will be no cost to you or the school for participating in this study. All measurements, 
tests, and activities related to the study will be given to you at no cost for the duration of the 
project. 
Confidentiality: 
The information that we obtain will be completely confidential and transported directly to the 
Technological Institute of Higher Studies of the West (ITESO), to Dr. Laura Arellano 
Gómez's office, and will be for the exclusive use of the researchers participating in this 
project. 
Contacts: 
You have the right to receive answers to any questions about the procedures, risks, and 
benefits related to this project. For this purpose, you may contact Professor Roberto Paulo 
Orozco Hernández, responsible for the project, at (01 - 33) 36 69 34 34 ext. 3989. 
 
Sincerely, 
 
 
Professor Roberto Paulo Orozco Hernández  
 ITESO Project Coordinator 
 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
 
Parent or Guardian Consent for their Child's Participation 
Your signature indicates your agreement for your child to voluntarily participate in this study. 
Date: 
Month / Day / Year 
Name of participant's parent/guardian: 
 
Name of the child participating: 
 
 
 
 
Parent/Guardian's Signature: 
Family relationship to the child:  __  __  ___  
__  __  __ 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
 
Acceptance of the Child to Participate 
(To be obtained orally when the child is interviewed) 
Date: 
Month / Day / Year 
Name of the child: 
The child has received an explanation and has agreed to 
participate: 
1. Yes 
2. No 
Witness #1: 
Family relationship to the child: 
Witness #2: 
Family relationship to the child: 
 
Name and signature of researcher obtaining consent 
 
 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
October 2015 
LETTER OF CONSENT: Principal's consent for the elementary school to participate 
in the project: 
 
PARTICIPATORY INTERVENTION TO IMPROVE THE NUTRITION AND PHYSICAL 
ACTIVITY OF SCHOOL CHILDREN IN ACATLAN DE JUAREZ, JALISCO 
 
Dear Director: 
On behalf of the Technological Institute of Higher Studies of the West (ITESO), the 
University of Guadalajara (UdeG), we request your consent for the educational facility you 
lead to participate in this study, which has the following objective: To evaluate the functioning 
and effect of a participatory intervention to improve nutrition and physical activity within the 
school environment in children aged 6 to 10 years from public elementary schools in Acatlan 
de Juarez, Jalisco, Mexico. 
 
Procedure: 
The project will have a total duration of 3 years (Start 2015, end 2018). Outcome variables 
will be: change in consumption and availability of food and beverages, time invested in 
physical activity within the school environment, knowledge and attitudes towards the 
consumption of healthy food, simple water, and physical activity, as well as the 
empowerment of community actors involved on their health. On the other hand, it is expected 
to find modifications in serum lipids and glucose, the prevalence of overweight and obesity, 
and the physical capacities (resistance, strength, and speed) of children. Finally, it is 
intended that the present project establishes a background of the need to maintain a health 
promoter permanently in all basic education schools. 
The study will have three moments of evaluation: baseline, intermediate, and final, and an 
initial evaluation of viability and formative research. The measurement periods will use 
simple instruments in the school context to obtain information at the school level about the 
dynamics of food and water consumption within the schools, the dynamics and infrastructure 
for physical activity, the quality of physical education classes, and food availability. 
In each measurement period, anthropometric measurements will also be taken of all 
elementary school children. Qualitative methodologies will be applied to obtain information 
on community satisfaction and the benefits and barriers observed. 
After each measurement period, a report with the overall results of the school will be 
provided to the school principal and any members of the school community considered 
relevant by the principal. 
In addition to the procedures described in the previous paragraphs, a random subsample of 
children in grades 1-4 will be selected and the following additional measurements will be 
taken to complement the information: 
• Household socio-economic characteristics questionnaire. 
• Questionnaires (semi-quantitative) of the child’s food consumption frequency, applied to 
his mother. 
• Questionnaire and observation of the consumption of school lunch/refreshments applied 
to the child in school. 
• Breakfast questionnaire and observation of school breakfast consumption (if the school 
counts with the service). 
• Blood pressure 
• A blood sample to determine glucose and lipid levels 
• Evaluation of physical endurance capacities with the application of Eurofit Battery and the 
realization of endurance and speed tests. 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
• Twenty-two detailed anthropometric measurements according to ISAK methodology, to 
obtain body composition. 
 
Prior to applying the test, the informed consent of the children’s parents will be requested. 
Each test will be realized on a different day during school hours. Each child’s results will be 
compared with the standard parameters, and they will be given to the children’s parents 
confidentially. 
In order to achieve a greater approach to the population, qualitative tools will also be 
implemented, such as non-participating observation, focus groups, and semi-structured 
interviews, that will aim to generate new strategies suggested by the population, as well as 
to identify barriers and possible solutions to improve eating habits and encourage physical 
activity in the community. 
Possible risks: 
The study does not pose any risk to students' health since the amount of blood drawn will 
be the same as that required for regular blood testing. Drawing the blood sample may cause 
a burning sensation at the point where the needle is inserted into the skin and may result in 
a small bruise that disappears within a few days. On rare occasions, it can cause temporary 
dizziness. Fitness tests are low impact; however, medical care will be available at all times. 
 
Participation / Voluntary Withdrawal: 
Participation in this project is entirely voluntary; however, the permanence of the elementary 
school is fundamental to obtain reliable results that will allow us to propose actions that will 
improve the nutrition and physical activity of both this campus and the rest of the country. 
The school has the right to refuse to participate and to abandon the study at any time. 
 
Cost of Participation: 
There will be no cost to any member of the school community for being part of this study. All 
measurements, tests, and activities related to the study will be provided at no cost to you for 
the duration of the project. Also, no food or other products will be sold or promoted as part 
of the project. 
 
Confidentiality: 
The information that we obtain will be completely confidential and transported directly to the 
ITESO or UdeG facilities, under the supervision and analysis of Dr. Laura Arellano Gómez, 
and will be for the exclusive use of the researchers participating in this project. 
 
Contacts: 
You and any member of the school community have the right to receive answers to any 
questions about the procedures, risks, and benefits related to this project. You may contact 
Professor Roberto Paulo Orozco Hernández, responsible for this project, at (01 - 33) 36 69 
34 34 ext. 3989. 
 
Sincerely, 
Professor Roberto Paulo Orozco Hernández  
 ITESO Project Coordinator 

Participatory intervention to improve the nutrition and physical activity of 
school children in Acatlan de Juarez, Jalisco 
Collaborative Proposal 
ITESO-CUTonala-CUCS-INSP 
2015 
 
 
 
 
 
Principal's Consent for the Elementary School to Participate in the Project: Participatory 
Intervention to Improve Nutrition and Physical Activity in School Children in Acatlan de 
Juarez, Jalisco 
Your signature indicates your agreement to allow the elementary school you lead to 
participate in this study voluntarily. 
Date: 
Month / Day / Year 
School Name and code: 
 
 
Principal’s name 
Signature of the Director