Perceptions par divers acteurs d'une politique éventuelle de promotion de santé nutritionnelle en milieu scolaire libanais

Poor nutrition among school-aged youth seriously compromises their health and learning capacity. It also has a disastrous effect through damaging dietary patterns which affects the prevalence of diseases in adulthood such as diabetes, cardiovascular diseases, obesity, and hypertension. There is disturbing evidence that the nutritional status among school youth is deteriorating. Current radical changes in lifestyle among both poorest and richest strata of developing and developed countries mean that personal preference about food, fashion, physical activity, and media are now driving the nutritional patterns of school youth more than the availability of the food itself. Schools have a major role in ameliorating youth’s lifestyles and food habits. However, it’s not the only setting for intervention; it should be emphasized by other environments as well such as family, community, government. To this end, many national and international food policies were developed and implemented at different levels and in many countries. Thus, there were few that used a pre-implementation analysis and tried to study the perceptions of multidisciplinary stakeholders (government, schools, youth, family, food industry, municipalities, pediatrics, dietitians, academics, NGOs, UN agencies, media).  Lebanon has been experiencing a nutritional transition in food choices during the past years. As a consequence, youth dietary habits and lifestyle have been affected; thus weight problems are increasingly being observed. In answer to this alarming reality, Lebanon proposed in 2009 a national "Strategy of school health" (SSH) to implement a health program at schools aiming to improve the health condition of the students, the school personnel and the community. SSH has not been deployed yet and it is reasonable to believe that several factors are likely to act as facilitators or barriers to its implementation. The general objective of this study is to identify the facilitators and the barriers to the SSH project implementation by studying stakeholders' perceptions of an eventual policy of nutritional health promotion in Lebanese schools. Methodology: An integrated conceptual framework based on social marketing approach and inspired from several social and changing behaviors theories and models  was developed to approach the subject at three levels of action, namely individual, community and organizational. The target population of this study consists of multidisciplinary stakeholders and of public/private schools in rural and urban Lebanese regions. Directed and semi-structured individual interviews were conducted. Collected data have been submitted to a qualitative analysis. Results: In total, 48 youth, 40 adults (4 school principals, 4 school food services, 32 multidisciplinary stakeholders) and 4 focus groups (parents-teachers) participated in this study Collaboration, coordination, participation and leadership are identified as the main facilitating factors for the development of school health promotion policy. However, inappropriate school environment, poverty, political pressure, and sociocultural structures' diversity are the major barriers identified. Conclusion: The integrated framework of this study offers completed perspectives on how a scholar health policy is intended to work and to produce desired changes.

Keyphrases: Nutrition, Ecole, Parents, Perceptions, Health promotion, Nutritional education, School policy, Nutrition, Physical activity, School, Youth, Parents, Key stakeholders, Perceptions