Physical activity (PA) and nutrition are key health behaviors underlying the design and implementation of prevention strategies for non-communicable diseases (NCDs) in Latin America. Nevertheless, research still reports low prevalence of PA and fruit and vegetable consumption throughout the region. This paper aims at reviewing the ways in which models of behavior change theory have been applied in study development and implementation regarding nutrition and PA in Latin America. In August 2011 we conducted a systematic literature review of the behavior change studies that targeted such NCDs risk factors published until then. Out of 4279 surveyed abstracts, only 29 corresponded to articles that met our inclusion criteria. Twenty-six articles reported the application of behavior change theory, with the trans-theoretical model (n = 12) being the most frequently used. Other theories and models included the socio-ecological model (n = 4), cognitive theory (n = 3), social cognitive theory (n = 2) and theories related to health education and counseling (n = 5). Based on this review, we recommend that the application of behavior change theory be explicitly reported in Latin American peer-reviewed articles, and that outcome evaluations include behavior change constructs so as to better assess their contribution to the effectiveness of nutrition and PA interventions in the region. Furthermore, we state the need for a better understanding of the behavior change mechanisms that may be specific to the Latin American context.
World Health Organization. The global burden of disease, 2004 update. Geneva, Switzerland: World Health Organization; 2008.
2.
World Health Organization. Global health risks, mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: World Health Organization; 2009.
3.
AbegundeDMathersCAdamTOrtegonMStrongK. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007; 370(9603): 1929–1938.
4.
LeeIMShiromaELobeloFPuskaPBlairSNKatzmarzykPT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012; 380(9838): 219–229.
5.
World Health Organization. Global recommendations on physical activity for health. Geneva, Switzerland: World Health Organization; 2010.
6.
World Health Organization, FaAO2. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation 2003. Geneva, Switzerland: WHO; 2013.
7.
De MaioFG. Understanding chronic non-communicable diseases in Latin America: towards an equity-based research agenda. Global Health. 2011; 7(1): 36.
8.
BaumanABullFCheyTCraigCAinsworthBSallisJ. The International Prevalence Study on Physical Activity: results from 20 countries. Int J Behav Nutr Phys Act. 2009; 6(1): 21.
9.
HallJMooreSHarperSLynchJ. Global variability in fruit and vegetable consumption. Am J Prev Med. 2009; 36(5): 402–409.
10.
PomerleauJFLockKFMcKeeMFAltmannDR. The challenge of measuring global fruit and vegetable intake. J Nutr. 2004; 134(5): 1175–1180.
11.
HallalPCAndersenLBBullFCGutholdRHaskellWEkelundU. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012; 380(9838): 247–257.
12.
World Health Organization, Dept. of Chronic Diseases and Health Promotion. Global strategy on diet, physical activity and health. Geneva, Switzerland: World Health Organization; 2004.
13.
UauyRAlbalaCKainJ. Obesity trends in Latin America: transiting from under- to overweight. J Nutr. 2001; 131(3): 893S-899S.
14.
World Health Organization. Ottawa charter for health promotion an International Conference on Health Promotion, the move towards a new public health, November 17–21, 1986, Ottawa, Ontario, Canada. Ottawa: Health and Welfare Canada; 1986.
15.
GlanzKBishopDB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010; 31: 399–418.
16.
GlanzKRimerBKViswanathaR. Health behaviour and health education: Theory, Research and Practice. San Francisco, CA, USA: Jossey-Bass;2008.
17.
RogersRW. A protection motivation theory of fear appeals and attitude change. J Psychol. 1975; 91(1): 93–114.
18.
AjzenI. The theory of planned behavior. Organ Behav Hum Decis Process. 1991; 50: 179–211.
19.
BanduraA. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001; 52: 1–26.
20.
ProchaskaJDiclementeC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983; 390–395.
21.
BanduraA. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ, USA: Prentice Hall;1986.
22.
MarcusBLewisB. Physical Activity and the Stages of Motivational Readiness for Change Model. President’s Council on Physical Fitness & Sports. Washington, DC; 2003.
23.
BanduraA. Health promotion by social cognitive means. Health Educ Behav. 2004; 31(2): 143–164.
24.
BanduraA. Self-efficacy: the Exercise of Control. New York, NY, USA: W.H. Freeman;1997.
25.
StokolsD. Establishing and maintaining healthy environments. Toward a social ecology of health promotion. Am Psychol. 1992; 47(1): 6–22.
26.
SallisJCerveroRAscherWHendersonKKraftMKerrJ. An ecological approach to creating active living communities. Annu Rev Public Health. 2006; 27: 297–322.
27.
BrugJOenemaAFerreiraI. Theory, evidence and Intervention Mapping to improve behavior nutrition and physical activity interventions. Int J Behav Nutr Phys Act. 2005; 2(1): 2.
28.
GreenLKreuterM, editors. Health Program Planning: an Educational and Ecological Approach. 4th ed.New York: McGraw Hill; 2005.
29.
KokGSchaalmaHRuiterRACVan EmpelenPBrugJ. Intervention mapping: protocol for applying health psychology theory to prevention programmes. J Health Psychol. 2004; 9(1): 85–98.
30.
PainterJBorbaCHynesMMaysDGlanzK. The use of theory in health behavior research from 2000 to 2005: a systematic review. Ann Behav Med. 2008; 35(3): 358–362.
31.
AshfordSEdmundsJFrenchDP. What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis. Br J Health Psychol. 2010; 15(2): 265–288.
32.
HardemanWJohnstonMJohnstonDBonettiDWarehamNKinmonthAL. Application of the theory of planned behaviour in behaviour change interventions: a systematic review. Psychol Health. 2002; 17(2): 123–158.
33.
HorwathCC. Applying the transtheoretical model to eating behaviour change: challenges and opportunities. Nutr Res Rev. 1999; 12(2): 281–317.
34.
MichieSAbrahamCWhittingtonCMcAteerJGuptaS. Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol. 2009; 28(6): 690–701.
35.
NothwehrFSnetselaarLWuH. Age group differences in diet and physical activity-related behaviors among rural men and women. J Nutr Health Aging. 2008; 12(3): 169–174.
36.
KellerCFleuryJGregor-HoltNThompsonT. Predictive ability of social cognitive theory in exercise research: an integrated literature review. Online J Knowl Synth Nurs. 1999; 6:2.
37.
AbuSabhaRAchterbergC. Review of self-efficacy and locus of control for nutrition- and health-related behavior. J Am Diet Assoc. 1997; 97(10): 1122–1132.
38.
FloydDPrentice-DunnSRogersR. A meta-analysis of research on protection motivation theory. J Appl Soc Psychol. 2000; 30(2): 407–429.
39.
MarshallSJBiddleSJ. The transtheoretical model of behavior change: a meta-analysis of applications to physical activity and exercise. Ann Behav Med. 2001; 23(4): 229–246.
40.
KahnERamseyLBrownsonRHeathGHowzeEPowellK. The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med. 2002; 22: 73–107.
41.
AdamsJWhiteM. Are activity promotion interventions based on the transtheoretical model effective? A critical review. Br J Sports Med. 2012; 37(2): 106–114.
42.
BhattacharyyaOReevesSGarfinkelSZwarensteinM. Designing theoretically-informed implementation interventions: Fine in theory, but evidence of effectiveness in practice is needed. Implement Sci. 2006; 1(1): 5.
43.
HoehnerCMSoaresJParraPDRibeiroICJoshuCEPrattM. Physical activity interventions in Latin America: a systematic review. Am J Prev Med. 2008; 34(3): 224–233.
44.
SearightHGaffordJ. Behavioral science education and the international medical graduate. Acad Med. 2006; 81(2): 164–170.
45.
LiberatiAAltmanDGTetzlaffJMulrowCGotzschePCIoannidisJPA. The PRISMA Statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Int Med. 2009; 151(4): 65–94.
46.
ZacaríasHRodríguezOLeraMHillDDomperRGonzálezA. Consumo de verduras y frutas en centros de salud y supermercados, de la región metropolitana de Chile: Programa 5 al día. Rev Chil Nutr. 2009; 36: 159–168.
47.
SilvaDPereiraIM. Estágios de mudança de comportamento para atividade física e fatores associados em acadêmicos de educação física / Stages of behavior change for physical activity and associated factors in physical education students. Rev Bras Ativ Fís Saúde. 2010; 15:1.
48.
SilvaDASmith-MenezesAAlmeida-GomesMde SousaT. Stages of behavioral change regarding physical activity in students from a Brazilian town. Rev Salud Publica (Bogota). 2010; 12(4): 623–634.
49.
Rodriguez-HernandezHMorales-AmayaURosales-ValdezRRivera-HinojosaFRodriguez-MoranMGuerrero-RomeroF. Adding cognitive behavioural treatment to either low-carbohydrate or low-fat diets: differential short-term effects. Br J Nutr. 2009; 102(12): 1847–1853.
50.
ReisRPetroskiEL. Application of the social cognitive theory to predict stages of change in exercise for brazilian adolescents. Rev Bras Cineantropom Desempenho Hum. 2005; 7(2): 62–68.
51.
ReisRSHallalPCParraDCRibeiroICBrownsonRCPrattM. Promoting physical activity through community-wide policies and planning: findings from Curitiba, Brazil. J Phys Act Health. 2010; 7(Suppl 2): S137–S145.
52.
PereiraMHN. Mudança na adiposidade de mulheres adultas após um programa de exercícios enriquecido das técnicas do modificação comportamento. Revista Brasileira de Ciência e Movimento. 1990; 4:4.
53.
MatsudoVMatsudoSAraujoTAndradeDOlivieraLHallalP. Time trends in physical activity in the state of Sao Paulo, Brazil: 2002–2008. Med Sci Sports Exerc. 2010; 42(12): 2231–2236.
54.
MatsudoVMatsudoSAndradeDAraujoTAndradeEBraggionG. Physical activity promotion: experiences and evaluation of the Agita Sao Paulo Program using the ecological mobile model. J Phys Act Health. 2004; 1: 81–97.
55.
MarinhoMCHamannELimaAC. Práticas e mudanças no comportamento alimentar na população de Brasília, Distrito Federal, Brasil. Revista Brasileira de Saude Materno Infantil. 2007; 7: 251–261.
56.
MadureiraACorseuilHPelegriniAPetroskiE. Association between stages of behavior change related to physical activity and nutritional status in university students. Cadernos de Saúde Pública. 2009; 25: 2139–2146.
57.
LucumiDSarmientoOForeroRGomezLEspinosaG. Community intervention to promote consumption of fruits and vegetables, smoke-free homes, and physical activity among home caregivers in Bogota, Colombia. Prev Chron Dis. 2006; 3(4): A120.
58.
GuedesDSantosCLopesC. Estágios de mudança de comportamento e prática habitual de atividade física em universitários. Revista Brasileira de Cineantropometria e Desempenho Humano. 2006; 8(4): 5–15.
59.
DiazREsparza-RomeroJMoya-CamarenaSRobles-SardinAValenciaM. Lifestyle intervention in primary care settings improves obesity parameters among Mexican youth. J Am Diet Assoc. 2010; 110(2): 285–290.
60.
de BarrosMNahasMHallalPde Farias JúniorJFlorindoAHonda de BarrosS. Effectiveness of a school-based intervention on physical activity for high school students in Brazil: the Saude na Boa project. J Phys Act Health. 2009; 6(2): 163–169.
61.
De Almeida-GomesMDuarteM. Efetividade de uma intervenção de atividade física em adultos atendidos pela estratégia saúde da família: programa ação e saúde Floripa, Brasil. Rev Bras Ativ Fís Saúde. 2008; 13:1.
62.
da Silva MdeLMartinsJShiromaGOrtolaniMHorieLWaitzbergD. Nutritional recommendation alone does not change the obesity profile of health professionals. Nutr Hosp. 2008; 23(5): 429–432.
63.
ChávezS. Nutrición en el Primer Nivel de Atención: Sobrepeso y Obesidad. Mexico City, Mexico: Universidad Autónoma Metropolitana Unidad Xochimilco; 2007.
64.
CastilloCKainB. Consejería en vida sana y cambio de conductas en escolares obesos: intervención controlada en madres/cuidadoras. Rev Chil Nutr. 2010; 37: 155–163.
65.
CarrenoJFVyhmeisterGFGrauLFIvanovicD. A health promotion programme in Adventist and non-Adventist women based on Pender’s model: a pilot study. Public Health. 2006; 120(4): 346–355.
66.
CamposMNogueiraNPazSNogueiraA. Nutritional education and its contribution for change in health indicators of the employees of a nutrition and food unit. Nutr Rev Soc Bras Aliment Nutr. 2009; 34(2): 27–42.
67.
CabreraGGómezLMateusL. Activida física y etapas de cambio comportamental en Bogotá. Colombia Médica2004; 35(2): 82–86.
68.
BrazaoMHirayamaMCrispimCZelantiA. Estágios de mudança de comportamento e barreiras percebidas à prática de atividade física em idosos residentes em uma cidade de médio porte do Brasil. Motriz Revista de Educação Física UNESP. 2009; 15(4): 759–763.
69.
BonvecchioAFPeltoGHEscalanteEMonterrubioEHabichtJPNavaF. Maternal knowledge and use of a micronutrient supplement was improved with a programmatically feasible intervention in Mexico. J Nutr. 2007; 137(2): 440–446.
70.
BonhauserMFFernandezGFPuschelKFYanezFFMonteroJFThompsonBF. Improving physical fitness and emotional well-being in adolescents of low socioeconomic status in Chile: results of a school-based controlled trial. Health Promot Int. 2005; 20(2): 113–122.
71.
Balas-NakashMRodríguez-CanoAMuñoz-ManriqueCVásquez-PeñaPPerichart-PereraO. Tres métodos para medir la adherencia a un programa de terapia médica y nutricia en mujeres embarazadas con diabetes y su asociación con el control glucémico. Rev Invest Clin. 2010; 62(3): 235–243.
72.
AlcalayRFGheeAFScrimshawS. Designing prenatal care messages for low-income Mexican women. Public Health Rep. 1993; 108: 354–362.
73.
AlbarranNBallesterosMMoralesGOrtegaM. Dietary behavior and type 2 diabetes care. Patient Educ Couns. 2006; 61: 191–199.
74.
Aguilera-SosaVRLeijaGRodríguezJDTrejoJILópezMR. Evaluación de cambios en esquemas tempranos desadaptativos y en la antropometría de mujeres obesas, con un tratamiento cognitivo conductual grupal. Revista Colombiana de Psicología. 2009; 18(2): 157–166.
75.
MichieSvan StralenMWestR. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6: 42.
76.
TrumanBSmith-AkinCHinmanAGebbieKBrownsonRNovickL. Developing the Guide to Community Preventive Services–overview and rationale. The Task Force on Community Preventive Services. Am J Prev Med. 2000; 18(suppl1): 18–26.
77.
MaherCSherringtonCHerbertRMoseleyAElkinsM. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003; 83(8): 713–721.
78.
TaggartJWilliamsADennisSNewallAShortusTZwarN. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Fam Pract. 2012; 13(1): 49.
79.
FjeldsoeBNeuhausMWinklerEEakinE. Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychol. 2011; 30(1): 99–109.
80.
DzewaltowskiDAEstabrooksPAKlesgesLMBullSGlasgowRE. Behavior change intervention research in community settings: how generalizable are the results?Health Promot Int. 2004; 19(2): 235–245.
81.
WhitelawSBaldwinSBuntonRFlynnD. The status of evidence and outcomes in Stages of Change research. Health Educ Res. 2000; 15(6): 707–718.
82.
B-âbanACr-âciunC. Changing health-risk behaviors: A review of theory and evidence-based interventions in health psychology. J Cogn Behav Psychother. 2007; 7(1): 45–66.
83.
ConnerMNormanP. Predicting Health Behaviour. Buckingham, UK: Open University Press; 1996.
84.
WilliamsSFrenchD. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour–and are they the same?Health Educ Res. 2011; 26(2): 308–322.
85.
A Dictionary of Epidemiology. 5th ed.New York, NY, USA: Oxford University Press; 2008.
86.
DobrowMGoelVUpshurR. Evidence-based health policy: context and utilisation. Soc Sci Med. 2004; 58(1): 207–217.
87.
PrattMSarmientoOMontesFOgilvieDMarcusBPerezL. The implications of megatrends in information and communication technology and transportation for changes in global physical activity. Lancet. 2012; 380(9838): 282–293.
88.
BrownsonRCBallewPBrownKLElliottMBHaire-JoshuDHeathGWKreuterM. The effect of disseminating evidence-based interventions that promote physical activity to health departments. Am J Public Health. 2007; 97(10): 1900–1907.
89.
SpencerLAdamsTBMaloneSRoyLYostE. Applying the transtheoretical model to exercise: a systematic and comprehensive review of the literature. Health Promot Pract. 2006; 7(4): 428–443.
90.
HutchisonAJBreckonJDJohnstonLH. Physical activity behavior change interventions based on the transtheoretical model: a systematic review. Health Educ Behav. 2008; 36(5): 829–845.
91.
MichieSAshfordSSniehottaFDombrowskiSBishopAFrenchD. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011; 26(11): 1479–1498.
