Open Access Research article

Formative research to develop a community-based intervention for chronic disease prevention in Guatemalan school-age children

Paola Letona1*, Manuel Ramirez-Zea1, Benjamin Caballero2 and Joel Gittelsohn2

Author Affiliations

1 INCAP Comprehensive Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City 1118, Guatemala

2 Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA

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BMC Public Health 2014, 14:101  doi:10.1186/1471-2458-14-101

Published: 31 January 2014



Noncommunicable diseases (NCD) are the most common causes of morbidity and mortality worldwide, even in low- and middle-income countries (LMIC). Recent trends in health promotion emphasize community-based interventions as an important strategy for improving health outcomes. The aim of this study was to conduct formative research regarding the perceptions of NCD risk factors, their influencing factors, and community resources available to aid the development and implementation of a community-based intervention with school-age children.


Focus group discussions (n = 18), home visits (n = 30), and individual semi-structured interviews (n = 26) were conducted in three urban communities in Guatemala with school-age children (10–12 years of age), teachers, parents, and local community members (i.e., school principals, school food kiosk vendors, religious leaders, authority representatives). All focus groups and interviews were transcribed verbatim for thematic analysis.


Children, parents, and teachers have general knowledge about modifiable risk factors. Adults worried more about tobacco use, as compared to unhealthy diet and physical inactivity in children. Participants identified features at the intrapersonal (e.g., negative emotional state), interpersonal (e.g., peers as role models), and organizational and community levels (e.g., high levels of crime) that influence these risk factors in children. School committees, religious leaders, and government programs and activities were among the positive community resources identified.


These findings should help researchers in Guatemala and similar LMIC to develop community-based interventions for NCD prevention in school-age children that are effective, feasible, and culturally acceptable.

Formative research; Community-based intervention; Behavioral risk factors; Chronic disease prevention; Developing countries