Elaboração e validação de instrumento de avaliação de práticas sustentáveis de saúde e bem-estar em serviços de alimentação

Abstract

The adoption of sustainable practices by nutritionists contributes to achieving target 3.4 of the UN Sustainable Development Goal (SDG), which aims to reduce mortality from noncommunicable diseases by one third, promote mental health and well-being, and worker health by 2030. The objective was to develop and validate an instrument for evaluating sustainability practices related to the health and well-being dimension developed by collective food nutritionists. The research took place in four stages: 1) scope review based on PRISMAScR recommendations; 2) development of the instrument for evaluating the promotion of health and well-being in collective nutrition. The instrument was structured into four constructs (knowledge about the SDGs; dimension of health and food quality; health and well-being of workers in food and nutrition units and risk behaviors for health and well-being), totaling 34 items using a scale 5-point Likert to check frequency; 3) validation of content and clarity with a panel of experts using the Delphi method and applying the content validate index with over 80% consensus; 4) pilot test with nutritionists. The structure of the instrument was evaluated for its reliability using the statistical techniques of Cronbach's Alpha and Mcdonald's Omega Coefficient, and its validity through confirmatory factor analysis. In step 1, for the scope review, 34 studies were included, 88% of which were conducted in Brazil, with a focus on evaluating the nutritional quality of menus and public worker food policies. Activities of collective feeding nutritionists related to achieving target 3.4 of the SDG were listed: planning healthy and sustainable menus, promoting worker health surveillance actions, periodic evaluation of workers' nutritional status, and fostering participatory leadership. In steps 2 and 3, validation by an expert panel in three rounds (evaluation and feedback) culminated in the instrument containing 37 items, maintaining the four constructs of analysis. In step 4, the instrument was applied to 105 nutritionists, revealing that 76% recognize the importance of the SDGs. It is noteworthy that 70% of the nutritionists frequently offer red meat on the menus, and only 13% reported using ultra-processed meat products. Regarding worker health, it was observed that only 29% frequently perform anthropometric evaluations of their workers. The main risk factors observed among workers in food units were sedentary lifestyle (53%), low consumption of fruits and vegetables (39%), and stress (67%). Confirmatory factor analysis indicated the presence of 8 factors, obtaining Cronbach's alpha (0.766) and Mcdonald's omega (0.882), indicating that the instrument has good internal consistency. The reliability of the factors was adequate (above 0.70) for almost all factors except for factor 2 (on the use of ultra-processed foods on menus) (ω= 0.661; Cronbach α=0.645). It is concluded that the instrument compiled variables capable of identifying nutritionists' practices in collective nutrition aligned with the achievement of goal 3.4. of SDG3, being statistically valid and reliable.