Institutional Barriers and Promotors for Healthy Eating and Physical Activity in Costa Rican Educational Centers: A Multiple Case Study

Abstract

This study aimed to identify institutional barriers and facilitators influencing the promotion of healthy eating, physical activity, and school management practices in three Costa Rican educational centers. A multiple case study using an action research approach was conducted between 2018 and 2019, involving 432 participants. Diagnostic and intervention workshops were carried out to identify determinants shaping health behaviors within school communities. Nutritional status was assessed using Body Mass Index in accordance with World Health Organization standards. Half of the students exhibited malnutrition (30% overweight/obesity, 20% underweight). Key barriers to healthy eating included economic constraints, high consumption of ultra-processed foods, and the availability of unhealthy items in school cafeterias. Physical activity was hindered by limited infrastructure and the prioritization of academic subjects over physical education. Institutional management emerged as a critical cross-cutting determinant shaping the feasibility and sustainability of health promotion efforts. Findings underscore the need for comprehensive, context-sensitive strategies to strengthen school-based health promotion.