Expanding our conceptualization of program implementation: lessons from the genealogy of a school-based nutrition...

This work presents a theoretical framework in which health promotion and health education program implementation can be conceived as an open dynamic system. By tracing the evolution of an elementary school-based nutrition program from its conception to its recent form, we construct a program genealogy. Data were derived from two interviews and three historical documents from which historical events were identified and reconstructed in the form of a tree analogy. Data analysis ensued using concepts from the actor-network theory about social innovation. These concepts identified social and technical program attributes and situated them within a process which evolved over time, thus permitting the program's genealogy to appear. The genealogy was found to be influenced by the ways in which the involved actors interpreted the issue of food security, namely, as a professional issue, with a nutrition education response and as a social issue, with a community-building response. The interaction between the interests of the actors and the technical components of the program resulted in three temporal program iterations. The results highlight the important role played by the involved actors during program implementation and suggest the need to take these interests into consideration during all phases of program planning.