Social-ecological obesity prevention: Measuring systemic interpenetration and multi-level impact of investing in promotoras human, social and political capital

Aventuras para Niños (APN) is a childhood obesity prevention intervention for Mexican-Americans in Southern California. The intervention has a multi-level, 2x2 factorial research design based on social-ecological models and health communication theories. Promotoras implemented the intervention in participants' homes, schools and community food retailers. Systemic measurement is proposed to reflect APN's effects. This theoretical discussion defines the constructs of boundaries and interpenetration, integrating Luhmann's social systems theory and social-ecological models. These constructs are illustrated through qualitative analysis of project documents, participant observation and staff interviews. The intervention has changed the community, independently of its eventual effect on the primary outcome (child BMI). Childhood obesity prevention entered the social agenda, obtaining media coverage and endorsement by policy makers. This new awareness and APN's human capital development empowered the promotoras and enhanced their social status. They are now recognized as vehicles for cause-related market influence and community mobilization. Capitalizing on these social and political resources, the promotoras increased their neighborhoods' supply of healthy food options and influenced public investment in park infrastructure. The project's material and human capital investments had noticeable social and political impact. Individual-based measures may not reflect the multidirectional interpenetrating effects across individual, social and political systemic boundaries in the targeted environments. The difficult to measure, upwards-cascading effects of investment in promotoras' human capital are rarely captured by traditional measurement methods nor recognized by journal editors, funding agencies or cost-effectiveness analyses. The suggested operational definitions can be instrumental in making these effects measurable.