Food security and related wellness indicators of health sciences students in central South Africa during Covid-19: a programme to mitigate the impact of isolated, confined and extreme environments

Abstract

Thesis (PhD: Environmental Health)--Central University of TechnologyThe negative impact of the COVID-19 pandemic resulting from isolated, confined, and extreme (ICE) environments brought about by strict lockdown restrictions has been widely documented, including its effects on Higher Education. Decreased physical activity, change in nutritional habits, weight gain, food insecurity, inadequate quality sleep, poor mental health and decreased academic performance are amongst manifestations of such impacts. In developing economies, the impact of the pandemic has been argued to be more pronounced as a result of limited resources and infrastructure. The aim of this study was to investigate possible changes in the nutritional health and related wellness indicators of students at a selected higher education institution in South Africa due to COVID-19 circumstances, and to propose a programme to the Higher Education portfolio that may mitigate negative impacts during future events resulting in ICE environments. Such future events may include political instability and conflicts, pandemics, climate change consequences, economic decline and the like. A mixed method investigation was performed using both questionnaires and focus group discussions amongst final year students selected from four health science curricula at a prominent South African university of technology (UoT). The questionnaire and focus group discussions measured similar constructs and utilised existing, validated questionnaires, including Household Food Insecurity Access Scale, SA Demographic and Health Survey surveys, and questionnaires to assess adherence to diet and exercise advice, as well as Depression, Anxiety and Stress Scale of 21 Items. Data from questionnaires and focus group discussions were coded, analysed, and interpreted, whereafter a targeted and aligned mitigation programme was proposed for Higher Education institutions. To achieve the former, design thinking and project management processes were integrated towards a suitable and effective methodology to develop interventions and strategies for the challenges that emerged from the findings of the study. The adapted and integrated design process consists of six phases: (1) Initiation and planning, (2) Empathise, (3) Execute and define, (4) Ideate, (5) Prototype, (6) and Closure. The results of the study showed that the majority of the participants (n=148) that completed the questionnaires were female (82%), while all focus group participants (n=17) were females, resulting from the sampling methodology applied. Questionnaire participants mainly resided in urban areas (76%) during the pandemic, while 36% had parents/guardians at home. Nutritional-related data indicated that food insecurity existed at varying levels amongst 84% of questionnaire participants. The main reason for food insecurity was financial constraints, and correlation statistics indicated participants from rural areas were more food insecure. Adequate water was available to participants during the pandemic, although the quality of the water may be questionable. Questionnaire participants’ dietary intake changed, with mainly a decrease in sugary and salty snacks, although maintaining fruit, vegetables, and meat intake. Focus group participants indicated an increase in the intake of starchy food such as noodles and reverting to binge eating, primarily due to emotional stress. Dietary intake changes were also attributed to limited resources, e.g. funds and electricity. Only a few participants were aware (18%) or utilised (1%-4%) nutritional-related, as well as health and wellness support services that were offered at the institution during the pandemic. This observation suggests that respondents were unaware of the services offered by the institution. Findings on related health and wellness indicators showed that most participants perceived their general health to have deteriorated, and they fell ill more often. Questionnaire participants reported considerable weight gain (33%) or slight weight gain (24%), as well as decreased physical activity with an increase of 11% in the no exercise category. Similarly, focus group participants indicated weight fluctuations, including weight gain, as well as more sedentary behaviour. The reasons for decreased activity included lack of motivation (17%) and inaccessible training facilities such as gymnasiums (24%). Both focus group and questionnaire participants’ reported deterioration of mental health with the anxiety levels of questionnaire participants in the extreme category. Inferential statistics analysing the inter-relationships amongst tested variables indicated that a statistically significant relationship exists between food insecurity and poor mental health. Utilising a mind map methodology, interventions and strategies were developed aimed at mitigating the challenges/impacts that emerged from the findings on nutritional and related health and wellness indicators of students. These interventions and strategies were classified into two categories: awareness and communication, and resources. In the awareness and communication category, improved communication of offered support services, awareness campaigns, developing skills and knowledge and evaluation of the student cohort as part of ensuring adequate capacity of support services, were suggested interventions. The resources category consisted of the following strategies: a wellness software application utilising Artificial Intelligence (AI), an adequate food aid programme with easy access, as well as wellness support that includes nutritional and fitness support. It was recommended that the proposed programme be implemented by Higher Education institutions in accordance with the Nadler-Tushman (N-T) model of congruence. The N-T model was selected due to its authority and proven effectiveness, as well as its simple and pragmatic approach to identify gaps and shortcomings. The model is also focused on a process of transformation – the latter being a priority within the current-day Higher Education sector and peripheral institutions in developing countries. The proposed programme is not a one-size-fits-all model, whereas institutions are advised to implement it into their specific contexts and ensure congruence between all the elements. In conclusion, the study clearly showed that the ICE environment that resulted from the COVID-19 pandemic negatively impacted the students’ nutritional status, especially food security. Moreover, these COVID-19 circumstances also had a significant impact on health and wellness indicators of students. A need was identified for a health and wellness programme at Higher Education institutions, including improved awareness, health and wellness training and support. As a result, a programme with strategies and interventions has been proposed to institutions that must reflect on their current support service structures to amend the strategies to suit their specific circumstances. Therefore, the proposed programme serves as point of departure for institutions wanting to ensure maintenance of student health and wellness, as well as academic performance during future ICE events. Ultimately, this study endeavoured to cast light on the impact of isolated, confined, and extreme environments brought about by events currently rife on the international stage, and to suggest mediation strategies to cope in such environments, with a focus on Higher Education students