Perceptions of body weight and health risks among primary school educators in the Western Cape, South Africa

Magister Public Health - MPHThe global problem of overweight and obesity is disturbing judging by the World Health Organization 2008 statistics which estimate that 1.4 billion and 500 million adults are overweight and obese. Thus, as a major risk for non-communicable diseases (NCDs) which are the foremost cause of disability and death, the problem of obesity needs to be addressed not only globally but in South Africa as well. South Africa’s burden of disease includes NCDs and causes of death of diseases such as diabetes (3%), cardiovascular diseases (CVDs) (11%), cancer (7%) and chronic respiratory diseases (3%). The HealthKick study is a school-based nutrition and physical activity intervention programme in the Western Cape, S.A., aimed to promote healthy behaviours such as healthful eating and physical activity in children, parents and teachers to reduce the risk of non-communicable diseases. During the formative phase of the study it emerged that educators were at high risk for NCDs because of their high levels of obesity. This study therefore aimed to describe primary school educators’ perceptions regarding body weight, related health risks and barriers to weight management. A qualitative approach was used to collect data and included focus group discussions (FGDs), and in-depth individual interviews (IDIs). In addition anthropometric measurements were taken. Four schools were purposively selected and a total of thirty one male and female educators participated in the seven focus group discussions and four in-depth interviews from the four schools. Male FGDs and IDIs and female FGDs and IDIs were conducted separately. The focus group discussions and in-depth interviews were digitally recorded and transcribed verbatim. Thematic data analysis was conducted with the use of ATLAS ti 6.1 computer software.The results of the study indicate that educator perceptions regarding their own body weight varied slightly from the actual. Positive and negative weight loss experiences and feelings regarding their own body weight were expressed. Educators appeared knowledgeable about overweight/obesity and its health risks for particular NCDs. Several personal barriers were identified by the educators; however, of particular interest were the barriers relating to the school environment, identified barriers included lack of time, heavy workloads and school responsibilities. Several factors for consideration emerged relating to implementing an educator weight management programme in the schools. These included: the involvement of the department of education (DOE), the type of activities planned and the time of implementation

"HealthKick": Formative assessment of the health environment in low-resource primary schools in the Western Cape Province of South Africa

BACKGROUND: This study evaluated the primary school environment in terms of being conducive to good nutrition practices, sufficient physical activity and prevention of nicotine use, with the view of planning a school-based health intervention. METHODS: A sample of 100 urban and rural disadvantaged schools was randomly selected from two education districts of the Western Cape Education Department, South Africa. A situation analysis, which comprised an interview with the school principal and completion of an observation schedule of the school environment, was done at all schools. RESULTS: Schools, on average, had 560 learners and 16 educators. Principals perceived the top health priorities for learners to be an unhealthy diet (50%) and to far lesser degree, lack of physical activity (24%) and underweight (16%). They cited lack of physical activity (33%) and non-communicable diseases (NCDs; 24%) as the main health priorities for educators, while substance abuse (66%) and tobacco use (31%) were prioritised for parents. Main barriers to health promotion programmes included lack of financial resources and too little time in the time table. The most common items sold at the school tuck shops were crisps (100%), and then sweets (96%), while vendors mainly sold sweets (92%), crisps (89%), and ice lollies (38%). Very few schools (8%) had policies governing the type of food items sold at school. Twenty-six of the 100 schools that were visited had vegetable gardens. All schools reported having physical activity and physical education in their time tables, however, not all of them offered this activity outside the class room. Extramural sport offered at schools mainly included athletics, netball, and rugby, with cricket and soccer being offered less frequently. CONCLUSION: The formative findings of this study contribute to the knowledge of key environmental and policy determinants that may play a role in the health behaviour of learners, their parents and their educators. Evidently, these show that school environments are not always conducive to healthy lifestyles. To address the identified determinants relating to learners it is necessary to intervene on the various levels of influence, i.e. parents, educators, and the support systems for the school environment including the curriculum, food available at school, resources for physical activity as well as appropriate policies in this regard

The association between nutrition and physical activity knowledge and weight status of primary school educators

The purpose of this study was to investigate primary school educators' health status, knowledge, perceptions and behaviour regarding nutrition and physical activity.Thus, nutrition and physical activity knowledge, attitudes, behaviour and risk factors for the development of non-communicable diseases of 155 educators were assessed in a cross-sectional survey. Height, weight, waist circumference, blood pressure and random glucose levels were measured. Twenty percent of the sample had normal weight (body mass index (BMI, kg/m2) 25 to 140/90 mmHg: 50.3%), and were inactive (48.7%) with a high waist circumference (> 82 cm: 57.4%). Educators' nutrition and physical activity knowledge was poor. Sixty-nine percent of educators incorrectly believed that eating starchy foods causes weight gain and only 15% knew that one should eat five or more fruit and/or vegetables per day. Aspects of poor nutritional knowledge, misconceptions regarding actual body weight status, and challenges in changing health behaviours, emerged as issues which need to be addressed among educators. Educators' high risk for developing chronic non-communicable diseases (NCDs) may impact on educator absenteeism and subsequently on school functioning. The aspects of poor nutrition and physical activity knowledge along with educators' high risk for NCD development may be particularly significant not merely in relation to their personal health but also the learners they teach

Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation

Abstract Background The HealthKick intervention, introduced at eight primary schools in low-income settings in the Western Cape Province, South Africa, aimed to promote healthy lifestyles among learners, their families and school staff. Eight schools from similar settings without any active intervention served as controls. Methods The Action Planning Process (APP) guided school staff through a process that enabled them to assess areas for action; identify specific priorities; and set their own goals regarding nutrition and physical activity at their schools. Educators were introduced to the APP and trained to undertake this at their schools by holding workshops. Four action areas were covered, which included the school nutrition environment; physical activity and sport environment; staff health; and chronic disease and diabetes awareness. Intervention schools also received a toolkit comprising an educator’s manual containing planning guides, printed resource materials and a container with physical activity equipment. To facilitate the APP, a champion was identified at each school to drive the APP and liaise with the project team. Over the three-years a record was kept of activities planned and those accomplished. At the end of the intervention, focus group discussions were held with school staff at each school to capture perceptions about the APP and intervention activities. Results Overall uptake of events offered by the research team was 65.6 % in 2009, 75 % in 2010 and 62.5 % in 2011. Over the three-year intervention, the school food and nutrition environment action area scored the highest, with 55.5 % of planned actions being undertaken. In the chronic disease and diabetes awareness area 54.2 % actions were completed, while in the school physical activity and sport environment and staff health activity areas 25.9 and 20 % were completed respectively. According to educators, the low level of implementation of APP activities was because of a lack of parental involvement, time and available resources, poor physical environment at schools and socio-economic considerations. Conclusions The implementation of the HealthKick intervention was not as successful as anticipated. Actions required for future interventions include increased parental involvement, greater support from the Department of Basic Education and assurance of sufficient motivation and ‘buy-in’ from schools

Did HealthKick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?

Background: Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. Methods: Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. Results: The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: −0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. Discussion: The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty.Conclusions: The HK intervention did not significantly improve quality of diet of children

HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings

<p>Abstract</p> <p>Background</p> <p>The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors.</p> <p>Methods/Design</p> <p>This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).</p> <p>The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.</p> <p>The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.</p> <p>Discussion</p> <p>This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.</p