HEAD TEACHERS' SUPERVISION OF PROFESSIONAL DEVELOPMENT AND ACADEMIC PERFORMANCE IN EMBU AND MURANGA COUNTIES, KENYA

Supervision means overall duties performed by a head teacher which ensures teachers perform their expected roles in the transmission of knowledge and enhance academic performances. Academic performance in examinations has consistently declined in primary schools in Kenya and the world over. The objective of the study was to; assess the relationship between the head teacher’s supervision of professional development and academic performance in Embu and Muranga counties, Kenya. The study adopted the Role theory championed by Biddle. A descriptive survey research design was used. The Target Population was 14786 and comprised of head teachers and teachers. The researchers purposefully sampled 378 public and private primary schools. Simple random sampling was used to select 256 respondents. Data were collected using questionnaires, interviews, and observation. Reliability was ascertained by a pilot study which generated a Cronbach’s alpha coefficient of 0.93. Data were analysed using descriptive and inferential statistics, precisely, correlation computations. The findings of the study informed that the highest percentage of supervision 87.4percentwas the head teachers’ permission for teachers to attend seminars, workshops, and conferences. The least facilitated activity was the training of teachers by subject panels 60.3 percent. There was a negative correlation between head teachers' supervision and teacher professional development in public and private primary schools, at r=-.0690.05. The relationship was not statistically significant. The Supervision of teacher’s professional development was not strongly linked to academic performance. There should be a balance between the supervision of teacher professional development. Governments should allocate more funds towards professional development. The findings of the study will inform policy decision making in the education sector in Kenya and worldwide

Subjects’ experiences of a nutrition education programme: a qualitative study of adults with type 2 diabetes mellitus living in a rural resource-limited setting in South Africa

Objective: The objective of the study was to explore the views and experiences of adults with type 2 diabetes mellitus on a nutrition education programme.Design: Interpretative phenomenological design.Setting: The setting was two community health centres in Moretele, North West province, South Africa.Subjects and outcome measures: The study subjects were adults with type 2 diabetes mellitus (n = 41, aged 40–70 years) participating in a nutrition education intervention (one-year randomised controlled trial). The intervention was based on the assessed nutrition education needs of the target group, and included the provision of nutrition education materials. Data were collected at the end of the training intervention (eight weeks) and at the end of the study (12 months). A self-administered, open-ended questionnaire was used at eight weeks (n = 31). Five focus group discussions were conducted at 12 months. A framework thematic analysis technique was employed.Results: The majority of participants indicated that they enjoyed the nutrition education programme at the two time periods. They were satisfied with its content and delivery. The education materials (pamphlet and fridge or wall poster) were seen as useful for the whole family, and as constant reminders of positive behaviour. Benefits indicated by the participants included a gain in health knowledge and skills, positive dietary changes, and improved health and family support. Participants also recommended the programme to other people with diabetes mellitus. Positive educator characteristics, such as competence, patience, being respectful and approachable, were cited as desirable.Conclusion: Participant-customised nutrition education can contribute to programme satisfaction, perceived benefits and adherence to the programme. The provision of education materials should form part of such programmes. Facilitators of nutrition education programmes should take responsibility for employing desirable personal attributes as this can enhance client participation.Keywords: diabetes mellitus, nutrition education programme, qualitative study, rura

Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults

OBJECTIVE : To inform the adaptation of an intervention from a primary healthcare setting to a tertiary setting, the dietary and related self-management challenges and education programme preferences of adults with type 2 diabetes (T2DM) were explored. SETTING : A study was undertaken in a tertiary teaching hospital in Gauteng Province, South Africa. METHODS : A qualitative approach was employed. Data were collected via focus-group discussions and open-ended selfadministered questionnaires from a convenient purposive sample of T2DM patients (n = 28; 40–70 years) and health professionals (n = 10) respectively. Data were analysed using a thematic framework method. RESULTS : Participants revealed diabetes-related knowledge deficits and struggle with adhering to diet, exercise, medication and appointment keeping as problems affecting patients. They also perceived multiple barriers to effective self-management (financial constraints, unsupportive social and physical environments and personal factors). Patients perceived the challenges to greatly impact on their quality of life and consequently the motivation to self-care appropriately. Participants desired an education programme in the form of monthly group meetings with approaches to enhance learning (e.g. use of examples from peers and the provision of education materials). Strategies for motivating and sustaining programme participation (e.g. testimonials from successful participants) were perceived as necessary. Involving family was seen as a key support for positive behaviour change. CONCLUSION : In adapting the intervention, the participants’ preferences for education need to be considered and the unique challenges addressed. In particular, strategies for enhancing the patients’ motivation and the self-efficacy to effectively selfmanage are essential.The Claude Leon Foundation is acknowledged for the postdoctoral fellowship.https://www.tandfonline.com/loi/oemd20Human NutritionInternal Medicin

Subjects’ experiences of a nutrition education programme : a qualitative study of adults with type 2 diabetes mellitus living in a rural resource-limited setting in South Africa

OBJECTIVE : The objective of the study was to explore the views and experiences of adults with type 2 diabetes mellitus on a nutrition education programme. DESIGN : Interpretative phenomenological design. SETTING : The setting was two community health centres in Moretele, North West province, South Africa. SUBJECTS AND OUTCOME MEASURES : The study subjects were adults with type 2 diabetes mellitus (n = 41, aged 40–70 years) participating in a nutrition education intervention (one-year randomised controlled trial). The intervention was based on the assessed nutrition education needs of the target group, and included the provision of nutrition education materials. Data were collected at the end of the training intervention (eight weeks) and at the end of the study (12 months). A self-administered, open-ended questionnaire was used at eight weeks (n = 31). Five focus group discussions were conducted at 12 months. A framework thematic analysis technique was employed. RESULTS : The majority of participants indicated that they enjoyed the nutrition education programme at the two time periods. They were satisfied with its content and delivery. The education materials (pamphlet and fridge or wall poster) were seen as useful for the whole family, and as constant reminders of positive behaviour. Benefits indicated by the participants included a gain in health knowledge and skills, positive dietary changes, and improved health and family support. Participants also recommended the programme to other people with diabetes mellitus. Positive educator characteristics, such as competence, patience, being respectful and approachable, were cited as desirable. CONCLUSION : Participant-customised nutrition education can contribute to programme satisfaction, perceived benefits and adherence to the programme. The provision of education materials should form part of such programmes. Facilitators of nutrition education programmes should take responsibility for employing desirable personal attributes as this can enhance client participation.The South African Sugar Association (grant number 212) & Nestlé Nutrition Institute Africa.http://www.sajcn.co.za/index.php/SAJCNam2016Human NutritionInternal Medicin

Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa : a randomised controlled trial

OBJECTIVE : To evaluate the effect of a participant-customised nutrition education programme on glycated Hb (HbA(1c)), blood lipids, blood pressure, BMI and dietary behaviours in patients with type 2 diabetes mellitus. DESIGN : A randomised controlled trial. The control group (n 41) received education materials. The intervention group (n 41) received the same education materials and participated in eight weekly (2-2·5 h) group nutrition education sessions and follow-up sessions. Outcomes were assessed at 6 and 12 months. An intention-to-treat analysis was conducted. ANCOVA compared the groups (adjustments for baseline values, age, sex and clinic). SETTING : Two community health centres, Moretele sub-district (North West Province), South Africa. SUBJECTS : Adults (aged 40-70 years) with type 2 diabetes, HbA(1c) ≥8 %. RESULTS : Differences in HbA(1c) (primary outcome) were -0·64 % (P=0·15) at 6 months and -0·63 % (P=0·16) at 12 months in favour of the intervention group. Starchy-food intake was significantly lower in the intervention group, 9·3 v. 10·8 servings/d (P=0·005) at 6 months and 9·9 v. 11·9 servings/d (P=0·017) at 12 months. Median energy intake was significantly lower in the intervention group at 12 months (5988 v. 6946 kJ/d, P=0·017). No significant group differences in BMI, lipid profile, blood pressure and intakes of macronutrients, vegetables and fruits were observed. CONCLUSIONS : Nutrition education was not efficacious on HbA(1c); however, it improved specific dietary behaviours. Group education and hands-on activities appeared to contribute to the improvement. Optimal goal setting and self-efficacy training/assessment could benefit future nutrition education programmes for people with type 2 diabetes mellitus in resource-limited settings.http://journals.cambridge.org/action/displayJournal?jid=PHNhb2017Human NutritionInternal Medicin

Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

Diabetes self-management education is crucial in diabetes care. Education that is tailored to the needs of the patient is considered the most effective in improving health outcomes. Diet, a critical element of diabetes treatment, is reported as the most difficult to adhere to by both patients and health professionals. Tailored nutrition education (NE) could benefit diabetic individuals with low socio-economic status, who are amongst those noted to have poor health outcomes. This qualitative interpretive phenomenological study aimed to explore and describe the NE needs of adults with type 2 diabetes mellitus to guide development of a tailored NE programme for resource-poor settings. Participants were 31 non-insulindependent type 2 diabetic patients (convenience sample) and 10 health professionals. Focus group discussions using semi-structured questions were held with the diabetics, and openended self-administered questionnaires were used with the health professionals. Data analysis was done using Krueger’s framework approach. Disease-related knowledge deficits and inappropriate self-reported dietary practices, including intake of unbalanced meals, problems with food portion control and unsatisfactory intake of fruits and vegetables, were observed. Recommendations for the NE programme included topics related to the disease and others related to diet. Group education at the clinic, a competent educator and comprehensive education were indicated by the patients. Participation of family and provision of pamphlets were aspects recommended by patients and health professionals. Barriers that could impact the NE included financial constraints, food insecurity, conflict in family meal arrangements and access to appropriate foods. Support from family and health professionals and empowerment through education were identified as facilitators to following dietary recommendations by both groups of participants. Knowledge deficits, inappropriate dietary practices and barriers are issues that need addressing in an NE programme, whilst the suggestions for an NE programme and facilitators to dietary compliance need to be incorporated.Onderrig in die selfbestuur van diabetes is essensieel in diabetessorg. Onderrig wat spesifiek ooreenkomstig die behoeftes van die pasiënt aangepas is, word die mees doeltreffend in die verbetering van gesondheiduitkomste geag. Dieet, ’n kritiese element in diabetesbehandeling, word deur pasiënte en gesondheidpraktisyns as die moeilikste beskou om na te volg. Spesifiek beplande voedingonderrig kan tot voordeel van lae sosio-ekonomiese diabete wees wat deel van diegene wat swak gesondheiduitkomste toon, uitmaak. Die doel van hierdie kwalitatiewe interpreterende fenomologiese studie was om die voedingonderrigbehoeftes van volwassenes met tipe 2 diabetes mellitus te ondersoek en te beskryf ten einde die ontwikkeling van ’n voedingonderrigprogram wat op hulpbrondbeperkte omgewings afgestem is, te rig. Een en dertig nie-insulien afhanklike tipe 2 diabetes pasiënte (geriefsteekproef) en 10 gesondheidpraktisyns was evalueer. Fokusgroepbesprekings deur gebruikmaking van semi-gestruktureerde vrae, is met die diabete gehou. Self-geadministreerde oop-eindigende vraelyste is deur die gesondheidpraktisyns voltooi. Data-analise is volgens Krueger se raamwerkbenadering gedoen. Siekteverwante kennisgapings en ontoepaslike self-gerapporteerde dieetpraktyke, insluitend ongebalanseerde maaltye, probleme met porsiekontrole en ontoereikende inname van groente en vrugte is gerapporteer. Aanbevelings vir die voedingonderrigprogram het onderwerpe verwant aan die siekte en die dieet ingesluit. Die pasiënte het groeponderrig by die kliniek, ’n bevoegde onderrigpraktisyn en omvattende onderrig verkies. Die pasiënte en die gesondheidpraktisyns het gesinsdeelname en die beskikbaarstelling van pamflette aanbeveel. Struikelblokke wat negatief op die voedingonderrigprogram kon inwerk, het finansiële beperkinge, voedselinsekuriteit, konflik met gesinsmaaltydreëlings en toegang tot geskikte voedsels ingesluit. Ondersteuning van die gesin en gesondheidpraktisyns, sowel as bemagtiging deur kennis is as fasiliteerders ter bevordering van die navolging van dieetaanbevelings deur beide groepe deelnemers geïdentifiseer. Tekortkominge in kennis, ontoepaslike dieetpraktyke en struikelblokke is aspekte wat in ’n voedingonderrigprogram aangespreek behoort te word. Voorstelle wat vir die voedingonderrigprogram en fasiliteerders gemaak is vir dieetnavolging, behoort in die program ingesluit te word.http://www.hsag.co.z

Impact of nutrition education on diabetes knowledge and attitudes of adults with type 2 diabetes living in a resource-limited setting in South Africa : a randomised controlled trial

OBJECTIVE : To evaluate the effect of a nutrition education (NE) programme on diabetes knowledge and attitudes of adults with type 2 diabetes mellitus (T2DM). METHODS : Eighty-two adults (40–70 years) with poorly controlled T2DM (HbA1c ≥ 8%) and attending two community health centres in Moretele, North West Province (South Africa) participated in a one-year randomised controlled trial. Participants were randomised to the intervention group (n = 41; 8 weekly group education (2–2.5 hours); follow-up meetings and education materials) or control group (education materials only). Diabetes Knowledge Form B assessed knowledge about diabetes. Diabetes Attitudes Scale-III assessed the attitudes towards diabetes and treatment. Assessments were done at 6 and 12 months. Analysis of co-variance compared the groups (baseline, age, gender and clinic adjustments). An intention-to-treat analysis was employed. RESULTS : The intervention group had higher mean diabetes knowledge scores + 0.95 (p = 0.033) and + 2.05 (p < 0.001) at 6 and 12 months respectively. However, the scores were below 50%. Patient autonomy for diabetes attitudes was the only score significantly higher in the intervention group + 0.27 (p = 0.028) at 12 months. CONCLUSION : NE significantly improved diabetes knowledge in the intervention group, though not satisfactorily, but had limited effects on the attitudes towards diabetes.The Nestlè Nutrition Institute Africa and the South African Sugar Association [grant number 212].http://www.jemdsa.co.zaindex.php/JEMDSAam2016Human NutritionInternal Medicin

Face validity and content assessment of a diabetes nutrition education DVD for low literacy adults living with diabetes : a mixed-method study

AIM : A study was undertaken to assess the face validity and content correctness of a diabetes nutrition education (DNE)-DVD developed for low literacy adults living with diabetes. SETTING : The study was undertaken in the city of Tshwane Municipality, Gauteng province. PARTICIPANTS : Adults living with diabetes (n = 73, 18–65 years) attending a tertiary hospital diabetes outpatient clinic and 18 health professionals (HPs) with expertise in diabetes from three healthcare-related organisations were included. METHODS : A mixed-methods approach was used. Quantitative data were collected from patients (n = 63) using a Likert scale questionnaire, and from HPs using ‘Yes/No’ and Likert-scale questions. Qualitative data were collected using three focus-group discussions with patients (n = 10) and comments from HPs. RESULTS : Quantitative results indicated that patients perceived the visuals to be clear, appealing, culturally appropriate, contained familiar images and aided in their understanding of diabetes. Both patients and HPs found the language, length and layout of the DVD to be suitable. The HPs perceived the content to be accurate and concise. The qualitative data supported the quantitative findings. Participants perceived the DNE-DVD to be useful for patients and families, and provided suggestions for improving the DVD. CONCLUSION : Quantitative and qualitative results agreed that the face validity and content correctness of the DNE-DVD was appropriate. Improving the DNE-DVD could further enhance its utility and effectiveness for the target population.https://www.tandfonline.com/loi/oemd20hj2023Consumer ScienceFood ScienceHuman Nutritio

Effectiveness of an adapted diabetes nutrition education program on clinical status, dietary behaviors and behavior mediators in adults with type 2 diabetes : a randomized controlled trial

PURPOSE : This study evaluated the effectiveness of an adapted social-cognitive theory underpinned diabetes nutrition education program (NEP) on: clinical (HbA1c, BMI, blood lipids, blood pressure) and selected dietary behaviors (starchy foods and energy intake, vegetables and fruit intake) and behavior mediators (knowledge and diabetes management self-efficacy) in patients with type 2 diabetes mellitus (T2DM). METHODS : A tertiary hospital outpatient adults (40–70 years) with poorly controlled (HbA1c ≥ 8 %) T2DM were randomized to either intervention group (n = 39: NEP, 7-monthly group education sessions, bi-monthly follow-up sessions, 15-minute individual session, workbook + education materials) or control group (n = 38: education materials only). NEP aimed to improve clinical status through improved dietary behaviors and behavior mediators. Outcomes and changes in diabetes medication were assessed at six and 12 months. Intention-to-treat analysis was conducted. ANCOVA compared the groups (baseline values, age, sex adjustments). RESULTS : Forty-eight (62.3 %) participants completed the study. Intervention group compared to the control group had lower (-0.53 %), clinically meaningful HbA1c (primary outcome) at 6 months, albeit not sustained at 12 months. Compared to the control group, the intervention group had significantly lower: (i) systolic blood pressure at six and 12 months (ii) diastolic pressure at 12 months, (iii) energy intake at six-months, (iv) up-titration of insulin at six and 12 months and higher diabetes knowledge scores at six months. CONCLUSIONS : NEP had limited effects on HbA1c, targeted dietary behaviors and behavior mediators but showed positive effects on blood pressure. The NEP health cost savings potential supports the need for improving program participation. TRIAL REGISTRATION : ClinicalTrials.gov. number NCT03334773; 7 November 2017 retrospectively registered.The South African Sugar Association.https://www.springer.com/journal/40200hj2022Human NutritionInternal Medicin