Adherence challenges encountered in an intervention programme to combat chronic non-communicable diseases in an urban black community, Cape Town

Background: Chronic non-communicable diseases (CNCD) have become the greatest contributor to the mortality rate worldwide. Despite attempts by Governments and various non-governmental organisations to prevent and control the epidemic with various intervention strategies, the number of people suffering from CNCD is increasing at an alarming rate in South Africa and worldwide. Objectives: Study's objectives were to explore perceived challenges with implementation of, and adherence to health messages disseminated as part of a CNCD intervention programme; to gain an understanding of participants' expectations of CNCD intervention programmes;, and to explore the acceptability and preference of health message dissemination methods. In addition, participants' awareness of, and willingness to participate in CNCDs intervention programmes in their community was explored. Methods: Participants were recruited from the existing urban Prospective Urban Rural Epidemiology study site in Langa, Cape Town. Focus group discussions were conducted with 47 participants using a question guide. Summative content analysis was used to analyse the data. Results: Four themes emerged from the data analysis: practical aspects of implementation and adherence to intervention programmes; participants' expectations of intervention programmes; aspects influencing participants' acceptance of interventions; and their preferences for health message dissemination. The results of this study will be used to inform CNCDs intervention programmes. Conclusions: Our findings revealed that although participants found current methods of health message dissemination in CNCDs intervention acceptable, they faced real challenges with implementing and adhering to CNCDs to these messages.DHE

The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review

Objective: To examine the effectiveness of interventions using the World Health Organization Health Promoting Schools (HPSs) framework approach in increasing physical activity (PA) and improving the diet of 11-18-year-olds. Study design: A systematic review guided by the National Health Services Centre for Reviews and Dissemination framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Methods: Nine databases and trial registries were searched from 2013 to 2018 for cluster randomised controlled trials involving adolescents' aged 11-18 years. We also included relevant studies from a 2014 Cochrane Review of HPS approach on health behaviours. Data were extracted from included studies and assessed for quality. Results: Twelve eligible studies were identified from seven countries. The studies varied in outcome measures, sample size, quality and duration of intervention and follow-up. Only four of the included studies were of high to moderate quality. We found some evidence of effectiveness for physical activity only interventions and limited evidence of effectiveness for nutrition only and combined PA and nutrition interventions. Conclusions: There were no discernible patterns across the studies to suggest effective mechanisms for the HPS approach. The family/community component was poorly developed and superficially reported in all studies. Future research should seek to understand how best to work in partnership with secondary schools, to foster and sustain a healthy eating and physical activity culture, which aligns with their core aims. More attention should be paid to the restriction of unhealthy foods in the school environment.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.All Saints Education Trust (ASET) fund CMc's Fellowship, the views expressed are those of the authors and not necessarily those of ASET. This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, now recommissioned as NIHR Applied Research Collaboration (ARC) South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.published version, accepted version (12 month embargo

The impact of the World Health Organization Health Promoting Schools framework approach on diet and physical activity behaviours of adolescents in secondary schools: a systematic review

Objective: To examine the effectiveness of interventions using the World Health Organization Health Promoting Schools (HPSs) framework approach in increasing physical activity (PA) and improving the diet of 11-18-year-olds. Study design: A systematic review guided by the National Health Services Centre for Reviews and Dissemination framework and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Methods: Nine databases and trial registries were searched from 2013 to 2018 for cluster randomised controlled trials involving adolescents' aged 11-18 years. We also included relevant studies from a 2014 Cochrane Review of HPS approach on health behaviours. Data were extracted from included studies and assessed for quality. Results: Twelve eligible studies were identified from seven countries. The studies varied in outcome measures, sample size, quality and duration of intervention and follow-up. Only four of the included studies were of high to moderate quality. We found some evidence of effectiveness for physical activity only interventions and limited evidence of effectiveness for nutrition only and combined PA and nutrition interventions. Conclusions: There were no discernible patterns across the studies to suggest effective mechanisms for the HPS approach. The family/community component was poorly developed and superficially reported in all studies. Future research should seek to understand how best to work in partnership with secondary schools, to foster and sustain a healthy eating and physical activity culture, which aligns with their core aims. More attention should be paid to the restriction of unhealthy foods in the school environment.published version, accepted version (12 month embargo)All Saints Education Trust (ASET) fund CMc's Fellowship, the views expressed are those of the authors and not necessarily those of ASET. This research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, now recommissioned as NIHR Applied Research Collaboration (ARC) South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site

Political participation, diffused governance, and the transformation of democracy : patterns of change

Although democratic governments have introduced a number of institutional reforms in part intended to increase citizens’ political involvement, studies show a continued decline in regular political engagement. This book examines different forms of political participation in democracies, and in what way the delegation of public responsibilities—or, the diffusion of politics—has affected patterns of participation since the 1980s. The book addresses this paradox by directly investigating the impact of institutional changes on citizens’ political participation empirically. It re-analyses patterns of political participation in contemporary democracies, providing an in-depth time series cross-sectional analysis that helps develop a better understanding of how variation in political participation can be explained, both between countries and over time. As such, it develops an institutional theoretical framework which can help to explain levels of participation and shows that, instead of displaying more political apathy, citizens have reallocated or displaced their activities to a broader array of forms of participation.-- Part I: The Changing Democratic System -- 1. Patterns of Change -- 2. The Three Sides of the Coin: Unpacking Political Participation -- 3. Structuring Diffusion: Explaining Levels of Political Participation -- Part II: Patterns of Participation: The Impact of Competence Diffusion -- 4. Participation and Horizontal Diffusion -- 5. Participation and Vertical Diffusion -- 6. Political Participation and Diagonal Diffusion -- Part III: Democracy at the Crossroads? Some Conclusions -- 7. Levels of Political Participation and Multi-Directional Diffusion -- 8. Patterns of Change: Diffused DemocracyPublished version of EUI PhD thesis, 201