BACKGROUND: Community health workers (CHWs) are lay people trained to assist with health care in their
communities. This study took place at two sites in Khayelitsha, a township in the Cape Peninsula, from 2000 to
2002.
OBJECTIVES: To describe the process of developing an intervention programme for primary prevention of noncommunicable
diseases (NCDs) in general and cardiovascular disease in particular, targeting CHWs.
METHOD: Forty-four CHWs were assigned to either an intervention or a control group. The intervention group,
living in Site C, received training on lifestyle modification with emphasis on healthy eating and physical
activity, while the control group, living in Site B, did not receive any training until a year later. The process was
undertaken in four stages. Stage 1 involved assessment of the CHWs’ risk factors by obtaining anthropometric
measurements. CHWs were interviewed and focus group discussions were held on the socio-cultural factors
associated with body weight and body image, and barriers to physical activity. Stage 2 involved developing and
implementing a training programme for primary prevention of NCDs among CHWs. Stage 3, conducted at Site
C, involved a situational assessment of available resources in the community for promoting healthy lifestyles. The
fourth and final stage involved the implementation of community interventions by the CHWs.
RESULTS: A large percentage of CHWs were overweight and obese, and therefore at risk for NCDs. They had
misconceptions about causes and treatment of these diseases, and also lacked knowledge on nutrition and the
risk of high fat intake. Easy access to cheap unhealthy food, rather than fresh fruit and vegetables, limited their
ability to make healthy food choices. The findings from stage 1 led to a community participatory intervention.
CONCLUSIONS: Developing community-targeted interventions for NCDs can be achieved by involving CHWs at
the initial stage and utilising a multifaceted approach. Education of community members and CHWs does not
guarantee behaviour modification. Unless the environment encourages healthy living, NCDs will continue to be a
burden in the poor populations of South Africa.Health Promotion
Directorate, Provincial Government of the Western Cap
