Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation (original) (raw)
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BMC Public Health, 2010
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.
BMC Public Health, 2012
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.
Background: Recent evaluation of the Interdisciplinary Health Promotion (IHP) course offered by the University of the Western Cape (UWC) at schools revealed that the needs expressed by the schools had not changed in the last five years. Objectives: This paper describes the process that was undertaken to identify specific interventions that would have an impact on the schools and, in turn, the broader community, and provides an overview of the interventions conducted in 2011 - 2012. Methods: A stakeholder dialogue explored notions of partnership between the university and the schools, sustainability of health promotion programmes in the schools, and social responsiveness of the university. An action research design was followed using the nominal group technique to gain consensus among the stakeholders as to which interventions are needed, most appropriate and sustainable. Results: A comprehensive plan of action for promoting health in schools was formulated and implemented based on the outcome of the stakeholder dialogue. Conclusion: The study’s findings reiterate that an ongoing dialogue between schools and higher education institutions is imperative in building sustainable partnerships to respond to health promotion needs of the school community.
South African Journal of Education
This study explores the feasibility of implementing the curriculum and action-planning components of the HealthKick (HK) intervention in eight low-resourced schools in the Western Cape, South Africa. Process evaluation comprising workshops and personal interactions with teachers and principals were followed up with semi-structured interviews and focus group discussions, along with a questionnaire and evaluation sheet, during three implementation phases. Since promoting healthy habits during the early formative years is of key importance, the research team actively intervened to ensure successful implementation of the curriculum component. Time constraints, teachers' heavy workload, and their reluctance to become involved in non-compulsory activities, were the main reasons for non-compliance in using the curriculum document. Furthermore, the priorities of the teachers were not necessarily those of the researchers. However, findings indicate that with an appropriate introduction a...
BMC Public Health
Background: A community-based approach can be a promising strategy for implementing school-based health promotion aimed at stimulating healthy physical activity and dietary behaviour. Such an approach builds on the community capacity of multiple stakeholders, empowering them to design and implement tailored activities, supported by the whole school community. This paper describes the background and evaluation design of the community-based school intervention 'Fit Lifestyle at School and at Home' (FLASH) in four prevocational schools. FLASH includes four strategies for building the community capacity of students, school personnel and parents: 1) identifying leaders in each stakeholder group, 2) stimulating a school culture of participation, 3) having stakeholders design and implement tailored activities and 4) creating a network of local partners for structural embedding. The objective is to monitor the capacity-building processes of the FLASH intervention and to explore if these processes contribute to changes in community capacity. In addition, we will explore if the FLASH intervention is related to changes in PA, dietary behaviours and BMI of students. Methods: This study has a mixed methods design and uses a participatory action-oriented approach to monitor and evaluate changes in community capacity, tailored health-promotion activities and implementation processes. Methods include semi-structured interviews, focus groups, journals, document analysis and observational scans of the physical environment. In addition, changes in BMI, physical activity and dietary behaviours of prevocational students will be explored by comparing the four intervention schools to four control schools. Data are collected by questionnaires and anthropometric measurements. Discussion: The main strength of this study is its use of mixed methods to evaluate real-life processes of creating a healthy-school community. This will provide valuable information on capacity-building strategies for the structural embedding of health-promotion activities within school settings. The results could help schools become more empowered to adapt and adopt integral health-promotion interventions in daily practice that suit the needs of their communities, that are expected to be sustainable and that could lead to favourable changes in the PA and dietary behaviour of students.
Evaluation of a school-based physical activity intervention in Alexandra Township
South African Journal of Sports Medicine
Objectives. Non-communicable diseases and limited participation in school physical education have become increasing concerns in South Africa. In response to these concerns, a schoolbased physical activity intervention, Healthnutz, was implemented in three primary schools in Alexandra Township, Johannesburg. Evaluation of Healthnutz included assessing its feasibility and acceptability, and short-term changes in learners’ physical fitness, knowledge and attitudes. Methods. To assess feasibility and acceptability, a situational analysis and focus groups with teachers and programme monitors were conducted. Pre-post fitness testing (3-month interval) was conducted with learners, and a questionnaire assessed changes in learners’ knowledge, attitudes, self-efficacy, and perceived barriers to physical activity, in control and intervention schools. Results. At implementation, teachers identified the need for more physical activity in the school environment and were positive about Healthnutz....
Motricidade, 2017
The early development of chronic non-communicable diseases has represented the greatest concern in the health prevention in all countries. The goal of this research was to investigate how a program to promote the health of school children through physical activity and healthy diet can be implemented aiming sustainability and continuity. The participants of this study were 1098 students, aged 6 to 10 years, of both sexes. The students belong to two schools: experimental school (ES-n=592)/control school (CSn=506). The project was implemented in 2013 (pre-test) and was followed until 2015 (post-test), with an intervention in 2014. The following variables were evaluated: nutritional status, level of blood glucose, cardiorespiratory endurance, fondness for exercises and 4 categories of food. The statistical analysis used was the Wilcoxon test (paired) and the Wilcoxon test (U of Mann Whitney) (independent samples), assuming a significance level of p<0.05. The results showed difference...
Process evaluation of implementation fidelity in a Danish health-promoting school intervention
BMC Public Health
Background: "We Act" is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils' dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5-6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools. Methods: The Medical Research Council's new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n = 43 days), questionnaires (n = 17 teachers, 52 parents), and interviews (n = 9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation. Results: A total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils' presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the schoolyear plan and weak management support. Conclusions: Although 'We Act' was designed to comply with evidence-and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools' preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.
Understanding the social context of school health promotion program implementation
Health …, 2006
Purpose -Although implementation fidelity is an important component in the evaluation of school health promotion programs, it assumes that teaching is the most relevant teacher role. To understand the social context of program implementation, a qualitative study was undertaken with the aim of identifying the schoolteacher's role in implementing the objectives of the Kahnawake Schools Diabetes Prevention Project (KSDPP), a locally governed Kanienke:háka (Mohawk) community-based diabetes prevention program. Design/methodology/approach -Prospective semi-structured interviews were conducted cross-sectionally with 30 teachers, two administrators and one physical education teacher across four intervention years. Interviews were analysed retrospectively using qualitative thematic analysis. Findings -In implementing KSDPP objectives teachers adopted, to varying degrees, the roles of teaching the health education curriculum, enforcing the school nutrition policy, role modelling healthy lifestyles, and encouraging healthy lifestyles. Taken together, these roles point to a high-order role of teachers taking responsibility for enabling healthy lifestyles in their children, which is congruent with a wholistic approach to health. Study findings suggest that children in different classrooms were exposed to a different intervention dose based on the extent to which teachers applied each role.