Abstract
BackgroundSouth Africa (SA) is undergoing multiple transitions with an increasing burden of non-communicable diseases and high levels of overweight and obesity in adolescent girls and women. Adolescence is key to addressing trans-generational risk and a window of opportunity to intervene and positively impact on individuals’ health trajectories into adulthood. Using Intervention Mapping (IM), this paper describes the development of the Ntshembo intervention, which is intended to improve the health and well-being of adolescent girls in order to limit the inter-generational transfer of risk of metabolic disease, in particular diabetes risk.MethodsThis paper describes the application of the first four steps of IM. Evidence is provided to support the selection of four key behavioural objectives: viz. to eat a healthy, balanced diet, increase physical activity, reduce sedentary behaviour, and promote reproductive health. Appropriate behaviour change techniques are suggested and a theoretical framework outlining components of relevant behaviour change theories is presented. It is proposed that the Ntshembo intervention will be community-based, including specialist adolescent community health workers who will deliver a complex intervention comprising of individual, peer, family and community mobilisation components.ConclusionsThe Ntshembo intervention is novel, both in SA and globally, as it is: (1) based on strong evidence, extensive formative work and best practice from evaluated interventions; (2) combines theory with evidence to inform intervention components; (3) includes multiple domains of influence (community through to the individual); (4) focuses on an at-risk target group; and (5) embeds within existing and planned health service priorities in SA.
Highlights
South Africa (SA) is undergoing multiple transitions with an increasing burden of non-communicable diseases and high levels of overweight and obesity in adolescent girls and women
One of the consequences, which partly accounts for the increase in the incidence of non-communicable diseases [2], is the double burden of early life under-nutrition, characterised by low birth weight and postnatal stunting, and later overnutrition characterised by rapid child and adolescent weight gain and obesity [3]
Aim This paper describes the application of the Intervention Mapping approach to the development of an intervention, referred to as the Ntshembo intervention, which is intended to improve the health and well-being of adolescent girls in order to limit the intergenerational transfer of risk of metabolic disease
Summary
Study (intervention) setting The work presented in this paper forms part of a broader body of work referred to as: “Project Ntshembo – Health and well-being of female adolescents: limiting the intergenerational risk of metabolic disease”. Availability of alternative active leisure opportunities Availability of adolescent-friendly health education material, delivered by an appropriate health care worker nor are they intended to provide details of the interventions These matrices of change help to provide a ‘map’ for the development of specific intervention components. Systematic reviews on obesity interventions in adolescents have shown that the effectiveness of school-based interventions can be limited (only 41% of studies reviewed showed a positive effect) [89], and that there is a need for more quality trials examining physical activity behaviour change strategies appropriate for adolescents [90] It is the experience of the authors that intervening in the school environment in SA is challenging, especially since local and national ministries of education have become far stricter about the implementation of interventions within the school environment, even outside of learning time. Based on the results of the feasibility study, the intervention will be further refined so that it can be evaluated in a cluster randomised controlled trial
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