Abstract
BackgroundThe 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.Methods/DesignThis study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.DiscussionThis study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.
Highlights
The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa
Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa
Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings
Summary
This paper describes the three phases of the HealthKick study that aims to develop, implement and evaluate a nutrition and physical activity intervention in lowincome primary schools aimed at reducing risk factors for the development of type 2 diabetes. The development of the HealthKick intervention was based on the Intervention Mapping process [20], and a formative assessment phase. Throughout the development and implementation of the HealthKick intervention, the team has been constantly aware of the need to balance educators' sense of autonomy with the need to be prescriptive about what needs to get done This has been relevant during the action planning process and to some extent the nomination of champions. Plans are on the way to continue the work done with parents [21] and develop a cost-effective social marketing intervention to educate family and community members about the influences of media and marketing on children's food choices, and to use health communication to change the home environment as it relates to nutrition and physical activity. All authors participated in the writing of the paper, provided comments on drafts and approved the final version
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