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BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Research

Acceptability and perceived feasibility of the KaziKidz health promotion intervention among educators and caregivers in schools from South Africa: a qualitative descriptive study

Authors: Patricia Arnaiz, Manfred Max Bergman, Harald Seelig, Larissa Adams, Danielle Dolley, Markus Gerber, Nandi Joubert, Siphesihle Nqweniso, Peter Steinmann, Jürg Utzinger, Rosa du Randt, Cheryl Walter, Uwe Pühse, Ivan Müller

Published in: BMC Public Health | Issue 1/2024

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Abstract

Background

Despite the uncontested benefits of physical activity, its promotion lags behind in the public health agenda of low- and middle-income countries (LMICs). School-based interventions are promising strategies to foster health during childhood, but evidence of their effectiveness is limited and inconclusive for LMICs. Thus, further investigation is needed on contextual factors associated with intervention implementation in low-resource settings. We studied the acceptability and feasibility of the KaziKidz health promotion intervention and its implementation and make recommendations to improve future adoption and sustainability.

Methods

KaziKidz was implemented in four primary schools from low-income communities in South Africa in 2019. Semi-structured interviews with four school principals, three focus group interviews with 16 educators, and another three with 16 caregivers were conducted between October and November 2021. Participants were purposively recruited. Interview transcripts were analyzed via thematic analysis using a deductive and reflexive approach.

Results

Three main themes influencing intervention implementation and adoption were identified: (1) prioritizing teachers’ needs (2), integrating the program into the school structure, and (3) creating opportunities in the community. Supporting recommendations included: (theme 1) adopting intervention approaches that are inclusive of educators’ health and providing them with capacity development and external support; (theme 2) fostering a feeling of ownership and belonging among school stakeholders to adapt interventions to specific resources and needs; and (theme 3) raising community awareness to encourage individuals to claim power over and actively engage with the program.

Conclusions

Comprehensive interventions comprising health support, adequate training, and ongoing assistance for educators combined with school-wide and community outreach actions seeking to strengthen program ownership, accountability, and engagement can enhance uptake of school-based interventions and long-term maintenance.

Trial registration

ISRCTN15648510, registered on 17/04/2020.
Appendix
Available only for authorised users
Literature
1.
2.
Bidzan-Bluma I, Lipowska M. Physical activity and cognitive functioning of children: a systematic review. Int J Environ Res Public Health. 2018;15(4).
3.
Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput JP, Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S197–239.CrossRefPubMed
4.
Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants. Lancet Child Adolesc Health. 2020;4(1):23–35.CrossRefPubMedPubMedCentral
5.
Kohl HW 3rd, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305.
6.
Ramirez Varela A, Hallal PC, Mejia Grueso J, Pedisic Z, Salvo D, Nguyen A et al. Status and trends of Physical Activity Surveillance, Policy, and Research in 164 countries: findings from the Global Observatory for physical Activity-GoPA! 2015 and 2020 surveys. J Phys Act Health. 2022:1–17.
7.
Pratt M, Ramirez Varela AS, Deborah, Kohl HW III, Ding D. Attacking the pandemic of physical inactivity: what is holding us back? Br J Sports Med. 2020;54(13):759–62.
8.
Douryang M, Tsafack Nanfosso KJ, Bouba Y. Physical Activity for Health Promotion and Disease Prevention in Africa and Cameroon: a call to action. J Phys Act Health. 2023:1–3.
9.
Watkins D, Hale J, Hutchinson B, Kataria I, Kontis V, Nugent R. Investing in non-communicable disease risk factor control among adolescents worldwide: a modelling study. BMJ Glob Health. 2019;4(2):e001335.CrossRefPubMedPubMedCentral
10.
Müller I, Smith D, Adams L, Aerts A, Damons BP, Degen J, et al. Effects of a School-Based Health Intervention Program in marginalized communities of Port Elizabeth, South Africa (the KaziBantu Study): protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2019b;8(7):e14097.CrossRefPubMedPubMedCentral
11.
McLennan N, Thompson. Jannine. Quality Physical Education (QPE): guidelines for policy makers. Paris: United Nations Educational, Scientific and Cultural Organization; 2015.
12.
Dolley D, du Randt R, Gerber M, Pühse U, Bosma J, Arnaiz P et al. Effect of the KaziBantu school-based health intervention on non-communicable disease risk factors of children from low-income schools in Gqeberha, South Africa. Afr J Phys Activity Health Sci. 2023;29(4).
13.
Arnaiz P, Seelig H, Gerber M, Adams L, Degen J, Dolley D et al. Intervention effects and long-term changes in physical activity and cardiometabolic outcomes among children at risk of noncommunicable diseases in South Africa: a cluster-randomized controlled trial and follow-up analysis. Front Public Health. 2023;11.
14.
Mannocci A, D’Egidio V, Backhaus I, Federici A, Sinopoli A, Ramirez Varela A et al. Are there effective interventions to increase physical activity in children and Young people? An Umbrella Review. Int J Environ Res Public Health. 2020;17(10).
15.
Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2021;9(9):CD007651.PubMed
16.
Adom T, De Villiers A, Puoane T, Kengne AP. School-based interventions Targeting Nutrition and Physical Activity, and Body Weight Status of African children: a systematic review. Nutrients. 2019;12(1).
17.
Pfledderer CD, Burns RD, Byun W, Carson RL, Welk GJ, Brusseau TA. School-based physical activity interventions in rural and urban/suburban communities: a systematic review and meta-analysis. Obes Rev. 2021;n/a(n/a):e13265.
18.
Barbosa Filho VC, Minatto G, Mota J, Silva KS, de Campos W, Lopes Ada S. Promoting physical activity for children and adolescents in low- and middle-income countries: an umbrella systematic review: a review on promoting physical activity in LMIC. Prev Med. 2016;88:115–26.CrossRefPubMed
19.
Peters D, Tran N, Adam T, Organization AHPSRWH. Implementation research in health: a practical guide. World Health Organization; 2013.
20.
Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65–76.CrossRefPubMed
21.
da Silva Bandeira A, Pizani J, de Sousa A, da Silva JA, Minatto G, Barbosa Filho VC, Silva KS. Implementation of a school-based physical activity intervention for Brazilian adolescents: a mixed-methods evaluation. Health Promot Int. 2022;37(2).
22.
Duijster D, Monse B, Dimaisip-Nabuab J, Djuharnoko P, Heinrich-Weltzien R, Hobdell M, et al. Fit for school’ - a school-based water, sanitation and hygiene programme to improve child health: results from a longitudinal study in Cambodia, Indonesia and Lao PDR. BMC Public Health. 2017;17(1):302.CrossRefPubMedPubMedCentral
23.
van Sluijs EMF, Ekelund U, Crochemore-Silva I, Guthold R, Ha A, Lubans D, et al. Physical activity behaviours in adolescence: current evidence and opportunities for intervention. Lancet. 2021;398(10298):429–42.CrossRefPubMedPubMedCentral
24.
Cassar S, Salmon J, Timperio A, Naylor PJ, van Nassau F, Contardo Ayala AM, Koorts H. Adoption, implementation and sustainability of school-based physical activity and sedentary behaviour interventions in real-world settings: a systematic review. Int J Behav Nutr Phys Act. 2019;16(1):120.CrossRefPubMedPubMedCentral
25.
Arnaiz P, Adams L, Müller I, Gerber M, Walter C, du Randt R, et al. Sustainability of a school-based health intervention for prevention of non-communicable diseases in marginalised communities: protocol for a mixed-methods cohort study. BMJ Open. 2021;11(10):e047296.CrossRefPubMedPubMedCentral
26.
Creswell JW, Plano Clark VL. Core mixed methods designs. Designing and conducting mixed methods research. 3 ed. SAGE Publications, Inc; 2017. p. 50.
27.
Stroebel LCE, Hay J, Bloemhoff HJ. Physical education in South Africa: have we come full circle? South African Journal for Research in Sport. Phys Educ Recreation. 2016;38(3).
28.
29.
Donaldson R. South African Township Transformation. In: Michalos AC, editor. Encyclopedia of Quality of Life and Well-Being Research. Dordrecht: Springer Netherlands; 2014. pp. 6223–8.CrossRef
30.
Stroebel LCE. Opportunities for all? The impact of resources on the implementation of Physical Education in Free State schools. Afr J Phys Activity Health Sci (AJPHES). 2020;26(sup11):67–81.
31.
Vosloo JJ, du Toit D. Sports participation in South African schools. Have we lost the plot? In: Lucy-Joy W, editor. Sport and Fitness in Children and adolescents. Rijeka: IntechOpen; 2023. Ch. 5.
32.
Braun V, Clarke V, Weate P. Using thematic analysis in sport and exercise research. Routledge handbook of qualitative research in sport and exercise. London: Taylor & Francis (Routledge); 2016. pp. 191–205.
33.
Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101.CrossRef
34.
Mini GK, Sarma PS, Thankappan KR. Cluster randomised controlled trial of behavioural intervention program: a study protocol for control of hypertension among teachers in schools in Kerala (CHATS-K), India. BMC Public Health. 2019;19(1):1718.CrossRefPubMedPubMedCentral
35.
Draper CE, de Kock L, Grimsrud AT, Rudolph M, Nemutandani S, Kolbe-Alexander T, Lambert EV. Evaluation of a school-based physical activity intervention in Alexandra Township. South Afr J Sports Med. 2010a;22(1):12–9.CrossRef
36.
Dreer B, Gouasé N. Interventions fostering well-being of schoolteachers: a review of research. Oxf Rev Educ. 2021;48(5):587–605.CrossRef
37.
Cook CR, Miller FG, Fiat A, Renshaw T, Frye M, Joseph G, Decano P. Promoting secondary teachers’ well-being and intentions to implement evidence-based practices: randomized evaluation of the Achiever Resilience Curriculum. Psychol Sch. 2017;54(1):13–28.CrossRef
38.
van den Berg V, Salimi R, de Groot RHM, Jolles J, Chinapaw MJM, Singh AS. It’s a Battle… You Want to Do It, but How Will You Get It Done? Teachers’ and Principals’ Perceptions of Implementing Additional Physical activity in School for Academic Performance. Int J Environ Res Public Health. 2017;14(10).
39.
Eyre ELJ, Adeyemi LJ, Cook K, Noon M, Tallis J, Duncan M. Barriers and facilitators to physical activity and FMS in children living in Deprived Areas in the UK: qualitative study. Int J Environ Res Public Health. 2022;19(3).
40.
Domville MS, Watson PM, Richardson DJ, Graves LEF. Educator perspectives on factors influencing children’s school-based physical activity. Health Promot Int. 2019;34(5):931–40.CrossRefPubMed
41.
Gammon C, Morton K, Atkin A, Corder K, Daly-Smith A, Quarmby T, et al. Introducing physically active lessons in UK secondary schools: feasibility study and pilot cluster-randomised controlled trial. BMJ Open. 2019;9(5):e025080.CrossRefPubMedPubMedCentral
42.
Stroebel LCE, Hay J, Bloemhoff HJ. Needs and challenges of foundation phase life skills teachers in delivering physical education: Jack of all trades and master of none? South African Journal for Research in Sport. Phys Educ Recreation. 2017;39(3).
43.
Santos F, Sousa H, Gouveia ER, Lopes H, Peralta M, Martins J, et al. School-based family-oriented Health interventions to promote physical activity in children and adolescents: a systematic review. Am J Health Promot. 2023;37(2):243–62.CrossRefPubMed
44.
Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E et al. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev. 2014(4):CD008958.
45.
Skar M, Kirstein E, Kapur A. Lessons learnt from school-based health promotion projects in low- and middle-income countries. Child Care Health Dev. 2015;41(6):1114–23.CrossRefPubMed
46.
Wang H, Zhou Y, Blake H, Chattopadhyay K. School-based physical activity intervention: a qualitative process evaluation of a feasibility trial in Yangzhou, China. Int J Environ Res Public Health. 2022;19(2).
47.
Shoesmith A, Hall A, Wolfenden L, Shelton RC, Powell BJ, Brown H, et al. Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review. Implement Sci. 2021;16(1):62.CrossRefPubMedPubMedCentral
48.
Christian DL, Todd C, Rance J, Stratton G, Mackintosh KA, Rapport F, Brophy S. Involving the headteacher in the development of school-based health interventions: a mixed-methods outcome and process evaluation using the RE-AIM framework. PLoS ONE. 2020;15(4):e0230745.CrossRefPubMedPubMedCentral
49.
Hill J, Draper CE, Villiers AD, Fourie JM, Mohamed S, Parker W-a, Steyn N. Promoting healthy lifestyle behaviour through the life-orientation curriculum: teachers’ perceptions of the HealthKick intervention. South Afr J Educ. 2015;35(1).
50.
Vander Ploeg KA, Maximova K, McGavock J, Davis W, Veugelers P. Do school-based physical activity interventions increase or reduce inequalities in health? Soc Sci Med. 2014;112:80–7.CrossRefPubMed
51.
James ME, Bedard C, Bremer E, Cairney J. The acceptability and feasibility of a Preschool Intervention Targeting Motor, Social, and Emotional Development. Front Pediatr. 2020;8:319.CrossRefPubMedPubMedCentral
52.
Naylor PJ, Nettlefold L, Race D, Hoy C, Ashe MC, Wharf Higgins J, McKay HA. Implementation of school based physical activity interventions: a systematic review. Prev Med. 2015;72:95–115.CrossRefPubMed
53.
de Villiers A, Steyn NP, Draper CE, Hill J, Dalais L, Fourie J, et al. Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation. BMC Public Health. 2015;15:818.CrossRefPubMedPubMedCentral
54.
Beames JR, Spanos S, Roberts A, McGillivray L, Li S, Newby JM, et al. Intervention Programs Targeting the Mental Health, Professional Burnout, and/or Wellbeing of School Teachers: systematic review and Meta-analyses. Educ Psychol Rev. 2023;35(1):26.CrossRefPubMedPubMedCentral
55.
Draper CE, Thwala N, Slemming W, Lye SJ, Norris SA. Development, implementation, and process evaluation of Bukhali: an intervention from preconception to early childhood. Glob Implement Res Appl. 2023;3(1):31–43.CrossRefPubMedPubMedCentral
56.
Lambrinou CP, Androutsos O, Karaglani E, Cardon G, Huys N, Wikstrom K, et al. Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component. BMC Endocr Disord. 2020;20(Suppl 2):52.CrossRefPubMedPubMedCentral
57.
Verjans-Janssen SRB, van de Kolk I, Van Kann DHH, Kremers SPJ, Gerards S. Effectiveness of school-based physical activity and nutrition interventions with direct parental involvement on children’s BMI and energy balance-related behaviors - a systematic review. PLoS ONE. 2018;13(9):e0204560.CrossRefPubMedPubMedCentral
Metadata
Title
Acceptability and perceived feasibility of the KaziKidz health promotion intervention among educators and caregivers in schools from South Africa: a qualitative descriptive study
Authors
Patricia Arnaiz
Manfred Max Bergman
Harald Seelig
Larissa Adams
Danielle Dolley
Markus Gerber
Nandi Joubert
Siphesihle Nqweniso
Peter Steinmann
Jürg Utzinger
Rosa du Randt
Cheryl Walter
Uwe Pühse
Ivan Müller
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18456-3

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