The role of attitude and barriers on the implementation of a nutrition intervention in primary school children
Background: South Africa is a multicultural, multi-ethnic developing country currently experiencing a unique quadruple burden of disease, of which malnutrition (both over- and under nutrition) is one of them. The increase in childhood obesity within the current South-African health setting is of serious concern, approximately 14% boys and 18% girls currently are overweight and it is estimated that this number will increase to 25% within the next decade. Healthy eating habits and increased physical activity are important components of a healthy lifestyle, and decrease the risk of overweight and obesity. It is also often the corner stone of many lifestyle modification intervention programmes aimed at preventing or decreasing overweight/obesity. Aim: This sub-study was part of a larger intervention study where a nutrition education intervention programme (NEIP) for children in the form of a musical play (based on the South African Food Based Dietary Guidelines [SAFBDG]) was developed to increase nutrition knowledge and thereby also contribute towards healthy lifestyle behaviour. The aim of this sub-study was therefore to explore and describe the attitude of a specific group of primary school children (aged 6-12 years) towards healthy eating, unhealthy eating, and physical activity before and after a NEIP as well as the standard school curriculum. Secondly, it was aimed to identify possible barriers to and motivators for healthy eating, unhealthy eating and physical activity. Methods: Children were randomly selected from the experimental group (n=143) of the main study. Children were selected into one of four focus groups per school (6 children per focus group) from which qualitative data were gathered on children’s attitude and perception towards healthy eating, unhealthy eating, and physical activity. Focus groups were defined by age and gender (boys and girls seperately, grades I-III and grades IVVI seperately), totalling a number of 96 children. A total of 75 children completed this sub-study, 21 children dropped out due to school-related problems or after school activities that clashed with the time slots during which the NEIP was implimented. Quantitative data was gathered with a socio-demographic and physical activity questionnaire, as well as a 3-point hedonic facial expression scale which was used to quantify attitude towards healthy eating, unhealhty eating and physical activity. All data (quantitative and qualitative) were collected at both baseline and end measurements. Results: The main findings of this sub-study were that the attitude of most primary school children towards healthy eating, unhealthy eating or physical activity remained unchanged after a unique NEIP. Five major themes were identified out of focus group discussions namely health awareness, healthy eating, unhealthy eating, physical activity, and consequences of unhealthy eating and sedentary behaviour. Mothers were identified as the main motivator for eating healthy and avoiding unhealthy eating. The taste and smell of food were both either identified as motivators or barriers for healthy eating and unhealthy eating. Older girls associate unhealthy eating with becoming fat while many children associate the combination of unhealthy eating and being sedentary with becoming fat. Most children have a positive attitude towards physical activity and enjoy doing it although the biggest motivator for partaking in physical activity is their parents and not themselves. Conclusion: Even though some children’s attitude did change in the desired direction after the implementation of a unique and fun NEIP, most children’s attitude towards healthy eating, unhealthy eating and physical activity remained unchanged. This might have been due to the measurement tool that was not sensitive enough to detect subtle changes. Various factors that can influence children’s attitude and perceptions towards healthy eating, unhealthy eating and physical activity both positively or negatively were identified. This study is one of only a few that explored and described the ‘true’ motivators of and barriers for children’s attitude towards healthy eating, unhealthy eating and physical activity. Results generated from this sub-study can thus make a valuable contribution to the existing literature available in this specific study field.
- Health Sciences