1,721,091 research outputs found
A survey of perceptions and behavioural responses towards the COVID-19 pandemic in South Africa
Full text linkBackground: The South African response to the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus was swift and assertive, although it came with economic and social costs. An understanding of the pandemic experiences of different population groups is integral to enhancing disease control.
Aim: The aim of this study was to identify behavioural responses and public perceptions relating to the coronavirus disease 2019 (COVID-19) pandemic.
Setting: The study was conducted in South Africa.
Methods: In June 2022, a national online survey (N = 3018) was conducted among adults ( 18 years). Logistic regression was used to examine the factors associated with adherence to government measures and vaccination. Structural equation modelling (SEM) was applied to examine the direct and indirect relationship of socioeconomic status (SES) with protective behaviours.
Results: Data showed no direct association between SES and vaccination uptake, but SES was indirectly and positively associated with vaccination uptake. Socioeconomic status was also indirectly and positively associated with adherence to government measures through pathways mediated by access to the Internet, access to local news, government trust and positive government experiences.
Conclusion: This study highlights the complexity of government measures and vaccination adoption and the socioeconomic barriers affecting these.
Contribution: Results from this study should be used to inform future pandemic preparedness plans. In particular, policymakers should consider the importance of providing scientific information through channels accessible to each socioeconomic group to promote positive behavioural changes, as well as the need to adapt pandemic responses to different socioeconomic groups
Contextualising individual, household and community level factors associated with sugar-sweetened beverage intake and screen time in Soweto, South Africa
No full textThis study examined the relationship between individual, household, and community-level factors with obesity-related health behaviors. Households (n = 6110) were enumerated, and participants (>18 years) reported their screen time and how many sugar-sweetened beverages they consumed per day. Individuals from food insecure and higher SES households were more likely to report higher sugar-sweetened beverage consumption. Screen time was negatively associated with age (p < .01), and being female was associated with 35 minutes more screen time per day (p < .01). Community and household factors were independent drivers of behavior that need to be incorporated into individual level interventions, or considered in analyses.</p
Development, implementation, and process evaluation of Bukhali: an intervention from preconception to early childhood
No full textThe Healthy Life Trajectories Initiative, an international consortium developed in partnership with the World Health Organization, is addressing childhood obesity from a life-course perspective. It hypothesises that an integrated complex intervention from preconception, through pregnancy, infancy and early childhood, will reduce childhood adiposity and non-communicable disease risk, and improve child development. As part of the Healthy Life Trajectories Initiative in South Africa, the Bukhali randomised controlled trial is being conducted with 18–28-year-old women in Soweto, where young women face numerous challenges to their physical and mental health. The aims of this paper were to describe the intervention development process (including adaptations), intervention components, and process evaluation; and to highlight key lessons learned. Intervention materials have been developed according to the life-course stages: preconception (Bukhali), pregnancy (Bukhali Baby), infancy (Bukhali Nana; birth—2 years), and early childhood (Bukhali Mntwana, 2–5 years). The intervention is delivered by community health workers, and includes the provision of health literacy resources, multi-micronutrient supplementation, in-person health screening, services and referral, nutrition risk support, SMS-reminders and telephonic contacts to assist with behaviour change goals. A key adaption is the incorporation of principles of trauma-information care, given the mental health challenges faced by participants. The Bukhali process evaluation is focussing on context, implementation and mechanisms of impact, using a mixed methods approach. Although the completion of the trial is still a number of years away, the documentation of the intervention development process and process evaluation of the trial can provide lessons for the development, implementation, and evaluation of such complex life-course trials
Exploring early childhood development interventions for building human capital in sub-Saharan Africa: a scoping review
No full textBackground: Inequalities in the provision and implementation of early childhood development (ECD) interventions in Sub-Saharan Africa remain a challenge. This scoping review aimed to investigate the types and extent of ECD interventions in this region, using the Nurturing Care framework (NCF).Methods: This review included randomised controlled trial (RCT) studies related to ECD interventions in Sub-Saharan Africa. Sources from 2019 to 2024 were included. PubMed, MEDLINE (Ebsco), Web of Science, ProQuest and PsychInfo were searched in September 2024. Abstracts and full texts were reviewed using Rayyan.Results: Of 85 studies retrieved, 21 conducted across 13 countries were included in our review. Most were conducted in Eastern and Southern Africa, with Western and Central Africa notably underrepresented. Sample sizes varied from 134 to over 9000 participants. ECD interventions targeting children from 0 to 8 years old were included. Nutrition-focused interventions were the most common (n = 9) and showed the biggest positive impact on child weight and growth. Responsive caring interventions were the second most common (n = 2), resulting in fewer reports of maltreatment, reduced endorsement of corporal punishment and fewer behavioural problems in children. The remaining three NCF dimensions (i.e., early learning opportunities, safety and security, and good health) each had only one intervention focusing solely on that dimension and showed mixed results on child development. Multidimensional interventions were common, with seven studies combining multiple ECD support elements to create a holistic approach. Although these interventions showed mixed results, they were more likely to report positive outcomes across multiple NCF domains compared to single-focus interventions.Conclusions: Most interventions focus only on a couple of NCF elements. There is a need for increased focus on underrepresented regions to address local ECD needs effectively and to develop and evaluate interventions that incorporate all elements of NCF in African contexts
Social Support during pregnancy: A phenomenological exploration of young women’s experiences of support networks on pregnancy care and wellbeing in Soweto, South Africa
No full textSocial support is deemed to have a crucial influence on maternal health and wellbeing during pregnancy. The objective of the study was to explore the experiences of pregnant young females and their receipt of social support in Soweto, South Africa. An interpretive phenomenological approach was employed to understand and interpret pregnant young women’s lived experiences of support networks on their pregnancy care and wellbeing. Data was collected conducting 18 indepth interviews with young pregnant women. Analysis of the data resulted in the development of two superordinate themes: (1) relationships during pregnancy and (2) network involvement. Each superordinate theme was linked to subthemes that helped explain whether young women had positive or negative experiences of social support during their pregnancy care, and their wellbeing. The sub-themes emanating from the superordinate theme ‘relationships during pregnancy’ were (a) behavioural response of partner following disclosure of pregnancy, (b) behavioural response of family following disclosure of pregnancy, and (c) sense of emotional security. Accompanying subthemes of the superordinate theme ‘network involvement’ were (a) emotional and instrumental support, and (b) information support. An interpretation of the young women’s experiences has revealed that young women’s satisfaction with existing support networks and involvement of the various social networks contributed greatly to the participants having a greater sense of potential parental efficacy and increased acceptance of their pregnancies. Pregnant women who receive sufficient social support from immediate networks have increased potential to embrace and give attention to pregnancy-related changes. This could, in turn, foster positive behavioural outcomes that encourage engaging in good pregnancy care practices and acceptance of motherhood.Focusing on previously unexamined factors that could improve maternal health, such as social support, could improve maternal mortality rates and help achieve reproductive health accessibility universally
Integration of nutrition support using the FIGO nutrition checklist in the Bukhali trial: a dietitian’s perspective
No full textThe burden of malnutrition experienced globally, coupled with the increasing rate of micronutrient deficiencies, compromises the health and well-being of women during their reproductive years. Obesity places young South African women at particular risk during pregnancy, and increases obesity risk for their offspring. To address these risks, the Bukhali trial is being implemented in Soweto, South Africa with 18–28-year-old women, as part of the Healthy Lifestyle Trajectory Initiative. A dietitian is part of the Bukhali intervention team (community health workers) to provide nutritional support for overweight/obese trial participants, making use of the International Federation of Gynaecology and Obstetrics (FIGO) Nutrition Checklist. This paper reflects on the experiences and lessons learned by the Bukhali dietitian, including the use of the FIGO Nutrition Checklist and Healthy Conversation Skills to facilitate conversations about making healthy dietary behaviour changes. Identified challenges that influence nutrition and behaviour are discussed, including lack of food affordability, cultural and social influences on healthy food choices, unsupportive environments and food insecurity. Strategies to optimise this nutritional support are also mentioned. The Bukhali trial is showing that introducing additional nutrition support by a dietitian for at-risk participants has the potential to encourage young women to prioritise nutrition and health, even in the midst of contextual challenges to both nutrition and health
Barriers and facilitators of micronutrient supplementation among non-pregnant women of reproductive age in Johannesburg, South Africa
No full textThe prevalence of anaemia among South African women of reproductive age (WRA) remains high at 39%. Multiple micronutrient supplementation (MMS) may be an effective strategy in the prevention and management of anaemia. Our aim was to understand facilitators and barriers to preconception MMS adherence and to explore perceptions and beliefs of MMS in the prevention and treatment of anaemia among non-pregnant WRA. This qualitative study was embedded in a preconception MMS intervention trial of WRA and was conducted in two phases. Phase one assessed the barriers and facilitators of MMS adherence. Individual interviews were conducted with the community health workers (n = 7) administering MMS, and with non-pregnant WRA (n = 25) participating in the trial. Phase two included four focus groups with participating WRA (n = 26), which further explored participants’ perceptions and beliefs of MMS provision and adherence, and strategies to improve adherence. The reported facilitators to supplementation were family support, interaction with the community health workers, easy access to MMS, and experienced benefits of MMS. Barriers to preconception supplementation included the lack of family support, the link of supplements to antenatal care, and the perceived lack of benefits of MMS. Participants reported negative associations of supplements with medication, individual and societal stigma around medication and challenges around the supplementation schedule. For successful preconception MMS interventions, young women, their families, and communities need to be convinced of the value of supplementation. Public health interventions utilising preconception supplementation will require specialised training for health care providers, targeted counselling materials and community household suppor
A protocol for monitoring fidelity of a preconception-life course intervention in a middle-income setting: the Healthy Life Trajectories Initiative (HeLTI), South Africa
Full text linkINTRODUCTION: Despite the importance of intervention fidelity in interpreting the outcomes of complex public health interventions, there is a lack of both reporting fidelity trial protocols and uniformity. In evaluating complex, adaptable/pragmatic interventions in resource-strapped settings with systemic issues, unique challenges to intervention adherence and monitoring are introduced, increasing the importance of a fidelity protocol. We aim to describe the intervention fidelity and monitoring protocol for the Healthy Life Trajectories Initiative (HeLTI) South Africa, a complex four-phase intervention set in urban Soweto, starting preconceptionally and continuing through to pregnancy, infancy, and early childhood to improve the health of young women and reduce the intergenerational risk of obesity. METHODS: The HeLTI SA fidelity protocol was based on the NIH Behaviour Change Consortium (NIH BCC) Treatment Fidelity Framework, outlining the following components of intervention fidelity: study design, provider training, intervention delivery, intervention receipt, and intervention enactment. Context-specific fidelity challenges were identified. The intervention fidelity components and associated monitoring strategies were developed to align with HeLTI SA. Strategies for fidelity monitoring include, amongst others, qualitative process evaluation methods, reviewing observed and recorded intervention sessions, monitoring of activity logs, standardized training, and intervention session checklists. Possible challenges to fidelity and fidelity monitoring include high provider turnover, lack of qualification amongst providers, difficulty tracing participants for follow-up sessions, participant health literacy levels, and the need to prioritize participants’ non-health-related challenges. Solutions proposed include adapting intervention delivery methods, recruitment methods, and provider training methods. DISCUSSION: The NIH BCC Treatment Fidelity Framework provided a solid foundation for reporting intervention fidelity across settings to improve intervention validity, ability to assess intervention effectiveness, and transparency. However, context-specific challenges to fidelity (monitoring) were identified, and transparency around such challenges and possible solutions in low- and middle-income settings could help foster solutions to improve adherence, reporting, and monitoring of intervention fidelity in this setting. TRIAL REGISTRATION: Pan African Clinical Trials Registry PACTR201903750173871. Registered on 27 March 2019 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13063-022-06696-w
Retention in the Bukhali trial in Soweto, South Africa: a qualitative analysis using self-determination theory
No full textIntroduction There is limited research on applying theory to retention in complex intervention trials. To address this gap, this study aimed to qualitatively examine retention in the Bukhali randomised controlled trial, from the perspective of trial participants and staff, through the lens of self-determination theory (SDT). The Bukhali trial is part of the Healthy Life Trajectories Initiative in Soweto, South Africa, with young women.Methods Nine focus group discussions were used to generate data from Bukhali trial staff (n=45, 23–64 years), and participants, including those currently enrolled (n=16, 25–31 years) and those who had withdrawn from the trial (n=20, 24–32 years). A codebook thematic approach was taken to data analysis; SDT was used to develop a conceptual model to analyse the data in context. The main themes identified were external influences on the trial, trial implementing environment, controlled motivation and intrinsic autonomous motivation.Results Our findings highlighted the contextual issues influencing the trial, including participants’ socioeconomic circumstances, and the presence or absence of social support, the trial complexity and participant burden. Issues related to controlled motivation comprised challenges of staying in contact, financial incentives and food, health services provided and other incentives. We also identified aspects of the trial supporting participants’ psychological needs of autonomy, competence and relatedness, which in turn contributed to their intrinsic autonomous motivation. These included participants’ interest in the trial and its relevance to them; participants’ sense of agency, meaning and purpose through their involvement; the building of their knowledge and awareness about their health; relating to other participants and the relationships built with staff and being treated well.Conclusion SDT provides a helpful frame for a contextualised understanding of the complexity of retention of Bukhali trial participants (longitudinal study and intervention). These findings have relevance for trials in under-resourced settings
Mobile technology use in clinical research examining challenges and implications for health promotion in South Africa: mixed methods study
No full textBackground: the use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies.Objective: this study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa.Methods: a convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH).Results: of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number.Conclusions: remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice
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