Introduction and problem identification
- Overweight and obesity: A public health concern in South Africa
- Overweight and obesity: A public health concern among educators in South
- Health interventions for educators
- Intervention development
- Problem statement
School principals identified lack of physical activity (33%) and non-communicable diseases (24%) as the main health priorities of primary school teachers [de Villiers et al., 2012]. The UK (UK) MRC framework for the development and evaluation of complex interventions describes four phases and recommends that once an intervention has been developed in Phase 1, its feasibility is tested (Phase 2) before proceeding with a full-scale evaluation (phase 3) and implementation of the intervention (phase 4) [Skivington et al., 2021].
Aims and objectives
Despite the high prevalence of overweight and obesity reported among public school educators in low-income settings, and the recognized importance of educators in shaping students' lifestyle and health behaviors, there is a paucity of research regarding interventions related to health risk for educators. which is a huge gap and concern. Sub-study 3: Investigating the perception of principals of participating schools on the identified feasibility indicators (qualitative).
Outline of thesis
2013 AHA/ACC/TOS guidelines for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. School policy framework: implementing the WHO global strategy on diet, physical activity and health.
Literature review
Overview of the etiology of obesity
- Theoretical framework for obesity in South Africa
- Environmental factors
- Social factors
- Individual behavioural factors
- Individual physiological factors
In some cultures, providing/serving excessive amounts of food is associated with hospitality [van der Valk et al., 2018]. In addition, a sedentary lifestyle has also been associated with an increased energy intake [Brownson et al., 2005].
Lifestyle change based management/treatment of obesity…
- Overview
- Diet
- Physical activity
- Physiological and behaviour therapy
However, weight loss maintenance becomes a challenge after the first three to six months when weight loss reaches a plateau [Jensen et al., 2014]. The researchers concluded that physical activity may not be as important for initial weight loss as for maintaining weight loss [Johns et al., 2014].
Delivery of lifestyle interventions for weight loss
- Overview
- Workplace interventions
- Telephonic delivery
- Self-help delivery
- Digital delivery
Similar findings were observed in a previous systematic review consisting of 9 studies [Verweij et al., 2011]. The approach of implementing weight loss interventions in the workplace is considered highly effective [Jensen et al., 2014;.
Predictors of weight loss and weight maintenance
Early weight loss success, adherence and self-monitoring have also been found to be predictors of weight loss [Chopra et al., 2021]. Insights into predictors of weight loss maintenance come from a previous systematic review [Varkervisser et al., 2019].
The health and wellbeing of South African educators….…
- Educator health status
- Health interventions for educators within the South African school setting
- Challenge’s educators experience within the South African schooling system
- Educators as weight management role models for learners
Repetitive dieting can also lead to the development of disordered eating habits, which negatively affects weight loss efforts [Carraça et al., 2018]. In addition, they encouraged private health providers to collaborate with this initiative [Zuma et al., 2016].
Intervention development
- Intervention development and design defined
- Approaches to intervention development
- Theoretical frameworks for intervention development
49 refinement in accordance with the context and setting of the planned intervention [French et al., 2012]. A review of the use of the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB), and the Trans-Theoretical Model (TTM) to study and predict health-related behavior change ( 1 -212). Health and economic burden of projected obesity trends in the US and the UK.
A total of 21 of the 40 BCTs were selected for use in the weight loss intervention. Development of the wellness day structure (first element of the intervention) Background and tasks performed. Development of the content of the intervention manual (the second element of the intervention) Background and completed tasks.
Development of the content of text messages (the third element of the intervention) Background and performed tasks. This was particularly important in the development of the Health4LIFE intervention with 13 target behaviors to address.
MRC framework for developing and evaluating complex interventions
- Overarching critique on intervention development frameworks…
- Behaviour change theories
- Overarching perspectives
- The Social Cognitive Theory (SCT)
- The Transtheoretical Stages of Change Model (TTM)
- The Health Belief Model (HBM)
- The Theory of Planned Behaviour (TPB)
- Feasibility testing
- Overview
- Feasibility of the intervention design
- Feasibility of the evaluation design
- Progression criteria
- References
Theory and evidence-based development of a weight loss intervention for
Introduction
NCD causes have been designated as non-modifiable such as genetic predisposition, sex, age and race, as well as modifiable such as unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol [WHO, 2018; Zaman et al., 2015]. Obesity by itself increases the risk of hypertension, hyperlipidemia and insulin resistance [Dwivedi et al., 2020]. 2015a) reported that overweight was present in 37% of male and 27% of female primary school educators in lower socioeconomic urban and rural areas, while 38% of males and 55% of females were obese [Senekal et al., 2015a ].
Adeniyi et al., 2017; Senekal et al., 2015a] and their modeling function, it is imperative to develop and implement appropriate weight loss interventions to manage the problem of overweight/obesity among educators, ensuring that they model some form of healthy body and lifestyle behaviors. learning environment. This approach to intervention development was defined as the “theory and evidence-based category” of intervention development approaches [O'Cathain et al., 2019a]. Further approaches identified by these authors include: partnership (target population involved in decision-making), target population-focused (based on the views and actions of the target population), implementation-based (focusing on real-world applicability), efficacy-based (intervention components tested experimentally), scale-based or phase-based (focusing on the systematic overview of development processes), intervention-specific (the approach is built for a particular type of intervention) and a combination of approaches [O'Cathain et al., 2019a] .
Several frameworks are described that support a systematic approach to intervention development and include, but are not limited to, the MRC framework for developing and evaluating complex interventions, the Behavior Change Wheel (BCW), the Intervention Map (IM), the Assisting Matrix Practitioner's Intervention Planning Tool (MAP-IT), Normalization Process Theory (NPT) and finally the Theoretical Domain Framework (TDF) [O'Cathain et al., 2019a]. Intervention development should further consider theories or models of behavior change such as the health belief model (HMB) [Rosenstock et al., 1988; Rosenstock Hochbaum, 1958], the Transtheoretical Model [Prochaska et al., 1992] and the Theory of Planned Behavior (TPB) [Azjen to assist researchers in deciding which theoretical constructs to target to achieve behavior change.
Methods and outcomes…
- Intervention development overview
- Selection of an intervention development framework
- Identification of behaviour change theories to be integrated in the selection
- Execution of the framework in its entirety
- Stage 1: Identify target behaviours for weight loss
- Stage 2: Understanding the behaviours
Review of existing research identifying target behaviors (behavioral problems) for weight loss in primary school teachers working in public schools in low-income institutions in the Western Cape. Review of existing research identifying salient beliefs of primary school teachers working in public schools in low-income settings in the Western Cape regarding identified target behaviors (application of the TPB to assess educators' beliefs regarding feeding and exercise behaviors). understand) 2 Understand purpose. Review of existing research identifying target weight loss behaviors in primary school teachers working in public schools in low-income institutions in the Western Cape.
2015a) argue that this may reflect a lack of interest in health by educators, which should be considered in weight loss intervention development. Physical activity levels of educators: Physical activity was assessed in the HK educator survey using the Global Physical Activity Questionnaire (GPAQ) that was developed by WHO to quantify energy expenditure in subjects in developing countries [Armstrong & Bull, 2006]. Key beliefs of primary school educators employed in public schools in low-income settings in the Western Cape regarding healthy dietary behaviors and physical activity As mentioned, it is essential that theories of behavior change are considered in developing interventions aimed at improving weight loss behaviors.
Unpublished data) conducted an elicitation survey to gain insight into the beliefs of primary school teachers employed in public schools in low-income settings in the Western Cape regarding fruit and vegetables, sugar, fat and salt intake and physical activity. Beliefs were classified as behavioral, normative, or controlling as outlined in the TPB [Azjen, 2011] (Appendix I, page 282).
Overview
- Discussion
- Limitations
- Conclusion and Recommendations
- References
- Introduction
- Methods
- Identification and definition of feasibility indicators
- Feasibility testing design
- Sub-study 1
For the generation of the list of such behaviors for the four problem behaviors defined in step 2, an expert panel (Senekal, Steyn, de Villiers, Faber and the PhD candidate) considered the sub-performance targets identified in the formative assessment by Seme (2013), relevant literature [Vorster et al., 2013;. Once the intervention features were identified, the next step in BCW was to identify associated policies that could support implementation of the features [Michie et al., 2011a]. In this research, the 40 BCTs that form part of the CALO-RE taxonomy were considered for inclusion in the weight loss intervention.
This step requires consideration of the most appropriate way or ways of delivering the intervention taking into account the target population and their statement [Michie et al., 2011a]. Outcomes after testing and refining the Health4LIFE intervention manual and text messages. Rosenstock Hochbaum, 1958] and the use of the SatMDT [Lewis et al., 2016] in the development process, which strengthens the theory component and makes this research unique in its approach.
HBM advised the development of the first element of the intervention, namely the wellness day. The definition of outcomes for the purposes of this study (Table 4.1) is consistent with that described by Duijzer et al. The feasibility of the Health4Life weight loss intervention was investigated in three sub-studies.
The intervention group received the remaining two elements of the Health4LIFE weight loss intervention (hard copy manual and text messages) and the control group received a hard copy from the Department of Health (DHs).
Study design
- Sub-study 3
- Quantitative data
- Qualitative data
- Ethical and institutional approval
- Ethical approval
- Institutional approval
- Results
- Sub-study 1
Eligible teachers were provided with information about the purpose of the study and the nature of the required assessments was explained. An overview of the contents of the Health4LIFE manual and associated text messages is provided in Table 4.2. The creation of the manual and messages included testing on a target sample consisting of a group of seven educators (5 female educators and 2 male educators).
The PhD candidate collected the names of the recipients and forwarded these to the service provider. The control group educators received a copy of the intervention manual at the end of the study period. The headpiece was lowered to the crown of the head and the reading was taken.
171 with a similar socioeconomic status background [Seme et al., 2017] was modified to meet the needs of the current study. 173 teachers of the intervention as a whole, and more specifically of the manual and text messages (Addendum XVI, page 361).
Reach of this intervention
- Sub-study 3
- Summary assessment of feasibility outcome measures
- Discussion
- Limitations of the study
- Conclusions and recommendations
- References
- Final conclusions
- Recommendations
- Intervention refinement
- Advocacy for DoBE endorsement
- References
Define the problem in behavioural terms
Selecting the target behaviour
Specifying the target behaviour
Using the COM-B components to identify what needs to change for the target
Selected behaviour change techniques, intervention functions, and COM-B
Description of the intervention for each target behaviour
Text messaging library matrix
Intervention assessment tool for each chapter in the manual, the associated text
Final list of text messages of the 16-week weight loss intervention
Educator copy of the health indicators
Referral letter to health practitioner or health care facility
Eligibility checklist
Participant information and informed consent form for Health4LIFE
Participant questionnaire for Health4LIFE intervention
Interview guide for educator interviews
Participant information and informed consent form for educator interviews
Participant information and informed consent form for principal interviews
Department of Health’s “Choose a Healthy Lifestyle” Booklet
Baseline belief scores of the intervention and control group in the total baseline
Change in belief scores in the intervention and control groups from baseline to 16-
