Draper Catherine E, Nemutandani Simon M, Grimsrud Anna T, Rudolph Michael, Kolbe-Alexander Tracy L, de Kock Lauren, Lambert Estelle V
UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
Rural Remote Health. 2010 Jul-Sep;10(3):1467. Epub 2010 Sep 19.
Chronic diseases, an increasing global concern, are prevalent in the low-income communities of South Africa, where rural health systems bear the double burden of infectious and chronic diseases. The Discovery Healthy Lifestyle Programme (DHLP) is a physical activity-based chronic disease prevention program that has been implemented in a low-income, rural setting in South Africa. The DHLP consists of both school- and primary healthcare clinic-based interventions for learners (Healthnutz) and adults (Live it Up), facilitated by teachers, nurses and community volunteers. The aim of this evaluation was to qualitatively assess the process by which the DHLP was implemented, identifying enabling factors and barriers.
Data were collected in target communities at schools and clinics from semi-structured focus groups of program leaders and members, teachers and community members (n = 45), situational analyses of the school physical activity environment, informal community observations and informal interviews with program coordinators.
The target communities faced socioeconomic and health inequalities and remained under-resourced and under-served. In spite of these and other challenges, the DHLP was well received by community members and stakeholders. It was valued by respondents for its health and psychosocial outcomes, evidenced by increased knowledge and awareness of the importance of physical activity and healthy lifestyles, and positively altered perceptions of physical activity. Program implementers believed the Live it Up component was growing, and this suggested the sustainability of the program. There were, however, some concerns about the fidelity of the Healthnutz intervention, due to timetabling difficulties. Despite this, teachers were positive about the program and its value for their learners, staff and school. The community characteristics of being under-resourced and under-served appeared to positively influence DHLP implementation. Local government involvement in the DHLP resulted in greater ownership of the program, which enabled successful implementation.
This study presents a unique opportunity to assess the implementation and sustainability requirements of programs in environments of limited resources, considerable burden of infectious and chronic diseases and extensive socioeconomic challenges. The findings suggest that through enhancement of knowledge, transfer of appropriate skills and the provision of an enabling environment, participation in physical activity can be effectively promoted in a low-income, rural setting. Physical activity interventions that promote the participation and empowerment of rural communities can be feasible and accessible, thereby assisting in addressing the growing burden of chronic diseases in low-income.
慢性病是全球日益关注的问题，在南非低收入社区中普遍存在，当地农村卫生系统承受着传染病和慢性病的双重负担。“发现健康生活方式计划”（DHLP）是一项基于体育活动的慢性病预防计划，已在南非一个低收入农村地区实施。DHLP包括针对学习者（Healthnutz）和成年人（“动起来”）的基于学校和初级医疗诊所的干预措施，由教师、护士和社区志愿者提供协助。本次评估的目的是定性评估DHLP的实施过程，确定促成因素和障碍。
在目标社区的学校和诊所收集数据，来自项目负责人和成员、教师及社区成员的半结构化焦点小组（n = 45）、学校体育活动环境的情境分析、非正式社区观察以及对项目协调员的非正式访谈。
目标社区面临社会经济和健康不平等问题，资源仍然不足且服务欠缺。尽管存在这些及其他挑战，DHLP受到了社区成员和利益相关者的欢迎。受访者因其健康和心理社会成果而重视该计划，这表现为对体育活动和健康生活方式重要性的认识和了解有所增加，以及对体育活动的看法得到积极改变。项目实施者认为“动起来”部分在不断发展，这表明该计划具有可持续性。然而，由于时间安排困难，对Healthnutz干预措施的忠实度存在一些担忧。尽管如此，教师对该计划及其对学生、教职员工和学校的价值持积极态度。资源不足和服务欠缺的社区特征似乎对DHLP的实施产生了积极影响。地方政府对DHLP的参与导致对该计划的更大自主权，从而实现了成功实施。
本研究提供了一个独特的机会，可评估在资源有限、传染病和慢性病负担较重以及社会经济挑战广泛的环境中项目的实施和可持续性要求。研究结果表明，通过增强知识、传授适当技能和提供有利环境，可以在低收入农村地区有效促进体育活动的参与。促进农村社区参与和赋权的体育活动干预措施可以是可行且可及的，从而有助于应对低收入地区日益加重的慢性病负担。
