Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.
MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2019 Jul 31;14(7):e0219787. doi: 10.1371/journal.pone.0219787. eCollection 2019.
Rising levels of obesity in South Africa require innovation in community-level lifestyle change programmes. Our aim was to co-develop Impilo neZenkolo ('Health through Faith'), a healthy lifestyle programme for low-income, black South Africans delivered through churches, and evaluate its feasibility, acceptability and potential effectiveness. In the first phase we developed programme materials with church members. In the second phase we trained lay leaders to deliver the programme and assessed feasibility, acceptability (observation, focus groups and interviews) and potential effectiveness (pre and post measurement of weight, hip and waist circumferences, blood pressure, self-reported physical activity, dietary habits, health status, self-esteem, psychological distress). The study was conducted in four churches in urban and rural South Africa. The development workshops led to increased focus on positive benefits of participation, widening inclusion criteria to all adults and greater emphasis on Christian ethos. Challenges to feasibility included: recruitment of churches; scheduling of programme sessions (leading to one church not delivering the programme); attendance at the programme (63% attended more than half of the 12 weekly sessions); and poor programme fidelity (in particular in teaching behaviour change techniques). Aspects of the programme were acceptable, particularly the way in which the programme was aligned with a Christian ethos. There was some indication that amongst the 42/68 (62%) for whom we were obtained pre- and post-programme measurements the programme has potential to support weight loss. We conclude that a healthy lifestyle programme for low-income, black South Africans, delivered through churches, may be viable with extensive re-development of delivery strategies. These include finding external funding for the programme, endorsement from national level denominational organisations and the professionalization of programme leadership, including paid rather than volunteer leaders to ensure sufficient time can be spent in training.
南非肥胖率不断上升，需要在社区层面的生活方式改变项目中进行创新。我们的目标是共同制定“Im-pilo neZenkolo”（“通过信仰获得健康”），这是一个针对低收入、黑人南非人的健康生活方式项目，通过教堂来实施，并评估其可行性、可接受性和潜在效果。在第一阶段，我们与教堂成员共同制定了项目材料。在第二阶段，我们培训了非专业的领导人员来提供该方案，并评估了可行性、可接受性（观察、焦点小组和访谈）和潜在效果（在体重、臀围和腰围、血压、自我报告的身体活动、饮食习惯、健康状况、自尊、心理困扰进行测量前后）。该研究在南非城乡的四所教堂进行。发展研讨会使人们更加关注参与的积极益处，扩大了纳入标准，涵盖所有成年人，并更加注重基督教教义。可行性面临的挑战包括：招募教堂；计划方案会议（导致一个教堂没有提供该方案）；参加方案的人数（63%的人参加了 12 个每周课程中的一半以上）；以及方案的忠实度差（特别是在教授行为改变技术方面）。该方案的某些方面是可以接受的，特别是该方案与基督教教义相一致的方式。有一些迹象表明，在我们获得方案前后测量数据的 68 名参与者中，有 42 名（62%）方案有潜力支持体重减轻。我们得出的结论是，通过教堂为低收入、黑人南非人提供的健康生活方式方案可能是可行的，但需要对交付策略进行广泛的重新开发。这些策略包括为该方案寻找外部资金、获得国家一级教派组织的认可以及方案领导的专业化，包括付费而不是志愿领导，以确保有足够的时间进行培训。
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