Browsing by Author "Draper, Catherine E"

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    Alignment between chronic disease policy and practice: case study at a primary care facility
    (Public Library of Science, 2014) Draper, Claire A; Draper, Catherine E; Bresick, Graham F
    BACKGROUND: Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. METHODS: One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. RESULTS: The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. CONCLUSIONS: Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting.
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    Application of Intervention Mapping to develop a community-based health promotion pre-pregnancy intervention for adolescent girls in rural South Africa: Project Ntshembo (Hope)
    (2014-06-20) Draper, Catherine E; Micklesfield, Lisa K; Kahn, Kathleen; Tollman, Stephen M; Pettifor, John M; Dunger, David B; Norris, Shane A
    Abstract Background South Africa (SA) is undergoing multiple transitions with an increasing burden of non-communicable diseases and high levels of overweight and obesity in adolescent girls and women. Adolescence is key to addressing trans-generational risk and a window of opportunity to intervene and positively impact on individuals’ health trajectories into adulthood. Using Intervention Mapping (IM), this paper describes the development of the Ntshembo intervention, which is intended to improve the health and well-being of adolescent girls in order to limit the inter-generational transfer of risk of metabolic disease, in particular diabetes risk. Methods This paper describes the application of the first four steps of IM. Evidence is provided to support the selection of four key behavioural objectives: viz. to eat a healthy, balanced diet, increase physical activity, reduce sedentary behaviour, and promote reproductive health. Appropriate behaviour change techniques are suggested and a theoretical framework outlining components of relevant behaviour change theories is presented. It is proposed that the Ntshembo intervention will be community-based, including specialist adolescent community health workers who will deliver a complex intervention comprising of individual, peer, family and community mobilisation components. Conclusions The Ntshembo intervention is novel, both in SA and globally, as it is: (1) based on strong evidence, extensive formative work and best practice from evaluated interventions; (2) combines theory with evidence to inform intervention components; (3) includes multiple domains of influence (community through to the individual); (4) focuses on an at-risk target group; and (5) embeds within existing and planned health service priorities in SA.
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    Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study
    (2021-02-27) Klingberg, Sonja; van Sluijs, Esther M F; Jong, Stephanie T; Draper, Catherine E
    Background Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3–5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. Methods A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. Results The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs’ scope of work. Conclusions Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention’s effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources.
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    Coaches' perception of catastrophic injuries risks in South African Rugby Union : A qualitative exploration through a socio-ecological lens
    (2017) Joshua, Jonathan; Draper, Catherine E; Brown, James Craig
    Introduction: The annual rate of rugby-related catastrophic injuries (CIs) in South Africa has been classified as "acceptable". However, of all injuries, CIs are the most traumatic for all involved. Therefore, the BokSmart programme was introduced in South Africa to reduce CIs by training all coaches in safe coaching principles. South Africa presents a particularly difficult implementation context for injury prevention interventions due to large variations in socio-economic statuses (SES) of sport participants. In addition, individuals are known to accept perceived levels of risks and ignore the actual levels of risks. Thus, rugby policy makers, experts, coaches and players may have conflicting views regarding CIs risks associated with the sport. In rugby, objective measures of risks such as risk probability are well defined however; little is known about how rugby coaches perceive the risks of CIs in rugby. This is a concern for rugby governing bodies such as SARU because coaches' perceptions of CIs risks could play a role in their adoption of BokSmart coaching principles. Additionally, risk perceptions of South African rugby coaches may vary by SES. Socio-Ecological Models (SEM) give attention to the intrapersonal, interpersonal and societal influences that affect the perceptions of coaches from various SES settings. Using qualitative methods, the aim of this research was to explore South African rugby coaches' perceptions of CIs, through the lens of a SEM. Methods: Six semi-structured focus groups were conducted with junior and senior coaches from three tiers of SES settings: low, middle and high. An additional focus group was conducted with rugby referees' to corroborate evidence from the coaches' focus groups. For analysis, a thematic framework was developed based on factors that were found to influence risk perceptions from catastrophic event studies. Themes were: 1) SES, 2) Knowledge of rugby and CIs, 3) CIs experience, 4) Cognitive biases, 5) Attitudes and intentions, 6) Coach pressure, and 7) Mass media. Results and Discussion: This study's findings suggest that coaches' perceptions of CI risks vary according to SES. Low SES coaches predominantly implied that lack of adequate rugby infrastructure influenced beliefs that their players are at risks of CIs. For Middle SES coaches, lack of knowledge about CIs prevention influenced perceptions about their players' risks of CIs. Lastly, high SES coaches' were mainly influenced by cognitive biases, perceiving their players to be less vulnerable to CIs than players in lower SES settings. All coaches were influenced by 1) a lack of CIs experience that prompted perceptions of invulnerability to CIs, 2) 'win at all costs' attitudes and intentions, and 3) coaches' pressure, both of which lowered concerns for CIs risks and resulted in players 'playing on' despite injuries. In addition, the SEM provided the overall perspective of the ecological factors that influenced coaches' perceptions of CIs. Conclusion: Perceptions of CIs risk differ among coaches from various SES settings. Therefore interventions such as the BokSmart programme should be tailored towards targeting various SES groups.
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    Cross-sectional associations between mental health indicators and social vulnerability, with physical activity, sedentary behaviour and sleep in urban African young women
    (2022-07-10) Draper, Catherine E; Cook, Caylee J; Redinger, Stephanie; Rochat, Tamsen; Prioreschi, Alessandra; Rae, Dale E; Ware, Lisa J; Lye, Stephen J; Norris, Shane A
    Background Relationships between mental health and multiple health behaviours have not been explored in young South African women experiencing social constraints. The aim of this study was to identify associations between mental health indicators and risk factors with physical activity, sedentary behaviour, and sleep, amongst young women living in Soweto, a predominantly low-income, urban South African setting. Methods For this cross-sectional study, baseline measurements for participants (n = 1719, 18.0–25.9 years old) recruited for the Healthy Life Trajectories Initiative were used including: physical activity, sedentary behaviour (sitting, screen and television time), sleep (duration and quality), depression and anxiety indicators, emotional health, adverse childhood experiences, alcohol-use risk; social vulnerability, self-efficacy, and social support. Results Multiple regression analyses showed that depression (β = 0.161, p < 0.001), anxiety (β = 0.126, p = 0.001), adverse childhood experiences (β = 0.076, p = 0.014), and alcohol-use risk (β = 0.089, p = 0.002) were associated with poor quality sleep. Alcohol-use risk was associated with more screen time (β = 0.105, p < 0.001) and television time (β = 0.075, p < 0.016). Social vulnerability was associated with lower sitting time (β = − 0.187, p < 0001) and screen time (β = − 0.014, p < 0.001). Higher self-efficacy was associated with more moderate- to vigorous-intensity physical activity (β = 0.07, p = 0.036), better-quality sleep (β = − 0.069, p = 0.020) and less television time (β = − 0.079, p = 0.012). Having no family support was associated with more sitting time (β = 0.075, p = 0.022). Binomial logistic regression analyses supported these findings regarding sleep quality, with anxiety and depression risk doubling the risk of poor-quality sleep (OR = 2.425, p < 0.001, OR = 2.036, p = 0.003 respectively). Conclusions These findings contribute to our understanding of how mental health indicators and risk factors can be barriers to health behaviours of young women in Soweto, and that self-efficacy and social support can be protective for certain of these behaviours for these women. Our results highlight the uniqueness of this setting regarding associations between mental health and behaviours associated with non-communicable diseases risk.
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    Did HealthKick, a randomised controlled trial primary school nutrition intervention improve dietary quality of children in low-income settings in South Africa?
    (2015-09-23) Steyn, Nelia P; de Villiers, Anniza; Gwebushe, Nomonde; Draper, Catherine E; Hill, Jillian; de Waal, Marina; Dalais, Lucinda; Abrahams, Zulfa; Lombard, Carl; Lambert, Estelle V
    Background: Numerous studies in schools in the Western Cape Province, South Africa have shown that children have an unhealthy diet with poor diversity and which is high in sugar and fat. HealthKick (HK) was a three-year randomised controlled trial aimed at promoting healthy eating habits. Methods: Sixteen schools were selected from two low-income school districts and randomly allocated to intervention (n = 8) or control school (n = 8) status. The HK intervention comprised numerous activities to improve the school nutrition environment such as making healthier food choices available and providing nutrition education support. Dietary intake was measured by using a 24-h recall in 2009 in 500 grade 4 learners at intervention schools and 498 at control schools, and repeated in 2010 and 2011. A dietary diversity score (DDS) was calculated from nine food groups and frequency of snack food consumption was determined. A school level analysis was performed. Results: The mean baseline (2009) DDS was low in both arms 4.55 (SD = 1.29) and 4.54 (1.22) in the intervention and control arms respectively, and 49 % of learners in HK intervention schools had a DDS ≤4 (=low diversity). A small increase in DDS was observed in both arms by 2011: mean score 4.91 (1.17) and 4.83 (1.29) in the intervention and control arms respectively. The estimated DSS intervention effect over the two years was not significant [0 .04 (95 % CI: −0.37 to 0.46)]. Food groups least consumed were eggs, fruit and vegetables. The most commonly eaten snacking items in 2009 were table sugar in beverages and/or cereals (80.5 %); followed by potato crisps (53.1 %); non-carbonated beverages (42.9 %); sweets (26.7 %) and sugar-sweetened carbonated beverages (16 %). Unhealthy snack consumption in terms of frequency of snack items consumed did not improve significantly in intervention or control schools. Discussion: The results of the HK intervention were disappointing in terms of improvement in DDS and a decrease in unhealthy snacking. We attribute this to the finding that the intervention model used by the researchers may not have been the ideal one to use in a setting where many children came from low-income homes and educators have to deal with daily problems associated with poverty.Conclusions: The HK intervention did not significantly improve quality of diet of children.
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    Evaluation of a school-based physical activity intervention in Alexandra Township
    (2010) Draper, Catherine E; de Kock, Lauren; Grimsrud, Anna T; Rudolph, Michael; Nemutandani, Simon; Kolbe-Alexander, Tracy; Lambert, Estelle V
    Objectives. Non-communicable diseases and limited participation in school physical education have become increasing concerns in South Africa. In response to these concerns, a schoolbased physical activity intervention, Healthnutz, was implemented in three primary schools in Alexandra Township, Johannesburg. Evaluation of Healthnutz included assessing its feasibility and acceptability, and short-term changes in learners’ physical fitness, knowledge and attitudes. Methods. To assess feasibility and acceptability, a situational analysis and focus groups with teachers and programme monitors were conducted. Pre-post fitness testing (3-month interval) was conducted with learners, and a questionnaire assessed changes in learners’ knowledge, attitudes, self-efficacy, and perceived barriers to physical activity, in control and intervention schools. Results. At implementation, teachers identified the need for more physical activity in the school environment and were positive about Healthnutz. Follow-up focus group discussions suggested that it was positively impacting teachers, learners and the school in general. Scores for sit and reach (p<0.001), sit ups (p<0.02) and shuttle run (p<0.0001) improved significantly in intervention but not control schools. A significant decrease was observed in learners’ perceived external barriers to physical activity (p<0.0001) along with a positive change in learners’ self-efficacy for physical activity (p<0.05). Conclusions. Healthnutz raised awareness of the importance of physical activity in intervention schools. Findings indicate that even limited exposure to a physical activity intervention can lead to a significant improvement in aspects of learners’ fitness, knowledge, attitudes and perceptions regarding physical activity. Furthermore, training and support of teachers needs to be nonjudgemental and empowering.
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    Factors associated with participation in a phase three cardiac rehabilitation programme
    (2013) Noorbhai, Mohammed Habib; Kolbe-Alexander, Tracy; Draper, Catherine E
    Background Patients with cardiovascular diseases (CVDs) and non-communicable diseases (NCDs) benefit from participating in cardiac rehabilitation programmes (CRPs). The aim of this research project was to evaluate the factors associated with participation in a phase three CRP, the Prime Time programme (PTP). A secondary aim was to compare attendance and baseline measures between Prime Time (PT) and non-Prime Time (NPT) members at a commercial gym. Methodology The first chapter comprised of focus group discussions (n = 3) and key-informant interviews (n = 5 current members and n = 5 ex-members). Staff participants (n = 9) included the Biokineticists, programme managers and sales consultants who participated in key-informant interviews and provided their perceptions and experiences while working on the programme. Atlas.ti was used for the data analysis and a thematic coding framework was used to analyse the focus groups and interviews. The second chapter, which was a pilot study, employed a case-control research design to compare attendance and baseline data between PT (n = 11) and NPT (n = 40) members at a commercial gym. Three age-matched controls for every case were included in this pilot study. Descriptive statistics (means and standard deviations), one-way analysis of variance (used to determine if there were any significant differences between groups at baseline for continuous variables) and Chi-square analysis (used to determine if there were any significant differences between groups at baseline for categorical variables) were performed. The level of significance was set at p<0.05.
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    Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation
    (2015-08-22) de Villiers, Anniza; Steyn, Nelia P; Draper, Catherine E; Hill, Jillian; Dalais, Lucinda; Fourie, Jean; Lombard, Carl; Barkhuizen, Gerhard; Lambert, Estelle V
    Abstract Background The HealthKick intervention, introduced at eight primary schools in low-income settings in the Western Cape Province, South Africa, aimed to promote healthy lifestyles among learners, their families and school staff. Eight schools from similar settings without any active intervention served as controls. Methods The Action Planning Process (APP) guided school staff through a process that enabled them to assess areas for action; identify specific priorities; and set their own goals regarding nutrition and physical activity at their schools. Educators were introduced to the APP and trained to undertake this at their schools by holding workshops. Four action areas were covered, which included the school nutrition environment; physical activity and sport environment; staff health; and chronic disease and diabetes awareness. Intervention schools also received a toolkit comprising an educator’s manual containing planning guides, printed resource materials and a container with physical activity equipment. To facilitate the APP, a champion was identified at each school to drive the APP and liaise with the project team. Over the three-years a record was kept of activities planned and those accomplished. At the end of the intervention, focus group discussions were held with school staff at each school to capture perceptions about the APP and intervention activities. Results Overall uptake of events offered by the research team was 65.6 % in 2009, 75 % in 2010 and 62.5 % in 2011. Over the three-year intervention, the school food and nutrition environment action area scored the highest, with 55.5 % of planned actions being undertaken. In the chronic disease and diabetes awareness area 54.2 % actions were completed, while in the school physical activity and sport environment and staff health activity areas 25.9 and 20 % were completed respectively. According to educators, the low level of implementation of APP activities was because of a lack of parental involvement, time and available resources, poor physical environment at schools and socio-economic considerations. Conclusions The implementation of the HealthKick intervention was not as successful as anticipated. Actions required for future interventions include increased parental involvement, greater support from the Department of Basic Education and assurance of sufficient motivation and ‘buy-in’ from schools.
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    “Just because you’re pregnant, doesn’t mean you’re sick!” A qualitative study of beliefs regarding physical activity in black South African women
    (BioMed Central, 2016-07-19) Watson, Estelle D; Norris, Shane A; Draper, Catherine E; Jones, Rachel A; van Poppel, Mireille N M; Micklesfield, Lisa K
    Background: Despite the benefits of physical activity during pregnancy, the physiological and psychological changes that occur during this unique period may put women at greater risk of being sedentary. Lifestyle and environmental transitions have left black South African women at increased risk of physical inactivity and associated health risks. Therefore, the aim of this qualitative study was to describe the beliefs regarding physical activity during pregnancy in an urban African population. Methods: Semi-structured interviews (n = 13) were conducted with pregnant black African women during their third trimester. Deductive thematic analysis was completed based on the Theory of Planned Behaviour. Coding and analysis was completed with the assistance of ATLAS.ti software. Results: Participants had a mean age of 28 (19–41) years, and a mean BMI of 30 (19.6–39.0) kg/m2. Although the majority of women believed that physical activity was beneficial, this did not appear to translate into behaviour. Reported reasons for this included barriers such as pregnancy-related discomforts, lack of time, money and physical activity related education, all of which can contribute to a reduced perceived control to become active. Opportunities to participate in group exercise classes was a commonly reported facilitator for becoming active. In addition, influential role players, such as family, friends and healthcare providers, as well as cultural beliefs, reportedly provided the women with vague, conflicting and often discouraging advice about physical activity during pregnancy. Conclusions: This study provides new theoretical insight on the beliefs of urban South African pregnant women regarding physical activity. Findings from this study suggest a holistic approach to improve physical activity compliance during pregnancy, inclusive of physical activity education and exercise opportunities within a community setting. This study presents critical formative work upon which contextually and culturally sensitive interventions can be developed.
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    Nurses’ lifestyle behaviours, health priorities and barriers to living a healthy lifestyle: a qualitative descriptive study
    (BioMed Central, 2014-11-28) Phiri, Lindokuhle P; Draper, Catherine E; Lambert, Estelle V; Kolbe-Alexander, Tracy
    Background: Nurses have an increased risk for non-communicable diseases (NCDs), along with a high prevalence of obesity, poor eating habits and insufficient physical activity. The aim of this study was to determine the health concerns, health priorities and barriers to living a healthy lifestyle among nurses and hospital management staff from public hospitals in the Western Cape Metropole, South Africa. Methods: Participants were purposively sampled (n = 103), and included management personnel (n = 9), night shift (n = 57) and day-shift nurses (n = 36). Twelve focus groups (FGDs) were conducted with nursing staff to obtain insight into nurses’ health concerns, lifestyle behaviours and worksite health promotion programmes (WHPPs). Seven key informant interviews (KII) were conducted with management personnel, to gain their perspective on health promotion in the worksite. Thematic analysis was used to analyse the data with the assistance of Atlas.ti Qualitative Data Analysis Software. Results: Night shift nurses frequently identified weight gain and living with NCDs such as hypertension as their main health concerns. Being overweight was perceived to have a negative impact on work performance. All nurses identified backache and exposure to tuberculosis (TB) as occupation-related health concerns, and both management and nurses frequently reported a stressful working environment. Nurses frequently mentioned lack of time to prepare healthy meals due to long working hours and being overtired from work. The hospital environment was perceived to have a negative influence on the nurses’ lifestyle behaviours, including food service that offered predominantly unhealthy foods. The most commonly delivered WHPPs included independent counselling services, an online employee wellness programme offered by the Department of Health and wellness days in which clinical measures, such as blood glucose were measured. Nurses identified a preference for WHPPs that provided access to fitness facilities or support groups. Conclusions: Public hospitals are a stressful work environment and shift work places an additional strain on nurses. The risk of NCDs and exposure to infectious disease remains a concern in this working population. Our findings highlight the need for WHPPs that support nurses in managing stress and transforming the work environment to facilitate healthy lifestyles.
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    Perceived and objective neighborhood support for outside of school physical activity in South African children
    (BioMed Central, 2016-06-01) Uys, Monika; Broyles, Stephanie T; Draper, Catherine E; Hendricks, Sharief; Rae, Dale; Naidoo, Nirmala; Katzmarzyk, Peter T; Lambert, Estelle V
    Background: The neighborhood environment has the potential to influence children’s participation in physical activity. However, children’s outdoor play is controlled by parents to a great extent. This study aimed to investigate whether parents' perceptions of the neighborhood environment and the objectively measured neighborhood environment were associated with children's moderate-to-vigorous intensity physical activity (MVPA) outside of school hours; and to determine if these perceptions and objective measures of the neighborhood environment differ between high and low socio-economic status (SES) groups. Methods: In total, 258 parents of 9–11 year-old children, recruited from the South African sample of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), completed a questionnaire concerning the family and neighborhood environment. Objective measures of the environment were also obtained using Geographic Information Systems (GIS). Children wore an Actigraph (GT3X+) accelerometer for 7 days to measure levels of MVPA. Multilevel regression models were used to determine the association between the neighborhood environment and MVPA out of school hours. Results: Parents’ perceptions of the neighborhood physical activity facilities were positively associated with children’s MVPA before school (β = 1.50 ± 0.51, p = 0.003). Objective measures of neighborhood safety and traffic risk were associated with children’s after-school MVPA (β = −2.72 ± 1.35, p = 0.044 and β = −2.63 ± 1.26, p = 0.038, respectively). These associations were significant in the low SES group (β = −3.38 ± 1.65, p = 0.040 and β = −3.76 ± 1.61, p = 0.020, respectively), but unrelated to MVPA in the high SES group. Conclusions: This study found that several of the objective measures of the neighborhood environment were significantly associated with children’s outside-of-school MVPA, while most of the parents’ perceptions of the neighborhood environment were unrelated.
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    Psychological factors and physical outcomes in patients with chronic diseases of lifestyle
    (2016) Skowno, Philippa; Derman, Elton; Stein, Dan J; Draper, Catherine E
    INTRODUCTION: Chronic diseases of lifestyle (CDL) are a major cause of global morbidity and mortality. Although CDL are largely preventable and treatable through adopting and maintaining healthy lifestyle behaviours, CDL rehabilitation programmes remain an underutilised resource. Behaviour modification is thus complex, and requires a collaborative approach between psychologists and medical clinicians involved in the management of CDL. This thesis examined the role of psychological factors in the management of patients with CDL who participated in a comprehensive lifestyle intervention (CLI) programme. METHODS: An explanatory mixed methods design was used to describe the CLI experience. These included an initial clinical audit of 308 patients commencing and completing a twelve week CLI programme to test associations of psychological, demographic, medical and diagnostic factors with physical outcomes. Two qualitative studies were subsequently conducted to further understand patient experiences of CDL and CLI programmes. The first involved interviews of 14 patients at programme commencement and completion. The second consisted of a case study of a patient participating in the programme using human centred design principles as well as ethnography.
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    Sleep and BMI in South African urban and rural, high and low-income preschool children
    (2021-03-23) Rae, Dale E; Tomaz, Simone A; Jones, Rachel A; Hinkley, Trina; Twine, Rhian; Kahn, Kathleen; Norris, Shane A; Draper, Catherine E
    Abstract Background The extent to which income setting or rural and urban environments modify the association between sleep and obesity in young children is unclear. The aims of this cross-sectional observational study were to (i) describe and compare sleep in South African preschool children from rural low-income (RL), urban low-income (UL) and urban high-income (UH) settings; and (ii) test for associations between sleep parameters and body mass index (BMI). Methods Participants were preschoolers (5.2 ± 0.7y, 49.5% boys) from RL (n = 111), UL (n = 65) and UH (n = 22) settings. Height and weight were measured. Sleep, sedentary behaviour and physical activity were assessed using accelerometery. Results UL children had higher BMI z-scores (median: 0.39; interquartile range: − 0.27, 0.99) than the UH (− 0.38; − 0.88, 0.11) and RL (− 0.08; − 0.83, 0.53) children (p = 0.001). The UL children had later bedtimes (p < 0.001) and wake-up times (p < 0.001) and shorter 24 h (p < 0.001) and nocturnal (p < 0.001) sleep durations than the RL and UH children. After adjusting for age, sex, setting, SB and PA, for every hour less sleep obtained (24 h and nocturnal), children were 2.28 (95% CI: 1.28–4.35) and 2.22 (95% CI: 1.27–3.85) more likely, respectively, to belong to a higher BMI z-score quartile. Conclusions Shorter sleep is associated with a higher BMI z-score in South African preschoolers, despite high levels of PA, with UL children appearing to be particularly vulnerable.
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    Socio-ecological factors in talent development in cricketers in a diverse society
    (2018) Dove, Mary Ann; Draper, Catherine E; Gray, Janine; Taliep, Sharhidd
    Introduction: In recent years, there has been a move to understand the environment and context in which athletes develop. South Africa’s unique context provides an opportunity to understand how environmental factors could influence talent development in cricket. Since democracy, there has been limited representation of Black African cricketers at the elite levels in South Africa. Therefore, the aim of this thesis was to determine the role that socio-ecological factors may play in the development of cricket talent in a diverse society. Methods: Qualitative research methods were used to explore the experiences and perceptions of South Africa’s male cricketers as they progressed through the talent pathway from exposure to the game to the elite level. The perceived effectiveness of the introduction of an ethnic target policy was also explored. Seventy-one semi-structured interviews were conducted with a purposive sample of players from all ethnic groups (n=43), and with knowledgeable and experienced key informants (n=16). A thematic analysis of the data resulted in the identification of themes which are presented using a multi-level socio-ecological framework. Results: All players progressed to the elite level; however, their access points to and routes through the pathway varied. This progress was influenced by the inter-relationship of distal and proximal socio-ecological factors that they experienced during their cricketing careers. These influences can be summarised into five talent development components that acted either as barriers or enablers to progress: (1) access to opportunities and competition, (2) holistic player development, (3) effective support networks, (4) inclusive team environments, and (5) adaptive mind-sets. In addition, various intrapersonal characteristics were identified that further affect a player’s ability to achieve elite cricketing success. Finally, it was determined that an ethnic target policy alone is not an effective intervention for developing cricket talent in a diverse society undergoing transition. Conclusion: A socio-ecological framework to talent development lends additional support to the idiosyncratic, multifactorial, dynamic and complex way in which cricket expertise is achieved, particularly in diverse societies. It provides stakeholders involved in the talent development process with evidence to inform policy and practice, as well as design effective interventions.
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    Socio-ecological influences on physical activity in primary school children: a view from South Africa
    (2015) Uys, Monika; Lambert, Estelle V; Draper, Catherine E
    The prevalence of childhood overweight and obesity has increased substantially globally with a concurrent decline in both children's physical activity and fitness levels. The socio-ecological model proposes that health behaviour, such as physical activity, is influenced by multiple factors, at an individual, social and environmental level. However, there seems to be a lack of consensus in the current literature on the factors influencing physical activity in different settings (e.g. school, neighbourhood), and across a wide range of socio-economic conditions. To our knowledge, there are no data available on the role of different environmental factors (within the school and the neighbourhood environment) in relation to children's physical activity in a South African setting. Therefore, one of the key aims of this thesis was to assess the effectiveness of a novel intervention on fitness, measures of physical activity and factors that influence physical activity. Specifically, this thesis assessed the effectiveness of a school-based, curriculum-grounded, educator-focused intervention designed to increase physical activity and healthy eating in South African primary school students in low income settings, on fitness levels and physical activity related knowledge, attitudes and behaviour (Chapter 2). Additionally, this thesis examined factors within the school environment associated with observed physical activity in children during in-school break time, self-report activity, and moderate- to -vigorous, in-school objectively-measured activity (Chapter 3-5). Furthermore, this thesis assessed the influences of parental perceptions and the neighbourhood environment on children's physical activity (Chapter 6). The overarching aim of this thesis is to examine the association between environmental constructs (physical spatial and built environment, social environment, and policy environment) and children's physical activity.
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    The association between nutrition and physical activity knowledge and weight status of primary school educators
    (2014) Dalais, Lucinda; Abrahams, Zulfa; Steyn, Nelia P; de Villiers, Anniza; Fourie, Jean M; Hill, Jillian; Lambert, Estelle V; Draper, Catherine E
    The purpose of this study was to investigate primary school educators' health status, knowledge, perceptions and behaviour regarding nutrition and physical activity.Thus, nutrition and physical activity knowledge, attitudes, behaviour and risk factors for the development of non-communicable diseases of 155 educators were assessed in a cross-sectional survey. Height, weight, waist circumference, blood pressure and random glucose levels were measured. Twenty percent of the sample had normal weight (body mass index (BMI, kg/m2) < 25), 27.7% were overweight (BMI> 25 to < 30) and 52.3% were obese (BMI < 30). Most of the participants were younger than 45 years (54.2%), females 78.1%, resided in urban areas (50.3%), with high blood pressure (> 140/90 mmHg: 50.3%), and were inactive (48.7%) with a high waist circumference (> 82 cm: 57.4%). Educators' nutrition and physical activity knowledge was poor. Sixty-nine percent of educators incorrectly believed that eating starchy foods causes weight gain and only 15% knew that one should eat five or more fruit and/or vegetables per day. Aspects of poor nutritional knowledge, misconceptions regarding actual body weight status, and challenges in changing health behaviours, emerged as issues which need to be addressed among educators. Educators' high risk for developing chronic non-communicable diseases (NCDs) may impact on educator absenteeism and subsequently on school functioning. The aspects of poor nutrition and physical activity knowledge along with educators' high risk for NCD development may be particularly significant not merely in relation to their personal health but also the learners they teach.