Nutrition education message topics and accessibility for the well-being of infants in an urban slum area

De Villiers, Anniza (2004-04)

Thesis (MSc (Dietetics))--University of Stellenbosch, 2004.

Thesis

ENGLISH ABSTRACT: The aim of the study was to contribute to the nutritional well-being of 0 - 24 month old children who attend primary health care clinics (PHC) in Duncan Village, an urban slum. This was to be achieved by first formulating essential nutrition-related message topics and second by formulating recommendations for optimising the accessibility of services, including nutrition-related messages, aimed at mothers attending PHC clinics in Duncan Village. In order to formulate targeted and relevant nutrition-related messages for mothers attending the PHC clinics (Phase I of the research) the need for more information on the six focus areas for intervention that were identified in the previous Duncan Village Day Hospital (DVDH) study" was determined. This was done through key-informant interviews and studying other relevant published research. Eleven research questions related to the six focus areas were subsequently formulated to guide further research. Non-scheduled structured interviews were conducted with mothers with children in specific age groups until data saturation was achieved. A total of 31 interviews were thus conducted at the homes of participants and observation data was also collected at the same time. Three focus groups with corresponding participant categories were also conducted to check the information obtained through the interviews. Two focus groups were conducted with grandmothers to serve as a further form of checking research but also to obtain a different perspective on the research questions. The data available for the formulation of the message topics was analysed qualitatively by hand. The focus areas and the research questions gave a specific focus to the analysis process and the unprocessed data was available in these broad predetermined categories. All the information from all sources (DVDH study, the non-scheduled structured interviews with mothers, focus groups with mothers and grandmothers and observation data) was studied, interpreted and integrated for each identified category. During this process key-factors, which need to be addressed in nutrition-related messages essential for the well-being of infants attending PHC clinics in Duncan Village, were identified. The final step in the analysis process was the formulation of message topics based on these key-factors. During the analysis process it became clear that some of the identified key factors were not suitable for the formu lation of nutrition-related message topics but rather give insight into the total context of the mothers attending the clinics in Duncan Village. It was evident that the information contained in the key factors could be used by health workers to identify and assist vulnerable mothers. These key-factors led to the formulation of relevant help topics. Eighteen main message topics and 16 help topics were formulated. The message topics included topics on: self-development, household food security, breastfeeding, good feeding practices, mothers' health and nutrition and hygiene practices. in Phase 2 of the study the accessibility of services, including nutrition-related messages, to mothers attending PHC clinics in Duncan Village was determined. This was done by determining how mothers inDuncan Village experience the clinics where they could be exposed to nutrition-related messages and by determining the experiences of health care workers with mothers as clients as well as with service delivery. This information was obtained through focus group discussions with different participant categories. These categories included mothers with children in the same age groupings as in Phase I who had either attended clinic for all the child's immunisations or who had not attended clinic for all the child's immunisations or who had attended clinics outside Duncan Village for immunisation purposes. Pregnant women who had either attended antenatal clinics or had not attended antenatal clinics were also included. The last participant category involved health workers. This category included health workers from the obstetric unit where mothers from Duncan Village give birth, the primary health care clinics and community health care workers. The data obtained was analysed with ATLAS/ti, computer software specifically designed for qualitative data analysis. Twelve code families were created during the analysis process, each family referring to a specific aspect of accessibility of services provided at the PHC clinics. A detailed description of each code family is presented after which six networks were compiled. The data and networks were used to create a framework for data interpretation. According to the framework it is proposed that the final elements in the process of providing accessible nutrition-related messages to clients at clinics are (1) that the clients must attend the clinic and (2) that appropriate nutrition-related messages must be available. Problems with interpersonal and organisational aspects of service delivery were found to be two of the most important aspects that influence accessibility of clinic services and therefore nutrition-related messages at the clinics. The last phase of the study (Phase 3) involved the formulation of recommendations to the relevant authorities about targeted and relevant nutrition-related message topics to be included in the education of mothers and pregnant women as well as recommendations to optimise accessibility of nutrition-related messages at the three PHC clinics in Duncan Village and the obstetric unit where mothers of Duncan Village give birth. A total of fifteen recommendations were formulated based on the frndings and recommendations of Phase I and Phase 2. These recommendations focus especially on the necessity for the municipality to create a health empowering environment at the clinics, on the provision of appropriate nutrition-related messages at the clinics and on the need to reach vulnerable mothers. The importance of involving the community in these processes was also emphasised in the recommendations. It is concluded that the implementation of the recommendations will contribute to the nutritional well-being of all young children in Duncan Village and could play an important role in realising the rights of children living in the area.

AFRIKAANSE OPSOMMING: Die doel van die studie was om 'n bydrae te maak tot die voedingswelstand van 0-24 maandoue kinders wat prirnere gesondheidsorg (PGS) klinieke in Duncan Village, 'n verarmde stedelike gebied, besoek. am die doel te bereik is daar eerstens beplan om essensiele voedingsverwante boodskappe te formuleer. Tweedens is daar beplan om aanbevelings vir die optimalisering van die toeganklikheid van gesondheidsorgdienste vir rna's wat die klinieke bywoon, insluitend die toeganklikheid van voedinsgverwante boodskappe, te maak. Voordat relevante voedingsverwante boodskappe vir rna's wat die klinieke in Duncan Village besoek, geformuleer kon word, was meer inligting nodig oor die ses fokusareas vir intervensie wat in die vorige Duncan Village Daghospitaal studie bepaal is. Die bepaling van watter inligting nodig was, is gedoen deur sleutelinformantonderhoude en die bestudering van ander relevante gepubliseerde navorsing. Na aanleiding hiervan is elf navorsingsvrae wat verband hou met die ses fokusareas geformuleer. Nie-geskeduleerde, gestruktureerde onderhoude is vervolgens met 111a's met kinders in spesifieke ouderdomsgroepe gehou totdat dataversadiging bereik is. 'n Totaal van 31 onderhoude is met respondente gehou by hul huise, waartydens die onderhoudvoerder ook sekere waamemingsdata ingesamel het. Drie fokusgroepe is ook met rna's met kinders in ooreenstemmende kategoriee gehou om die inligting na te gaan wat deur die onderhoude ingesamel is. Twee fokusgroepe is ook met oumas gehou om die data verder na te gaan maar ook om 'n ander perspektief op die navorsingsvrae te verkry. Die data wat verkry is, is kwalitatief met die hand geanaliseer. Die fokusareas en die navorsingsvrae het 'n spesifieke fokus aan die analiseproses gegee en die ongeprossesseerde data was beskikbaar in hierdie bree vooraf gedetermineerde kategoriee. Die inligting van aile bronne (DVDH-studie, die nie-geskeduleerde gestruktureerde onderhoude met die rna's, die fokusgroepe met die rna's en oumas asook die observasie data) is bestudeer, geinterpreteer en geintegreer vir elke geidentifiseerde kategorie. Gedurende hierdie proses is sleutelfaktore geidentifiseer wat aangespreek moet word in essensiele voedingsverbandhoudende boodskappe wat gemik is om die voedingswelstand van klein kinders wat die PGS-klinieke in Duncan Village besoek te verbeter. Die finale stap in die analiseproses was die formulering van boodskaponderwerpe. Die onderwerpe is gebaseer op die geidentifiseerde sleutelfaktore Dit het duidelik geword tydens die analiseproses dat sommige van die sleutelfaktore nie geskik was vir die formulering van voedingsverbandhoudende boodskaponderwerpe nie, maar dat dit eerder insig verskaf in die totale lewenskonteks van die rna's. Die inligting in hierdie sleutelfaktore kan wei gebruik word deur gesondheidswerkers om kwesbare ma's te identifiseer en by te staan. Hierdie sleutelfaktore het dus tot die formulering van relevante hulpboodskappe gelei. Agtien voedingsverbandhoudende en 16 hulpboodskappe is geformu leer. Die boodskaponderwerpe sluit in onderwerpe oor selfontwikkeling, huishoudelike voedselsekuriteit, borsvoeding, goeie voedingspraktyke, gesondheid van die rna en voeding- en higienepraktyke. Tydens Fase 2 van die studie is die toeganklikheid van PGS dienste, insluitend voedingsverbandhoudende boodskappe vir rna's, bepaal. Dit is gedoen deur te bepaal hoe mas in Duncan Village die kliniekdienste ondervind, waar hulle aan hierdie boodskappe blootgestel kan word asook die ondervindinge van die gesondheidswerkers met die rna's en die diensleweringsproses. Hierdie inligting is deur middel van fokusgroepbesprekings met verskillende deelnemerskategoriee ingesamel. Hierdie kategoriee het rna's ingesluit wat die klinieke in Duncan Village besoek het vir a.l die spesifieke kinders se immunisasies maar ook ma's wat nie kinders geneem het vir al hul immunisasies nie of wat hul kinders na klinieke buite Duncan Village geneem het. Swanger vroue wat die voorgeboortelike klinieke besoek het asook die wat nie die klinieke besoek het nie, is ook ingesluit. Die laaste kategorie wat betrek is, was gesondheidswerkers. Hierdie kategorie het werkers van die kraamafdeling van die nabygelee hospitaaI en die primere gesondheidsorgklinieke ingesluit. Beide professionele verpleegpersoneel en gemeenskapsgesondheids= werkers van die klinieke is betrek. Die data wat verkry is, is met ATLAS/ti, 'n rekenaarprogram spesifiek geskep vir die analise van kwalitatiewe data, ontleed. Twaalf kodefamilies is geskep tydens die analiseproses. Elke familie verwys na 'n spesifieke aspek van toeganklikheid van dienste by die klinieke. 'n Gedetailleerde beskrywing van elke kodefamilie is gegee asook ses netwerke. Die data en die netwerke is gebruik om 'n raamwerk vir data-intepretasie te skep. Die raamwerk postuleer dat die finale elemente in die proses van die verskaffing van toeganklike voedingsverbandhoudende boodskappe by klinieke die volgende is: (1) kliente moet die kliniek besoek en (2) toepaslike voedingsverbandhoudende boodskappe moet beskikbaar wees. Probleme met interpersoonlike en organisatoriese aspekte van dienslewering is geidentifiseer as die twee belangrikste aspekte wat toeganklikheid van kliniekdienste en daarom ook toeganklikheid van voedingsverbandhoudende boodskappe beinvloed. Die laaste fase van die studie (Fase 3) het die formulering van aanbevelings aan die relevante owerhede behels Die aa.nbevelings handel oor die insluiting van toepaslike voedingsverbandhoudende boodskappe by die gesondheidsonderrig van ma's en swanger vroue sowel as aanbevelings oor die optimalisering van toeganklikheid van dienste by die PGS klinieke en die kraamafdeling waar Duncan Village rna's geboorte gee. Vyftien aanbevelings gebaseer op die bevindinge van Fases I en 2 is geformuleer . Die aanbevelings fokus veral op die nocdsaaklikheid vir die plaaslike owerheid om 'n atmosfeer van gesondheidbemagtiging by die klinieke te skep, die nodigheid om toepaslike voedingsverbandhoudende boodskappe by die klinieke te verskaf en die belangrikheid daa.rvan om kwesbare rna's te bereik. Die noodsaaklikheid om die gemeenskap te betrek in hierdie prosesse is ook benadruk. Samevattend kan gese word dat die implementasie van die aanbevelings sal bydra tot die voedingswelstand van alle jong kinders in Duncan Village en dat dit 'n belangrike bydrae kan lewer tot die realisering van die regte van kinders in die area.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/50047
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