Exploring the obesogenic environment and behaviour in adolescents : a qualitative study, in the Cape Town Metropole of the Western Cape

Berry, Laura Jayne (2019-04)

Thesis (MNutr)--Stellenbosch University, 2019.

Thesis

ENGLISH SUMMARY : Background: Obesity is now seen as a global pandemic in adults and children. There are many factors that are understood to have an impact on the obesogenic environment for adolescents including those that affect physical activity and nutrition at different levels of the socio-ecological model. However, much more needs to be understood about this complex phenomenon, to tailor programmes for adolescent health needs and address the growing SA adolescent obesity problem. Aim: The aim of this study was to perform an assessment of school nutrition policies and programmes in the context of the Integrated School Health Policy (ISHP) and in relation to adolescents and the obesogenic environment in urban areas of the City of Cape Town. This was done by engaging with stakeholders and learners through a participatory approach to identify opportunities for having an impact on obesogenic behaviour. Method: This was a qualitative study that made use of focus-group discussions (FGDs) for school learners and individual in-depth interviews (IDIs) for members of the school health team to engage with relevant stakeholders. Seven schools took part in the study. Fourteen FGDs and twenty-one IDIs were held. A boy and girl FGD of 8−12 participants was held at each school. Participants for the IDIs were purposively selected from members of the school health team including: principals, life orientation (LO) teachers, parent-teacher association (PTA) representatives, counsellors and food service managers. The data was audio recorded and transcribed using a transcription service. The raw data was analysed using the qualitative software package Atlas.ti 8. Content analysis was performed and the ‘thematic analysis’ approach was employed to interpret the data. Results: There are many factors that affect the obesogenic environment for urban SA adolescents from Cape Town. The main physical-activity barriers include: intrapersonal factors (feeling lazy, not enough time, low self-esteem and not enjoying the feeling of exercise); interpersonal factors (lack of role models, lack of parental support and not wanting to be a nuisance to parents); environmental factors in the school (lack of resources including school sport facilities and sports equipment); and community safety (gang-related crime). Physical-activity enablers include: intrapersonal (enjoying the feeling of exercise and finding it fun); interpersonal (team spirit and camaraderie); and environmental factors (school sport facilities and equipment; community fun walk/runs). The main barriers to healthy eating include: intrapersonal (taste preferences, knowledge and psychological); interpersonal (working parents); and environmental aspects, such as easily available (tuck shops, fence vendors, fast-food outlets) and accessible (cheap) unhealthy junk food, together with the limited availability (fewer items in tuck shop) and inaccessibility (more expensive) of healthy food. Opportunities for heathy eating include: intrapersonal (taste enjoyment of healthy foods), together with limited environmental factors (provision of healthy foods by home, feeding schemes and some tuck shops). Further to these findings, there appear to be several gaps in the implementation of the ISHP within the school environment, particularly with regards to nutrition policy awareness/knowledge, implementation, monitoring and collaboration. Conclusion: Findings from this study highlight several obesogenic barriers and enablers having an impact on adolescent physical-activity levels and nutrition. The main factors that emerged are at the environmental (school and community) level, including food security and accessibility of physical activity. The results of this study should be shared with the Departments of Health and Education as a matter of urgency. Further research is needed to identify the best ways to overcome the identified barriers and use the enablers to curb the growing problem of obesity.

AFRIKAANSE OPSOMMING : Agtergrond: Vetsug word tans beskou as ‘n globale pandemie in volwassenes en kinders, met die hoogste vlak in Suid-Afrikaanse adolessente ooit. Daar is talle faktore wat bydra tot die impak op die vetsug-omgewing vir adolessente wat weer bydra tot die invloed op fisiese aktiwiteite en voeding op verskillende vlakke in die sosiaal-ekologiese model. Daar is egter veel meer om te verstaan oor hierdie komplekse verskynsel met die oog daarop om die groeiende vetsug probleem onder Suid-Afrikaanse adolessente aan te spreek en programme aan te pas vir adolessente se gesondheidsbehoeftes. Doel: Die doel van die studie was om die skool se beleide en programme ten opsigte van voeding in die konteks van die Geïntegreerde Skool Gesondheidbeleid (GSBG) te assesseer teenoor vetsug in adolessente in die stedelike gebiede in Kaapstad. Die studie is gedoen deur belanghebbendes en leerders te betrek in ‘n deelnemende benadering om sodoende geleenthede te identifiseer om ‘n impak op vetsug gedrag te maak. Metode: Die kwalitatiewe studie het gebruik gemaak van fokusgroepbesprekings (FGB) vir skoolleerders asook individuele in-diepte onderhoude (IDO) met lede van die skool se gesondheidspan om sodoende die deelnemende belanghebbendes te betrek. Sewe skole het deel uitgemaak van die studie. Veertien FGBs en een-en-twintig IDOs was gehou. ʼn Seuns en meisies FGB met agt tot 12 deelnemers was gehou by elke skool. Deelnemers vir die IDO’s was doelbewus geselekteer van die skool se gesondheidsgroep wat insluit: skoolhoofde, lewensoriëntering onderwysers (LO), verteenwoordigers van die ouer-onderwysersvereniging, beraders en voedseldiensbestuurders. Oudio-opnames is getranskribeer met die hulp van ʼn transkripsiediens. Die rou data was geanaliseer met die gebruik van die kwalitatiewe sagteware program ‘Atlas.ti 8’. Inhoudsanalise was uitgevoer en die ‘tematiese analise’ benadering was toegepas om die data te interpreteer. Resultate: Daar is vele faktore wat ʼn rol speel in die impak van vetsug onder adolessente in stedelike gebiede in Kaapstad. Van die hoof fisiese hindernisse sluit in: intrapersoonlike - (om lui te voel, nie genoeg tyd nie, lae selfbeeld en om nie die gevoel van oefeninge te geniet nie), interpersoonlike - (gebrek aan rol modelle, gebrek aan ondersteuning van ouers en om nie ʼn oorlas te wees vir ouers nie), en omgewings-faktore in die skool en die gemeenskap (gebrek aan hulpbronne, insluitende skool fasiliteite en sporttoerusting asook bende-verwante misdade). Fisiese aktiwiteite se bydrae sluit in: intrapersoonlike - (geniet die gevoel van oefeninge), interpersoonlike - (spangees en kameraadskap) en omgewings-faktore (skool sport fasiliteite en toerusting; gemeenskapspretlope/wedrenne). Die hoof struikelblokke tot gesond eet sluit in: intrapersoonlike - (smaak voorkeur, kennis en sielkundige aspekte), interpersoonlike - (werkende ouers) en omgewingsaspekte soos maklike beskikbaarheid (snoepie, straatsmouse, kitskos afset punte) en toeganklikheid (goedkoop) van ongesonde gemorskos tesame met die beperkte beskikbaarheid (minder items in die snoepie) en ontoeganklikheid (duurder) van gesondheidskosse. Geleenthede vir gesond eet sluit in: intrapersoonlike - (geniet die smaak van gesonde kos) saam met beperkte gemeenskapsfaktore (voorsiening van gesonde kos by die huis, voedingsprogramme en sommige snoepies). By verdere ondersoek blyk dit dat daar vele gapings in die implementering van die GSGB in die skoolsomgewing is, met spesifieke verwysing na beleide, bewustheid/kennis, implementering, monitering en samewerking vir voeding. Gevolgtrekking: Bevindings in hierdie studie het vele struikelblokke en hulpmiddels wat ʼn impak het op adolessente se fisiese aktiwiteite en voeding in die konteks van vetsug, uitgewys. Die hoof faktore wat na vore gekom het, is die omgewing (skool en gemeenskaps-vlak), insluitende voedselsekuriteit en toeganklikheid tot fisiese aktiwiteite. Die uitslag van hierdie studie sal gedeel word met die Departemente van Gesondheid en Onderwys as ʼn saak van dringendheid. Verdere studies is noodsaaklik om die beste roete te identifiseer om hierdie struikelblokke te identifiseer en om die hulpbronne te gebruik om die groeiende vetsug probleem te bekamp.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/105711
This item appears in the following collections: