The development of a model for nutritional intervention in rural communities in South Africa

Abstract

BACKGROUND This study commenced with a certain rationale in mind, emerging from a personal, felt responsibility, which were further embedded in global declarations by the FAO and the WHO, as well as commitments made during the World Food Summit in 1996 and 2002. Results from the most recent ‘National Food Consumption Survey’ also inspired the study and the intervention. This study has to be viewed against the background of community development, which in a broad sense connotes a process of social learning through participation. Within the context of this study, it means to identify and address felt needs of people within a particular community and to improve their lives for the better. A commonly accepted approach to rural community development was followed, namely to establish programmes, which were referred to in this study as the nutritional intervention. AIM The challenge was to design, implement and evaluate a community-based intervention, specifically with the aim to address nutrition-related problems in a rural community on a commercial farm in South Africa. It was not the intention to strive for external validity (generalise the findings to other rural communities) but to internalise the process of research (specifically Participatory Action Research) within a rural community, contributing to the body of knowledge on the relevance and success of interventions in rural communities within the realms of health and nutrition. This process provided opportunities for the research team to learn more about implementing Participatory Action Research in rural communities, to learn from the community itself and to apply that knowledge into a constructed model for future projects. METHODOLOGY The research study and intervention process were based on a four-phase approach, which included a situation analysis (also called needs assessment), design, implementation and evaluation. Findings from the needs assessment were prioritised and incorporated in the design and implementation of a relevant intervention. Qualitative data-gathering techniques were mainly used which included observations with field notes, group discussions and key informant interviews. Several techniques were deployed during the implementation-phase, of which the personalised, educational support material was considered an important outcome. Principles of evaluative research have been incorporated from the starting point to measure the success of the process as well as the outcomes of the intervention. OUTCOME The value of the study is found in the generic model that was structured as a visual presentation of a nutritional intervention in a rural area. The model was drawn from previously applied models, grounded in this research study and was further enriched with comments from a panel of external evaluators. It can be considered a comprehensive, logic methodological framework, ready for pragmatic testing. It addresses the entire continuum of processes involved in developing valid and reliable interventions for rural communities and should serve as guideline for similar projects in future times. RECOMMENDATIONS During this study certain insights were gained, which centred on the factors that motivated or hindered behavioural change. A list of lessons learned was formulated to guide future projects, which were set in terms of managerial aspects, financial aspects, methodology (instruments and methods) and enabling factors.