Development and implementation of a nutrition education programme for primary school teachers in Bronkhorstspruit Gauteng Province South Africa

Abstract

Introduction: Nutrition education (NE) is one of the most enduring, effective and economic interventions to fight malnutrition and food-related diseases through the impartation of nutrition knowledge and skills on healthy eating. The school remains a viable platform for NE with teachers playing significant roles. Aim: To develop and implement a Nutrition Education Programme (NEP) for primary school teachers in order to improve teachers skills to teach nutrition effectively. Setting and population: The study setting was the Bronkhorstspruit district, east of Pretoria, involving eleven primary schools. The study population was teachers who taught nutrition to learners in Grades 4 to 7 and learners in Grades 5 and 6. Methodology: The study was an intervention, comprising qualitative and quantitative research methodology in three phases. In the needs assessment (phase 1), qualitative and quantitative data on the nutrition knowledge, attitudes and dietary practices (KAP) of teachers and learners were obtained. The findings of phase 1, in conjunction with selected constructs of the Social cognitive theory (SCT) and the Meaningful learning model (MLM), the existing curriculum of the Department of Basic Education (DoBE) were used to develop a contextual NEP with supporting materials for teaching nutrition topics to Grade 5 and 6 learners (phase 2). In phase 3, the NEP was implemented in two of the eleven schools, allocated as the treatment and control schools. The NE materials were used by the teachers in the treatment school to teach nutrition to Grade 5 and 6 learners; while in the control school, the teachers taught nutrition in the usual manner. The implementation stretched over eight months and was assessed through a process evaluation with the teachers. The impact of the NEP on the teaching of nutrition and on the nutrition KAP of the teachers and the learners were assessed. The thematic framework approach was used to analyse the qualitative data. The quantitative data were analysed with descriptive and inferential statistics. An analysis of variance (ANOVA) was done with adjustment for pre-implementation scores to test the changes between schools in nutrition KAP from pre- to post-implementation. A random effects Generalised Least Squares (GLS) was used to compare overall change between the schools from pre- to post-implementation and to estimate within school differences in nutrition KAP from pre- to post-implementation. The level of significance to test the hypotheses was set at 0.025 for a one-tailed test. The NEP consisted of the developed NE materials comprising the teacher s manual, the picture book, posters, learner s work book; the implementation of the NEP to the teachers and the learners; and the evaluation of the impact of the NEP. Results: The needs assessment (phase 1) revealed that the mean nutrition knowledge and mean nutrition attitudes scores for the teachers were good albeit with deficits in certain nutrition topics and in the method of teaching nutrition. There was an unavailability of up to date instructional materials, lack of in-service nutrition training for the teachers and limited time for teaching nutrition. The mean nutrition knowledge (58.8 ± 23.9%) and mean nutrition attitudes (58.4 ± 18.6%) for the learners were low and needed to improve. The impact of the NEP (phase 3): Twenty teachers and 644 learners completed the post-implementation assessment. Results indicated a significantly higher mean score (85.5 ± 8.2% versus 73.4 ± 10.3%, P = 0.003) in the total nutrition knowledge of the treatment school teachers compared with the control school. There was a non-significant higher mean score (84.2 ± 16.4% versus 75.8 ± 17.3%, P = 0.531) in dietary attitudes of the treatment school teachers compared with the control school. The teachers in the treatment school showed no significant improvement in the mean scores on any of the categories of dietary practices compared with the control school. However, the personal dietary practices of the teachers in both schools revealed improvement in healthy eating practices, and their views regarding school wide food practices were in support of healthy eating. The teachers reported satisfaction with the use of the NE manual as well as their improved skills to teach nutrition and would like to continue to use the manual to teach nutrition. However, time constraint was a major challenge in the implementation fidelity of the NEP by the teachers. Regarding the learners assessment, there was a significant higher mean score in the total nutrition knowledge (53.2 ± 16.9% versus 53.1 ± 17.6%, P = 0.001) and a significant higher mean score (63.9 ± 19.7% versus 56.8 ± 19.6%, P = 0.002) in nutrition attitudes in the treatment school compared with the control school. The dietary practices of the learners in the treatment school showed a non-significant lower mean score (60.0 ± 19.7% versus 62.2 ± 16.8%, P = 0.24) compared with the control school. Conclusion: Implementing a theory based context specific NEP in line with the existing school curriculum holds the potential for programme sustainability as the teachers implemented the programme. In this way, the aim of the DoBE at enabling the learners to benefit their lives with their knowledge could be realised. The NEP enhanced the teachers skills in teaching nutrition and improved the teachers and the learners , nutrition knowledge and attitudes. The findings emphasise the value of a contextualised NEP consisting of theory based NE materials for primary schools as recommended in the literature.