Browsing by Author "Delobelle, Peter"

Now showing 1 - 11 of 11
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    Determinants of dietary patterns in school going adolescents in Urban Zambia
    (Frontiers Media, 2022) Mukanu, Mulenga Mary; Delobelle, Peter; Thow, Anne Marie
    Understanding dietary patterns in a population is critical for decision making. This study aimed to identify the prevailing dietary patterns and their associated individual and school environment factors among school going adolescents in Lusaka, Zambia. Method: A cross-sectional study involving 404 Grade 10 pupils from 10 secondary schools in Lusaka district was conducted. A 108-item unquantified Food Frequency Questionnaire (FFQ) was used to assess the learner's food intake practices.
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    Diet-related non-communicable diseases in South Africa: determinants and policy responses
    (Health Systems Trust (HST), 2016) Spires, Mark; Delobelle, Peter; Sanders, David; Puoane, Thandi; Hoelzel, Philipp; Swart, Rina
    Non-communicable diseases (NCDs) are the leading cause of death globally and they are on the rise both in low- and middle-income countries, with South Africa being no exception. Implicated in this upward trend in the country is an observed change in diet - a transition from traditional foods, to what has come to be known as the 'western' diet, i.e. more energy-dense, processed foods, more foods of animal origin, and more added sugar, salt and fat. Increasingly, international research links rapidly changing food environment with escalating chronic disease, i.e. it implicates population-level dietary change over individual factors such as knowledge, attitudes and behaviours. Environmental and/or policy interventions can be some of the most effective strategies for creating healthier food environments. This chapter explores the link between the rise in diet-related NCDs, their proximal determinants (specifically an observed change in diet patterns), contributing environmental factors, what is currently being done or recommended to address this internationally, and the most relevant national-level policies for South Africa. The authors conclude that to improve dietary patterns and reduce chronic diseases in South Africa will require a sustained public health effort that addresses environmental factors and the conditions in which people live and make choices. Overall, positive policies have been made at national level; however, many initiatives have suffered from a lack of concerted action. Key actions will be to reduce the intake of unhealthy foods and make healthy foods more available, affordable and acceptable in South Africa.
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    Expanding the prevention armamentarium portfolio: A framework for promoting HIV-conversant communities within a complex, adaptive epidemiological landscape
    (Taylor and Francis Group, 2015) Burman, Christopher J.; Aphane, Marota; Delobelle, Peter
    The article describes a design journey that culminated in an HIV-Conversant Community Framework that is now being piloted in the Limpopo Province of South Africa. The objective of the initiative is to reduce the aggregate community viral load by building capacity at multiple scales that strengthens peoples’ HIV-related navigational skill sets—while simultaneously opening a ‘chronic situation’ schema. The framework design is based upon a transdisciplinary methodological combination that synthesises ideas and constructs from complexity science and the management sciences as a vehicle through which to re-conceptualise HIV prevention. This resulted in a prototype that included the following constructs: managing HIV-prevention in a complex, adaptive epidemiological landscape; problematising and increasing the scope of the HIV knowledge armamentarium through education that focuses on the viral load and Langerhans cells; disruptive innovation and safe-fail probes followed by the facilitation of path creations and pattern management implementation techniques. These constructs are underpinned by a ‘middle-ground’ prevention approach which is designed to bridge the prevention ‘fault line’, enabling a multi-ontology conceptualisation of the challenge to be developed.
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    Improving self-management for Type 2 diabetes and hypertension patients in Peri-urban townships in the Western Cape, South Africa
    (University of the Western Cape, 2022) Masupe, Tiny Kelebogile; Delobelle, Peter
    The rising burden of Type 2 diabetes mellitus (T2D) and hypertension (HTN) and the impact of non-communicable diseases (NCDs) in general on weak public health systems in low- and middle-income countries (LMICs) require innovative approaches for disease prevention and management. T2D and HTN are major preventable NCDs through early risk factor detection. Once diagnosed with these conditions, patients’ monitoring and control is done to reduce the occurrence of disease complications. We hypothesized that optimized contextual patient self-management plays a critical role in risk factor control, disease management and prevention of complications.
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    Motivational determinants of physical activity in disadvantaged populations with (pre)diabetes: A cross-cultural comparison
    (Research Square, 2021) De Man, Jeroen; Kasujja, Francis Xavier; Delobelle, Peter
    Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model across samples from diverse populations with, or at risk of diabetes.Measurement invariance of barrier identified regulation, barrier self-efficacy and social support was assessed in a rural Ugandan sample (n=712) and disadvantaged samples with high proportions of immigrants in urban South Africa (n=566) and Sweden (n=147). These motivational determinants were then compared through multigroup structural equation modeling.
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    Reducing the role of the food, tobacco, and alcohol industries in non-communicable disease risk in South Africa
    (SAGE Publications, 2016) Delobelle, Peter; Sanders, David; Puoane, Thandi
    Noncommunicable diseases (NCDs) impose a growing burden on the health, economy, and development of South Africa. According to the World Health Organization, four risk factors, tobacco use, alcohol consumption, unhealthy diets, and physical inactivity, account for a significant proportion of major NCDs. We analyze the role of tobacco, alcohol, and food corporations in promoting NCD risk and unhealthy lifestyles in South Africa and in exacerbating inequities in NCD distribution among populations. Through their business practices such as product design, marketing, retail distribution, and pricing and their business practices such as lobbying, public relations, philanthropy, and sponsored research, national and transnational corporations in South Africa shape the social and physical environments that structure opportunities for NCD risk behavior. Since the election of a democratic government in 1994, the South African government and civil society groups have used regulation, public education, health services, and community mobilization to modify corporate practices that increase NCD risk. By expanding the practice of health education to include activities that seek to modify the practices of corporations as well as individuals, South Africa can reduce the growing burden of NCDs.
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    School food environment in urban Zambia: A qualitative analysis of drivers of adolescent food choices and their policy implications
    (MDPI, 2022) Mukanu, Mulenga Mary; Thow, Anne Marie; Delobelle, Peter
    Identifying context specific points for reforming policy to promote healthier food environments and consumer behavior in critical life stages like adolescence is crucial in addressing the double burden of malnutrition. Using a qualitative study design, we conducted 20 focus group discussions with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into two domains—the external domain (availability, pricing, vendor and product properties, and marketing and regulation of food) and the internal domain (accessibility, affordability, convenience, and desirability of food)—was used to guide thematic data analysis and results interpretation. Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers.
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    Study protocol for the SMART2D adaptive implementation trial: a cluster randomised trial comparing facility-only care with integrated facility and community care to improve type 2 diabetes outcomes in Uganda, South Africa and Sweden
    (BMJ Publishing Group, 2018) Guwatudde, David; Absetz, Pilvikki; Delobelle, Peter; Östenson, Claes-Göran; Sanders, David; Puoane, Thandi
    INTRODUCTION Type 2 diabetes (T2D) is increasingly contributing to the global burden of disease. Health systems in most parts of the world are struggling to diagnose and manage T2D, especially in low-income and middle-income countries, and among disadvantaged populations in high-income countries. The aim of this study is to determine the added benefit of community interventions onto health facility interventions, towards glycaemic control among persons with diabetes, and towards reduction in plasma glucose among persons with prediabetes. METHODS AND ANALYSIS An adaptive implementation cluster randomised trial is being implemented in two rural districts in Uganda with three clusters per study arm, in an urban township in South Africa with one cluster per study arm, and in socially disadvantaged suburbs in Stockholm, Sweden with one cluster per study arm. Clusters are communities within the catchment areas of participating primary healthcare facilities. There are two study arms comprising a facility plus community interventions arm and a facility-only interventions arm. Uganda has a third arm comprising usual care. Intervention strategies focus on organisation of care, linkage between health facility and the community, and strengthening patient role in selfmanagement, community mobilisation and a supportive environment. Among T2D participants, the primary outcome is controlled plasma glucose; whereas among prediabetes participants the primary outcome is reduction in plasma glucose. ETHICS AND DISSEMINATION The study has received approval in Uganda from the Higher Degrees, Research and Ethics Committee of Makerere University School of Public Health and from the Uganda National Council for Science and Technology; in South Africa from the Biomedical Science Research Ethics Committee of the University of the Western Cape; and in Sweden from the Regional Ethical Board in Stockholm. Findings will be disseminated through peer-reviewed publications and scientific meetings. Trial registration number ISRCTN11913581; Pre-results.
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    Testing a self-determination theory model of healthy eating in a South African township
    (Frontiers Media S.A., 2020) De Man, Jeroen; Wouters, Edwin; Delobelle, Peter; Puoane, Thandi; Daivadanam, Meena; Absetz, Pilvikki; Remmen, Roy; van Olmen, Josefien
    Type 2 diabetes (T2D) is one of the leading causes of death and disability, and its prevalence has been growing rapidly in sub-Saharan Africa (International Diabetes Federation, 2017). In response to this T2D pandemic, engaging in healthy lifestyle activities such as healthy eating, can substantially reduce the risk of T2D onset and complications (International Diabetes Federation, 2017). However, maintaining a healthy diet has been shown challenging and motivation is believed to be a crucial factor, also because the benefits are often not immediately apparent (Kwasnicka et al., 2019).
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    Understanding key drivers of performance in the provision of maternal health services in eastern cape, South Africa: a systems analysis using group model building
    (BMC, 2018) Lembani, Martina; de Pinho, Helen; Delobelle, Peter
    Background: The Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented understanding among stakeholders, a study was conducted in one of the chronically poorly performing districts. Methods: The study used a systems analysis approach to understand the drivers and outcomes affecting maternal health in the district in order to identify key leverage points for addressing the situation. The approach included semistructured interviews with a total of 24 individuals consisting health system managers at various levels, health facility staff and patients. This was followed by a participatory group model building exercise with 23 key stakeholders to analyze system factors and their interrelationships affecting maternal health in the district using rich pictures and interrelationship diagraphs (IRDs) and finally the development of causal loop diagrams (CLDs). Results: The stakeholders were able to unpack the complex ways in which factors were interrelated in contributing to poor maternal health performance and identified the feedback loops which resulted in the situation being intractable, suggesting strategies for sustainable improvement. Quality of leadership was shown to have a pervasive influence on overall system performance by linking to numerous factors and feedback loops, including staff motivation and capacity building. Staff motivation was linked to quality of care in turn influencing patient attendance and feeding back into staff motivation through its impact on workload. Without attention to workload, patient waiting times and satisfaction, the impact of improved leadership and staff support on staff competence and attitudes would be diminished. Conclusion: Understanding the complex interrelationships of factors in the health system is key to identifying workable solutions especially in the context of chronic health systems challenges. Systems modelling using group model building methods can be an efficient means of supporting stakeholders to recognize valuable resources within the context of a dysfunctional system to strengthen systems performance.
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    User assessments and the use of information from MomConnect, a mobile phone text-based information service, by pregnant women and new mothers in South Africa
    (BMJ Publishing Group, 2018) Skinner, Donald; Delobelle, Peter; Pappin, Michele; Pieterse, Desiree; Esterhuizen, Tonya Marianne; Barron, Peter; Dudley, Lilian
    MomConnect was designed to provide crucial health information to mothers during pregnancy and in the early years of child rearing in South Africa. The design drew on the success of the Mobile Alliance for Maternal Action’s programme in South Africa, as well as a growing list of mobile health (mHealth) interventions implemented internationally. Services such as MomConnect are dependent on user acceptability as all engagements are voluntary, meaning that tools have to be easy to use and useful to be successful. This paper describes the evaluation of the tool by pregnant women and new mothers using the tool. A purposive sample of 32 individual semistructured interviews and 7 focus groups were conducted, across five provinces in South Africa. All the sessions were transcribed and then analysed using a contextualised interpretative approach, with the assistance of Atlas. ti. The women were consistently positive about MomConnect, attaching high value to the content of the messages and the medium in which they were delivered. The system was found to work well, with minor problems in some language translations. Respondents were enthusiastic about the messages, stating that the information was of great use and made them feel empowered in their role as a mother, with some saving the messages to use as a resource or to share with others. The most significant problems related to network coverage. There was strong support for this intervention to continue. Given the user acceptability of mHealth interventions, MomConnect appeared to meet the target of identifying and responding to the recipient’s needs.