Dr Paula Griffiths, Centre for Global Health and Human Development, Loughborough University and Dr Rebecca Pradeilles, School of Health and Related Research, University of Sheffield, discuss a new study conducted in adolescents in the area of Johannesburg- Soweto, South Africa. The study highlights that faith-based organisations could play a role in preventing adolescents becoming overweight or obese, and act as a leverage point for interventions.
The need for obesity prevention interventions
South Africa has one of the highest prevalences of overweight and obesity in Sub-Saharan Africa. The 2012 South African National Health and Nutrition Examination Survey showed that 30.7% of adult men and 64.0% of women are overweight or obese. In adolescents aged 15-17 years, the prevalence of overweight and obesity is lower but not negligible with 8.8% of males and 27.3% of females being either overweight or obese. In terms of future health and wellbeing, it is vital to find ways to address these issues of chronic disease in adolescence, which may track into adulthood. Our previous qualitative work conducted with adolescents in the South African urban context identified the Church as being an important part of an adolescent’s community, and we have now assessed the role that these social contexts might play in tackling issues of overweight and obesity in adolescents.
The aim of our pilot study was to explore the potential for faith based organisations to act as community-based organisations for adolescent overweight and obesity prevention interventions. We did this by assessing the readiness of religious leaders to engage in such interventions in the Johannesburg Soweto area of South Africa.
We conducted six focus group discussions (FGDs) in six churches between November 2012 and January 2013 with male and female religious leaders including pastors, bishops, teachers, and elders, recruited from Christian religious organisations. Open-ended questions used in the FGDs addressed perceived determinants of obesity, and the role of the Church in adolescents’ health.
We also asked participants to complete a survey designed to assess community readiness (i.e. the degree to which a community is prepared to take action on an issue) for intervention known as the Community Readiness Model (CRM) whose development was led by researchers at the Tri-Ethnic Center for Prevention Research in Colorado State University. The survey assessed six different dimensions of readiness:
– Community efforts (i.e. programmes and policies in place that address the issue)
– Knowledge of efforts (i.e. the extent to which community members know about local efforts and effectiveness)
– Leadership (i.e. the extent to which appointed leaders and influential community members are supportive of the issue)
– Community climate (i.e. the prevailing attitude of the community towards the issue)
– Knowledge of the issue (i.e. the extent to which community members know about the causes and consequences of the issue)
– Resources (i.e. the extent to which people, time, money and space are available to support efforts).
The mean readiness score was 2.67 on a scale of 1-9 which corresponds to the “denial/resistance stage” and is reached when “at least some community members recognise that the issue is a concern, but there is little recognition that it might be occurring locally”. This finding highlights the need to increase the awareness of the adolescent obesity issue in faith-based organisations. The low score can be explained by the fact that religious leaders recognised overweight or obesity as a problem among adults and in the wider population, but did not view it as a concern among adolescents in their congregation. Furthermore, in the FGDs adolescents were described as experiencing various problems in their daily lives (social and health issues) that have greater priority.
“In our Church, we have challenges like adolescents being raped, physically abused, homeless and poverty stricken, and obesity has in a way been shoved low on the list of priorities relatively.”
Female leader, Evangelical Church, Johannesburg suburb
Despite the readiness score being low, a strong sense of responsibility towards adolescents’ health and well-being in general was apparent. Participants in our study felt that faith-based organisations were a good context for intervention delivery in this setting. Indeed, community leaders were enthusiastic and recognised that they were perceived as role models within the community and thus could play an important role in improving children and adolescent’s health.
“We are responsible for the well-being of the young people that attend at this Church, their health is part of our responsibility towards them (…).
Male leader, Methodist Church, Johannesburg
The youth leaders (youth pastor, youth coach, etc.) were recognised as the most influential people working with adolescent members of the congregation. Furthermore, religious leaders also recognised that their role was not limited solely to spiritual guidance and mentoring, but also to physical well-being.
“The Church plays a very important role in this regard as it has always been a central meeting place for people of different backgrounds coming together for one agenda. The Church is responsible for uplifting and informing people spiritually and otherwise. “
Female leader, Roman Catholic Church, Soweto
Religious leaders mentioned that the scriptures could be used to develop health messages and felt that this was part of their remit. This resource was seen as valuable when teaching adolescents about healthy lifestyles as “adolescents pay more attention when there is biblical backing on a principle” (Male leader, Pentecostal Church, Johannesburg).
“The word of God actually guides us to take care of our bodies.”
Male leader, Pentecostal Church, Johannesburg
“Over and above the mention of your body being a temple, the bible makes reference to gluttony. It condemns over eating and gives a stern warning that we shouldn’t make the stomach our God. We are encouraged to eat to live rather than to live to eat.”
Female leader, Methodist Church, Johannesburg
Religious leaders were also shown to be knowledgeable with regard to the causes and consequences of the obesity issue and highlighted that they could develop the necessary resources (human or physical) to implement obesity prevention interventions.
Given the high prevalence of overweight and obesity in adults in South Africa, there is an urgent need for interventions to be implemented to prevent overweight and obesity in adolescents as this group will become the next generation of adults.
This study highlighted that religious leaders in the Church setting could be used as a leverage point in addressing overweight and obesity prevention in adolescents living in urban South Africa. Religious leaders recognised that they act as role models within the community and thus have a role to play in improving adolescent health. Future obesity prevention interventions could potentially be implemented by youth leaders given their influence. Religious leaders have some knowledge about the overweight/obesity issue and some of the resources could be made available to support overweight/obesity prevention-related initiatives. However, the low community knowledge of efforts and the negative prevailing attitude of the community towards overweight and obesity highlight the need to increase awareness of this issue prior to implementing initiatives on overweight and obesity prevention. Overall, this study showed that despite the readiness level being low, the community is ready to move forward with the obesity prevention agenda in adolescents. The first actions should aim to increase the awareness of the obesity issue amongst religious leaders and there should be a re-evaluation of the CRM stage after such an intervention.
The next steps
In the coming months, we are planning on extending the work we started on adolescent overweight and obesity prevention interventions. So far, we have conducted focus group discussions with religious leaders to assess their readiness and willingness to engage in adolescent overweight and obesity prevention initiatives. We are now planning on capturing other key stakeholders’ views (i.e. adolescents; youth agencies; government bodies) on the implementation of overweight and obesity prevention interventions via faith-based organisations in this setting. This would provide us with a wide range of views from different stakeholders involved in addressing the overweight and obesity issue and will help us gaining insight into developing and piloting intervention materials targeted at preventing overweight and obesity in urban South African adolescents. This proposed research will will be useful for developing a grant proposal for obesity prevention interventions.
We presented these findings in a recent joint publication submitted to the journal of BMC Public Health. More information can be found here.