title: Qualitative evaluation of a physical activity-based chronic disease prevention program in a low-income, rural South African setting.
abstract: BACKGROUND
  Chronic diseases, an increasing global concern, are prevalent in the low-income communities of South Africa, where rural health systems bear the double burden of infectious and chronic diseases. The Discovery Healthy Lifestyle Programme (DHLP) is a physical activity-based chronic disease prevention program that has been implemented in a low-income, rural setting in South Africa. The DHLP consists of both school- and primary healthcare clinic-based interventions for learners (Healthnutz) and adults (Live it Up), facilitated by teachers, nurses and community volunteers. The aim of this evaluation was to qualitatively assess the process by which the DHLP was implemented, identifying enabling factors and barriers.
  
  
  METHODS
  Data were collected in target communities at schools and clinics from semi-structured focus groups of program leaders and members, teachers and community members (n = 45), situational analyses of the school physical activity environment, informal community observations and informal interviews with program coordinators.
  
  
  RESULTS
  The target communities faced socioeconomic and health inequalities and remained under-resourced and under-served. In spite of these and other challenges, the DHLP was well received by community members and stakeholders. It was valued by respondents for its health and psychosocial outcomes, evidenced by increased knowledge and awareness of the importance of physical activity and healthy lifestyles, and positively altered perceptions of physical activity. Program implementers believed the Live it Up component was growing, and this suggested the sustainability of the program. There were, however, some concerns about the fidelity of the Healthnutz intervention, due to timetabling difficulties. Despite this, teachers were positive about the program and its value for their learners, staff and school. The community characteristics of being under-resourced and under-served appeared to positively influence DHLP implementation. Local government involvement in the DHLP resulted in greater ownership of the program, which enabled successful implementation.
  
  
  CONCLUSIONS
  This study presents a unique opportunity to assess the implementation and sustainability requirements of programs in environments of limited resources, considerable burden of infectious and chronic diseases and extensive socioeconomic challenges. The findings suggest that through enhancement of knowledge, transfer of appropriate skills and the provision of an enabling environment, participation in physical activity can be effectively promoted in a low-income, rural setting. Physical activity interventions that promote the participation and empowerment of rural communities can be feasible and accessible, thereby assisting in addressing the growing burden of chronic diseases in low-income.
authors.affiliation: UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa. catherine.draper@uct.ac.za
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Draper
authors.forename: Simon M
authors.initials: SM
authors.lastname: Nemutandani
authors.forename: Anna T
authors.initials: AT
authors.lastname: Grimsrud
authors.forename: Michael
authors.initials: M
authors.lastname: Rudolph
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Kolbe-Alexander
authors.forename: Lauren
authors.initials: L
authors.lastname: de Kock
authors.forename: Estelle V
authors.initials: EV
authors.lastname: Lambert
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control*; D015444:Exercise; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration*; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008019:Life Style; D011203:Poverty; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D012574:Schools / Q000458:organization & administration; D013019:South Africa