title: Implementation of the HealthKick intervention in primary schools in low-income settings in the Western Cape Province, South Africa: a process evaluation.
abstract: BACKGROUND
  The HealthKick intervention, introduced at eight primary schools in low-income settings in the Western Cape Province, South Africa, aimed to promote healthy lifestyles among learners, their families and school staff. Eight schools from similar settings without any active intervention served as controls.
  
  
  METHODS
  The Action Planning Process (APP) guided school staff through a process that enabled them to assess areas for action; identify specific priorities; and set their own goals regarding nutrition and physical activity at their schools. Educators were introduced to the APP and trained to undertake this at their schools by holding workshops. Four action areas were covered, which included the school nutrition environment; physical activity and sport environment; staff health; and chronic disease and diabetes awareness. Intervention schools also received a toolkit comprising an educator's manual containing planning guides, printed resource materials and a container with physical activity equipment. To facilitate the APP, a champion was identified at each school to drive the APP and liaise with the project team. Over the three-years a record was kept of activities planned and those accomplished. At the end of the intervention, focus group discussions were held with school staff at each school to capture perceptions about the APP and intervention activities.
  
  
  RESULTS
  Overall uptake of events offered by the research team was 65.6% in 2009, 75% in 2010 and 62.5% in 2011. Over the three-year intervention, the school food and nutrition environment action area scored the highest, with 55.5% of planned actions being undertaken. In the chronic disease and diabetes awareness area 54.2% actions were completed, while in the school physical activity and sport environment and staff health activity areas 25.9 and 20% were completed respectively. According to educators, the low level of implementation of APP activities was because of a lack of parental involvement, time and available resources, poor physical environment at schools and socio-economic considerations.
  
  
  CONCLUSIONS
  The implementation of the HealthKick intervention was not as successful as anticipated. Actions required for future interventions include increased parental involvement, greater support from the Department of Basic Education and assurance of sufficient motivation and 'buy-in' from schools.
authors: Non-communicable Diseases Research Unit (NCDRU), South African Medical Research Council (SAMRC), Francie van Zijl Drive, Tygerberg, 7505, South Africa. anniza.devilliers@mrc.ac.za.
authors: Anniza
authors: A
authors: de Villiers
authors: Division of Human Nutrition, University of Cape Town Medical Campus, Anzio Road, Observatory, 7925, South Africa. nelia.steyn@uct.ac.za.
authors: Nelia P
authors: NP
authors: Steyn
authors: Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, PO Box 115, Newlands, 7725, South Africa. catherine.draper@uct.ac.za.
authors: Catherine E
authors: CE
authors: Draper
authors: Non-communicable Diseases Research Unit (NCDRU), South African Medical Research Council (SAMRC), Francie van Zijl Drive, Tygerberg, 7505, South Africa. jillian.hill@mrc.ac.za.
authors: Jillian
authors: J
authors: Hill
authors: Division of Human Nutrition, University of Cape Town Medical Campus, Anzio Road, Observatory, 7925, South Africa. luc1_za@yahoo.com.
authors: Lucinda
authors: L
authors: Dalais
authors: Non-communicable Diseases Research Unit (NCDRU), South African Medical Research Council (SAMRC), Francie van Zijl Drive, Tygerberg, 7505, South Africa. jean.fourie@mrc.ac.za.
authors: Jean
authors: J
authors: Fourie
authors: Biostatistics Unit, SAMRC, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa. carl.lombard@mrc.ac.za.
authors: Carl
authors: C
authors: Lombard
authors: Western Cape Education Department (WCED), Cape Town, South Africa. Gerhard.barkhuizen@westerncape.gov.za.
authors: Gerhard
authors: G
authors: Barkhuizen
authors: Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, PO Box 115, Newlands, 7725, South Africa. vicki.lambert@uct.ac.za.
authors: Estelle V
authors: EV
authors: Lambert
mesh_terms: D001364:Awareness; D002908:Chronic Disease; D003920:Diabetes Mellitus; D004032:Diet; D015444:Exercise; D005190:Family; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008019:Life Style; D011203:Poverty; D012572:School Health Services / Q000458:organization & administration*; D013019:South Africa; D013177:Sports