Healthier lifestyles through a peer-education and peer-support system: a school-based pilot project in adolescents in Ho Chi Minh City, Vietnam

Lead Research Organisation: Pham Ngoc Thach University of Medicine
Department Name: Community Health

Abstract

Plain summary: Overweight and obesity in junior high school students have been rising sharply over the recent years in Ho Chi Minh City. The obese state is dangerous as it makes the children more prone to a series of diseases including heart and blood problem, diabetes and even some types of cancer. Recent studies found that low physical activity and quite high consumption of fast food and soft drinks were among the main causes. The research team has planned for a program to tackle this problem at junior high schools around the city. The program consists of four weekly education sessions of why and how to choose food & drinks healthily and also how to be more physically active. Additionally, the program includes a school and online support system to help maintain the effort of the students. Both of the education sessions and the support system are run by the star students (peer leaders) to take advantage of the influence between the children themselves. This first small-scale project is for the purpose of checking the acceptance of the students, their teachers and their family members and the possibility of success in school settings for the future larger program in Ho Chi Minh City. This purpose is achieved through the results of interviews and group discussions with the students, the peer leaders, the teachers and the parents.

Technical Summary

Overweight and obesity in junior high school students have been rising sharply in the past decade in Ho Chi Minh City. Obesity in these adolescents increased the risk of metabolic and cardiovascular diseases, diabetes and even some types of cancer later in life. Recent findings from previous local cohort and observations revealed several possible causes including the low level of physical activity and medium to higher consumption of fast food and sugar-sweetened beverages among these students. The research team has planned for an intervention to help students change their lifestyles into healthier and more active ones. This intervention consists of four sessions of nutrition and physical activity education program followed by a school-based and online support system. The innovative focus point in this study is that both education and support system are run and managed by peer leaders of the students themselves who can potentially have more influence among the adolescent community. This initial study is a pilot of intervention with the objectives of assessing the acceptability of the students, their teachers, and their parents and also the feasibility of larger scale intervention in school setting in HCMC. The objectives of this pilot will be measured through qualitative interviews and focus group discussions along and after the intervention.

Planned Impact

This pilot study is a major setup for later full-scale intervention to tackle three issues the low level of physical activity, the increased time spent in sedentary behaviours and high-energy dietary patterns (including fast food and sugar-sweetened beverages) of the junior high school students. At this stage, the research team believes that the people who benefit the most are the students and the peer leaders of the intervention program because they will have the greatest chance to have a more precise understanding of nutrition and physical activity to make a better decision to maintain the healthy life. Their family members including parents and any sisters or brothers living in the same household are also benefited from the child who is attending the intervention school as there is a section of the education program which also encourages the student to spread knowledge and to inspire others to be active. At the school level, teachers will be informed and they will increase the preparedness to help children actively prevent obesity through healthier lifestyles. Also, the Department of Education of Ho Chi Minh City will have another method/approach to engage the child obesity.
 
Description Collaboration between University of Sydney and Pham Ngoc Thach University of Medicine 
Organisation University of Sydney
Country Australia 
Sector Academic/University 
PI Contribution This project brings together a highly qualified and experienced multidisciplinary team from Australia and Vietnam who have strengths in public health and nutritional epidemiology, health social science, human nutrition, adolescent and child malnutrition, peer-led nutrition and health education, biostatistics and health economics. PNT University of Medicine is responsible for implementation of both intervention and evaluation in the field.
Collaborator Contribution University of Sydney leads the process of developing all intervention and evaluation tools, and peer education training. Uni Syd leads the process evaluation. University of Sydney and PNTUM jointly conduct data analysis and dissemination of results.
Impact Engagement with stakeholders was done via Community Participation that included communication with the Department of Education before the start of the capacity building and actual PE activities in schools to increase community support for delivering PE lessons within the school curriculum. We also conducted meetings with the school representatives, including school principals and heads of youth associations, to design and implement activities that introduce the project brand to attract the attention of students, parents and the broader school community. The brand platform formed the foundation for all information materials and messages produced for the project. This platform included a website and student posters of information that enabled the students to connect. A flagship event was a festival held at the school to engage the students through music, games and other interactive activities that carried the project's messages. The results also increased parents' awareness of the benefits of their children engaging in daily physical activity.
Start Year 2017
 
Title A peer-education and peer-support system to promote a healthier lifestyle among adolescents of Ho Chi Minh City 
Description Intervention: The peer education will consist of i) Identifying and training medical students as Peer Educators, who then train selected Year 8 students as Peer Leaders. ii) The Peer Leaders deliver four classes to Year 6 students over a school term, working in small teams and guided by the Peer Leader's Manual. The classes cover healthy eating, movement, lifestyle, and an action project. iii) The year six students decide on actions to promote physical activity and healthy eating, guided by the Peer Leaders and teachers. Peer support comes from Peer Leader-led behaviour reinforcement monitoring and social network support with monitoring by schoolteachers. The home component includes parents meeting on healthy diets and cooking and physical activity to increase their ability to create a supportive environment for healthy lifestyles for their children. 
Type Preventative Intervention - Nutrition and Chemoprevention
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2020
Development Status Closed
Impact The results of this trial provided evidence of the benefits of increasing the number of students engaging in an adequate level of physical activity at school. The HCMC Health and Education Departments could potentially use this information to formulate new approaches to including physical activity and healthy lifestyle courses in the school curriculum. Investigators of the pilot trial conducted formative research in 2015 in two high schools in HCMC that identified diversified perceptions of obesity, diet and physical activity and their relationship with adolescent obesity among students, teachers and parents. The findings indicated a low level of physical activity among the students. This study generated insights to design a culturally appropriate SALSA program to evaluate in HCMC. We used this experience to develop the Peer Education and Peer Support (PEPS) pilot project funded by the MRC-UK. Our pilot project has proved the feasibility of the peer-led intervention at high schools, which allows more insight into the influence of "peers" among adolescents on the change of being active physically and dietary behaviors. This project brings together a highly qualified and experienced multidisciplinary team from Australia and Vietnam with strengths in public health and nutritional epidemiology, health social science, human nutrition, adolescent and child malnutrition, peer-led nutrition and health education, biostatistics and health economics. WHO recognises obesity as one of the most pressing global public health problems. Adolescent obesity increases the risk of adult obesity and mortality. The proposed trial provided evidence on the efficacy of multi-component, peer-led behavioural change education with parents' support to promote healthy behaviours to prevent excess weight gain in adolescents, improve dietary patterns, increase physical activity levels, and reduce sedentary behaviour. The trial also established if a school-based approach with parents' support to obesity prevention works in a large urban population in Vietnam. We have demonstrated that the proposed intervention is feasible for schools across Vietnam using currently available resources. 
 
Description Community Participation 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Patients, carers and/or patient groups
Results and Impact Engagement with stakeholders was done via Community Participation that included communication with the Department of Education before the start of the capacity building and actual PE activities in schools to increase community support for delivering PE lessons within the school curriculum. We also conducted meetings with the school representatives, including school principals and heads of youth associations, to design and implement activities that introduce the project brand to attract the attention of students, parents and the broader school community. The brand platform formed the foundation for all information materials and messages produced for the project. This platform included a website and student posters of information that enabled the students to connect. A flagship event was a festival held at the school to engage the students through music, games and other interactive activities that carried the project's messages. The results also increased parents' awareness of the benefits of their children engaging in daily physical activity.
Year(s) Of Engagement Activity 2019