Health through Faith: can faith-based organisations support weight management and reduce the risk of NCDs in South Africa?

Background: In 2013, 63% of South African (SA) women and 31% of SA men aged over 15 were overweight or obese. Being overweight or obese puts people at risk of non-communicable diseases (NCDs); black South Africans have high rates of diabetes and high blood pressure which, alongside other NCDs, reduces their quality of life and economic wellbeing. The government promotes community-based programmes to improve diet and physical activity but few have been evaluated or are accessible to low-income black South Africans. Our team has experience of developing effective weight management and healthy living programmes that: a) attract people through loyalty to community organisations; and b) continue to engage them through enjoyment of being with 'people like me' in a valued context. We will use this experience to develop a weight management and healthy living programme for obese adults delivered through churches in a rural and an urban setting in South Africa.

Objectives: to establish: i) what adaptations to existing evidence-based programmes are necessary for this audience and church setting?; ii) the target group of the programme in terms of age and gender and whether mixed or single sex groups will be most appealing; iii) the feasibility of delivery of the programme; iv) the acceptability of the programme and feasibility of collecting data in a more formal evaluation in the future.

Methods: We will work participatively with faith leaders and adult congregation members to develop the programme so that it is attractive and appropriate. We already have agreement from church leaders to work with us if this proposal is funded. First we will adapt components of existing, evidence-based, group weight management programmes to the SA setting. To do this we will invite 14 congregation members and faith leaders to 3 co-development workshops (in both a rural and urban setting, 6 workshops in total). The first 2 workshops will provide experience of elements of the programme and participants' views on: the best 'hook'; recruitment; programme leadership; inclusion criteria; adaptation of techniques for behaviour change and physical activity; whether programmes should be single sex; and the extent to which they should be sensitised for Christian ethos. The third workshop will focus on a training programme for people who will deliver it. In between workshops we will adapt the programme. Second we do a pilot delivery of the programme. We will recruit and train programme leaders to deliver the programme in 4 churches and invite congregation members to participate in it. In order to understand whether we need to refine the programme and improve the processes we will: i) observe the programme being delivered in each church to find whether it was easy to deliver and how participants responded; ii) arrange group discussions with up to 6 participants to ask their views on whether the programme was acceptable and which components they found helpful; iii) interview church leaders about what helped and hindered delivery of the programme in their churches; iv) ask participants to take part, before and after they do the programme, in measurement of their weight, waist, blood pressure, physical activity and eating habits, and an assessment of whether they would be willing to be followed up face to face and through linking their data to data held by clinics. Outputs will be a description of a weight management and healthy living programme delivered through 4 SA churches in rural and urban settings and assessment of what would need to change to a) improve the programme and b) conduct a more formal, pilot, outcome evaluation.

Future research: This study is the first step in a much larger programme to develop and evaluate a weight management and healthy lifestyle programme for predominantly low-income South Africans which attracts them, continues to engage them, and is effective in the long term in reducing risk of NCDs.

Background: Increasing levels of obesity and rises in prevalence of non-communicable diseases (NCDs) bring high costs for the already over-burdened South African health system and people and families affected by them. Low-income, adult, South Africans do not have access to effective support for weight management. We will use our experience of developing effective weight management and healthy living programmes that reach, and engage, low income groups to develop a weight management and healthy living programme for obese adults delivered through churches in a rural and an urban setting in South Africa.

Objectives: to establish: i) what adaptations to existing evidence-based programmes are necessary; ii) the target group for the programme; iii) the feasibility of delivery of the programme; iv) its acceptability and feasibility of collecting data in a future trial.

Methods: First we will adapt existing, evidence-based, group weight management programmes to the SA setting. We will lead 3, experiential, co-development workshops with end-users in a rural and urban setting (6 workshops in total). We will investigate: recruitment; programme leadership; inclusion criteria; adaptation of programme components; how programmes should be delivered; and best ways to train programme leaders. The programme will be adapted iteratively between each workshop. Second we try to deliver the programme in 4 churches in a formative evaluation. We will triangulate data from observations, focus group discussions, interviews and baseline and post programme measurements to assess the feasibility and likely success of future programmes within a larger scale, formal, pilot trial.