Food-based dietary guidelines as a nutrition education tool : a study among Tsonga women in the Limpopo Province
Mawila, Tintswalo Eunice
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Background and motivation: South Africa is a developing country with a heterogeneous socio-economic multi-cultural society. It is experiencing a nutrition transition characterized by changes from traditional eating patterns to those typical of a Western lifestyle. The consequences of this are the incidence of malnutrition, with diseases of both under and over-nutrition creating a burden on the health resources. A working group representing different stakeholders developed food-based dietary guidelines (FBDGs) for South Africa over a period of four years. These guidelines will be adopted by the Department of Health during 2004. It is important for all South Africans to clearly understand the messages from this FBDG in order to successfully implement these guidelines in health policies. The objectives of this study were: To test the understanding of consumers in a Tsonga-Shangaan community on the new food-based dietary guidelines, To evaluate the outcomes of gained knowledge on good nutrition practises through focus group discussions by using the new FBDGs. Method: Tsonga speaking women in the Greater Tzaneen municipality participated in the study. A total of 64 women were sampled. The population was classified in four strata with 16 participants each, namely: Group 1 - Rural, Group 2 - Farm dwellers, Group 3 - Urban informal, Group 4 - Urban formal. The participants were selected according to availability on the meeting dates and who met the following criteria: Adult African female, Tsonga- speaking, a Responsible for the planning and preparation of meals for their households, without any formal nutrition training. A structured questionnaire was used at baseline and after the focus group discussions to measure the knowledge and understanding of the participants on the FBDGs. The focus group discussions were used to educate the participants on good nutrition practices. Results: The use of the FBDGs as an education tool during the focus group discussions to improve the knowledge of the participants on nutrition practices had mixed results in this study. It was found that the understanding of the messages carried by some of the food-based dietary guidelines was interpreted differently by the different groups. At the end of the focus group discussions, some groups reflected an increase in knowledge of the guidelines, while other groups reflected a "decrease" in knowledge in the same guideline. A variety of factors had an influence on the understanding of the FBDGs, such as household preferences, affordability and availability of foods, taboos, tradition, ignorance and acculturation of consumers. Conclusion The overall conclusion reached was that most of the messages of the FBDGs were well understood by the participants and that the FBDGs per se may be used as an education tool to educate consumers in good nutrition practises. However, from this study it seems as if there are five guidelines that need to be addressed with specific care if used in future education programmes: 1. "Be active" 2. "Make starchy foods the basis of most meals" 3. "Eat salt sparingly" 4. "Eat fat sparingly" 5. "If you drink alcohol, drink sensibly" Recommendations: More time should be spent on focus group discussions, especially when dealing with people of a low education level. More sessions can be scheduled to include all the FBDGs (not all guidelines at one session) and should be repeated after some time. Specific caution should be taken to make sure that the way FBDGs are explained to the consumer fell within the experience field of the consumer. In this regard the socioeconomic status of participants in the project should be taken into consideration, because their low income status can serve as a barrier to the success in the understanding of the messages. Traditions and the use of indigenous foods and the availability thereof, as well as the affordability of the other foods must also be taken into account. Foods that are used to explain the guidelines should be foods that the consumers are familiar with in order to avoid any misunderstanding when trying to interpret the message carried by the guidelines.
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