Development of nutrition education support material for the South African elderly food based dietary guidelines for isiXhosa and seSotho speaking communities
Authors:   , Nteleza Matsidiso Laneria 
Published: August 2024

South Africa has the highest percentage of older people in the continent at risk of developing Non-Communicable-Diseases (NCDs), contributing to 51% of deaths in SA. As part of efforts to address elderly-specific needs, 13 EFBDGs published in 2017 exist in South Africa but currently there is no known NE support material to communicate and educate the elderly on these EFBDGs. Literature reveals that the elderly present unique challenges to nutrition educators who try to accommodate diversity in terms of culture, nutrition requirements and changes experienced during ageing. In developing NE support material, it therefore becomes crucial to incorporate elements of acceptability for older persons such as being age-friendly, culturally acceptable, and adaptable to older people’s needs whilst considering various health risks and circumstances. The Elderly Food Based Dietary Guidelines (EFBDGs) were translated into the five mostly spoken South African languages for the purpose of Knowledge Mobilisation. The aim of this study, therefore, was to develop and test nutrition education support material for the EFBDGs for the isiXhosa- and seSotho-speaking communities. Developing the NE material to support the EFBDGs was done through a three-phase explanatory sequential study, incorporating the quantitative study of a sample of 40 elderly people comprising both isiXhosa and seSotho language speakers to gather information on a preferred and suitable method of knowledge mobilisation for the elderly. The phase one data was collected through a self-administered questionnaire and analysed on SPSS, version 22.0 for descriptive analysis. In the second phase, qualitative methods were used to test for face and content validity through a Delphi panel. Six experts participated in the Delphi technique on the basis of their knowledge of and expertise in the subject and related topics. The Delphi technique was used to obtain consensus among the experts on the design and presentation of the NE material to be developed. A 5-point Likert scale was used to measure the strength of a participant’s agreement with a clear statement (1 being strongly agree and 5 being strongly disagree). The results were grouped into three brackets (1 – 2 agree; 3 neutral, and 4 – 5 disagree). Consensus was defined if 60% or more of the responses fell into one of the three brackets. The third phase was testing for acceptability of the developed NE material. This was done through FGDs with two FGDs in each of the two languages made up of 8 participants in each group. Consensus on FGDs was met in the second round, and consequently the process was terminated. Data was collected in three phases as were the results. The pre-development survey results indicated that 55% (n=22) of the respondents were in the age bracket of (60 – 69) years, whereas 40% of the (n=16) were in the age bracket of (70 – 79) years. The least number of the respondents (5%; n=2) were from the age bracket of 80+ years. More females 62.5% (n=25) participated in the study compared to males that made up (37.5; n=15) of the study population. A majority of the participants 60% (n=24) had a primary education level, whereas 17.5% (n=7) of the participants had matric as their highest level of education. Similarly, 17.5% (n=7) of the participants had never attended school. The least number of the participants (5%; n=2) had tertiary education. Fifty-two-point-five percent of the participants (52.5%; n=21) had never had any learning opportunities. Twenty-five percent of the participants (25%; n=10) had attended workshops or short courses run by a community organisation, whereas 10% (n=4) of the participants had attended on-campus learning through a college or university, and (7.5%; n=3) of the participants had attended other learning opportunities that were not provided as options in the questionnaire. Only 5% (n=2) of the participants had registered for learning opportunities offered by a clinic or healthcare centre, and none of the participants had ever participated in an online or distance course. Seventy-five percent of the participants (75%; n=30) had never used a computer before, whereas 25% (n=10) of the participants had used a computer before. Of the 25% (n=10) of the participants who had used a computer before, they had used it for the purposes of writing, editing and research (30%: n=3); work 30% (n=3); watching movies and playing games each reflected (10%: n=1) of the participants; and internet browsing reflected 20% (n=2). No participant had ever used a computer for emailing purposes. A majority of the participants 52,5% (n=21) indicated to have a moderate sense of hearing. Sixty-two-point-five percent (62.5%; n=25) of the participants indicated to have a moderate sense of sight. Sixty seven-point-five percent (67.5%; n=27) of the participants reported to have a good sense of smell. Ninety percent (90%; n=36) of the participants indicated to have an excellent sense of touch. The poster and the booklet were preferred by 57.5% (n=23) and 25% (n=10) of the participants respectively as the preferred tools to communicate the EFBDGs. Fifty-two-point five percent (52.5%; n=21) of respondents were unaware of the FBDGs. Forty-seven-point five percent (47.5%; n=19) of respondents knew about the FBDGs but only partially understood what they meant. Only (12,5%; n=5) of the respondents indicated they understood the meaning of the FBDGs. Fifty-seven-point-five percent (57.5%; n=23) of the respondents did not understand the meaning of the FBDGs, and 30% (n=12) of the respondents only partially understood the meaning of the FBDGs. The Delphi technique results indicated that 66.6% of the experts reached consensus that the poster and a booklet were the best forms of communication for the elderly. A consensus of 66.6% of the Delphi experts was reached on the aspect that the material held the potential to attract the attention of the elderly. All the experts (100%) agreed that the font type, font size and colours to be used in the NE support material would be suitable for the elderly. No consensus was reached (50%) on the aspect of evaluating the language used in the material. All the experts (100%) agreed that the material was scientifically sound. All three aspects evaluated in round two of the Delphi technique reached consensus, and consequently the process was terminated. Focus group discussions identified five themes. These themes were that: 1) The font size used in the poster was too small; 2) The visuals were easy to relate to and were attractive and “attention grabbing” insofar as the colours used; 3) The tools held good potential to influence change in elderly eating habits; 4) The tools were an informative, user-friendly source of learning that could be used at any time as a reminder of or a guide to healthy eating; 5) The material would be easily accessible if it were to be placed in the elderly care facilities where some of the elderly lived, local clinics, hospitals and local doctor’s rooms. The elderly population is drastically increasing together with the economic burden for the treatment of NCDs that are more prevalent among the elderly. Even so, the elderly are not prioritised when it comes to nutrition education. The elderly lack nutrition education because nutrition education in South Africa is targeted at all the other vulnerable groups except the elderly. This leads to poor food choices and habits, which subsequently result in the development of NCDs among the elderly. Achieving an optimum level of public awareness about the EFBDGs is crucial in getting elderly people to implement them. Posters are recommended to promote health education in institutions for the elderly and could also be used by health practitioners, and booklets are seen as the best support material for the personal use of the elderly.