https://orcid.org/0000-0002-1176-196X
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ABSTRACT
Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical.
Objectives: This study assessed the effectiveness of a health promotion intervention on mothers’ knowledge, attitude and practice (KAP) and their children’s behavior regarding diet and physical activity.
Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1–9-year-old children in the peri-urban Jhaukhel–Duwakot Health Demographic Surveillance Site, Nepal, during August–November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline.
Results: Post-intervention, mothers’ KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had ‘good’ KAP (>75% of maximum possible scores), and mothers with ‘good’ knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers’ attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children’s diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers’ KAP scores and children’s behavior scores in the intervention area compared to the control area.
Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal’s Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.
Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden
Responsible Editor Jennifer Stewart Williams, Umeå University, Sweden
Acknowledgments
This study is part of the HARDIC project, which was developed by NO as her PhD project at University of Gothenburg, Sweden. We thank the District Public Health Office in Bhaktapur and other local health authorities for their support during the study. We also acknowledge the field supervisors and enumerators, female community health volunteers in Duwakot and Jhaukhel, and all participants for their contribution. We are grateful to scientific editor Karen Williams (Kwills Editing Services, Weymouth, MA, USA) for providing professional English language editing of this article.
Author contributions
NO, AV, GE and AK designed the study. NO and AV did the fieldwork and analyzed the data. NO wrote the first draft of the manuscript. All authors contributed during manuscript preparation.
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics and consent
Ethical approval was given by the Nepal Health Research Council (No. 150/2014) in August 2014. All study participants provided verbal consent to participate before the study began.
Paper context
High prevalence of risk factors contributes to the rising burden of cardiovascular diseases in Nepal. Nepal currently lacks community interventions on diet and physical activity, and does not prioritize prevention of cardiovascular diseases from a young age. The HARDIC health promotion intervention, which is based on the peer education approach, improved mothers’ KAP for diet and physical activity. The intervention has potential for use in other sub-populations and low-resource settings.
