Pre/post intervention study of FIFA’s “11 for Health” Program to Improve Health Knowledge among Children in Mauritius and Zimbabwe

DETAILED SUMMARY

Importance

• Communicable and non-communicable diseases cause substantial morbidity in Africa and school- and community-based health promotion are WHO priorities. Scalable, sport-based health education programmes for children have had limited multi-country evaluation.

Objective

• To evaluate whether the “11 for Health” program improves children’s health knowledge among mixed-gender adolescents over the intervention period in school and out-of-school settings

Study details

• Study design: Pre/post intervention study; no control group
• Data collection tools: Pre- and post-questionnaires; attendance registers
• Participants: Adolescents aged 12–15 years in Mauritius with a mean of 13 years and 10–14 years in Zimbabwe with a mean of 11.5 years; mixed gender; not specified by HIV status, coaches and teachers delivered sessions
• Implementation setting: 11 secondary schools across Mauritius (in-school; urban/mixed); out-of-school community groups in Bulawayo, Zimbabwe (urban/peri-urban)
• Study period: Intervention delivered Feb–Jun 2010 and outcomes assessed immediately post intervention.

Intervention

• Eleven 90-minute sessions (each = 45 min Play Football + 45 min Play Fair); usually delivered by a male/female Coach pair to groups for around 20 children; teacher and Coach training (5-day) and guidance manual provided

Results

• 389 children in Mauritius and 395 children in Zimbabwe completed both pre- and post- intervention questionnaires.
• Knowledge change: Mean health-knowledge scores increased from 69.3% to 87.1% in Mauritius and from 57.8% to 76.2% in Zimbabwe. The programme produced statistically significant increases in knowledge for 26 of the 30 evaluated statements in both countries (generally p≤0.01; many comparisons p≤0.001).
• Gender: Results demonstrate few significant differences between boys and girls
• High Acceptability: Most children agreed sessions were easy to understand and enjoyable; average agreement scores were 92% and mean item scores were 4.5/5.
• Other outcomes: High feasibility and scalability indicators

Conclusions and implications

• The “11 for Health” program was feasible to deliver in school and community settings and produced large, statistically significant increases in children’s health knowledge across diverse socioeconomic settings.
• The intervention benefitted boys and girls similarly and was well received by participants.
• Based on these positive results, the authors recommend that the programme be widely implemented in Africa in co-operation with government and non-government organisations.