Prospective Cohort Study of Programming to Promote Health Knowledge and Disease Prevention among Children in South Africa

DETAILED SUMMARY

Importance

• Health education in childhood is essential for lifelong healthy behavior, but many children in disadvantaged communities lack access.
• Football (soccer) is the world’s most popular sport and therefore provides an engaging and effective platform for promoting health awareness in children.

Objective

• To develop, implement, and assess the acceptability and effectiveness of an interactive, health education program addressing the causes and prevention strategies of communicable and non-communicable diseases among children living in a township in South Africa.

Study details

• Study design: Prospective cohort study with a control group
• Data collection tools: Pre, post, and follow-up questionnaires, attendance registers
• Participants: 370 children making up two intervention groups (125 from Grade 6, 131 from Grade 7), 114 students from Grade 7 making up the control group, and 23 coaches. Mean ages of 12.2–13.5 years across groups. Overall range across groups 11-16 years.
• Implementation setting: Two primary schools in the Khayelitsha Township, South Africa
• Study period: 3 years in total, but 10 month cohort study with an 11 week intervention delivered to experimental groups.

Intervention

• Football for Health: 90-minute sessions split in half. The first half covered a specific football skill. The second half introduced facts about one of the diseases and how to prevent it.

Results

• Attendance averaged 89.5% (Intervention Grade 7), 93.9% (Control Grade 7), and 93.4% (Intervention Grade 6)
• Children’s questionnaire completion rates were 70.1% (Intervention Grade 7), 70.8% (Control Grade 7), and 86.8% (Intervention Grade 6)
• Post-intervention, the Grade 7 intervention group showed significant knowledge gains in 9/20 health statements (11/20 at 3-month follow-up), compared with only 1/20 (post–Play Football) and 9/20 (post–Play Fair) in the control group. The Grade 6 intervention group showed significant improvement in 15/20 questions. p values ranged from p<0.05 to p<0.001.
• Intervention coaches’ correct responses to 20 health-related questions increased from 75% to 95% (p < 0.001), while control coaches showed no significant change
• Both groups rated the training highly; the intervention group reported higher overall satisfaction (mean = 4.5 vs 4.4) and more positive responses (94% vs 88%)

Conclusions and implications

• The program demonstrates that it is possible to implement a football-based health-education program for children in Africa that achieves significant increases in health knowledge and that is well received by participants.
• Future programs should follow-up on this study by implementing it with larger cohorts of children in other southern African countries using a similar structure.