Background
Methods
Study setting
Data collection
Data analysis
Results
Sample characteristics
Ga Mashie (Accra) (n = 12) | Ho Central (Ho) (n = 12) | ||||
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n | % | n | % | ||
Sex | Male | 8 | 66.7 | 6 | 50.0 |
Age (years) | 25–34 | 2 | 16.7 | 2 | 16.7 |
35–44 | 5 | 41.7 | 3 | 25.0 | |
55+ | 5 | 41.7 | 7 | 58.3 | |
Key informant roles/sectors | Non-Governmental Organisations | 2 | 16.7 | 1 | 8.3 |
Healtha | 2 | 16.7 | 2 | 16.7 | |
Assembly officers | 1 | 8.3 | 2 | 16.7 | |
Religious leadersb | 2 | 16.7 | 2 | 16.7 | |
Traditional leaders | 2 | 16.7 | 2 | 16.7 | |
Youth leaders | 1 | 8.3 | 1 | 8.3 | |
Educationc | 1 | 8.3 | 1 | 8.3 | |
Commerce | 1 | 8.3 | 1 | 8.3 |
Community readiness scores
Knowledge of efforts | Leadership | Community Climate | Knowledge of Issue | Resources | |
---|---|---|---|---|---|
Community mean scores (SD) for Ga Mashie | 2.65 (2.49) | 3.50 (1.34) | 3.42 (0.78) | 4.10 (1.61) | 3.08 (0.40) |
Overall Readiness Score (SD) for Ga Mashie
|
3.35 (0.54)
|
“Vague Awareness stage”
| |||
Community mean scores (SD) for Ho Central | 3.81 (3.12) | 3.85 (1.96) | 4.29 (1.32) | 4.38 (1.81) | 3.35 (1.03) |
Overall Readiness Score (SD) for Ho Central
|
3.94 (0.41)
|
“Vague Awareness stage”
|
Community knowledge of efforts
Ga Mashie (Accra) | Ho Central (Ho) | |
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Type & content | ‘There has been…researchers… to investigate into the dietary patterns among adolescent ladies in this community…those who did the research came back to the community to report back...they did some posters on their findings’...’And then there is another programme that is targeting non-communicable diseases, people that are living with stroke, diabetes, hypertension’ (Male, NGO). ‘We go to the schools, we educate them, we tell them which one (food and drinks) is good, which one is not good. Those that can be taken in moderation and those that if there is the will, they could eliminate’ (Male, Education Sector). ‘I have not seen any such efforts. We have NGOs and things coming here but issues of our eating habits and then the rest it doesn’t happen’ (Male, Youth Leader). | ‘They [community health nurses] talk about health issues, they always talk health issues. I even have a pregnancy class. So once a while, we call them, the pregnant women, we call them and tell them all they should eat’ (Female, Traditional Leader). ‘We don’t know about any such programmes...There is little [information]...Normally they are graphic representations...at institutions like the hospitals where you can see one or two things talking about the dangers on eating unsafe foods. But within community you are hardly to get such’ (Male, Health Sector). ‘We now have the SMART schools. Schools that...they are being educated on good nutrition. With the nurse being the facilitator’ (Female, Health Sector). ‘My church… they let the community health nurses to come…and they encourage any age…to come and listen about the kind of food we eat and the rest but aside that, I have not heard anything’ (Female, NGO). |
Target group | ‘We talk to the pregnant women...we don’t have anything specifically for those who are not pregnant but are in that age [13–49 yrs]...we have been educating them as well - The diabetics and the hypertensives’ (Female, Health Sector). | ‘In actual fact, I think some of these efforts are done in schools, where the pupils are advised on eating healthy foods. Apart from that…the community health nurses, when they come for weighing also advise the parents on good diets for their children’ (Female, Education Sector). |
Facilitator | ‘We [health officers at the polyclinic] organise and plan everything’ (Female, Health Sector). ‘The Regional Institute of Population Studies [University of Ghana]. They did the study here’ (Male, NGO). | ‘Some of these efforts are done in schools... the community health nurses...at times...NESTLE organised a programme’ (Female, Education Sector). ‘I am also aware that the municipal Nutrition Officer has been doing a lot in terms of radio and talks’ (Female, Health Sector). ‘Yes, at the church, programmes like youth programmes, women programmes, they do invite resource persons that are well invested in healthy lifestyle, including nutrition aspect and they do educate them’ (Male, Religious Leader). |
Duration and time | ‘They probably do something one-off and then that is it and then they may be underlying factors like funding...so they are also not able to implement long-term programmes that will actually lead to behavioural changes’ (Male, NGO). | ‘My church... they let the community health nurses to come and…it was a week programme... I was expecting that same kind of programme in my church which never happened again, so it is being assumed that it has been done so that is it’ (Female, NGO). |
Community engagement & reach | ‘So it is only when they come to the facility that... but in the community to be frank nutrition... I have not gone round...[laughs] I have quite a number of brochures and all that about anaemia in pregnancy, what to eat, what not to eat but I have never sent out to the community to give out. We don’t have anything like that in the community. It is only at the facility’ (Female, Health Sector). | ‘Announcements are made to let them know.. at times these information vans go around to inform the people that there will be a talk on nutrition... so all are invited to come’ (Female, Education Sector). ‘Another strength is that the champions, like the model mothers... so now they are also getting the information out to others to replicate the information to more people. So, it is not only the community health nurses, so one of the strengths is that we are able to give the information out to others to who are able to spread it out’ (Female, Health Sector). |
Misconceptions about the efforts | ‘Well I am being very careful because as I said most of the populace there are semi-literate, so it is just a few that will understand exactly what we are carrying out. The others some may hear it and they have their own interpretation they give to some of these things’ (Male, Education Sector). ‘Normally, these people I will say they think it is just for the elderly’ (Male, NGO). | ‘Oh, there is no misconception, they always take it in good faith. So, there isn’t any misconception’ (Male, Youth Leader). |
Weaknesses | ‘The weaknesses will be the fact that we don’t reach out to a larger group of people and it is most of the time the pregnant women and all that. So that is the number one weakness’ (Female, Health Sector). | ‘So, most of the information is not going out as fast as we want it, as it should. The smart school I said, uptake of those programmes in Ho Central is quite difficult, because they tell you they go to the school and international schools and this, so it is difficult to penetrate into the schools, so it is not working as well as it would be working in other districts’ (Female, Health Sector). |
Obstacles | ‘Influence from relatives…Like we tell them not to eat this and then somebody tells them ooh what is it? you can eat this’. (Female, Health Sector). ‘No they will not oppose but some people will be asking what is in for them. They will ask what they will get from participating in the programme and that will be in terms of financial gains’ (Male, NGO). | ‘The obstacles, one is poverty. And also, some are not working, so they lack the means. And some too are single parents’ (Female, Education Sector). ‘Anything you tell them, they don’t partake in activities… even though it is bringing harm to their bodies, they don’t listen. You see them, you talk to them and then the following day, they are more drunk than anything’ (Male, Traditional Leader). ‘Some don’t even have TVs, those who don’t have, they are people in this Ho Municipality that they don’t even have TVs in their homes, so and the person might not even have radio so how will this person get the information’ (Female, NGO). |
Strengths | ‘So, for those people that are receiving the intervention [university research] ... they like the food and the advice on how to prepare the food and what goes into preparing good food’... ‘So, the effort in getting people to participate in such an intervention I think is a strength. They come with vehicles and they are able to move them around so to me the effort from the university is ok’ (Male, NGO). | ‘The strengths of it is that it is very basic to understand…we are not introducing anything that is new to the community...And we are talking about…locally available foods’… ‘And another strength is…the champions, like the model mothers we talk about… the smart schools... we are able to give the information out to others to who are able to spread it out’ (Female, Health Sector). |
Opportunities for change | ‘Such interventions I will recommend that it should be communal. The community should own it...the university should be seen in training community members...once the community owns it, it will be sustainable and then the community will also find resources to make it work and sustain it’ (Male, NGO). ‘I feel it is a wakeup call because you have done something in the community and you have seen what is going on. It is a wakeup call for my NGO and we are ready to partner with any organization in Ga mashie’ (Male, NGO). ‘Yes, they will but that one is a long-term process, you see... so it must be a joint, let me say a partnership with the traditional council. If it is a partnership and it is long term process, then it can really work - it can work’ (Male, Religious Leader). | ‘We in the leadership, we have realised that eating junk food is resulting in a lot of sudden deaths…so we are considering it and see how best we can start some educational programmes’ (Male, Traditional Leader). ‘At times, the radio is the most important one, you know. If you start shouting on radio, they hear it. That is the only way to educate people’ (Female, Traditional Leader). ‘Oh, once they [the community] are educated on these things, I think they will support...when they [leadership] are empowered, they will be able to help in that direction. Once they know what they are to do, they will do that’ (Male, Assembly Officer). ‘On the job training is one of the sustainable ways, that we are looking at... the municipal nutrition officer, she is on the field, to take the opportunity to train people on the job to take up on these roles and fill up some of these responsibilities’ (Female, Health Sector). |
Leadership
Ga Mashie (Accra) | Ho Central (Ho) | |
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Leadership level of concern | ‘It is a concern to the traditional council so I will say 9 [out of 10] but nothing much has been done to address this issue...The chief is keen and interested in the health of the community so he is ready to support scaling up efforts to address this unhealthy eating problem identified in the community’ (Female, Traditional Leader). | ‘We have realised that eating junk food is resulting in a lot of sudden deaths, diseases ...so we are concerned’ (Male, Traditional Leader). ‘Because we have not come together to discuss anything on consumption of unwholesome foods. Nothing like that, no…we don’t discuss anything concerning this topic. Never’ (Male, Assembly Officer). ‘I have interacted with a couple of chiefs and traditional leaders, particularly those in my church and it’s always about the women being involved with alcohol and that kind of thing’ (Female, Religious Leader). |
Leadership priority level | ‘They know it is a challenge, they know it is a problem, they know people are consuming erm... junk food but they don’t go in with any intervention. They are aware of the problem but they do not move in to undertake anything’ (Male, NGO) ‘Yes, it is of much priority to the leadership of this community and we are planning to have people to come and support us to address this health problem. Because of that we try to get leaders to serve on the health boards to that we could get those support....it is a big priority to the traditional leaders’ (Female, Traditional Leader) | ‘It is not a concern at all.. [she laughs] because there has never been, ermmm, any forum on which these issues have been discussed. Except the health personnel who come to talk. It has never been their priority’ (Female, Education Sector). ‘There is some apathy toward that commitment, especially when they feel it is not within the core responsibilities’ (Male, Health Sector). ‘They put other concerns too into practice. Usually, as a church, they target the salvation of the members than other things, but they added to, the members need to be healthy before salvation can also work’ (Male, Religious Leader). ‘We rather seek funds for more classrooms and to celebrate traditional festivals and to bring in more beers and drinks’ (Female, Religious Leader). |
Leadership engagement | ‘I will say that the leaders are not supporting the course of addressing the consumption of unhealthy foods and drinks. If you like you could go to the leaders of the community and arrange for a meeting and they will start asking for monetary gains before the program is even planned’ (Female, Commerce). | ‘Even those that we are saying many, most of them [leaders], majority of them will not do it. Though they will say they will, they will participate in it, but they will not do the work they are supposed to do’ (Female, Commerce). ‘It seems motivation, in the form of personal reward is not forthcoming and there is some apathy toward that commitment, especially when they feel it is not within the core responsibilities, and their responsibilities, you know, normally for the public sector, it is our specific line of issues we are supposed to be addressing. So that the issue’ (Male, Health Sector). ‘that’s what I was saying that, when they are empowered, they will be able to help in that direction. Once they know what they are to do, they will do that’ (Male, Assembly Officer). |
Key leaders | ‘[Who are leaders that are supportive of addressing this issue in your community?]’ ‘The opinion leaders, the assembly members or assembly men and women, the chiefs’ (Female, Health Sector). ‘If you go to the chief, the chief will always welcome you and will always be interested in promoting these good practices in his community. Likewise, the assembly member and then the MP [member of Parliament]’ (Male, Education Sector). | ‘It should be the chief, queen mother and the elders…I have been saying no, no, no, because in our community, there is chieftaincy dispute. The community is divided into two... hopefully by the end of this year, we will seal that thing off, and we will be okay’ (Male, Assembly Officer). |
Community climate
Ga Mashie (Accra) | Ho Central (Ho) | |
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Community level of concern | ‘Most of the community members know that some of those foods may be harmful to their health but they still go ahead to consume them’ (Male, NGO). | ‘It is not a concern to them because it’s like everybody does whatever he or she likes’ (Female, Commerce). ‘In conversations, where people complained and its mainly about the alcoholic beverages that the young girls and women have been taking. I haven’t heard anything being said about the, concern being said about the food, dietary habits and the rest’ (Female, Religious Leader). |
Community priority level | ‘It is not a priority to them. it only becomes a priority when like I said they are diagnosed hypertensive or diabetic, that is when what goes into them becomes a priority but till that time nobody thinks about it.’ … ‘Preventive health its... its... I don’t know people are not so much interested’ (Female, Health Sector). | ‘I think generally we’ve been concerned more about the adolescent girls and women taking alcoholic beverages’ (Female, Religious Leader). |
Community engagement | ‘That is when they are contacted, some willingly would want to help but then most of them they will want to know what incentives come with it or what they will get from it after putting in their effort’ (Male, Education Sector). | ‘Oh, I think a few people might [oppose efforts]. I think those who will think it’s a danger to them, those who might think its pulling their businesses down’ (Female, NGO). ‘Their support [the community], usually is mobilising the people for you as well as they themselves participating in it’ (Male, Religious Leader). |
Key community members | ‘Once the opinion leaders contact the youth leaders in the community and they see the need and benefit of the intervention programs, then they will avail themselves to ensure that programs are well organised and education given to the community members to help address the consumption of unhealthy foods’ (Female, Commerce). | ‘But I don’t think the consumers will have an issue with it but those who in charge of that kind of business, I think they will be offended and they will try their best to convince the people against what is good and just be taking their money’ (Female, NGO). ‘At times in churches, the women groups talk to their members on these issues’ (Female, Education Sector). |
Knowledge about the issue
Ga Mashie (Accra) | Ho Central (Ho) | |
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Occurrence within the community | ‘the consumption of these unhealthy foods has been one of the major cause of death in our society. In the past, when we were eating the nkontomire [Taro Leaves]…when we were cooking with the Prekese [Aridan; local spice]…look at the age that our fore-fathers attained before they died. Today, the eating habit has changed - junk especially in our community here’ (Male, Youth Leader). | ‘we have realised that eating junk food is leading, is resulting in a lot of sudden deaths, diseases that we haven’t, never experienced when we were young but the youth of today have all types of disease. You see a young person having stroke, which when we were young we never heard of, it’s the elderly people. The youth of today, a young girl is suffering from cancer, we never heard of’ (Female, Education Sector). |
Misconceptions | ‘At the CWC we talk to them about breastfeeding, don’t give water until the child is 6 months but…the grandmothers, the older women they tell them it’s a lie…they give them this funny, funny [incorrect] information’ (Female, Health Sector). ‘They may think... it is coming from an attack from an “enemy” [spiritual beliefs]- a particular example being stroke. Other people may think that it is not from my eating habit or... alcohol that is leading me to experience this but they may think that it is somebody who is using juju or black magic to curse them with such a disease’ (Male, NGO). | ‘At times when you tell them, some may tell you I have been eating this for a long time and I am okay so… continuous talk and citing certain people that have done the right thing and are living healthy, will give them the idea or will alert them to desist from or to eat good’ (Female, Education Sector). |
Causes | ‘These unhealthy foods are bought and sold here in the community at low prices and people are buying because of the prices’ (Female, Traditional Leader). ‘There are unhealthy foods sold all over us here. Anywhere you go the foods sold there are unhealthy’ (Male, Religious Leader). | ‘We see a lot of adverts, we see things that, if we were to say eat some kenkey with ‘amaa detsi’ [green vegetable stew] or something, you will prefer a bottle of coke and then you also fill that you are trending. So, I think the food choices’ (Female, Health Sector). |
Consequences | ‘They don’t know the consequences. It is only when they have the condition and even when they get the condition they don’t even know’ (Female, Health Sector). ‘They know the consequences of taking in unhealthy foods and drinks because we tell them but the sad thing is they hear but they will not do what you are telling them to do’ (Female, Health Sector). | ‘I think now, knowledge is growing. I spoke to some people who told me they have been listening to one dietitian who comes, or he is on radio every, once a week to talk about these things. Talking about them’ (Female, Religious Leader). |
Prevention | ‘A lot do know that by mass education and public health information. Also by forming health clubs and groups and they will be the disciples of announcing the good and bad foods in the community’ (Male, Traditional Leader). ‘What can be done to prevent?... the thing is they don’t even know whether what they are taking is healthy or not. They don’t know whether they are taking is not healthy.... because they don’t know how will they know how to prevent it’ (Female, Health Sector). | ‘hmmm, nothing can be done. Because if they have made their mind up. they enjoy the fat’ (Female, Traditional Leader). |
Resources
Ga Mashie (Accra) | Ho Central (Ho) | |
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Action or inaction to mobilise resources | ‘If we are saying community leadership purposively going around to mobilize these volunteers for future programmes...They are not going to them in frantic efforts to get money to upscale or improve upon certain interventions that are ongoing in the community’ (Male, NGO). | ‘Once they know that these resources are available, the experts, the will make use of them to support’ (Male, NGO). ‘because at times when you put the effort there they don’t get so they feel reluctant to do’ (Male, Religious Leader). |
Information | ‘I have quite a number of brochures and all that about anaemia in pregnancy, what to eat, what not to eat but I have never sent out to the community to give out... It is only at the facility ‘Female, Health Sector | ‘Normally they are graphic representations, and they are normally at institutions like the hospitals’... ‘But within community you are hardly to get such’ (Male, Health Sector). ‘I think it’s just verbal because I don’t know of any newspaper or article or anything. Posters that...It’s just verbal I know and radio’ (Female, NGO). |
Money | ‘I must be honest with you, anything that has to do with funding just take it off because they will go in for something for themselves not for you. You see, you are coming in for a programme then they expect that you have your luggage full of cedis to support them rather’ (Male, Religious Leader). | ‘for funding…it’s the community, from our own meagre resources…We usually have contributions from the community, we have our own levies’…‘so if we need any money, that is where we will go to’ (Male, Traditional Leader). ‘Now that we say we are a middle-income country, that is what we are touting ourselves as a country so yeah, donor support is reducing drastically’ (Female, Health Sector). |
Organisations | ‘We have some NGOs around and…they will support in addressing the consumption of unhealthy foods and drinks.’ (Male, Traditional Leader) ‘Yes, we have community groups, we have women groups, we have hairdressers’ association, we have church women groups…we will meet with all of them…they will give us time’ (Female, Health Sector). | ‘I know Pencils of Promise, but we deal with only school, I know PLAN Ghana is also there, they also do health education and which other NGO? I don’t know some of the NGOs. I wouldn’t say a lot. I will say few or there’s no few there?’ (Female, NGO). |
Experts | ‘Ok so we have people that academically they have the expertise and then we…the food and drugs board…they…have the technical experts’ (Male, NGO). ‘We have some people here who are experts in the community that could help like the health officials’ (Female, Traditional Leader). | ‘As for the experts, we have nurses, both community and public health nurses, we have food and nutrition, ermm, teachers and nutritionists. So, they are available, so some’ (Female, Education Sector). ‘so, we have a lot of them (experts) who are there. But just that maybe those who will be willing to do it will be the problem’ (Female, NGO). |
Volunteers | ‘I will say that once the health programs are started…the volunteers will be available to support the program to be a success and also help to sustain those efforts’ (Female, Traditional Leader). ‘Like I said earlier, if you motivate the volunteers with some incentives, they will avail themselves to help’ (Male, Religious Leader). | ‘Volunteers, will I say some?... I say some because, there are a lot of people who, even I do it myself, can you come to this place and talk about this, and I go like oh I don’t have the time or something. So, people are not willing, they complain about time, they complain about not being able to’ (Female, NGO). |
Space | ‘A lot of spaces are available here in the community. We have churches, parks like the Mantse Agboona Park, London market area, lots of places here to be used for the health education activities’ (Male, Traditional Leader). | ‘space, maybe, we have the radio stations, the media that could be used address this issue, we have the churches and the schools, and the traditional rulers place and they can create the avenues for such news’ (Female, Religious Leader). |
Time | ‘if we could have... more time... maybe you have 30 min so sometimes the mothers don’t have time to ask questions’ (Female, Health Sector). ‘The leaders will rather be talking about using their time for other profitable ventures’ (Female, Traditional Leader). | ‘So, if you’re sitting down listening to education, you feel that you are wasting your time…why won’t I use that time to go and prepare something for sale…even those who are doing nothing, they don’t also have time...the radios, people hear everything, they listen’ (Female, Traditional Leader). |