Research Projects

Diet, Smoking and Physical Activity Research – Prof Krisela Steyn

Diet, Smoking and Physical Activity Research – Prof Krisela Steyn

Prof Krisela Steyn

Title of the project

Development and testing of lifestyle modification tools with a focus on diet, smoking and physical activity.

Highlights of the project

Non-communicable diseases (NCDs) are a leading cause of preventable morbidity and mortality in South Africa. The most common NCDs include cancer, cardiovascular disease and diabetes. These are linked to common risk factors, namely an unhealthy diet high in fat, sugar and salt; physical inactivity; smoking and excessive use of alcohol.

Yet opportunities to promote lifestyle change are underutilised in health care and other related settings. A systematic review by the Counselling and Behavioural Interventions Work Group of the US Preventive Services Task Force (USPSTF, 2002 & 2009) established that there is strong evidence to show that brief counselling assistance can be effective in changing risk behaviours and can produce clinically meaningful improvements in important biological indicators. Whilst the strongest evidence for these types of interventions comes from tobacco cessation, there is accumulating evidence to show that similar, brief interventions integrated into routine primary care can effectively address risk behaviours such as problem drinking, poor diet, lack of physical activity, substance use and risky sexual behaviour (Elford et al., 2001; Whitlock et al., 2002; Walker et al., 2010).

The aim of this research project is to develop and test a resource package for primary health care providers to use in motivating and supporting behavioural change among patients with or at risk of non-communicable diseases (NCDs). The package will be called “Putting Prevention into Practice”. Primary and secondary prevention of chronic disease, through the promotion of a healthy diet, physical activity and non-smoking, are important objectives of current health care policy in SA (and of the Cancer Association). In September 2011 the South African government signed a declaration on the prevention and control of non-communicable diseases, committing itself to a concerted, multi-sectoral policy effort to ensure the full integration of  NCDs into the re-engineering of primary health care, with the view to increasing community based prevention, screening, self management, care and referral according to the WHO innovative model for chronic care.

Primary health care providers have an important role to play as they have regular contact with patients with or at risk of chronic disease and are trusted sources of information and advice. However, the latest SA Health Review noted that high risk patients are not being adequately identified at a primary care level and another local study showed that few health care providers in SA have adequate knowledge, skills or confidence to provide effective counselling to patients on lifestyle change (Parker et al, 2011).

This package consists of best practice guidelines for brief, behavioural change counselling in relation to the four main, lifestyle related, risk factors for chronic disease (including cancer): namely; smoking, an unhealthy diet, lack of physical activity and alcohol use. In addition, it will include educational/motivational materials, which can be distributed directly to patients in the context of the consultation and a training module.

Non-Scientific Report

Chronic diseases of lifestyle (CDLs), especially cancer, cardiovascular disease, diabetes and chronic respiratory disease are as important a threat to the health of South Africans as HIV and TB. And the problem is steadily increasing, with research showing disturbing increases in the risk behaviours which cause these diseases among the South African population.

As the name suggests. chronic diseases of lifestyle can be prevented by living a healthy lifestyle, If you adopt a healthy diet, do regular physical activity, limit alcohol intake and avoid smoking, you can significantly reduce your risk of getting a chronic disease. If you already have a chronic disease, leading a healthy lifestyle can help you manage your condition effectively and enhance treatment.

A comprehensive, multi-faceted approach is needed to prevent the rising epidemic of chronic disease in SA. This would include legislative, regulatory and policy approaches to, for example, control the advertising, marketing and availability of tobacco, certain processed foods and alcohol. However, the issue also needs to be addressed within the health care system. Health care providers can play an important role in educating and supporting patients make healthy lifestyle choices. Not only do patients have frequent contact with doctors and nurses, but research shows that they are trusted sources of information and can be unique catalysts for change.

The focus of this particular project is the development and testing of a resource package for health care providers, which aims to equip them to provide effective counselling on lifestyle risk factors as part of routine primary care. The package will be called, “Putting Prevention into Practice”. It will also be suitable for use in community-based programmes with health promoters and community health workers, with minor adaptations. It is being developed in consultation with experienced scientists/ researchers and health educators in the fields of nutrition, physical activity and exercise, smoking and alcohol use and will be tested as part of a PhD study through the University of Stellenbosch.

This package will consist of best practice guidelines for brief, behavioural change counselling in relation to the four main, lifestyle related, risk factors associated with chronic disease (including cancer): namely; smoking, an unhealthy diet, lack of physical activity and alcohol use. In addition, it will include educational/motivational materials, which can be distributed directly to patients in the context of the consultation. These include a self-help quit smoking guide, a leaflet suggesting how physical activity can be easily integrated into every-day life and a recipe book on how to cook healthy meals on a tight budget. All the materials developed will be pre-tested with the proposed target audience before being finalised to ensure that they are appealing, acceptable and appropriate.

Up to 40% of cancers can be prevented by living a healthy lifestyle. At every opportunity, South Africans should be encouraged to adopt a healthy diet, to do regular physical activity, to reduce alcohol intake and to avoid tobacco use, in order to reduce their risk of cancer, as well as other chronic diseases. Primary health care providers can play an important role in persuading people to modify their lifestyles to avoid the risk of chronic disease or to enhance the management and treatment of such conditions. This project aims to equip them for this task.

Publications

“Putting Prevention into Practice”: A resource package for primary health care providers to discuss lifestyle risk factors with their patients/clients.

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Research protocols

These research studies were initiated by Katherine Everett-Murphy and will be directly relevant to the development of the ‘Putting Prevention into Practice’ intervention package.

Training medical and nursing students in best practice, brief, behavioural change counselling methods and the impact on their practice in primary care. A case study of students at UCT and University of Stellenbosch. Zelra Malan, PhD student, Family Medicine, University of Stellenbosch. Protocol accepted by PhD and Ethics Committee 25 Nov 2011. Study starting Jan 2012. Supervised by Professor Bob Mash, Dept Family Medicine and Primary Care, US and Dr Katherine Everett-Murphy, CDIA.

Formative research for the development of a budget recipe book for healthy eating: Qualitative research on the food preferences and the cheap, healthy options available and acceptable to a range of culturally diverse, lower socio-economic communities in South Africa. Study underway. Principal investigators: Dr Katherine Everett-Murphy, CDIA and Dr Anniza De Villiers, CDL unit, MRC.

Current practices regarding the care and management of patients with chronic disease in a primary care setting: A case study of Retreat Community Health Centre. Claire Draper, Family Medicine, UCT. Study underway.

Please note: Each of these 3 studies will generate manuscripts for publication in selected scientific journals, with Dr Katherine Everett-Murphy as a co-author. CANSA’s indirect contribution to this research, through their support of Dr Katherine Everett-Murphy, will be given due acknowledgement. It is anticipated that manuscripts will be prepared for publication in the latter half of 2012 and in 2013.

Please summarise how you believe this project is of value in the struggle against cancer:

Up to 40% of cancers can be prevented by living a healthy lifestyle. At every opportunity, South Africans should be encouraged to adopt a healthy diet, to do regular physical activity, to reduce alcohol intake and to avoid tobacco use, in order to reduce their risk of cancer, as well as other chronic diseases. Primary health care providers can play an important role in persuading people to modify their lifestyles to avoid the risk of chronic disease or to enhance the management and treatment of such conditions. This project aims to equip them for this task.

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