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. 2025 Jul 25;11(1):144.
doi: 10.1186/s40795-025-01124-z.

Supporting community health workers in South Africa for context-specific food and nutrition literacy: implementation of a multi-media education-entertainment intervention

Elochukwu C Okanmelu  1   2 , Machoene D Sekgala  3 , Peter Delobelle  4   5 , Olufunke Alaba  6 , Nicole Holliday  7   8 , Jillian Hill  9 , Martina Lembani  6 , Zandile J Mchiza  9   6
Affiliations

Supporting community health workers in South Africa for context-specific food and nutrition literacy: implementation of a multi-media education-entertainment intervention

Elochukwu C Okanmelu et al. BMC Nutr. .

Abstract

Background: Multimedia technology, recognized for its efficacy in education, offers a complementary approach to traditional health education. In South Africa, community health workers (CHWs) play a pivotal role in improving population health, but often lack comprehensive health knowledge. This study explores the effectiveness of using a multimedia education-entertainment (MM-EE) intervention to enhance food and nutrition literacy among CHWs in resource-challenged townships.

Methods: Seventy-seven participants completed a baseline and 6-month post-intervention follow-up survey. The MM-EE intervention comprised short stories conveyed via comic booklets and 30-second video clips, covering food knowledge, use of food labels, meal preparation, planning, and eating behaviour. Materials were distributed via mobile messaging services, including WhatsApp (as the primary social media platform), MMS, and SMS. Descriptive statistics, chi-square tests, Wilcoxon signed-rank tests, and multivariate linear regression were conducted using R studio version 4.3.3.

Results: Over 70% of participants were classified as having obesity, and 18.2% as overweight, leading to 88.3% of participants being classified as overweight or having obesity. A significant proportion of participants (68.8%) reported having an existing non-communicable disease (NCD). The MM-EE intervention significantly improved CHWs' food and nutrition literacy, reflected in improved median scores for meal preparation (43.1% [IQR: 19.6] pre- vs. 62.7% [IQR: 11.7] post-intervention), planning (58.6% [IQR: 12.1] pre- vs. 67.2% [IQR: 13.4] post-intervention), and overall food and nutrition literacy (63.0% [IQR: 8.1] pre- vs. 69.4% [IQR: 10.9] post-intervention; p <.001).

Conclusion: The study showed effective MM-EE intervention outcomes, positioning this method of health dissemination as suitable for improving the food and nutrition literacy of CHWs in South Africa. The study suggests the potential effectiveness of MM-EE approaches to enhance the health knowledge of the South African population. However, adaptation for the wider population will require further research on scalability, sustainability and an improved intervention design to address all dimensions of literacy.

Keywords: Community health workers; Food and nutrition literacy; Malnutrition; Multimedia education-entertainment; South Africa.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the principles of the Declaration of Helsinki. This research has received ethical approval from the ethical review board of Ludwig-Maximilians-Universität München (LMU Munich) and the University of the Western Cape (ethics reference numbers: BM18/9/17 & BM22/2/7). Written informed consent was received from the participants in one or more of the South African languages (English, Afrikaans and Xhosa) used in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Conceptual Framework of MM-EE approach for CHWs. This framework outlines the five operational constructs used to assess food and nutrition literacy among community health workers: (i) Food knowledge, (ii) Meal planning, (iii) Meal preparation, (iv) Eating behaviours, and (v) Use of food labels. Adapted from Vidgen & Gallegos (2014) and Nutbeam (2000)
Fig. 2
Fig. 2
Violin box-plots showing pre- and post-score distribution for domains and subdomain
Fig. 3
Fig. 3
Food and Nutrition literacy constructs showing Pre- and Post-intervention scores
See this image and copyright information in PMC

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