Development of a pre-adolescent inter-generational intervention to address HIV and obesity using intervention mapping

Background: South Africa has a high prevalence of HIV and obesity. Interventions to date have primarily focused on adolescents and adults. Prevention of obesity, in particular, is not addressed substantively in the current pre-adolescent school curriculum. Education about factors underlying these issues early in life could reach beyond children, to their parents. Objective: We aimed to increase awareness about HIV and obesity/underweight risks and prevention through the development of a combined intervention delivered directly to pre-adolescent learners and indirectly to their parents, for immediate- and long-term benefits. Design: Scoping review and needs assessment. Setting: Five government-run primary schools in a district in Gauteng Province, South Africa. Method: Five of the six-step intervention mapping protocol guided intervention development: (1) a formative study, comprising a scoping review and needs assessment; (2) definition of programme objectives; (3) selection of theory-based intervention methods; (4) programme development and (5) adoption, implementation and sustainability planning. Results: Educators perceived that health and lifestyle issues among learners affected classroom learning and saw a need for school-based health curricula. They highlighted that HIV was an issue in their communities and that malnutrition was a concern in rural schools. The scoping review shortlisted 11 evidence-based practices which informed the design. Intervention components comprised a learning curriculum, environmental support and activity-based constituents that targeted the learner in the school environment and the parent in the home environment. The intervention was designed to increase knowledge about HIV and nutrition, enhance skills and strengthen autonomous self-efficacy in communication. Accompanying resources were designed, and implementation strategies were developed. Conclusion: The scoping review and the needs assessment informed intervention development as well as critical adaptations. In particular, stakeholder engagement guided the tailoring of the intervention to fit the target populations and context.