Table 3 Supporting quotes for ‘community knowledge of efforts’

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).