According to Freeman (2009) hearing parent voices is the first step in health promotion. The author stresses the value of community participation in health research. There has been little research into the role of the ECCD centre as a setting for health promotion, incorporating the roles of advocacy and community participation. However, some other studies based in African countries offer some lessons learned on the importance of community participation and advocacy.
An evaluation of an integrated nutrition programme in primary schools in Zambia, acknowledged the importance of parental perceptions for the success of a nutritional education programme (Sherman & Muehlhoff, 2007). In this study, funded by the FAO of the UN, an evaluation was conducted of a curriculum-based nutrition program that had been taught in Zambian primary schools. In class, students were educated on the importance of a balanced diet and hand washing. However the study found that there were challenges in the application of this health education. Parents did not see the link between health and nutrition, so children were not supported at home in applying their new knowledge. In addition, other challenges existed in the home environment such as lack of water in homes to implement hand washing; and protein foods grown by the family were sold as a cash crop rather than used for family nutrition. The report concluded that educational lessons needed to be complemented by food security and sanitation interventions. Sanders et al. (2008) also conclude that initiatives that focus only on healthy behaviours such as hand washing, will have limited effect if there isn’t
Several other authors agree with the need for advocacy in health promotion, as stated in the Zambian study. Baum (1998) described the importance of understanding parental perceptions of health as this can serve as an advocacy strategy by raising parents’ awareness of health issues, and providing an opportunity for their involvement in the process of determining health needs. Williams & Drummond (2000) concluded that addressing perceived barriers to health was as important as developing health education sessions. They suggested that policy advocacy and social action to promote health were important roles for public health workers.
Recording parental perceptions of health can allow for community participation. Community participation is described as important because “for a community-based intervention to be effective and sustainable perceptions of community members must be determined and then used to plan and tailor interventions” (Yadrick et al., 2001:267). Sanders & Chopra (2006), claim that community participation can lead to empowerment of the participants. This process of empowerment can be a way of working towards advocacy. Several authors explain that community participation allows for solutions to be created from within the community rather than imposed from outside of the community (Chapman & Davey, 1997; Harris, Wise, Hawe, Finlay, & Nutbeam, 1995). Sanders et al. (2005) challenged the international community to create conditions in which African people can develop their own solutions to their problems.
The process of gaining an understanding of the factors a community perceives as being healthy can enable people to determine their own health priorities. This was the conclusion of Cameron (2005), who outlined an empowering model of qualitative research through the use of health impact assessments and vision workshops. Although this research was conducted with a small sample in an Indian community, rather than an ECCD centre, the participatory approach offers
some useful lessons. Cameron’s conclusion reinforces the earlier recommendation by Kemm (2003) of using participatory methods in qualitative research on health education.
2.8 Summary of the Literature Review
The literature review sought to provide an overview of the broad range of issues related to parental perception of heath and child health needs in ECCD settings. The dynamic concept of health was defined and noted to have various meanings, according to the context. The social determinants of health were explored and the influence of the social and physical environment on health was detailed. The development of health promotion as an approach to respond to health inequity was strongly influenced by the Ottawa Charter. The review of health promotion literature stressed that health education alone is insufficient to address the existing health inequalities. In order to be effective, health education focused on increasing personal skills must be accompanied by the other four health promotion actions of the Ottawa Charter. The health promoting settings movement has endeavoured to utilise this comprehensive approach. Very little has been documented in the literature, regarding health promoting schools in South Africa and the influence of the social and physical environment of the ECCD centre in promoting child health. Sustainable health promotion within an ECCD setting needs to incorporate the parental perceptions of health and child health needs. The focus of this research endeavours to be a starting point in that direction.
3. METHODOLOGY
3.1 Aim
To explore the perceptions of health and child health needs held by parents of children enrolled in ECCD centres partnering with WESSA, in Amathole District, Eastern Cape, South Africa.
3.2 Objectives
i. To explore the perceptions of health held by parents of children enrolled in selected ECCD centres in Amathole District.
ii. To explore the perceived child health needs identified by these ECCD centre parents. iii. To identify the factors that these parents believe either contribute to or challenge their
children’s health.
iv. To explore how parents view the early childhood centre in Amathole District as contributing to health in positive or negative ways.