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

## TL;DR

A multimedia education program improved nutrition knowledge among South African community health workers, who can then better educate their communities.

## Contribution

This study demonstrates the effectiveness of a multimedia education-entertainment intervention in improving food and nutrition literacy among community health workers in resource-limited settings.

## Key findings

- The MM-EE intervention significantly improved median scores for meal preparation, planning, and overall food and nutrition literacy among participants.
- Over 88% of participants were classified as overweight or having obesity, and 68.8% reported an existing non-communicable disease.
- The intervention showed potential for scalability and suggests MM-EE as a suitable method for health dissemination in South Africa.

## Abstract

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.

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.

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).

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.

The online version contains supplementary material available at 10.1186/s40795-025-01124-z.

High levels of food and nutrition literacy (FNL) are key to preventing diet-related health issues and improving health outcomes and overall well-being globally. CHWs play a pivotal role in bridging the gap between healthcare services and communities, making them ideal agents for disseminating nutrition information and fostering behaviour change. This intervention study aimed to increase food and nutrition literacy among community health workers in resource limited townships in South Africa, with the potential to enable food and nutrition-related health education of the communities they serve. The effectiveness of this study further signals the potential of MM-EE in improving population literacy.

The online version contains supplementary material available at 10.1186/s40795-025-01124-z.