TALENT Collaboration: Exploring adolescent diet and physical activity in India and sub-Saharan Africa.
By Polly Hardy-Johnson, Susie Weller, Sarah Helen Kehoe, Mary Barker, Abraham Haileamalak, Landing Jarju, Julie Jesson, GV Krishnaveni, Kalyanaraman Kumaran, Valeriane Leroy, Sophie Moore, Shane A Norris, Suvarna Patil, Sirazul Sahariah, Kate Ward, Chittaranjan Yajnik and Caroline Fall on behalf of the TALENT collaboration.
The TALENT collaboration also includes Ulka Banavali (BKL Walawalkar Hospital, India), Edna Bosire (University of the Witwatersrand, South Africa), Harsha Chopra (Centre for the Study of Social Change, India), Meera Gandhi (Centre for the Study of Social Change, India), Ramatoulie Janha (MRC Keneba, MRC Unit The Gambia), Shama Joseph (CSI Holdsworth Memorial Hospital, India), Kejal Joshi Reddy (KEM Hospital, India), Elizabeth Kimani-Murage (African Population and Health Research Center (APHRC), Kenya), Egnon Kouakou (PAC-CI, Ivory Coast), Mubarek Abera Mengistie (Jimma University, Ethiopia), Stephanie Wrottesley (University of the Witwatersrand, South Africa) and Pallavi Yajnik (KEM Hospital, India).
The authors would like to acknowledge their funders, the Global Challenges Research Fund and the University of Southampton Global Challenges Research Fund.
Location: Cote D’Ivoire, Ethiopia, India, South Africa and The Gambia.
What this article is about: This article describes the findings from the TALENT Consortium stakeholder engagement, survey and focus group discussions regarding adolescent diet, physical activity and health.
- The study found that all adolescents knew about healthy lifestyles but a range of other factors often led them to make unhealthy choices.
- Food choices and opportunities to engage in physical activity differed between rural, urban and peri-urban areas and were sometimes area of conflicts between adolescents and parents/caregivers.
- Interventions to improve adolescent diet and physical activity need to be context-specific and responsive to changing environments.
The Transforming Adolescent LivEs Through NutriTion (TALENT) Consortium, established in 2018, comprises biomedical scientists (epidemiology, nutrition, laboratory science, intervention development), social scientists (psychology, sociology, social geography) and experts in policy and public engagement from the United Kingdom, four African countries (Cote d’Ivoire, Ethiopia, South Africa and The Gambia) and four locations in India (Dervan, Pune, Mumbai and Mysore) (Figure 1). TALENT includes eight sites (in five different low- and middle-income countries (LMICs)) at different stages of economic and nutrition transition. TALENT recruited participants from both rural (Dervan in India and Keneba in The Gambia), urban (Abidjan in Cote D’Ivoire, Mumbai in India, Mysore in India and Soweto in South Africa) and peri-urban (Jimma in Ethiopia and Pune in India) settings (Figure 1). TALENT aimed to share expertise and build capacity amongst biomedical researchers in qualitative research through training and mentorship and by leveraging local funding. A further aim was to provide new insights into ways to address the double burden of malnutrition amongst adolescents living in LMICs by affording opportunities for young people to discuss their own lived experiences and views of diet and physical activity.
Figure 1: TALENT collaborating sites
A series of stakeholder engagement sessions, survey data collection and focus groups was conducted to answer the following research questions:
- What do young people and parents/caregivers think about diet, physical activity and health and how important are these to them?
- What and who decides and shapes their eating and activity habits?
- What might engage adolescents in changing their diet and physical activity?
The qualitative research was conducted by local researchers already embedded in each setting. Focus groups were conducted with 480 adolescents and their parents/caregivers using creative techniques such as a photograph sorting activity where adolescents were invited to categorise different food types. The views of parents/caregivers were also sought as we considered these to be important in understanding the challenges and for developing solutions. In addition to the qualitative data collection, we collected small-scale contextual quantitative data from approximately 40 boys and 40 girls in each site (Fall et al., 2020). We used surveys to generate data on adolescent diet, body composition and socioeconomic status. Three systematic reviews were also conducted, including one qualitative evidence synthesis (Wrottesley et al, 2020; Jesson et al, 2020; Hardy-Johnson et al, 2021).
The qualitative research captured rich and nuanced data on adolescents’ everyday lived experiences. It highlighted the complexity of diet and physical activity influences and demonstrated the importance of the broader contexts and processes that shape adolescent health in transitioning societies. A cross-site analysis of the pooled qualitative data (Weller et al, 2020) identified three themes.
The first theme focused on transitions in generational nutrition education and knowledge. Adolescents, even in resource-poor settings, knew about healthy diets and lifestyles. They wanted to have energy, feel happy, look good and live longer but their desire for autonomy, a need to ‘belong’ in their peer group, plus vulnerability to marketing campaigns that exploited their aspirations, often led them to make unhealthy choices. Across all sites, participants displayed a good level of nutritional knowledge that was often underestimated by parents/caregivers who felt it was their job to educate their young people on such matters.
The second theme, transition in caregiver– adolescent power balance, described how adolescents and caregivers discussed power imbalances related to diet and physical activity. In the more urbanised settings, both adolescents and caregivers described the frequent negotiations and, in some instances, conflict that would occur regarding food options/choices and physical activity. For example, in Mumbai, caregivers expressed immense frustration that their children preferred ‘outside’ junk food to their home-cooked ‘healthy’ food. In contrast, adolescents felt constrained by their parents and expressed joy in the social element of eating outside food with their friends. In Indian sites such as Mysore, adolescents described pressure from adults to excel in exams which meant that academic studies often squeezed out physical activity time.
The final theme, the implications of societal and economic transition for diet and physical activity, depicts the differences between the rural and urban sites in relation to food choice and the opportunities to engage in physical activity. For example, urban adolescents in sites such as Soweto had easy access to calorie-dense, unhealthy foods bought outside the home whereas junk foods were only beginning to permeate rural sites such as Keneba. Across the sites, it was clear that rural and urban transition influenced the types of foods that were available, where those from more urbanised sites had more choice.
The data generated far exceeded expectations; 13 journal articles have been published on adolescent nutrition in LMICs. The added value produced from this relatively small award is a testament to the extraordinary collaboration we have established.
Through TALENT, primary investigators and early career researchers have been trained in qualitative methods and now have experience in applying social science methodologies to the study of adolescent nutrition. The TALENT teams are keen to use these newly developed skills to develop interventions to improve adolescent nutrition which will need to be context-specific and responsive to transitions at the individual, economic and societal levels. Solutions need to acknowledge gender inequalities in different contexts and structural and cultural influences on diet and physical activity in resource-limited settings. Programmes need to be effective in engaging and reconciling the perspectives of adolescents and caregivers. Consequently, there is a need for action at both the community household level and through policy. In the next phase of work, the TALENT Consortium will use community engagement and participatory research techniques by employing groups of adolescents to develop and implement interventions to improve adolescent nutritional status.
Find out more information about TALENT through Twitter @GCRF_TALENT and TALENT publications.
For more information about this article, please contact Polly Hardy-Johnson at email@example.com
Abera, M, Hardy-Johnson, P, Abdissa, A, Workicho, A, Ali, R, Weller, S and Haileamlak, A (2020) Social, economic and cultural influences on adolescent nutrition and physical activity in Jimma, Ethiopia: perspectives from adolescents and their caregivers. Public Health Nutrition, 1-9.
Banavali, U, Patil, S, Chavan, R, Sonawane, S, Joglekar, C, Fall, C and Hardy-Johnson, P (2020) What shapes adolescents’ diet and physical activity habits in rural Konkan, India? Adolescents’ and caregivers’ perspectives. Public Health Nutrition, 1-10.
Barker, ME, Hardy-Johnson, P, Weller, S, Haileamalak, A, Jarju, L, Jesson, J and Fall, CHD (2020) How do we improve adolescent diet and physical activity in India and sub-Saharan Africa? Findings from the Transforming Adolescent Lives through Nutrition (TALENT) consortium. Public Health Nutrition, 1-9.
Chopra, HV, Gandhi, MJ, Sahariah, SA, Weller, S, Potdar, RD, Barker, M and Hardy-Johnson, P (2020) Conflicts between adolescents and their caregivers living in slums of Mumbai, India in relation to junk food consumption and physical activity. Public Health Nutrition, 1-11.
Fall, CH, Abera, M, Chopra, H, Hardy-Johnson, P, Janha, RE, Jesson, J and Barker, ME (2020) Anthropometric nutritional status, and social and dietary characteristics of African and Indian adolescents taking part in the TALENT (Transforming Adolescent Lives through Nutrition) qualitative study. Public Health Nutrition, 1-12.
Hardy-Johnson, P, Dhuria, P, Strommer, S, Weller, S, Barker, M and Fall, CH (2021) Exploring the diet and physical activity behaviours of adolescents living in India and sub-Saharan Africa: a qualitative evidence synthesis. Public Health Nutrition, 1-11.
Janha, RE, Hardy-Johnson, P, Kehoe, SH, Mendy, MB, Camara, I, Jarjou, L, Ward, K, Moore, SE, Fall, C, Barker, M and Weller, S (2020) Exploring influences on adolescent diet and physical activity in rural Gambia, West Africa: food insecurity, culture and the natural environment. Public Health Nutrition, 1-11.
Jesson, J, Kouakou, EK, Hardy-Johnson, P, Ngoran-Theckly, P, Kehoe, SH, Adonis, L and Weller, S (2020) Adolescent nutrition and physical activity in low-income suburbs of Abidjan, Côte d’lvoire: the gap between knowledge, aspirations and possibilities. Public Health Nutrition, 1-11.
Joshi-Reddy, K, Kamble, V, Kunte, P, Hardy-Johnson, P, Fall, CH, Barker, M and Kehoe, SH (2020) Adolescent diet and physical activity in the context of economic, social and nutrition transition in rural Maharashtra, India: a qualitative study. Public Health Nutrition, 1-10.
Weller, S, Hardy-Johnson, P, Strommer, S, Fall, C, Banavali, U, Chopra, H and Barker, M (2020) ‘I should be disease free, healthy and be happy in whatever I do’: a cross-country analysis of drivers of adolescent diet and physical activity in different low-and middle-income contexts. Public Health Nutrition, 1-11.
Wrottesley, SV, Bosire, EN, Mukoma, G, Motlhatlhedi, M, Mabena, G, Barker, M and Norris, SA (2019) Age and gender influence healthy eating and physical activity behaviours in South African adolescents and their caregivers: Transforming Adolescent Lives through Nutrition Initiative (TALENT). Public health nutrition, 1-20.
More like this
FEX: Use of media to engage school-age children and adolescents to improve their nutrition and health
View this article as a pdf By Stephanie V. Wrottesley Stephanie Wrottesley is a Nutritionist with ENN As children and adolescents age, they experience rapid physical, mental...
FEX: The link between foetal and childhood nutrition and adult non-communicable disease: lessons from birth cohort studies in India
View this article as a pdf Research summary1 Location: India What we know: Non-communicable diseases (NCDs) are rising in prevalence globally and they particularly affect...
View this article as a pdf Rah, JH, Melse-Boonstra, A, Agustina, R, van Zutphen, KG and Kraemer, K (2021) The triple burden of malnutrition among adolescents in Indonesia....
FEX: Improving the nutritional well-being of school-age children through the Nutrition-Friendly Schools Initiative (NFSI) in the State of Palestine
View this article as a pdf By Selena Bajraktarevic, Kanar Qadi, Amani Badwan, Younis Awadallah and Rania Abueita This Field Exchange report is a summary of the cumulative...
View this article as a pdf Lisez cet article en français ici Meseret Zelalem is a paediatrician and Director of the Maternal and Child Health Directorate of the...
View this article as a pdf This is a summary of the following two papers: Islam MR, Rahman SM, Tarafder C, et al. (2020). Exploring Rural Adolescents' Dietary Diversity and...
FEX: Barriers to the uptake of nutritional services among adolescent girls from rural communities in Tigray region, Ethiopia
View this article as a pdf Research snapshot1 Considerable nutritional problems attributed to an inadequate diet continue to lead to poor health status among adolescents. In...
Lisez cet article en français ici View this article as a pdf Min Raj Gyawali is the Senior Manager for Health Services with the Suaahara II programme in...
By Erin Lisemby Erin Lisemby is a registered dietitian/nutritionist currently working with the US Special Supplemental Nutrition Program for Women, Infants and Children (WIC)...
View this article as a pdf By Deepika Sharma and Vilma Tyler Deepika Sharma is a Nutrition Specialist and the focal point for the nutrition of children in school-age and...
FEX: Weekly iron and folic acid supplementation and nutrition education for adolescent girls in Africa and Asia
View this article as a pdf By Anjali Bhardwaj, Lucy Murage, Shibani Sharma, Dhian Dipo, Christine Makena, Marion Roche and Mandana Arabi Anjali Bhardwaj is the Regional...
View this article as a pdf By Julia Weatherson, Ritu Ghosh, Eriana Asri, Octavia Mariance and Firda Dewi Yani and Tutut Sri Purwanti Hnin (Julia) Weatherson is the Asia...
FEX: Adolescent Girl Power Groups in Bangladesh: Placing gender equality at the centre of nutrition interventions
View this article as a pdf By Melani O'Leary, Asrat Dibaba and Julius Sarkar Melani O'Leary is currently a Nutrition Technical Specialist at World Vision Canada and has over...
FEX: Determinants of adolescent nutritional status and practices in Burkina Faso: A pooled secondary analysis
View this article as a pdf By Deepali Godha, Maurice Zafimanjaka, Estelle Bambara, Nathalie Likhite and Manisha Tharaney. Deepali Godha is an independent researcher with...
FEX: Early lessons from Swabhimaan, a multi-sector integrated health and nutrition programme for women and girls in India
View this article as a pdf By Monica Shrivastav, Abhishek Saraswat, Neha Abraham, R.S. Reshmi, Sarita Anand, Apolenarius Purty, Rika Shalima Xaxa, Jagjit Minj, Babita...
Read a Spanish version of the article here View this article as a pdf By Angélica Hernández, Gabriela Tamez Hidalgo and Anabel Fiorella...
FEX: An integrated multi-sector approach to improve the nutritional status among school-age children and adolescents in Malawi
View this article as a pdf By Doreen Matonga, Keisha Nyirenda, Jason Chigamba and Dalitso Kang'ombe Doreen Matonga is a Communication for Development Specialist at UNICEF...
View this article as a pdf By Sara Bernardini, Geraldine Honton, Laura Irizarry, Jesús Sanz, Estefanía Castillo, Carmen Guevara and Lorena Andrade Sara...
Summary of report1 This summary was prepared by Emily Mates (ENN) who undertook the review as an independent consultant together with Tanya Khara (independent), with the...
View this article as a pdf By Sauli John, Geofrey Mchau, Heavenlight Ayubu, Stanslaus Mafung'a, Samafilan Ainan, Wiggins Kyatikila, Elizabeth Lyimo, Frank Chacky, Fatoumata...
Reference this page
TALENT Collaboration: Exploring adolescent diet and physical activity in India and sub-Saharan Africa.. Field Exchange 66, November 2021. p61. www.ennonline.net/fex/66/adolescentdietphysicalactivity