From Community to Clinic: Evidence from the Eat Better South Africa Program
1
The Noakes Foundation, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Under-resourced South African communities face a high burden of type 2 diabetes (T2D), alongside hypertension, HIV, and tuberculosis, within contexts of food insecurity, limited healthcare resources, and inadequate access to sustained lifestyle support. The Eat Better South Africa (EBSA) program, developed by The Noakes Foundation, is a structured 6-week nutrition education intervention emphasising practical dietary guidance, therapeutic carbohydrate restriction, whole-food choices, and peer support. While EBSA has been evaluated in community settings, this study represents the first evaluation of the program delivered within a public primary healthcare clinic. This paper reports interim findings from an ongoing mixed-methods evaluation at Dunoon Community Health Centre, Cape Town.
METHODS:
A single-arm mixed-methods study was conducted among adults with T2D or prediabetes and comorbidities. Quantitative assessments were completed at baseline and post-intervention, with follow-up at 3, 6, and 12 months. Measures included anthropometry, blood pressure, random blood glucose, HbA1c, dietary intake, and validated psychosocial questionnaires. Qualitative data were collected through focus group discussions conducted pre- and post-intervention, with additional discussions planned at later follow-up points. Findings were integrated to examine convergence between outcomes and participant experiences.
RESULTS:
Twenty-three participants completed the intervention. Post-intervention improvements were observed across metabolic indicators, including reductions in body weight (−2.0 kg), waist circumference (−9.3 cm in women; −11.9 cm in men), systolic (−2 mmHg) and diastolic blood pressure (−3 mmHg), and random blood glucose (−1.5 mmol/L). Psychosocial outcomes improved, including diabetes self-management, medication adherence, and depressive symptoms. At 3-month follow-up, HbA1c decreased by a mean of 0.5%. Qualitative findings aligned with quantitative improvements and highlighted increased nutritional literacy, confidence, motivation, and perceived control over health, alongside structural challenges such as financial constraints.
CONCLUSIONS:
EBSA is a feasible, clinic-linked, community-informed intervention for chronic disease management in low-resource settings. Ongoing follow-up will inform sustainability and scalability within public health systems.
Under-resourced South African communities face a high burden of type 2 diabetes (T2D), alongside hypertension, HIV, and tuberculosis, within contexts of food insecurity, limited healthcare resources, and inadequate access to sustained lifestyle support. The Eat Better South Africa (EBSA) program, developed by The Noakes Foundation, is a structured 6-week nutrition education intervention emphasising practical dietary guidance, therapeutic carbohydrate restriction, whole-food choices, and peer support. While EBSA has been evaluated in community settings, this study represents the first evaluation of the program delivered within a public primary healthcare clinic. This paper reports interim findings from an ongoing mixed-methods evaluation at Dunoon Community Health Centre, Cape Town.
METHODS:
A single-arm mixed-methods study was conducted among adults with T2D or prediabetes and comorbidities. Quantitative assessments were completed at baseline and post-intervention, with follow-up at 3, 6, and 12 months. Measures included anthropometry, blood pressure, random blood glucose, HbA1c, dietary intake, and validated psychosocial questionnaires. Qualitative data were collected through focus group discussions conducted pre- and post-intervention, with additional discussions planned at later follow-up points. Findings were integrated to examine convergence between outcomes and participant experiences.
RESULTS:
Twenty-three participants completed the intervention. Post-intervention improvements were observed across metabolic indicators, including reductions in body weight (−2.0 kg), waist circumference (−9.3 cm in women; −11.9 cm in men), systolic (−2 mmHg) and diastolic blood pressure (−3 mmHg), and random blood glucose (−1.5 mmol/L). Psychosocial outcomes improved, including diabetes self-management, medication adherence, and depressive symptoms. At 3-month follow-up, HbA1c decreased by a mean of 0.5%. Qualitative findings aligned with quantitative improvements and highlighted increased nutritional literacy, confidence, motivation, and perceived control over health, alongside structural challenges such as financial constraints.
CONCLUSIONS:
EBSA is a feasible, clinic-linked, community-informed intervention for chronic disease management in low-resource settings. Ongoing follow-up will inform sustainability and scalability within public health systems.
| eISSN: | 2654-1459 |
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