Periodic Reporting for period 1 - Changemaker (Promoting co-designed sustainable health interventions with young changemakers for reduced risk of non-communicable diseases (NCDs) in urban Burkina Faso, Kenya and Tanzania )
Periodo di rendicontazione: 2024-01-01 al 2025-06-30
Many countries in sub-Saharan Africa are now experiencing the double burden of nutrition with both persistent under nutrition, and growing rates of overweight and obesity. In LMICs, unhealthy diets are responsible for nearly half of all NCD related deaths. The Changemaker project involves a collaborative approach with adolescents in three urbanizing cites in Burkina Faso, Kenya, and Tanzania (Figure 1) to address this double of nutrition. Adolescents are a critical target population as it is an important period when behaviors and patterns form that can last throughout the lifespan. Approximately 70% of premature adult deaths can be associated with behaviors that began in adolescence, according to the WHO. Thus, the Changemaker project aims to implement and evaluate a co-designed sustainable health intervention program on health, nutrition, and environmental outcomes for the primary prevention of adolescent malnutrition and other related NCDs.
Figure 1. Changemaker Project Settings
The Changemaker intervention comprises four key components, utilizing a whole-systems approach. The interventions work synergistically to increase impact. These components include:
1) creating urban farms in schools,
2) delivering sustainable health- classroom modules,
3) providing health counselling that use motivational interviewing (MI) techniques, and
4) conducting mass media campaigns (MMC) to encourage healthy lifestyle practices.
Figure 2. Changemaker Intervention Components
Please see our website: https://changemaker.ki.se/(si apre in una nuova finestra) or social medias @changemaker_grp for more information and updates!
Figure 1. Changemaker Project Settings
The Changemaker intervention comprises four key components, utilizing a whole-systems approach. The interventions work synergistically to increase impact. These components include:
1) creating urban farms in schools,
2) delivering sustainable health- classroom modules,
3) providing health counselling that use motivational interviewing (MI) techniques, and
4) conducting mass media campaigns (MMC) to encourage healthy lifestyle practices.
Figure 2. Changemaker Intervention Components
Please see our website: https://changemaker.ki.se/(si apre in una nuova finestra) or social medias @changemaker_grp for more information and updates!
The Changemaker project has made significant strides in the first part of the project towards understanding the context, developing the intervention, preparing for implementation, and planning for evaluation. Our research project has five main parts: formative desk research, co-designing for intervention development and implementation strategies, intervention implementation, a randomized control trial, and a process evaluation. Each of these stages is well underway within the first period of the project.
Formative Research: To build on existing knowledge and contextually relevant information, we conducted a context assessment and stakeholder analysis using desk reviews and team expertise. Six literature reviews are underway on the components, barriers and facilitators of implementation, and implementation frameworks. Additionally, a systematic review on multi-needs theories, models and frameworks aims to develop a suitable framework for the project.
Co-design: In this project, we are adopting a cascading co-design approach to engage adolescents, parents, community members, teachers, agriculture experts, school administration and other local stakeholders in the adaptation and contextualization of the intervention components. The co-design is being conducted in a four-stage process with an initial discover phase which includes focus group discussions and in-depth interviews with key stakeholders to gather initial insights, understand and create phases that involve interactive workshops and prototyping of ideas, and an implement phase with multilevel workshops to refine the implementation strategies. We have completed the discover phase and the first cascade of the understand, create, and implement phase focusing on the development and refinement of the first two intervention components (urban farming and sustainable health modules). The results are currently being analyzed and integrated into a detailed and concrete implementation manual for each of the three sites. A further set of workshops for second cascade for the next two components (motivational interviewing and mass media campaign) will be conducted throughout the remainder of 2025.
Implementation: The three sites are currently preparing for implementation through working on the implementation manual, developing detailed timelines, and beginning procurement. The intervention will be implemented in a cascading approach with urban farming and sustainable health modules being implemented in the first part of the academic year followed by the motivational interviewing and mass media campaigns. Implementation is planned for the last quarter of 2025 in Kenya and Burkina Faso and the first part of 2026 in Tanzania.
Trial: Three cluster-randomized controlled trials (RCTs) will be implemented over one academic year to assess the impact of the Changemaker intervention on health, nutrition and environmental outcomes with a baseline and endline data collection. We have selected and randomized the four schools in each site with two intervention and two control schools. The data collection tools for biometric and survey-response data have been developed. In July 2025 a workshop for the training-of-trainers was held in Dar es Salaam. Baseline data collection will begin in the remainder of 2025 and early 2026. The goal is to recruit 190 adolescents in the target grades at each school for a total sample size of 760 students.
Process Evaluation: Implementation evaluation will be guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework to create a Theory of Change model. The evaluation focuses on understanding the program's influence, adoption, implementation, sustainability, reach, and overall effectiveness. Currently, we have an initial version of a project wide ToC which is to be adjusted to each country site. There is also on going work to refine the monitoring and evaluation tools that will be used to assess the implementation process of the four intervention components.
Formative Research: To build on existing knowledge and contextually relevant information, we conducted a context assessment and stakeholder analysis using desk reviews and team expertise. Six literature reviews are underway on the components, barriers and facilitators of implementation, and implementation frameworks. Additionally, a systematic review on multi-needs theories, models and frameworks aims to develop a suitable framework for the project.
Co-design: In this project, we are adopting a cascading co-design approach to engage adolescents, parents, community members, teachers, agriculture experts, school administration and other local stakeholders in the adaptation and contextualization of the intervention components. The co-design is being conducted in a four-stage process with an initial discover phase which includes focus group discussions and in-depth interviews with key stakeholders to gather initial insights, understand and create phases that involve interactive workshops and prototyping of ideas, and an implement phase with multilevel workshops to refine the implementation strategies. We have completed the discover phase and the first cascade of the understand, create, and implement phase focusing on the development and refinement of the first two intervention components (urban farming and sustainable health modules). The results are currently being analyzed and integrated into a detailed and concrete implementation manual for each of the three sites. A further set of workshops for second cascade for the next two components (motivational interviewing and mass media campaign) will be conducted throughout the remainder of 2025.
Implementation: The three sites are currently preparing for implementation through working on the implementation manual, developing detailed timelines, and beginning procurement. The intervention will be implemented in a cascading approach with urban farming and sustainable health modules being implemented in the first part of the academic year followed by the motivational interviewing and mass media campaigns. Implementation is planned for the last quarter of 2025 in Kenya and Burkina Faso and the first part of 2026 in Tanzania.
Trial: Three cluster-randomized controlled trials (RCTs) will be implemented over one academic year to assess the impact of the Changemaker intervention on health, nutrition and environmental outcomes with a baseline and endline data collection. We have selected and randomized the four schools in each site with two intervention and two control schools. The data collection tools for biometric and survey-response data have been developed. In July 2025 a workshop for the training-of-trainers was held in Dar es Salaam. Baseline data collection will begin in the remainder of 2025 and early 2026. The goal is to recruit 190 adolescents in the target grades at each school for a total sample size of 760 students.
Process Evaluation: Implementation evaluation will be guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework to create a Theory of Change model. The evaluation focuses on understanding the program's influence, adoption, implementation, sustainability, reach, and overall effectiveness. Currently, we have an initial version of a project wide ToC which is to be adjusted to each country site. There is also on going work to refine the monitoring and evaluation tools that will be used to assess the implementation process of the four intervention components.
The Changemaker project has laid a strong foundation for our implementation and evaluation. These efforts are shaping context-specific strategies to reduce NCD risks and promote long-term health and social benefits for adolescents.
Early achievements include the completion of stakeholder mapping and context assessments, the creation of a multi-actor governance structure, and conducting of several scoping and grey literature reviews. These along with interviews, focus group discussions, photo elicitation sessions, and workshops supported the early development of the first two co-designed intervention components. The project also initiated a robust trial infrastructure with harmonized protocols, ethical approvals, and data collection tools to evaluate health, nutrition, and environmental outcomes. A monitoring structure is also in progress to assess the implementation process of the four intervention components across the three sites. The consortium developed tailored implementation strategies, initiated a Theory of Change framework, and began drafting tools for fidelity and impact evaluation. These efforts position the project to inform scalable, context-sensitive policies and interventions that reduce adolescent NCD risk and promote long-term community health and resilience.
More results to come as the analysis of co-design progresses, baseline data is collected, and implementation gets underway later this year.
Early achievements include the completion of stakeholder mapping and context assessments, the creation of a multi-actor governance structure, and conducting of several scoping and grey literature reviews. These along with interviews, focus group discussions, photo elicitation sessions, and workshops supported the early development of the first two co-designed intervention components. The project also initiated a robust trial infrastructure with harmonized protocols, ethical approvals, and data collection tools to evaluate health, nutrition, and environmental outcomes. A monitoring structure is also in progress to assess the implementation process of the four intervention components across the three sites. The consortium developed tailored implementation strategies, initiated a Theory of Change framework, and began drafting tools for fidelity and impact evaluation. These efforts position the project to inform scalable, context-sensitive policies and interventions that reduce adolescent NCD risk and promote long-term community health and resilience.
More results to come as the analysis of co-design progresses, baseline data is collected, and implementation gets underway later this year.