Ghanaian Female Adolescents Perceived Changes in Nutritional Behaviors and Social Environment After Creating Participatory Videos: A Most Significant Change Evaluation

Abstract

Background: Understanding the influence of participatory video-making on the nutrition-related behavior of video creators may help shape nutrition education interventions. Objectives: This study assessed the perceived value and influence of a participatory video intervention among participants and stakeholders. Methods: A 2018–2019 cluster randomized controlled trial (registered at clinicaltrials.gov as NCT03704649) selected 20 schools (10 intervention, n = 181; 10 control, n = 170) in 1 Ghanaian rural district, enrolled adolescent girls aged 13–16 y, and provided a nutrition curriculum. Each intervention school also participated in 2 series of activities designed to help adolescents plan, film, and screen 2 nutrition-related videos. The Most Significant Change method involved intervention participants and local stakeholders to assess the value and influence of the intervention – a secondary outcome of the trial. Project staff collected 116 stories of change from the adolescents. Stories described shifts in 4 domains: participant, peer, and family behavior, and structural changes in the school. The project team used a selection rubric to identify 14 stories that reflected heightened nutrition literacy. Staff conducted interviews with the 14 adolescents whose stories were selected to elaborate on details and perceived resonance. Finally, local stakeholders assessed the stories to identify the 4 most significant changes of the intervention – 1 per domain. A separate thematic analysis identified emerging patterns of motivation and action across the 14 interviews. Results: The chosen Most Significant Change stories revealed how adolescents found creative solutions to acquire iron-rich foods, encouraged neighbors to eat iron-rich foods, taught their family new agricultural practices, and promoted change in their school canteen. Local stakeholders valued stories that addressed common community nutrition issues in a creative and sustainable way, whereas adolescents prioritized stories that showed a change in health outcomes. Conclusion: Stories of change revealed that the intervention promoted a transformative influence; participants modified their eating habits, lifestyle, and their environment.