This research proposal explores the effectiveness of the Eat Better South Africa (EBSA) community-based nutrition education program in improving physical and mental health outcomes among individuals living with Type 2 Diabetes (T2D) and those at risk of developing it,
particularly in the under-resourced community of Dunoon, Cape Town. The study follows a two-phase mixed-methods approach and aims to generate evidence on how lifestyle changesāfocusing primarily on therapeutic carbohydrate restriction and reduction of ultra-processed foodsācan influence metabolic, immune, and psychosocial health, especially in individuals managing multiple chronic conditions such as HIV and tuberculosis (TB) alongside diabetes.
The first phase of the study focuses on engaging healthcare providers at the Dunoon Community Health Centre (CHC). These practitioners are equipped with continuous glucose monitors (CGMs) for a two-week period to gain firsthand experience of how daily lifestyle factors influence blood glucose levels. Their perceptions and experiences are then explored through focus group discussions, where they also provide recommendations for adapting the EBSA program to better meet the needs of patients facing multiple co-morbidities. This phase serves not only to gather qualitative insights into current healthcare challenges but also to bridge the gap between clinical practice and patient-centred lifestyle interventions. This component of the research is currently being concluded, with qualitative data now under analysis.
In the upcoming second phase, these insights will inform the implementation of an enhanced 6-week EBSA intervention with 50 participants from the Dunoon CHC diagnosed with or at risk for T2D, many of whom are also living with HIV or TB. Participants will attend weekly education sessions focused on making accessible, sustainable dietary changes with the support of trained EBSA community coaches. Alongside this, they will receive regular health monitoring, including assessments of blood glucose, insulin resistance, cholesterol, blood pressure, and body composition, as well as comprehensive questionnaires capturing food intake, medication adherence, mental health, quality of life, and self-efficacy. Focus group discussions will also be held before and after the intervention, and again at 12 months, to explore participants’ experiences, behaviour changes, and ongoing challenges.
This study holds significant public health relevance in South Africa, where the dual burden of communicable and non-communicable diseases, particularly in low-income communities, places enormous strain on healthcare resources. By investigating how a grassroots nutrition education program can support better management of diabetes and associated comorbidities, the research aims to inform scalable solutions that are culturally and economically appropriate. The program’s focus on community empowerment, education, and support aligns with growing calls for holistic, preventative models of chronic disease care.