In short

• The HSRC’s FASTA study in KwaZulu-Natal shifts nutrition research from studying young people to actively involving them in designing solutions.
• Researchers used focus groups with adolescents to understand their experiences of diet, physical activity and wellbeing before developing a mobile health app.
• Young participants highlighted the importance of mental wellbeing alongside nutrition and exercise, leading researchers to incorporate it into the intervention.
• The study demonstrates that effective nutrition interventions require meaningful youth participation and should be designed with young people rather than for them.

Young people in South Africa have long been the subjects of nutrition research. A HSRC-led study in KwaZulu-Natal is changing that by engaging with adolescents as active participants in designing a mobile health intervention that speaks to their lived experiences around diet, physical activity and mental wellbeing. 

AI generated image, ChatGPT

In earlier phases of nutrition research, young South Africans were largely treated as subjects of study: weighed, assessed and reported on. Their bodies told a story that researchers translated into policy. 

This work was rigorous and necessary, and it helped to build a strong national evidence base. However, while initial nutritional challenges facing young people have evolved, the role they play in shaping responses has not kept pace. This raises a simple but urgent question: Are we genuinely co-creating nutrition interventions with young people, or are we still only measuring them? 

The HSRC has conducted two of the largest household-based national surveys on nutrition, the South African National Health and Nutrition Examination Survey (SANHANES) in 2012 and the National Food and Nutrition Security Survey (NFNSS) in 2023. These surveys provided critical population-level data on nutrition indicators such as stunting and overweight/obesity. The findings have been instrumental in shaping South Africa’s public health and social development policies. Yet surveys alone don’t drive behaviour change. Targeted, context-sensitive nutrition interventions remain essential.  

Why co-creation matters 

Co-creation in public health is not merely about making research more participatory. It is grounded in the recognition that those most affected by a problem hold valuable lived experiences and knowledge about it. Without this knowledge, interventions risk being ineffective.  

For adolescents and young people, food choices are shaped by complex and overlapping influences: peer dynamics; food environments in the home, community, school and tertiary institutions; social media marketing; and shifting cultural norms around food, body image and what it means to eat well.  

Behaviour change strategies that treat young people as passive recipients of information are unlikely to succeed. Effective nutrition interventions should speak to their lived experiences, creating space for young people to contribute, reflect and act on their own health decisions, where their voices are heard and they are given the opportunity to make informed decisions about their own health.  

The FASTA study: listening before building 

A compelling example of this shift is the HSRC-led Feasibility and Acceptability of Smartphone Technology for Adolescent Obesity Prevention (FASTA) study, conducted in the poverty-challenged iLembe District of KwaZulu-Natal.  

The iLembe District presents a challenging nutrition landscape. It is characterised by the triple burden of malnutrition, where undernutrition, food insecurity and rising rates of overweight and obesity coexist within the same communities, even within the same communities and households, as reported in the NFNSS KwaZulu-Natal Province Report (2023).  

Many children grow up in contexts of significant poverty, where food access is constrained not only by cost but by the limited availability of diverse, nutritious foods. At the same time, cheap, energy-dense and nutrient-poor foods are often the most accessible option. The food environments young people navigate daily, at home, at school tuck shops, and in their communities, tend to reinforce these patterns.  

Understanding this context is essential: it explains not only why targeted nutrition interventions are needed in iLembe, but why they must be designed with, and not merely for, the young people who live within it. 

What distinguishes FASTA from other top-down nutrition interventions is its methodology. Rather than designing an intervention and delivering it to young people, the study began by listening to them.  

In its first phase, FASTA used focus group discussions with Grade 5 learners (aged 10 to 12 years) to explore their understanding of diet and physical activity, their cultural beliefs, and their views on whether mobile technology, in the form of an app, has a place in addressing their health.  

During the focus group discussions, learners spoke about how exercise and eating well made them feel good, connecting physical activity and diet to their emotional wellbeing and sense of self. These unprompted reflections signalled to the research team that mental wellbeing was already woven into how young people understood and experienced health. In qualitative and participatory research, such insights carry weight not because of how many voices raised them, but because of what they reveal about lived experience. Mental wellbeing was therefore incorporated as a core component of the app alongside diet and physical activity, a decision grounded in both the emerging evidence base on adolescent mental health and the learners’ own expressed realities. 

These insights directly influence the next phase: the development of a mobile app shaped by the voices of the young people it is intended to serve, using culturally and contextually specific language, activities and messages drawn from their lived realities. The app content will be pre-tested with another group of Grade 5 learners later in 2026, who will provide feedback through focus group discussions, enabling the research team to identify gaps, address challenges, and refine the app accordingly.  

From consultation to genuine participation 

It is important to understand that co-creation is not homogeneous. Consulting young people during intervention design is not the same as involving them in shaping research questions, funding priorities or implementation decisions. It also raises the question of whose voices are included. Participatory nutrition research often reaches those already connected to schools, digital platforms, or established research networks. By situating the FASTA study in iLembe – a context where high levels of overweight and obesity coexist with significant stunting and food insecurity – the project begins to address this gap. It also illustrates the importance, and difficulty, of engaging young people whose perspectives are often overlooked.  

Across sub-Saharan Africa, meaningful youth participation in health research and intervention design remains limited. Expanding this participation is essential for relevance, uptake and impact. 

The way forward 

To improve the nutrition profile of our youth, we cannot focus only on how nutrition and burdens of disease have changed over the years. We also need to engage and listen to our youth so we can incorporate their contributions and ideas into the design and implementation of effective nutrition interventions. If earlier research positioned youth as data, the next phase must recognise them as co-creators of solutions that affect and aim to improve their lives. 

The FASTA project is ongoing. Publications on the first phase of FASTA are currently under review and will be disseminated in due course. 

Research contacts and acknowledgements 

This Review article was written by Dr Natisha Dukhi and Dr Whadi-ah Parker from the HSRC’s Public Health, Societies and Belonging Division. It was based on a paper from a novel study titled Evaluation of the Feasibility and Acceptability of Smartphone Technology in Delivering Diet and Physical Activity Interventions for Adolescent Obesity Prevention (FASTA), which is currently under review. For more information about this work, please contact Dr Natisha Dukhi at ndukhi@hsrc.ac.za.