From Savings to Nutrition: How Stokvels Currently Operate and How They Could Enable Nutrition-Sensitive Interventions: A Realist Evaluation in South Africa.

内容摘要

We examined how informal rotating savings and credit associations influence food purchasing and nutrition-related behaviors in urban communities with low income, and we explored their potential as platforms for adding nutrition value to purchasing decisions and behavior change interventions. We conducted a qualitative realist evaluation guided by an Initial Programme Theory. We analyzed interview and focus group discussion data thematically to identify context-mechanism-outcome configurations shaping decision-making and food choices. Two urban communities with low income in Cape Town, South Africa. Sixty individuals from 20 grocery stokvels participated, including 20 leaders interviewed individually and 40 general members in 4 focus group discussions. Thematic analysis examined governance structures, collective decision-making, food purchasing practices, and mechanisms relevant to nutrition-focused education and interventions. Stokvels comprised 10-30 members contributing ZAR200-ZAR1500 monthly. All operated under formal constitutions, with 85% enforcing penalties for rule breaches. Bulk purchasing of staple foods, sugar, and processed meats occurred in 95% of stokvels, whereas only 1 group considered nutritional value. Stokvels were predominantly women-led (95%). Stokvels are well-governed and socially cohesive groups. While governance and collective systems generate economic leverage, they also shape purchases toward shelf-stable, nutrient-poor foods.