Doctoral Degrees (School of Nursing)

Permanent URI for this collection

http://hdl.handle.net/11660/365

Browse

Browsing Doctoral Degrees (School of Nursing) by Advisor "Reid, Marianne"

Now showing 1 - 4 of 4
  • Thumbnail Image
    ItemOpen Access
    Enabling adult diabetes self-management in a Kenyan context: a design science research approach
    (University of the Free State, 2023) Opisa, Esther Asenahabi; Reid, Marianne; Swanepoel, Juanita
    Diabetes is one of the non-communicable conditions of which the prevalence is increasing globally, with a particularly sharp increase experienced in low and middle-income countries (LMICs). If diabetes is not managed properly, it can lead to physical complications, and increase the financial burden on the individual, the health care system and the government. Since diabetes is a chronic condition, self-management is key in the control of this condition. However, it is evident that most people diagnosed with diabetes exhibit an uncontrolled condition. This is an indication that diabetes self-management (DSM) is suboptimal among people diagnosed with diabetes. The main aim of this study was to design a context-specific product that would enable DSM by adults in Kenya. This study was anchored on the integrated model of behaviour prediction (IMBP) theory, with IMBP distal variables forming the foundation for designing the product. This study was designed using a pragmatic approach, informed by design science research (DSR). DSR comprises three cycles that are closely related. The three cycles are relevancy, design and rigour. In the relevancy cycle, the problem was investigated. Preliminary design requirements (PDRs) and design requirements (DRs) were derived. The PDRs and DRs formed part of the acceptance criteria of the product. In the design cycle, the product was finalised and its practicability determined. The iterative nature of the prototype product was due to the synthesis of data obtained during the relevancy cycle. In the rigour cycle, the prototype product was evaluated against certain evaluation criteria. The final product was then designed. These three cycles were adapted as the phases of the study. Applying the general methodology of design science research (DSR) to the current study yielded three executable phases of the research study: 1) the problem explication phase, 2) the design phase, and 3) the evaluation phase. A multiple method design was used. In the first phase, the problem explication phase, a literature overview, a scoping review and Kawa group discussions were conducted. The findings of these three methods involve a list of four IMBP distal variables, nine PDRs and six DRs respectively. In the second phase, the design phase, surveys and design were the two methods that were applied. The surveys yielded additional 13 DRs, giving a total of 19 DRs. This phase gave rise to a prototype product and the evaluation criteria that were used by diabetes experts in the third phase of the study. The third phase, the evaluation phase, involved expert reviews. Four diabetes experts evaluated the prototype product using the evaluation criteria. Their feedback was analysed and the findings factored in the development of the final product. The final product is a DSM guide that will be used mainly by adults diagnosed with diabetes, either on their own or with the aid of health care providers during clinic visits. In this last phase, design principles were also articulated, based on the DRs that emerged throughout the study. This study makes a contribution to the body of knowledge in DSR, by unearthing design principles that other researchers can use to design similar studies elsewhere. Additionally, the DSM guide that emerged in this study may contribute to improved DSM by adults diagnosed with diabetes in Kenya. A context-specific DSM product was developed through the application of the DSR approach. Alongside the DSM product, the researcher also extracted DRs and design principles, which are the knowledge contribution of this study to DSR.
  • Thumbnail Image
    ItemOpen Access
    A face-to-face peer support model for patients with type 2 diabetes
    (University of the Free State, 2020-07) Pienaar, Melanie; Reid, Marianne
    Background: Prevalence of Type 2 diabetes has reached pandemic proportions globally. New and effective ways are needed to improve diabetes self-management. However, many barriers to self-management exist, such as lack of support, lack of resources, geographical constraints and lack of knowledge, which may be fuelling the increase of Type 2 diabetes. Face-to-face peer support may have the potential to improve self-management in Type 2 diabetes. Purpose: The purpose of the study was to establish the feasibility of a face-to-face peer support model for patients with Type 2 diabetes in a sub-district in the Free State province of South Africa. Methods: Multiple research methods, guided by the integrated model of behaviour prediction, were used to establish the feasibility of a developed face-to-face peer support model developed for patients with Type 2 diabetes. In the first stage of the study, a systematic review, guided by the steps of the Cochrane Collaboration (2006), was conducted to critically synthesise the best available evidence on face-to-face peer support models for adults with Type 2 diabetes in low and middle-income countries. Multiple data sources were consulted for the period January 2000 to December 2017. Screening and selection of papers followed, as well as critical appraisal and data extraction, by at least two reviewers and, finally, narrative synthesis was done. The synthesised data of the systematic review informed the pilot of the face-to-face peer support model. The second stage of the study established the impact of the implemented face-to-face peer support intervention on adults with Type 2 diabetes in South Africa. A cluster randomised control trial was conducted involving adults with Type 2 diabetes from six communities in a semi-urban rural area in the Free State province. Three communities were randomly allocated to the intervention group and three to the control group. Trained community health workers provided monthly group sessions and home visits to the intervention group. The control group received their usual care. The primary outcome of the study was taken as glycated haemoglobin measured by the BioHermes Automatic Glycohemglobin Analyzer; secondary outcomes were blood pressure, waist circumference and body mass index. Outcomes were assessed at baseline and after four months. Descriptive statistics was determined per group. The last stage of the study determined the experiences of the patients with Type 2 diabetes who took part in the face-to-face peer support intervention. Sesotho-speaking women who participated in the face-to-face peer support intervention were purposively sampled, and took part in this visual-based narrative inquiry. Textual and visual data was collected using the Mmogo-method® and data was analysed thematically. Results: In the systematic review, Stage 1 of the study, two common models of face-to-face peer support were identified for low and middle-income countries, namely, diabetic patients and community health workers. Essential components were highlighted for the planning and implementation of these models, such as recruitment, selection, training and supervision of peer supporters, as well as the nature of the peer intervention. The cluster randomised controlled trial study, Stage 2 of the study, resulted in a significant improvement in diastolic blood pressure of individuals (P=0.02) in the intervention group. No differences were, however, found from baseline between groups regarding the variables glycated haemoglobin (P=0.87), systolic blood pressure (P=0.13), body mass index (P=0.21) and waist circumference (P=0.24). The Mmogo-method®, Stage 3 of the study, showed that the participants valued the face-to-face peer support intervention and acknowledged community health workers as an important source of support to them. Participants expressed that the intervention helped them to make positive lifestyle changes, and because they were exposed to the support continuously, their confidence in the self-management of diabetes improved. Conclusions: The study demonstrated that, despite modest results, a face-to-face peer support model for patients with Type 2 diabetes that involves community health workers is feasible and valuable in low and middle-income countries like South Africa.
  • Thumbnail Image
    ItemMetadata only
    An mHealth communication framework for caregivers of adolescents with mental health issues
    (University of the Free State, 2020-06) Jansen, Ronelle; Reid, Marianne
    This study focused on developing an mHealth communication framework for rural caregivers of adolescents with mental health issues. Adolescents carry a high burden of mental health issues. Their caregivers, usually parents, relatives or community members, play a pivotal role in caring for these adolescents, which causes challenges for the caregivers. Caregivers in rural settings face specific challenges relating to adolescents with mental health issues, leading to unmet support needs. The potential value of using communication technology to support rural caregivers has been recognised by research. The aim of the study was to develop an mHealth communication framework for caregivers of adolescents with mental health issues in the Kopanong municipality of the Free State province of South Africa. This study is best conceptualised as the developmental phase of a complex intervention. A pragmatic study was undertaken by employing a multiple method design and harnessing a three-phase approach that was guided by the theory-of-change logic model, while the integrated model of behaviour prediction (IMBP) served as a conceptualisation of the programme that targeted rural caregivers. Phase 1 implemented a visual-based narrative inquiry that collected data through the Mmogomethod®, and aimed to explore caregivers’ interest in using communication technology in two towns of the Kopanong municipality in the Free State province of South Africa. The researcher collected data from rural caregivers (n=17) comprising three groups in the towns of Springfontein and Trompsburg. Through a stepwise literature-based process for investigating textual and visual data, the researcher identified four themes. Three themes represent challenges facing caregivers, namely, psychosocial, social resources and informational challenges. Interest in communication technology was the fourth theme. Caregivers favoured using SMS (short messaging service), phone calls and computers. In Phase 2, literature was reviewed systematically to find the best evidence available to strengthen positive behaviour by caregivers of adolescents with mental health issues by using communication technology interventions. Five articles out of an initial 1 746 articles met the eligibility criteria and were included in the data synthesis. The researcher derived three thematic conclusions: 1) The target population included parents and family members serving as caregivers; 2) Caregivers experienced improved IMBP determinants (self-efficacy, knowledge, parent/child communication, parental skills), which was reflected in positive behaviour; and 3) Caregivers used various types of communication technologies (SMS, emails, phone calls, online communication, social media). Findings from these two phases were triangulated to develop a draft framework based on the theory-of-change logic model components. The completed draft framework was presented to expert stakeholders in the third phase during a workshop. Phase 3 comprised a one-day validation workshop that was attended by nine expert stakeholders involved in various adolescent healthcare settings. An experienced facilitator coordinated the workshop, thereby enabling a discussion on each component suggested in the theory-of-change logic model, using forward and backward mapping. Expert stakeholders contributed to three theory-of-change components depicted in the framework, specifically, community needs, desired results, and evidence-based strategies, to finalise the framework. This validation workshop concluded after consensus was reached on the final framework. Through evidence-based research, the framework can facilitate a programme for supporting caregivers through an mHealth initiative that results in positive caregiver behaviour change. This framework for an mHealth initiative for rural caregivers of adolescents with mental health issues illustrates the development phase of a complex intervention. Piloting this framework will be the next phase. The researcher will participate in the piloting, with the Free State Department of Health being a key stakeholder.
  • Thumbnail Image
    ItemOpen Access
    A mobile health communication framework for postnatal care in rural Kenya
    (University of the Free State, 2020-06) Mbuthia, Florence; Reid, Marianne; Fichardt, Annali
    Background: Maternal and neonatal health remains a major challenge in low- and middle-income countries, resulting in the burden of a high rate of maternal and neonatal deaths. Postnatal care is an intervention recommended by the World Health Organization to promote maternal and neonatal health. In spite of this recommendation, uptake of postnatal care in Kenya, as in many other sub-Saharan African countries, has remained low, particularly in rural areas, despite targeted postnatal care services being implemented. Mobile health communication is proposed to promote the uptake of postnatal care; however, no theory-based framework has been developed in this regard to date. This study, therefore, aimed to develop a mobile health communication framework for postnatal care in rural Kenya. Methods: A multi-method research design guided the development of the framework through a multi-phased approach. The first phase systematically reviewed literature to gather the best available evidence on how mobile health communication could strengthen postnatal care in rural areas. The second phase of this study used a visual-based narrative inquiry to explore the experiences of postnatal mothers with health care providers and their views on mobile health communication in a rural area in Kenya. In the final phase, the findings of the preceding phases were used to draft the framework, which was validated by policymakers from the same rural area where data had been gathered. The theoretical underpinning of the study was provided by both the integrative model of behaviour prediction and the theory of change logic model. The integrative model of behaviour prediction was used to identify determinants of postnatal care uptake, while theory of change logic model underpinned the development of the mobile health communication framework by describing what the framework comprised. Results: The findings of the systematic review reveal that one-way messaging is the most common type of mobile health communication that is used in an attempt to strengthen postnatal care in rural areas. Evidence reveals that mobile health communication can be used to improve uptake of postnatal care by influencing the critical determinants that predict behaviour uptake, which are, according to the integrative model of behaviour prediction, intention, skills and environmental factors. The findings also reveal that changing beliefs related to attitudes, perceived norms and self-efficacy can enhance the intention to use postnatal care. Mobile health communication can enhance the skills necessary to use postnatal care, such as breastfeeding, cord care, thermal care, delayed bathing of babies, safer sleep practices, care-seeking and problem-solving. The environmental factors that are considered to hinder uptake of postnatal care in rural areas, and which can be reduced by use of mobile health communication, were inaccessibility, unavailability and unaffordability. The findings of the visual-based narrative inquiry reveal that postnatal mothers had expectations of health care providers, with some expectations being met, and others not. The postnatal mothers reported having positive experiences with their health care providers as a result of the physical and emotional support they received. The positive experiences had various outcomes for both mothers and their children. The findings also reveal that postnatal mothers had expectations of mobile health communication, viewing it as a way in which health education and psychological support in relation to postnatal care could be provided. In addition, they expressed positive attitudes towards mobile health communication – they regarded it as useful for improving access to health care providers, and the availability of and access to the health facility. From the validation exercise, guided by theory of change logic model, a mobile health communication framework for postnatal care in rural Kenya was developed. The model helped to address the problem caused by the absence of a mobile health communication framework in rural areas, by linking postnatal mothers’ needs, the desired results, influential factors and strategies. In addition, the assumptions behind the effectiveness of the framework were highlighted. The framework that was developed integrated the integrative model of behaviour prediction and theory of change logic model. In addition to the models, both users and policymakers’ inputs were incorporated, as was additional literature, which strengthened the framework. Conclusion: In this study, a theory-based mobile health communication framework for postnatal care in rural Kenya was developed on the basis of the best evidence available on mobile health communication, and users’ and the policymakers’ inputs. Given that the mobile health communication framework was developed on the basis of the contextual realities of rural Kenya, its piloting and implementation is recommended, as it is likely to improve the uptake of postnatal care, as well as both maternal and neonatal health, thereby helping to address the high rate of maternal and neonatal mortality, especially in rural settings and in low- and middle-income countries.