Doctoral Degrees (School of Nursing)
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Browsing Doctoral Degrees (School of Nursing) by Author "Botma, Y."
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Item Open Access A framework to expand public health services to HIV exposed and HIV positive children(University of the Free State, 2009-07) Reid, Marianne; Botma, Y.The aim of this study was to develop a framework to expand public health care services to HIV exposed and HIV positive children in the Free State. The objectives set in order to meet the aim were to identify strategies to expand health care services to these children and to then develop a framework to expand health care services to them within the Free State public health sector. The study consisted of various component projects, depicted as phases. The researcher conducted two components, Phase 1b and Phase 2 which links to the fore mentioned objectives of the study. A colleague, conducting research as Master student, conducted Phase 1a of the study, describing health care services rendered to HIV exposed and HIV positive children in the Free State public health sector. The researcher was intimately involved in Phase 1a, as she was acting as co-study leader. Health policy research was used, which is a type of health systems research, in an effort to inform higher levels of health on policy choices. Health managers were therefore active stakeholders in the development of the framework. The identification of strategies to expand health care services to HIV exposed and HIV positive children were one such activity where stakeholders assisted in the development of the framework. The Nominal Group Technique was used to identify mentioned strategies. A draft framework was developed using the Theory-of-Change Logic model as theoretical underpinning of the framework, with the empirical foundation being based on triangulated data obtained from literature findings, Phase1a and Phase 1b of the study. During a workshop with stakeholders, the framework was finalized, providing stakeholders the opportunity to validate the identified problem, namely that of fragmented care being delivered to HIV exposed and HIV positive children, due to over-verticalisation of programs. The validation of the framework was completed by confirming the desired results, possible influential factors that could impact on the results, as well as strategies that could be followed to expand health care services to fore mentioned children. Since health policy research only informs policy choices, the extent to which the framework will actually inform policy is in the hands of the Free State Department of Health.Item Open Access Models of care for antiretroviral treatment delivery : a faith-based organization's response(University of the Free State, 2012-04-14) Wilke, Marisa; Botma, Y.; Stark, R.; Van Rensburg, H. C. J.Background: Since 1849, Catholic religious have provided health services in South Africa. They have established hospitals, clinics, and have provided community-based preventive and curative services throughout the country. Today faith-based organizations (FBOs) continue to play an important role in healthcare delivery and are crucial to the goal of providing universal access to antiretroviral therapy (ART). In order to scale up HIV care and treatment, there is a need to describe and analyze ART models of care (MOC) that address the challenges faced by developing countries. The South African Catholic Bishops’ Conference (SACBC) manages twenty ART clinics in medically underserved South African communities, where the need is great, but the resources limited. These SACBC managed ART clinics operate on different MOC. A study to describe, analyze and compare the different MOC can inform future directions in healthcare delivery in resource-constrained settings. Method: A single case-study design was used to describe, analyze and compare four different MOC (managed by the SACBC) for ART delivery, as embedded units of analysis. A mixed method approach was used, incorporating qualitative and quantitative information. Data were collected using structured interviews (n=1,006 adult ART patients), file audits (n=1,006 files of the respondents), semistructured interviews (n=27 healthcare workers) and nominal groups (n=12 groups with Home Based Care-workers). Descriptive and inferential data analyses were conducted by a biostatistician from the Department of Biostatistics at the University of the Free State and the researcher. Findings: In the study, patients accessed care late (CD4=119 cells/mm3). Decentralized care provided better access. Family members are a potential source of support because disclosure rates to relatives and others were high (95.63%). Nurse-driven, doctor supported care was not inferior to doctor-driven care. Task-shifting to registered nurses and HBC-workers can be implemented successfully with support. Differences exist between the South African Government (SAG) -managed model and the FBO–managed models. Partnership between the SAG and FBO strengthened the SAG-managed MOC, while capitalizing on the sustainability of the government services. Functional information systems, developed by the FBO, were implemented at all the MOC in 2009. All the MOC focused on acute care. Conclusions: Nurse-driven decentralized service can most effectively and appropriately address the chronic nature of HIV and strengthen the healthcare system by a paradigm shift to a chronic care model. Based on the findings, a chronic care model was adapted for South Africa that has seven elements: (1) an integrated, decentralized chronic care system based within a primary health setting; (2) partnerships with NGOs; (3) an effective information management system; (4) patients and their families; (5) self-management support to patients; (6) provider decision support and (7) delivery system redesign. Implications for the nursing profession include adaptation of focus and training, as well as the recognition of the nurse practitioners/specialist role in South Africa.