Community Health

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Browsing Community Health by Author "Kruger, W. H."

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    Chronic diseases of lifestyle: a risk assessment and health promotion framework for a rural and urban primary health care setting in the Free State province
    (University of the Free State, 2021) Van Zyl, Sanet; Kruger, W. H.; Walsh, C.
    Non-communicable diseases (NCDs), also known as chronic diseases (CD), are the leading cause of death globally. The World Health Organization (WHO) projects a significant increase in CD mortality rates, especially in developing countries. Chronic diseases of lifestyle (CDL) are chronic diseases that share similar modifiable risk factors resulting in long-term disease processes. The WHO's country-specific profile for NCDs illustrates the persistent high prevalence of modifiable risk factors in South Africa (SA) relating to CDL that place a significant burden on health systems. Shifting from an expensive hospital-centred acute-care approach to an affordable and effective primary health care (PHC) approach requires knowledge of communities' risk and disease profiles. Effective community-based PHC responses can reduce morbidity and mortality caused by CDL. However, detailed information relating to CDL and risk factors that maintain the risk cycle for CDL in rural and urban Free State (FS) communities is still limited. This study aimed to develop a framework to provide a better understanding of the CDL risk profiles and barriers and challenges experienced with regard to the effective implementation of CDL programmes in a rural and an urban PHC setting in the FS. A convergent mixed method design was applied in the study. Using the existing Assuring Health for All in the FS database, the quantitative study (PHASE I) aimed to compile a risk factor profile for the FS's rural and urban study populations. Qualitative data (PHASE II), obtained during focus group discussions, explored participants’ knowledge of CDL (patients with CDL) and related training programmes (PHC team members and medical students). Participants' attitudes and experiences of the practical implementation of CDL intervention programmes in these communities were also investigated. The quantitative part of the study found similarities and distinct differences in the CDL risk profiles between the urban and rural study communities. The qualitative part of the study provided insight into CDL-related health needs and current experiences of intervention programmes in the PHC settings. PHC team members indicated that CDL guidelines covered a range of diseases relevant to the SA context; however, several challenges and barriers to implementing the protocols and guidelines were identified. Focus group discussions with patients revealed, among others, staff shortages, high patient load leading to long waiting times, lack of supporting health care services, and transport as barriers to optimal health care at PHC facilities. Focus group discussions conducted with medical students confirmed the before-mentioned findings. In addition, medical students indicated that community-based education provided valuable opportunities to develop knowledge, skills, and attitudes relating to PHC. However, they highlighted the importance for students to have a contextualised understanding of the multi-factorial aetiology of CDL in different communities. A combination of quantitative and qualitative data was used to construct a CDL risk assessment and health promotion framework for the urban and rural settings. In Step 1 of developing the risk assessment and health promotion framework, identified CDL risk factors in each study population were prioritised to complete the risk assessment process. Step 2 identified CDL training needs for PHC teams, patient educational needs, and MBChB CDL curriculum development needs. Step 3 revealed three main barriers: resource constraints, patient noncompliance, and the lack of supporting healthcare services to the effective implementation of CDL programmes. Step 4, the final step, used the six main focus areas identified in steps 1-3 to develop a tailor-made community-based patient-centred approach to facilitate the development of focused and effective PHC programmes for CDL in these resource-constrained areas. This thesis contains details of the research study.
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    A public health ethics framework for the geriatric community: a South African perspective
    (University of the Free State, 2021) Lategan, Laetus Oscar Kotze; Van Zyl, G. J.; Kruger, W. H.
    At the end of her tenure (2007–2017) as Director-General for the World Health Organization (WHO), Margaret Chan (2017) published a report on the developments in public health during this period. She emphasised the growing role that social determinants can play to improve public health. The new thinking is that social determinants, and not physical challenges only, contribute to health. The downside of her comment is that social factors can also negatively influence quality of health and well-being of communities. Such a negative impact will increase the vulnerability of a community. Ethical challenges are often associated with vulnerability. This is particularly evident in thegeriatric community. A growing ageing and consequently an elderly or geriatric community will place more demands on the already challenged social and health services. This, in turn, will put more strain on the geriatric community. Statistics from the WHO’s World Report on Ageing and Health (2015) suggests that the world population older than 60 years will nearly double by 2050. This is a global phenomenon. The 2020 South African Mid-year Population Estimates Report approximates the people older than 60 years to be 9.1% of the population. This Report states that the population 60 years and above increased by 1.9 million people from 2002 to 2020. This growth represents an increase of 1.1% for the period 2002 to 2003, and 3.0% for the period 2019 to 2020. A review of literature relevant to the geriatric community obtained from databases such as Science Direct, Proquest, Taylor and Francis, Sabinet African Journal Collection and relevant National Department of Health policies, strategies and plans, suggest the apparent absence of a public health ethics framework for the geriatric community. The perspectives originating from the literature led to the research question for this study: What are the important ethical aspects to consider for a public health ethics framework for the geriatric community in the South African context? This study was based on a literature review as part of a qualitative method and the Qmethodology, which is qualitative in its information collection and data sampling but quantitative in terms of the method of analysis. Six geriatric institutions, two each from the Free State, Northern Cape and Northwest Provinces, participated in the data collection for the study. A questionnaire (Q-sort table) was completed, comprising 50 statements (Q-set) which were ranked (Q-sorting) by the twenty-two participants (P-set) from the six participating institutions. The collection of data derived from the ranking of statements was representative of three indexes: (a) an Index of Social Determinants (Questions 1 – 20); (b) an Index of Public Health Ethics (Questions 21 – 35); and (c) an Index of a Public Health Ethics Framework (Questions 36 – 50). The data collected from the ranking of statements was analysed using the Statistical Package for Social Sciences software. Information was produced based on the interpretation of the data against the literature review presented in Chapter 1. The research results are discussed in Chapters 2 – 4. From Chapter 2 it is evident that the lack of sufficient healthcare provision and the quality of healthcare provision are social determinants impacting negatively on the geriatric community’s health. These social determinants contribute to the ethical challenges experienced by the geriatric community. Chapter 3 addresses the question of what public health ethics implies for the geriatric community. Working with the geriatric community, the ethical principles of (a) respecting their vulnerability and fragility, (b) protecting their lives from abuse and neglect, and upholding dignity, (c) securing a safe environment to live in, and (d) providing quality access to healthcare and provision, were identified as the ethical basis of public health for the geriatric community. The chapter concludes that public health ethics is the application ofethical principles through a professional ethic resulting in care and relationship building. In Chapter 4 eight building blocks are identified that were used in the development of a framework for public health ethics. These building blocks are: Promote the core value of public health; • Identify the principles for public health ethics; • Recognise ethical challenges for agent and recipient of service; • Advance ethics leadership; • Introduce ethics education; • Promote social justice; • Develop ethical expertise; and • Practise care ethics. In Chapter 5 an integrated public health ethics framework for the geriatric community is presented. The perspectives presented in the literature review (cf. Chapter 1), the perspectives developed on social determinants having an impact on the geriatric community (cf. Chapters 1 & 2), and the ranking of statements (cf. Chapters 2 – 4) contributed to the development of a public health ethics framework. Based on the ranking of statements, building blocks were identified that contributed to the public health ethics framework for the geriatric community (cf. Chapter 5). These building blocks contributed to a public health ethics framework, and were grounded in normative and applied ethics and linked to virtue ethics, deontology and consequentialism. Four questions associated with ethics were posed to explain the application of the framework. These questions also assisted with the alignment of the building blocks to the basic purpose of public health, namely the organised strategies, interventions, and services to improve the health and well-being of the community or population. The questions are: (a) Are we doing things right? (b) Are we doing the right thing? (c) How can the common good be promoted? (d) What benefit is there?