Centre for Health Systems Research & Development

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Open Access
Mentoring children guilty of minor first-time crimes: methods, strengths and limitations
(University of the Free State, 2012) Steyn, Francois; Louw, Dap; Van Rensburg, Dingie
English: In the absence of evidence regarding the impact of mentoring on child offenders in South Africa, this article explores the strengths and limitations of this approach in a local context. It investigates the theory and methods of mentoring, and presents a case study of the strategy as practised by the National Youth Development Outreach in Pretoria. Mentoring appears ineffective for children with hardened negative attitudes and chronic offending as their value preferences may contradict those of mentors. Three months are insufficient to establish meaningful relationships and achieve mentoring goals. Reconciliation – a central objective of the Child Justice Act (75 of 2008) – is difficult to achieve given the absence of victims in the mentoring process.
Open Access
Construct validity and reliability of the generalised anxiety disorder-7 scale in a sample of tuberculosis patients in the Free State Province, South Africa
(AOSIS, 2021) Kigozi, Gladys
Background: Generalised anxiety disorder (GAD) frequently occurs amongst patients with tuberculosis (TB) and contributes to poor quality of life and treatment outcomes. This study evaluated the construct validity and reliability of the GAD-7 scale in a sample of patients with TB in the Free State Province. Methods: A pilot study was conducted amongst a convenience sample of 208 adult patients newly diagnosed with drug-susceptible TB attending primary healthcare (PHC) facilities in the Lejweleputswa District in the Free State. A structured interviewer-administered questionnaire comprising social demographic questions and the GAD-7 scale was used. Confirmatory factor analysis was used to investigate the construct validity of the GAD-7 scale. The reliability of the scale was assessed by calculating Cronbach’s α. Results: The analysis showed that a modified two-factor (somatic symptoms and cognitive-emotional symptoms) model, in which the items ‘Not being able to stop or control worrying’ and ‘Worrying too much about different things’ were allowed to covary (Comparative Fit Index: 0.996, Tucker–Lewis Index: 0.993, Root Mean Square Error of Approximation: 0.070, 90% confidence interval: 0.032–0.089), fitted the data better than a unidimensional (generalised anxiety) or an unmodified two-factor model. The indicators all showed significant positive factor loadings, with standardised coefficients ranging from 0.719 to 0.873. The Cronbach’s alpha of the scale was 0.86. Conclusion: The modified two-factor structure and high internal consistency respectively provide evidence for construct validity and reliability of the GAD-7 scale for assessing GAD amongst patients with TB. Studies are necessary to assess the performance of this brief scale under routine TB programme conditions in the Free State.
Open Access
Post-traumatic stress and coping strategies of South African nurses during the second wave of the COVID-19 pandemic
(MDPI, 2021) Engelbrecht, Michelle C.; Heunis, J. Christo; Kigoze, N. Gladys
Prior to the 2019 novel coronavirus (COVID-19) outbreak, the South African healthcare system was already under severe strain due to amongst others, a lack of human resources, poor governance and management, and an unequal distribution of resources among provinces and between the public and private healthcare sectors. At the center of these challenges are nurses, the backbone of the healthcare system, and the first point of call for most patients in the country. This research investigated post-traumatic stress and coping strategies of nurses during the second wave of COVID-19 in the country. A structured self-administered questionnaire captured the biographic characteristics, perceived risk factors for COVID-19, and views on infection control of 286 nurses Data were subjected to descriptive and binomial logistic regression analyses. More than four in every 10 nurses screened positive for higher levels of post-traumatic disorder (PTSD). Self-reported risk for contracting COVID-19 mainly centered on being a health worker and patients’ non-adherence to infection prevention guidelines. Unpreparedness to manage COVID-19 patients, poorer health, and avoidant coping were associated with PTSD. Nurses voiced a need for emotional support and empathy from managers. Emotional, psychological, and debriefing intervention sessions that focus on positive coping strategies to actively address stress are recommended.
Open Access
Construct validity and reliability of the perceived stress scale for nursing students in South Africa
(AOSIS, 2022) Engelbrecht, Michelle C.
Background: Increased levels of stress in nursing students are negatively related to caring behaviours and also result in poorer job proficiency and nurses who are more inclined to leave the profession. The Perceived Stress Scale (PSS), developed by Sheu and colleagues, is one of the most cited instruments for measuring stress and sources of stress amongst nursing students in international studies. However, it has not been widely validated for this purpose. Objectives: This research aimed to test the construct validity and reliability of the PSS for South African nursing students. Method: A cross-sectional survey was conducted at a Central South African University, and 471 of the 685 registered nursing students (68.8% response rate) participated in the study. Questionnaires were distributed and collected during classes. Confirmatory factor analysis was performed to test the hypothesised six-factor latent structure and determine the construct validity of the PSS. The internal consistency of the PSS was measured using Cronbach’s alpha. Results: The model fit was a good fit and supported the six-factor latent structure as stress from (1) taking care of patients, (2) teachers and nursing staff, (3) assignments and workload, (4) peers and daily life, (5) lack of professional knowledge and skills and (6) clinical environment. Overall the PSS had a Cronbach’s alpha of 0.93. Conclusion: The results confirm the construct validity and the internal consistency of the PSS for South African nursing students.
Open Access
COVID-19 vaccine hesitancy in South Africa: lessons for future pandemics
(MDPI, 2022) Engelbrecht, Michelle; Heunis, Christo; Kigozi, Gladys
Vaccine hesitancy, long considered a global health threat, poses a major barrier to effective roll-out of COVID-19 vaccination. With less than half (45%) of adult South Africans currently fully vaccinated, we identified factors affecting non-uptake of vaccination and vaccine hesitancy in order to identify key groups to be targeted when embarking upon COVID-19 vaccine promotion campaigns. A cross-sectional, anonymous online survey was undertaken among the South African adult population in September 2021. Our research identified race, interactive–critical vaccine literacy, trust in the government’s ability to roll out the COVID-19 vaccination programme, flu vaccination status and risk perception for COVID-19 infection as key factors influencing the uptake of COVID-19 vaccination. Respondents who did not trust in the government’s ability to roll out vaccination were almost 13 times more likely to be vaccine-hesitant compared to those respondents who did trust the government. Reliable, easy-to-understand information regarding the safety of COVID-19 vaccines is needed, but it is also important that vaccination promotion and communication strategies include broader trust-building measures to enhance South Africans’ trust in the government’s ability to roll out vaccination effectively and safely. This may also be the case in other countries where distrust in governments’ ability prevails.
Open Access
Factors associated with limited vaccine literacy: lessons learnt from COVID-19
(MDPI, 2022) Engelbrecht, Michelle C.; Kigozi, N. Gladys; Heunis, J. Christo
Compared to many other developed countries, South Africa has a lower uptake of COVID-19 vaccinations. Although not widely researched, there is evidence that vaccine literacy (VL) is positively associated with vaccination uptake. Therefore, this study aimed to assess levels of VL among the adult population in South Africa, as well as to identify factors associated with limited VL. A cross-sectional, anonymous online survey was conducted during September 2021. The survey, which included the standardized Health Literacy about Vaccination in adulthood (HLVa) Scale, was widely advertised, yielding a total of 10,466 respondents. The average scores for the two HLVa sub-scales were relatively high: functional (M = 2.841, SD 0.799) and interactive-critical (M = 3.331, SD 0.559) VL. A proposed ‘limited’ VL score (score value ≤ 2.50) was observed in 40% of respondents for functional literacy and 8.2% of respondents for interactive-critical literacy. The main factors associated with limited VL included lower levels of education, lower socio-economic status, not being vaccinated against COVID-19, self-identifying as Black/African or Colored (i.e., people of mixed ethnic descent), having poorer health, and being a woman. The significant association between VL and vaccination uptake provides an impetus for policy makers such as the South African Department of Health to promote VL in the attempt to increase COVID-19 vaccination uptake.
Open Access
Barriers to and facilitators of male uptake of HIV testing services in Orange Farm Township, Gauteng Province: user and provider perspectives
(University of the Free State, 2024) Chauke, Nyeleti P.; Kigozi-Male, N. G.; Heunis, J. C.
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱 𝗮𝗻𝗱 𝗢𝗯𝗷𝗲𝗰𝘁𝗶𝘃𝗲𝘀: South Africa remains heavily burdened by the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic, with devastating effects among men. Unlike women, men are increasingly unlikely to access HIV testing services (HTS) at primary health care (PHC) facilities. Male uptake of HTS is very low with high rates of HIV-related deaths among men. The 2016 South Africa Demographic and Health Survey found that although 94% of men aged 15 to 49 were aware of HIV testing locations, only 29% had undergone an HIV test. The study draws on the Socio-Ecological Model (SEM) to explore, from the perspective of both users and providers, barriers to and facilitators of men’s uptake of HTS at three PHC facilities in the Orange Farm township. The SEM illustrates how multiple factors influence an individual’s health behaviour. The SEM comprises five levels which include the individual, interpersonal, organisational, community, and policy levels. 𝗠𝗲𝘁𝗵𝗼𝗱: The researcher adopted a constructivist paradigm for this study as it is believed that individuals give meaning to their experiences through interactions with their environments. A case study design was employed, and qualitative semi-structured interviews were used as a data collection tool. The semi-structured interviews were conducted among a total of 23 conveniently selected participants including, 12 male patients, six lay counsellors and five Nurse-initiated Management of Antiretroviral Therapy (NIMART) trained professional nurses. The purpose of these sample sizes was to reach saturation as opposed to the generalisability of findings. Data were analysed thematically using the SEM constructs as a priori themes with subsequent development of subthemes. The process involved the grouping of key barriers to and facilitators of HTS perceived by male patients, lay counsellors, and professional nurses according to the SEM constructs. 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀:. Both users and healthcare providers perceived similar barriers to male uptake of HTS. These included, at the (1) individual level – lack of knowledge; (2) interpersonal level – negative peer and family influence; (3) organisational level – discomfort when attended by female healthcare providers; (4) community level – lack of education and awareness within the community; and (5) policy level – non-adherence to policy and privacy concerns. Again, perceived similarly by both patients and healthcare providers, facilitators of HTS included at the (1) individual-level – overcoming fear; (2) interpersonal level – fostering supportive family and friend networks; (3) organisational level – initiation of ‘male-friendly services’ in PHC facilities; (4) community level – initiating community health education and awareness tailored for men; and (5) policy level – reinforcement of policy adherence. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀: The findings indicate that barriers to and facilitators of male HTS uptake vary across the SEM levels. Both users and providers’ views highlighted a multifactorial influence on male uptake of HTS at PHC facilities, necessitating a multifaceted intervention strategy, encompassing all five SEM levels. Such efforts can result in more men accessing HIV testing at PHC facilities, enrolling in treatment, and most importantly, adopting preventative measures to curb the spread of HIV/AIDS.
Open Access
Exploring health research priority setting in a South African Province: a nominal group technique approach
(MDPI, 2024) Heunis, Christo; van Jaarsveldt, Deirdre; Chikobvu, Perpetual; Kigozi-Male, Gladys; Litheko, Moroesi
In August 2022, the Free State Provincial Health Research Committee used the online nominal group technique (NGT) for Health Research Priority Setting (HRPS) for the Free State Department of Health (FSDoH) and the research community, considering various stakeholders’ perspectives. This paper explores and describes the identified health research priorities. It also assesses their alignment with the National Health Research Strategy. Additionally, it provides an opinion on the feasibility of using the online NGT for collaborative co-creation of provincial-level health research priorities. Most of the identified health research priorities resonate with the national health research priorities identified by the National Health Research Committee. However, research to “𝘴𝘵𝘳𝘦𝘯𝘨𝘵𝘩𝘦𝘯 𝘴𝘶𝘳𝘷𝘦𝘪𝘭𝘭𝘢𝘯𝘤𝘦” was uniquely perceived to be a priority by the participants in the Free State HRPS exercise. A plausible reason for this might be their heightened awareness of the vital role optimal surveillance systems play in coordinating intersectoral responses to pandemics, particularly considering the serious challenges emerging during the initial stages of the COVID-19 outbreak.
Open Access
Sexual and Reproductive Health Services: experiences and views of young adults and providers in Soshanguve
(University of the Free State, 2024) Maeko, Naum Mahlatse; Heunis, Christo; Kigozi-Male, Gladys
𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Despite efforts to educate young people about healthy sexual behaviours and the availability of sexual and reproductive health (SRH) services, risky sexual behaviour (RSB) outcomes such as unplanned pregnancies, unsafe abortions, and sexually transmitted infections (STIs) among youth in South Africa persist. Efforts have been made to implement SRH interventions aimed at addressing RSB outcomes through targeted clinic SRH services tailored for young people. However, implementation discrepancies continue, necessitating improvements in service delivery strategies and policy guidelines. These discrepancies stem from various barriers such as insufficient knowledge, education gaps, myths, misconceptions, family dynamics, socio-cultural elements, and systemic health issues. To comprehensively analyse these challenges, this study adopted the Socio-Ecological Model (SEM) proposed by McLeroy et al. (1988). The SEM framework acknowledges the multi-layered influences on human behaviour; that is, the 𝘪𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭, 𝘪𝘯𝘵𝘦𝘳𝘱𝘦𝘳𝘴𝘰𝘯𝘢𝘭, 𝘤𝘰𝘮𝘮𝘶𝘯𝘪𝘵𝘺, 𝘪𝘯𝘴𝘵𝘪𝘵𝘶𝘵𝘪𝘰𝘯𝘢𝘭 𝘢𝘯𝘥 𝘱𝘰𝘭𝘪𝘤𝘺-𝘭𝘦𝘷𝘦𝘭 𝘧𝘢𝘤𝘵𝘰𝘳𝘴. 𝗠𝗮𝗶𝗻 𝗿𝗲𝘀𝗲𝗮𝗿𝗰𝗵 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻: How do socio-ecological factors influence young adults and SRH providers’ experiences and views regarding SRH services in Soshanguve, South Africa? 𝗔𝗶𝗺: The aim of the study was to explore how socio-ecological factors influence the experiences and views of young adults and SRH providers regarding SRH services in Soshanguve. 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆: The research project utilised an interpretive paradigm. A qualitative approach was employed by using an exploratory research design to explore the personal views and experiences of young adults and SRH providers regarding SRH services at clinics. The study was conducted in three purposively selected local clinics in Soshanguve. The sample consisted of fifteen young adults, comprising of seven females and eight males, selected through convenience sampling. Five SRH providers were selected through purposive sampling. They were collected through in-depth interviews (IDIs) with young adult participants, in addition to key informant interviews (KIIs) with SRH provider-participants. All interviews were audio-recorded and transcribed for analysis by applying Thompson’s (2022) eight-step abductive analysis, which allowed the blending of inductive and deductive reasoning. Data from young adults and SRH providers was triangulated. Ethical considerations focused on informed consent, confidentiality, privacy, and respect throughout the research. 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: Both young adults and SRH providers identified key challenges across the SEM that affected their views and experiences of clinic SRH service in Soshanguve. At the 𝘪𝘯𝘥𝘪𝘷𝘪𝘥𝘶𝘢𝘭 𝘭𝘦𝘷𝘦𝘭, knowledge, attitudes and beliefs about SRH were crucial determinants. At the 𝘪𝘯𝘵𝘦𝘳𝘱𝘦𝘳𝘴𝘰𝘯𝘢𝘭 𝘭𝘦𝘷𝘦𝘭, both groups perceived parent-child and peer communication as the critical factors influencing young adults' knowledge, attitudes, and behaviours towards SRH. 𝘊𝘰𝘮𝘮𝘶𝘯𝘪𝘵𝘺-𝘳𝘦𝘭𝘢𝘵𝘦𝘥 factors hindering and facilitating young adults’ access to and utilisation of clinic SRH services such as societal attitudes, religious beliefs, and cultural norms emerged as significant barriers contributing to stigma and discrimination for both groups. Both groups perceived similar 𝘪𝘯𝘴𝘵𝘪𝘵𝘶𝘵𝘪𝘰𝘯𝘢𝘭-𝘳𝘦𝘭𝘢𝘵𝘦𝘥 barriers and facilitators such as limited clinic operating hours, overcrowding, and lack of confidentiality. However, young adults expressed greater concerns about SRH providers’ judgemental and gender-bias attitudes, while SRH providers were concerned with the impact of the clinic booking system, especially for the abortions. At the 𝘱𝘰𝘭𝘪𝘤𝘺 𝘭𝘦𝘷𝘦𝘭, both groups emphasised the need for guidelines that could support comprehensive education, youth-friendly services, and mobile SRH services to address systemic issues and enhance access for young adults. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: The findings revealed the views and experiences of both young adults and SRH providers regarding young adults’ access to and utilisation of clinic SRH services in Soshanguve, thus underscoring the necessity for a multi-layered SEM approach. Addressing the identified SEM factors through targeted interventions and policies can assist in bridging the gaps in service delivery and the utilisation of resources to promote better SRH outcomes among young adults.

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