Family Medicine

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Browsing Family Medicine by Subject "Dissertation (M.Med. (Family Medicine))--University of the Free State, 2020"

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    Knowledge, attitude and practices of health care providers on smoking cessation intervention – a case of Sol Plaajtie Subdistrict, Northern Cape
    (University of the Free State, 2020-01) Muza, Lizwe Calvin; Steinberg, W. J.
    Background: Clinicians are crucial in influencing smokers to quit through provision of behavioural (counselling) or pharmacological smoking cessation interventions. Numerous studies conducted across different parts of the world indicate an increase in smokers who quit with assistance compared to those without. However in-order for healthcare providers to efficiently offer this advice; they need to be equipped with the right knowledge on smoke intervention and possess the right attitude and willingness to counsel their patients on smoking cessation. Objective: To determine the knowledge, attitude and practises of healthcare providers on smoking cessation intervention strategies in Sol Plaatjies Sub-district in the Northern Cape. Methodology: The researcher made use of a descriptive cross-sectional design with a selfadministered questionnaire aimed at determining the knowledge, attitude and practises of health care providers on smoking cessation intervention. One hundred and sixty five participants were selected to participate in the study from four groups namely; medical officers, professional nurses, enrolled nurses and assistant enrolled nurses. Results: Responses were received from 156 participants constituting 95% of the targeted population. The results revealed that 52% had no knowledge of South African tobacco smoking cessation guidelines highlighting a lack of training on smoking cessation intervention whilst 87% knew the importance of counselling patients on smoking and its impact on quitting. Majority of them did not know the medicines recommended for tobacco treatment in South Africa. Three-quarters (75%) expressed that smoking cessation counselling is an important part of their jobs, but only half of them indicated that they made follow-up arrangements on those attempting to quit. They also cited a number of barriers to smoking cessation interventions mainly due to lack of community-based tobacco cessation treatment centres for referrals as well as unavailability of educational materials among others. Conclusions: The study revealed that most of healthcare workers in the Sol Plaatje District are not aware of the existence of smoking cessation guideline. It was also observed that respondents agree that smoking cessation knowledge is an important element of their jobs and it’s necessary to provide smoking cessation counselling. However, these healthcare providers do not consistently record patient smoke history and quit attempt. They also faced other challenges such as lack of time and unwillingness of patients to quit smoking. Recommendations: It is to improve training and development among healthcare providers in-order to adequately equip them with the right knowledge on smoking cessation as well making available material on smoking cessation; there is also need to open more communitybased tobacco cessation treatment and referral centres for patients to avoid relapse.
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    Knowledge, attitude, and practices on diabetic foot care among nursing staff at primary health care facilities in Sol Plaatje sub-district, Kimberley
    (University of the Free State, 2020-08) Mafusi, Labala Guy Juste; Steinberg, W. J.; Harmse, M. C.
    As essential team members of the healthcare system, nurses have more contact with the patients and are indispensable in patients' education. They can ameliorate diabetic patients' quality of life by aiding in preparing and implementing educational programs that assist patients in growing self-care behaviours associated with diabetic foot care. Furthermore, they can stop or prevent diabetic foot problems by pointing out risk groups in the community. To reduce Diabetic Foot Disease's load sensibly, improve patient education and preventive and screening programmes on Diabetic Foot Care, healthcare providers need to be knowledgeably possessing the right attitude, which is crucial in offering any meaningful advice to their clients. Positive attitudes, combined with sound knowledge, prevent compromising health care standards. However, for nurses to efficiently offer education, they need organised training programs combining theory and practice. Nurses involved in the management of diabetes-related foot problems must be encouraged to take part in these programs. Objectives: To assess the knowledge, attitude, and practice of nursing staff regarding diabetic foot care in Sol Plaatje primary healthcare centres in the Northern Cape. Methodology: The researcher used a descriptive cross-sectional study with a self-administered questionnaire to assess the knowledge, practice, and nursing staff attitude on diabetic foot care. A total number of one hundred and twenty-eight nurses providing primary care to patients within the Sol-Plaatje sub-district were targeted to participate in the study from three groups: professional nurses, enrolled nurses, and auxiliary nurses. Results: Responses were received from 105 participants constituting 82% of the targeted population. Of the participants, 88% were professional nurses, and the majority, 95%, were female; the median age was 48 years and the median year of practice was 15 years. The results showed that 58% of this sample had a good knowledge of South African Diabetic foot guidelines even though compliance level was low, highlighting a lack of training on diabetic foot care with 86% needing diabetic foot care training whilst 94% knew the importance of foot assessment on diabetic patients. The majority, 59%, did not know the importance of diabetic foot prevention and 57% did not know of the 60-Second Screening Tool for high-risk diabetic foot, and 70% did not know about the 10g monofilament tool used for foot neurology check. 98% expressed that diabetic foot education is an essential part of their job, yet only 46% indicated that they record foot examination, whilst 82% do not do a 60-Second comprehensive assessment. The majority, 91% of Nurses displayed a positive attitude towards caring for diabetic foot patients despite 59% of poor screening attitude. Also, the knowledge of specialist referrals was insufficient among nurses. Conclusions: This study revealed that most frontline healthcare providers (nurses) in Sol Plaatje Sub-District are aware of the diabetic foot guideline for primary care in contrast to the majority not being aware of the 60-Second Screening Tool for high-risk diabetic foot and the 10g monofilament tool. It was also noted that respondents agree that diabetic foot education is an essential part of their jobs. Nurses do not regularly record patient diabetic foot examination findings. They also requested training in diabetic foot care. Poor screening attitude may be attributed to inadequate training and suboptimal update of knowledge. Recommendations: My recommendation is to promote the 60-Second Screening Tool for high-risk diabetic care and avail tool for foot neurology check whilst also improving training and development among healthcare providers (nurses) to equip them with the right knowledge on diabetic foot care and improve their attitude on diabetic foot prevention, which will increase their compliance to guidelines. There is also a need to make available material on diabetic foot care whilst also improving referral systems to avoid delay in specialist care and amputation complication.
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    Reasons cited for the interruption of anti-retroviral treatment in the Bloemfontein/Mangaung area
    (University of the Free State, 2020-11) Thomas Ross, Du Plessis; Van Lill, M.; Nel, R.
    Background: HIV infection is a chronic condition that affects millions of people worldwide and causes significant morbidity and mortality. It is however treatable with anti-retroviral treatment. This does require regular, uninterrupted dosages to prevent the development of treatment resistance. There are many reasons why patients may be unable to remain compliant on their treatment including medication, healthcare and psycho-social reasons. Objectives: To investigate the reasons cited for treatment interruption of anti-retroviral treatment in patients admitted to National District Hospital from the Mangaung district. Methods: This was a prospective descriptive study. Data was obtained by voluntary structured interviews from patients admitted to National district hospital between February and April of 2020. A total of 17 patients were included. Results: Unemployment among participants was at 68%, with 54% reporting no consistent income. There was a fairly even spread of reasons cited for treatment interruption between the healthcare, medication and psychosocial factors. Stock issues, however, remained a prominent problem reported. Almost half of participants reported omissions in their counselling prior to treatment initiation. Medication side effects remains a problem with 52% of participants reporting side effects and 44% of those attributed non-compliance to it. The majority of patients reported good family support and fear of disclosure or stigma was not reported. All participants screened positive for symptoms of depression, with 52% falling into the moderate and severe depression categories. Conclusions: The challenges for people living with HIV to remain compliant with their treatment remains numerous and varied. The role that unemployment and poverty plays cannot be ignored. Continuing efforts need to be made to create a robust supply of medication to patients if good outcomes are to be achieved. Patients need to be well educated prior to treatment initiation and given good advice regarding the management of side effects. The prevalence of symptoms for Depressive Mood disorder in this patient population is high and needs to be actively screened for at initiation and follow-up of patients. Further research within more well-defined communities can be beneficial for the healthcare workers working in those areas.
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    A study of the knowledge, attitudes and practice of lifestyle modifications among patients with type 2 Diabetes mellitus attending the Outpatient Department of the National District Hospital, Bloemfontein, Free State
    (University of the Free State, 2020-09) Peter, Paul Ifeanyi; Steinberg, W. J.; Van Rooyen, F. C.
    Introduction: Type 2 Diabetes Mellitus (DM), no doubt, constitutes a major public health burden globally with uncontrolled diabetes mellitus often resulting in several short and longterm complications. It may also sometimes result in loss of lives. Therefore, it is of utmost importance that individuals with diabetes mellitus are regularly made aware of the need for optimal glucose control. Apart from the pharmacological management of Type 2 DM, a healthy lifestyle plays a prominent role in the optimal control of the blood glucose level and prevention of complications but often little is known about the practice of lifestyle modifications among the Type 2 DM patients. Objectives of the study: To determine the knowledge, attitude and practice of lifestyle modifications among patients with Type 2 DM attending the outpatient department (OPD) at the National District Hospital, Bloemfontein, Free State. Methods: This project was a descriptive study with a cross-sectional component. The study was conducted among patients with Type 2 Diabetes Mellitus attending the outpatient department (OPD), National District Hospital, Bloemfontein, Free State. A self-administered structured questionnaire was used for the data collection. Information regarding the socio-demographic characteristics of the participants and their anthropometric measurements was obtained. The participants' knowledge, attitude and practice regarding physical exercise and healthy diet with regards to lifestyle modification practices among Type 2 diabetes were assessed. Results: A total of 149 correctly filled questionnaires were included in the data analysis. Majority of the participants, 104(69.8%) were females, while the mean age of the participants was 47.7 years. Majority of the participants (82.0%) had a varied level of formal education. Only 23.3% of the respondents were employed. Almost half (49.3%) of the respondents have been living with diabetes for more than ten years since diagnosis. Of the respondents, 64.4% were obese, and 23.8% were overweight. There was decent knowledge of lifestyle modification practices with regards to physical exercise and healthy dietary habits among the respondents. Respondents displayed a good attitude to physical exercise, but more than half had a poor attitude regarding the adjustment of their diet. Even though the majority of the respondents (94.0%) had a positive attitude to the need for weight control, about two-thirds of the respondents admitted they do not monitor their weight regularly. Only 63.3% of the respondents engage in physical exercise on a regular basis. The practice of controlled and planned diet was found to be poor among the respondents. The identified barriers to lifestyle modifications were respondents feeling too heavy to engage in physical exercise, bad weather and financial constraints. There was no statistically significant association between the gender of the respondents and their attitude to regular physical exercise or dietary modifications. There was also no significant association between the gender of the respondents and their practice of lifestyle modifications. There was no statistically significant association between the number of years the respondents have been living with diabetes mellitus and their attitude to lifestyle modification practices. There was also no association with their practice of regular exercise or dietary modifications. There was no significant association between the BMI of the respondents and their practice of regular physical or dietary modifications. Conclusion: In conclusion, the study revealed that despite the good knowledge of physical exercise and healthy dietary habits with regards to lifestyle modification among the Type 2 DM patient at the Outpatient Department of the National District Hospital, Bloemfontein, the uptake of these practices is still low. There is a need to address the poor attitude and poor practice of dietary modification and the sub-optimal engagement in physical exercise among the patients. It is also vital to regularly emphasise to the patient the importance of not only engaging in the lifestyle modification practices but also the need to do it correctly. Proper practices are essential for it to be efficient and bring about the desired purpose, which is the optimal control of blood glucose, by so doing, preventing potential complications associated with uncontrolled diabetes mellitus.