Community Health

Permanent URI for this community

http://hdl.handle.net/11660/58

Browse

Browsing Community Health by Title

Now showing 1 - 5 of 5
  • Thumbnail Image
    ItemOpen Access
    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.
  • Thumbnail Image
    ItemOpen Access
    An educational approach for the generation profile of undergraduate students in the Faculty of Health Sciences, University of the Free State
    (University of the Free State, 2011-11) Van der Merwe, Lynette Jean; Van Zyl, G. J.; Nel, M. M.
    English: In this research project, an in-depth study was done by the researcher with a view to formulating an educational approach for the distinct generation profile of undergraduate students in the Faculty of Health Sciences (FoHS), University of the Free State (UFS). This research was initiated in response to the identification of a gap in the knowledge regarding the so-called Generation Y (born 1981-2000), forming the current cohort of undergraduate students at the UFS. According to both scholarly and popular literature, Generation Y possesses unique characteristics that impact on the teaching and learning environment. Their distinctive values and behaviours, communication styles, skills and needs, learning styles and needs, as well as the prevailing environment and the shaping events of their position in history influence their attitudes and actions as students. In addition, the perceived differences between these students and the academic staff lecturing them, who generally belong to older generational cohorts, may lead to conflict and misunderstanding that impairs the successful attainment of outcomes in Health Sciences Education. Both education and health care face tremendous challenges in the 21st century. For example, the current Information-Communication Technology revolution has exerted compelling effects on social interaction as well as the current teaching and learning and health care environments. However, the demands on education and health care stretch further than just emerging technologies and their aftermath. Issues such as globalisation, socio-political and economic instability, inadequate and unequal access, as well as sustainability should also be addressed. The aim of this study was to formulate an educational approach for the generation profile of undergraduate students at the FoHS, UFS. This was attained by means of the following objectives, namely, obtaining data as to whether the characteristics of Generation Y as described in the literature are applicable and relevant to undergraduate students in the FoHS, UFS; identifying discrepancies in awareness and understanding of perceptions regarding the characteristics of Generation Y between undergraduate students and academic staff lecturing them; and finally, formulating an educational approach (including recommendations) for the generation profile of undergraduate students in the FoHS, UFS, incorporating the characteristics of undergraduate students as well as discrepancies in perceptions between undergraduate students and academic staff lecturing these students that could affect the teaching and learning environment. This study made use of a mixed-methods research design in two phases. In the first phase, concurrent triangulation, quantitative and qualitative data were gathered simultaneously by means of closed and open questions in a questionnaire survey for undergraduate students and academic staff members respectively. In the second phase, sequential explanatory design, the results from the first phase were used to inform the formulation of an agenda for a focus group interview held with academic staff members, yielding qualitative data. Quantitative data were analysed statistically, while thematic analysis of qualitative data were done. The final steps in the second phase included making use of the literature survey as well as the results of the questionnaire survey and focus group interview respectively to inform the formulation of the educational approach as indicated in the aim of the study. From the results of the questionnaire survey it emerged that although many of the characteristics typically ascribed to Generation Y in the literature are similar to those perceived by both undergraduate students and academic staff members regarding the cohort of undergraduate students in the FoHS, UFS, there were distinct differences between these perceptions and those described in the literature, indicating that Generation Y students in the FoHS possess a unique generational profile. In addition, academic staff members indicated significant differences in their perceptions from those of undergraduate students, with subsequent implications for the teaching and learning environment. Major themes identified from the focus group interview indicated that three important aspects were vital in the development of an educational approach, namely the nature of the teaching and learning environment, the personal qualities and attributes of the lecturer and the characteristics and role of the student.These findings were incorporated in the formulation of guidelines and recommendations for the educational approach proposed by the researcher. The conceptual framework guiding this approach alluded to the realisation that in order to stay relevant, educational approaches need to move away from traditional and somewhat archaic teacher-centred to innovative student-centred approaches intent on actively engaging students in transformative knowledge construction, as well as providing for mentoring by motivational role-models. Furthermore, emerging technology must be incorporated in a rational and balanced way without losing vital human interaction to ensure that an optimal teaching and learning environment is created. The training of skilled health professionals who are equipped to deal with the challenges of the future should ultimately lie at the heart of the educational approach in Health Sciences Education. This research project generated comprehensive knowledge of the profile of the so-called Generation Y undergraduate students in the Faculty of Health Sciences, University of the Free State, which informed the formulation of an educational approach that is both thoroughly grounded in theory as well as applicable in practice. This research study offers a novel contribution to the field of Health Sciences Education by providing evidence-based data incorporated into an educational approach that takes into consideration key elements for successful pedagogy in Health Sciences Education. These include the a) teaching and learning environment, b) approaches to teaching and learning as well as the role-players in this context, namely the c) participants (students) and d) practitioners (academic staff). The approach is built on the four key elements, and forms an integrated background to a central nexus alluding to concepts including structure and support, a student-centred viewpoint, technology, relationships, student characteristics, mentoring, engagement and supervision. Both the survey instrument developed for the purpose of data collection in this study, as well as the educational approach that was formulated, may be used to facilitate the creation of optimal teaching and learning environments in Health Sciences Education, both locally and further afield.
  • Thumbnail Image
    ItemOpen Access
    Employee assistance programme in health care: a framework for best practice and quality management
    (University of the Free State, 2011-05) Kruger, Willem Hendrik; Van Zyl, G. J.; Venter, A.
    Employee assistance was initiated early in the 19th century in the United States of America to assist employees with alcohol abuse in the workplace. During the 1970s, the concept of an employee assistance programme (EAP) was adapted to assist employees not only with alcohol-related problems, but also with personal and other work-related problems resulting in poor work performance. It is evident from the literature that no EAP is the same and that researchers have developed the seven EAP core technologies to promote uniformity within the field of employee assistance. The aim of this study was to establish a framework for a best-practice EAP for the health care sector and the quality management thereof. As background to the study, the researcher conducted an extensive literature review to investigate the current situation on the utilisation of EAPs in various industries worldwide. The literature review was used as a guide during the empirical phase of the study in order to gain more in-depth knowledge with regard to employee assistance in the health care sector. A case study design as a qualitative research approach was applied. Five focus group discussions were held with supervisors from various levels in several health care institutions as a data-gathering method. Several criteria for the bestpractice EAP were identified during the data gathering and a six-round Delphi survey was conducted to achieve consensus with regard to the criteria to be included in the best-practice EAP. Accordingly, a framework for a best-practice EAP and the quality management thereof was developed. The management of health care institutions should realise that their health care workers are their most valuable resource and that there is a need to assist them with personal and work-related problems. The framework was developed specifically for a health care institution with the option to adapt it in order to suit the unique requirements of each individual health care institution. This proposed framework could be used to develop an institution-unique EAP. The establishment of a workplaceunique EAP will show employees that they are regarded as the most valuable resource in the health care institution. The overall goal and objectives, as set out for the research study, were addressed and realised, and meaningful recommendations in the field of employee assistance have been made. The framework for a best-practice EAP is in line with the core technologies of EAPs, the needs of supervisors in health care institutions and the EAPs used internationally. The proposed framework includes the following main aspects, namely the need for an EAP in a health care institution, the strategic approach for the development of such a programme, the structure and processes of an EAP, and the evaluation of an EAP in terms of its effectiveness. The framework will contribute significantly to the management of human resources in the health care industry and provide a supportive work environment for health care workers to ensure healthy and productive employees.
  • Thumbnail Image
    ItemOpen Access
    Evaluation of the effectiveness of implemention of the practical approach to lung health (PALSA) in the Free State
    (University of the Free State, 2005-02) Majara, Bosielo Phillip; Joubert, G; Bachmann, O. M.
    English: Currently, respiratory diseases constitute about one third of patients that present to primary care clinics in under-resourced countries of the world. Communicable respiratory diseases such as tuberculosis, acute respiratory infections in adults and non-communicable respiratory diseases such as asthma, chronic obstructive pulmonary disease, lung cancer represent about one-fifth of the global burden of disease measured in disability adjusted life years (DALY). Opportunistic infections, other respiratory complications, and the widespread use of tobacco further increase the respiratory disease burden in high HIV prevalence settings. In developing countries clinic nurses with limited training and basic skills are entrusted to properly diagnose and treat respiratory patients from overloaded clinics. We developed an educational outreach intervention, Practical Approach to Lung Health in South Africa (PALSA) on integrated respiratory case management aimed at improving the quality of respiratory care in South African primary care clinics. The intervention comprised 3 to 4 academic detailing training sessions of primary care nursing practitioners; dissemination of locally adapted PALSA guidelines and support materials; changes in prescribing provisions for primary care nurses, and doctors' sensitization about PALSA. The impact of PALSA on the processes and outcomes of respiratory care was evaluated through a pragmatic cluster randomized controlled trial in the Free State province in 2003. A total of 1000 patients in the intervention arm and 999 patients in the control arm presenting with respiratory conditions to the 40 largest primary care clinics of the Free State province were interviewed at the first post-intervention survey. The number of patients recruited ranged from 47 to 52 patients per clinic. The follow up rate was 92.9% for the intervention arm and 92.7% for the control arm. Twenty two patients died in the intervention clinics and twenty six died in the control clinics. During data analysis, four patients in each arm were deleted due to unavailability of the first post-intervention survey data and/or because they did not meet the inclusion criteria. Professional nurses in intervention clinics received a median of 2 training sessions while nurses in the control clinic received nothing. First post-intervention survey characteristics of the intervention and control arms balanced as a result of randomization. Almost two thirds of the patients were females with the most frequent age group being 25-54 years. About 50% of patients had a smoking history, about 50% had primary education, close to 50% were unemployed, above 80% walked to get to the nearest clinic and 70% spent between 2 and 12 hours to travel to and from the clinic. The inclusion criteria to the study were adults 15 years and older presenting with a cough or difficulty breathing on the day of the interview, recurrent cough or difficulty breathing in the last 6 months or cough for less than two weeks with any of the four severity markers. Rates of cough and difficulty breathing ranged between 70% and 90%. About 70% of the patients complained about chest symptoms interfering with their usual activities while around 36% had gone to the clinic for a check-up on recurrent respiratory problem. Compared to control clinics, intervention clinics had a significant improvement in inhaled steroid prescription of 16.1% versus 10.3% (odds ratio 1.70; 95%CI 1.13 to 2.56), and an improvement in sending of sputa for tuberculosis testing of 16.7% versus 11.2% (odds ratio 1.60; 95%CI 1.00 to 2.54). There were also significant improvements seen on appropriate referral of patients that had one of the four severity makers of 10.6% versus 4.9% (odds ratio 2.56; 95%CI 1.06 to 6.17), and close to significant improvement of the tuberculosis detection rate of 3.0% versus 1.8% (odds ratio 1.67; 95%CI 0.92 to 3.02). There was a significant increase in interference with usual activities due to chest symptoms of 68.0% versus 60.1% (odds ratio 1.44; 95%CI1.13 to 1.85). There was no improvement on antibiotic prescription of 36.1% versus 38.0% (odds ratio 0.92; 95%CI 0.62 to 1.36) as well as cotrimoxazole prophylaxis of 12.6% versus 9.9% (odds ratio 1.52; 95%CI 0.60 to 3.89). Results of this study suggest that inhaled steroid prescription, tuberculosis case detection rate, and appropriate referral of patients with severe respiratory diseases can be improved in nurse staffed primary care clinics in developing countries and under-resourced settings. This study exemplifies an evaluation of the effectiveness of an educational intervention in South African primary care. It shows how a carefully developed intervention, using a syndromic approach to diagnosis and treatment, can improve several aspects of clinical care after brief training of primary care nurses. It also illustrates opportunities for, and difficulties in, implementing such an intervention, and conducting a large scale trial in this setting. This study suggests that other international interventions based on dissemination of clinical guidelines, such as, for IMCI, STls and HIV/AIDS should be developed and rigorously evaluated locally, given their potential impact on public health and on services.
  • Thumbnail Image
    ItemOpen Access
    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?