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Item Open Access Strategies to enhance the approach to prostate cancer screening of African men in the Free State(University of the Free State, 2023) Benedict, Matthew Olukayode Abiodun; Claassen, Frederik M.; Steinberg, Wilhelm J.; Mofolo, Nathaniel๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ: Prostate cancer is a significant public health concern in South Africa, with rising incidence and mortality rates, particularly among African men. Prostate-specific antigen (PSA) screening is a practical method for early detection and improved outcomes. However, it carries the risks of overdiagnosis and overtreatment. Recent studies have shown a more significant net benefit of PSA screening for Black men than the general population. However, there are knowledge, attitude and practice gaps among primary healthcare providers and users, especially Black men, regarding prostate cancer screening. Practical strategies to address these gaps are lacking. This study focuses on vulnerable African men in the Free State Province, South Africa. ๐ ๐ฒ๐๐ต๐ผ๐ฑ๐: This thesis presents the results of five complementary studies aiming to identify gaps in prostate cancer screening and determine strategies to enhance prostate cancer screening among African men in the Free State Province from the perspectives of primary healthcare providers and users. The first study employed a cross-sectional descriptive design, using case record information and self-administered questionnaires to profile Black South African men with prostate cancer attending a tertiary hospitalโs oncology and urology clinics in the Free State Province. The second study used a cross-sectional analytical survey design, administering self-administered questionnaires to assess the knowledge, attitude and practice of primary healthcare providers in the study setting. The third study also employed a cross-sectional analytical survey design, utilising self-administered questionnaires to investigate African menโs knowledge, cultural beliefs and screening intentions regarding prostate cancer screening. Factors associated with their intention to screen for prostate cancer were examined. Quantitative data were analysed using descriptive statistics, and associations were tested using chi-squared or Fisherโs exact tests. The fourth and fifth studies comprised a scoping review and a modified Delphi survey to identify and propose strategies to enhance prostate cancer screening among African men in the study setting, addressing the identified gaps. ๐ฅ๐ฒ๐๐๐น๐๐: The findings revealed that aggressive prostate cancer is prevalent among African men in the study setting. Poor knowledge and awareness of the disease and low screening uptake were observed. Factors such as dietary habits, lifestyle and presentation time were associated with aggressive disease at diagnosis. Cultural beliefs influenced screening uptake among men. Factors associated with a higher intention to screen included reduced fear, perceived benefits, situational barriers, and perceived risk of developing prostate cancer. Regarding primary healthcare providers, the majority demonstrated poor knowledge (64.8%), neutral attitudes (58.6%) and poor practice (40.0%) related to prostate cancer screening. Female providers, lower cadre nurses and community health workers had lower knowledge scores. Lack of prostate cancer-related continuing education was significantly associated with poor knowledge, negative attitudes and poor practice among healthcare providers. The study proposed strategies to address the identified gaps among African men and primary healthcare providers. Community-oriented approaches involving the active participation of both providers and community members were emphasised. These strategies focused on relevant prostate cancer health education topics in public spaces, employing diverse, comprehensive, user-friendly and culturally sensitive methods. ๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป: This thesis highlights the gaps in prostate cancer screening among African men and primary healthcare providers in the Free State Province, South Africa. Targeted strategies are needed to enhance prostate cancer screening uptake and improve outcomes in this vulnerable population. Implementing the proposed strategies can improve awareness and knowledge of the disease and ultimately enhance screening practices among African men in the study setting.Item Open Access Developing an improved seizure diary as a monitoring tool for epileptic patients in South Africa(University of the Free State, 2023) Egenasi, Chika Kennedy; Moodley, A. A.; Steinberg, W. J.๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ Epilepsy is a debilitating disease with a high risk of morbidity and mortality globally. A seizure diary is one of the methods described in the literature that can be used to manage patients living with epilepsy. These diaries are available in two formats, paper-based and electronic diaries. This study aimed to develop an improved seizure diary and determine patientsโ perception of its use in the management of patients with epilepsy in South Africa. ๐ ๐ฒ๐๐ต๐ผ๐ฑ๐ In the first phase of this study, a scoping review of literature was performed. An extensive search of appropriate literature was conducted using online databases, such as MEDLINE, Scopus, CINAHL, Cochrane and EBSCOhost. Key phrases, such as seizure diary, paper diary, and seizure tracker, were used to identify and retrieve relevant themes, categories, and subcategories of literature for examination. In the second phase of the study (a cross-sectional study), cohorts of patients with epilepsy were identified at the casualty and local clinics of a hospital in Kimberley, and the neurology specialist epilepsy clinic in Bloemfontein. Questionnaires were distributed to patients, to gather data on their perceptions of and attitudes to the epilepsy diary, and their opinions on what must be included in a seizure diary. The third phase of the study involved a modified Delphi survey with a panel of 10 local and two international experts, who deliberated on what they believed were the required contents of a seizure diary. In the fourth phase, a longitudinal study, a new seizure diary was developed, based on the suggestions of the expert Delphi panel and the recommendations of patients living with epilepsy. The new seizure diary was distributed to patients who had completed the initial questionnaire, and they were requested to use it for six months. In phase 5a (cross-sectional study), patients, relatives, and caregivers (participants) were requested to complete a questionnaire about their experiences of the new seizure diary. Finally, in phase 5b, a final version of the new seizure diary was designed. ๐ฅ๐ฒ๐๐๐น๐๐ In phase 1, 1 125 articles were identified from the database search, of which 23 were selected for review by the study. In phase 2, 182 patients with epilepsy were recruited for the study, 65 were patients who had previous exposure to a seizure diary, and 117 were unexposed. Of the patients who had previous exposure to the seizure diary, 64 (98.5%) found the diary useful, but 15 (23.1%) reported facing various challenges with using the seizure diary. In phase 3, the modified Delphi survey had three rounds, with 12 expert panellists completing each round. Consensus for any item was set at 70%. Eighteen items were suggested as the required contents of a seizure diary. The seizure diary, designed in phase 4, was distributed to 139 patients (81 previously diary-unexposed and 58 who had previous exposure to a seizure diary) to use for six months. In phase 5a, of the 139 patients who received the new seizure diary,100 (67 previously diary-unexposed participants and 33 participants who had previous exposure to a seizure diary) completed questionnaire 2. Participants who had previous exposure to a seizure diary were predominantly very positive about the new diary because it had more information. However, 21.2% preferred the old one, because it was easier to complete. In phase 5b of the study, the final draft of the new seizure diary was designed for use by patients with epilepsy. ๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป An expert panel of specialists, patients, caregivers, and relatives participated in developing a new seizure diary. Despite a few patients reporting that they preferred the old seizure diary, most participants preferred the new seizure diary and were willing to use it.