published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M.Pharm) -- University of Limpopo, 2013 / Introduction: Many patients with chronic illnesses including asthma, hypertension, diabetes mellitus and HIV/AIDS, have difficulties adhering to their recommended regimens. This may result in sub-optimal management and control of the illness. What a patient understands about a specific regimen, including the reason for taking each medication and the intricacies of dosing schedules and administration requirements, can have a profound influence on adherence. Monitoring the effectiveness and safety of the treatment administered helps to decide whether this should be continued, changed or stopped. Any drug may produce unwanted or unexpected adverse reactions. The choice of drugs depends on many factors, such as the pattern of diseases, the treatment facilities, the training and experience of the available personnel, the financial resources available and demographic or environmental factors. The level of adherence to medication among with hypertension and diabetes mellitus or anti-retroviral therapy has not been studied in Limpopo province Aim: The aim of the study was to determine the adherence patterns and the factors contributing to the adherence to treatment by diabetic, hypertensive and HIV/AIDS patients at Mokopane Hospital. Methodology: This was a cross-sectional, descriptive study conducted through use of a questionnaire administered as an exit interview at the pharmacy after the patients had consulted the doctor and received their medication from the pharmacy. Results: The data was collected over a period of two months, where every patient was seen only once using their hospital numbers to avoid repetition. The study included a total of 307 participants, 201 (60%) were patients on ARVs, 48 (16%) were on anti-hypertensive, 35 (11%) on anti-diabetic, and 23 (8%) on both anti-hypertensive and anti-diabetics. The respondents were predominantly female (n = 234; 76%) while 73 (24%) male. Similarly of the 201 participants on ARVs treatment, 153 (76%) were females and 48 (24%) were males; among those on anti-hypertensives only 11 (22%) were males. For the diabetics 6 (17%) were males and 29 (83%) were females. Of participants with both hypertension and diabetes 9 (39.1%) were males and 14 (60.9%) were females. Seventy-nine percent (79%) of respondents on ART, 69% of those on anti-hypertensive, 72% of those on anti-diabetics, and 66% of those on both anti-diabetics and anti-hypertensives were adherent to their treatment. The younger patients (21 to 40 years) were less likely to have forgotten to take their treatment in the last one month (21% of respondents) than the older patients (41 to 87 years), 34% of whom forgot to take medication in the month prior to the study. Most respondents 250 (81%) reportedly used an alarm system/timer as reminder to take their medication. Most of them reported that they received information regarding their condition and medication, though some were not sure of the side effects or indications for the medications. Adherence was attributed to faith in the healthcare worker, fear of complications of the condition, and a desire to control the condition. Non-adherence was seen as an active decision, partly based on misunderstandings of the condition and general disapproval of medication which was only taken in order to facilitate daily life or minimize adverse effects. Conclusion: The levels of non-adherence (21% to 34%) among the patients on chronic medication are not acceptable. Elderly patients were more likely to be non-adherent to their treatment compared to the younger patients. Some information gaps were identified regarding their conditions and indications for medications. It is therefore important for the health professional to provide patients with full information about the indications, efficacy, and side effects of the medication given to them. Ways should be found to support elderly patients who are on chronic medications; for instance through directly observed therapy and/or using treatment supporters.

Thesis (M.A. (Clinical Psychology)) -- UNiversity of Limpopo, 2014 / A number of studies have revealed that chronic diseases are common in all communities. This study explored the views of indigenous healers regarding the causes and treatment of chronic diseases in Ga-Dikgale community. A qualitative approach was followed and participants were selected through snowball sampling. Seven participants (2 males and 5 females) who are indigenous healers were recruited for the study. Data was collected using in-depth semi-structured one-to-one interviews and analysed using content analysis. The results of the study are presented in terms of the following themes: a). Participants’ views regarding the types of chronic diseases: despite the divergent views held by indigenous healers regarding chronic diseases, they all perceive these debilitating conditions as incurable. b). Participants’ own explanations of the causes of chronic diseases: it appeared the causes of chronic diseases were attributed to both cultural beliefs and modern medical science. c). Participants’ experiences and subjective notions on the treatment methods for chronic diseases: it was found that Western medicine is considered the most viable option to treat chronic diseases instead of indigenous medicine. d). Participants’ descriptions of the most common diseases that they treat: indigenous healers treat non-chronic conditions instead of chronic diseases. e). Participants’ own perceptions of their roles in the community: it appeared indigenous healers felt they received support from their community as they were consulted mostly for non-chronic conditions; and f). Participants’ recommendations on how people with chronic diseases should be managed: indigenous healers recommend that people should seek medical intervention for treatment of chronic diseases. The study further revealed that indigenous healers in this community are not always the first line of treatment for chronic conditions. Instead, it was found that indigenous healers tend to advice patients with chronic diseases to seek medical intervention rather than traditional healing. The study is concluded by recommending further investigation on chronic diseases, including the possibilities of integrating indigenous healing and Western-oriented health care systems.

The Namibian Treatment Guidelines of 2011 for hypertension management provide evidence-based care protocols for effective management of hypertension. Documentation of health care in clients’ records is important to ensure patient safety and effective continuity of care. Documentation in this study reflected the extent of implementation and compliance with the hypertension management guidelines. The purpose of this study was to examine physicians’ implementation and compliance with hypertension management guidelines, through auditing documentation in health passports of clients diagnosed with hypertension. The guidelines were used as a framework to assess completeness of documentation. The study used a non-experimental, descriptive, retrospective quantitative research to examine the physicians’ implementation and compliance with hypertension management guidelines at the selected hospital outpatient department in Namibia. Non-probability convenience sampling was used to select client records. Data were collected by means of a structured three point Likert scale checklist. Data were analysed using the (SPSS) version 23 for Windows. The findings showed poor documentation of care provided, thus, assuming low compliance with hypertension management guidelines. Major areas of poor documentation were found in monitoring of risks factors, investigations to monitor organ damage, advise on when to seek care and client-centred health education. Based on study results, recommendations were formulated to improve quality of documentation and thus, implementation of and compliance with hypertension management guidelines. / Health Studies / M. P. H. (Health Studies)

Thesis (MTech (Business Administration))--Cape Peninsula University of Technology, 2018. / Research findings indicate that between 42% and 56% of people dying between the ages of 25 to 70 are most likely to die out of a preventable cause. Most of these illnesses are chronic illnesses, directly a result of lifestyles that people have adopted over long periods. Whilst it has been difficult to cure some of the diseases, it has been however possible to treat the ailments. Consequently, patients who have followed faithfully the treatment regimes have lived far longer than would have been expected. Because these illnesses needed continued treatment, they are therefore referred to as chronic illnesses. It is expected therefore that the patients should regularly go for medical check-ups as well as take their medicines continuously. Chronic illnesses are an increasing cause of morbidity and mortality in Metro District primarily because most chronic patients die even though their deaths are preventable. The research findings presented here are a result of a survey of 200 chronic-patients in the Metro-District in Cape Town using mixed qualitative and quantitative methods. The objectives of the studies were primarily to establish reasons for the noticed defaulting rate amongst the patients. Because the medication was subsidised by the government and the patients got the treatment at no cost, it was expected that few, if any, would default. The findings indicated that close of 40% of the patients’ default and various reasons were provided ranging from forgetting, no transport money, no one to accompany them to the outlets to absence from town. The findings provide valid information to be used by the district to address the high rate of chronic medicines defaulting.

The purposes of this study are: a) to understand the treatments compliance behavior of the patient with chronic disease at the behavioral level, particularly, the relationship between treatments compliance behavior and normative beliefs; b) develop a behavioral model of patient's treatments compliance behavior that could be used for predicting, combating, treating, tracking and controlling the treatments compliance behavior of the patients with chronic disease. Seventy-two patients from senior daycare centers in the Dallas area, who suffer or had suffered from at least, one chronic disease, participated in the study. Data gathering was conducted using paper-based questionnaire. The most significant finding of this study is the relationship between normative beliefs and the treatments compliance behavior of the patient with chronic disease. Normative beliefs were found to have significant impact on the treatments compliance intent and behavior of the patients with chronic disease. Another important finding showed that side-effects of prescribed treatments have little or no influence on the treatments compliance behavior of the patient with chronic disease. A relationship between the effectiveness of medicine, particularly, predictive medicine, and treatments compliance behavior was established. The design of the study was intended to provide coverages for a set of constructs that may be the interacting units in the environment of any chronic disease treatments decision. It depicts relational, information communications links between the constructs. The Imhonde model of treatments compliance behavior was designed to include cultural norms and other beliefs that are significant for real-time human ailments decisions behaviors. It is recommended that further studies may include the use of a larger population of participants from diverse cultures and localities in multiple states and countries, with the object of finding the differences that culture and local environments may have on the normative leaning for treatments compliance behavioral decisions in chronic disease cases.