Stroke is the third leading cause of death and a major cause of disability in most societies. Individuals with physical disabilities are at risk of secondary complications due to the impact of the disability, which may be exacerbated by poor lifestyle choices. Although disabled persons desire to engage in wellnessenhancing activities, limited programmes based on their health promotion needs&rsquo / assessment have been developed. The aim of the present study is to determine the health promotion needs of stroke patients accessing selected Community Health Centres in the Metropole region of the Western Cape. A cross-sectional survey, utilizing a self-administered questionnaire and in depth interviews with a purposively selected sample was used to collect the data. The quantitative data was analysed using Microsoft Excel &reg / . Means, standard deviations and percentages were calculated for descriptive purposes and the chi-square test was used to test for associations between socio-demographic and health-related variables. Audiotape interviews were transcribed verbatim, the emerging ideas were reduced to topics, categories and themes and finally interpreted. In order to qualify for between-method triangulation used in the study, complementary strengths were identified by comparing textual qualitative data with numerical quantitative results and vice versa. The quantitative analysis revealed that the participants were engaging in health risk behaviours such as physical inactivity, substance usage, non-compliance to medication use and inappropriate diet modification. Lack of financial resources, facilities and access to information predisposed them to involvement in risky health behaviours. In-depth interviews supported the quantitative findings and revealed that numerous participants&rsquo / suffered from depression and frustration as a result of having a stroke. The necessary ethical considerations were upheld. The outcome of the study could contribute to the need to develop, encourage and promote wellness-enhancing behaviours and activities to improve the participants&rsquo / health status and ultimate quality of life.

The existing District Health Information System in South Africa can be described as a facility based Information System, focusing on the clinics and hospitals and not on the community. Consequently, only those who access health services through these facilities are included in the system. Many children do not have access to basic health and social services and consequently, are denied their right to good health. Additionally, they are excluded from the routine Health Information System. Policy and resource decisions made by the District Managers, based on the current health facility information, reinforces the exclusion of these already marginalised children. The premise behind this research is that vulnerability of children can be tackled using two interconnected strategies. The first is through the creation of awareness of the situation of children and the second through mobilising the commitment and action of government and society to address this situation. These strategies can be supported by designing an Information System for action / an Information System that can be used to advocate and influence decisions and policies for the rights of these children / an Information System that includes all children. An interpretive participatory action research approach, using a case study in a rural municipality in South Africa, was adopted for the study of a child-health Community-Based Information System. The context in which the community is placed, as well as the structures which are embedded in it, was examined using Structuration Theory. This theory also influenced the design of the Information System. As the aim of the research is to change the Information System to include vulnerable children, a Critical Social Theoretical and longitudinal perspective was adopted. In particular, concepts from Habermas, such as the creation of a public sphere and the &rsquo / Ideal Speech Situation&rsquo / , informed the methodology chosen and were used to analyse the research undertaken. <br /> <br /> Based on the research conducted in this municipality, four main changes to the Health Information System were made. These were: &bull / determination of the community&rsquo / s own indicators / &bull / changes in data collection forms / &bull / creation of forums for analysis and reflection, and / &bull / changes in the information flows for improved feedback. Other practical contributions of the research are the development of local capacities in data collection and analysis, the development of practical guidelines on the design of a child-health Community-Based Information System, and the development of strategies for enabling participation and communication. In line with the action research approach adopted, and the desire to link theory and practice, the research also contributed on a theoretical level. These contributions include extending the use of Structuration Theory, in conjunction with Habermas&rsquo / Critical Social Theory, to the empirical context of South Africa / addressing the gap of Community-Based Information Systems in Information System design / extending the debate on participation and communication in Information Systems to &rsquo / developing&rsquo / countries, and developing generalisations from a qualitative case study.

Assignment (MPA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: Primary Health Care (PHC) approach is currently receiving tremendous attention worldwide as a mechanism to ensure effective and efficient public health services. The concept has evolved from the Alma Ata conference (1978). Since then many countries began to reorient their health services to achieve the goals of availability, accessibility and affordability of health care for all citizens and a number of management issues came to the forefront. Therefore, the provision of comprehensive PHC services is the key aspect to improving health services. A district health system has been identified as an ideal model for comprehensive PHC services to all the citizens in South Africa. Public health services in the Cape Metropolitan Area are characterised by functional fragmentation. Two public authorities render Primary Health Care services, namely the: Provincial Administration of the Western Cape through CHSO, and the Municipal Health Department. The fragmented nature of the public health services, which result in poor coordination of service delivery between the two health authorities, compromises the quality of service delivery. Historically, PHC services in the Cape Metropolitan Area - and indeed in the whole South Africa - have developed in a skewed manner. This work is an attempt at conceptualising the implications and consequences of this skewed health development. South Africa is presently undergoing fundamental reform, which has brought the PHC into disarray of fundamental change. Since the South African health care system is a highly complex institution, attempts have been made to critically analyse those aspects and features of inequality, inaccessibility, and inequity. Among these is the historical and present development of Cape Metropolitan Area health care and the structural features it assumed with the passing of time, trends and characteristics. In order to examine the theory in practice, the evolvement of PHC in the Cape Metropolitan Area will be analysed. The analysis highlights how different political formations have affected the development of PHC services and points out obstacles and limitations throughout the process, which had to be dealt with. Transformation of the existing health services, based on the principles of PHC, requires the redressing the imbalances of the past. Therefore, the integration of the two health authorities into one entity would best achieve the principles of district health system and will ensure comprehensive PRe. / AFRIKAANSE OPSOMMING: Die Primêre Gesondheidsorg benadering geniet tans wereldwyd erkenning as 'n meganisme om doeltreffende openbare gesondheidsdienslewering te versker. Die konsep, wat ontwikkel en gegroei het uit die Alma Ata-konferensie van 1978, is reeds deur verskeie regerings ge-implementeer ten einde die doelwitte van beskikbaarheid, toeganklikheid en bekostigbaarheid van gesondheidsorg vir alle landsburgers te verseker. Die voorsiening van omvattende Primêre Gesondheidsorgdienste word erken as 'n noodsaaklike middelom gesondheidsorg te verbeter. Die Distrikgesondheid-stelsel is geidentifiseer as 'n ideale model vir die implementering van omvattende Primêre Gesondheidsorgdienste in Suid Afrika. Publieke Gesondheidsdienste in die Kaapse Metropolitaanse-gebied word gekenmerk deur die feit dat dit funksioneel gefragmenteer is. Twee publieke owerhede, te wete die Provinsiale Administrasie van die Wes Kaap en die Kaapse Stadsraad lewer Primêre Gesondheidsorgdienste, wat aanleiding gee tot swak koordinering met die gevolg dat dienslewering daaronder ly. Primêre Gesondheidsdienste in die Kaapse Metropolitaansegebied, soos in die res van Suid Afrika, het op 'n onlogiese, skewe manier ontwikkel Hierdie werk is 'n poging om die gevolge en implikasies van die onlogiese, skewe gesondheids-ontwikkeling te konseptualiseer. Daar is gepoog om die uiters gekompliseerde gesondheidsdiens-stelsel in Suid Afrika krities te analiseer met spesifieke verwysing na die kenmenrke van ongelykheid, ontoeganklikheid en onbillikheid. Dit sluit die historiese en huidige ontwikkeling van gesondheidsorg in die Kaapse Metropolitaanse gebied en die strukturele kenmerke in wat deur die loop van jare as gevolg van verskeie invloede en neigings sigbar geraak het. Die ontwikkeling van Primêre Gesondheidsorg in die Kaapse Metropolitaanse-gebied word ge-analiseer ten einde bogenoemde teorie in die praktyk te bevestig. Die analise beklemtoon die invloed van verskillende politieke rolspelers op ,die ontwikkeling van Primêre Gesondheidsorgdienste en bevestig die struikelblokke en beperkings wat deurentyd opgeduik het. Transformasie van gesondheidsdienste soos dit tans daaruit sien, gegrond op die beginsels van Primêre Gesondheidsorg, vereis dat die ongelykhede van die verlede aangespreek word. Die integrasie van die twee gesondheidsdiensowerhede sal die beginsels van die Gesondheidsdistrik-stelsel verwesenlik, wat daartoe sal aanleiding gee dat omvattende Primêre Gesondheidsorg 'n werklikheid word.

This study explores environmental understanding among the health care practitioners serving a rural community in the Eastern Cape Province in South Africa. During the preliminary phases of the research, the decision was made to adopt a participatory approach to the inquiry as far as was possible. Semi-structured interviews, participant observation and focus group discussions were the techniques chosen to focus the participants' thinking about: the meaning of environment, environmental issues and problems which impact on health, and, environmental education in practice. Comparisons between the recently transformed health education idea proposed by the World Health Organization (WHO), known as "health promotion", and a popular environmental education model are made. It is argued that many of the obstacles to effective health education described by the participants in the study can be overcome by using environmental educationlhealth promotion approaches. The findings show that the health practitioners studied relate to a wide range of environmental issues with varying levels of engagement. They are influenced by changing values, their feelings about indigenous knowledge, and their notions about how people should respond to the environment. An urgent need for more and better communication among the different levels of health practitioners is identified. Finally, it is recommended that health care practitioners be supported with opportunities for professional development which can lead to a confident, seIfreflective approach to health education.

The South African government has initiated the transformation of health services in the country towards primary health care (PHC) in order to provide comprehensive care to individuals and families. The move to PHC involves an increased need for collaboration between health professionals. It is proposed that for effective team-work to take place, an understanding of the roles and functions of team members is imperative in providing quality mental health care. This study explored health professionals’ perceptions of the role and function of clinical psychologists working as part of a health care team in a community context. Three focus groups and three individual interviews were conducted with social workers, nurses and doctors. The data was then processed and analysed using a grounded theory method. The research highlighted the importance of knowledge, and how this affects referrals, perceptions, inter-professional relations and the perceived usefulness of clinical psychology and clinical psychologists. What is of significance is the potential power that the health professionals have as gatekeepers between the general public and clinical psychologists.

Thesis (MTech (Public Management))--Cape Peninsula University of Technology, 2017. / The purpose of this study was to examine the problem of access to health care centres in the Western Cape and to forward recommendations that will improve access to health care facilities in the Western Cape. The first objective of the study was to identify trends in primary health care looking at Nigeria, with the view of learning lessons of experience. Secondly, the study provided an overview of the South African health care system. The study further examined the problems around access to Gugulethu Community Health Clinic. The research objectives were directly linked to the composition of chapters. The study utilised a mixed-method approach of quantitative and qualitative approaches. This method is called multi-method approach. The purpose of combining the two approaches was to understand the research problem from a subjective and objective point of view, as well as to provide an in-depth understanding of a research topic, which led to more reliable research results. Data collection was acquired by utilising a structured questionnaire and personal observations. Two groups of respondents participated in the study inter alia: the patients and the staff of Gugulethu Community Health Clinic.

Evidence suggests that the prevalence of certain non-communicable diseases, such as hypertension, is increasing rapidly, and that patients with these diseases are making significant demands on the health services of the nations in sub-Saharan Africa. However, these countries also face other health-related challenges such as communicable diseases and underdevelopmentrelated diseases. Developing countries like South Africa have limited resources, in terms of man power and financial capital, to address the challenges that they are facing. Non-communicable diseases cannot be ignored and since health care providers cannot meet the challenges, it is worthwhile to empower patients to be involved in the management of their conditions. Patient education is a tool that can be used to enable patients to manage their chronic conditions and thereby reduce the morbidity and mortality rates of these conditions. The aim of this study was to investigate the effect of a patient education intervention on participants’ levels of knowledge about hypertension and its therapy, beliefs about medicines and adherence to anti-hypertensive therapy. The intervention consisted of talks and discussions with all the participants as one group and as individuals. There was also written information given to the participants. Their levels of knowledge about hypertension and its therapy were measured using one-on-one interviews and self-administered questionnaires. Beliefs about medicines were measured using the Beliefs about Medicines Questionnaire (BMQ) whilst adherence levels were measured using pill counts, elf-reports and prescription refill records. The participants’ blood pressure readings and body mass indices were also recorded throughout the study. The parameters before and after the educational intervention were compared using statistical analyses. The participants’ levels of knowledge about hypertension and its therapy significantly increased whilst their beliefs about medicines were positively modified after the educational intervention. There were also increases, though not statistically significant, in the participants’ levels of adherence to anti-hypertensive therapy. Unexpectedly, the blood pressure readings and body mass indices increased significantly. The participants gave positive feedback regarding the educational intervention and indicated a desire for similar programmes to be run continuously. They also suggested that such programmes be implemented for other common chronic conditions such as asthma and diabetes. This study proved that patient education programmes can be implemented to modify patients’ levels of knowledge about their conditions and the therapy, beliefs about medicines and adherence to therapy. However, such programmes need to be conducted over a long period of time since changes involving behaviour take a long time.

Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.

This thesis analyses the state of health care in South Africa with particular reference to a clinic and the Provincial Hospital in Port Elizabeth, Eastern Cape. The complexities of health care provision in a diverse sociolinguistic environment where certain languages are emphasized over others, forms the cornerstone of the research. The research focuses on health care in a complex multi-cultural environment. The goal of the research is to present a coherent and robust translation framework for the development of suitable materials to enhance communication across language and cultural barriers in the health care sector. A model (based on research completed in the USA) is presented as a possible alternative in the final chapter of the thesis.

M.Cur. / The entire country is currently in a process of reconstruction that inevitably lead to reconstruction within the health care system. The ANC (African National Congress) formulated a National Health Plan based on primary health care that is a practical expression of providing an effective and equitable health care to all inhabitants of the country. Recognising the need for transformation, a process was initiated by the African National Congress (ANC) to develop an overall National Health Plan based on the Primary Health Care approach (ANC, 1994: 7) . In the light of these present needs, the vision is to develop a strategy to empower our professional nurses that can effectively implement primary health care whilst operating within the limitations of the existing resources (Human Resource Committee for Health, 1994:5). The context of the study is applicable to the Northern Region of the North West Province. There are various courses available to empower professional nurses to primary health care, but for the purpose of the study is the Diploma Course in Clinical Nursing Science, Health Assessment, Treatment and Care described