Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Background: In Africa, internet access and use is plagued by numerous barriers. Whilst South Africa (SA) boasts a better population penetration than the rest of Africa there is a lack of regulation regarding the internet and e-mail use amongst health professionals and their patients. The aim of this study was to assess the use of the internet amongst dietitians and medical doctors (MDs) in clinical practice in SA and draft a policy on such usage amongst health professionals and their patients. Methods: A cross-sectional analytical web-based survey was conducted amongst registered dietitians and MDs. A cover letter including a hyperlink to the self-administered questionnaire was e-mailed to all dietitians and a proportionate, stratified random sample of MDs with contactable e-mail addresses. The questionnaire consisted of open and closed questions, including demographics, influence of the internet on the quality of care of patients, quality control with web resources and aspects of information technology (IT) which were recommended by health professionals to be incorporated as part of undergraduate health science education Results: A total of 176 health professionals participated in the study (106 dietitians and 70 MDs). The mean age of the dietitians was 32.6± (8.0) and the MDs 50.5± (8.9). The majority of the respondents in this study population were White (82%) females (67%). On average, practitioners had been in practice for 9.1(8.0) years. The majority of dietitians (58%) and MDs (68%) had access to the internet at both their practice or workplace and their home. More dietitians (65%) than MDs (41%) were using e-mail or internet. MDs did not use the internet for research purposes, whilst a fifth of dietitians (21%) reported using the internet as a research tool. A greater percentage of the sample [MDs (69%) and dietitians (82%)] reported that, the internet had improved the quality of care of their patients. The dietitians (60%) and MDs (53%) in this study sample were unclear about how to source information and determine the reliability or accuracy of the information obtained from internet resources. Conclusion: Internet is incorporated into the practice of most dietitians and to a lesser extent by MDs. In this study, the need for training amongst health professionals regarding the use of the internet was highlighted. The study reflects that even though health professionals were unsure of the credibility of the internet information resourced, it did not stop the use of the internet in the practice. This is an area of concern, since it could potentially result in the distribution of misinformation. This warrants regulation on the use of the internet in health practices in SA. A policy on the use of IT in health care practice has been drafted. Further research on the use of IT in the healthcare practice is required before the policy can be finalized. The advantage is that some elementary information is now available. The challenge is to ensure that the time lapse between additional research, policy finalization and policy implementation is kept to a minimum. / OPSOMMING: Agtergrond: In Afrika is internet toegang en gebruik met baie hindernisse belas. Alhoewel Suid-Afrika (SA) met ‘n beter bevolkingspenetrasie as die res van Afrika spog is daar ‘n gebrek aan regulasie in verband met internet en e-pos gebruik tussen gesondheidswerkers en hul pasiënte. Die doel van hierdie studie was om die gebruik van die internet deur dieetkundiges en mediese dokters (MDs) in kliniese praktyk in SA te assesseer en om ‘n konsepbeleid rakende sulke gebruik tussen gesondheidswerkers en hul pasiënte op te stel. Metode: ‘n Dwarssnit analitiese web-gebaseerde opname is met geregisteerde dieetkundiges en MDs onderneem. ‘n Dekkingsbrief met ‘n webskakeling (hyperlink) tot die selfgeadministreerde vraelys is aan alle dieetkundiges en aan ‘n eweredig, gestratifiseerde ewekansige steekproef van MDs met kontakbare e-pos adresse gestuur. Die vraelys het uit oop en toe vrae bestaan, insluitend demografie, invloed van die internet op die kwaliteit van sorg van pasiënte, kwaliteitskontrole met web-hulpmiddels en aspekte van informasie tegnologie (IT) wat deur gesondheidswerkers aanbeveel was om deel te word van voorgraadse gesondheidswetenkaplike onderrig. Resultate: ‘n Totaal van 176 gesondheidswerkers het aan die studie deelgeneem (106 dieetkundiges en 70 MDs). Die gemiddelde ouderdom van die dieetkundiges was 32.6± (8.0) jaar en die MDs 50.5± (8.9) jaar. Die meerderheid respondente in hierdie studie populasie was blank (82%) en vroulik (67%). Oor die algemeen was praktisyne vir 9.1± (8.0) jaar in praktyk. Die meerderheid dieetkundiges (58%) en MDs (68%) het toegang tot die internet by beide hul praktyk of werkplek en hul huis. Meer dieetkundiges (65%) as MDs (41%) het e-pos of internet gebruik. MDs het nie die internet vir navorsingsdoeleindes gebruik nie, terwyl ‘n vyfde van dieetkundiges (21%) raporteer het dat hulle die internet vir navorsingsdoeleindes gebruik het. ‘n Groot persentasie van die populasie [MDs (69%) en dieetkundiges (82%)] het gerapporteer dat die internet tot ‘n verbetering in sorg van hul pasiënte gelei het. Die dieetkundiges (60%) en MDs (53%) in hierdie studie was onseker hoe om informasie te verkry en die betroubaarheid en akuraatheid van die informasie vanaf internetbronne te bevestig. Opsomming: In hierdie studie word internet in die praktyke van die meerderheid dieetkundiges en tot ‘n mindere mate in die van MDs geinkorporeer. Die noodsaaklikheid vir opleiding in die gesondheidsberoepe met betrekking tot die gebruik van die internet is aan die lug gebring. Hierdie studie weerspieël dat alhoewel gesondheidswerkers onbewus was van die geloofwaardigheid van internet informasie, dit nie die gebruik van die internet in hul praktyk gestop het nie. Dit is ‘n area van kommer aangesien dit potensieel na die verspreiding van misinformasie kan lei. Dit motiveer dus reguleering van die gebruik van die internet in gesondheidspraktyke in SA. ‘n Beleid oor die gebruik van IT in gesondheidspraktyke is in konsepvorm opgetrek. Verdere navorsing oor die gebuik van IT in gesondheidspraktyke word benodig om die konsepbeleid te finaliseer. Die voordeel is dat basiese inligting nou beskikbaar is. Die uitdaging is om te verseker dat die tydsduur tussen addisionele navorsing, beleidsfinaliseering en beleidsimplementering tot ‘n minimum gehou word.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of this study was to explore the barriers that doctors experience to referring patients to dietitians. The study sample (n = 700) included a selection of all practicing medical doctors and specialists in the Gauteng province of South Africa. Registration with the Health Professions Council of South Africa (HPCSA) was a prerequisite. METHOD: This was a quantitative study using a validated questionnaire e-mailed to participating doctors in order to determine factors affecting their referral practices. The first part of the questionnaire consisted of demographic and general information about the respondent and the second and third parts consisted of a series of closed-ended questions that related to specific issues of nutrition information and dietitian referral practices respectively. The questionnaire comprised a total of 21 questions. Subjects were sent the questionnaire by e-mail and given four weeks to respond. Three reminder e-mails were sent to encourage participation. Statistical analysis methods included: Kruskal-Wallis, Pearson Chi-square, likelihood ratios, linear-by-linear associations, as well as Goodman and Kruskal tau tests. RESULTS: Of the questionnaires sent out, 134 (19%) out of 700 were finally useable. Doctors who had a nutrition component in their training referred patients to dietitians more often than those who did not and older doctors referred to a dietitian less often (Chi-square tests, p < 0.05). A correlation was observed between the duration of medical practice and frequency of referral (p = 0.03) while gender had no influence on referral practice. A correlation (p < 0.001) was also found between frequency of referral and university of study with symmetric measures. Hyperlipidaemia, diabetes mellitus and obesity were identified as the conditions doctors would most likely refer to a dietitian. For 45% of the doctors insufficient time during consultation was the strongest barrier to providing nutrition councelling to their patients. The barrier identified most commonly was that doctors were unaware of dietitians in the vicinity of their practices (49%). Sixty four percent of doctors believed that better marketing by dietitians would increase their referrals, and 21.4% believed that the title ‘nutritionist’ or ‘nutrition specialist’ would be more suitable for the profession of dietetics. CONCLUSION: The findings of the study indicate that a number of factors contribute to the barriers that doctors experience to referring patients to dietitians. Although the study was limited by a small sample, it nevertheless draws attention to the responsibility of both dietitians and doctors to work together toward providing patients with a more efficient team approach treatment and care system. More qualitative studies are needed to explore the identified barriers further, especially within the South African context, as well as to establish appropriate recommendations to overcome the barriers to referral.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2009. / Thesis presented in partial fulfillment of the requirements for the degree of Master of Nutrition at Stellenbosch University. / ENGLISH ABSTRACT: The glycemic index (GI) has proven to be a valuable nutritional tool in the management and prevention of diabetes and other chronic diseases of lifestyle 1,3,4,5,6,79,12,14,15. In this quantitative, cross-sectional, observational and descriptive study, the aim was to determine the knowledge and level of comprehension of South African registered dietitians with regard to GI and glycemic load (GL) as well as to determine their ability to use/implement the GI in the treatment of diabetes / insulin resistance. A questionnaire was emailed to 388 registered dietitians for completion. The questionnaire was based on relevant scientific literature and divided into three parts. The first part gathered demographical information about the participants, with special emphasis on where they had acquired their knowledge of GI principles. The second and third parts contained closed-end questions to which the participants were required to answer ‘true’ or ‘false’ or were presented with a multiple choice. Twenty-five questions specifically focused on the GI and the other 12 focused on GL. One hundred and fourteen subjects took part in the study. The results showed that most dietitians (54 %) did not learn GI principles at university and that the year that they qualified did not affect test results. The University attended did not seem to affect test results either, with the exception of Medunsa (Medical University of South Africa), where graduates scored on average significantly lower than the rest of the group). The test scores varied between 43% and 97%. The average test score for the group was 71% with those dieticians in private practice scoring the highest average (76%) compared to those working in other practice areas. Although 84% percent of participants reportedly used GI principles in their daily practice with patients, compared to only 33% who reportedly used GL principles, results showed no significant difference between knowledge or comprehension levels of GI and GL or the ability to implement GI or GL principles. To conclude, South African dietitians seem to have a good general knowledge of GI, but there is still room for improvement in order to ensure that dietitians can become experts in the field. It is recommended that curricula be revised to give this subject more attention during formal university training. / AFRIKAANSE OPSOMMING: Navorsing het bewys dat die Glukemiese Indeks (GI) ‘n waardevolle wetenskaplike hulpmiddel is in die voorkoming en bestuur van diabetes en ander chroniese siektes van lewenstyl 1,3,4,5,6,79,12,14,15 . Die doelwit in hierdie kwantitatiewe, dwars-snit, beskrywende studie was om die kennis- en begripsvlak van Suid-Afrikaanse dieetkundiges te toets rakende die GI en glukemiese lading (GL) asook hul vermoëns om hierdie beginsels toe te pas en te gebruik in die behandeling van diabetes en insulienweerstandigheid. ‘n Vraelys is aan 388 dieetkundiges gepos. Die vraelys was gebasseer op relevante wetenskaplike literatuur en het uit drie afdelings beslaan. Die eerste afdeling was ten doel om demografiese inligting oor deelnemers te bekom met spesifieke belang by die afkoms van hul kennis oor die GI. Die tweede en derde afdelings het bestaan uit vrae waarop ‘waar’ of ‘vals’ gemerk moes word of uit veelvuldige keuse vrae. Vyfen-twintig vrae het gefokus op die GI en twaalf vrae het gefokus op die GL. Eenhonderd-en-veertien persone het deelgeneem aan die studie. Die resultate het getoon dat meerderheid van die deelnemers (54%) nie die beginsels aangaande die GI op universiteit geleer het nie. Die jaar waarop graduasie plaasgevind het, het blykbaar nie ‘n invloed op uitkoms gehad nie, en die universiteit waar graduasie plaasgevind het, het ook nie die uitslag beïnvloed nie, uitsluitend Medunsa (waar gegradueerdes aansienlik swakker gevaar het as die res van die groep). Toets uitslae het gewissel tussen 43% en 97%. Die gemiddelde toetspunt was 71%. Dieetkundiges werkend in privaat praktyk het die hoogste gemiddelde toetspunt van 76% behaal in vergelyking met dieetkundiges wat in ander velde praktiseer. Ten spyte daarvan dat 84% deelnemers aangetoon het dat hulle GI beginsels in hulle werksomstandighede toepas, in vergelyking met slegs 33% wat GL beginsels toepas, was daar geen noemenswaardige verskil in uitkomste rakende deelnemers se kennis of begripsvlak van GI of GL, of hul vermoë om verwante beginsels toe te pas nie. Ter opsomming wil dit voorkom of Suid- Afrikaanse dieetkundiges oor ‘n goeie vlak van algemene kennis betrekkende die GI beskik. Daar is wel steeds ruimte vir verbetering om te verseker dat dieetkundiges as ware kenners op die gebied kan optree. Dit word aanbeveel dat universiteite se kurrikulums aangepas word om sodoende voorsiening te maak vir verbeterde voor-graadse opleiding oor die onderwerp.

Introduction: The aim of this research was to establish the attitudes, knowledge, job satisfaction and professional development of community service dietitians because negative attitudes, poor knowledge, low levels of job satisfaction and poor professional development would be detrimental to the process of community service and ultimately to the provision of health services. Methodology: Three distinct annual intakes of qualified dietitians completing compulsory community service were the subjects of an analytical cross sectional survey conducted biannually for the period 2003-2005. Data collection methods included telephone interviews, mail, emailed questionnaires and focus group discussions. Individual factors: sex, population group, language, university attended; institutional factors: organisation of community service, mentorship rating, hospital manager support type of facility, rural allowance, hospital location, access to resources, working and living conditions and personal safety and other factors: attitude, community nutrition knowledge, job satisfaction and professional development were included in the data set. Management of data: Data were divided into 2003 cohort (n=20) and 2004-2005 cohorts (n=26). Analysis of the demographic details for 2003 and 2004-2005 cohorts were, respectively: mean ages 23.6 (±0.99) and 24.05(±4.96) years, 60 percent and 73 percent white, 90 percent and 96 percent female, 35 percent and 73 percent University of KwaZulu-Natal graduates and 65 percent of both cohorts were placed in rural facilities. Results: Community nutrition knowledge of the 2003 cohort was unacceptable but improved in the 2004-2005 cohort. Subjects had a generally positive attitude towards community service. Community nutrition levels of knowledge of the 2003 ranged between 60 percent at entry and 67 percent at exit and for the 2004-2005 between 72.8 percent and 78.42 percent. The job satisfaction level of the 2003 cohort at exit was 13.65 (±3.573). In the 2004-2005 cohort job satisfaction was 15.75(±3.360) at entry and 15.75 (±3.360) at exit. 85 percent of the 2003 cohort rated their professional development positively whereas 65 percent of the 2004-2005 cohort rated theirs' positively. This decline and associated problems were to some extent shown in the interview responses. The 2004-2005 cohort did however show a tendency for improvement in the professional practitioner ranking (p=0.088). The majority (95%) of the 2004-2005 cohort rated the dietetic services positively. Focus group discussions highlighted problems that the community service dietitian (CSD) encountered such as lack of supervision and support, lack of basic facilities, poor hospital administration, problems with transport, work overload and problem with their professional role in the community and health facility. A model showing the results of the research indicated that the objectives of the Department of Health for improved service in rural areas were obtained but the retention of health professionals and capacity was lost due to annual rotation of subjects. Community service as a strategy to overcome service delivery has merit provided identified problems are addressed. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2006.