Ph.D. (Community Nursing Science) / The provision of reproductive health promotion services to females in South Africa is the responsibility of the national and provincial governments, while in primary healthcare (PHC) settings the local government is responsible for the provision of free reproductive health promotion services to females. The prevalence of sexually transmitted infections (STIs), the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) led to the development and provision of noncollaborated vertical PHC reproductive health programmes. The purpose of this study was to develop a model to collaborate the provision of reproductive health promotion services in PHC settings. A qualitative, descriptive phenomenological design, exploratory and descriptive approaches and contextual and theory generating design were used. The study was conducted in three phases. In phase 1, data collection consisted of individual indepth interviews and focus group interviews. Non-probability purposive sampling was used to include three population groups: females who utilised the reproductive health promotion services and reproductive health promotion service providers and those who provide clinical teaching regarding reproductive health promotion in two different PHC settings who were sampled through non-probability convenience sampling methods. Throughout the study, ethical principles were strictly adhered to and trustworthiness was ensured. Data analysis was done according to Tesch’s open coding data analysis method. The findings revealed four emerging themes: service provision factors that impact on reproductive health promotion provision; barrier factors towards safer sex practice; low health literacy of females regarding reproductive health promotion, and disclosure of positive HIV status. In phase 2, the conceptual framework was described according to the survey list of Dickoff, James and Wiedenbach (1968) and the Research Model in Nursing as described in the Theory for Health Promotion in Nursing (University of Johannesburg, 2009). In phase 3, the described conceptual framework served as the guideline for the model development guided by Chinn and Kramer’s (2008) theory and model generating design. Two phases of model evaluation was done: firstly by clinical experts and secondly by academic experts. The model that was developed was based on collaboration, community participation, and cooperative decision making processes and was named: A model to collaborate the provision of reproductive health promotion services in PHC settings. The outcomes from implementing this model envisaged to be the reduction of unintended pregnancy, STIs, and HIV and AIDS among females and males.

M.Cur. / We are living in a century of industialization, with noise as the more general of the polutents. Because Eskom workers are subjected to this risk factor, it was decided to institute and implement a hearing conservation programme. Literature concerning noise and hearing conservation was researched with the view to suggestions as a basis for a successful hearing conservation programme. A programme was compiled and included in research of the relevance concerning the knowledge and attitude towards the active use of hearing protection. For the purpose of this research a true experimental design, with a pre-test and post test in the form of a standardised questionnaire, wa~ used. The hearing conservation programme was implemented and controlled by an occupational health nurse in conjunction with other competents on the subject. On completion of the presentation and analysis of the questionnaires, certain findings were noted and used as guidelines to specific recommendations.

Appropriate e-services as well as revenue generation capabilities are key to the deployment and the sustainability for ICT installations in poor areas, particularly common in developing country. The area of e-Health is a promising area for e-services that are both important to the population in those areas and potentially of direct interest to National Health Organizations, which already spend money for Health campaigns there. This thesis focuses on the design, implementation, and full functional testing of HealthAware, an application that allows health organization to set up targeted awareness campaigns for poor areas. Requirements for such application are very specific, starting from the fact that the preparation of the campaign and its execution/consumption happen in two different environments from a technological and social point of view. Part of the research work done for this thesis was to make the above requirements explicit and then use them in the design. This phase of the research was facilitated by the fact that the thesis' work was executed within the context of the Siyakhula Living Lab (SLL; www.siyakhulaLL.org), which has accumulated multi-year experience of ICT deployment in such areas. As a result of the found requirements, HealthAware comprises two components, which are web-based, Java applications that run in a peer-to-peer fashion. The first component, the Dashboard, is used to create, manage, and publish information for conducting awareness campaigns or surveys. The second component, HealthMessenger, facilitates users' access to the campaigns or surveys that were created using the Dashboard. The HealthMessenger was designed to be hosted on TeleWeaver while the Dashboard is hosted independently of TeleWeaver and simply communicates with the HealthMessenger through webservices. TeleWeaver is an application integration platform developed within the SLL to host software applications for poor areas. Using a core service of TeleWeaver, the profile service, where all the users' defining elements are contained, campaigns and surveys can be easily and effectively targeted, for example to match specific demographics or geographic locations. Revenue generation is attained via the logging of the interactions of the target users in the communities with the applications in TeleWeaver, from which billing data is generated according to the specific contractual agreements with the National Health Organization. From a general point of view, HealthAware contributes to the concrete realizations of a bidirectional access channel between Health Organizations and users in poor communities, which not only allows the communication of appropriate content in both directions, but get 'monetized' and in so doing becomes a revenue generator.

The goal of mental health delivery system is to allow the individual with severe and persistent mental illness to live and function effectively in the community and to ensure that the consumers and their families have access to accurate information that promotes learning, self-monitoring and accountability (Stuart & Laraia, 2005:710). In community-based health care, the persons living with severe and persistent mental illness (SPMI) are in their natural environment in the context of the family and the community. The goals of care are focused around maximizing the person living with SPMI’s quality of life (Hunt, 2001:15-16). In South Africa, an integrated package of essential Primary Health Care (PHC) services has been made available to the entire population in order to provide the solid foundation of a single unified health care service (Department of Health, 2000:4). The assessment of health care needs of persons living with SPMI is a dynamic on-going process that is used to collect information, recognise changes, analyse needs and plan health care to provide baseline information to help evaluate the physiological and psychological normality and functional capacity of persons with SPMI (Hunt, 2001:100). There is insufficient information from the Department of Health to either satisfy the enquiry of whether the health care needs of persons living with SPMI are being met comprehensively or whether the practitioners rendering community-based health care are knowledgeable and comply with PHC norms and standards developed by this Department. The researcher is interested in understanding how the persons living with SPMI and their families experience the community-based health care provided by PHC nurses. The purpose of this research study is to develop strategies that would assist the PHC nurses in the selected rural areas of the Eastern Cape to facilitate community-based health care and to render a health care service relevant to the health care needs of the persons living with SPMI and their families. To achieve the objective of the study, the research design was based on a qualitative, exploratory, descriptive, contextual research approach. Phase one includes describing and selecting the research population and the sampling process prior to conducting the field work which comprises individual interviews with persons living with SPMI and their families as well as PHC nurses. According to Dickoff, James and Weidenbach (1968:422) and Chinn and Kramer (1995:78), this strategy involves identifying concepts from fieldwork and creating conceptual meaning to provide a foundation for developing strategies to facilitate community-based care for persons living with mental illness. Phase two of the research design will focus on development of conceptual framework in order to allow better understanding of the phenomenon of interest, as the major concepts will be simplified by connecting all related concepts together by means of statements. This was done by making use of the themes identified during data analysis and the literature sources used throughout this research process. The evaluation criteria of Chinn and Kramer (2008:237-248) were used to evaluate the strategies. It is therefore concluded that the researcher succeeded in achieving the purpose of this study because strategies which were understandable, clear, applicable and relevant to the nursing practice have been developed for use by Department of Health and Primary Health Care to facilitate the multifaceted role of the PHC nurses.

Context: The Women’s Health Initiative (WHI) study, published in July 2002, had a significant impact on the prescribing of hormone replacement therapy (HRT). The controversy surrounding the findings, however, has led to much uncertainty regarding the prescription of HRT. Aims and Objectives: The aim of this study is to determine both the initial and the continued impact of the WHI study on the prescribing of HRT in a defined South African population and to determine whether HRT was appropriately individualised based on recommendations published subsequent to the WHI study. Setting: Claims data from a Managed Healthcare Organisation (MHO) that administers for a number of medical aid schemes in South Africa. Method: A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined populations. The time-frame of the dataset included January 2002, to assess prescribing patterns prior to the publication of the WHI study, January 2003 to determine the initial impact of the WHI study, and January 2005 to assess the continued impact. An extensive, additional dataset of all the HRT users in the defined populations was utilised to conduct a sub-group analysis and determine whether HRT had been appropriately individualised. Key Findings: The percentage of patients in the dataset using HRT decreased from 30.05 percent in January 2002 to 28.30 percent in January 2003 and to 23.24 percent in January 2005, with the latter decrease reaching statistical significance. Although sex hormones and modulators (G03) of the genital system were the most frequently prescribed drug class in all three years of the study period, the prescribing frequency decreased significantly from 10.40 percent in January 2002 to 9.32 percent in January 2003 and 7.44 percent in January 2005. The most noteworthy change in the prescribing of HRT was a 3.95 percent decrease in the prescribing of conjugated equine estrogen (CEE), with a corresponding 2.53 percent increase in the prescribing of estradiol between January 2002 and January 2003. However, less pronounced changes were observed in the prescribing frequencies of other types of HRT, including medroxyprogesterone and estrogen (the HRT type investigated in the estrogen plus progestin phase of the WHI study). Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study) and were at a higher risk for disease states for which HRT use is considered harmful or has an uncertain effect, such as diseases affecting the cardiovascular system. Conclusion: It can be concluded that the WHI study did have an impact on the prescribing of HRT in the defined South African population of this study, but that the impact was considerably less than the impact reported in global studies. It was also determined that HRT was appropriately individualised according to recommendations made subsequent to publication of the WHI study.

In South Africa, suicidal behaviour in the younger generations has become rapidly part of a major public health problem. It is a well-known fact that adolescence is a critical period of progression in a teenager’s development which makes them more susceptible and vulnerable to suicide. Statistics have shown that there has been an increase in suicide among adolescents within the last decade (Schlebusch, 2005). The main aim of this research study is to explore the perceptions of adolescents regarding the factors that contribute to adolescent suicide. This study reviews literature concerning various risks factors for adolescent suicidality. It also described major social and psychological theories of suicide and the extent to which these studies support the importance to adolescent suicide. In the literature review theories of Bronfenbrenner’s Ecological Systems Theory, Durkheim’s sociological theory of suicide, Freud’s psychological perspective and Baumeister’s Escape Theory were discussed. A qualitative research design will be used by using visual participatory methodology techniques namely photo voice and reflective writing. A sample of 12 grade 11 learners, male and female, was purposely selected to participate in the research study. The focus of the study is to investigate the risk factors underlying adolescent suicidal behaviour in schools in the Northern Areas of Port Elizabeth, as well as to explore the stressors experienced by adolescents that could contribute to them having a higher suicide risk. Another focus point will be to look at prevention strategies as an antipode for suicidal behaviour. The main findings that emerged from the data analysis include contributing factors namely: socio-economic factors, personal factors, psychological factors and educational and school-related factors. The main prevention strategy themes emerged from findings derived from the data and include: parental involvement, religion, professional help and support groups and confiding in someone that you trust.

Purpose of this treatise- This Paper aims to investigate the Sustainability of Health Facility Committees in the Nelson Mandela Bay Health District. Design/methodology/approach – This study consists of a literature review and a pilot study. Qualitative research approach was used in order to obtain descriptive data from the targeted group. The primary sources of data collection the researcher used were from the members of the committee, health facility manager, chairperson and the health promoter who are members of the health committees. Focus group discussions with health committees were conducted to provide rich in-depth data. Literature and journal articles were also used to provide secondary data to corroborate findings. Research limitations- A major limitation to this study is that due to the nature of the nature of the research report it was not possible to assess the sustainability of health Facility Committees from other areas in the Nelson Mandela Bay Health District. Findings-The study has revealed that Community Health committees are sustained by the commitment and passion members have for the work done in the facilities and health committees. The study also revealed that social cohesion plays a major part in the sustainability of Community Health Committees (CHC). Lack of involvement by ward councilors, support from the Health Department, uncertainty of responsibilities by the health committees and limited skills were indicated as major setbacks threatening the sustainability of Community Health Committees. It can thus be concluded that these limitations must be properly addressed in order to enable and uphold the sustainability of Community Health Committees. Original/value -So far, there has been limited research which has been undertaken with regards to the subject of Sustainability of Health Facility Committees in Nelson Mandela Bay Health District. This study will aid in enabling a better understanding of what sustains Community Health Committees and the Challenges facing such communities in order to enable individuals and the parties involved to better formulate solutions to overcome these challenges in Nelson Mandela Bay.

M.Cur. (Community Health Nursing) / During employment as a registered nurse and while rendering mobile family planning services on farms in the Eastern Transvaal, it was found that appreciable time was spent on non-nursing tasks. The impression gained, was that the people who visited the clinics were only a part of the total farm community and that possibly a mutual communication gap existed between the formal health sector and the community. The purpose of this study was to establish whether the lay health worker should be formally recognised as a member of the primary health team. The research design was a descriptive, quantitative study in a contextual framework. Data was collected using a literature study and a survey using a questionnaire. The research has confirmed that a gap exists between the formal health sector and the rural community. This gap is bridged by the lay health worker, implying that she should be formally recognised as a member of the primary health team.

The purpose of this dissertation is to evaluate an attempt to use the facilities of a general hospital with minimal psychiatric cover to deal with acute psychiatric conditions. This is in keeping with current psychiatric opinion in South Africa as expressed by Dr. C.W. Allwood and Dr G.A.D. Hart. This dissertation will examine the needs structure, difficulties and results of the provision of a service dealing with acute psychiatric disorders in a peripheral General Hospital and make suqqestions should similar satellite facilities be established at other peripheral hospitals. Although in principle. the concept of part-time specialist cover at a peripheral general hospital is not new in medical. surgical and gynaecological departments. the previous involvement of private psychiatrists within the teaching department has been in the form of out-patient department sessions only at academic and state psychiatric hospitals as is practiced in Cape Town. This project however allowed for the evaluation of emergency cases with subsequent referral to appropriate treatment centres if needed from a peripheral hospital. A consultation-liaison service within the general wards and the opportunity to conduct seminars, lectures and in-house training for all level of professional staff were also encompassed.

Since 1994 a number of health reforms took place in furthering democracy. These changes included the decentralisation of Primary Health Care Services. This study is a phenomenological research that chronicles the Primary Health Care decentralisation experiences in the Bophirima District of the North-West Province. Using a descriptive phenomenological orientation, the purpose of this study was to describe the experiences of participants associated with decentralisation in the Bophirima District. Also, to illustrate how the participants perceive these experiences in relation to Primary Health Care services. Furthermore, to provide scientific evidence regarding factors related to the decentralisation of PHC services in the Bophirima District. These and other issues remain of paramount importance given the current state of health care in the South Africa. This study took place in the outskirts of the semi-rural area of Bophirima and Central District in the North-West Province. The investigation followed qualitative research design that was descriptive, exploratory, contextual and phenomenological in nature. The sampling procedure involved non-probability purposive, sampling technique with a sample size of five participants. Data was collected by using an unstructured interview technique. The modified Giorgi method of analysis was used for qualitative data analysis. These are contained in Burns and Grove (2001:596) and Polit and Beck (2004:394) are fully explicated in Chapter Four. Guba model (in Babbie & Mouton, 2001:180) was utilised to ensure the trustworthiness of the study. Ethical requirements were considered throughout and these are reflected in chapter four of the thesis.Three forms of decentralisation: deconcentration, delegation and devolution were identified in the findings. The investigation further indicated that the integration of primary health care services was also underway at the time of decentralisation. This integration triggered different psychological and emotional states amongst research participants. Most importantly, the research revealed that the interest of leadership across three spheres of government played a key role in the decentralisation of PHCs and integration of PHCs, while highlighting the importance of community participation in health service delivery (CP). In conclusion, the decentralisation process was generally perceived as empowering although, nationally, leadership needs to be strengthened to support provinces and districts regarding major policy issues such decentralisation. Key recommendations were made and further research was suggested. / Health Studies / D. Litt. et Phil. (Health Studies)