Sammanfattning Titel: Patienters erfarenheter av kontakten med äldresköterskan i primärvården. Bakgrund: Andelen äldre människor i Sverige ökar eftersom vi lever längre. Med stigande ålder ökar mottagligheten för sjukdom. Både sjukdom och åldersförändringar kan ge funktionsnedsättningar men trots detta bor många äldre med hälso- och sjukvårdsbehov hemma utan inskrivning i den kommunala hemsjukvården. Syfte: Att belysa patienters erfarenheter av kontakten med äldresköterska inom primärvården. Metod: Studien utgår från en kvalitativ design med induktiv ansats. Fem patienter deltog enskilt i en semistrukturerad intervju. Dataanalysen genomfördes med kvalitativ manifest innehållsanalys. Resultat: De intervjuade upplevde att samtalet är den viktigaste erfarenheten av kontakten med äldresköterskan. Patienterna upplever att kontakten ger dem stöd och minskad oro i vardagen. Deras trygghet ökar genom den kontinuitet och tillgänglighet som äldresköterskan erbjuder. Slutsats: Det arbete som äldresköterskan utför bör lyftas fram och tillåtas utvecklas eftersom antalet äldre med vård- och omsorgsbehov ökar. / Abstract Titel: Patients' experiences of contact with elder nurses in primary health care. Background: The proportion of elderly people in Sweden will increase due to longer life span. With age susceptibility to disease increases. Both disease- and agerelated changes can cause impairments even though many elderly people with health needs live at home, without enrollment in the municipal home care. Objective: The aim was to illuminate patients´experiences of contact with the elder nurse in primary health care. Method: The study uses a qualitative design with inductive approach. Five patients participated individually in a semi-structured interview. Data analysis was performed by qualitative manifest content analysis. Results: The interviewees felt that the conversation is the most important experience of contact with the nurseproviding elder care. Patients feel that the contact give them support and reduced anxiety in daily life. Their safety is enhanced by the continuity and availability provided by the elder nurse. Conclusion: The work that elder nurse perform should be emphasized and allowed to evolve as the number om elderly people with health and care needs increase.

Thesis (MCur)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Nationally and internationally emphasis is placed on quality care in health services. The researcher identified a need to evaluate a component of primary health care service in the Northern province. A study based on the combination of qualitative and quantitative methods was conducted to formulate and evaluate structure, process and outcome standards for selected clinics in the Northern Province. The most important results are: • The standard relating to the structure was suboptimal. Physical and human resources are of critical importance to the rendering of quality patient care. However this did not comply with the pre-set standard norm of 80%. • Process standards focused on physical examination of patients taking into account the age of the client and the systems involved. Substandard care was found in all these aspects. • Outcome standards determined by the patient questionnaire also revealed negative findings. Recommendations include the development of a quality improvement model for the Northern Province Health Services, formulation of standards for all disciplines of health care, annual evaluation of patient care and the institution of a formal staff development programme. Key words: quality care, formulation of standards, structure, process, outcome / AFRIKAANSE OPSOMMING: Nasionaal en internasionaal word die belang van gehaltesorg in gesondheidsdienste beklemtoon. Die navorser het enbehoefte ge'identifiseer om en component van prirnerre gesondheidsorgdienste in die Noordelike provinsie te evalueer. en Kombinasie van kwalitatiewe en kwantitatiewe metodes is gebruik om struktuur-, proses en uitkomsstandaarde in geselekteerde klinieke in die Noordelike provinsie te formuleer en evalueer. Die belangrikste resultate was: • Die standard ten opsigte van die standard was suboptimal. Fisiese en menslike hulpbronne is van kritiese belang vir gesondheidsdienslewering. Die standaard hiervan het nie voldoen aan die voorafbepaalde norm van 80% wat gestel is nie. • Prosesstandaarde het op fisiese ondersoek van die pasiente gefokus met inagneming van die ouderdom van die klient en die simptome waarmee pasiente presenter. Sub-standaardsorg is ten opsigte van al hierdie aspekte gevind. • Uitkomsstandaarde is deur middel van en pasientevraelys gemeet en he took negatiewe bevindinge opgelewer. Aanbevelings sluit in die ontwikkeling van engehalteversekeringsmodel vir die Noordelike Provinsie se gesondheidsdienste, die formulering van standaarde vir aile dissiplines van gesondheidsorg, jaarlikse evaluering van pasientesorq en die instelling van enformele personeelontwikkelingsprogram. Kernwoorde: Gehaltesorg, formulering van standaarde, struktuur, proses, uitkomsstandaarde.

Thesis (MPhil)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: Health service utilization by people with mental health problems seem to be a large public health issue, especially in low-income countries. In Malawi, the situation is not different from other developing countries in Sub-Saharan Africa as far as access to services for people with mental health problems is concerned. Non specialized health care workers provide mental health services in the primary care settings in Malawi and, given the workload at primary health care (PHC) setting level, little time is available to screen for mental disorders, hence these may go unrecognized. Therefore, there is a possibility that a significant proportion of patients attending primary care in Malawi may have common mental disorders (CMD) and may be deprived of routine screening. Consequently, the possibility of misdiagnosis may lead to higher service utilization by people with common mental health problems. However, no study has been carried out to assess the health service utilization by people with common mental disorders in Malawi. Aim: The aim of the study was to evaluate health services utilization patterns of patients with CMDs in primary care clinics. Methods: This was a quantitative study employing a cross-sectional descriptive design. The study was conducted in two primary health care clinics in one of the 28 districts in Malawi. The study included all consecutive patients aged 18 years and older who attended the primary health care clinics for any reason. Face-to-face interviews using the Self-Reporting Questionnaires (SRQ-20) were conducted in a sample of 323 primary health care attendees. Findings: The prevalence of probable CMD was 20.1%. People with CMD had a higher average number of health facility visits in the previous three months compared to those without probable CMD thus 1.6 vs. 1.19 (p-value 0.02). There was no significant difference in the average number of traditional healer visits in the previous three months between those with probable CMD and those without thus 0.05 vs. 0.08 (p-value = 0.565). The total average number of both health facility and traditional healer visits was 1.68 vs. 1.24 (p-value 0. 019), people with probable CMD having a higher average compared to those without a probable CMD. It was found that people who have visited the health care facility repeatedly in the past 3 months were likely to be suffering from CMD. The odds of probable CMD increased with each visit to a health facility by 1.2 (p-value=0.024). Almost all those who had probable CMD had no treatment prescribed for CMD by PHC clinicians. Conclusion: The study reveals high utilization of health services for people with CMD, as well as a treatment gap of mental health care in primary care settings. PHC workers are misdiagnosing patients with CMDs leading to high utilization of PHC services. There is need for PHC workers to improve skills in diagnosing patients with CMD to make PHC services more effective by reducing re-attendances and improving patient outcomes. There is also need to direct effort towards creating awareness about mental health and encourage patient disclosure of psychological or mental health problems. / AFRIKAANSE OPSOMMING: Agtergrond: Dit blyk dat veral in lae-inkomste lande, die gebruik van gesondheidsdienste onder mense met geestesgesondheidsprobleme `n kwellende gesondheidskwessie te wees. Malawi, soos ander ontwikkelende lande in Sub-Sahara Afrika, ervaar die probleem van toegang tot gesondheidsdienste vir mense met geestesgesondheidsprobleme. In die primêre gesondheidsdienste in Malawi, word pasiënte met geestesgesondheidsprobleme behandel, deur algemene gesondheidswerkers wat nie gespesialiseerd is in geestesgsondheid. Verder veroorsaak die arbeidslas in primêre gesondheidsorg dat daar nie altyd tyd is om pasiënte voldoende vir geestesgversteurings te ondersoek nie. Dit is daarom moontlik dat `n merkwaardige aantal pasiënte wat gebruik maak van primêre gesondheidsorg in Malawi aan algemene geestesversteurings lei, maar hulle word nie voldoende ondersoek nie en gevolglik word hulle of nie gediagnoseer nie of verkeerdelik gediagnoseer. Dit kan daartoe lei dat `n groter aantal pasiënte, met algemene geestesversteurings, gebruik maak van primêre gesondheidsdienste. Die probleem is dat daar nog geen navorsing in Malawi gedoen is, oor die gebruik van gesondheidsdienste onder mense met algemene geestesversteurings. Doelwit: Die doel van die studie is om pasiënte, met algemene geestesversteurings, se gebruik van primêre gesondheidsorg klinieke te ondersoek. Metodes: `n Dwarssnee kwantitatiewe beskrywende studie-ontwerp was gebruik. Data-insameling het by twee primêre gesondheidsorg klinieke, in een van die 28 distrikte in Malawi, plaasgevind. Pasiënte, 18-jaar en ouer, wat die primêre gesondheidsklinieke vir enige rede besoek het, was ingesluit in die studie. Die steekproef het bestaan uit 323 pasiënte wat gebruik gemaak het van primêre gesondheidsorg klinieke. Onderhoude was met pasiënte gevoer deur middel van `n self-relaas vraelys (ook verwys na as „Self-Reporting Questionnaires‟). Bevindinge: Daar was `n voorkomssyfer van 20.1% pasiënte wat waarskynlik aan algemene geestesversteurings gelei het. Mense wat waarskynlik aan algemene geestesversteurings gelei het, het in `n tydperk van drie maande gemiddeld meer gebruik gemaak van gesondheidsdienste, in vergelyking met diegene wat waarskynlik nie aan algemene geestesversteurings gelei het nie, dus 1.6 teenoor 1.19 (p-waarde van 0.02). In die gegewe drie maande was daar geen betekenisvolle verskil in die gemiddelde aantal besoeke afgelê aan tradisionele geneeshere deur pasiënte wat waarskynlik aan algemene geestesversteurings gelei het, in vergelyking met diegene wat waarskynlik nie aan geestesversteurings gelei het nie, dus 0.05 teenoor 0.08 (p-waarde= 0.565). In totaal het diegene met geestesversteuring ook gemiddeld meer besoeke, 1.68 teenoor 1.24 (p-waarde 0.019), aan beide gesondheidsorg en traditionele geneeshere afgelê het, as diegene wat waarskynlik nie aan geestesversteurings gelei het nie. Die bevindinge dui daarop dat mense wat in die afgelope drie maande herhaaldelik gebruik gemaak het van gesondheidsdienste, waarskynlik aan algemene geestesversteurings gelei het. Die moontlikheid dat `n pasiënt aan `n algemene geestesversteuring gelei het, het met 1.2 (p-waarde=0.024) verhoog met elke besoek aan die gesondheidsdienste. Byna al die pasiënte wat waarskynlik aan `n algemene geestesversteuring gelei het, het nie behandeling ontvang nie. Gevolgtrekking: Daar is bevind dat mense met algemene geestesversteurings geredelik gebruik maak van gesondheidsdienste en dat daar `n gaping is in die voorsiening van geestesgesondheidsdienste in primêre gesondheidsfasiliteite. Primêre gesondheidsorg personeel se hantering van pasiënte lei daartoe dat pasiënte met algemene geestesversteurings meer geredelik gebruik maak van primêre gesondheidsorg. Daar is `n behoefte aan die verbetering van primêre gesondheidsorg personeel se vaardighede en vermoë om pasiënte met geestesversteuring te diagnoseer en sodoende ook herhaaldelike besoeke te verminder en die gesondheidsuitkomste van pasiente te verbeter. Daar is `n behoefte aan groter bewusmaking van geestesgesondheid en om pasiënte aan te moedig om hulle sielkundige en geestesgesondheidsprobleme aan personeel te openbaar.

Background: Diabetes type 2 is a chronic disease with rising prevalence worldwide. The implementation of lifestyle changes is an important part of diabetes treatment. Nurses in primary care have a central role to support and guide diabetics for starting and retaining lifestyle changes to prevent later diabetes complications. Aim: The purpose of this study was to describe the primer care nurse’s experiences regarding the type 2 diabetes patients’ compliance to their advice regarding lifestyle changes. The aim was also to describe the primary care nurse’s experiences and reflections of contributing and hindering factors of compliance. Method: A descriptive design with a qualitative approach is used in this study. Eight diabetes nurses from seven health centers were interviewed. Semi-structured interviews conducted and data analyzed by qualitative content analysis method. Results: The emerged theme from the result was that compliance varies and is affected by different influential factors. Factors such as patients’ motivation and understanding of illness, other simultaneous physical and mental disorders, language difficulties and cultural differences have either contributing or hindering effects on compliance. Primary care nurses reported that they used different strategies, such as justifying the small changes at the beginning, establishing of mutual communication and confirmative relationship and give personalized lifestyle advice to improve patient compliance. According to interviews the items that could be improved are arrangements for group therapy sessions, active involvement of the family members in diabetes care, and assigning more resources to approach the desired goals. Conclusion: Compliance to lifestyle advice is a variable affected positively or negatively by various factors such as the individual characteristic, motivation, self-awareness, language difficulties and cultural differences. Diabetes nurses use strategies which improve compliance of diabetics to their lifestyle advice. Group Training, the involvement of the family and access to more resources are areas that need to be developed. / Bakgrund Diabetes typ 2 är en kronisk sjukdom med stigande prevalens i hela världen. Genomförandet av livsstilsförändringar utgör en viktig del av diabetes behandling. Distriktssköterskor i primärvården har en central roll att stödja och vägleda diabetiker genom rådgivning för att kunna etablera livsstilsförändringar samt att upprätthålla för att förhindra diabetes sena komplikationer. Syftet var att beskriva distriktssköterskans erfarenheter och reflektioner av typ 2 diabetespatienters följsamhet till distriktssköterskansråd avseende livsstilsförändringar. Syftet var även att beskriva distriktssköterskans erfarenheter och reflektioner av följsamhetens bidragande och hindrande aspekter. Metod En beskrivande design med kvalitativ ansats användes. Åtta distriktssköterskor från sju hälsocentraler intervjuades. Semistrukturerade intervjuer utfördes som sedan analyserades med kvalitativ innehållsanalys. Resultatet visade att följsamheten varierar och påverkas av olika inflytelserika faktorer. Faktorer såsom patientens motivation och sjukdomsinsikt, andra samtidiga kroppsliga och psykiska sjukdomar, språksvårigheter och kulturella skillnader har antingen bidragande eller hindrande effekter på följsamheten. Distriktssköterskor uppgav att de använde olika strategier som till exempel att motivera till små förändringar i början, etablering av ömsesidig kommunikation och bekräftande relation och att ge individanpassade livsstilsråd, för att förbättra patientens följsamhet. Att genomföra grupputbildningar, involvering av diabetikers familj och tillgång till mer resurser ansågs som områdena som kunde förbättras för att öka följsamheten hos diabetiker. Slutsats: Följsamheten till livsstilsråd var varierande vilket påverkades positivt eller negativt av olika faktorer såsom individens egenskaper, motivation, sjukdomsinsikt, språksvårigheter och kulturella skillnader. Diabetessköterskor använde strategier som gynnade diabetikers följsamhet till livsstilsråd. Grupputbildningar, involvering av familjen och tillgång till mer resurser är områdena som behöver utvecklas.

published_or_final_version / Medicine / Doctoral / Doctor of Philosophy

Increasing lifestyle-related ill health, escalating health care costs, expanding health inequalities within and between nations, and an aging population are challenges facing governments globally. Governments, especially in industrialized countries like Sweden, are investing in health promotion and health communication, especially in ICT-supported health communication as a way to increase health literacy and empowerment at individual and population levels. Studies show that many eHealth communication efforts are narrow in scope, medical oriented and therefore not enough to address the complexity of lifestyle-related ill health and equity issues. This thesis proposes integrating health promotion values and principles in the design process of eHealth systems for health promotion in order to develop usable, sustainable, engaging, eHealth resources that are adaptable to their context of use and user’s skills. The overall aim of this thesis was study the participatory development process of an interactive ICT-supported health communication channel for health promotion and enhancing health literacy in PHC context. Participatory Action Research (PAR) with a multi-phase and multi-method approach was used in this thesis. A model entitled Spiral Technology Action Research’ (STAR) was used to guide the development of the health channel. This design process was framed in three developmental and evaluation phases corresponding to formative, process and outcome evaluation. A total of 146 participants consisting of professionals from primary health care services, information technology and academia, and local citizens participated in the project’s different phases. A triangulation of methods was used to collect the data; survey, document analysis, participatory observations with field notes, individual interviews, focus groups, think aloud protocols and log statistics. Qualitative and quantitative content analyses were used to analyse data. The results revealed that integrating health promotion values and principles in the design process proved to be valuable not only to the content of the channel, but also in PHC practice. The different design phases yielded valuable results that built into each other and contributed to an eHealth channel that was perceived as relevant to the local people’s need for health communication; accessible and user friendly. The results also indicated that an Internet based interactive health channel, could be a valuable resource for enhancing health literacy if users are involved in the design.

Within the field of public health, there has been increasing interest in the factors that influence national priorities in health in low- and middle-income countries (LMICs), where resources are often particularly scarce and decision-making processes are often ad- hoc. Understanding how priorities are set in these countries necessitates a look at the process concealed in the black box that transforms policy inputs into outputs. However, rigorous health policy analysis of macro-level priority setting in LMICs is rare. Using a case study approach, this thesis explores the drivers of priority for primary health care, sanitation and HIV/AIDS over the past five decades in Barbados. To do this I use process tracing techniques, drawing on analysis of public expenditure on health from 1960 to 2010, in-depth interviews with key policy actors, non-participant observation, archives, media reports, parliamentary records and other documents. I argue that powerful individual policy actors or 'policy entrepreneurs' act as necessary drivers of macro-level priority setting in Barbados, although they do not single- handedly determine the outcomes. In particular, I find that these actors are successful in generating priority when they are able to propagate powerful framing ideas and can effectively navigate the policy context by seizing windows of opportunity and managing negative constraints. Moreover, because resources are scarce, their ability to mobilize external financial support is also important. In particular, this thesis stresses the fact that allocating public resources for health is a political process and suggests that it is best explained by considering a set of interrelated factors. In doing so, it illustrates the utility of health policy analysis in helping to open the black box of macro-level priority setting in LMICs more broadly.

The overall aim of this thesis is to define a candidate set of quality indicators that are evidence-based, feasible to implement, and have the potential to improve the quality of care provided for children in UK general practice. The indicators were developed using a three-stage process. First, the areas and aspects of care of highest priority for quality indicator development were identified. This was achieved by seeking the views of primary care clinicians and by undertaking a formal analysis of unplanned hospital admissions for ambulatory care sensitive conditions. Then, the evidence-base to underpin indicator development was identified through an overview of Cochrane systematic reviews of interventions relevant to the primary care of children. A search of SIGN and NICE national guidelines was also conducted to inform the evidence-base. Lastly, an expert panel determined the formulation and selection of indicators by applying the RAND appropriateness methodology. This process created a final set of 26 quality indicators in six priority areas: early recognition of potentially serious illness (n=7); child protection and safeguarding (n=4); mental health (n=4); health promotion (n=1); routinely managed conditions (n=6); and general practice management (n=4). The main strength of these indicators is that they reflect a strong professional consensus on their validity and feasibility. The main weakness is that the indicators are underpinned by evidence mainly derived from expert opinion rather than formal research; the requirement for professional consensus means that they do not challenge existing models of care delivery.

A Atenção Primária à Saúde (APS) é vista como condição essencial para o cumprimento dos Objetivos de Desenvolvimento Sustentável (ODS) acordados internacionalmente. Porém, mesmo quando o uso do geoprocessamento tem sido considerado um poderoso aporte para a Saúde Pública, o potencial desta ferramenta não tem sido suficientemente explorado como instrumento de pesquisa e gestão dentro do trabalho diário dos serviços de APS, o que poderia prejudicar o cumprimento das metas destes serviços, quanto dos próprios ODS. Sendo assim, o objetivo deste estudo foi explorar abordagens territoriais na APS e nos ODS, pelo uso do geoprocessamento e pela análise de planos municipais de saúde. A metodologia inclui uma revisão sistemática do uso do geoprocessamento na APS no mundo todo, uma revisão integrativa respeito das técnicas de geoprocessamento utilizadas em APS, e uma revisão da convergência entre agendas municipais de saúde e os ODS, tomado como exemplo os municípios de Santiago do Chile e São Paulo no Brasil. Os resultados mostraram que o uso do geoprocessamento melhora a abordagem territorial da APS, contribuindo para uma gestão mais eficiente dos serviços, influenciando também uma mudança na forma de trabalho das equipes de saúde, que se reflete em benefícios concretos para a comunidade. Contudo, a relação entre a APS e os ODS não foi informada adequadamente dentro dos planos municipais de saúde estudados. Conclui-se que se requer de maior alinhamento dos planos e políticas locais, nacionais e globais de saúde, maior divulgação das ações realizadas pela APS, e maior uso e difusão de tecnologias já disponibilizadas à abordagem territorial e intersetorial destes serviços. / Primary Health Care (PHC) is seen as an essential condition for achieving the internationally agreed Sustainable Development Goals (SDGs). However, even when the use of geoprocessing has been considered a powerful contribution to public health, the potential of this tool has not been sufficiently explored as a research and management tool within the daily work of PHC services, which could hinder the achievement of the targets of these services, as well as the SDGs. Thus, the objective of this study was to explore territorial approaches in PHC and SDGs, through the use of geoprocessing and the analysis of municipal health plans. The methodology includes a systematic review of the use of geoprocessing in PHC worldwide, an integrative review of the geoprocessing techniques used in PHC, and a review of the convergence between municipal health agendas and the SDGs, taking as an example the municipalities of Santiago de Chile and São Paulo in Brazil. The results showed that the use of geoprocessing improves the territorial approach of PHC, contributing to more efficient management of services, also influencing a change in the way of work of health teams, which is reflected in concrete benefits for the community. However, the relationship between PHC and SDGs was not adequately informed within the municipal health plans studied. It is concluded that is it required greater alignment of local, national and global health plans and policies, greater dissemination of actions carried out by PHC, and greater use and diffusion of technologies already available for the territorial and intersectoral approach of these services.

Background: This study is located within a complex network of paradigmatical methodological, and institutional relationships, and draws concepts from a range of scholastic traditions. The hermeneutical tradition within Sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. The concept of the lifeworld/ healthworld as a description of the complex of health beliefs and behaviours of individuals in relation to the ailing body is used to describe chronic illness and healthcare access, both as lived experience and as fields for public health intervention. Aim: To understand how women living with chronic illness experience their illness and access healthcare in an urban and rural context. Methods: This study is a mixed-methods comparative case study of the healthcare access experiences of women with chronic illness in an urban and rural area in South Africa. The core of the study methodology is a comparative qualitative case study, with quantitative methods serving to contextualise the findings. The urban component of the study was conducted in Birth to Twenty (Bt20), a birth cohort study located in Johannesburg-Soweto. The rural component of the study was conducted in Agincourt, a sub-district of the Bushbuckridge district in Mpumalanga Province. The quantitative context for the Soweto case study uses secondary data collected by Bt20 to construct a historical overview of the use of formal and informal healthcare services in Soweto. It also uses the findings of a large scale cross sectional survey of the primary caregivers of the Bt20 cohort, conducted between November 2008 and June 2010. The rural case study is contextualised by a detailed review of research conducted in the Agincourt sub-district. For the qualitative case studies I employed a qualitative methodology incorporating serial narrative interviews to present an experience-based overview of concepts of disease causation, self treatment and coping. Results: The cross-sectional survey describes a low resource population with a high prevalence of chronic noncommunicable disease (NCDs). Over one third (37.3%) of the population in Soweto could be categorised as having a low socio-economic status, defined as access to only one or less of 5 socio-economic items. Slightly over half the respondents in Soweto (50.7%) reported having at least one chronic illness. Only around a third (33.3%) of the survey participants with chronic illnesses reported accessing formal healthcare services in the last 6 months. Similar trends were found in the review of research carried out in Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how the medicine from the clinic interacts with the body. The search for alternative remedies took place not as an attempt to cure disease, but to reach a deeper understanding of the diseased state of the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. In both study sites there is evidence that traditional healers were consulted for social purposes rather than health-related purposes. Discussion: Soweto and Agincourt share similar patterns of healthcare utilisation and healthcare belief. Both study sites were characterised by increasing trends in formalisation. At the same time, only a small portion of individuals in both study sites with chronic illness utilised formal healthcare services. A consideration of the findings suggests five broad themes for further research: (1) Processes of constructing body narratives; (2) Encounters with purposive-rational systems; (3) Encounters with traditional medicine; (4) Encounters with contemporary informal medicine; and (5) Religion and healthcare. These five themes constitute the beginning of a comprehensive map of the lifeworld/ healthworld schema. Such a schema has implications for healthcare policy and practice, particularly with regard to the development of integrative paradigms in South Africa as exemplified by Community Oriented Primary Care (COPC). Conclusion: The aims and objectives of the study were met through the development of an initial lifeworld/ healthworld schema, which suggests that the coexistence of diverse public healthcare concerns of high NCD prevalence and low formal healthcare utilisation is best addressed through the adoption of integrated healthcare approaches based on lifeworld/ healthworld rationalistion.