Curative primary health care nurses are the first level of contact with health personnel the patient has when entering the district-driven health system of South Africa. It is imperative that these nurses are competent, or patients may suffer. Several factors exist as barriers to competent curative care. Donabedian's structure-process-outcome framework has been used in the study of these factors. Literature were selected from international and national studies of nursing to discover barriers and enablers in general nursing care but also specifically in curative primary health care. The curative primary health care nurses in the Southern Cape/Karoo region were used as a sample for the study. Data gained from questionnaires were organised to present the findings: Barriers to a curative PHC service seem to be multifactorial, with scarce resources causing great stress for the workforce. This have a negative impact on relationships between employer and employee, CPHCNs and their patients, the type of managing that take place, and the quality of the examination and treatment of patients. Slow changes frustrates workers, causing more stress and poor attitudes, feelings of not being valued, and not being motivated (internally and externally). Enablers examined showed that although the workforce may be discontented and overworked, they still try to deliver their best, with few medical mistakes. Patients still have a lot of respect for their healthcare deliverers, but this trend may not continue for much longer. Patients are already returning more often to clinics, causing even more stress for staff. / Health Studies / M.A. (Health Studies)

Curative primary health care nurses are the first level of contact with health personnel the patient has when entering the district-driven health system of South Africa. It is imperative that these nurses are competent, or patients may suffer. Several factors exist as barriers to competent curative care. Donabedian's structure-process-outcome framework has been used in the study of these factors. Literature were selected from international and national studies of nursing to discover barriers and enablers in general nursing care but also specifically in curative primary health care. The curative primary health care nurses in the Southern Cape/Karoo region were used as a sample for the study. Data gained from questionnaires were organised to present the findings: Barriers to a curative PHC service seem to be multifactorial, with scarce resources causing great stress for the workforce. This have a negative impact on relationships between employer and employee, CPHCNs and their patients, the type of managing that take place, and the quality of the examination and treatment of patients. Slow changes frustrates workers, causing more stress and poor attitudes, feelings of not being valued, and not being motivated (internally and externally). Enablers examined showed that although the workforce may be discontented and overworked, they still try to deliver their best, with few medical mistakes. Patients still have a lot of respect for their healthcare deliverers, but this trend may not continue for much longer. Patients are already returning more often to clinics, causing even more stress for staff. / Health Studies / M.A. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / In the fields of formal and informal online adult education, the absence of a social context for instruction has been found to present significant limitations for learner persistence and retention. In the field of online psychoeducational intervention, self-administered and self-paced individualized prevention programs have been developed for delivery to large populations of anonymous users. These delivery models provide limited social context for instructional activities, due in part to the anonymity of their participants. When social interaction is included in their prevention programs through voluntary, asynchronous self-help/mutual aid discussion forums, anonymity may still limit social interaction, in favor of observational learning advantages for self-efficacy appraisals derived from "lurking". When these large-group models have been applied to online psychoeducation intervention programs for the purposes of encouraging mutual aid, interactive participation has been limited. This mixed methods study focused on a model for the design of an online small group psychoeducational intervention that integrated individual and social learning in a parent management training program. Self-paced participation was replaced with facilitator-led participation in an asynchronous discussion forum where topics were prioritized and sequenced with learning content from individual web-based training modules. Social interaction was facilitated through online problem-based learning discussion group. Despite assertions that interactive participation in online psychoeducational discussion forums may only be accomplished once a subscriber threshold of several hundred participants has been reached, this study found that small group participation through the program's integrated design resulted large effects for increases in parent self-agency and reduction of over-reactive, coercive parenting behaviors. Participation in the online problem-based group discussion forum was found to have contributed to participant outcomes when posting characteristics revealed the presence of both mutual aid processes and the application of individual learning module content.