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.

Text in English / Lack of knowledge and skills among health care providers for provision of integrated TB/HIV activities for better health outcomes for co-infected patients is a public health concern. A qualitative, non-experimental, explorative and descriptive research design based on the phenomenological philosophical tradition by Heidegger to broaden hermeneutics was conducted. The study was conducted at Mopani district to explore and describe the experiences of eligible nurse managers relating to the implementation of the TB/HIV activities at management level. A purposive sample of 14 participants was recruited and consent form obtained. An unstructured interview guide, with a grand tour question, was used to conduct face to face individual interviews. Tesch’s method of analysis was employed until two themes, five categories and ten subcategories emerged from the data. The major findings were on challenges experienced by nurse mangers such as shortage of resources, poor planning, lack of support by management and patient related challenges. Recommendations were based on the findings to encourage staff retention strategies, adequate funding for TB control programs, support by management, co-joint planning, team work and effective tracing strategies. / Health Studies / M.A. (Health Studies)

In severely ill hospitalised patients with diabetes mellitus (type 1 and type 2) there is an increase in metabolic rate. Insulin requirements are increased and glycaemic control becomes more difficult to achieve. The insulin sliding-scale is a form of „top up‟ therapy used to supplement the patients existing hypoglycaemic medication. In 2002, research at Livingstone Hospital found that 14 different sliding scales were used in 38 patients (Du Plessis, 2002: 79). In 2006 the nurses and doctors working in the general medical wards at Livingstone Hospital indicated that they were willing to use a standardised insulin sliding scale protocol (Smith, 2006: 56). Thus the aim of this study was to assess whether a standardised insulin protocol can be effectively implemented. The objectives of the study were to: 1) assess insulin usage via insulin sliding scales prior to the implementation of the standardised insulin protocol; 2) implement the standardised insulin protocol; and 3) reassess insulin usage after the implementation of the standardised insulin protocol. As the study involved evaluating the use of insulin via the insulin sliding scale and the implemented insulin protocol, it occurred in four phases. The preliminary phase entailed obtaining ethical approval. The pre-intervention phase included data collection in the form of a nursing questionnaire and the auditing of patient medical records using a data collection tool. The intervention phase involved education sessions on the new insulin protocol for the nursing staff, and the implementation of a standardised insulin protocol, while the post-intervention phase comprised of post-intervention data collection, which included a nursing questionnaire, a prescribers questionnaire and the auditing of patient medical records using a data collection tool. The overall impression obtained from the comparison between the pre- and post-intervention nursing questionnaire was conflicting; in some aspects the educational intervention was successful in others not. Regardless the indication obtained was that the nursing staff require more in-service training on a more regular basis as a lack of knowledge regarding diabetes mellitus as a disease state may negatively affect patient outcomes. The overall response from the nursing staff towards the insulin protocol was positive. The prescribers‟ response to the insulin protocol was conflicted. The number of correct insulin sliding scale doses administered in the pre-intervention and post intervention phase improved by 5.25 percent. The number of incorrect insulin sliding scale doses administered during the pre- and post -intervention phase decreased by 5.25 percent. These results are positive and may be due to fewer sliding scales being prescribed in the post-intervention phase and the implemented insulin protocol. Only three (5.55%; n=54) inpatients with Type 1 diabetes mellitus were placed on the implemented protocol that is, the basal bolus regime, and rarely were dose adjustments to their insulin made rendering the effectives of the protocol undesirable. Only four (7.40%; n=54) inpatients with Type 2 diabetes mellitus were placed on the implemented protocol that is, an intermediate- to long-acting insulin (Protophane®). However all four patients experienced immediate improvements in their fasting blood glucose levels. These results indicated that by adding an intermediate- to long-acting insulin (Protophane®) to the therapy of a patient with Type 2 diabetes mellitus fasting blood glucose levels decrease. This would improve patient outcomes and decrease the risk of related diabetic complications. These limited results may indicate a clinical inertia on the part of the prescribers. Unfortunately overall the educational intervention was not successful and the implementation of the protocol was not successful and did not yield the desired results.

A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.

Thesis (MTech (Public management))--Cape Technikon, Cape Town, 2004 / The evolution of the South African health system has been characterised by inequities, imbalances as well as fragmentation. The unification of South Africa in 1910 did not consolidate public health administration, which was characterised by increasing institutionalisation, professionalism and organisation. This was the status-quo up until after 1990, whereby there were marked efforts and endeavours to effect defragmentation. In the context of the dramatic political changes that the country has seen over recent years, many aspects of local health care have been upgraded. Issues such as policy making and planning, the development of human resources and training for health care and the establishment of health systems and structures requires a different approach from the previous. Effective human resources development and management in consultation with communities, can contribute towards improvement of service delivery around health issues. Personnel matters and skills development should be considered in the exercise to boost employee morale and job satisfaction. The challenge facing South Africa has been to design a comprehensive programme to redress social and economic injustices, to eradicate poverty, increase efficiency and reduce waste. In the health sector this has been ongoing to involve the complete transformation of the national health care delivery system and the relevant institutions. Health care workers jointly, require the right skills, knowledge and expertise with attitude in their duties and obligation to serve the community.

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.

Submitted in fulfillment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Background. Unintended pregnancy is a major global challenge among sexually active women of childbearing age. Non-use of modern contraception and inconsistent use of short term contraceptive methods are the main reasons associated with unintended pregnancy. Long acting reversible contraceptives (LARCs) have proven to be highly effective with good continuation rates, and are cost-effective compared to other methods, when used more than one year. However, there is low uptake of LARC methods globally and in South Africa. Aim of the study. The aim of the study was to determine factors influencing the uptake of LARC methods among women at the primary health care (PHC) clinics in eThekwini District. Methodology. A quantitative, descriptive survey was used in this study. Purposive sampling of six fixed PHC clinics from the three sub-districts was done. Convenience sampling resulted in 371 participants. A survey questionnaire in English and isiZulu was used to collect data. Data was analysed using SPSS version 23.0. Inferential statistics were used to determine the relationship between the variables. Results. The results of this study revealed that the contraceptive injection was most common LARC used, and the least used method was the intrauterine contraceptive device. The side effects were the main reasons for discontinuation with LARCs and all other contraceptive methods. Irregular vaginal bleeding was the main side effect cited by respondents associated with contraceptive implant usage. The respondents had positive attitudes and perceptions towards LARCs; however, the majority of respondents were not interested in using LARC methods. Common myths and misconceptions were not negatively associated with LARCs, since respondents disagreed with them all. / M

M.A. (Social Work) / This study serves to provide social workers in foster care practice in South Africa with a social technology innovation that is: Contextually appropriate Grounded in theory and User friendly. Social workers in South Africa do not have access to a set of standardised assessment criteria with which to assess prospective foster parents, and yet there are over half a million children in the foster care system in South Africa. Consequently, the research goal of this study is to design and develop a contextually appropriate protocol in social work for the assessment of prospective foster parents in South Africa. In order to achieve this, a number of objectives are linked to this goal: 1. To conduct a literature study for the identification of the dimensions (assessment) areas of the protocol. 2. To design a theoretically grounded model of the competencies of effective foster parents in South Africa. 3. To develop a professional social work protocol with which to assess the competencies of prospective foster parents. 4. To conduct focus groups and Delphi cycles to improve the face validity and content validity of the protocol. Developmental research methodologies were used to design the protocol. In the process of using the DR&U model (Thomas, 1984), a further outcome of the study is the development of a research method for the development of a contextually appropriate protocol in social work. The study comprises two stages: Stage 1 entails the design of a model of the competencies of effective foster families (determining “what” constitutes a good foster parent and developing a model of the ideal foster parents). The dimensions or assessment areas of the protocol are identified by means of a detailed literature study. Data obtained from the literature study is integrated with the outcomes of two Nominal Group Techniques and a Delphi Technique. This is to ensure user participation and to contextualise the model and protocol. Stage 2 entails the design and development (to a limited degree) of an assessment protocol with which to assess prospective foster families (specifying “how” one determines if foster parents meet the criteria of the ideal foster parents in the model designed in Stage 1). The conceptual framework of a model of the assessment of prospective parents is refined through a workshop and Delphi Technique with foster parents and social workers. This is to ensure a measure face validity and the adequacy of the protocol. This study concludes with an evaluation of the outcomes of the study, as well as the research method used to develop the model and the protocol. The model and the protocol are attached to this study.

Magister Educationis - MEd / This thesis investigated the potential role of indigenous healers in life skills education in South African schools. The main focus of this study was to explore how indigenous knowledge of traditional healers can contribute to the development of life skills education in South African schools. The research also sought to strengthen Education Support Services in the South African education system, in order to address barriers to learning. These barriers to learning are linked to health challenges such as substance abuse, violence, malnutrition and HIV/AIDS and many other health-related issues in school-going age learners. / South Africa

The general aim of this study was to determine the experiences of a sample of terminally ill patients in using spiritually focused psychotherapy. This was a qualitative study conducted to a sample of 2 terminally ill patients from hospice in Grahamstown, South Africa. The research was conducted in 3 phases: an initial in-depth interview conducted to determine the participants' level of spirituality as well as the extent to which their terminal illnesses had affected their functioning. This was followed by a minimum of 6 spiritually focused therapy (SFT) sessions as a second phase of the research. To determine the participants' experiences of SFT, 2-3 in-depth interviews were conducted during the 3m phase of the research study. The research revealed that a belief in a higher power helps terminally ill patients cope better with their illness and that social disconnectedness is related to HIV / AIDS stigma. It also revealed that terminal illness is co-morbid with other psychiatric symptoms such as depression, evokes existential concerns, results in a change in the level of spirituality and affects the whole family. Participants blamed themselves for their illness, but found that engaging in the process of forgiveness of self and others brought about psychological healing for them. They experienced SFT as a coping resource that assisted them to deal with the fear of death as well as increased insight into the development of psychopathology and spiritual blockages. It is recommended that a comprehensive and holistic assessment during intake be undertaken so that where spiritual needs are available, therapy can be spiritually augmented to ensure that such needs/ struggles are addressed. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in