Magister Curationis - MCur / The South African health care system shifted the focus of treating psychiatric disorders from institutional care level mental health services to facilitate this process of integration into the Primary Health Care (PHC) settings. All the provinces were thus engaged in improving mental health care services at community level by providing training for professional nurses in mental health at PHC settings. Consequently, mental health nursing has also changed considerably by shifting the focus of mental health care to the primary care level. It is however, suggested that the current revolving door syndrome experienced at psychiatric institutions was partly due to inadequate community-based psychiatric services. It was also suggested that the attitudes and knowledge of health professionals towards mental illness has a major impact on service delivery, treatment and outcome of mental illness. The aim of this research study was to assess the attitude of nursing staff working at a Community Health Centre (CHC) towards the mental health care user. A CHC was chosen that renders 24 hour services. The inclusive sample included all the different categories of nurses permanently employed at this CHC. The Attitude Scale for Mental Illness questionnaire was used to collect the data. Descriptive statistics: means, median and standard deviations were calculated for the following variables: separatism; stereotyping; restrictiveness; benevolence; pessimistic prediction and stigmatization. In conclusion it can be said that the nursing staff with more experience irrespective of category of nurse has less of a stereotyping attitude towards mental illness. The longer the nurse worked at the setting and irrespective of their nursing qualification the more positive their attitude towards the MHCU became.

Introduction: South Africa has embarked on a massive roll out of ARVs to more than 1.4 million people living with HIV/AIDS. Provision of ARVs to people living with HIV/AIDS encounters many challenges associated with adherence. Properly taken ARVs have been shown to reduce viral loads to undetectable levels and increase the CD4 count. This in turn leads to a drop in opportunistic infections and better health outcomes but the requirements for adherence are high. Several patient-related factors have been reported to affect adherence rates. Nonadherence on the other hand has been reported to lead to the development of drug resistant strains of HIV. It recognised that the resistance to ARVs can quickly lead to build up of highly resistant strains in the blood due to one week of missed medication. Aims and objectives: This study set out to identify factors which affect adherence to HAART among adults on HAART in two health facilities in Gauteng province in 2006.The main objectives were to assess the patient adherence using viral load response and self-report data. Secondly, the study was to determine factors that facilitate adherence and finally barriers to adherence at the two sites. Materials and methods: A cross sectional study was done at the two ARV facilities in Gauteng from July to November 2006. Two physiological methods -CD4 counts and plasma viral load, and one subjective-3 day recall self- report methods were used to asses adherence. Exit interviews and record reviews were done to collect data. Virologic outcome was the preferred surrogate marker for adherence. Univariate and bivariate analyses were done to determine measures of association. Measures of association (Chi square) at a 95% significance level for factors affecting adherence were then determined and results obtained. Results: The mean age was 36.9 years (range 18-70 years) and 73.5% were women. Self-report data (n=343) indicated 98.4% in the higher adherence category (taken 100% of their doses). Viral load data (n=343) showed that 88.8% were in the adherence lower category (<400 RNA copies). Viral load outcome (“adherence”) was significantly associated with the length on treatment (p<0.05) and patients who had been on treatment for 12-24 months had lower viral load than those who had been treatment for a shorter time (<12 months) or longer (>24months). However, gender (p=1.000), age (p=0.223), level of education (p=0.697) and access to social grants (p=0.057) were not associated with “adherence”. Socio-economic status was significantly associated with viral load outcome (p<0.01) as well as cost (n=185; p<0.05). Individuals who incurred the highest costs (>R25) were the least likely to adhere followed by those facing average costs (R15-25) compared to the reference group (< R15). Conclusion: Adherence rates of 88.8% suggest that respondents from both facilities can optimally adhere to their medication when they have been on ARVs for longer than a year. These are minimum adherence rates. There were factors that still hinder adherence at both the individual patient level. There is still a need for more targeted interventions especially towards men who were noted to have a relatively low uptake of HAART within the two sites.

The move toward primary health care renewal in Canada and in industrialized nations around the world is resulting in a fundamental change in the way health care is delivered. Citizen participation is one of the five pillars of primary health care-not just participation in decisions related to an individuals health care treatment, but also from the larger perspective of decision-making that affects policy and structure within an organization. Health care organizations want to be responsive to the needs of their communities, and consumer-savvy citizens increasingly expect to play a part in the decision-making process of organizations. <p>The relationship between health care administrators, providers and citizens is sculpted by fundamental philosophies, values and processes. These include organizational culture, change process, social capital, citizen role definition and shared power or citizen empowerment. This research seeks to link the concepts and create an understanding of the dynamic and complex relationships which result in effective or ineffective citizen participation in decision-making within organizations. A theoretical framework was used which addresses these fundamental philosophies.<p> The object of this research is to explore the processes and structures of organizations that facilitate or hinder meaningful citizen participation. Community health centres (CHCs) have long been recognized in Canada and around the world as leaders in the facilitation of citizen participation, and this research reviews pertinent documents from fourteen CHCs across Canada. Some of the data collected from a national research project on community health centres is used. Through secondary analysis, the original results of the document audit are compared to the original results of a quantitative survey administered to volunteers, clients, health care professionals and board members at each site that collected information about community capacity, organizational capacity and outcomes. <p> Results of this thesis research are presented in a framework of community and organizational characteristics influencing the degree of public participation supported in the literature. The research presented in this thesis shows some relationship between supportive factors identified in the organizations documents and the degree of participation and satisfaction identified in the quantitative survey results. Possible reasons for this relationship are explored and recommendations are made based on a hierarchical model of participation, with greater citizen participation as the goal.

The move toward primary health care renewal in Canada and in industrialized nations around the world is resulting in a fundamental change in the way health care is delivered. Citizen participation is one of the five pillars of primary health care-not just participation in decisions related to an individuals health care treatment, but also from the larger perspective of decision-making that affects policy and structure within an organization. Health care organizations want to be responsive to the needs of their communities, and consumer-savvy citizens increasingly expect to play a part in the decision-making process of organizations. <p>The relationship between health care administrators, providers and citizens is sculpted by fundamental philosophies, values and processes. These include organizational culture, change process, social capital, citizen role definition and shared power or citizen empowerment. This research seeks to link the concepts and create an understanding of the dynamic and complex relationships which result in effective or ineffective citizen participation in decision-making within organizations. A theoretical framework was used which addresses these fundamental philosophies.<p> The object of this research is to explore the processes and structures of organizations that facilitate or hinder meaningful citizen participation. Community health centres (CHCs) have long been recognized in Canada and around the world as leaders in the facilitation of citizen participation, and this research reviews pertinent documents from fourteen CHCs across Canada. Some of the data collected from a national research project on community health centres is used. Through secondary analysis, the original results of the document audit are compared to the original results of a quantitative survey administered to volunteers, clients, health care professionals and board members at each site that collected information about community capacity, organizational capacity and outcomes. <p> Results of this thesis research are presented in a framework of community and organizational characteristics influencing the degree of public participation supported in the literature. The research presented in this thesis shows some relationship between supportive factors identified in the organizations documents and the degree of participation and satisfaction identified in the quantitative survey results. Possible reasons for this relationship are explored and recommendations are made based on a hierarchical model of participation, with greater citizen participation as the goal.

Thesis (B.A. Hons.) -- University of Adelaide, Dept. of Psychology, 1977.

The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

The practice environment of nurses plays a very important role in the delivery of quality health care. However, there is limited knowledge on what positive practice environments entail with specific reference to the primary health context of the public health care sector of South Africa. Nurses in this context are the frontline health personnel and are affected not only by nursing shortages, but also high workloads as the public health care sector serves 83% of the South African population and the private health care sector only 17%. In this study the researcher decided to conduct a study to explore the practice environment of nurses in the primary health care context as no studies have previously been undertaken in this regard. The researcher used a case study design with quantitative and qualitative approaches and implemented descriptive, explanatory and contextual strategies. This design, together with the findings of objectives one, two and three, the World Health Organization Strengthening of Health Systems and Fourteen Forces of Magnetism Frameworks and inductive and deductive logic enabled the researcher to achieve the overarching aim, which is objective four, of this study. Descriptive statistics, confirmatory factor analysis and Cronbach’s alpha assisted the researcher in assessing the demographic profile (objective 1) and the status of the practice environment of community health centres in North West Province (objective 2). Thereafter, the researcher was also able to identify the community health centre with the most favourable practice environment in order to conduct semi-structured individual interviews (objective 3). The descriptive data of objective 1 revealed that community health centres in the North West Province are located on average 36 km from the nearest referral hospital to which an average of five patients per day are referred. The average number of patients consulted per month is 3 545 of which the nurse consults an average of 40 and the physician 15 patients per day. In the community health centres the average age of nurses is 40, with 10 years of nursing experience. There were more female than male nurses of which 65% of the registered nurses had a diploma in nursing and had only started their careers at 31 years of age. There is an average of eleven registered nurses, five auxiliary and one enrolled nurse in the community health centres of which only four of the registered nurses (36%) had a qualification in Clinical Health Assessment, Treatment and Care. The overall staff turnover rates were very low and the satisfaction levels were high. The factor analysis of objective 2 revealed that the Practice Environment Scale of the Nursing Work Index’s sub-scales staffing and resource adequacy and nurse participation in primary health care/community health centre affairs had means below 2.5, indicating that nurses were not in agreement with these sub-scales. However, nurse manager ability, leadership and support; collegial nurse-physician relationships and nursing foundations for quality of care had a mean above 2.5 indicating that the nurses were in agreement with these sub-scales. Lastly, the qualitative findings indicated that although the community health centres with the most favourable practice environment were affected by factors that decrease quality of care which included a lack of resources, limited infrastructure, limited support from pharmacy and staff shortages. These mentioned factors were not in the control of the community health centres. Although the community health centres were affected by the above-mentioned factors these community health centres excelled in support, leadership and governance, collegial nurse-physician relationships and factors influencing quality of care which were in the control of the community health centre. / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013.

Magister Curationis - MCur / The Western Cape Province of South Africa has the worst multifactorial crime problem in the country. It has the fastest growing crime rate in many crime categories, such as rape and gun related incidents. The youth in the Cape Flats faces many challenges, such as drug abuse and high incidents of violent attacks. The youth who are exposed to violence are inclined to be violent themselves and are at a higher risk of psychopathology. The experiences of the youth after a violent physical incident were unclear. The purpose of this study is to describe actions for the support of professional nurses at a community health centre to youth victims of physical violence in the Cape Flats. A phenomenological, exploratory, descriptive, contextual design was followed in this study. This study explored and described the lived experiences of youth victims of physical violence in terms of the support they received in a natural setting at a community health centre in the Cape Flats. Purposive sampling was used for the study, and data saturation determined the size of the sample, that was eight participants. Participants were male and female youth members between the ages of 18 and 27 years who had experienced a violent incident and visited a health care centre for follow-up treatment. They were given information sheets that explained the nature of the research project. Individual in-depth interviews were used to collect data. Interviews were conducted in one of the consultation rooms at a community health centre that was quiet and where minimal interruptions occurred. The researcher sought permission from the participants to conduct the interviews and to audio record those interviews. All ethical principles were adhered to in this study; that is confidentiality, anonymity, withdrawal, autonomy, and informed consent. Trust worthiness was ensured during the research process. In cases where participants had experienced psychological distress, they could be referred to a psychologist. However, none of the participants displayed any signs of emotional discomfort during the interviews. Data was analysed using Creswell’s six steps of open coding. All data would be kept under lock and key for five years after the research report has been made available. Main themes that emerged from the data analysis were related to violent incidents that had a negative impact on the participant; participants applied defence mechanisms to deal with their trauma, and participants experienced care and support either negatively or positively. A recommendation of this study is the implementation of an in-service training programme to the nurses who care for the youth after violent physical incidents.

Magister Pharmaceuticae - MPharm / South Africa is faced with a high number of people living with HIV/AIDS, and subsequently a great need to access quality medicines for improving patient therapeutic outcomes. Antiretroviral drugs (ARVs) require rigid, efficient and effective management, due to their valuable efficacy in prolonging the survival of HIV/AIDS patients, and the limited possibility of substitution. Managing their flow is vital to ensure an uninterrupted supply. Problematic inventory management was experienced by some healthcare facilities in South Africa where in recent years it resulted in stock outs and stock losses through thefts. These factors present obstacles to the availability of quality medicines, which ultimately leads to treatment failure and deterioration of the health status of patients. The aim of this study was to characterise the inventory management practices and medicine store maintenance of ARVs in community health centres (CHCs) in the Cape Metropole, Western Cape, in order to identify specific problems associated with ARV stock management. The study used a descriptive, cross-sectional study design to examine ARV records and to highlight associated discrepancies between recorded iii quantities on logistics tools used and physical counts, to assess the store maintenance, to measure the supply rate and identify factors contributing to poor stock management. The sample comprised 15 CHCs under the Western Cape Provincial Government (WCPG) accredited to provide ARV treatment. A checklist developed by Management Sciences for Health was adapted and was used to gather quantitative information (e.g. physical stock count). Some qualitative data was collected from responsible personnel for ARV drug management at each site. 86.7% of CHCs utilised a logistics tool (either manual or electronic) to manage ARVs. The average number of adult ARV drugs with a logistics tool available in all CHCs was 82.7% of which 21.9% met the criteria for accuracy. Only 32.9% of all logistics tools had records that were up to date. The average percentage of total variation between stock records and physical counts for the ARV drugs assessed was 51.6%. No historical data on stock outs and monthly usage (monthly consumption) could be retrieved in any of the CHCs, although there were no actual stock outs on the day of the fieldwork. The order fill rate was 91.9%. Since ordering is done more often that it should, stock availability did not appear to be problematic. Standard appropriate physical dimensions were not met by 20% of the CHCs and only 66.7% of the CHCs had appropriate labeling of the shelves in the dispensary and in the storeroom. This study demonstrated poor inventory management with respect to the general quality of record keeping, space allocation and general organisation of the medicine storeroom. Making timely entries and recording issues on logistics tools are recommended to keep up to date inventory records and management information system. Frequent monitoring of stock status is suggested, to avoid discrepancies and to keep it to adequate levels iv which will minimise multiple ordering. Regular supervision by the district pharmacist is needed to identify training and other needs. A study on general cost and delivery costs associated with poor record keeping should be carried out.

This thesis explores the role and functionality of the Hamilton Urban Core Community Health Centre (HUCCHC) within the context of advocacy and activism to understand how this institution can contribute a pathway for social change in public health. This qualitative case study uses an interpretive lens to analyze primary health care at the HUCCHC, and how it is being used to improve the social determinants of health (SDH). The study investigated participants’ understandings of how the HUCCHC demonstrates that a community health centre can be a catalyst for social change. Moreover, this research project asked what sorts of conditions or circumstances are necessary to foster an environment conducive for community organizing for social change. This study employed field observation and interview techniques to gather data. Findings suggest that building equitable relationships based on dignity and respect, and community engagement were the foundational aspects necessary to provide the conditions conducive for community organizing. However, the outcomes from these relations put the HUCCHC at risk of becoming marginalized. Findings further suggest that equitable relationships and community engagement also provided a foundation for social action. The HUCCHC demonstrated that it is a catalyst for social change by embracing a primary health care model that also fosters a social action approach to health care. / Thesis / Master of Social Work (MSW)