This study aims to characterize and understand the search for health in a rural Transkeian community. It begins with the observation that the people of Jotelo have to negotiate considerable hardships in their daily lives. These hardships include the impact of malnutrition, undernourishment and a wide range of diseases like tuberculosis, typhoid and gastro-enteritis. To survive ill-health, people develop numerous practical strategies. Most significantly, they attempt to maximise availalble resources, like cash, their relations with others and local medical facilities. Hence the study attempts to characterize how and why patients select various kinds of therapy in their search for health. By focusing on patients' recourses to treatment, the study reveals that the search for health is as much a personal experience as it is a social and economic one. This idea is developed in an analysis of the links betw'een work, illness and social reproduction. The point which emerges from this discussion captures the central theme of the study: the search for health is a profoundly personal, social and economic experience. This notion is strengthened by an examination of the historical and contemporary nature of local health and health care. It is observed that health and health care is intimately linked to the local and wider political economy. This not only serves to contextualise the discussion on patients' actual experiences, but points to the fact that these experiences are part of wider processes. By depicting the search for health in this way, the study hopes to have illustrated what people do in times of illness and why. Yet it also claims to have gone beyond such a depiction. By abstracting from its findings, it aims to conclude that the search for health is not merely caused by various local and wider processes, to which it has referred. In other words, it hopes to avoid a deterministic view of patients' experiences in times of distress. Instead, it is argued that the search for health is ultimately an integral part of the local and wider economic and political environment

This qualitative descriptive research study was conducted to understand nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. Examination of the literature revealed research on the importance of ambulatory care nurses, their bond with the communities they serve, and the need for ambulatory settings for underserved communities. The review also explored the fierce strike of the COVID-19 pandemic on these communities and the social justice implications of serving low-income and low-resource patients. No literature was found on this specific dissertation topic: ambulatory nurses’ experiences working in underprivileged communities during the COVID-19 pandemic. The sample used for this study consisted of 25 registered nurses who worked in ambulatory settings during the inception of the COVID-19 pandemic. In particular, the time period spanned February 2020 through the end of June 2020. The communities consisted of poorly resourced neighborhoods. The narrative description and accounts of nurses interviewed for this study will facilitate an understanding of nurses’ experiences caring for patients from communities of low income and low resources in hospital-based ambulatory clinics during the COVID-19 pandemic. The researcher used a qualitative methodology, qualitative descriptive, to frame the stories. Qualitative content analysis methods, specifically thematic analysis, were used to understand the nurses’ reflections and experiences. Roy’s Adaptation Model (RAM) was the theoretical framework to guide the open-ended interview questions. The researcher developed questions based on the four modes of RAM: the physiologic mode, the self-concept mode, the role function mode, and the interdependence mode. Thematic analysis was used to identify themes from the interview transcripts. A thematic analysis strategy is an approach used to identify and analyze patterns of meaning from interview data (Braun & Clarke, 2006). A thorough overview was made of all the data, including initial notes. The notes were obtained by reading and rereading the transcripts and highlighting interesting phrases or statements called meaningful units. These units were then compiled into sub-themes, and ultimately themes were comprised after highlighting parts of the transcripts that generated similar content. Themes were developed by identifying patterns among meaningful units and data relevant to each theme. Themes were then reviewed to ensure they accurately represented the data after highlighting, constant review, and compounding them in meaningful units that identified and generated the final set of themes. The researcher developed and kept reflexive journal notes, which were reviewed constantly throughout the study to maintain best-practice qualitative methodology (Ortlipp, 2008). The thematic analysis revealed multiple themes. The themes discovered were crying, protector vs. moral distress, resilience vs. compassion fatigue, family vs. bereavement, and self-concept vs. self-care. An overarching theme of struggle was also manifested within this research.

Thesis (PhD)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Good health is a major imperative for social, economic and personal development, thus an important dimension of quality of life. Quality of life, in turn, is significantly influenced by access to the goods and services provided by the State. Access to infrastructure and services such as water and sanitation, has direct effects on health. Thus, the delivery of health, water and sanitation services should ensure improved access to basic needs, enhance the health profile of poor communities and their access to employment opportunities. Safe clean water supplies and adequate sanitation services therefore are among the major determinants of health. Health-related services such as water and sanitation should ensure a certain average life expectancy and eliminate mass disease and ill health. Mindful of the fact that there are many factors that determine the quality of life, the aim of the study was to investigate the impact of health, water and sanitation services in improving the quality of life among poor communities. To do this, this study adopted a comparative qualitative analysis approach between poorly serviced and adequately serviced areas. Subsequent to the findings, this study espouses constructive suggestions and recommendations that could act as guidance to community development agencies' strategies in amelioration of the quality of life among poverty-stricken communities. The research was based on a narrow model of services (health, water and sanitation services) that have impact on improving the quality of life among poor communities. The empirical findings of this study indicate these services to be insufficient to draw conclusive findings in other aspects of the survey. The research was conducted in a sample of 573 households in 6 communities in the Eastern Cape and Western Cape Provinces in South Africa. The sample comprised 3 communities in the category classified as poorly serviced with health, water and sanitation services, and 3 communities that were regarded as adequately provided with these services. The data was gathered by means of structured questionnaires, administered by the researcher with the assistance of a trained field worker. Additional, the data was gathered by means of a semi-structured, open-ended interview with a Sister-in-Charge of a clinic in the rural villages. The interaction between variables on the improvement of the quality of life were explored by means of basic statistics, which made it possible to assess the effects of independent and dependent variables. The results of data analysis provided support for the proposition contained in the premise of the study that although the provision of health, safe clean water and adequate sanitation services lead to improvement in the standard of living, their impact alone does not incorporate all the attributes that enhance quality of life as suggested by mainstream schools of thought in the health sector. Poverty-related factors also have to be taken into account. As such, the findings of this study have shown that poverty, combined with poor public health conditions, inadequate nutrition, overcrowded poor quality housing, lack of accessible drinking water and sanitation, renders communities vulnerable to ill health. Given the poor socio-economic conditions prevalent in the communities under investigation, it was not surprising that tuberculosis was most prevalent in all areas. In line with the premise of this study, there were instances that povertyrelated factors such as income, housing and nutrition had significant influences with regard to improvement in the quality of life. It became evident therefore that in certain instances, health, water, and sanitation services alone are not sufficient to make conclusive findings. Thus, the impact of povertyrelated factors such as income, housing and nutrition necessitate expansion of factors that impact on the quality of life to include their influence. / AFRIKAANSE OPSOMMING: Goeie gesondheid is 'n belangrike vereiste vir sosiale, ekonomiese en persoonlike ontwikkeling, en dus ook 'n wesenlike aspek van 'n goeie lewensgehalte. Toegang tot goedere en dienste wat deur die staat voorsien word, het ook 'n beduidende invloed op lewensgehalte. Boonop het die toegang tot infrastruktuur en dienste soos water en sanitasie 'n direkte invloed op gesondheid. Die lewering van gesondheids, water- en sanitasiedienste verseker dus die bevrediging van basiese behoeftes, onderwyl arm gemeenskappe se gesondheidsprofiel en daarmee saam hul toegang tot werksgeleenthede verbeter word. Toegang tot veilige en skoon waterbronne en voldoende sanitasiedienste is gevolglik van die belangrikste gesondheidsbepalers. Gesondheidsverwante dienste soos water en sanitasie verseker 'n sekere gemiddelde lewensverwagting, en verminder die moontlikheid van wydverspreide siektetoestande. Met inagneming van die feit dat lewensgehalte deur talle faktore beïnvloed kan word, was die doel van hierdie studie om ondersoek in te stel na die invloed van gesondheids, water- en sanitasiedienste op die verbetering van lewensgehalte in arm gemeenskappe. Gevolglik is 'n vergelykende analise tussen areas met swak dienslewering en areas met bevredigende dienslewering uitgevoer. Op grond van die bevindinge word sekere voorstelle en aanbevelings gemaak wat kan dien as riglyne vir ontwikkelingsagentskappe ter bevordering van die lewensgehalte in arm gemeenskappe. Die navorsing was gegrond op 'n beperkte model van dienste (gesondheids, water- en sanitasiedienste) wat die verbetering van lewensgehalte in arm gemeenskappe beïnvloed. Die empiriese bevindinge van die studie toon aan dat hierdie dienste onvoldoende is om as basis te dien vir beslissende uitsprake oor ander aspekte van die opname. Die studie het 'n steekproef van 573 huishoudings in 6 gemeenskappe in die provinsies van die Oos-Kaap en Wes-Kaap in Suid-Afrika ingesluit. Die steekproef het bestaan uit 3 gemeenskappe met swak gesondheids, water en sanitasiedienste, en 3 gemeenskappe waar sulke dienste op 'n bevredigende vlak voorsien word. 'n Gestruktureerde vraelys is gebruik om die navorsingsinligting in te samel, wat deur die navorser en 'n opgeleide veldwerker toegedien is. Bykomende inligting is bekom deur 'n semigestruktureerde onderhoud met die verpleeghoof van 'n kliniek in 'n landelike gemeenskap. Die invloed van die verskillende veranderlikes op lewensgehalte is deur middel van basiese statistiese analise geëvalueer. Die resultate van die data-analise verleen 'n mate van steun vir die premis van die studie dat hoewel die voorsiening van gesondheid, veilige, skoon water en voldoende sanitasie tot 'n beter lewenstandaard kan lei, die uitwerking daarvan as sodanig nie alle vereistes insluit vir 'n beter lewenstaard nie, soos voorgestaan deur hoofstroom denkskole in die gesondheidsektor. Faktore wat met armoede verband hou moet ook in ag geneem word. Die studie se bevindinge dui dus daarop dat armoede, tesame met swak openbare gesondheidstoestande, onvoldoende voeding, gebrekkige behuising en swak water- en sanitasiegeriewe gemeenskappe meer kwesbaar maak. Weens die swak sosio-ekonomiese toestande in die gemeenskappe in die steekproef, is gevind dat tuberkulose wydverspreid voorkom. Alhoewel die studie se hipotese met betrekking tot verskeie aspekte bevestig is, was daar ook gevalle waar armoede-verwante faktore soos inkomste, behuising en voeding 'n beduidende rol gespeel het. Dit het dus geblyk dat gesondheids, water- en sanitasiedienste nie in alle gevalle voldoende is om swak lewensgehalte te verklaar nie. Dus sal die faktore wat op lewens kwaliteit 'n impak maak, uitgebrei moet word om vir die invloed van armoede-verwante faktore soos inkomste, behuising en voeding voorsiening te maak.

Thesis (MSc)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: In developing countries the increasing number of the aged are often viewed as a problem. In particular, the indigent elderly residing in poor urban areas are at risk of becoming marginalised and underserved. The Western Cape has the third largest elderly population in proportion to the total population in the country. Social assistance in the form of a monthly pension is paid out to all elderly who pass a national means test carried out by South African Social Security Agency (SASSA). An assessment of the characteristics and health status of the elderly collecting old age pensions living in low-income urban poor communities in the City of Cape Town was carried out at pension pay points across four communities, i.e. Gugulethu, Khayelitsha, Mitchells Plain and Bonteheuwel. In community health surveys, choices regarding the methodology have to be made that can have profound effects on the study design and study outcomes. The milieu of the present study is one of urban poverty and specifically those urban elderly who qualify for non-contributory pensions (also called social cash transfers or government grants). The paucity of existing community-based studies on old-age pensioners in the City of Cape Town meant that a cross-sectional survey with wide-ranging coverage of demographic, social and health factors was the most logical design to employ in order to determine the extent of present needs and generate hypotheses for further controlled studies. A systematic random sample of 703 elderly was drawn at nine pension pay-out points in Cape Town Metropole. No pensioners refused to participate in the study. Structured interviews were carried out covering demographics, number of dependents, living conditions, socioeconomic circumstances, health status and needs and utilisation of health services. A reported 43% of participants lived in shacks and 88% reported regularly eating less than 3 meals a day. Eighty-seven percent of respondents reported waiting 3 hours or longer for medication at a clinic while 90% reported being dissatisfied with the service at their clinic. Fifty-eight percent of pensioners reported not being able to see well while 83% did not know where to get their eyes tested. Almost 70% of pensioners said that they have been ill-treated by a family member and 64% scored as severely depressed on the geriatric depression scale. In this study, 266 pensioners solely supported 471 children of which 65 (14%) were disabled children. In 95% of cases the pensioner does not receive any support from the child's parents. The study found that the elderly on a state grant had considerable unmet health needs and required assistance with activities of daily living. The indigent pensioners in this study bore a huge duty of care for minor children as custodial grandparents while not receiving a high level of health support themselves. / AFRIKAANSE OPSOMMING: Die toenemende aantal bejaardes word dikwels in ontwikkelende lande as 'n probleem gesien. In die besonder loop die bejaardes wat in lae-inkomste stedelike gebiede woon die risiko om gemarginaliseer te word en swak dienslewering te ondervind. Die Wes-Kaap het die derde grootste populasie van bejaardes in verhouding tot die totale bevolking in die provinsie. Sosiale bystand in die vorm van 'n maandelikse pensioen word betaal aan alle bejaardes wat die inkomstetoets slaag wat deur die Suid-Afrikaanse Agentskap vir Maatskaplike Sekerheid (SAAMS) uitgevoer word. 'n Ondersoek na die eienskappe en gesondheidstatus van bejaardes wat hulle ouderdomspensioene in lae-inkomste stedelike gemeenskappe in die Stad Kaapstad kom afhaal is uitgevoer. Die studie is gedoen by pensioen-uitbetaalpunte in vier gemeenskappe, naamlik Gugulethu, Khayelitsha, Mitchells Plein and Bonteheuwel. In gemeenskapsgesondheid-opnames moet keuses gemaak word ten opsigte van die metodologie wat diepgaande gevolge vir die studieontwerp en -uitkomste kan inhou. Die milieu van die huidige studie in dié van stedelike armoede en spesifiek die leefruimte van stedelike bejaardes wat kwalifiseer vir nie-bydraende pensioene (ook genoem sosiale kontantoordragte of staatstoelaes). Die gebrek aan bestaande studies van ouderdomspensioenarisse in Kaapstad het beteken dat 'n dwarsdeursnit-opname van die demografie, sosiale en gesondheidsfaktore die mees logiese ontwerp was om uit te voer. Dit is gedoen om die omvang van huidige behoeftes te bepaal en verdere hipoteses te genereer wat deur vergelykende studies ondersoek behoort te word. 'n Stelselmatige ewekansige steekproef van 703 bejaardes is getrek by nege betaalpunte in die Kaapse stadsgebied. Geen proefpersone het geweier om deel te neem nie. Gestruktureerde onderhoude is gevoer wat die volgende aspekte gedek het: demografiese eienskappe, aantal afhanklikes, gesondheidstatus en benutting van gesondheidsdienste. Van die deelnemers het 43% in informele behuising ("shacks") gewoon en 88% het gerapporteer dat hulle gereeld minder as 3 daaglikse maaltye eet. Daar het 87% gerapporteer dat hulle 3 uur of langer gewag het om medikasie by hulle plaaslike kliniek te ontvang terwyl 90% ontevrede was met die diens wat hulle by die kliniek ontvang het. Daar het 58% van die bejaardes gerapporteer dat hulle nie goed kan sien nie terwyl 83% van hulle nie geweet het waar hulle hulle oë kan laat toets nie. Omtrent 70% van bejaardes het gesê dat hulle deur 'n familielid mishandel word en 64% kon as ernstig depressief geklassifiseer word op die geriatriese depressieskaal. In hierdie studie was 266 pensioenarisse die enigste sorg en voog van 471 kinders van wie 65 (14%) gestremd was. In 95% van gevalle het die pensionaris geen geldelike of ander bydraes van die kind(ers) se ouers ontvang nie. Die studie het bevind dat bejaardes wat 'n staatstoelaag ontvang aansienlike onvervulde gesondheidsbehoeftes het en hulp benodig met aktiwiteite van daaglikse bestaan. Die behoeftige pensioenarisse in hierdie studie het 'n groot las gedra aan die versorging van minderjarige kinders as toesighoudende grootouers ("custodial grandparents") terwyl hulleself nie 'n hoë vlak van ondersteuning geniet nie.

Thesis (M. Dev.) -- University of Limpopo, 2008 / Refer to the document

MCur / Department of Advanced Nursing Science / Background: Perinatal and neonatal mortality rates remain high in South Africa especially in rural areas and townships where the majority of poor people live. With regard to perinatal and neonatal mortality, South Africa like many other developing countries has failed to achieve MDG 4 and 5 by 2015 regardless of many efforts by the governments. To achieve the SDG which replaced MDGs for child health, it is necessary for the South African public and private health care to reduce substantially perinatal and new born deaths, particularly in rural areas. There are many factors that contribute to a high perinatal mortality rate in public hospitals in rural areas. To understand these factors, a study was conducted with midwives from selected public hospitals in Limpopo, Vhembe district which experiences the highest perinatal mortality rates in South Africa. Purpose and methodology: The purpose of this research study was to assess factors contributing to high perinatal mortality rates in the selected public hospitals in Vhembe district. A quantitative, descriptive, exploratory and cross-sectional design was used to collect data from the sampled hospitals in the Vhembe district. Hospitals were purposively sampled based on the statistics of monthly deliveries. The target population consisted of all registered midwives who had been working in the maternity units for at least two years. Cochrane's formula was used to determine the sample from the target population for each hospital. A random sample of 110 respondents was selected upon which a questionnaire was administered to each by the researcher. Responses from the close-ended and open-ended questions was grouped and analysed quantitatively by means of Statistical Package for Social Sciences 23.0 (SPSS). Results and findings: Results were presented in frequency tables and graphs revealed that most of the midwives lacked knowledge and skills in a number of key areas needed for them to operate efficiently in the maternity wards. There was also high staff turnover which led to a few midwives being overworked. The utilisation of guidelines and protocols in maternity was left to individual midwives as the hospitals did not evaluate the use of it. Conclusions: Lack of key skills in assisting women in labour, and poor use of guidelines and understaffing were the main contributing factors to high perinatal mortality rates in the selected public hospitals of Vhembe district. Midwife attitudes were not a contributory factor. / NRF

Introduction: Du fait des faibles résultats enregistrés par différents systèmes de santé dans le monde, la conférence d'Alma Ata de 1978 avait préconisé l’approche des Soins de Santé Primaires. Pour renforcer cette approche et faciliter l’accessibilité universelle aux soins, l’Initiative de Bamako fut adoptée en 1987. Cette initiative se fonde sur la participation financière des patients aux soins. L'une des conséquences est le coût financier des soins pour les bénéficiaires avec un risque d'exclusion de certains patients. Mais l’Initiative de Bamako suggère les dispositions à prendre pour éviter l'exclusion des indigents. Au Bénin, les comités de gestion des centres de santé ont la responsabilité de veiller à l'accès aux soins des indigents. Mais malgré cela, la prise en charge des indigents n’est pas effective. Les professionnels de la santé se plaignent de ne pas disposer de critères d'identification des indigents. Sur cette base, l'identification des indigents constitue la pierre angulaire de leur prise en charge. En conséquence, la mise en place d'une stratégie opérationnelle fondée sur l'identification des indigents par les personnes ressources de la communauté et soutenue par un outil quantitatif d'identification, permet une identification fiable des indigents en vue de leur prise en charge sanitaire. <p>Méthode: Après un état des lieux de la situation des indigents dans le système de santé au Bénin, trois études ont été réalisées pour approfondir la question des indigents; <p>•\ / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

Cultural factors have been shown to play a role in human decision making and behaviour. The main objective for this research was to identify and evaluate the possible influence of Shangaan cultural beliefs, myths and behaviours, on the spread of HIV within the Mnisi tribe. A qualitative method of investigation was followed; interviews with three participants and observations of the Mnisi culture were used in the construction of the investigation and findings. Through the information obtained two cultures influencing the spread of HIV in the Mnisi tribe were identified, they are (1) The culture of power-rule and fear, and (2) The culture of poverty. / Psychology / M.Sc. (Psychology)

Cultural factors have been shown to play a role in human decision making and behaviour. The main objective for this research was to identify and evaluate the possible influence of Shangaan cultural beliefs, myths and behaviours, on the spread of HIV within the Mnisi tribe. A qualitative method of investigation was followed; interviews with three participants and observations of the Mnisi culture were used in the construction of the investigation and findings. Through the information obtained two cultures influencing the spread of HIV in the Mnisi tribe were identified, they are (1) The culture of power-rule and fear, and (2) The culture of poverty. / Psychology / M.Sc. (Psychology)

Indiana University-Purdue University Indianapolis (IUPUI) / Oral health is crucial to overall health and a focus of the U.S. Health Center program, which provides preventive dental services in medically underserved communities. Dental hygiene is an oral health profession whose practice is focused on dental disease prevention and oral health promotion. Variations in the practice and regulation of dental hygiene has been demonstrated to influence access to dental care at a state level; restrictive policies are associated lower rates of access to care. Understanding whether and to what extent policy variations affect availability and access to dental care and the oral health of medically underserved communities served by grantees of the U.S. Health Center program is the focus of this study. This longitudinal study examines dental service utilization at 1,135 health center grantees that received community health center funding from 2004 to 2011. The Dental Hygiene Professional Practice Index (DHPPI) was used as an indicator of the state policy environment. The influence of grantee and state level characteristics are also considered. Mixed effects models were used to account for correlations introduced by the multiple hierarchical structure of the data. Key findings of this study demonstrate that state policy environment is a predictor of the availability and access to dental care and the oral health status of medically underserved communities that received care at a grantee of the U.S. Health Center program. Grantees located in states with highly restrictive policy environments were 73% less likely to deliver dental services and, those that do, provided care to 7% fewer patients than those grantees located in states with the most supportive policy environments. Population’s served by grantees from the most restrictive states received less preventive care and had greater restorative and emergency dental care needs. State policy environment is a predictor of availability and access to dental care and the oral health status of medically underserved communities. This study has important implications for policy at the federal, state, and local levels. Findings demonstrate the need for policy and advocacy efforts at all levels, especially within states with restrictive policy environments.