Magister Public Health - MPH / Introduction: Nigeria operates a three tiered health care delivery system with a large percentage of health care delivery vested at the primary care level. There has been over the years a continued effort by the government to decentralize health care service thereby increasing the range of services provided at the primary care level. Despite all these efforts there is still low utilization of primary health care services. This study therefore seeks to explore the factors that may be responsible for poor utilization of primary health service in Nasarawa State, Nigeria using two primary health clinics in Lafia local government area as case studies. Methodology: The study was carried out using the qualitative research methodology primarily using two data collection methods, the focus group discussions and individual interviews. A total of sixty participants were sampled, these consisted of ten members of staff, twenty non facility users and thirty facility users. Thirty individual interviews were conducted and four focus group discussions held with staff and facility users at the two clinics. Facility users were randomly selected as they attended the clinic on the data collection days and were invited to participate in the study. Every second patient attending the clinic was selected for the focus group discussion and every third person for the interviews. The staff participants were randomly selected based on their availability while non-facility users were selected using snowballing. Data was analyzed using thematic analysis method. Findings: Two major themes emerged following data analysis; these were perception and experiences of facility users and barriers to utilization of health services. Users had a good perception of the services they received and are reasonably satisfied but certain deficiencies in the health care systems compromised the quality of service. Several factors were however hindering the utilization of these services and these include mainly institutional factors such as lack of infrastructure, equipment and staffing constraints; household factors such as cost of service and responsibility of decision making and other factors such as stigmatization and beliefs. Conclusion: Facility users of these clinics seem to have an overall good impression of services at the clinics; however there are certain fundamental deficiencies that need to be urgently addressed to improve the care provided at these clinics as these constitute barriers to utilization. These deficiencies such as the absence of electricity and water, lack of basic work equipment and inappropriate staff composition need to be addressed by the local government health department to ensure utilization and improved quality of service.

Tuberculosis is one of the major health tragedies facing South Africa. It is estimated that nearly two-thirds of the population of the country are infected with the tuberculosis bacterium and 160 000 South Africans from all walks of life become ill with tuberculosis every year (Department of Health, 1997: 4). An innovative approach is needed to fight the problem of tuberculosis. In view of the important role played by primary health care nurses with regard to the care of patients with tuberculosis, the overall aim of the study is to contribute to an improvement of tuberculosis patient care, inter alia, by attending to the problems pertaining to the provision of tuberculosis patient care at the government clinics in the Qwa-Qwa district of the Free State. The study attempts to describe the difficulties that primary health care nurses at the government clinics in Qwa-Qwa experience in the provision of tuberculosis patient care, and how their attitudes towards patients affect their service. The nurses need to be informed about how their attitudes influence their service. The perceptions of primary health care nurses in this matter are ascertained to assess their personal experience in their routine care of tuberculosis patients. The results of this research study indicate the following obstacles for primary health care nurses to render effective tuberculosis patient care at the government clinics in Qwa-Qwa: · Lack of knowledge, training and skills amongst some of the nurses in the treatment of tuberculosis, · Poor access to tuberculosis information, which include the procedures that protect nurses from tuberculosis infection; · Poor management system for nurses in tuberculosis patient care; · Lack of key health resources related to tuberculosis treatment; · Fear of the consequences of contracting tuberculosis by some of the nurses, and; · Negative attitudes of some nurses towards tuberculosis patients as well as towards their work. / Dissertation (MA (Sociology))--University of Pretoria, 2005. / Sociology / unrestricted

This small scale research study explores psychotherapists’ experience of medical model thinking on their practice delivered in the two separate settings of GP surgeries and private practice. The study’s key philosophical theme is the difference between modern and postmodern perspectives and how they might manifest themselves in social practices (such as medical interviews), knowledge creation and the practice of psychotherapy. The researcher locates the concepts key to the research in existing literature in terms of theory, research studies and their historical development – this latter being in support of the use of a Foucauldian discourse analytic method which is selected as that which best supports a social constructionist, postmodern approach to research. Parker’s method of using the research interview as a text-in-progress is explained and implemented, with eight participants being interviewed twice by the researcher. A discourse analytic framework which draws on defined theoretical resources was applied. The findings from the two part study show that for those participants working in primary care the GP/patient relationship has at least four key impacts on psychotherapy delivered in that setting and that for those working in a private setting it is through their relationships with individual GPs and psychiatrists that participants’ have constructed the biggest impact of medical model discourse on their practice and perhaps more importantly on their clients. Links are made to the literature reviewed concerning notions of the power of doctors and ideas for future research focused on the prevalence of ‘splitting’ in the UK are discussed. The researcher concludes with some thoughts about the fact that whilst the medical models’ invisibility and taken-for-granted nature for participants working within a primary care setting was more severe than expected, it was discursively constructed as having less of a wide-ranging impact on the participants in private practice. The importance of remaining awake to the influence of the medical model is discussed particularly during a cultural moment dominated by modernist approaches to notions of research and increasingly, practice.

Health is a basic human right enshrined in the South African Constitution. It is the responsibility of government to ensure that the nation is healthy because good health is a prerequisite for social and economic development as well as an outcome of that process. Special attention on the healthcare needs of rural communities should be given because these communities were the worst affected by the legacy of the apartheid regime. Moses Mabida community is no exception. Since the advent of democracy, work has been done to ensure that adequate primary health care services are delivered to previously disadvantaged communities such as Moses Mabida. To monitor progress on health care service delivery, evaluation of these services is needed. The evaluation of these services will help identify the strengths and weaknesses so as to come up with quality improvement strategies, hence this study. This study takes form of an assessment survey involving a literature review and a survey of members of the Moses Mabida community who depend on the clinic for their health care needs. The literature identified best practice models of primary health care and these were used as an analytic tool to determine to what extent the primary health care services at Moses Mabida comply with national and international standards. It has been shown that the primary health care services at Moses Mabida Clinic largely comply with national and international standards although several recommendations have been presented for consideration.

Objective: To explore the role of interprofessional collaboration in the delivery of team-based tobacco dependence treatments within primary care. Methods: A narrative review of the literature was completed to examine FHT team functioning in Ontario, followed by a single, multi-site qualitative exploratory case study. Results: Interprofessional collaboration contributed to changes in tobacco dependence treatment through the initiation of system-wide change, cultivation of collective action, and supporting enhanced quality of smoking cessation care. Conclusion: Interprofessional collaboration can enhance the comprehensive delivery of evidence-based treatments for individuals trying to quit smoking. Supportive public policy, education for patients and providers, and evaluation research is needed to advance FHT functioning.

The aim of the study was to identify, evaluate and compare the determinants of patient satisfaction in fee-for-service, and health maintenance organisation (HMO), medical service delivery centres. Staff at both centres, who were also patients, were surveyed to determine the congruence with patients’ quality improvement priorities. The survey was conducted using a questionnaire consisting of closed questions given to patients as they departed from the medical centres. The questionnaire was tested for convergent and divergent validity, content analysis and reliability. A rating scale was then applied to yield the scores for each determinant. The unique Patient Satisfaction Priority Index was determined using determinants that were rated low on satisfaction but high on importance. The results revealed that patients at the fee- for- service medical centre were significantly more satisfied than patients at the HMO. The priority index for patients were found to be different to that of the staff at both medical centres, proving that staff and patient priorities were incongruent. Accordingly, the recommendations were that patient satisfaction be continuously evaluated at medical service delivery centres, in order to achieve a competitive advantage, sustainability and growth in South Africa’s highly competitive private healthcare industry. Copyright / Dissertation (MBA)--University of Pretoria, 2008. / Gordon Institute of Business Science (GIBS) / unrestricted

ABSTRACT Background: Community Health Workers are faced with challenges in the community when conducting home visits. The re-engineering of Primary Health Care services in South Africa brought a new cadre of Community Health Workers. The role of Community Health Workers relieved the workload and activities which were done by Primary Health Care nurses. Community Health Workers had to conduct home visits as one of the activities. The Community Health Workers experienced challenged during home visits. Aim: This study was conducted to describe and explore the challenges Community Health Workers perceived regarding home visits in the Tshwane district Method: Semi-structured interviews were undertaken with a purposive sample of fourteen Community Health Workers conducting home visits. The individual face to face interviews concentrated on the challenges perceived regarding home visits. All the interviews were transcribed verbatim and analysed using the tesch method. Findings: The challenges perceived were that of the community, logistical, occupational, human resource and managerial. The participants expressed the need for respect and acceptance by the community during home visits. Improved planning related to delegation of households by Outreach Leaders and provision of material resources. The support by managers for career development through training and education for various disease prevention. Conclusion: the findings suggest that training of Community Health Workers need to be formalised and in-service education related to home visits should be planned, structured and supported by the Department of Health. Key words Challenges, Perceived, Community Health Workers, Home visit. / Dissertation (MNurs)--University of Pretoria 2020. / Nursing Science / MNurs / Unrestricted

Mental health concerns are presented in primary care settings regularly, yet a majority of these issues go undetected or are misdiagnosed by primary care physicians (PCPs). This may be due to a lack of mental health training for PCPs during their medical education. Over time, medical school curricula have evolved to include mental health training in order to bridge this gap in the healthcare system and to more readily identify patients in need of mental health services. The current study investigated AMA-accredited medical school curricula from universities across the US and US territories (N = 170) who train physicians in primary care, family medicine, or other generalist tracks. Data on mental health training were collected from the public websites of each school. Results showed that most universities indicated at least some type of required mental health training (85.3%), which were either didactic or experiential in nature. Although this result appears encouraging, further examination reveals that this training was most often limited to only one 4-week psychology-related course and a 6-week psychiatry rotation. Overall, many universities indicated at least one required course (N = 95), and most universities reported a required psychiatry rotation (N = 135). Moreover, only 12.9% of the sample reported having at least both didactic and experiential training required. The implications of this are varied. First, PCPs often have only a short amount of time with their patients, reducing their ability to fully assess both medical and mental health. A lack of exposure to mental health needs may lead to missed opportunities for intervention and improvement in patient health. Second, it is important for mental health professionals to work closely with PCPs in primary healthcare settings in order to improve rates for detection and treatment of mental health problems. In addition to improved patient outcomes, having mental health professionals integrate within primary healthcare can serve to decrease the stigma associated with seeking mental health treatment, as well as reduce long-term healthcare costs. This can also increase access to care for those individuals who are unable to see a mental healthcare provider, especially in rural areas. Finally, overall health may improve in relation to better mental healthcare, since medical and mental health have been consistently shown to significantly influence one another.

Thesis (M.Cur.) --University of Limpopo, 2010 / In this study, a qualitative, descriptive and contextual research methodology was applied to describe the problems faced by newly diagnosed diabetes mellitus patients at the primary healthcare facilities of the Mopani district in the greater Giyani municipality, Limpopo Province, South Africa. Purposive sampling was used and phenomenological interviews were held with newly diagnosed diabetes mellitus patients after investigations within the first six months. The data were analyzed using Tesch’s open coding method of data analysis for qualitative research. The findings indicated that newly diagnosed diabetes mellitus patients faced a number of problems, such as emotional disturbance, fear, anger, denial, frustration, depression, uncertainty, and poor interpersonal relationships with nurses. This study found that lack of support and proper health education for newly diagnosed diabetes mellitus patients demand government intervention, and thus proposes guidelines and recommendations for more effective healthcare practices and education for implementation at primary healthcare facilities.

No abstract available. / Thesis (M.Med)-University of Natal, Durban, 1986.