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Background: Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. Methods: A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. Results: Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. Conclusion: Policymakers should consider PWCDs when responding to a public health concern in the future. Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs. [ABSTRACT FROM AUTHOR]

Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems. Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes. Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities. Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems’ performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine. [ABSTRACT FROM PUBLISHER]

People living with HIV facing impairments and subsequent disabilities related to the virus and its treatment require involvement of a collaborative team of healthcare professionals to ensure reintegration into daily life and community living. Healthcare teams responsible for this care include doctors and physiotherapists. This paper explores the collaboration of doctors and physiotherapists in the rehabilitation of people living with HIV in a semi-rural healthcare setting in KwaZulu-Natal, South Africa. Six doctors and two physiotherapists were interviewed using a semi-structured interview guide. The qualitative approach led to the emergence of five themes, namely a biomedical versus biopsychosocial approach; scope of practice challenge; multidisciplinary team enigma; institutional structure limitations; and recommendations from healthcare professionals. Both groups of professionals believed that a lack of understanding of the scope of practice and role of the associate profession in the multidisciplinary team led to poor referrals and lack of communication. Furthermore, shortage of personnel and resource limitations posed barriers to effective team interaction. Timely referrals, good communication and understanding of roles were suggested as endorsements to improved collaboration. [ABSTRACT FROM AUTHOR]

Background: Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. Methods: This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Results: Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Conclusion: Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level. Contribution: This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level. [ABSTRACT FROM AUTHOR]

Background: Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. Methods: An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. Results: The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Conclusion: Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time. Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country. [ABSTRACT FROM AUTHOR]

Background: The use of alcohol amongst first-year students in institutions of higher learning is problematic as it often leads to social and academic problems, for instance high dropout rates and high-risk sexual behaviour. Research on first-year students' opinions regarding their own use of alcohol at the University of Limpopo, Medunsa Campus, was seen as pertinent as this institution trains medical doctors, dentists and other health professionals. The findings could inform appropriate interventions by policy-makers at the institution. This paper presents the qualitative data nested from a larger study on alcohol use among first-year medical students. Methods: A sample of 217 first-year students was obtained, to whom a questionnaire was administered which included open-ended questions formulated from discussions with a focus group of eight first-year students. The open-ended questions were formulated in a manner that allowed participants to give an account of their experience and opinions related to the drinking of alcohol. Thematic content analysis was used to analyse qualitative data. Results: The participants comprised 90 (41.5%) females, 13 (6%) White, 196 (90.3%) Black, 4 (1.8%) Asian and 4 (1.8%) Coloured students. The study revealed substantive views relating to first-year students' opinions and experiences of alcohol consumption. Themes gleaned from the interpretation were awareness, physical location of the campus, economic opportunities, health considerations, identity, belief in alcohol use, and interventions. Conclusion: The results indicate that first-year students have varying opinions and experiences concerning alcohol consumption at the University of Limpopo (Medunsa campus). Social identity and peer pressure are motivating factors in students' use of alcohol. [ABSTRACT FROM AUTHOR]

Background: Family medicine (FM) is often perceived to be a 'lesser' speciality compared with other disciplines, despite its importance as a generalist discipline in the healthcare system. Family physicians (FPs) provide comprehensive care at the district level and act as a gatekeeper for patient's upward referral to other specialists. This study aimed to explore the perceptions of healthcare specialists other than FPs involved in registrar training regarding FM at the University of KwaZulu-Natal, South Africa (SA). Methods: This was a qualitative study, with seven consultants, other than FPs, who worked at three public sector regional hospitals using purposive sampling. Individual semistructured interviews were conducted, audio-recorded and transcribed verbatim and analysed thematically. Results: Four themes emerged (perception of FM as a medical speciality, role of FPs in the healthcare system and proposed National Health Insurance, FM registrars rotating in units and the scope of their training and how to improve the perceptions of FM by other specialities). Family medicine was regarded as a major and relevant specialist field with a significant contribution to make in advancing patients' care. The country's healthcare system is yet to make the best use of the FM specialist's role in improving quality of care. Conclusion: The perceptions of FM from other specialists were generally positive and reinforced its importance in facilitating improved healthcare in SA. These specialists have high regard for FM and emphasised the large responsibility of practitioners. [ABSTRACT FROM AUTHOR]

Background: The high burden of tuberculosis (TB) in South Africa (SA) is associated with uncontrolled transmission in communities and delayed diagnosis of active cases. Active surveillance for TB is provided by community-based services (CBS). Research is required to understand key factors influencing TB screening services in the CBS. This study explored the implementation of active surveillance for TB where community-oriented primary care (COPC) had been successfully implemented to identify these factors. Methods: This was a qualitative study of four established COPC sites across two provinces in SA where active surveillance for TB is implemented. Semi-structured interviews were conducted with purposively selected healthcare workers in the CBS and citizens in these communities. The recorded interviews were transcribed for data analysis using ATLAS.ti software. Results: The factors influencing active surveillance for TB were directly related to the major players in the delivery of CBS. These factors interacted in a complex network influencing implementation of active surveillance for TB. Building effective relationships across stakeholder platforms by community health workers (CHWs) was directly influenced by the training, capacity building afforded these CHWs by the district health services; and acceptability of CBS. Each factor interplayed with others to influence active surveillance for TB. Conclusion: Community health workers were central to the success of active surveillance for TB. The complex interactions of the social determinants of health and TB transmission in communities required CHWs to develop trusting relationships that responded to these issues that have impact on TB disease and linked clients to healthcare. [ABSTRACT FROM AUTHOR]

Background: The global pandemic associated with coronavirus disease 2019 (COVID-19) had a considerable effect on higher education in South Africa, with online instruction replacing traditional lectures for many students. Medical students were required to vacate their residences in March 2020 but returned to campus in July 2020 to enable them to continue with clinical teaching and learning. The aim of this study was to understand the learning experiences of 5th year medical students at the University of KwaZulu-Natal (UKZN) during 2020. Methods: This was a qualitative study conducted via Zoom in December 2020 with 18 students in four focus group discussions and four semi-structured interviews. These were all facilitated by an independent researcher with experience in qualitative research. All the interviews were recorded, transcribed verbatim and analysed qualitatively through the identification of codes, categories and themes. Results: The following major themes emerged: A stressful and at times an overwhelming year, mental health issues, developing strategies to cope, and issues that related to teaching and learning. Conclusion: The disruptions caused by COVID-19, the lockdown, a condensed academic programme and uncertainty about their competency resulted in high levels of anxiety and stress among medical students. Participants highlighted strategies that had helped them to cope with the isolation and academic pressures. Given the large volume of work, careful thought needs to be given to what should be taught and how it should be taught to ensure that graduates have the competencies they need to practise. [ABSTRACT FROM AUTHOR]

Background: Many health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs. Methods: This multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers. Results: Most of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers' response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging. Conclusion: Lessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication. [ABSTRACT FROM AUTHOR]

Background: Globally, universal health coverage (UHC) has gained traction as a major health priority. In 2011, South Africa embarked on a UHC journey to ensure that everyone has access to quality healthcare services without suffering financial impoverishment. National Health Insurance (NHI) and primary healthcare (PHC) re-engineering were two vehicles chosen to reach UHC over a 14-year period (2012-2026). The first phase of health system strengthening (HSS) initiatives to improve the quality of health services in the public sector began in 2012. These HSS initiatives are still being carried out by the Department of Health in conjunction with other partners. Methods: A qualitative case study design utilising a theory of change (TOC) approach was employed. Data were collected from key informants (n = 71) during three phases: 2011--2012 (contextual mapping), 2013--2014 (Phase 1) and 2015 (Phase 2). In-depth face-to-face interviews were conducted with participants using a TOC interview guide, adapted for each phase. All interviews were audio-recorded and transcribed verbatim. An iterative, inductive and deductive data analysis approach was utilised. Transcripts were coded with the aid of MAXQDA 2018. Results: Six broad themes emerged: make PHC work, transform policy development, transform policy implementation, establish public--private partnerships, transform systems and processes and adopt a systems lens. Conclusion: A third great transition seems to be sweeping the globe, changing how health systems are organised. Actors in our study have identified this need also. Health system transformation rather than strengthening, they say, is needed to make UHC a reality. Who is listening? [ABSTRACT FROM AUTHOR]

Background: It was noted that family medicine (FM) was not used properly by doctors at Letaba Hospital. Anecdotally, misconceptions and misunderstandings about FM were reported. An exploration was recommended to understand the perceptions and attitudes of doctors at Letaba Hospital with regard to FM. Identifying doctors' misconceptions and the possible reasons for mistaken beliefs about FM by other specialists could offer possible solutions. Methods: A qualitative study was conducted that attempted to identify the perceptions of doctors about FM and to explore their attitudes towards this specialty. Results: The primary findings indicate more positive than negative perceptions of other disciplines towards FM. The participants viewed FM as the centre of the healthcare system, with prevention being its core business. This includes a holistic approach, the continuity of care, being community-based, and receiving recognition as a specialty. Family medicine was described by various medical personnel as making a positive contribution to the healthcare system. They note the role of FM discipline in district hospitals, its support of primary healthcare and its ability to fill the gaps in the healthcare system, including surgical skills. The few negative perceptions that were identified mostly related to the status of FM as a specialty and doctors' level of surgical ability. Based on individual interviews, 11 themes were extracted and a 'wheel' model was created, depicting the core values of the FM discipline. Conclusion: The study concluded that most participants have a positive perception of the role of FM, similar to the views of the senior staff in the discipline itself. The concerns from most participants are in the area of preventative medicine, which has not been given enough priority in South Africa and where doctors are expected to rapidly attend to long queues and manage casualties. There was also concern of a perceived lack of surgical skills. [ABSTRACT FROM AUTHOR]

The outcome of the undergraduate medical programme is to produce clinically competent health care providers relevant for the South African context. Educational institutions find it hard to ensure the quality of assessments where competency must be assessed. This study aimed to compile an assessment framework that can be used to benchmark current assessment practices in the clinical phase of the undergraduate medical programme where competency must be certified. In this observational, descriptive study, qualitative data were gathered using the steps described by the World Health Organization for rapid reviews. Literature was searched, screened and selected before data were analysed and a framework was constructed. Twenty-five official documents were included in the study. The framework addressed the three components of quality assessment, namely, accreditation, assessment and quality assurance. Assessors should attend to the principles of assessment, namely, validity, reliability, fairness, feasibility, educational effect and acceptability, but realise that no assessment meets all these criteria. The first step to ensure quality assessment is to identify a clear outcome. Assessment should be planned and aligned with this outcome. It is clear that clinical assessment is multidimensional and that no assessment is perfect. Programme accreditation, assessment practices and psychometrics can assist to improve the quality of assessment but cannot judge clinical competence. Using experienced assessors with a variety of assessment methods on a continuous basis is the proposed way to assess clinical competence. An assessment framework can assist to improve assessment, but it cannot guarantee quality assessment. [ABSTRACT FROM AUTHOR]

The MMed in Family Medicine is a professional Master's qualification spanning 4 years of training. The outcomes were predetermined by national consensus. While these outcomes are measured in the form of a national exit examination, there has been no exploration of the experiences of registrars (residents) in this relatively new programme. To evaluate the experiences of registrars in one of the nine training programmes in South Africa and to identify areas for improvement. This study used purposive sampling to recruit registrar (n = 9) and supervisor (n = 8) participants into respective groups. Data were collected via semi-structured interviews and analysed thematically, and consensus was built using the nominal group technique. Supervisors identified the strengths and weaknesses of the programme which will impact on further strategic planning. Data from registrar interviews yielded two themes: affirmation, referring to the positive social engagement and facilitation of professional identity formation; and frustrations, referring to structural aspects of the programme which hindered academic progress. Qualitative programme evaluation is a useful tool in understanding the learning environment. The student perspective helped to identify the unintended consequences of the programme. It was also shown that the nominal group consensus building technique worked well in a resource-constrained environment. [ABSTRACT FROM AUTHOR]

Background: Coordinating care for patients is a key characteristic of effective primary care. Family physicians in the Western Cape formed a research network to enable them to perform practical research on key questions from clinical practice. The initial question selected by the network focused on evaluating the quality of referrals to and feedback from outpatient departments at referral hospitals to primary care providers in the Western Cape. Methods: A descriptive survey combined quantitative data collected from the medical records with quantitative and qualitative data collected from the patients by questionnaire. Family physicians collected data on consecutive patients who had attended outpatient appointments in the last three months. Data were analysed using the Statistical Package for the Social Sciences. Results: Seven family physicians submitted data on 141 patients (41% male, 59% female; 46% metropolitan, 54% rural). Referrals were to district (18%), regional (28%) and tertiary hospitals (51%). Referral letters were predominantly biomedical. Written feedback was available in 39% of patients. In 32% of patients, doctors spent time obtaining feedback; the patient was the main source of information in 53% of cases, although many patients did not know what the hospital doctor thought was wrong (36%). The quality of referrals differed significantly by district and type of practitioner, while feedback differed significantly by level of hospital. Conclusion: Primary care providers did not obtain reliable feedback on specialist consultations at referral hospital outpatients. Attention must be given to barriers to care as well as communication, coordination and relationships across the primary–secondary interface. [ABSTRACT FROM AUTHOR]

Objectives: Health care in South Africa takes place within a diverse cultural context and includes perceptions about health that strongly link to cultural beliefs and values. Biomedical healthcare professionals, particularly nurses, are exposed to and expected to cope with cultural challenges on a daily basis, with little or no training on how to do so. In this paper, we explore nurse and patient attitudes to and beliefs about how the systems of health care coexist, what issues this raises and how nurses and patients address these issues in their daily practice. Design: The study employed an exploratory, qualitative research design. Setting and subjects: Four in-depth focus group discussions were conducted with nurses and patients at a deep rural, district hospital in northern KwaZulu-Natal. Participants were selected based on their availability and willingness to contribute to the discussion. Results: Traditional and biomedical healthcare systems coexist and are used simultaneously with the healthcare- seeking pattern of patients traversing multiple systems of care. Currently, patients and nurses have developed strategies to address this by steering a pragmatic course to minimise risks, and by doing so, bridging the gap between the two healthcare mediums. Conclusion: Further research is required to understand which illnesses are primarily seen as traditional, how this gap can be effectively addressed, and how different healthcare co-delivery models can best be utilised and evaluated. [ABSTRACT FROM AUTHOR]

Background: Understanding caregivers' challenges in caring for children with diabetes mellitus (DM) and their perceptions of consultations with the multidisciplinary team (MDT) may be valuable in assisting in achieving control. Methods: Using a qualitative descriptive design, anonymised, transcribed recorded data from semi-structured interviews with a purposive sample of caregivers were thematically analysed in three areas: (a) challenges experienced in caring for their child, (b) feelings around MDT consultations pertaining to helpfulness, support and diabetes education, and (c) suggestions for clinic improvement. University of KwaZulu-Natal ethics committee approval and informed consent were obtained. Results: All caregivers (n = 14) were female with a mean age of 38 years. Total diabetes caring experience was 47.4 years. The primary caregiver was the mother in nine interviews. Ten interviewees were unemployed. The children's ages ranged from 3 to 15 years with mean age at diagnosis of 6.7 years. Caregivers' challenges in caring were reflected in two global themes: 'DM care is difficult' and needs a 'process of adjustment' over time to accept and meet demands. These included emotional, practical, financial, behavioural and social challenges. Caregivers' feelings regarding overall consultations were mostly positive, including satisfaction. The MDT's helpfulness and support were perceived as patient-centred and meeting education and care needs. Negative feelings were frustration and boredom. Clinic improvement suggestions included shorter waiting times and seeing the same doctor for continuity of care. Conclusion: Caregivers in South Africa experienced caring for children with DM as difficult, requiring an adjustment process. Perceptions of consultations were mostly positive. Relevant clinic improvements were suggested. [ABSTRACT FROM AUTHOR]

Background: National Health Insurance (NHI) intends to provide universal health coverage to all South Africans, with equity and quality as its tenets. The participation of private general practitioners (GPs) in NHI is essential. The aim was to explore perceptions of GPs on NHI in Chris Hani district, Eastern Cape, South Africa. Methods: A descriptive phenomenological qualitative study using semi-structured individual interviews of 12 GPs from six municipalities was undertaken. Data analysis used the framework method assisted by Atlas.ti software. Results: GPs in Chris Hani district felt that NHI would improve health and benefit society and be of particular benefit to poor and rural people as it will improve access to healthcare. Lack of governmental administrative capacity and a human resource plan were seen as barriers to implementation. They believed that NHI would benefit them through a single purchaser system and support more comprehensive care. GPs were concerned about a lack of information on primary care packages, accreditation, remuneration and patient allocation. They thought that NHI might disadvantage solo GPs. NHI implementation could be improved by actively engaging with GP organisations. Improvement of existing government health facilities and continued medical education were seen as possible ways to better implement NHI. Conclusion GPs in this study were generally positive about NHI and thought it would benefit both patients and providers. However, they had concerns regarding the capacity of government to implement NHI and the implications for solo GPs, and needed more information. Government needs to actively engage GPs. [ABSTRACT FROM AUTHOR]

Background: Substance abuse is recognised as a worldwide concern, contributing significantly to morbidity and mortality in South Africa. There is minimal research that has considered influences in mental health care service delivery in rural and disadvantaged communities in South Africa. Methods: A qualitative study with substance abuse service providers in uMkhanyakude rural district of KwaZulu-Natal was undertaken to gain insight into the experiences and challenges in service delivery. Focus groups and semi-structured interviews were conducted with various stakeholders (n = 29) in the rural district. Results: The findings of the study suggest that service providers experience challenges in service delivery in this rural area. The effects of culture (amarula festival and ancestral worship) exacerbate the use of substances; the high rate of unemployment and poverty lead to the produce of home-brewed substances for sustainable living; a lack of resources poses threats to service delivery; the poor prioritisation of mental health care services and a lack of monitoring and evaluation of services in the district were highlighted. Conclusions: Despite this being a single district study, findings reflect the need for a district, provincial and national standard for substance abuse rehabilitation services in addition to the improvement of monitoring and evaluation for quality improvement. There is also a need to respond to the gaps that exist in after-care and community-based or decentralised substance abuse services that are essential in such areas, which are under-resourced despite the high prevalence of substance users. [ABSTRACT FROM AUTHOR]

Background: International studies have shown that the best strategy for the long-term staffing of rural facilities is the recruitment and training of students of rural origin. However, the crisis in education in South Africa means that these rural students are the least likely to access institutions of higher learning to train as healthcare professionals (HCPs). The aim of this study was to explore the educational experiences of six HCPs of rural origin working in rural areas. Methods: This was a qualitative study using unstructured interviews supplemented by photomemory and collage development. All interviews were transcribed verbatim and themes were developed. Appropriate ethical permission was obtained prior to the study. Results: HCPs of rural origin found the journey from rural scholar to HCP to be tough. Personality characteristics such as tenacity, determination, problem-solving skills, self-belief and hard work were essential for success -- but not sufficient on their own. In addition these HCPs needed social support, academic and social mentoring as well as comprehensive financial support. Conclusions: HCPs of rural origin have the potential to provide long-term staffing for rural hospitals. However, if rural healthcare institutions are serious about finding long-term solutions to their staffing challenges, attention needs to be given to finding and appropriately supporting local scholars. [ABSTRACT FROM AUTHOR]

Objectives: South Africa is striving towards a strong primary healthcare system. Since 2007, departments of family medicine have been established in Gauteng to improve quality of care through improved access to doctors, the coordination of health services and better referrals. There have been anecdotal difficulties around clinical quality, the role of the increasing number of doctors and the value of family medicine as a new speciality in Johannesburg since these changes. This study aimed to explore Johannesburg stakeholder views on clinical priorities, the role of doctors and family medicine in primary care. Design: The study design comprised qualitative focus group discussions. Setting and subjects: Groups of nurse clinicians, clinic managers, senior managers, doctors and interns within the Johannesburg Health District. Outcome measures: The content was thematically analysed and a model developed. Results: There were nine focus groups, with 6-13 participants per group. Addressing staff burnout and poor management were viewed as clinical priorities in primary care. Discussing the role of doctors reflected deep conflict between doctors and nurses. Nurses and managers expected doctors to help to "push the queues". It took some time for further roles, such as helping with referrals, training, research and administration, to emerge. There was initial confusion and tension when participants were asked about family medicine. However, its role was seen as useful. Conclusion: Nurses appeared to suffer from burnout and resented the increasing burden placed on them with regard to primary care in Johannesburg. There appeared to be confusion with respect to the role of doctors, with doctor-nurse conflict and poor teamwork. This may threaten attempts to re-engineer primary health care in order to increase the presence of doctors at clinic level. The discipline of family medicine can make a difference, but reorganisation of the system is required. [ABSTRACT FROM AUTHOR]

Objective: To understand, by qualitative enquiry, the underlying reasons and narratives for patients that delay in accessing antiretroviral treatment. Design: A qualitative design was used, where patients were interviewed using the free attitude interview technique, after being selected based on a screening question: "How long did it take you to present at a clinic or hospital for treatment after receiving your human immunodeficiency virus-positive result?" Setting and subjects: Eight patients from the human immunodeficiency virus clinic at Potchefstroom were interviewed. Outcome measures: The interviews were transcribed verbatim and organised into themes. Results: The following themes were identified: stigma and discrimination, ignorance and lack of perceived risk of infection, denial and healthcare system constraints. These are discussed and quotations from the interviewed patients included. Conclusion: This qualitative study has contributed to an understanding of why patients delay in accessing highly active antiretroviral therapy. Some of the reasons supplied by patients have been documented globally. Others are poignantly coloured by personal stories. By understanding patients' perspectives and feelings, emphasis can be placed on the reduction of stigma, denial, practical clinic constraints and appropriate types of health education. [ABSTRACT FROM AUTHOR]

Objectives: This study was a qualitative assessment of a diabetes group education programme presented in community health centres of the Cape Town Metro District. The programme offered four sessions of group education and was delivered by trained health promoters using a guiding style derived from motivational interviewing. The aim of the study was to evaluate the programme by exploring the experiences of the patients who attended. Design: This was qualitative research that utilised in-depth interviews. Thirteen patients who had attended the educational programme, and who each came from a different health centre in the intervention arm of a larger randomised controlled trial, were purposively selected. The interviews were audiotaped, transcribed and then analysed using the framework approach. Setting and subjects: Patients with type 2 diabetes from community health centres in the Cape Town Metro District. Results: Patients gained useful new knowledge about diabetes and reported a change in their behaviour, especially with regard to diet, physical activity, medication and foot care. The educational material was experienced positively and enhanced recall and understanding. Health promoters were competent, utilised useful communication skills and structured the material well. There were organisational and infrastructural problems, especially with regard to space within which the groups could meet, and communication of the timing and location of the sessions. Conclusion: This study supports wider implementation of this programme, following consideration of recommendations resulting from patient feedback. [ABSTRACT FROM AUTHOR]

Background: Successful administration of antiretroviral therapy (ART) requires full adherence to the regimen by the patient. The introduction of ART needs a well-functioning health system with adequately trained health professionals, laboratory support, a constant supply of drugs and social systems to assist with patients' adherence and to prevent future treatment failure. Objectives: The objective of this study was to explore and describe the challenges experienced by nongovernmental organisations with regard to the roll-out of antiretroviral therapy. Design: A qualitative, exploratory and descriptive study was conducted to determine the challenges experienced by nongovernmental organisations (NGOs) with regard to the roll-out of ART in KwaZulu-Natal. Nine participants were included purposefully from the NGOs that participated in this study. Data were collected through semi-structured individual interviews. Open coding for analysis was used. Results: The findings revealed four themes: challenges relating to sustainability, adherence, health infrastructure and behaviour. Conclusion: The results indicate a need for multisectoral collaboration in the roll-out of ART to ensure a concerted, comprehensive and sustainable programme. [ABSTRACT FROM AUTHOR]