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BACKGROUND: Despite a long history of discrimination and persisting racial disparities in smoking prevalence, little research exists on the relationship between discrimination and smoking in South Africa. METHODS: This analysis examined chronic (day-to-day) and acute (lifetime) experiences of racial and non-racial (eg, age, gender or physical appearance) discrimination and smoking status among respondents to the South Africa Stress and Health study. Logistic regression models were constructed using SAS-Callable SUDAAN. RESULTS: Both chronic racial discrimination (RR=1.45, 95% CI 1.14 to 1.85) and chronic non-racial discrimination (RR=1.69, 95% CI 1.37 to 2.08) predicted a higher risk of smoking, but neither type of acute discrimination did. Total (sum of racial and non-racial) chronic discrimination (RR=1.46, 95% CI 1.20 to 1.78) and total acute discrimination (RR=1.28, 95% CI 1.01 to 1.60) predicted a higher risk of current smoking. CONCLUSIONS: Racial and non-racial discrimination may be related to South African adults' smoking behaviour, but this relationship likely varies by the timing and frequency of these experiences. Future research should use longitudinal data to identify the temporal ordering of the relationships studied, include areas outside of South Africa to increase generalisability and consider the implications of these findings for smoking cessation approaches in South Africa. [ABSTRACT FROM AUTHOR]

Background: Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective: To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods: Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results: The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion: The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution: The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities. [ABSTRACT FROM AUTHOR]

Migration to South Africa is motivated by the pursuit of employment, safety, and improved living conditions. However, immigrants encounter significant challenges, such as restricted access to essential services, which were exacerbated by the COVID-19 pandemic. This paper investigates the impact of the COVID-19 pandemic on Malawian immigrants in South Africa, addressing the lack of attention given to this immigrant population by highlighting their vulnerabilities. Using a qualitative exploratory and descriptive approach, in-depth interviews were conducted with 24 Malawi immigrants who were over 18 years old and had established residency in South Africa before the onset of the COVID-19 pandemic. Five key stakeholders were also interviewed for additional perspectives and to ensure triangulation and improve data reliability. The interviews were transcribed verbatim and analyzed using thematic analysis strategies and coding with Nvivo12 software. The study highlighted the exacerbated struggles of Malawian immigrants in South Africa amid the COVID-19 pandemic, uncovering systemic discrimination in healthcare, marked by longer wait times and reluctance from health workers to treat undocumented immigrants. The study also revealed a dire security situation, with immigrants living in high-crime areas and feeling particularly targeted due to their foreign status, a situation worsened by the pandemic's economic effects. Additionally, the economic downturn induced by COVID-19 significantly impacted employment opportunities, with many immigrants facing prolonged unemployment and job losses, especially in sectors where they traditionally found work. The detailed accounts of participants highlight not only the multifaceted challenges imposed by the pandemic but also the critical need for inclusive policies and support systems that ensure healthcare access, safety, and economic resilience for immigrants, particularly during global health emergencies. Future research should focus on effective interventions for socioeconomic integration and well-being, particularly for immigrants from other African countries. [ABSTRACT FROM AUTHOR]

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Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub‐district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration‐aware community‐based programmes that included the training of community‐based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi‐structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non‐state interventions and the fragmented state approach to community‐based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community‐based interventions that do not recognise community‐based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls. [ABSTRACT FROM AUTHOR]

Background: South Africa has the highest reported prevalence of fetal alcohol spectrum disorders (FASD) globally. The most recent study reported a weighted, estimated FASD prevalence of 310 per 1000 in a community in the Western Cape Province. Because there is as yet no reliable estimate of the national burden of FASD in South Africa, further epidemiological studies are needed in diverse settings. This paper reports on a multiyear, multisite FASD epidemiological study that took place from 2015 to 2022 at eight study sites in four provinces. Methods: The cross‐sectional epidemiological study used an active case‐ascertainment method, specifically in primary schools. All children were recruited when they were enrolled in Grade 1 at a participating school. All consented participants progressed through a tiered‐screening recruitment and diagnostic process. Results: Overall, 3033 children were included in the study. A total of 3001 children were screened for FASD in the first tier, with 1086 progressing to the second and 495 to the third tier. Of the 495 children referred, 475 were discussed during the final case conference. A total of 309 participants were diagnosed with FAS across the eight study sites. The highest reported prevalence was in the Northern Cape Province, with a rate of 199.3/1000 (95% CI, 147.6–251) using all eligible participants as the denominator. The lowest prevalence was in the Eastern Cape Province, with a rate of 57.4/1000 (95% CI, 36.5–78.3). The pooled FAS prevalence for the eight study sites was 80.2/1000 (95% CI, 70.4–89.9). Conclusions: As with previous studies, we found a concerningly high prevalence of FASD in South Africa. Given the scope of the problem it should be a high priority for health and welfare services to address. [ABSTRACT FROM AUTHOR]

Complementary medicines (CMs) that are formulated to facilitate weight loss are a popular and widely available treatment option, particularly among women. There is limited research regarding their use in the South African context. The aim of this study was to gather information on the use and perceived effectiveness of CMs for weight loss among adult women. A quantitative, descriptive survey design was used. Johannesburg, South Africa. A purposive sample of women over the age of 18 years who had used CMs for weight loss within the past five years were recruited from health stores and a university campus healthcare centre. Data were obtained through a self-administered 29-item, paper-and-pen questionnaire. Responses were descriptively analysed using cross-tabulation, multiple response analysis and frequency tables. Data from 160 questionnaires were analysed and the results demonstrated that a wide variety of CM products are used for weight loss, with branded combination products, green tea, Garcinia cambogia and conjugated linoleic acid being the most popular. Most participants also adopted lifestyle interventions such as exercise and calorie restriction during their weight loss attempt. While minor side effects were experienced by over half of the participants, the majority were satisfied with their product choice as well as the amount of weight that they lost. Most participants perceived their CM weight loss product of choice to be effective. However, other concomitant weight-loss strategies that were employed may have been responsible for these results. Despite their popularity, there is only very limited research surrounding the safety and efficacy of these weight-loss products, with most studies being conducted on single constituents rather than whole formulations as sold on the market. Healthcare providers should encourage the disclosure of the use of CM weight-loss products to ensure safe and effective patient care and mitigate the potential risks associated with their inappropriate use. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic continuously highlights the need for occupational health and safety among healthcare professionals. Physical and mental health safety resulting from needle prick injuries, stress, infections, and chemical hazards are priority work-related musculoskeletal disorders for nurses, including those working in the intellectual disability unit. The intellectual disability unit provides basic nursing care to patients with known mental disabilities, such as learning, problem-solving, and judgment problems, which demand diverse physical activities. Nevertheless, the safety of nurses within the unit receives little attention. Thus, we adopted a quantitative cross-sectional epidemiological survey design to determine the prevalence of work-related musculoskeletal disorders amongst nurses working in the intellectual disability unit at the selected hospital in Limpopo Province, South Africa. A self-administered questionnaire collected data from 69 randomly selected nurses from the intellectual disability unit. Data were extracted, coded, and captured in MS Excel format (2016) and imported into the IBM Statistical Package for the Social Sciences (SPSS), software version 25.0, for analysis. The study reported a low (38%) prevalence of musculoskeletal disorders in the intellectual disability unit, with significant effects on nursing care and staffing. The effects of these WMSDs included missing work, interference with the daily routine, disturbance with sleeping patterns after work, and absenteeism from work. Since intellectually disabled patients depend entirely on nurses for the basic activities of daily living, this paper recommends the incorporation of physiotherapy among nurses in the intellectual disability unit to treat the incidence of lower back pain while mitigating nurses missing work or absenteeism. [ABSTRACT FROM AUTHOR]

The demanding and complex training of learner nurses in clinical practices requires various occupational health and safety measures to curb occupational health hazards among learner nurses. This paper aimed to explore learner nurses' experiences concerning occupational health and safety during clinical learning. A qualitative descriptive, contextual and exploratory design study was conducted. A total of 31 learner nurses were selected using purposive sampling. Data were collected by semi-structured interviews and analysed using Tesch's open coding method. Two themes emerged from this study: "The experiences of learner nurses concerning their health and safety during clinical learning" and "The measures to be taken to promote occupational health and safety during clinical learning." Highlighting challenges and measures to mitigate occupational health hazards among learner nurses in the South African context, Limpopo province, would be beneficial. The findings can assist stakeholders in developing specific precautionary guidelines for learner nurses. Effective and innovative occupational health and safety training programmes for learner nurses can be developed despite constrained environmental resources. [ABSTRACT FROM AUTHOR]

Aims: Access to healthcare, especially among adolescents, is a public health issue with long-lasting health and socio-economic consequences. Adolescence is a distinctive growing period for developing healthcare behaviour that can either improve or worsen future health conditions. Hence, the need for quality healthcare behaviour among adolescents who usually constitute a large proportion of any country's population, is imperative. This paper thus examines the impact of medical aid coverage and other socio-economic factors in determining South African adolescents' utilisation of either private or public healthcare facilities in the event of illness. By extension, the study investigates the effects of pertinent parental characteristics on South African adolescents' choices of either private or public healthcare facilities. Subject and methods: Data come from the population-weighted 2018 General Household Survey (GHS). Units of analysis include adolescents within the ages of 10 and 19 years. The empirical analysis relies primarily on a regressions-based model and instrumental variable approach. Results: Result indicates that younger adolescents are more likely to use public healthcare facilities in the event of illness than older adolescents. However, adolescents who are medically covered are less likely to utilise public healthcare facilities in the event of illness. Further findings suggest that the likelihood of using public healthcare facilities is higher among adolescents who are black Africans, live in relatively poor households, large households and rural areas. Conclusion: Further implementation and review of any national health policy such as the National Health Insurance (NHI) scheme needs to address and take into consideration adolescents' healthcare utlisation and socio-economic variations in their healthcare utilisation. [ABSTRACT FROM AUTHOR]

Recall and social desirability bias undermine self-report of paper-and-pencil questionnaires. Mobile phone questionnaires may overcome these challenges. We assessed and compared sexual risk behavior reporting via in-clinic paper-and-pencil and mobile phone questionnaires. HVTN 915 was a prospective cohort study of 50 adult women in Soweto, who completed daily mobile phone, and eight interviewer-administered in-clinic questionnaires over 12 weeks to assess sexual risk. Daily mobile phone response rates were 82% (n = 3486/4500); 45% (n = 1565/3486) reported vaginal sex (median sex acts 2 (IQR: 1-3)) within 24 h and 40% (n = 618/1565) consistent condom. Vaginal sex reporting was significantly higher via mobile phone across all visits (p < 0.0001). There was no significant difference in condom use reporting by mobile phone and in-clinic paper-based questionnaires across all visits (p = 0.5134). The results show high adherence and reporting of sex on the mobile phone questionnaire. We demonstrate feasibility in collecting mobile phone sexual risk data. [ABSTRACT FROM AUTHOR]

Comprehensive sexuality education is seen as a key intervention to address the high HIV-incidence rate and low knowledge among young people in South Africa, yet this lacks inclusion of learners with disabilities. At the same time, educators of learners with disabilities experience cultural barriers and lack skills and knowledge on how to deliver sexuality education in accessible formats. In response, the Breaking the Silence approach, a curriculum implementation and disability-accommodating approach, was developed and tested. This paper presents findings from a formative evaluation using in-depth interviews with educators from eight “schools for learners with special educational needs”. The paper focuses on their experience with implementing the approach. The analysis used conventional content analysis and NVIVO software. Educators conceptualized sexuality education within a risk-protection discourse. They revealed that the training and tools enabled them to provide sexuality education in accessible formats, tackle difficult topics such as sexual orientation and masturbation, and improved awareness and assertiveness within their learners. Educators identified the need for further development including a whole school approach, adjustments to differentiating developmental stages and addressing gender-specific topics. Through its application within the South African mainstream Life Orientation curriculum, this approach lends itself for further development and testing through implementing the approach within a whole school setting and ongoing support that will not only drive change in educators’ skills and knowledge but also drive the needed shift in cultural norms and values. [ABSTRACT FROM AUTHOR]

Up to two-thirds of South African adolescent mothers drop out of school, which increases their HIV risk and other poor health outcomes. Despite variability in adolescent mothers' schooling trajectories, we have a limited understanding of their re-enrollment in school following the life-changing circumstance of childbirth. In this paper, we draw on qualitative interviews (n = 16) and quantitative surveys (n = 109) with adolescent mothers (aged 14–19) who had recently given birth to describe how access to individual and social resources contributes to their resilience following childbirth and thus affects their ability to re-enroll in school. Nearly all the adolescent mothers in our study expressed a desire to return to school, and most of their families also emotionally supported adolescent mothers in these goals. Despite mothers' high hopes and familial emotional support, only half of the adolescent mothers re-enrolled in the first six months following childbirth. Adolescent mothers' re-entry trajectories were strongly affected by institutional support and by family members' provision of instrumental support. To a lesser extent, support from partners and peers also played a role in re-enrollment. Multilevel interventions to maximise resilience following the onset of early motherhood may facilitate return to school and positively influence adolescent mothers' health and well-being. [ABSTRACT FROM AUTHOR]

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual‐, household‐ or population level, has implications for both health and the economic development of a community and country. This paper describes a large‐scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu‐Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0–29.9] and 28.4% had obesity grade 1 (BMI: 30–<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children. Key messages: The double burden of malnutrition is severe in KwaZulu‐Natal with high rates of maternal obesity and increasing prevalence of stunting and obesity among infants in the first 6 months of life.Breastfeeding and complementary feeding practices are suboptimal and additional support for breastfeeding is required in the post‐natal period and in the workplace to address breastfeeding challenges.Growth monitoring is inadequate in health facilities leading to many lost opportunities for early identification of malnutrition. Hence, anthropometric practices and interpretation of findings need to be strengthened. [ABSTRACT FROM AUTHOR]

Background: Critically ill patients have the right to communicate and participate in their treatment to avoid adverse medical outcomes due to the severity of their illness, their responsiveness, and level of consciousness. This human right has often been neglected by health care professionals, as a result of limited alternative communication support provided to patients who are unable to speak due to, for example, endotracheal intubation. Despite the successful use of alternative communication strategies in critical care units (CCUs) in other countries, limited implementation in South African hospitals has been reported. Aims and objectives: This study aimed to determine the perspectives of South African nurses working in CCUs on the frequency of use of alternative communication strategies to support patient‐centred communication with critically ill adult patients. Design: The study followed a quantitative non‐experimental survey research design. Methods: A total of 210 nurses working in both private and public hospitals completed a survey on their perspectives on the use of alternative communication strategies in CCUs. Results: Nurse participants reported experience working with critically ill and communication‐vulnerable patients. Nurse–patient communication mainly involved the use of pen and paper, facial expressions and gestures to obtain information relating to patients' needs and their health history. Limited use of speech‐generating communication devices was reported. Conclusion: Nurse training on the use and implementation of alternative communication strategies, such as communication boards or electronic speech‐generating devices, should be investigated to improve nurses' communication with communication‐vulnerable patients in South Africa. Relevance to clinical practice: The results are applicable in clinical practice due to patients' need for alternative communication. The nurses mainly used low‐tech solutions, which are cheap and easy to access. However, there exists an opportunity to increase the use of available digital solutions. [ABSTRACT FROM AUTHOR]

Industrialization and urbanization processes have challenged deeply held traditional gender norms and facilitated the emergence of modern ideologies in South Africa. This paper seeks to explore the gendered roles of family members on maternal and child nutrition and investigate indications of perceived change in related practices. A qualitative secondary analysis was conducted of data from nine focus group discussions (FGDs) held with men (n = 3) and women (n = 6) aged ≥18. Data from the FGD were coded and thematic analysis conducted. We found that elderly women seem to have a central advisory role with respect to maternal and child nutrition and that men and elderly women upheld patriarchal gender divisions of labour, which entrust mothers with the primarily responsibility for young children's nutrition. Young mothers relied on elderly women for provision of childcare and nutritious foods for children; however, they demonstrated some resistance to traditionally feminized forms of food preparation. We found that men's involvement in children's nutrition was limited, though they expressed a preference to be more involved in maternal and child nutrition and care practices. A gender transformative approach to policy development, which includes elderly women and men, has the potential to promote more gender‐equitable nutrition practices, increase young women's self‐efficacy and support them to overcome barriers that could be limiting their decision making power in achieving optimal nutrition for themselves and their children. [ABSTRACT FROM AUTHOR]

The aim of this qualitative study was to explore how individuals living with multiple sclerosis experience their disorder in the South African working environment. In this paper we present the experiences of office-based workers living with multiple sclerosis, their challenges, and coping mechanisms. We purposively recruited seven participants who have been diagnosed with multiple sclerosis in the last five years. Participants were interviewed telephonically. Interviews were guided by a semi-structured interview schedule which was supplemented with additional probes. Interviews were analysed thematically using a qualitative software programme. We identified two superordinate themes: bringing multiple sclerosis into the workplace and adapting to multiple sclerosis in the workplace. The findings demonstrated the diverse manner in which participants chose to disclose their multiple sclerosis and manage co-workers' perceptions of multiple sclerosis. Participants employed practical strategies, such as making using of mobility aids, taking notes, conserving energy, and adapting responsibilities. Participants also negotiated accommodations, such as changing working hours, to overcome their unique challenges. Participants emphasised the importance of keeping a general positive attitude but showed reluctance to prepare for their future decline. Our findings indicate that participants manage the disclosure of their diagnosis of multiple sclerosis in order to maintain a favourable relationship with the workplace. Further, despite various physical and psychological limitations, participants were mostly able to adapt to their work environment. Although further research is required, employers and clinicians should consider focusing on the current needs of individuals living with multiple sclerosis to mitigate work-related challenges, rather than planning for future decline. For individuals living with multiple sclerosis and in employment in South Africa, disclosure, management of perceptions and providing accommodations are key aspects in the experience of multiple sclerosis in the workplace. Finding ways to help those in employment disclose their MS diagnosis to employers and co-workers, is an important avenue and next step for intervention research in this field. Early adjustment and adaptation to MS in the workplace is challenging and further negotiation with line-managers regarding accommodations is often required. Employers and clinicians should focus on accommodating the needs of those diagnosed with multiple sclerosis as they arise, rather than focusing solely on the accommodations needed in the future. [ABSTRACT FROM AUTHOR]

Adolescents and youth with disabilities in South Africa still lack access to sexual and reproductive health and rights services including comprehensive sexuality education, which may increase their vulnerability to SRHR issues such as HIV and sexual violence. This is exacerbated for learners with intellectual disabilities whose educators often lack skills and tools to accommodate these learners in comprehensive sexuality education lessons. The following paper outlines the findings of a formative evaluation of an innovative sexuality training approach for educators of learners with diverse disabilities (Breaking the Silence approach). This approach was developed and piloted with educators across eight schools for learners with intellectual disabilities in KwaZulu-Natal, South Africa. The paper discusses the educators’ understanding and experiences of using this approach. The findings revealed that although educators were able to implement parts of the approach, contextual factors impacted the degree of implementation. These factors were related to perceptions of socio-cultural norms, interpersonal engagement with peers and management, the structural environment of school settings, and the wider community setting. Educators began to address cultural taboos related to talking about sexuality, but were challenged by untrained staff and the larger socio-cultural context, which includes a heighted risk of sexual violence against their learners. The paper concludes with recommendations for a further investigation of the approach within a whole school setting considering the needs of educators to not only acquire skills and knowledge but also to address their larger socio-cultural context in which they have to implement comprehensive sexuality education. [ABSTRACT FROM AUTHOR]

Abstract: This paper adopts a qualitative case study on the generalist service delivery model of I‐Care, a Durban‐based non‐governmental organization that works with male street children. Fifteen face‐to‐face interviews were conducted with 10 I‐Care employees and 5 former street children. A focus group was set up with I‐Care employees. Although existing literature is forthright about a generalist approach for children at risk, it remains unclear how to implement this approach in practice. This paper reviews a continuity of 5 fundamental social work practices for working with street children: (a) outreach work, (b) child–family and child–community mediation, (c) transitory care centres and programmes, (d) brokerage, and (e) mentorship and follow‐ups. The study analyses how these practices contribute to the capability and agency expansion of the street children and outlines challenges that service providers and former street children experience. The main challenges acknowledged are balancing between the agency and protection of street children and the adaptation of children to street life. The study proposes intervention strategies to overcome these challenges. [ABSTRACT FROM AUTHOR]

The dynamic nature of HIV care in the context of South Africa challenges nurses to continually keep abreast of changes in treatment and care policies. Communities of practice (CoPs) are considered an effective method of promoting lifelong learning, enhancing professional development and clinical reasoning through reflective practice. This paper reports on the conceptualisations and meanings that emerged from a critically reflective CoP established among nurses caring for women living with HIV. Based on social constructivism and underpinned on grounded theory, four themes emerged which conceptualised the meaning of a critically reflective CoP, namely: (i) a practice and learning community, (ii) a support network, (iii) collaborative, purposive-driven working to make a difference, and (iv) a space that fosters self-determination. The findings of this paper enhance the understanding of organisational learning strategies that can support nurses working in various settings through ongoing learning embedded in evidence-based practice through critical reflection and CoPs. [ABSTRACT FROM AUTHOR]

We conducted a discrete choice experiment (DCE) and quantified preferences for HIV testing among South African youth (Nov 2018 to Mar 2019). Six attributes and levels were identified through qualitative methods: source of HIV information; incentive amount and type; social support; testing method; and location. Each participant chose one of two options that comprised six attributes across 18 questions. Conditional logistic regression estimated the degree of preference [β]. Of 130 participants, median age was 21 years (interquartile range 19–23 years), majority female (58%), and 85% previously tested for HIV. Testing alone over accompanied by a friend (β = 0.22 vs. − 0.35; p < 0.01); SMS text over paper brochures (β = 0.13 vs. − 0.10; p < 0.01); higher incentive values (R50) over no incentive (β = 0.09 vs. − 0.07; p = 0.01); and food vouchers over cash (β = 0.06 vs. β = − 0.08; p = 0.01) were preferred. Testing at a clinic or home and family encouragement were important. Tailoring HTS to youth preferences may increase HIV testing. [ABSTRACT FROM AUTHOR]

Child protection social workers (CPSWs) do critical work protecting vulnerable children. Given the demanding nature of this work, CPSWs are reportedly at great risk for negative outcomes, such as burnout and depression. Another outcome is often unsatisfactory service delivery by CPSWs, leaving vulnerable children exposed to continued maltreatment. Understanding how some CPSWs do well, despite the demanding nature of their work, is important to inform future interventions that could potentially promote CPSW resilience and improve CPSW service delivery. While some research on the resilience of CPSWs exists, very little is known about resilience in South African CPSWs. The aim of this qualitative study was to contribute to the ongoing conversation of CPSW resilience, by exploring resilience among CPSWs in Gauteng, South Africa. Participants shared their lived experiences of workplace adversity and resilience. In this paper, we report only on the findings related to their resilience, which was analysed using thematic analysis. Findings reveal that participants' resilience was informed by a safe and appealing space away from work; drawing strength from religion; relaxation and self‐care as healing modalities; a passion for CPSW; the positive influence of personal background; supportive care systems; self‐efficacy and personal agency; and a positive outlook. The resilience of these CPSWs, although dependent on supportive and responsive ecologies, was mostly self‐directed since they appeared fundamentally accountable to procure support. [ABSTRACT FROM AUTHOR]

This paper focuses on the role of 'social support' in the experience of fibromyalgia (a musculoskeletal pain disorder) in South Africa. In-depth semi-structured interviews were used to collect narratives from 15 participants. Sources of social support constitute important mechanisms for coping with the illness experience of fibromyalgia. In providing a space for consultation and validation of the diagnosis of fibromyalgia, and the person living with the condition, people giving support fulfil a critical role in shaping the experience. The findings show how support from family, partners, and peers plays an integral role in the process of accepting fibromyalgia diagnosis, adapting to the demands of the condition, and seeking help from healthcare providers. The findings also show the ways in which people with fibromyalgia provide support for others with the condition, and the importance of this peer network in shaping the paths and outcomes of this illness experience. The findings of this study corroborate existing evidence that show fibromyalgia to be a complex condition to manage, due to the multiplicity, uncertainty and contestation that feature in the experience of the illness. Additionally, this study presents the challenges related to the limitations of access to healthcare in the South African context, and the utility of narrative approaches in garnering insight into the ways in which social support is harnessed in this environment. [ABSTRACT FROM AUTHOR]

This paper has the following aims: (i) to explore the extent to which students who received an intervention involving HIV/AIDS and sexuality perceived that their teacher cared for their health and well-being, (ii) to investigate the characteristics of students who reported to have caring teachers and (iii) to document the association between students’ perceptions of care and reported onset of sexual activity. Data were obtained from the second follow-up survey of a prospective study carried out among high school students in South Africa (Cape Town and Mankweng). We analyzed data from 3483 students who met the inclusion criteria. Students from the intervention group perceived greater care from teachers than students in the control group. Female students and students from Cape Town perceived having received more care, and their perception of care was associated with the number of lessons received, how often students expressed their opinions in class and how often teachers talked about HIV/AIDS, condoms and abstinence. Students who perceived that their teacher cared for their health and well-being were less likely to initiate sexual intercourse. This is the first paper to demonstrate the salience of the concept of care in studies of school-based HIV/AIDS prevention programs in sub-Saharan Africa. [ABSTRACT FROM PUBLISHER]

Children's participation and inclusion in violence research, particularly in low- and middle-income country (LMIC) contexts, is scant and not well understood. To assess how young children can be engaged in violence research, 4- to 7-year-old children were recruited into our pilot study in a rural area of South Africa. Six interviewers, recruited from the community, were trained to complete cognitive interviews (n = 24), interviewer-administered questionnaires (n = 21), and qualitative interviews (n = 18) with young children. Three focus group discussions (FGDs) were conducted with interviewers. Findings from FGDs and assessment of interview performance highlighted that young children could feasibly and meaningfully appraise violence they experience and articulate their view in a research context. Art- and play-based approaches offered participants an easier and developmentally appropriate platform for communication, expression, and engagement, and asking directly about violence was acceptable. The ease with which children participated was determined both by their level of development and the sensitivity of the interviewers; thus, intensive training and mentorship were required over time to assist interviewers in understanding child development and mental health and increase recognition of these issues and their presentation. Interviewers critically engaged with personal values regarding children's rights and voice in research, reflecting that some of the stories were difficult to listen to. They were able to use and value novel methods to facilitate the ethical involvement of young children to yield rich data. Without young children's involvement and dynamic participation in violence research, the field will not have the evidence to build best practices, respond appropriately to the needs of this vulnerable population, and interrupt the intergenerational transmission of violence that develops in these formative years. Our study adds to the burgeoning evidence that young participants are vital to the research process and are valuable active contributors to understanding violence in LMICs. [ABSTRACT FROM AUTHOR]

Introduction: South African women bear an intersecting burden of HIV, sexually transmitted infections (STIs) and unintended pregnancy. Multipurpose prevention technologies (MPTs) are a class of products that address multiple needs and have the potential to improve uptake and use of prevention products. Methods: Analysing survey data from 703 HIV-negative women 18--40 years in three provinces in South Africa, collected between July and November 2022, this study explores their preferences for prevention methods and factors influencing choice of hypothetical prevention methods, including MPTs. Descriptive statistics and multinomial regression analyses were conducted to determine prevention method preferences and factors associated with choosing a pill, injectable or MPT-implant type prevention method. Results: Most women wanted to prevent HIV, STIs and pregnancy. The most important factors when choosing a prevention product were whether it provided dual and long-term protection and if side effects were manageable. If choosing only one method, half of women would choose any MPT-implant and a quarter each would choose a pill or an injectable method, with method choices differing by population group. Discussion: Prevention method choices were influenced by sexual-behavioural factors and current and prior contraceptive method use. Providing a choice of prevention methods and a population specific approach to new method development and introduction with access to accurate information could enhance their ability to fill a gap in prevention needs. [ABSTRACT FROM AUTHOR]

Poor iron status is detrimental to physical and cognitive performance in adolescents. Due to the limited studies investigating the association between iron status and physical fitness components in adolescents from low- and middle-income countries, we aimed to determine the association of iron status with selected physical fitness components in South African adolescents. A cross-sectional study design, including 178 adolescents (102 girls and 76 boys) from the Physical Activity and Health Longitudinal Study (PAHLS), was followed. Height and weight were measured to calculate the body mass index (BMI). Subsequently, WHO BMI-for-age-specific categorised body fatness. Cardiorespiratory fitness was determined with a 20-m shuttle run test ( V ˙ O 2 max ), and lower-body explosive power by the standing broad jump (SBJ). Fasting haemoglobin (Hb) and ferritin were analysed from blood samples. Correlation analyses determine the association between iron status, explosive power and cardiorespiratory fitness. Of the 178 participants, 18.5% (n = 33) had low Hb, and 14% (n = 25) iron deficiency without anaemia. Significant positive correlations were found between the selected physical fitness components, ferritin, and Hb. In boys, a positive association was found between Hb and SBJ (r = 0.30, p = 0.006), whilst in girls, positive associations were found between ferritin (r = 0.25, p = 0.04) and SBJ, and Hb with both SBJ (r = 0.21, p = 0.03) and V ˙ O 2 max (r = 0.32, p = 0.001). Hb concentration remained associated with V ˙ O 2 max and SBJ in girls after adjustment for age, whilst in boys, Hb concentration was associated with SBJ. Higher iron status in South African adolescents is associated with higher lower-limb explosive power and cardiorespiratory fitness. We suggest monitoring of haematological parameters, and interventions to improve the iron status of South African adolescents. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about this topic?: Integrating mental health counselling into primary care services is a recommended strategy for reducing the mental health treatment gap in low‐ and middle‐income countries.To support this strategy, potential barriers to counselling integration must be identified and addressed.Organizational preparedness for implementation may influence the extent to which the introduction of counselling is successful.Features of primary care facilities associated with preparedness for the implementation of mental health counselling have not been explored. What the paper adds to existing knowledge?: This study uses a novel approach to explore variations in preparedness of primary care services to implement counselling and factors potentially associated with these variations.Findings suggest there is considerable variation in the preparedness of facilities to implement counselling.Organizational factors such as resource availability, management style and facility environment are potentially associated with capability for implementing mental health counselling. What are the implications for practice?: Health planners could use this method to identify poorly functioning services that may benefit from additional interventions to build preparedness for counselling implementation.Future research should examine whether differences in facility preparedness impact on the implementation and outcomes of this service. Introduction: Differences in primary care facilities' preparedness for implementing mental health counselling may affect the implementation process but have rarely been studied. Aim: To assess the feasibility of using a novel methodological approach to explore variations in capability for implementing mental health counselling and factors potentially associated with this variation among primary care services in the Western Cape, South Africa. Methods: Staff from 26 facilities participated in discussions about their facility's mental health implementation capability. Three researchers conducted observations of the facility's environment, staff–patient interactions and resources. We used qualitative comparative analysis to identify factors potentially associated with implementation capability. Results: Facilities appeared to vary in their capability for implementing counselling services. The availability of person‐centred health services, a therapeutic environment and sufficient human resources may be requirements for implementation preparedness. Other factors that seem to support preparedness include the availability of confidential space for counselling and an adequately managed facility. Discussion: This study identified several features of well‐functioning primary care facilities. Facilities with these features may be better prepared to implement a new counselling service. Implications for practice: This method may identify facilities that are poorly prepared for implementation that could benefit from preparedness‐building interventions. Whether differences in preparedness affect counselling outcomes is yet to be established. [ABSTRACT FROM AUTHOR]

Technological innovations are changing the face of nursing education, with teachers being expected to integrate best teaching practices in the classroom and to ensure that nursing students are motivated and engaged. Taking into consideration students' needs is essential to provide successful integration of the technology in teaching and learning. This paper aims to explore nursing students' perceptions and expectations regarding the use of technology in nursing education. A descriptive quantitative research design was used, and the study was conducted at a selected university in South Africa. A total of 150 nursing students completed the questionnaires, with the data being analysed descriptively using SPSS version 25. The nursing students reported that educators used technology to deliver course instructions (96.7%), and encouraged students to use it for creative or critical thinking tasks (95.3%). They were encouraged by their educators to use their own technology devices (94.7%) and online platforms (94.7%). More undergraduate students perceived that nurse educators used technology at school (15.63 ± 2.54) than postgraduate students (14.41 ± 3.07) (U =1341.00, p = .044). Overall, 77.3 per cent of the nursing students expected the use of technology in teaching, mainly Moodle (88.7%), search tools (75.3%), podcasts and videocasts (66.7%), EndNote (62.7%), and Turnitin (48.7%). The majority of the students (82.1%) from the lower academic levels (first and second year) had a high expectation of the use of technology compared to 71.2 per cent of the higher levels (third and fourth year). The use of technology in teaching requires nurse educators to have adequate skills to make it a powerful tool for teaching and learning. Much more effort should be put in motivating students to use various technological tools, and ensuring that they have adequate skills, particularly at the entry level. [ABSTRACT FROM AUTHOR]

Background This paper aims to examine determinants of multiple sexual partnerships (MSPs) among South African men and women using a nationally representative sample. Methods Quantitative and qualitative data from a 2008 population-based cross-sectional survey were used. The analysis focused on the 6990 (33.6% of total sample) who were 15 years and older and reported sexual activity in the prior 12 months. The qualitative component consisted of 15 focus group interviews investigating values underlying MSP behaviors. Results Predictors of MSP common across gender were race, having a history of STI, being in a short relationships (<1 year) and suspecting the current partner of infidelity. MSP among men enjoyed greater community acceptance and was mainly done for social status. Furthermore, men reporting MSP were mostly younger (15–24 years old) and use condom at last sex. Among women, determinants of MSP included economic vulnerability, younger age at sexual debut and living in formal urban rather than formal rural areas. Conclusions The data presented in this paper reinforces the importance of MSP as a risk factor for HIV and outline factors that should strongly be considered in strengthening condom use promotion and of partner reduction programs messaging in South Africa. [ABSTRACT FROM PUBLISHER]

Literature shows that learners with disabilities lack access to sexuality education in Africa and are therefore at increased risk of sexual abuse and exploitation as well as exposure to HIV. Teachers in special schools struggle to provide sexuality education to learners with disabilities. However, the challenges and how they are shaped by the teachers' knowledge, attitudes and practice in regards to the subject are little understood. This paper reports on the process of developing, culturally validating and piloting a questionnaire that assesses the teachers' knowledge, attitude and teaching practices. The questionnaire validation used the cultural equivalence testing framework from Stevelink and van Brakel testing for conceptual, item, semantic, operational and measurement equivalence using expert advice, literature, a sensitivity questionnaire and focus group discussions. The validation process provided crucial pointers toward improving and culturally adjusting scales. This has developed a robust tool with the exception of the knowledge scales. In the further process the latter will be refined and adjusted. This tool helps to identify teachers' challenges around sexuality education and has informed the development of a curriculum innovation and toolkit that supports teachers to effectively deliver sexuality education to learners with disabilities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to respond to food insecurity and environmental sustainability through school food gardens in Johannesburg, South Africa. Design/methodology/approach – Permaculture is a method of organic agriculture where the garden design maintains a stable and productive ecosystem, mimicking natural processes and thereby creating a more natural and sustainable environment. Organic permaculture food gardens were established and integrated with the curriculum at two schools over the course of one year. A nutrition study of dietary intake and assessment of dietary diversity score was undertaken with a sample of 68 children. Findings – Permaculture food gardens can contribute to children's physical, mental, and emotional health and can be a resource for teachers and learners. To achieve sustainability, practical and cultural challenges must be addressed. Research limitations/implications – The project was implemented at only school sites, findings may not be applicable to all schools in all settings. This assessment was conducted after one year of implementation, impacts, and sustainability would be best assessed after three years. Conclusions are therefore based both on this case study and on the wider literature. Practical implications – When implementing a school food garden there must be long-term support and mentoring for school staff. Social implications – The value of a school food garden goes beyond the provision of nutrition and addressing food insecurity. Participation in gardening can increase students’ interactions with the natural world, and contribute to skills development, academic achievement, and well-being. Originality/value – This paper informs discussion and practice related to school food gardens’ influence on holistic health and broader educational benefits. It is of relevance to health promotion and education practitioners, school garden developers, and funders. [ABSTRACT FROM AUTHOR]

Research efforts have overlooked anal sex as a risk factor for adolescents’ acquisition of HIV despite the high rates of HIV among South African youth. Here, we report findings from a survey conducted in 2012 among secondary school youth, ages 16-24, in Cape Town. 937 adolescents completed a pencil-and-paper survey. Eleven and 31% of female and male youth, respectively, reported ever having anal sex. By comparison, 59% and 78% of female and male youth reported ever having vaginal sex. The percentage of youth reporting lifetime rates of anal sex increased with age: 32% of 20-to-24 year olds had anal sex compared to 16% of 16-to-17-year olds. When the sample was stratified by sex, this difference appeared to be driven by older male, but not female, sexual behavior. Despite noted differences in prevalence rates by sex, both boys and girls who had anal sex were more likely than their same-sex peers who had vaginal sex to report sexual coercion victimization and perpetration experiences and inconsistent condom use. Interestingly, some differences in HIV motivation, information, and behavioral skills were noted for youth who had vaginal sex versus youth who had never had sex; scores were largely similar for youth who had anal sex versus youth who had never had sex however. Together, these findings suggest that anal sex is not uncommon and may be an important marker for other HIV risk behaviors in at least one lower income South African community. Anal sex needs to be explicitly discussed in adolescent HIV prevention and healthy sexuality programing, incorporating age-relevant scenarios about negotiating condoms and other healthy relationship behaviors (e.g., refusing sex when it is not wanted). [ABSTRACT FROM AUTHOR]

Understanding the transition to adulthood has important implications for supporting young adults and understanding the roots of diversity in wellbeing later in life. In South Africa, the end of Apartheid means today's youth are experiencing their transition to adulthood in a changed social and political context which offers opportunities compared to the past but also threats. This paper presents the first national level analysis of the patterning of key transitions (completion of education, entry into the labour force, motherhood and marriage or cohabitation), and the association between the different pathways and health amongst young women. With the use of longitudinal data from the South African National Income Dynamics Study (2008–2015), this paper employs sequence analysis to identify common pathways to adulthood amongst women aged 15–17 years at baseline (n = 429) and logistic regression modelling to examine the association between these pathways and self-rated health. The sequence analysis identified five pathways: 1. ‘ Non-activity commonly followed by motherhood’, 2. ‘Pathway from school, motherhood then work’, 3. ‘Motherhood combined with schooling’, 4. ‘Motherhood after schooling’ , and 5. ‘Schooling to non-activity’ . After controlling for baseline socio-economic and demographic characteristics and health, the regression results show young women who followed pathways characterised by early motherhood and economic inactivity (1, 3 and 4) had poorer self-rated health compared to women whose pathways were characterised by combining motherhood and economic activity (2) and young women who were yet to become economically active or mothers (5). Therefore, policies should seek to prevent adolescent childbearing, support young mothers to continue their educational careers and enable mothers in work and seeking work to balance their work and care responsibilities. Further, the findings highlight the value of taking a holistic approach to health and provide further evidence for the need to consider work-family balance in the development agenda. [ABSTRACT FROM AUTHOR]

A multipurpose prevention technology (MPT) that combines HIV and pregnancy prevention is a promising women's health intervention, particularly for young women. However, little is known about the drivers of acceptability and product choice for MPTs in this population. This paper explores approval ratings and stated choice across three different MPT delivery forms among potential end-users. The Trio Study was a mixed-methods study in women ages 18-30 that examined acceptability of three MPT delivery forms: oral tablets, injections, and vaginal ring. Approval ratings and stated choice among the products was collected at baseline. Factors influencing stated product choice were explored using multivariable multinomial logistic regression. The majority (62%) of women in Trio stated they would choose injections, 27% would choose tablets and 11% would choose the ring. Significant predictors of choice included past experience with similar contraceptive delivery forms, age, and citing frequency of use as important. Ring choice was higher for older (25-30) women than for younger (18-24) women (aRR = 3.1; p < 0.05). These results highlight the importance of familiarity in MPT product choice of potential for variations in MPT preference by age. [ABSTRACT FROM AUTHOR]

Background: Although cervical cancer is preventable, it remains the most feared and second most common cancer in women worldwide, as well as the leading cause of cancer deaths in many lowand middle-income countries, including South Africa. Numerous studies conducted globally, in Africa and in South Africa revealed a knowledge gap about cervical cancer and its preventive strategies, including cervical cancer screening, among nurses and the general population. Aim: The purpose was to investigate and describe nurses' knowledge and management practices regarding cervical cancer screening in uMsunduzi Local Municipality, KwaZulu- Natal. Methods: The study was directed by a positivism paradigm. A quantitative research approach and nonexperimental descriptive design was used in this study. Probability random sampling was used, and a self-administered questionnaire was used to collect data. Eighty-three professional nurses participated in the study. Results: The study discovered that professional nurses working in selected clinics in uMsunduzi Local Municipality, KwaZulu-Natal, had a high level of knowledge about cervical cancer and its screening. Nonetheless, despite the high level of knowledge demonstrated, the level of practice remained low. Conclusion: Cervical cancer morbidity and mortality have long been a major health concern in South Africa's general population. The study found that PNs are knowledgeable about cervical cancer screening; conversely, practice was low. This paper includes recommendations for future research, nursing practice, nursing education and the Department of Health. Contribution: This study contributed vastly to the body of knowledge in managing cervical cancer screening practices, particularly in health promotion and prevention of diseases at primary care level. [ABSTRACT FROM AUTHOR]

Background: Midwifery students in South Africa place great value on the clinical support they receive from midwifery practitioners. Adequate clinical support should help midwifery students to practice procedures safely and independently, allowing them to be competent upon degree completion. Aim: To describe the clinical support and perceived competency levels of midwifery students. Setting: Public hospitals in KwaZulu-Natal. Methods: The researcher chose a quantitative research method using a descriptive design. An all-inclusive purposive and convenience sampling method was undertaken to recruit midwifery students from an undergraduate nursing programme at a university in KwaZulu-Natal. Gatekeepers permission and ethics approval was obtained from the university's registrar and research ethics committee. A self-evaluation questionnaire describing the clinical support and perceived competency levels was completed by 60 respondents. Data were analysed using International Business Machines Corporation Statistical Package for Social Sciences (IBM-SPSS) Version 27. Results: The results highlighted that the clinical support midwifery students received, was beneficial to their clinical learning outcomes. Eighty per cent of clinical support offered to midwifery students was obtained through clinical supervision. Ninety-three per cent of respondents revealed that the clinical support they received were from midwifery practitioners (without a speciality qualification). Although students rated themselves as competent in 88.6% of midwifery procedures, poor outcomes were identified in 11.4% procedures. Conclusion: Midwifery practitioners play a significant role in supporting midwifery students during clinical placement. Advancing the roles of midwifery practitioners through mentorship training is likely to strengthen the quality of clinical support provided and thus improve the competence levels of midwifery students. Contribution: The findings in this paper are valuable in developing clinical support training guidelines for midwifery practitioners. [ABSTRACT FROM AUTHOR]

There are ongoing debates and controversies about whether genderqueer individuals have specific sexual-reproductive healthcare services and needs (SRHSNs). This study intended to identify and explore queer-specific SRHSNs among healthcare providers (HCPs) in Gauteng Province, South Africa. This was an exploratory sequential mixed-methods study, and this article focuses on the qualitative findings of that investigation. Thirty-three HCPs were purposively sampled, and semi-structured one-on-one interviews were used to collect data between September and November 2023. The data were analyzed using thematic content analysis (TCA). The results of this study revealed nine main themes: a crucial need for inclusive healthcare facilities; a need for psychological, counseling, and therapeutic support in sexual and reproductive healthcare; access to sexual-reproductive education and integrating support; suggested reproductive health services for queer sexual wellness; improved accessibility and particular queer reproductive healthcare; optimizing services related to human immunodeficiency virus (HIV), pre-exposure prophylaxis (PrEP) access, and sexually transmitted illness (STI) treatment; genderqueer persons' parenthood aspirations and empowerment; the safe availability of intimacy tools; and navigation transitions. A holistic and inclusive healthcare approach that fits psychological support, comprehensive sexual-reproductive education, and specialized services to accommodate the unique needs of queer individuals should be implemented and made easily accessible. [ABSTRACT FROM AUTHOR]

Improving the practice environment, quality of care and patient safety are global health priorities. In South Africa, quality of care and patient safety are among the top goals of the National Department of Health; nevertheless, empirical data regarding the condition of the nursing practice environment, quality of care and patient safety in public hospitals is lacking. Aim This study examined nurses' perceptions of the practice environment, quality of care and patient safety across four hospital levels (central, tertiary, provincial and district) within the public health sector of South Africa. Methods This was a cross-sectional survey design. We used multi-phase sampling to recruit all categories of nursing staff from central (n = 408), tertiary (n = 254), provincial (n = 401) and district (n = 244 [large n = 81; medium n = 83 and small n = 80]) public hospitals in all nine provinces of South Africa. After ethical approval, a self-reported questionnaire with subscales on the practice environment, quality of care and patient safety was administered. Data was collected from April 2021 to June 2022, with a response rate of 43.1%. ANOVA type Hierarchical Linear Modelling (HLM) was used to present the differences in nurses' perceptions across four hospital levels. Results Nurses rated the overall practice environment as poor (M = 2.46; SD = 0.65), especially with regard to the subscales of nurse participation in hospital affairs (M = 2.22; SD = 0.76), staffing and resource adequacy (M = 2.23; SD = 0.80), and nurse leadership, management, and support of nurses (M = 2.39; SD = 0.81). One-fifth (19.59%; n = 248) of nurses rated the overall grade of patient safety in their units as poor or failing, and more than one third (38.45%; n = 486) reported that the quality of care delivered to patient was fair or poor. Statistical and practical significant results indicated that central hospitals most often presented more positive perceptions of the practice environment, quality of care and patient safety, while small district hospitals often presented the most negative. The practice environment was most highly correlated with quality of care and patient safety outcomes. Conclusion There is a need to strengthen compliance with existing policies that enhance quality of care and patient safety. This includes the need to create positive practice environments in all public hospitals, but with an increased focus on smaller hospital settings. [ABSTRACT FROM AUTHOR]

Background: Evidence-Based Practice (EBP) is a model utilised by the majority of healthcare professionals and is a clinical framework that assists with decision-making related to patient care, to improve outcomes and patient satisfaction. The study aimed to analyse the attitudes, skills, and utilization of evidence-based practice (EBP) among South African chiropractors, focusing on perceived skill levels, training, use and identifying facilitators and barriers to EBP application. Methods: A descriptive cross-sectional quantitative secondary analysis was conducted by inviting registered chiropractors in South Africa (n = 920) to participate in an anonymous online questionnaire using the Evidence-Based Practice Attitude and Utilisation Survey (EBASE). Results: A total of 132 chiropractors completed the survey, yielding a response rate of 14.4%. Of the respondents, 59.9% were female, 52.3% were between 26 and 35 years old, and 63.3% had graduated from the University of Johannesburg. A third of respondents stated they have poor clinical research skills. Over half of the respondents (56.8%) indicated that EBP constituted a significant part of their education except for completing systematic reviews or meta-analyses. Published clinical evidence was ranked 6th as a source of information for clinical decisions. The obstacles indicated were time constraints and a lack of clinical research in complementary and alternative medicine. Access to the internet, databases and research tools were facilitators that were deemed to be "very useful" in promoting EBP. Conclusion: The majority of South African chiropractors are generally favourable towards EBP, and this practice therefore appears to be utilised and embraced, with the requisite skills. [ABSTRACT FROM AUTHOR]

Aim: Human immunodeficiency virus (HIV) nursing has become more prominent with the increase in chronic HIV infections. This study examined articles related to HIV nursing to determine how the profession has developed and its future direction. Design: A bibliometric analysis was conducted. Methods: HIV nursing‐related articles published in the Web of Science core collection between 1999 and 2022 were searched. VOSviewer was used to identify the contributions of countries, institutions and authors in HIV‐related care. Collaborative maps, hot topics and keywords trends were analysed using VOSviewer and CiteSpace. Results: A total of 1513 publications were extracted. An increase in articles published between 1999 and 2012 was observed. After 2012, the increase in the number of publications was relatively stable. Since 2016, a downward trend in the number of publications has occurred. The USA, South Africa and the UK were the leading contributors to publications related to HIV nursing. The focus of the HIV nursing research has gradually shifted from "HIV infection", "risk factors", and "transmission routes" to "social support", "depression", and "public health". The result shows that increased collaboration among countries/regions can improve the development of HIV nursing and effectively reduce the global HIV infection rate. The mental health of patients has become a research centre in the field of HIV nursing. This study provides direction in clinical practice and future research areas in this field. [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]

Purpose: Developmental stuttering is a complex and multifaceted neurodevelopmental disorder that may cause pervasive negative consequences for adults who stutter (AWS). Historically, intervention for AWS has primarily addressed speech fluency, with less focus on the covert psychosocial aspects of the disorder. The purpose of this article is to report on a feasibility trial evaluating a novel integrated intervention that combines traditional stuttering management techniques with Acceptance and Commitment Therapy (ACT) for AWS. Method: Twenty-nine AWS participated in the feasibility trial. All participants successfully completed a combined fluency and ACT intervention, titled the fluency and Acceptance and Commitment Therapy for Stuttering (fACTS) Program. As this was a feasibility study, no control group was included. Intervention was administered by two certified practicing speech-language pathologists, over eight 60- to 90-min sessions. Results: Generalized linear mixed modeling was used to determine change from pre- to post-intervention and follow-up. Significant pre- and post-intervention improvements in self-efficacy, psychosocial functioning, and psychological flexibility were observed, along with significant reductions in observable stuttering behaviors (i.e., stuttered speech frequency). Intervention gains for all variables of interest were maintained 3 and 6 months post-intervention. Conclusions: The fACTS Program was created to be a holistic and flexible intervention to promote self-efficacy beliefs and address stuttering-related psychosocial impacts and speech fluency goals of AWS. Preliminary results indicated positive improvement in all psychosocial outcomes (i.e., self-efficacy, psychosocial impact, and psychological flexibility) and observable speech fluency following completion of the program. Future clinical trials of the fACTS Program with an included control group will further investigate the mechanisms of change for the positive effects observed. [ABSTRACT FROM AUTHOR]

The use of donated expressed breast milk (DBM) is encouraged in South Africa, with donor milk banks and legislated policies and programmes available in hospitals serving populations with a high HIV prevalence. Concerns over poor attitudes amongst mothers towards DBM seem to persist. A cross-sectional mixed-methods approach was used in a cohort of mothers of neonates in a regional hospital. Between April 2021 and January 2022, survey data on knowledge, awareness and attitudes towards DBM was collected. Qualitative data from open-ended questions were thematically analysed. Comparative analysis using independent sample t-tests and logistic regression to determine differences in variables and to understand associations related to knowledge was conducted. A total of 163 mothers with a mean (SD) age of 27.1 ± 6.3 years were included; 49.7% of mothers had post-high-school qualifications, 82.8% were unemployed and 87.0% received social security. Some 64.4% had inadequate knowledge of DBM. Awareness of DBM had the strongest association with better knowledge concerning DBM and AdjOR (25.25 95% CI 10.60–68.40; p < 0.001). Negative attitudes towards DBM were largely driven by a lack of knowledge regarding human immunodeficiency virus (HIV) screening of donor mothers and fears of HIV transmission when using DBM. Lack of awareness concerning DBM was associated with poor knowledge of DBM, which may drive poor uptake of this critical nutritional source for at-risk neonates. Implementing targeted awareness programmes on DBM, which begin in the antenatal period and specifically address HIV screening of donor mothers, could address the poor uptake of DBM. [ABSTRACT FROM AUTHOR]

Adolescents living with HIV (ALHIVs) are considered a priority population in the fight against HIV, requiring dedicated services. The COVID-19 pandemic and subsequent disruptions deprived ALHIVs on antiretroviral therapy (ART) of the care and social support essential for treatment adherence and positive treatment outcomes. This study describes health managers' and healthcare workers' responses to the impact of COVID-19 on service delivery to ALHIVs in HIV treatment in the Cape Town Metropole. A descriptive qualitative design was employed, where semi-structured individual interviews (n = 13) were conducted with senior and programme managers as well as healthcare workers between April and October 2023. Inductive thematic analysis was performed using Atlas.ti version 23. Two main themes emerged from these interviews: "HIV service delivery to adolescents during the COVID-19 pandemic" and "Lessons learnt—the way forward". The de-escalation of health services at primary health facilities and the disruption of HIV services resulted in disengagement from care by ALHIVs, increasing mental health and treatment challenges. This warrants the restoration of psychosocial support services and the re-engagement of ALHIVs. The findings from this study can function as a guide for health systems and healthcare providers to navigate future pandemics to ensure that vulnerable populations such as ALHIVs continue to receive care and treatment. [ABSTRACT FROM AUTHOR]

Background: HIV partner disclosure rates remain low among pregnant women living with HIV in many African countries despite potential benefits for women and their families. Partner disclosure can trigger negative responses like blame, violence, and separation. Women diagnosed with HIV late in pregnancy have limited time to prepare for partner disclosure. We sought to understand challenges around partner disclosure and non-disclosure faced by women diagnosed with HIV late in pregnancy in South Africa and Uganda and to explore pathways to safe partner disclosure. Methods: We conducted in-depth interviews and focus group discussions with pregnant women and lactating mothers living with HIV (n = 109), disaggregated by antenatal care (ANC) initiation before and after 20 weeks of gestation, male partners (n = 87), and health workers (n = 53). All participants were recruited from DolPHIN2 trial sites in Kampala (Uganda) and Gugulethu (South Africa). Topic guides explored barriers to partner disclosure, effects of non-disclosure, strategies for safe disclosure. Using the framework analysis approach, we coded and summarised data based on a socio-ecological model, topic guides, and emerging issues from the data. Data was analysed in NVivo software. Results: Our findings illustrate pregnant women who initiate ANC late experience many difficulties which are compounded by the late HIV diagnosis. Various individual, interpersonal, community, and health system factors complicate partner disclosure among these women. They postpone or decide against partner disclosure mainly for own and baby's safety. Women experience stress and poor mental health because of non-disclosure while demonstrating agency and resilience. We found many similarities and some differences around preferred approaches to safe partner disclosure among female and male participants across countries. Women and male partners preferred healthcare workers to assist with disclosure by identifying the 'right' time to disclose, mentoring women to enhance their confidence and communication skills, and providing professional mediation for partner disclosure and couple testing. Increasing the number of counsellors and training them on safe partner disclosure was deemed necessary for strengthening local health services to improve safe partner disclosure. Conclusion: HIV diagnosis late in pregnancy amplifies existing difficulties among pregnant women. Late ANC initiation is an indicator for the likelihood that a pregnant woman is highly vulnerable and needs safeguarding. Respective health programmes should be prepared to offer women initiating ANC late in pregnancy additional support and referral to complementary programmes to achieve safe partner disclosure and good health. [ABSTRACT FROM AUTHOR]

Health promoting schools, as conceptualised by the World Health Organisation, have been developed in many countries to facilitate the health-education link. In 1994, the concept of health promoting schools was introduced in South Africa. In the process of becoming a health promoting school, it is important for schools to monitor and evaluate changes and developments taking place. The Health Promoting Schools (HPS) Monitoring Questionnaire was developed to obtain opinions of students about their school as a health promoting school. It comprises 138 questions in seven sections: sociodemographic information; General health promotion programmes; health related Skills and knowledge; Policies; Environment; Community-school links; and support Services. This paper reports on the reliability and face validity of the HPS Monitoring Questionnaire. Seven experts reviewed the questionnaire and agreed that it has satisfactory face validity. A test-retest reliability study was conducted with 83 students in three high schools in Cape Town, South Africa. The kappa-coefficients demonstrate mostly fair (j-scores between 0.21 and 0.4) to moderate (j-scores between 0.41 and 0.6) agreement between test-retest General and Environment items; poor (j-scores up to 0.2) agreement between Skills and Community test-retest items, fair agreement between Policies items, and for most of the questions focussing on Services a fair agreement was found. The study is a first effort at providing a tool that may be used to monitor and evaluate students' opinions about changes in health promoting schools. Although the HPS Monitoring Questionnaire has face validity, the results of the reliability testing were inconclusive. Further research is warranted. [ABSTRACT FROM AUTHOR]

Background: Registered nurses working in the mobile health clinics (MHCs) play an important role in enabling HIV care access to populations in remote areas through Nurse Initiated Antiretroviral Therapy program (NIMART). Aim: To explore and describe the nurses' experiences regarding operational factors influencing the implementation of HIV care services in the mobile health clinics (MHCs) of eThekwini Municipality in KwaZulu Natal. Methods: Qualitative Exploratory Descriptive (QED) method was used after permission was granted from North-West University Human Research Ethics Committee provincial and local health authorities. Data saturation informed sample size of thirteen MHCs nurses were purposefully sampled to participate. Audio-recorded, semi-structured, online, one-on-one interviews guided by open-ended questions were done for data collection, and including demographic profile. The interview transcripts were analysed using Atlas-TI and SPSS descriptive statistics was used for demographics. Results: Eleven subthemes emerged under patient-related, nurse-related, and organisational-related themes which influence the operational factors in the MHCs, namely: patient defaulting treatment, lack of privacy, unavailability of phones, stressful and demotivating MHCs, nurses feel unsafe, lack of support from management, lack of budget, unavailability of computers, shortage of medical equipment, shortage of nursing staff and absence of data capturers. Conclusion: Structured contextual coaching and support program for nurses is imperative to ensure effective and strengthened operations in MHCs, further supported by improvement in human resource for health allocation for MHCs in light of expanding health care programs Contributions: Evaluation of health care programmes, and human resource for health quality improvement needs in the clinical practice of HIV care of MHCs nurses which advocate for specific policy formulations. [ABSTRACT FROM AUTHOR]

Background: Dementia care in South Africa faces challenges including a paucity of published research, a prevalent medical model in healthcare, and inadequate caregiver training. Music is a meaningful psychosocial intervention in dementia care, yet its application is not always safe and effective. A training protocol was codesigned to enhance caregivers' delivery of person‐centred care through attuned, live singing. Objectives: This study explored the acceptability and caregivers' experiences of a person‐centred caregiver singing (PCCS) protocol in South Africa. Methods: A PCCS workshop was applied at seven aged care homes in Cape Town, South Africa. Forty‐one formal caregivers adhered to inclusion criteria and consented to attend one workshop on PCCS. Mixed methods data collection was obtained from questionnaires containing a Likert scale and written reflections. Quantitative data were analysed through nonparametric tests and narrative descriptions, and qualitative data through thematic content analysis. Findings were integrated deductively using seven components of acceptability. Results: Findings converged to show caregivers' positive experiences, highlighting observed improvements in residents' wellbeing, caregivers' capabilities, empathic connection, and person‐centred care beyond the one‐on‐one. Caregivers' limited song repertoire and residents' unpredictability hindered implementation, however, the skills acquired appeared useful and applicable. Conclusions: Integration of findings suggests the acceptability of PCCS as caregivers experienced PCCS as a helpful, easy‐to‐implement intervention that contributes to their delivery of person‐centred care. Further research focused on caregiver self‐efficacy, empathy, and caregivers' own personhood is needed as well as determining the most effective strategies to ensure maximum uptake and sustainability in the sector. Patient or Public Contribution: Formal caregivers participated in this study, both attending the training and implementing the singing protocol with residents in their care at their respective care homes. The people living with dementia residing at the care home were recipients of the singing protocol but not included as participants in the research. [ABSTRACT FROM AUTHOR]

Background: Palliative care (PC) has been integrated to a limited extent in the South African healthcare system. Contextual factors may be a pivotal influence in this integration. Objectives: This study aims to explore contextual factors that are possibly influencing the integration or lack thereof in an academic teaching hospital (ATH). Design: A mixed-method study was conducted in a large ATH in South Africa. Methods: The mixed methods were conducted in parallel and then merged. Findings were integrated to describe the contextual factors influencing PC integration, to develop a timeline of implementation and assess the probable influence of context on the integration process. The mixed-methods phases included a narrative review of published literature related to health systems, integration of health interventions and PC in teaching hospital settings; followed by interviews, documentary and routine data analyses. Semi-structured interviews with purposively sampled participants provided the qualitative data. Primary national, provincial and organizational documents expanded the contextual phenomena and corroborated findings. Routine hospital admission and mortality data was statistically analysed to expand further and corroborate findings. All qualitative data was thematically analysed using deductive coding, drawing from the aspects of the contextual dimensions of integration. Results: Enabling contextual factors for local PC integration were global and local advocacy, demonstrated need, PC being a human right, as well as the personal experiences of hospital staff. Impeding factors were numerous misconceptions, PC not valued as a healthcare priority, as well as limitations in functional elements necessary for PC integration: national and regional political support, leadership at all levels and sustainable financing. Conclusion: The normative and functional contextual aspects interplay at macro, meso and micro levels positively and negatively. How stakeholders understand and value PC directly and indirectly impacts on PC integration. Strategic interventions such as mandatory education are required to ensure PC integration. The health system is dynamic, and understanding the context in which the health system functions is core to the integration of PC. This may assist in developing integration strategies to address PC integration and the transferability of these strategies. Plain language summary: How the context influences a new palliative care intervention Palliative care is being integrated in a big hospital in South Africa. However, there are many contextual factors that influence this integration. These factors are both structural aspects like policies, but also how role players' values and understand of palliative care. It is important to know what these factors are and how these factors influence integration. This study describes the factors and how they influence palliative care integration. [ABSTRACT FROM AUTHOR]