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Background: Community health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment. Methods: We applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study. Results: We organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains—such as training, equipment, and supportive supervision—it is likely that the CHW cadre will continue to be seen as informal health care workers. Conclusions: CHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment. [ABSTRACT FROM AUTHOR]

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. Nurses working in intensive care units (ICUs) must incorporate new knowledge and evidence-based practice (EBP) into their daily routines to enhance patient outcomes. However, this integration often falls short in ICU settings. Weekly clinical audits reveal incidents where ICU nurses neglect evidence-based interventions, impacting patient outcomes and ICU stays. Objective. To explore the factors influencing the translation of knowledge into ICU practice. Methods. We conducted exploratory, qualitative research to investigate ICU nurses' perspectives on knowledge translation into ICU practices. The study employed purposive sampling to select ICU nurses. We used paired interviews and group discussions to gather insights from ICU nurses regarding the factors influencing the translation of knowledge into ICU practices. Data analysis was performed using Boomer and McCormack's nine steps of creative hermeneutic data analysis. Results. One main theme, 'We are just surviving' emerged, encompassing two sub-themes: management and workplace culture. Under management, participants described barriers, such as resource scarcity, behaviour, outdated evidence-informed protocols and workload. Under workplace culture, participants mentioned negative attitudes and a lack of teamwork, contributing to poor-quality care. Conclusion. In ICUs, nurses are expected to integrate new knowledge and scientific evidence into their daily practice, yet they face challenges in doing so. Interventions should be implemented to address management and workplace culture. [ABSTRACT FROM AUTHOR]

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low‐birth‐weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in‐depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping others and having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing culture and safety concerns at antenatal clinics. Key messages: The study emphasises the possible willingness to accept the concept of donating and utilising donor human milk for newborns who do not have access to their mother's own milk. However, safety concerns, bonding and cultural issues should be addressed.Promoting breastfeeding and milk donation in communities requires addressing cultural and health concerns by utilising the service of community health workers.Education about safe breast milk banking before neonatal intensive care unit admission is also an important factor. [ABSTRACT FROM AUTHOR]

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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: 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: Lay health workers (LHWs) are critical in linking communities and primary healthcare (PHC) facilities. Effective communication between facilities and LHWs is key to this role. We implemented a mobile health (mHealth) system to improve communication and continuity of care for chronically ill clients. The system focused on requests from facility staff to LHWs to follow up clients and LHW referrals of people who needed care at a facility. We implemented the system in two rural and semi-rural sub-districts in South Africa. Objective: To assess the feasibility of the mHealth system in improving continuity of care for clients in PHC in South Africa. Method: We implemented the intervention in 15 PHC facilities. The clerks issued recalls to LHWs using a tablet computer. LHWs used smartphones to receive these requests, communicate with clerks and refer people to a facility. We undertook a mixed-methods evaluation to assess the feasibility of the mHealth system. We analysed recall and referral data using descriptive statistics. We used thematic content analysis to analyse qualitative data from semi-structured interviews with facility staff and a researcher fieldwork journal. Results: Across the sub-districts, 2,204 clients were recalled and 628 (28%) of these recalls were successful. LHWs made 1,085 referrals of which 485 (45%) were successful. The main client group referred and recalled were children under 5 years. Qualitative data showed the impacts of facility conditions and interpersonal relationships on the mHealth system. Conclusion: Using mHealth for recalls and referrals is probably feasible and can improve communication between LHWs and facility staff. However, the low success rates highlight the need to assess facility capacity beforehand and to integrate mHealth with existing health information systems. mHealth may improve communication between LHWs and facility staff, but its success depends on the health system capacity to incorporate these interventions. [ABSTRACT FROM AUTHOR]

Continuous monitoring of glucose (CGM) via subcutaneous patch is an accurate self-monitoring tool of blood glucose, but also introduces a range of additional benefits such as real-time feedback. While its value among pregnant women with gestational diabetes mellitus (GDM) is established in high-income countries, little is known about the feasibility and acceptability among pregnant women without GDM in low-resource settings in low- and middle-income countries. This study aims to assess the feasibility and acceptability of CGM with pregnant mothers in South Africa and to explore the value of a collected data set for GDM prevention. Ten women between 12 and 18 weeks pregnant were recruited from the antenatal clinic at Chris Hani Baragwanath Academic Hospital into a prospective mixed-methods pilot study. Demographic and anthropometric data, HbA1c and a lipid panel were collected. Women then wore two consecutive Freestyle Libre 2 patches for a total of 28 days. In-depth interviews were undertaken with all 10 women on study exit to explore themes of acceptability and the use of technology during pregnancy. Thematic analysis was performed on the qualitative data while exploratory data-analysis techniques were applied to the CGM data. Pregnant women (n = 10) had a mean (SD) age of 29.81 years (4.39), with most being unemployed (8), unmarried (8) and without a tertiary degree (7). Analysis suggests that fear of use was greater than the actual discomfort experienced during use of the CGM patch. The main barrier to use was the patch falling off and women being uncomfortable to reapply it. This was borne out by all 10 women wearing the first patch for at least 12 of the 14 days, but only 4 managing the same with patch two – primarily applied by themselves at home. Women expressed support for the use of technology during pregnancy, especially as it related to feeling that their pregnancy was being monitored and that they were being supported. In this pilot study, women overwhelmingly found the wearing of a CGM patch during pregnancy to be acceptable. Feasibility was reasonable with most data being successfully retrieved from the devices over a two-week period. Longer use was found to have additional challenges. The use of CGM patches appear to be a possible candidate for inclusion in GDM prevention or behavioural interventions during pregnancy in South Africa. [ABSTRACT FROM AUTHOR]

Background: Research regarding the outcomes of child and adolescent psychiatric inpatients appears insufficient and neglected. Where data are available, the majority of studies focus on adolescents. This study aimed (a) to describe child and parental perspectives of short-, medium- and long-term outcomes of children who have had a pre-adolescent inpatient psychiatric admission, and (b) to analyse these dyadic experiential data to identify outcome variables of importance to families and service users that could be used in future outcomes-based research. Methods: The study employed a qualitative methodology, using semi-structured in-depth interviews of ten parent-child dyads to (a) collect the perspectives of children who have had an inpatient psychiatric admission at a pre-adolescent unit and their parents, and (b) to analyse the experiences of inpatient admission and perceived outcomes after discharge using thematic analysis. Results: Overall, inpatient psychiatric admission was viewed as a positive and empowering experience by parents and children. Clear short-term benefits were reported as a result of new diagnoses, medications and new skills gained through the admission process. More than half of parent-child dyads reported long-term benefits, but many families commented on ongoing challenges. Thematic analysis identified diagnostic certainty, acquisition of cognitive and behavioural skills, appropriate educational environment, peer relationships, sustained follow-up and medication management, and parent-child relationships, as important contributors to outcomes. Importantly, the presence or lack of these elements influenced outcomes. Conclusions: The study explored parent-child dyadic perspectives about their experiences of inpatient mental health admissions for pre-adolescents and perceived outcomes after admission. The majority of families found inpatient admission positive and helpful, and thematic analysis identified a number of functional variables that may predict outcome. However, positive outcomes were associated with ongoing difficulties over time, as indicated by the theme "a turn in the road, but still a rough journey". [ABSTRACT FROM AUTHOR]

Background. Community engagement is crucial for effective and sustainable sexual and reproductive health and rights (SRHRs) promotion. Community engagement in community-based health promotion initiatives is contextual and influenced by individual, community, and societal factors. In South Africa, community engagement in SRHR promotion is challenging due to numerous historical and contemporary factors including the socionormative community context and socionormative perceptions regarding SRHR matters. There is little empirical literature to guide community-based practitioners working in health promotion in understanding the contextual influences on community engagement with SRHR promotion generally or in South Africa specifically. Objective. This research aimed to explore the influences on community engagement in community-based SRHR promotion initiatives in the Eastern Cape, South Africa. Methods. An ethnographic and multiqualitative study was conducted in the Eastern Cape, South Africa, involving 78 purposively and conveniently sampled participants. Findings. Three superordinate themes influence community engagement with SRHR promotion in South Africa (i) representations of the issues; (ii) perceived relevance of SRHR issues and SRHR promotion; and (iii) the relational environment, often operating in interactive ways. The themes are presented in a conceptual framework. Conclusions. Influences on community engagement in SRHR promotion in the Eastern Cape of South Africa are highly contextual. The conceptual framework arising from the study's findings could be used in community-based health promotion and primary health care in other settings to develop the understanding of factors influencing community engagement in SRHR or other sensitive or emerging health issues, and inform relevant and appropriate design and implementation of community-based initiatives. [ABSTRACT FROM AUTHOR]

Background: Preterm birth (PTB) is a global health epidemic, sub-Saharan Africa is severely impacted due to its limited healthcare resources. Pregnancy knowledge, cultural beliefs and practices play a role in the identification of risk and management of PTB. This study explored knowledge, understandings, cultural beliefs and attitudes to pregnancy and PTB, as well as cultural considerations for the introduction of an intravaginal device which could be used to identify PTB risk. Methods: Qualitative research was conducted in South Africa and Kenya. In-depth interviews were conducted using semi-structured guides with women with a history of PTB (n = 10), healthcare providers (n = 16) and health systems experts (n = 10); and 26 focus group discussions with pregnant women seeking antenatal care (n = 132) and community male partners/fathers (n = 54). Interviews/discussions were transcribed, translated, and analysed thematically. Results: Pregnancy knowledge, especially for first time pregnancies was poor, with many reporting late entry to antenatal care. Knowledge about PTB was understood in terms of gestational age, weight or small size of baby, with concerns about long term health and stigma. Various risk factors for PTB were described, including those related to traditions and beliefs of witchcraft/curses. Cultural practices, such as the use of traditional medicines and pica, and religion and its impact on health seeking behaviour were also viewed as risk factors. Although insertion of intravaginal devices was not widely acceptable in traditional communities, especially during pregnancy, it was felt that the use of one to detect risk of PTB would be accepted if proven effective in reducing PTB risk. Conclusions: Various culturally-informed beliefs exist which explain understandings of and attitudes toward pregnancy, pregnancy risk, and PTB. An inclusive exploratory process is critical to facilitate an understanding of the beliefs and traditions which could impact the introduction and design of a product to detect the risk of PTB. [ABSTRACT FROM AUTHOR]

Introduction: Migration of people living with human immunodeficiency virus (PLWH) from triple pill therapy to a fixed-dose combination (FDC) was initiated to the public sector of South Africa to help with adherence to treatment as it would reduce the pill burden significantly. PLWH experiences regarding the transition from triple pill therapy to FDC in antiretroviral therapy (ART) remain unknown. Material and methods: This study explores and describes the experiences of PLWH regarding migration from triple pill therapy to FDC. The study was conducted in Community Health Centres (CHC) in Ngaka Modiri Molema District in the North West province, South Africa. A qualitative exploratory descriptive design was used and the target population comprised all PLWH who have been on ART for more than a year on the triple pill and are currently on FDC. A purposive sampling technique was used and the sample size was determined by data saturation (n = 15). Data collection was done using unstructured interviews, using audiotapes and field notes. Data analysis was done using ATLAS.ti and followed the notice-collect-think (NCT) analysis. Results: Results were discussed based on three themes: challenges experienced through the triple pill, factors influencing intake of FDC and other factors that negatively influence the triple pill and FDC intake. Conclusions: These findings provide insight into why patients do not adhere to ART. A focus on treatment education would promote knowledge among patients, increase responsibility, and enhance adherence. Support groups and treatment buddies must be emphasized in the provision of support for clients, even if community health workers can be involved. [ABSTRACT FROM AUTHOR]

BACKGROUND: The increasing prevalence of substance abuse in rural areas of Limpopo Province is a concern for most stakeholders including the families, South Africa Police Service, and social workers. Combating Substance Abuse requires the active roles of various stakeholders in the rural community, due to limited resources for prevention, treatment, and recovery. PURPOSE: To report on the roles of stakeholders in tackling Substance Abuse during the awareness campaign conducted in the deep rural community of Limpopo Province, DIMAMO surveillance area. METHODS: Qualitative narrative design was adopted to explore the roles of stakeholders in combating Substance Abuse during the awareness campaign conducted in the deep rural community. The population consisted of different stakeholders who play an active role in reducing Substance Abuse. The triangulation method was used for data collection (interviews, observations, and taking field notes during presentations). Purposive sampling was used to select all the available stakeholders who actively combat substance abuse in the communities. Thematic narrative analysis was used to analyze the interviews conducted with and content presented by the stakeholders to generate the themes. RESULTS: The prevalence of Substance Abuse among the youth in the Dikgale community is high with a growing trend of Crystal Meth, "nyaope," and Cannabis(marijuana). The prevalence is worsened by the diverse challenges experienced by the families and stakeholders which impact the strategies targeted to combat Substance Abuse. CONCLUSION: The findings indicated the need for strong collaborations among the stakeholders (including school leadership) to successfully combat Substance Abuse in rural areas. The findings demonstrated a need for a well-capacitated healthcare services with adequate rehabilitation centers and well-trained healthcare providers for combating Substance Abuse to minimize victim stigmatization. [ABSTRACT FROM AUTHOR]

Background: Worldwide, type 1 diabetes mellitus disease is a devastating health condition for both the diagnosed children and caregivers taking care of them. These challenges were drastically affecting caregivers in rendering the required homecare service for their patients. Caring for a child with diabetes mellitus often hurts the caregivers and other family members. Aim: This study aimed to explore the challenges experienced by caregivers during the provision of care to type 1 diabetic children. Setting: The study was conducted in selected health facility of Vhembe District, South Africa. Methods: A qualitative design that was both descriptive and exploratory was used. Non-probability purposive sampling was used to select the caregivers who were taking care of children with type 1 diabetes mellitus at their homes. Semi-structured interviews were conducted with 15 participants from the Vhembe district of Limpopo province. Results: Caregivers experienced various challenges related to re-admission, poor understanding of medication, low level of literacy, committed mistakes, poor adherence, and fear of giving an injection. Conclusion: It is imperative to educate the caregivers on the care of children with type 1 diabetes mellitus for them to be competent and knowledgeable in assisting their diabetic children at home. [ABSTRACT FROM AUTHOR]

Background: Although the experience of hospitalisation for cancer management has been widely researched, such research from the African sub-continent is limited. Objective: This study explored experiences of patient care in a tertiary, inpatient oncology setting in urban South Africa, from the point of view of patients and health professionals. Methods: In-depth interviews and focus groups were conducted with participants. Participants included oncology inpatients, oncologists, nurses and nursing management (N = 46) at an oncology unit in Johannesburg, South Africa. Data were analysed by a multidisciplinary research group using reflexive thematic analysis principles. Results: Our results suggest that barriers to establishing effective organisational routines included communication breakdowns between patients and healthcare providers, a lack of predictability in interactions with doctors, deficient access to information and diminished confidence in nurses. Conclusions: Oncology inpatients may not feel in control of their circumstances, in part due to lacking routine in the hospital setting. Ironically, nurses, who are often at the frontline of patient management, appear to be underutilised or disabled by the healthcare system as conveyors of information. Implications for practice: Robust organisational routines for oncology inpatients may be a good mechanism for allaying uncertainty and conferring a sense of control. Nursing staff, as the individuals with the most direct patient contact, could be instrumental in nurturing organisational routines towards improving patient perceptions of care. [ABSTRACT FROM AUTHOR]

Children under five depend on the caregivers to provide them with nutritious food to combat malnutrition. Several studies have been conducted about malnutrition in children, yet limited attention has been paid to the caregivers. Thus, the study investigated the perceptions of caregivers with regard to non-nutritious foods in rural areas in South Africa. This study explored caregiver's perception regarding non-nutritious food in children below five. This was done in primary health care clinics of Tshilwavhusiku local areas of Makhado Municipality in Vhembe District, South Africa. A qualitative approach was adopted. Nine caregivers were sampled randomly. In-depth individual interviews were conducted, and Tesch's analytical approach was adopted to analyze the data measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. The study revealed that caregivers were lacking knowledge regarding nutritious food to be given to their children and signs of malnutrition were also not known. It is imperative to ensure the improvement of caregivers' knowledge regarding nutritious food and children's nutritional status in order to reduce the malnutrition rate. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to understand the agency that caregivers who participated in a CBR empowerment component programme exercised, in order to promote the rights of their children with disabilities to a basic education. Methods: An interdisciplinary theoretical framework and qualitative methodology were used to examine the agency and the opportunity structures within which the caregivers operate. Focus group discussions, case study interviews and secondary Programme data were analysed using manual thematic analysis. Results: Thousands of children with disabilities in South Africa are effectively denied the right to a basic education as a result of discriminatory norms, stigmatising discourses and unjust power relations. Yet, a group of caregivers have successfully advocated for their children with disabilities in the township of Orange Farm, Gauteng. Their lobbying has contributed to the establishment, by the State, of a new school. Conclusion and Implications: The findings suggest that human rights advocacy movements, as well as disability organisations, would do well to recognise and encourage the power and agency possessed by caregivers of children with disabilities. Catalysing civic action and providing opportunities for active citizenry and self-help seem to nurture increased efficacy and competence at navigating systems and accessing rights. While advocacy organisations may act as proxy agents, direct and collective agentic strategies should be nurtured. In implementing inclusive education, policy makers and the Department of Education should recognise the role that caregivers of children with disabilities can play, and the potential contribution that their motivation, resourcefulness, and disability-related knowledge can make. [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]

Dysphagia is a 'hidden' disorder that can present with a range of consequences including fatality. It is important for intervention to be timeous and adopt a team approach, with each professional displaying understanding of both dysphagia and each other's roles. The nurse is at the epicentre of service provision in hospitals and is ideally positioned to collaborate with the speech-language therapist to manage dysphagia. The state of collaboration, however, is not ideal. Reasons perpetuating this need, to be understood to facilitate improved care by nurses for patients with dysphagia. The aim of the study was to describe the caseload of dysphagia patients seen by nurses, their experiences caring for patients with dysphagia, and nurses' views on inter-professional training. A qualitative, exploratory study was conducted with nurses working at two government hospitals in Johannesburg, South Africa. An open-ended semi-structured interview was conducted with nine nurses working with adult patients. Descriptive and inductive thematic analysis was used, comparisons were made between the responses, and data were categorised according to emerging themes. Results confirmed that while experience improved care, gaps in dysphagia knowledge, inexperience and contextual challenges adversely impacted efficiency of dysphagia care. Inter-professional training and recognition of nurse intervention positively impacted on interactions with dysphagia. Nurses have a central role in dysphagia care in acute settings. The study confirmed that multidisciplinary management, inter-professional training and inter-professional relations contribute to overall improved service delivery in dysphagia in acute settings, with nurses at the epicentre. [ABSTRACT FROM AUTHOR]

Female‐initiated HIV prevention methods, such as oral pre‐exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, male partners and grandmothers (N = 196) and 36 in‐depth interviews with key informants in Malawi, South Africa, Uganda and Zimbabwe. We analysed the data using a framework analysis method. Overall, breastfeeding was the norm, and participants described the transference of health (e.g., nutrition) and disease (e.g., HIV) to children through breast milk. Participants considered the early breastfeeding period as one of high HIV transmission risk for women. They explained that male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk. Participants highlighted concerns about the drugs in oral PrEP transferring to the child through breast milk, but fewer worried about the effects of the vaginal ring because the drug is localized. Women, grandmothers and key informants were supportive of women using these HIV prevention methods during breastfeeding, while male partners had mixed opinions. These findings can be used to tailor messages for promoting the use of PrEP or the vaginal ring during breastfeeding in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

When patient-reported measures are translated and cross-culturally adapted into any language, the process should conclude with cognitive interviewing during pretesting. This article reports on translation and cross-cultural adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire into Afrikaans (for the Western Cape). This qualitative component of a clinical measurement, longitudinal study was aimed at the pretesting and cognitive interviewing of the prefinal Afrikaans (for the Western Cape) DASH questionnaire highlighting the iterative nature thereof. Twenty-two females and eight males with upper limb conditions were recruited to participate at public health care facilities in the Western Cape of South Africa. Cognitive interviews were conducted as a reparative approach with an iterative process through retrospective verbal probing during a debriefing session with 30 participants once they answered all 30 items of the translated DASH questionnaire. The sample included Afrikaans-speaking persons from low socioeconomic backgrounds, with low levels of education and employment (24 of 30 were unemployed). Pragmatic factors and measurement issues were addressed during the interviews. This study provides confirmation that both pragmatic factors and measurement issues need consideration in an iterative process as part of a reparative methodology towards improving patient-reported measures and ensuring strong content validity. [ABSTRACT FROM AUTHOR]

Background: The Post Natal Club (PNC) model assures comprehensive care, including HIV and Maternal and Child Health care, for postpartum women living with HIV and their infants during an 18-month postnatal period. The PNC model was launched in 2016 in Town Two Clinic, a primary health care facility in Khayelitsha, South Africa. This qualitative research study aims to understand how participation in PNCs affected knowledge transmission, peer support, behaviour change and satisfaction with the care provided. Methods: We conducted ten in-depth interviews; three focus group discussions and participant observation with PNC members, health-care workers and key informants selected through purposive sampling. Seventeen PNC members between 21 and 38 years old, three key informants and seven staff working in PNC participated in the research. All participants were female, except for one of the three key informants who was male. Data was collected until saturation. The data analysis was performed in an inductive way and involved an iterative process, using Nvivo11 software. Results: PNC members acquired knowledge on HIV, ART, adherence, infant feeding, healthy eating habits, follow up tests and treatment for exposed infants. Participants believed that PNC created strong relationships among members and offered an environment conducive to sharing experience and advice. Most interviewees stated that participating in PNC facilitated disclosure of their HIV status, enhanced support network and provided role models. PNC members said that they adapted their behaviour based on advice received in PNCs related to infant feeding, ART adherence, monitoring of symptoms and stimulation of early childhood development. The main benefits were believed to be comprehensive care for mother-infant pairs, time-saving and the peer dynamic. The main challenge from the perspective of key informants was the sustainability of dedicating human resources to PNC. Conclusion: The PNC model was believed to improve knowledge acquisition, behaviour change and peer support. Participants, staff and the majority of key informants expressed a high level of satisfaction with the PNC model. Sustainability and finding adequate human resources for PNCs remained challenging. Strategies to improve sustainability may include handing over some PNC tasks to members to increase their sense of ownership. [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]

Objectives: The South African food-based dietary guidelines (FBDG) were developed and implemented to promote healthy lifestyles in the population along with preventing non-communicable diseases and other forms of diet-related illness. The FBDG were recommended for implementation within the national school curriculum. The objective of this study was to explore perceived challenges to successful implementation of these guidelines in the primary school curriculum. Design: This qualitative study gathered data via semi-structured individual interviews. Data were transcribed and analysed with ATLAS.ti software, using a thematic approach. Setting: Public primary schools located in three education districts in the Western Cape, South Africa. Subjects: Principals at twelve schools from communities with different socioeconomic statuses, and five curriculum advisors of relevant subjects from provincial and district levels. Outcomes measures: Perceived barriers to implementing FBDG in the primary school curriculum. Results: A lack of knowledge and/or expertise related to the FBDG by educators, time constraints within the teaching programme and lifestyle related factors of educators, parents and learners emerged as the three main challenge themes from the interviews. A lack of resources was identified as an additional theme. Conclusions: The principals and curriculum advisors anticipated many barriers to the success of implementing nutrition education using the FBDG in the primary school curriculum. Adequately addressing such barriers through improved awareness and knowledge of the FBDG by school staff could improve the potential of using the FBDG as a nutrition education tool in primary schools in South Africa. [ABSTRACT FROM PUBLISHER]

Background: Effective use of proven treatments for high blood pressure, a preventable health risk, is challenging for many patients. Prompts via mobile phone SMS-text messaging may improve adherence to clinic visits and treatment, though more research is needed on impact and patient perceptions of such support interventions, especially in low-resource settings. Method: An individually-randomised controlled trial in a primary care clinic in Cape Town (2012-14), tested the effect of an adherence support intervention delivered via SMS-texts, on blood pressure control and adherence to medication, for hypertensive patients. (Trial registration: ClinicalTrials.gov NCT02019823). We report on a qualitative evaluation that explored the trial participants' experiences and responses to the SMS-text messages, and identified barriers and facilitators to delivering adherence support via patients' own mobile phones. Two focus groups and fifteen individual interviews were conducted. We used comparative and thematic analysis approaches to identify themes and triangulated our analysis amongst three researchers. Results: Most participants were comfortable with the technology of using SMS-text messages. Messages were experienced as acceptable, relevant and useful to a broad range of participants. The SMS-content, the respectful tone and the delivery (timing of reminders and frequency) and the relational aspect of trial participation (feeling cared for) were all highly valued. A subgroup who benefitted the most, were those who had been struggling with adherence due to high levels of personal stress. The intervention appeared to coincide with their readiness for change, and provided practical and emotional support for improving adherence behaviour. Change may have been facilitated through increased acknowledgement of their health status and attitudinal change towards greater self-responsibility. Complex interaction of psycho-social stressors and health service problems were reported as broader challenges to adherence behaviours. Conclusion: Adherence support for treatment of raised blood pressure, delivered via SMS-text message on the patient's own phone, was found to be acceptable, relevant and helpful, even for those who already had their own reminder systems in place. Our findings begin to identify for whom and what core elements of the SMS-text message intervention appear to work best in a low-resource operational setting, issues that future research should explore in greater depth. [ABSTRACT FROM AUTHOR]

Background Evidence suggests that healthcare providers (HCPs) in South Africa do not consistently offer tobacco dependence treatment (TDT) during clinical consultations. In order to understand and explain this behaviour in a South African context, we conducted a qualitative exploration of HCPs' experiences, perceptions and behaviours regarding TDT. Methods Individual qualitative interviews were conducted with physicians and nurses who were purposively selected. Themes were identified from interview transcripts using content analysis. Findings were triangulated and peer-reviewed, and were also verified by the participants. Results Fifteen physicians and four nurses were interviewed, none of whom used tobacco. These participants perceived TDT as an important task, but could not consistently implement it during clinical consultations due to health systems constraints (time-constraints because of patient-overload, the unavailability of cessation medications and a lack of support for referrals), misperceptions and misconceptions (negative outcome expectations about the effectiveness and feasibility of TDT), socio-cultural barriers (counselling older persons was perceived as challenging) and personal limitations (perceived low self-efficacy, poor knowledge and skills on implementing any evidence-based TDT framework). Patients are therefore selectively screened based on clinical relevance and offered only prescriptive brief advice. Participants recommended several systems changes, including academic detailing of tobacco status, training HCPs and incorporating tobacco cessation medications in the Essential Drug List. Conclusion The reported selective screening and limited TDT interventions offered by HCPs are related to interactions between health systems constraints, personal limitations, and misperceptions and misconceptions about the effectiveness and feasibility of TDT during clinical consultation. Implementing the recommended systems changes has the potential to improve the implementation of TDT in South African primary health care (PHC). [ABSTRACT FROM AUTHOR]

Background: Antiretroviral therapy (ART) roll-out is fraught with challenges, many with serious repercussions. We explored and described patient behaviour-related challenges from the perspective of health care providers from non-governmental organisations involved in ART programmes in KwaZulu-Natal, South Africa. Methods: A descriptive case study design using qualitative approach was applied during this study. Data was collected from nine key informants from the three biggest NGOs involved in ART roll-out using in-depth semistructured interviews. Transcribing and coding for emergent themes was done by two independent reviewers. Ethical approval for the study was granted by the UNISA research ethics committee of The Faculty of Health Sciences. Written consent was obtained from directors of the three NGOs involved and individual audio taped informed consent was obtained from all study participants prior to data collection. Results: Findings revealed six broad areas of patient behaviour challenges. These were patient behaviour related to socio-economic situation of patient (skipping of medication due to lack of food, or due to lack of transport fees), belief systems (traditional and religious), stigma (non- disclosure), sexual practices (non-acceptability of condoms, teenage pregnancies), escapism (drug and alcohol abuse) and opportunism (skipping medication in order to access disability grant, teenage pregnancies in order to access child grant). Conclusion: New programmes need to address patient behaviour as a complex phenomenon requiring a multipronged approach that also addresses social norms and institutions. In the face of continued ART scale up, this is further evidence for the need for multi-sectoral collaboration to ensure successful and sustainable ART roll-out. [ABSTRACT FROM AUTHOR]

Background: Globally, the burden of tuberculosis or human immunodeficiency virus (TB/HIV) is at 24% and this alarming rate compelled the World Health Organization (WHO) to declare the African region as a critical workforce shortage area. To facilitate adherence to treatment guidelines, WHO recommended a strategy of task shifting for countries with high health workforce shortages. The strategy aimed at the redistribution of health care tasks to available workers. The study aimed to determine the factors facilitating nurse-initiated management of antiretroviral therapy (NIMART) trained nurses' adherence to TB/HIV treatment guidelines. Methods: The study employed an exploratory-descriptive design. The study was conducted in Ugu and Ngaka Modiri Molema Districts of KwaZulu-Natal (KZN) and North West (NW) Provinces of South Africa. The population comprised of 24 participants who were purposively selected. The in-depth focus group discussions were conducted and ATLAS T.I. was used for data analysis following the basic steps of notice-collect-think (NCT) analysis. Trustworthiness and adherence to ethics were ensured. Results: The singular theme of factors facilitating NIMART trained nurses' adherence to treatment guidelines which included positive attitudinal needs and positive behavioural change emerged from raw data. Conclusion: Continuous training, support supervision, and improved relationships with colleagues need to be enhanced to enable NIMART trained nurses to adhere to treatment guidelines. [ABSTRACT FROM AUTHOR]