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Background: Low- and middle-income countries (LMICs), including South Africa, are currently experiencing multiple epidemics: HIV and the rising burden of non-communicable diseases (NCDs), leading to different patterns of multimorbidity (the occurrence of two or more chronic conditions) than experienced in high income settings. These adversely affect health outcomes, increase patients' perceived burden of treatment, and impact the workload of self-management. This paper outlines the methods used in a qualitative study exploring burden of treatment among people living with HIV/NCD multimorbidity in South Africa. Methods: We undertook a comparative qualitative study to examine the interaction between individuals' treatment burden (self-management workload) and their capacity to take on this workload, using the dual lenses of Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) to aid conceptualisation of the data. We interviewed 30 people with multimorbidity and 16 carers in rural Eastern Cape and urban Cape Town between February-April 2021. Data was analysed through framework analysis. Findings: This paper discusses the methodological procedures considered when conducting qualitative research among people with multimorbidity in low-income settings in South Africa. We highlight the decisions made when developing the research design, recruiting participants, and selecting field-sites. We also explore data analysis processes and reflect on the positionality of the research project and researchers. Conclusion: This paper illustrates the decision-making processes conducting this qualitative research and may be helpful in informing future research aiming to qualitatively investigate treatment burden among patients in LMICs. [ABSTRACT FROM AUTHOR]

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Background: In South Africa, children with cerebral palsy are nested within a family setting by immediate relatives, particularly in the rural areas. These immediate relatives are regarded as caregivers and are not trained with regard to providing care to children with special needs. Therefore, they have to find ways to adapt to their new roles of caregiving using the available resources. The aim of this paper is to present the challenges encountered by caregivers of children with cerebral palsy in rural areas of South Africa. Methods: This qualitative, explorative, descriptive, and contextual study included 10 caregivers for children with cerebral palsy who were purposively recruited from the three respective hospitals in Vhembe District within Limpopo Province. Data were collected through individual in-depth interviews and analysed using a thematic approach. Ethical considerations and measures to ensure trustworthiness were upheld throughout the study. Results: Four themes emerged from the study, namely economic problems facing caregivers; health problems encountered by caregivers; maltreatment of caregivers by community members, as well as access to transport for caregivers and children. Conclusion: Participants narrated that caring for a child with cerebral palsy is not an easy task for the caregiver, particularly in the rural areas of South Africa. They encounter various challenges as they strive to provide quality care to the children that they are caring for. An investigation is recommended concerning the kind of model which should be developed to support caregivers in caring for children with cerebral palsy in the rural areas. [ABSTRACT FROM AUTHOR]

Young people, particularly adolescent girls and young women, represent a growing proportion of those living with HIV. Edutainment programmes have been widely used throughout the world to "educate" and "entertain" audiences and tackle serious social issues in bold and engaging ways. This paper examines the extent to which an edutainment programme, MTV-Shuga, was reported to influence young people's engagement with sexual and reproductive health (SRH) information in rural KwaZulu-Natal, South Africa. In 2019 we conducted eight community-based screenings of MTV-Shuga episodes followed by 25 individual in-depth interviews and 13 focus group discussions with young people aged between 15 and 30. Interviews were audio recorded and transcribed verbatim. Data analysis was thematic and complemented by constant comparison and deviant case analysis techniques. In this rural and poor setting with a high burden of HIV, young people exhibited high levels of awareness of SRH and HIV but had constrained access to services, and limited ability to engage with parents or guardians on SRH matters. MTV Shuga provided an entertaining guide of ways to navigate the risks that they faced in a way that resonated with them. The findings highlight the importance of enabling young people in rural areas to watch MTV Shuga with peers in a safe space in which discussion of the content is facilitated. There is also value in encouraging parents to watch MTV Shuga as a means of enabling discussions between children and adults in their lives about SRH matters. [ABSTRACT FROM AUTHOR]

The concept of a focused ethnographic study ( FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts ( Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children ( IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements ( LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are women's responsibilities. [ABSTRACT FROM AUTHOR]

Background: This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. Method: Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people's organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. Results: Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. Conclusion: A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development. [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: 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: 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]

Background: Traditional medicine (TM) plays a key role in maintaining health in many societies. Given the requirement for TM disclosure, Allopathic Medicine Practitioners (AMPs) must encourage open communication with patients to persuade those who use TM to disclose. Addressing patient non-disclosure of TM requires this dialogue to be facilitated. We sought to understand and describe how South African AMPs facilitate disclosure of TM use during a consultation with patients who use both TM and allopathic medicine (AM) and how it influences the patients' willingness to disclose TM use. Methods: This qualitative exploratory descriptive study on AMPs at Gauteng district public hospitals in South Africa was conducted between 2021 and 2022. Non-probability purposive sampling was employed to select a sample of 14 AMPs. Individual participants were encouraged to share their unique experiences and interpretations of the phenomenon concerning TM use disclosure. The raw transcribed textual data were processed using ATLAS.ti, and inductive content analysis was undertaken following the coding of the content to identify categories. Results: The data revealed four major categories: 'providing a suitable atmosphere for disclosure,' 'encouraging patients to disclose TM usage to AMPs,' 'patient autonomy,' and 'AMP training'. During a consultation with patients who use both TM and AM, participants expressed their experiences and perceptions of TM nondisclosure. They also discussed several methods for encouraging patients to disclose their TM usage, particularly when TM is used concurrently with AM. Conclusion: This study expands on previously reported findings by describing how South African AMPs facilitate the disclosure of TM use during consultation. Many AMPs struggle to initiate TM conversations with their patients which results in non-disclosure. This study revealed that integrating TM into AM training programmes, promoting cross-practice, and creating a safe environment is necessary for the development and application of the most appropriate approaches that would assist in facilitating disclosure. [ABSTRACT FROM AUTHOR]

From a public health standpoint, a stringent visitation policy was necessary during the COVID-19 pandemic, but it had unforeseen communicative and emotional health consequences for family members. This study explored family members' experiences regarding implementing a restricted visitation policy when a patient was admitted with COVID-19 at public hospitals in the Vhembe district. Researchers used an exploratory, descriptive, and contextual qualitative technique. Twelve family members made up the population. Unstructured telephone interviews were used to obtain the data, and open coding was used to analyse data. Ethics were consistently followed. Before taking part, participants provided verbal informed consent, acknowledging that they could withdraw from the study if necessary. Three themes emerged: inadequate measures for temporary communication channels and techniques, the mental health effects of COVID-19 admission, and poor/lack of standardised visitation policy during the COVID 19-pandemic. There was a need to balance safety from contracting COVID-19 infection and promoting family-centred care. Virtual visits through telecommunication solutions could reduce fear and anxiety as the family could be updated on the progress of the hospitalised relative. Alternatively, hospital managers must allocate a dedicated person in the unit to update families when they call and enquire about the conditions. [ABSTRACT FROM AUTHOR]

Background: South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa. Methods: A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12. Results: RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation. Conclusion: Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool. [ABSTRACT FROM AUTHOR]

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in the maternal mortality rate was reported between 2020 and 2021, with Limpopo ranking fourth highest out of nine provinces. The Vhembe district maintained its position as the third-ranked area with a notably elevated maternal mortality rate. This study aimed to explore the strategies used to reduce the maternal death rate and improve the provision of quality maternal healthcare services based on participant experiences in selected hospitals of the Vhembe district, Limpopo Province. One hospital was purposively sampled from every four municipalities. A qualitative approach using a phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data, complemented by the use of an audio recorder, continuing until data saturation was reached. Data saturation was reached at the 20th participant; however, the researcher continued until 28 sampled participants were interviewed. An interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). The results indicate that, despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as the lack of material resources, shortage of staff, incompetent staff and poor infection control, affect the quality of maternal health services in the Vhembe district. The Limpopo Department of Health and hospital management should ensure that hospitals have all the necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies. [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]

Background: Many children who contracted Human Immunodeficiency Virus (HIV) through vertical transmission are now in their adolescent and early adult years. The aim was to explore the experiences of adolescents living with HIV (ALWHIV) during the transition from childhood to adulthood. Methods and Material: The study was conducted at selected primary healthcare facilities in the Mopani and Vhembe districts in July 2021. A qualitative research approach that included contextual, descriptive, and exploratory designs was used. The population comprised 27 ALWHIV who were purposively sampled and enrolled for ART care. Data were collected using in-depth interviews, and the question was "How is it for you as you live with a virus and transit from adolescent to adulthood". The open coding approach was used to analyse the data. Measures to ensure trustworthiness articulated in Lincoln and Guba's criteria and ethical considerations were adhered to. Findings: The findings revealed four themes: poor understanding of the disease condition, improved physical health when adhering to ARV treatments, challenges related to sexual maturity and intimate relationships, and parents not disclosing their children's HIV status. Conclusion: Parents' delayed and non-disclosure of adolescents' positive HIV status led to a lack of awareness about the course of the disease, non-adherence to ART, and unsafe sex practices that could increase the risk of HIV transmission and re-infection. To address these multiple obstacles associated with ALWHIV, a comprehensive, multi-sectoral approach that is teenager-friendly should be undertaken. [ABSTRACT FROM AUTHOR]

Complementary foods are required to be given timeously, in adequate amounts, prepared safely and must be nutritious. Caregivers play a vital role in ensuring that the complementary feeding transition and beyond happens optimally to achieve normal growth and development in their children. The aim was to explore what factors influenced the primary caregivers' choices during the complementary feeding transition period. A cross-sectional qualitative study was conducted using focus-group discussions and interviews with caregivers of children enrolled in the Optimal Child Growth and Development (OrCHID) study, which included participants from the Mother and Child in Environment (MACE) cohort and SONKE mother and child cohort. During the analysis of the focus-group discussions (FGDs) and interviews, nine themes were identified including: (i) starting complementary feeding; (ii) food choices; (iii) family meals; (iv) food preparation methods; (v) meal composition; (vi) texture; (vii) education source; (viii) food source; and (ix) nutrition knowledge. These themes and the key concepts associated with them were categorised into timing and transition, meal preparation, and knowledge and choices. The caregivers relied largely on advice from family members who advised on their customs and cultural belief systems, which then impacted when the caregivers started complementary foods, food choices, texture, meal composition and transition to family meals. The caregivers sourced complementary foods based on accessibility, convenience and affordability. The caregivers described having a responsive feeding style, where their decisions were influenced by their sensitivity to how their child was responding emotionally and/or physically to the foods they were receiving. focus group discussion, complementary feeding practices, caregivers [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 treatment gap for mental health services is a growing public health concern. A lay-counselling service located at primary health care (PHC) level could potentially help to close the large treatment gap for common mental disorders in South Africa. The aim of this study was to understand multilevel factors contributing to implementation and potential dissemination of such a service for depression at PHC level. Methods: Process qualitative data of the lay-counselling service for patients with depressive symptoms was collected alongside a pragmatic randomized controlled trial evaluating a collaborative care model that included a lay-counselling service for patients with depressive symptoms. Semi-structured key informant interviews (SSI) were conducted with a purposive sample of PHC providers (lay-counsellors, nurse practitioners, operational managers), lay-counsellor supervisors, district and provincial managers, and patients in receipt of services. A total of 86 interviews were conducted. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection as well as Framework Analysis to determine barriers and facilitators for implementation and dissemination of the lay-counselling service. Results: Facilitators identified include supervision and support available for counsellors; person focused counselling approach; organizational integration of the counsellor within facilities. Barriers included lack of organizational support of the counselling service, including lack of counselling dedicated space; high counsellor turnover, resulting in a counsellor not available all the time; lack of an identified cadre to deliver the intervention in the system; and treatment of mental health conditions including counselling not included within mental health indicators. Conclusions: Several system level issues need to be addressed to promote integration and dissemination of lay-counselling services within PHC facilities in South Africa. Key system requirements are facility organizational readiness for improvement of integration of lay-counselling services; formal recognition of counselling services provided by lay counsellors as well as inclusion of lay counselling as a treatment modality within mental health treatment data element definitions and the need for diversification of the roles of psychologists to include training and supervision of lay counsellors was also emphasized. [ABSTRACT FROM AUTHOR]

Universal health coverage (UHC) aims to ensure people have access to the health services they need. Sixteen tracer indicators were developed for implementation by countries to measure UHC in the health system. South Africa uses 15 of the proposed 16 indicators. Operational managers in the public health care sector collect data and report on these indicators at a primary health clinic level. This qualitative study explored the knowledge and attitudes of managers toward data and UHC service indicators in a sub-district in Ugu, KwaZulu-Natal, South Africa. Operational managers saw data collection as information gathering, measuring performance and driving action. They understood UHC indicators as 'health for all' linking them to National Department of Health Strategic plans and saw the value of indicators for health promotion. They found the lack of training, inadequate numeracy skills, requests for data from multiple spheres of government and the indicator targets that they had to reach as challenging and untenable. While operational managers made the link between data, measuring performance and action, the limited training, skills gaps and pressures from higher levels of government may impede their ability to use data for local level planning and decision making. [ABSTRACT FROM AUTHOR]

This study investigated the impact of work-integrated learning (WIL) experiences for Technical and Vocational Education and Training (TVET) lecturers on their industry expertize and teaching skills. WIL was introduced to address the inadequate work experience of TVET lecturers and improve their capacity to deliver quality teaching. The study used face-to-face semi-structured interviews with 18 TVET lecturers to explore their WIL experiences. Non-participant observation was also conducted to validate findings from interviews. Kolb's experiential learning theory, Shulman's Teaching framework and the soft skills theory by Ibrahim et al. underpinned the study. Data were analyzed using thematic analysis. The study showed that WIL enhanced lecturers' ability to integrate theory with practice and provide effective teaching. Lecturers acquired a deep understanding of pedagogical content knowledge, soft skills, and awareness of workplace culture. Future studies focusing on a variety of trades for lecturers are recommended. [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]

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]

Although evidence indicates that task-shared psychological interventions can reduce mental health treatment gaps in resource-constrained settings, systemic barriers have limited their widespread implementation. Evidence on how to sustain and scale such approaches is scant. This study responds to this gap by examining the experiences of South African health managers involved in the implementation of a task-shared counselling service for Project MIND. To qualitatively describe managers' experiences of implementing the MIND programme and their insights into potential strategies for supporting sustained implementation. Two focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted with managers of urban and rural primary care facilities in the Western Cape province. All managers were female and 30–50 years old. FGDs and IDIs used an identical semi-structured topic guide to explore the experiences of the MIND programme and perceived barriers to sustained implementation. Normalisation process theory (NPT) guided the thematic analysis. Four themes emerged that mapped onto the NPT constructs. First, managers noted that their relational work with staff to promote support for the intervention and reduce resistance was key to facilitating implementation. Second, managers emphasised the need for staff reorientation and upskilling to foster openness to mental health practice and for adequate time for quality counselling. Third, managers underscored the importance of strengthening linkages between the health and social service sectors to facilitate delivery of comprehensive mental health services. Finally, managers recommended ongoing monitoring of the service and communication about its impacts as strategies for supporting integration into routine practice. Findings contribute to the emerging literature on strategies to support implementation of task-shared interventions in low- and middle-income countries. The findings highlight the leadership role of managers in identifying and actioning these strategies. Investing in managers' capacity to support implementation of psychological interventions is critical for scale-up of these mental health innovations. [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]

Purpose: Adolescents may be known to take risks, but they may also conform to societal norms if they are given proper guidance, implying that there is a need for proper monitoring. This qualitative study explores the influence of family dynamics on adolescents sexual risk behaviour within a migration affected community.Method: Using thematic analysis, we processed data collected from 13 adolescents and 10 parents.Results: The themes generated from our data include the following, "Household poverty", "Family conflicts", "Lack of discipline", "Parent-child closeness", "Generational gap between adolescents and their parents" and "Lack of sex education". Our study found that financial constrain was a major problem in this community, the impact of this was worse felt among adolescents who lived by themselves. In addition, some parents were delinquent, distant or detached from their adolescents. We also found evidence to suggest that couple conflict was a common occurrence, and this had negative influence on adolescent well-being and there sexual behaviour.Conclusion: In view of the deepening crisis of early sexual engagement among adolescents and the accompanying risk of unplanned pregnancy and sexually transmitted infections, it is imperative to foster adolescent friendly households where the parents/caregivers are empowered to support their adolescents. [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 presence of family members and their active involvement in caring for hospitalised children is an established practice in many African paediatric settings, with family members often regarded as a resource. This aspect of African paediatric nursing practice lacks formal expression or a clear conceptual basis, and difficulties arise when applying concepts of family involvement originating from the culturally distinct practice environments of higher resourced settings including Europe and America. The aim of this study was to articulate a nurse-led practice innovation intended to facilitate family involvement in the care of hospitalised children, observed in a paediatric inpatient ward in a district hospital in rural KwaZulu-Natal, South Africa. Methods: A qualitative case study design was used. Data collection included visual research methods (graphic facilitation, sociograms and photo-elicitation) as well as a focus group, interviews and practice observation. Activities associated with 20 nurses and 22 mother-child dyads were observed. Data were subjected to content analysis, with Standards for Reporting Qualitative Research (SRQR) applied. Results: Findings relate to six aspects of practice, categorised thematically as: preserving the mother-child pair; enabling continuous presence; psychological support and empathy; sharing knowledge; mothers as a resource; and belief and trust. Conclusion: The nursing practices and organisational policies observed in this setting relating to the facilitation of continuous maternal presence represent a distinctive nursing practice innovation. This deliberate practice contrasts with models of care provision which originate in higher resourced settings including Europe and America, such as Family Centred Care, and contrasts with informal practices in local African settings which tolerate the presence of mothers in other settings, as well as local institutional policies which limit mothers' presence to varying extents. [ABSTRACT FROM AUTHOR]

Background Despite acknowledgement of the complexity and challenges of the process of disclosure of HIV status to adolescents, little work has been carried out on the communication features which facilitate or hinder the process. This qualitative case study reflects the interactional dynamics of an interaction between caregiver, physician and counsellor around the topic of disclosure in a South African clinic. Methods A 40-minute encounter between a doctor, the grandmother of an adolescent with HIV/ AIDS and a counsellor around the process of disclosure was transcribed and examined in detail in relation to its structure, topics, timing and sequence as well as its movement towards a collaborative ending. Analysis was based on elements of conversational and thematic analysis. Results The session was characterized by distinct stages and the emergence of multiple voices and perspectives from the participants. The negotiated management of the session sheds light on multiple barriers to care as well as the influence of contextual factors on the process. The important mediating role of the counsellor in the triad emerges. The analysis highlights both unique features of the consultation and common challenges to clinicians when disclosing. Discussion and Conclusions The task of disclosure is complex and intricate. Results suggest team processes are critical, as are temporal and contextual factors and the need for an understanding of communication. Implications for the clinic team are discussed and suggestions made for the development of collaborative partnership based on an understanding of roles and responsibilities, time factors and enhancement of features such as trust and communication. [ABSTRACT FROM AUTHOR]

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: Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion often on the grounds of religious or moral beliefs including the unregulated practice of conscientious objection. Few studies have explored how providers in South Africa make sense of, or understand, conscientious objection in terms of refusing to provide abortion care services and the consequent impact on abortion access. Methods: A qualitative approach was used which included 48 in-depth interviews with a purposively selected population of abortion related health service providers, managers and policy influentials in the Western Cape Province, South Africa. Data were analyzed using a thematic analysis approach. Results: The ways in which conscientious objection was interpreted and practiced, and its impact on abortion service provision was explored. In most public sector facilities there was a general lack of understanding concerning the circumstances in which health care providers were entitled to invoke their right to refuse to provide, or assist in abortion services. Providers seemed to have poor understandings of how conscientious objection was to be implemented, but were also constrained in that there were few guidelines or systems in place to guide them in the process. Conclusions: Exploring the ways in which conscientious objection was interpreted and applied by differing levels of health care workers in relation to abortion provision raised multiple and contradictory issues. From providers' accounts it was often difficult to distinguish what constituted confusion with regards to the specifics of how conscientious objection was to be implemented in terms of the Choice on Termination of Pregnancy Act, and what was refusal of abortion care based on opposition to abortion in general. In order to disentangle what is resistance to abortion provision in general, and what is conscientious objection on religious or moral grounds, clear guidelines need to be provided including what measures need to be undertaken in order to lodge one's right to conscientious objection. This would facilitate long term contingency plans for overall abortion service provision. [ABSTRACT FROM AUTHOR]

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

Background: 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: Zimbabweans are immigrating to South Africa with a commonly cited reason being economic opportunities. Prospects of finding employment may be a significant reason to leave behind family, friends, and community, sources that buffer and offer social support against life's challenges. Currently, there is a dearth of research examining the motivators for Zimbabweans immigrating and the experiences encountered along the way and after arrival in South Africa. Such research is essential as large numbers of Zimbabweans may be at risk for emotional and physical trauma during this process. Methods: Two gender specific focus group discussions, each lasting 90-minutes and consisting of homeless Zimbabwean refugees, were conducted in the Limpopo Province of South Africa. A semi-structured interview assessed for experiences in and reasons for leaving Zimbabwe, as well as experiences en-route and within South Africa. Discussions were audio-recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method. Results: Three temporal themes were identified and included challenges and trauma experienced in Zimbabwe (pre-migration), during the immigration journey (mid-migration), and upon arrival in South Africa (post-migration). While there were some experiential differences, Zimbabwean men and women shared numerous traumatic commonalities. In addition to the themes, three subthemes contributing to reasons for leaving Zimbabwe, two subthemes of negative and traumatic experiences incurred mid-migration, and two post-migration subthemes of challenges were identified. Conclusion: Despite the difficulties encountered in their homeland, newly arrived Zimbabweans in South Africa may be exchanging old struggles for a new array of foreign and traumatic challenges. Reasons to immigrate and the psychological and physical toll of migration exacted at the individual and community levels are discussed. Recommendations advocating for culturally congruent mental health research, the training of culturally competent researchers and clinicians, and the development of policies that could influence the quality of life of Zimbabwean refugees are provided. [ABSTRACT FROM AUTHOR]

The development of critical consciousness is seen as a key stage in communities increasing levels of dialogue about priority problems and effecting structural change for health. However, relatively little research identifies concrete methods for programmes to build critical consciousness. We examined how a South African structural intervention used critical consciousness as a tool for prevention of intimate partner violence and HIV infection. We collected qualitative data in the form of in-depth interviews with managers, trainers, and participants of the Intervention with Microfinance for AIDS and Gender Equity intervention (IMAGE) in rural South Africa. The data were analysed through a coding structure developed in QSR NVivo. We draw practical lessons from IMAGE to guide other HIV programmes aiming to promoting critical consciousness and social mobilization. This research suggests that specific curricular tools can work towards critical consciousness and that mobilization efforts in future programmes can be strengthened by including individual and collective efforts by participants [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]

Despite efforts to support breastfeeding for HIV‐positive mothers in South Africa, being HIV‐positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision‐making about infant feeding practices among HIV‐positive mothers in a rural and urban settings in KwaZulu‐Natal, South Africa. HIV‐positive pregnant women were purposively sampled from one antenatal clinic in each setting. A qualitative longitudinal cohort design was employed, with monthly in‐depth interviews conducted over 6 months postdelivery. Data were analysed using framework analysis. We report findings from 11 HIV‐positive women within a larger cohort. Participants were aged between 15 and 41 years and were all on antiretroviral therapy. Before delivery, nine mothers intended to exclusively breastfeed (EBF) for 6 months, and two intended to exclusively formula feed (EFF). Three mothers successfully EBF for 6 months, whereas four had stopped breastfeeding, and two were mixed breastfeeding by 6 months. Mothers reported receiving strong advice from health workers (HWs) to EBF and made decisions based primarily on HWs advice, resisting contrary pressure from family or friends. The main motivation for EBF was to protect the child from HIV acquisition, but sometimes fear of mixed feeding led to mothers stopping breastfeeding entirely. Infant feeding messages from HWs advice were frequently inadequate and out of date, and failed to address mothers' challenges. Minimal support was provided for EFF. In conclusion, HWs play a pivotal role in providing infant feeding support to HIV infected mothers, but need regular updates to ensure if advice is correct and appropriate. [ABSTRACT FROM AUTHOR]