Search

Background: Literature shows that in South Africa there are insufficient resources to meet mental healthcare needs. At general or district hospital level, the non-specialist doctor is often responsible for the holistic assessment and management of mental health service users. Such situations inevitably increase doctors' care load as they are required to treat across disciplines. We highlight the particular challenges faced by a community service (CS) doctor in this context. Methods: The presented case study formed part of a larger project that investigated public mental healthcare provision in the Eastern Cape province. Data were collected through a once-off semi-structured interview with the participant. The interview was transcribed and data analysed by utilising thematic analysis to yield results. Results: The study suggests that the CS doctor experiences being overloaded with duties, and feels overwhelmed in a healthcare context that lacks resources needed for service provision, which may lead to inadequate mental healthcare provision to public health service users. Conclusion: Healthcare facilities in rural parts of the Eastern Cape province are in need of assistance. This in-depth account highlighted the consequences of working on the front line of a disadvantaged and under-resourced health system. The presented account can be interpreted as a cry for help by CS doctors for relevant authorities to improve access and provision of mental healthcare in the area. Contribution: The paper provides an exploration of the circumstances wherein mental healthcare is provided in rural parts of South Africa. [ABSTRACT FROM AUTHOR]

Background: Gender equality remains an outstanding global priority, more than 25 years after the landmark Beijing Platform for Action. The disconnect between global health policy intentions and implementation is shaped by several conceptual, pragmatic and political factors, both globally and in South Africa. Actor narratives and different framings of gender and gender equality are one part of the contested nature of gender policy processes and their implementation challenges. The main aim of this paper is to foreground the range of policy actors, describe their narratives and different framings of gender, as part exploring the social construction of gender in policy processes, using the Adolescent Youth Health Policy (AYHP) as a case study. Methods: A case study design was undertaken, with conceptual underpinnings combined from gender studies, sociology and health policy analysis. Through purposive sampling, a range of actors were selected, including AYHP authors from government and academia, members of the AYHP Advisory Panel, youth representatives from the National Department of Health Adolescent and Youth Advisory Panel, as well as adolescent and youth health and gender policy actors, in government, academia and civil society. Qualitative data was collected via in-depth, semi-structured interviews with 30 policy actors between 2019 and 2021. Thematic data analysis was used, as well as triangulation across both respondents, and the document analysis of the AYHP. Results: Despite gender power relations and more gender-transformative approaches being discussed during the policy making process, these were not reflected in the final policy. Interviews revealed an interrelated constellation of diverse and juxtaposed actor gender narratives, ranging from framing gender as equating girls and women, gender as inclusion, gender as instrumental, gender as women's rights and empowerment and gender as power relations. Some of these narrative framings were dominant in the policy making process and were consequently included in the final policy document, unlike other narratives. The way gender is framed in policy processes is shaped by actor narratives, and these diverse and contested discursive constructions were shaped by the dynamic interactions with the South Africa context, and processes of the Adolescent Youth Health Policy. These varied actor narratives were further contextualised in terms of reflections of what is needed going forward to advance gender equality in adolescent and youth health policy and programming. This includes prioritising gender and intersectionality on the national agenda, implementing more gender-transformative programmes, as well as having the commitments and capabilities to take the work forward. Conclusions: The constellation of actors' gender narratives reveals overlapping and contested framings of gender and what is required to advance gender equality. Understanding actor narratives in policy processes contributes to bridging the disconnect between policy commitments and reality in advancing the gender equality agenda. [ABSTRACT FROM AUTHOR]

Introduction: Multipurpose prevention technologies (MPTs) simultaneously prevent HIV, other sexually transmitted infections, and/or unintended pregnancy. Key gatekeepers, [healthcare providers (HCPs) and key stakeholders] require proactive engagement before product implementation. This manuscript identifies HCP demand creation strategies, key stakeholder considerations for the adoption of MPTs in South Africa. Methods: Formative research was conducted in three districts in three South African provinces (July to November 2022). Nurses initiating oral PrEP at facility and mobile study sites participated in 4-hour participatory workshops, exploring HIV prevention, including MPTs, demand creation strategies, and preferred MPTs training packages. Activities were observed, transcribed, and thematically analysed. Five online in-depth interviews (IDIs) with Key informants (KIs) (National/district programme implementers and technical leads) and one in person, exploring key programmatic and policy considerations for MPT adoption. IDIs were approximately 40 min long, audio recorded, transcribed, and thematically analysed. Results: Twenty-one Professional Nurses completed workshops: 19 female. Six IDIs were conducted with 4 Facility Managers, 1 NDoH representative and 1 DoH Provincial Deputy Director. All participants were females, aged 30-60+ years with >10 years' in SRH/HIV policy/advocacy/research. Community conversations and information at the clinic were the best MPT demand creation methods among HCPs. KIs identified five considerations for future MPT implementation: HCP training; demand creation and messaging; existing PrEP policy amendments; preparing users for additional choice; and sustaining MPT provision. Conclusion: Contraceptive implant and oral PrEP implementation lessons learned should be proactively considered when preparing for MPT introduction. HCP training and demand creation are of particular importance before MPT introduction. [ABSTRACT FROM AUTHOR]

Ubuntu was recently adopted as the first theme for the 2020–2030 global agenda for social work, and yet little research is available to explore how it is transmitted and implemented in communities. The authors present findings of a qualitative study conducted in an academic setting in South Africa, where the transmission of Ubuntu was discussed among 30 young adult 'born frees'. Students seemed to embrace principles of Ubuntu as a whole; however, economic, social and cultural strains are documented as obstacles to its pragmatic application. Implications of community engagement through service learning as a means of strengthening Ubuntu are discussed. [ABSTRACT FROM AUTHOR]

Using local language improves the quality of healthcare and patient safety but little has been done to understand and use local language in naming and defining conditions such as dysmenorrhea. Many indigenous African women value their language especially when communicating about women's health. In this exploratory study, we wanted to understand the local language used to construct and conceptualize dysmenorrhea and highlight the importance of local language when healthcare practitioners engage with women experiencing dysmenorrhea guided by Africana Womanism Theory. Data were collected from 15 Black indigenous women using a Lekgotla discussion group and in-depth interviews. Data were thematically analyzed. Participants described how local language is important in naming and seeking healthcare. Drawing from their descriptions three themes emerged: (1) Self-naming and self-defining dysmenorrhea using a local language; (2) Types of local words, phrases, and terms used to name and define dysmenorrhea; (3) The importance of self-naming and self-defining dysmenorrhea in a local language. Communication between healthcare seekers and healthcare providers is at the heart of effective healthcare provision. Poor communication due to language barriers contributes to misunderstanding, misdiagnoses, poor or incomplete patient assessment, and delayed treatment. Therefore, communicating healthcare issues in a local language would promote culturally sensitive care. [ABSTRACT FROM AUTHOR]

The migration of social workers has become an established trend internationally. Existing research largely ignored the impact of culture on this migration. The study presented here focused on the experiences of social workers who were trained in South Africa and migrated to England. South African-trained social workers had to adjust to significant cultural differences, ranging from the place of religion, the characteristics of the family and parenting, forms of interpersonal communication and what is considered polite and impolite behaviour. Whilst these issues have a wide societal impact, they also shape the daily reality of practising social workers. Implications for practice are discussed, and pre-migration education about the host country's structures, a systemic induction process, mentorship and supervision with an emphasis on culture, is recommended. [ABSTRACT FROM AUTHOR]

Hospital managers are best suited and located to enhance patient safety culture within their institutions. This study sought to provide insight on the perceptions of 10 managerial staff regarding the patient safety culture at a tertiary academic hospital in South Africa. In-depth interviews were conducted with strategic and operational managers within high-risk units in order to determine their perceptions regarding patient safety culture. Participants described diverse aspects of the hospital's patient safety culture including an overview of patient safety, implementation of patient safety initiatives, challenges to patient safety, current management of patient safety issues, as well as ways to improve the patient safety culture of the hospital. The findings highlighted a number of areas to improve on to advance patient safety within the South African context. These include improving basic services, strengthening the infrastructure, improving staff attitudes and implementation of patient safety initiatives. Further research and development of quality improvement plans are essential to enhance patient safety. [ABSTRACT FROM AUTHOR]

Tuberculosis, which is an infectious airborne disease remained the main leading cause of death in South Africa for three consecutive years from 2016 to 2018. In 2020 alone, the country had an estimated 328,000 people who suffered from TB, with 61,000 dying from it. Collins Chabane Municipality had 129 and 192 new TB cases recorded in 2017 and 2018, respectively, which is far from reaching the END TB STRATEGY targets. WHO scientific evidence demonstrates that TB control measures are effective in reducing the spread and development of new cases. Though scientific evidence revealed negative attitudes towards the recommended TB control measures in public hospitals of the Vhembe district, a deeper understanding of these attitudes is needed to remedy the situation. This study aimed to describe healthcare workers' perceptions of TB control measures at Collins Chabane Municipality in South Africa. A qualitative, exploratory case study design was adopted. Multi-stage sampling technique was used to select both the healthcare facilities and the participants. Only 24 healthcare workers trained on tuberculosis management were voluntarily recruited. However, data were saturated at the twelfth (12) participant purposively selected from six healthcare facilities of Collins Chabane Municipality. Data collected through unstructured in-depth individual interviews were analyzed thematically. The proposal for this study was ethically cleared by the University of Venda Ethics Committee (SHS/20/PDC/35/1111). Results indicate that TB administrative, environmental and respiratory control measures are well understood by health workers even though there are challenges with implementation concerning some, such as closing windows during winter, UVGI lights that are non-functional and taking too long to be fixed, no specimen collection during weekends and holidays thereby delaying TB diagnosis and lack of skills concerning how to use respirators and cough etiquette. The Vhembe district TB control programme should intensify infection control training and continue monitoring giving the needed support. [ABSTRACT FROM AUTHOR]

Exploring perinatal women's experience of nonfatal suicidal behaviour (NFSB) could help illuminate the contexts in which perinatal suicide occurs and new ways to conceptualise maternal suicide prevention. Our aim was to explore perinatal women's subjective experience of NFSB in South Africa. Data were collected via in-depth interviews with seven perinatal women hospitalised following NFSB. Thematic analysis showed how poverty and gender norms shape experiences of pregnancy and highlighted the need for eco-systemic interventions for perinatal women in resource scarce environments to increase social support, assist with childcare, improve educational retention, challenge gender norms and increase paternal involvement. Pregnancy can precipitate biographical disruption by disturbing women's view of themselves and their futures. An inability to reconstruct a coherent narrative and re-imagine the future impedes the transition to motherhood and provides a context for suicide. Using the concept of biographical disruption to frame perinatal suicide, could identify novel approaches to suicide prevention. [ABSTRACT FROM AUTHOR]

South Africa has an estimated 2.5 million children aged from birth to 14 years who have lost one or both of their parents due to the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS). There is a scarcity in the psychosocial support aspect of improving orphaned and vulnerable children's (OVC) adherence and retention of HIV/AIDS treatment. This study explores and describes the achievements of the SARCS community intervention that the South Africa Red Cross Society (SARCS) undertook in providing psychosocial support to OVC infected with HIV/AIDS in Maluti sub-village in the Matatiele Local Municipality, in Alfred Nzo District, Eastern Cape, South Africa. A descriptive qualitative design of appreciative inquiry was conducted to assess OVC's perceptions regarding the effectiveness of the SARCS community intervention. Data collection was done using the World Café method, which makes use of an informal café setting where participants can explore an issue by discussing it while seated in small groups around tables. Thirty OVC between the ages of 13 and 17 years were purposively sampled and moved between tables at fixed time intervals, and in small groups discussed the questions that were channelled through an interview guide. The study established that OVC can thrive when their psychosocial basic needs are met. The SARCS Maluti project was instrumental in forming synergies in the cultivation of support systems between the OVC and the communities in which they reside when addressing psychological and socio-economic issues and HIV/AIDS. The study made recommendations that emphasised the importance of applying a holistic approach and the positive aspects of the inclusion of activities in addressing the OVC's needs and their psychological adaptation. [ABSTRACT FROM AUTHOR]

Objectives: To determine the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDG) among siSwati speaking mothers/caregivers of children aged 0–36 months. Previous exposure to guidelines with similar messages, barriers and enablers to following the guidelines were also assessed. Design: A descriptive, cross-sectional qualitative research approach was followed. Purposive and snowball sampling were used to recruit a total of 75 participants. Data were collected by means of focus-group discussions from 12 groups. Setting: Kabokweni, Mpumalanga, South Africa. Subjects: The study population included mothers/caregivers older than 18 years who provided informed consent. Results: The participants were generally aware of messages similar to those contained in the revised, draft SA-PFBDG. They reported exposure to these messages at clinics/hospitals, radio/television, and the Road-to-Health booklet. Participants showed good understanding of guidelines on breastfeeding, complementary feeding, inclusion of protein-rich and starchy foods as well as fruit and vegetables in the diets of young children as well as hygiene practices. The guidelines on avoiding tea, coffee and sugar drinks and high-sugar, high-fat salty snacks, being active and providing five small meals were less well understood. Enablers to following the guidelines were its perceived importance and positive impact on children's health. Barriers included misinterpretation of the guidelines and lack of money and resources. Conclusion: The revised, draft SA-PFBDGs are appropriate for the age group 0–36 months. A degree of rewording is suggested to aid understanding. The guidelines can be used as an educational tool to improve the nutritional status of children in South Africa. [ABSTRACT FROM AUTHOR]