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Background: Coordinating care is a defining characteristic of high quality primary care. Currently, very little is known about coordination of care in South Africa's primary care setting. The Vula Mobile app was introduced in 2018 to assist with referring patients from primary care facilities to the Eerste River District Hospital (ERDH) emergency centre. The aim of this study was to evaluate the use of the app and its effect on coordination of care and capacity building of staff. Methods: Convergent mixed methods were used with quantitative data collected from hospital records and the Vula Mobile database, and with qualitative data collected from health professionals in primary care and the district hospital. Results: Out of 13 321 patients seen in the emergency centre of the district hospital over the 6-month study period, only 1932 (14.5%) of the patients were referred with Vula. Most of these referrals were accepted (85.5%). Sometimes, advice was given to (35.0%) or additional information was requested (27.4%) from the referring doctor. There was little use of Vula in providing other feedback (0.6%). The introduction of the Vula app led to a decrease in the number of inappropriately referred patients (6.7% to 4.2%, p = 0.004). Doctors using the Vula app perceived that it improved care coordination and had the potential for useful feedback. Conclusion: Vula improved coordination of patients referred from primary care facilities in the Metro Health Services to the district hospital, but missed the opportunity to support continuing professional development and learning. Utilisation of the Vula app should be increased and its potential to provide feedback should be enhanced. Attention should be given to reducing the number of patients self-referred or referred without using the Vula app. [ABSTRACT FROM AUTHOR]

Background: Non-compliance with designated referral pathways has ramifications such as increased patient waiting time, overburdening of higher levels of care and increasing healthcare costs on patients and the healthcare system. The purpose of this study was to assess the determinants of self-directed referrals amongst patients attending hospitals in the eThekwini district of KwaZulu-Natal. Methods: An analytic, cross-sectional study was conducted at the Medical Outpatient Departments across five district hospitals in eThekwini using interviewer-administered questionnaires. Descriptive statistics were used to determine the proportion and the most frequent factors contributing towards patient self-referral. The likelihood of patients to self-refer was tested using chi-square (X2) and a multivariate regression model. Results: There were 315 patients interviewed with 35% (n = 109/315) having self-referred. The majority (51%; 55/107) of self-referrals were male and were of African race (74%; n = 80/107). Five institutional factors, namely: availability of medication at the pharmacy (98%); quality of care at the facility (93%); waiting time at facility (92%); services provided (90%); and attitude of healthcare workers (87%), were ranked as the main drivers of self-referral. Multivariate logistic regression established a significant positive association between patient self-referral and male gender (OR 1.73; CI 1.04–2.87, p < 0.05). Age < 39 years (OR 0.96; CI 0.94–0.99, p < 0.05); and patient awareness of a referral letter (OR 0.28; CI 0.09–0.86, p < 0.05) emerged as protective factor against self-referrals. Conclusion: Males patients tend to bypass the referral pathway whilst younger patients and patients who were aware of a referral letter were less likely to bypass the referral system. In addition to addressing the systemic challenges of waiting times, quality of care and availability of medication, a patient-oriented approach that comprises education, encouragement and increased patient awareness is an important strategy to improve referral pathway compliance. [ABSTRACT FROM AUTHOR]

Background: Before 2006, the uptake into the prevention of mother-to-child transmission (PMTCT) for HIV programme was low in South Africa. We determined PMTCT programme uptake, and identified factors that affected enrolment into the PMTCT programme in the rural Limpopo province. Method: This cross-sectional study, conducted from 21 July to 20 August 2008, involved 200 consecutive women who met the inclusion criteria in the immediate postpartum period. An interviewer-administered questionnaire was used to obtain information on participants' knowledge and experience of, satisfaction with, and motivation for, enrolling in the PMTCT programme. Main outcome measures included voluntary counselling and testing (VCT) and PMTCT programme uptake rates, and factors reported to influence enrolment into the programme. Results: Of the 200 invited women, 169 (84.5%) responded. The mean age of participants was 25 years ± standard deviation. The human immunodeficiency virus prevalence rate was 23.6%. VCT and PMTCT programme uptakes were 96.9% and 90.9% respectively. Participants reported being aware of (95.2%) and satisfied with (81.6-97.4%) various aspects of the PMTCT programme. The safety of their babies was reported by most participants to be their motivation for enrolment (71.1%). Participants in the age-group 20-29 years were more likely than others to enrol in the PMTCT programme (p-value = 0.01). Conclusion: VCT and PMTCT programme uptakes were high and influenced by good knowledge, satisfaction with the PMTCT programme and participants' concern for the safety of their babies. [ABSTRACT FROM AUTHOR]

Objective: There is a lack of research on humour among adolescents in South Africa. This article examines cognitive flexibility and humor. The objective was to investigate the roles of gender and language as possible moderating variables in the relationship between adolescents' cognitive flexibility and sense of humour. Design: A correlational research design was used in which pupils were asked to complete the Multidimensional Sense of Humor Scale to assess their sense of humour. In order to determine the cognitive flexibility of the sample group, Martin and Rubin's Cognitive Flexibility Scale was applied. Setting and subjects: The initial sample comprised 1 203 adolescents (Grade 11 and 12 pupils) randomly selected from the Eastern Cape, Gauteng and Mpumalanga. Of these, a final 392 adolescents qualified after eliminating criteria had been applied. Results: No significant correlations were found between the total group or for the two genders. Significant positive correlations were found between cognitive flexibility and two of the scores for humour (creating and expressing humour), as well as for the total score for Afrikaans-speaking participants. Significant negative correlations were found between cognitive flexibility and all five of the scores for humour for the Nguni language speakers. Conclusion: This study recommends that culturally sensitive measuring instruments should be developed. [ABSTRACT FROM AUTHOR]