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Background: South Africa's progress towards forming a health promotion workforce lags behind the health promotion career opportunities and professional standards guided by the Australian Health Promotion Association (AHPA), from which South Africa can learn valuable lessons. Problem statement: Despite the existence of a national health promotion strategy, inconsistencies in health promotion workforce standards are a national reality. In one of the 10 National Health Insurance pilot districts in South Africa, researchers investigated health care workers' experiences of the barriers and enablers for the health promotion workforce. Methodology: A qualitative explorative descriptive design was used. Health care workers (health promoters, n = 8; operational managers, n = 6; senior managers, n = 3) in Dr Kenneth Kaunda District's public health sector were sampled using purposive proportional quota sampling. Data were gathered through semi‐structured individual interviews until data saturation was reached (N = 17). Transcribed interviews were thematically analysed, supported by ATLAS.ti 8. Results: Five themes and thirteen sub‐themes emerged, and barriers to the health promotion workforce exceeded enablers. Health promotion workforce structure and policies were deficient. Managerial supervision and monitoring were lacking. The health promotion workforce received insufficient resources with limited implementation of health promotion programs. Formal and informal health promotion training was necessary. Recommendations: The AHPA's proposed Health Promotion Workforce model is considered, focusing on a clear workforce structure, strengthened by managerial buy‐in and efficient monitoring and evaluation. Formal and informal health promotion training and advocacy of the health promotion workforce industry are highlighted. Countries with emerging economies and similar health systems to South Africa might find this article useful. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are increasing at an alarming rate among the South African population. This study aimed to determine the prognostic value of modifiable CVD risk factors for fatal and non-fatal events to inform cardiovascular health promotion practices in the South African public health system. Methods: Data was collected from individuals participating in the South African leg of a multi-national prospective cohort study. Binary logistic regression was applied to estimate odds of total, non-fatal and fatal cardiovascular events. Results: Binary logistic regression analyses identified age as a predictor of non-fatal and fatal CV events, with ORs of 1.87 to 3.21, respectively. Hypertension increased the odd of suffering a non-fatal CV event by almost two and a half (OR = 2.47; 95% CI = 1.26, 4.85). Moreover, being physically active reduced the odd of non-fatal CVD events by 38% (OR = 0.62; 95% CI = 0.46, 0.83 for 1 Standard deviation increase of the weighted physical activity index score (WPA)). On the one hand, gamma-glutamyltransferase (GGT) was associated with a higher fatal cardiovascular disease risk OR = 2.45 (95% CI = 1.36, 4.42) for a standard deviation increase. Conclusions: Elevated blood pressure, GGT, and physical activity have significant prognostic values for fatal or non-fatal CV events. These findings emphasise the importance of highlighting hypertension and physical activity when planning cardiovascular health education and intervention programmes for this population, with attention to the monitoring of GGT. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to give an overall view of the pattern of high-dose vitamin A supplementation (VAS) coverage in twenty-three sub-Saharan African countries and factors associated with receipt of VAS among children aged 6-59 months.Design: Cross-sectional data from the twenty-three Demographic and Health Surveys conducted from 2011 to 2015 in twenty-three sub-Saharan African countries were pooled. A multilevel logistic regression model was used to explore factors associated with VAS.Setting: Twenty-three sub-Saharan African countries.ParticipantsChildren (n 215 511) aged 6-59 months.Results: The overall coverage of VAS among children aged 6-59 months for the surveys included was 59·4 %. In the multivariable analysis, children whose mothers had primary (adjusted OR (aOR)=1·43; 95 % CI 1·39, 1·47) or secondary or above (aOR=1·72; 95 % CI 1·67, 1·77) educational status were more likely to receive VAS than children whose mothers had no formal education. Other factors associated with significantly increased likelihood of VAS were: living in urban areas; children of working mothers; children whose mothers had higher media exposure; children of older mothers v. children of mothers aged 15-19 years; and older children v. children aged 6-11 months. At the country level, lower media exposure was significant and negatively associated with VAS.Conclusions: Broader VAS coverage is needed according to our data. More efforts are needed to scale up coverage, focusing mostly on groups at risk of non-receipt of vitamin A. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to give an overall view of the pattern of high-dose vitamin A supplementation (VAS) coverage in twenty-three sub-Saharan African countries and factors associated with receipt of VAS among children aged 6–59 months. Design: Cross-sectional data from the twenty-three Demographic and Health Surveys conducted from 2011 to 2015 in twenty-three sub-Saharan African countries were pooled. A multilevel logistic regression model was used to explore factors associated with VAS. Setting: Twenty-three sub-Saharan African countries. Participants: Children (n 215 511) aged 6–59 months. Results: The overall coverage of VAS among children aged 6–59 months for the surveys included was 59·4 %. In the multivariable analysis, children whose mothers had primary (adjusted OR (aOR)=1·43; 95 % CI 1·39, 1·47) or secondary or above (aOR=1·72; 95 % CI 1·67, 1·77) educational status were more likely to receive VAS than children whose mothers had no formal education. Other factors associated with significantly increased likelihood of VAS were: living in urban areas; children of working mothers; children whose mothers had higher media exposure; children of older mothers v. children of mothers aged 15–19 years; and older children v. children aged 6–11 months. At the country level, lower media exposure was significant and negatively associated with VAS. Conclusions: Broader VAS coverage is needed according to our data. More efforts are needed to scale up coverage, focusing mostly on groups at risk of non-receipt of vitamin A. [ABSTRACT FROM AUTHOR]

Fragmented connectivity in South Africa is the dominant barrier for digitising initiatives. New insights surfaced when a university-based nursing programme introduced tablets within a supportive network learning environment. A qualitative, explorative design investigated adult nurses' experiences of the realities when moving from paper-based learning towards using tablets within a blended learning environment. Purposive sampling was applied. 45 (N) participants were included, each receiving a preloaded tablet (15 running on iOS, 15 on Android 4.2.2 Jelly Bean and 15 on Windows® 8 operating systems), being WiFi-dependent, integrated into a supportive learning network. Participants completed eleven compulsory Internet-based activities. Three reflective focus groups with 18 (n) participants concluded the project. Through self-empowerment and supportive environment, students adopted seamlessly, overcame network and resource-related challenges. Valuable lessons were learned within the digital divide, integrate tablets into distance learning from a resilient and pragmatic approach. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to investigate the complex mediation analysis between physical inactivity and overweight in relation to mortality. Methods: The study is based on public data collected by the Global Health Observatory (GHO) of the World Health Organisation. Results: We showed that the median early mortality attributable to NCDs during the period 2016 - 2019 in both men and women all together was 23.2% (5th to 95th range = 17.2, 35.6) while that in men alone was 25.1% (16.5, 45.7) and that of women was 22.0% (17.0, 27.9). When considering regional early NCDs mortality for both men and women, a systematically high median was observed in Southern Africa (28.7% (22.2, 43.8)) and a low median in Eastern Africa (21.1% (17.15, 27.3)). The analysis of the overall relation between physical inactivity, overweight and early mortality due to NCDs revealed a statistical significance of the direct association between physical inactivity and early mortality due to NCDs. Conclusion: Our findings revealed three main epidemiological and public health concerns. First, an early mortality attributable to NCDs in a range of about 20% to 30% across the SSA regions for both sexes were observed. Second, there was a direct effect between physical inactivity and early NCDs mortality as well as for the indirect effect mediated by overweight. Finally, a percentage point decrease of physical inactivity prevalence and overweight could effectively generate a reduction of mortality due to NCDs. Future studies are needed to confirm the scientific evidence observed in this study. Such studies should be based on observation of individual subjects, adopt a longitudinal design, and collect information that evaluate the complex relation between physical inactivity and early NCDs mortality, along with the role of overweight as a possible mediator. [ABSTRACT FROM AUTHOR]

Unhealthy food choices and consumption, coupled with sedentary lifestyles among consumers, intensify public health concerns regarding the quadruple disease burden, despite Primary Health Care (PHC) policy. However, the current relationship between consumer knowledge about healthy foods and following a healthy lifestyle needs to be explored. Our study, therefore, aimed to determine the association between consumers' subjective and objective knowledge about healthy foods and various healthy lifestyle choices. A cross-sectional survey was conducted among employed consumers (N = 157) from South African corporate settings. We used structural equation modelling (SEM) to determine associations between subjective and objective knowledge about healthy foods and healthy lifestyle choices. Our findings showed that most participants scored high on making healthy lifestyle choices relating to avoiding smoking (69.5%) and limiting drinking alcohol (68.7%) but less so for food and sleep (44.4%) while neglecting exercise, relaxation (13.7%), and choices that require dedicated effort (25.2%). On average, participants had high levels of subjective (mean = 3.59; 5-point Likert scale) knowledge and objective knowledge about healthy foods (88.4−95.9% correct responses). However, their objective knowledge about weight and cholesterol had severe deficiencies (36.7%). SEM confirmed an association between subjective knowledge and most healthy lifestyle choice categories, while income contributed to dedicated effort lifestyle choices. By contrast, objective knowledge did not associate with such choices. Our structural model suggests that subjective knowledge about healthy foods contributes to healthy lifestyle choices. Therefore, subjective knowledge and the objective knowledge deficiencies we identified among corporate consumers can serve as a valuable starting point for informed education to promote PHC policy and healthy lifestyle choices. [ABSTRACT FROM AUTHOR]

Objective:Design:Setting:Subjects:Outcome measures:Results:Conclusions:The aim of this study was to explore how participants and physicians experienced a plant-based dietary approach to type 2 diabetes mellitus (T2DM) in South Africa.A multiple-case study was undertaken.The pilot ‘Diabetes Reversal Challenge’ was initiated and led by UBUNTU Wellness Institute. Participants with T2DM consume a whole-food plant-based diet for 21 days and are assigned to private physicians for clinical monitoring of health outcomes.South African adults with T2DM (n = 10) and physicians (n = 4) participated in the challenge between April 2021 and May 2022.Participants’ health outcomes and contextual factors influencing how participants and physicians experienced the plant-based dietary approach in South Africa were the measures used.The plant-based dietary approach resulted in positive health outcomes for South African adults with T2DM, such as improved glycaemic control, weight loss, reduced need for medication and psychological benefits. Multiple layers of contextual factors influenced the plant-based dietary approach to T2DM in South Africa, mapped into a socio-ecological framework that includes (1) individual, (2) interpersonal, (3) organisational, (4) community and (5) healthcare system factors.These results encourage healthcare systems to explore plant-based dietary approaches as an option in the management of T2DM in South Africa. [ABSTRACT FROM AUTHOR]

Introduction: Limited research on cultural competence in nursing, midwifery, and education exists within low- and middle-income countries such as South Africa (SA). This study aimed to describe midwives' self-reported levels of cultural competence toward women receiving maternal care. Methodology: A descriptive, cross-sectional survey design and an all-inclusive sample of (N = 104; n = 82) midwives yielded a 79% response rate. Data were collected using the Transcultural Self-Efficacy Tool (TSET) questionnaire. Participants included midwives recruited from maternity units of five hospitals in South Africa: different hospitals that included one large district, two regional, and two tertiary hospitals in the North-West Province of SA. An all-inclusive sample of (N = 104; n = 82) midwives participated, representing a 79% response rate. Results: Midwives reported an overall moderate level of competence regarding their knowledge and understanding of cultural factors; it was concerning that their confidence in interviewing patients from different cultural backgrounds on factors such as acculturation and worldview were the lowest. Discussion: To the best of the authors' knowledge, this was the first study to assess the cultural competence of midwives in SA using TSET. The study highlighted the need for midwives' training to improve their cultural competence. [ABSTRACT FROM AUTHOR]

klopper h.c., coetzee s.k., pretorius r. & bester p. (2012) Journal of Nursing Management 20, 685-695 Practice environment, job satisfaction and burnout of critical care nurses in South Africa Aim To describe the practice environment, job satisfaction and burnout of critical-care nurses (CCNs) in South Africa (SA) and the relationship between these variables. Background CCNs are more sensitive to job satisfaction and burnout, and several studies have been published on the relationship between these variables. However, the research that was undertaken did not focus exclusively on the practice environment of CCNs or the context of SA. Method The RN4CAST survey was used. A stratified sample of 55 private hospitals and seven national referral hospitals were included in the study. A total of 935 CCNs completed the survey. Results The practice environment is positive, except for staffing and resource adequacy, and governance. The greatest job dissatisfaction is experienced with regard to wages, opportunities for advancement and study leave. CCNs have a high degree of burnout. Conclusion The high degree of burnout is related to dissatisfaction with wages, opportunities for advancement, study leave and a practice environment with inadequate staffing and resources, and lack of nurse participation in hospital affairs. Implications for nursing management Managers should ensure that adequate numbers of CCNs are on the staff allocation and provide opportunities for CCNS to participate in policy and governance of the hospital, while giving attention to good salaries and providing opportunities for advancement and study leave. [ABSTRACT FROM AUTHOR]