Challenges in the use of information technology in processing health information in resource limited settings: a comprehensive systematic review

The use of information technology in processing and utilising health information has significant health care outcomes. Its use in the assessment, diagnosis and management of health problems through access to relevant health information is crucial. The aim of this review was to identify the use of information technology in processing and utilising health information in low resource settings. A comprehensive systematic review focusing on resource limited settings was conducted. The review identified the following challenges in the use of information technology in resource limited settings: lack of health information system and networking; limited knowledge and skills; lack of information users’ participation; unavailability of standardised health indicators and poor quality information processing. Combining manual and technology assisted information processing system in less resource settings is essential in transforming and promoting the utilisation of health information. The capacity development training, involvement of community professional nurses and midwives in the design and development of health information system for processing and utilisation, and creating an enabling environment could help overcome the challenges in the use of information technology in low resource settings.Department of HE and Training approved lis

Rural-Urban Migration and its Consequence on Urban Living: The Case in Hawassa City Southern Ethiopia

In some developing countries such as Ethiopia the phenomenon of rural-urban migration which is mainly triggered by rural push factors and urban pull factors is the main cause of unbalanced rate of population growth and distribution between urban and rural areas This situation in turn affects the healthy development of both urban and rural areas In spite of this fact much is not known on many of the aspects of rural-urban migration As such this study is mainly concerned with an assessment of the consequence of rural-urban migration on the socio-economic condition of urban living consequence of rural-urban migration on the environment of urban areas and consequences of rural-urban migration on the urban labour scenario of the city In order to find out the problems household survey was conducted on 197 households sampled through systematic sampling Primary data had been collected through questionnaire and interview while the secondary one was from different documented sources Thus the data obtained from the participants was analyzed through descriptive statistics Having analyzed the collected data the researcher had arrived at the conclusion that rural-urban migration has impact on the socio-economic life of the urban dwellers Rural migrants came to urban areas in search of employment and to utilize urban services and facilities Since the continued out flow of rural migrants is in search for the urban basic facilities migrants have created pressure on the socio-economic and environmental condition of the host area Now the cities experiences problems such as a shortage of housing unemployment increasing cost of living lack of access to social services increased crime rate expansion of urban informal sector

Integrating prevention of mother to child HIV transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme

South Africa (SA) has the highest number of women infected with HIV and AIDS during pregnancy, which results in more than 70 000 infected babies being born each year AIDS is the major contributor to maternal and child morbidities and mortalities in the country. To combat this, the SA government has developed a national policy to prevent mother-to-child HIV transmission (PMTCT). However, for effective implementation of this policy, there is a dire need for a competent, skilled health worker to render the service. In response to this, the School of Nursing at the University of the Western Cape has integrated PMTCT competencies into the undergraduate Bachelor of Nursing Science curriculum. In this paper, we described teaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool. A quantitative descriptive design was used to analyse data collected from students in regard to assessment of PMTCT competencies achieved. The study used the conceptual framework of Lenburg’s competency outcomes and performance assessment model, which focuses on competency development and assessment in a clinical environment. HIV competencies, including PMTCT, should be integrated both theoretically and at service delivery into other nursing and midwifery competencies, including assessment strategies. Provincial policies in provision of antiretrovirals by nurses and midwives become barriers to successful implementation of PMTCT, resulting in limited learning opportunities for students to practice PMTCT competencies. Further research is required to assess an attribute, affect, which is another prong for competencies.Department of HE and Training approved lis

Health information officers’ views of mental health information processing and utilisation within an integrated primary healthcare service in Cape Town, South Africa

Health facility information officers have significant roles in gathering and processing health information and communicating it for utilisation. The purpose of this study was to explore the views of health information officers in processing and utilisation of mental health information within the context of primary health care. Fourteen health information officers were selected using purposive sampling techniques; they were interviewed, and data were grouped into themes. The study revealed a lack of structured information validation and feedback systems to improve the quality of information processing, and facility-level mental health information processing was fragmented and not used to improve service outcomes. Staff involved in health information recording and processing had limited skills to fulfill these tasks, and there were barriers to collecting and processing mental health information. These findings have major implications in improving mental health services within the integrated primary mental healthcare services, and in developing a sound and strong mental health information system.Department of HE and Training approved lis

Undergraduate nursing students’ perception of the psychosocial clinical learning environment at a selected Higher Education Institution

Master of Public Health - MPHBackground: Globally there is an urgent requirement for skilled nurses. For this reason, interventions in nursing education need to be carefully assessed and strategically planned and coordinated. In order to establish an effective clinical learning environment at education institutions, it is strongly recommended that one should gain insights from the perceptions of students, regarding their experience of their learning environment. Aim: The aim of the study was to investigate the undergraduate nursing students’ perceptions of the psychosocial clinical learning environment in a Higher Education Institution. Methodology: A quantitative descriptive survey design was used for this study in the form of questionnaires. The study utilized the pre-existing Clinical Learning Environment Inventory (CLEI) instrument developed by Chan (2001). The study utilised third year and fourth-year undergraduate nursing students. The target population comprised third year undergraduate nursing students (n=250), and fourth year undergraduate nursing students (n=248). The total target population was (n=498) undergraduate nursing students. A random sampling technique was used to select the study sample size of n=218. Self-administered questionnaires were distributed to two hundred and eighteen (218) respondents during class time and two hundred and eighteen (218) completed questionnaires were returned. The data was analysed using the Statistical Package for Social Science version 25. Descriptive statistical analysis was used to generate frequencies, mean values, median and standard deviation of observations. Reliability and validity of the study was ensured as described in the methodology section. Permission to use students for the study was sought from the registrar of the University. Informed written 3 consent was sought from all the participants in this study. The ethical principles were adhered to ensure confidentiality and anonymity of the participants throughout the study and beyond. Results: The fourth year respondents, 64.7% (n=90) agreed that their facilitators often think of interesting activities compared to their third-year counterparts, 35.3% (n=49); whereas, 63.6% (n=77) agreed that the facilitator thinks up innovative activities for students as compared with 36.4% (n=44) third years. This significant difference between the year levels cannot be justified from the study findings. However, it can be attributed to an underestimation of the impact of innovation and its impact on teaching and learning. The perception of fifty percent (50%) each for both year levels reported that the clinician talks more, rather than listening to the students. These findings indicate that communication between students and their clinical facilitator is hindering the clinical learning experience. There was a significant difference found between the groups (t=1.1, p=.027), as the average opportunities for interaction between students and clinical facilitators were lower for third year [2.3(±0.4)], compared with the average participation score for the fourth year 2.4 (±0.4). Most of the respondents, 81.2% (n=177) reported that clinical placement was a waste of time. The findings showed that the degree of satisfaction declined as students progressed from third to fourth year. There was a significant difference between the groups with 91.1% (n=102) fourth years reporting that clinical placement was a waste of time compared to 70.8% (n=75) of their third-year counterparts. A probable explanation for this might be the fact that the learning objectives and activities differed in the academic progression. The extent to which students are allowed to make decisions and are treated fairly was found to be more favourable by fourth years than third years, with mean scores of 2.7±0.4 and 2.6±0.4 respectively; thus highlighting a greater level of independence at the more senior 4 level. Study findings reported that 47% (n=102) agreed that the preceptor/clinician often became side-tracked instead of sticking to the point and only 45.9% (n=100) stated that clinical placements were disorganized. The findings from this study indicated that half of the students did experience a certain level of clarity and organization across their classes, while others did not consistently receive this level of clarity. Conclusion: The findings of the study indicates that there was inadequate supervision, poor student-mentor interaction, a lack of clarity and organization and ineffective teaching methods that impacted negatively on their decision making skills and revealed the need for new strategies to be implemented in the nursing education system, in order to ensure a successful CLE. Recommendations: This study demonstrated that students perceive the CLE as a place to learn and obtain skills for the nursing profession, yet their perceptions of how they were taught did not reflect their enjoyment of learning, and showed room for improvement in how clinical facilitators used different teaching methods, interacted with learners, and allowed them to make decisions, all the while ensuring that the lines of communication were kept open. Clarity and an organizational culture were lacking in the students learning environment which impacted negatively on their perception of learning. It is imperative that clinical facilitators evaluate their behavior with students consistently, be aware of their behavior and be open to suggestions and recommendations on how to improve their teaching

Experiences of community nurses in management of a district-based mental health information system in the Western Cape, South Africa

The aim of this study was to explore the experiences of community nurses in the management of a mental health information system (MHIS). A purposive convenient sampling method was employed to select 23 community mental health nurses from 23 community health facilities for the study. Individual semi-structured interviews were used, and the data were analysed for themes. The main findings of the study were categorised into the themes of information gathering tools and contents, information processing, and challenges of mental health information processing. Subthemes which emerged were information gathering tools, head count information content, knowledge and skills, computer technology, information flow and sharing, resources, and feedback in information processing. Information processing in terms of data gathering, compiling, analysing, getting feedback, and sharing information were the major concerns. There were inadequate knowledge and skills in information systems, no standard information collection tools designed for mental health, and lack of infrastructure, such as a mental health information network system across the health facilities and up to the higher level. Mental health requires a responsible person that deals with the MHIS in terms of reporting, analysing and getting feedback from the results of analysis back to the people at ground level for implementation. The amount of mental health information being collected and processed was inadequate and of poor quality. This has resulted in having few data available for the decision making process and/or planning mental health services.Department of HE and Training approved lis

District facility managers’ perspectives of mental health information processing and utilisation at primary care level in the Western Cape

District health facility managers play a significant role in provision of primary health care (PHC) services, particularly in integration of mental health services into the PHC level and developing a district health information system, which includes an integrated mental health information system (MHIS). The aim of the study was to explore the views and involvement of district health facility managers in the mental health information processing and utilization in improving mental health service delivery within the context of PHC. The study employed a qualitative research approach. Fourteen facility mangers were recruited using purposive sampling techniques, and interviews were conducted in 2012 and 2013. The interview data were analysed using thematic content analysis. The study identified that mental health information processing systems are fragmented and inadequate for decision making, and it was not known how to use mental health information. Lack of knowledge in information processing and utilization, as well as poor information infrastructure and networking was associated with poor understanding about mental health, not considering mental health as one of the priorities within the district health services, and lack of higher officials’ interest in the mental health development programme. Also notable were the attitudes towards mental illness, which were a major problem. These findings have major implications, such as behavioral /attitudinal risk factors of higher officials, policy makers, and the community for MHIS development and interventions in the reduction of mental health problems in South Africa.Department of HE and Training approved lis

Developing a framework for a district-based information management system for mental health care in the Western Cape

Philosophiae Doctor - PhDA review of the literature has shown that there is a lack of mental health information on which to base planning of mental health services and decisions concerning programme development for mental health services. Several studies have indicated that the use of an evidence-based health information system (HIS) reduces inappropriate clinical practices and promotes the quality of health care services. This study was aimed at developing a framework for a district-based mental health information management system, utilising the experiences of health care providers and caregivers about a district mental health information system (DMHIS). Activity Theory was used as the philosophical foundation of the information system for the study. A qualitative approach was employed using semi-structured individual interviews, Focus Group Discussions (FGDs), systematic review and document analysis. The intervention research design and development model of Rothman and Thomas (1994) was used to guide the study, which was conducted in the Cape Town Metropole area of the Western Cape. A purposive, convenient sampling method was employed to select study participants. Ethical clearance for the study was obtained from the University of the Western Cape, and permission to use the health facilities from the Department of Health. The data collection process involved 62 individual interview participants, from mental health nurses to district health managers, health information clerks, and patient caregivers/families and persons with stable mental conditions. Thirteen caregivers took part in the FGDs. Document review was conducted at three community mental health centres. The data were analysed manually using content analysis. Core findings of the interviews were lack of standardized information collection tools and contents for mental health, information infrastructure, capacity building, and resources. Information processing in terms of collection, compiling, analysing, feedback, access and sharing information were the major problems. Results from document analysis identified inconsistencies and inaccuracies of information recording and processing, which in turn affected the quality of information for decision making. Results from the systematic review identified five functional elements: organizational structure; information infrastructure; capacity building; inputs, process, output and feedback; and community and stakeholders’ participation in the design and implementation of a mental health information system (MHIS). The study has contributed a framework for a DMHIS based on the findings of the empirical and systematic review. It is recommended that there is a need to establish a HIS committee at district health facility level for effective implementation of the framework and quality information processing. There is a need to ensure that staffs have adequate knowledge and skills required for effective implementation of an information system. It is recommended that higher education institutions include a course on HISs in their curriculum. It is suggested that the South African Mental Health Policy be reviewed to include an MHIS and ensure involvement of the community and stakeholders in this system as well as adequate budget allocation

Analysing implementation of the integrated tuberculosis, HIV and AIDS policy in a rural sub-district, Western Cape

Magister Curationis - MCurGlobally, tuberculosis (TB) and AIDS are the leading causes of morbidity and mortality of people, particularly in many developing countries. South Africa is among those countries with a high double burden of TB and HIV infections in the world. Although policy guidelines have been developed to mitigate the problems of TB and HIV coinfection, there are still challenges with their implementation. The aim of this study was to analyse the implementation of the integrated TB and HIV policy in a rural sub-district of the Western Cape. The study applied a descriptive survey method to collect data from 60 respondents selected using an all-inclusive sampling strategy. A self-reporting questionnaire was used, and data were analysed using the Statistical Package for Social Sciences (SPSS) program version 23. Descriptive statistics are presented with graphs and percentages. All ethical principles were adhered to. The results showed that 86% of the respondents were female nurses, 59% were registered nurses, and the rest were enrolled and assistant nurses. The general view of participants was that implementation of the integrated TB and HIV policy was poor, as only 25% (11) felt that they have sufficient knowledge and skills to implement it, while 50% (22) did not feel equipped to implement the integrated policy. These perceptions of inadequacy were justified by a lack of sufficient training, with only 32% of the respondents having attended training on integrated TB and HIV management. The nurses’ responses on actual practices ranged from poor to sufficient, and example being the management of HIV-positive TB patients with CD4 count of <100/μl, where 27.9% were unsure when to initiate antiretroviral therapy and 44.7% were unsure when isoniazid prophylaxis could not be given to HIVpositive patients. However, the findings indicated that TB and HIV policy guidelines were 86% and 85.7% accessible respectively. The study concluded that nurses do not implement the integrated TB and HIV policy guidelines sufficiently, mainly due to lack of adequate training which resulted in limited knowledge thus poor practice. It is recommended that a continuous staff capacity development programme, which includes suitable pre-service and in-service training in TB and HIV/AIDS management be developed and implemented as it has the potential to address the current knowledge and skills gaps which impact on implementation of the integrated TB and HIV policy

Academic help-seeking behaviour and barriers among college nursing students

Background: First-year college student’s smooth transition and academic success influenced by academic help-seeking behaviour. Academic help-seeking behaviour is largely affected by many factors, including demographic factors, self-esteem and the use of sources for academic learning. Aim: The study investigated academic help-seeking behaviour and barriers among first-year college nursing students. Setting: The study was conducted at a nursing college in the Western Cape province of South Africa. Methods: A cross-sectional descriptive survey design with a self-administered questionnaire was used to collect data from 130 first year nursing college students. Descriptive statistics and bivariate analysis were computed using Statistical Packages for Social Sciences (SPSS). Results: More than 77.7% used course materials and books to help with academic learning, 50% of students sought help from their teachers. Only 24.6% and 17.7% of students used YouTube and computers respectively. In all items measured help-seeking is not a threat to self-esteem, teachers and parents did not have unrealistic expectations of their academic performance. Language is significantly associated with (p  0.001) academic help-seeking behaviour. Conclusion: Most students mainly used informal sources for academic learning. Help-seeking was not a threat to self-esteem. The language barrier is significantly associated with academic help-seeking behaviour. The nursing college should provide a coordinated academic language support, academic consultation and counselling services for academically stressed first-year nursing students. Contribution: The findings highlighted language as a barrier to academic help-seeking. The study provides insight to strengthen the language and academic support for academic learning for first year nursing students