Medical students' attitudes towards and perceptions of the Primary Health Care approach

Includes bibliographical references (p. 229-246).The aim of this research was to provide an understanding of medical students' attitudes towards and perceptions of the PHC approach, and this was done using mainly qualitative methods, namely focus groups, interviews, and one questionnaire. This research also investigated students' views of the way in which the PHC approach was taught, their understanding of the PHC approach, what could influence students' views of the PHC approach, the appropriateness of the PHC approach in South Africa, their opinions of the fact that UCT has a PHC-driven MBChB curriculum, their views of the role of doctors in the PHC approach, and a number of other related issues. The main findings were that students enter their medical degree with an expectation of a biomedical emphasis and a lecture-based curriculum

The impact of computer-based interventions with and without primary language support on reading skills of English language learners

Reading is the most important skill that English Language (EL) learners acquire in school (Slavin & Cheung, 2005). Success in reading has been shown to impact many areas of student social and economic opportunities (Peregoy & Boyle, 2005). Students who come to school with limited English proficiency have greater difficulty learning to read in English (Freeman & Freeman, 2004). With the rise in the number of EL learning students in schools, school districts are compelled to find ways to teach English literacy skills to students with primary languages other than English; This study had two purposes. The first purpose was to determine the impact of the Lexia Primary Reading Program (Lexia, 2004), a computer-based reading program, on the English reading skills of first grade students whose primary language is Spanish. The second purpose was to determine how the language of instruction (i.e., Spanish or English) provided by the Lexia Primary Reading Program impacts the English reading skills of EL learners; Forty-one first-grade EL students whose primary language is Spanish participated in this study. Of the 41 first-grade students, 16 were male and 25 were female. Students were assigned to three groups. Students in the experimental groups received computer-based instruction from Lexia Primary Reading Program (Lexia, 2004). One of the experimental groups received English oral language instructions while the other experimental group received Spanish oral language instructions. Students in the comparison group received an equal amount of computer time with non-literacy based instruction; Lexia Primary Reading Program (Lexia, 2004) was effective at increasing literacy skills in some of the areas measured (i.e., oral language, picture vocabulary, letter-word identification, and passage comprehension). Passage comprehension was the only area that showed a difference relative to the language of instruction provided. This study answered several important questions regarding literacy skills of EL learners

Spinal cord injuries in South African Rugby Union (1980-2007)

Objectives and design. To address an apparent increase in the number of rugby-related spinal cord injuries (SCIs) in South Africa, a retrospective case-series study was conducted on injuries that occurred between 1980 and 2007. We aimed to identify preventable causes to reduce the overall rate of SCIs in South African rugby. Methods. We identified 264 rugby-related SCIs. A structured questionnaire was used, and it was possible to obtain information on a total of 183 players, including 30 who had died. Results. SCIs increased in number in the 1980s and in 2006. Forwards sustained 76% of all SCIs, and club players 60%. Players aged 17 had the highest number of SCIs. In only 50% of cases were medical personnel present at the time of injury, and 49% of injured players waited longer than 6 hours for acute management. Of players with an SCI, 61% had a catastrophic outcome after 12 months, including 8% who died during that time; 65% received no financial compensation; and only 29% of players had medical aid or health insurance. Conclusion. A register of all rugby-related SCIs in South Africa is essential to monitor the magnitude of the problem, identify potential risk factors, and formulate appropriate preventive interventions. The lack of reliable denominator data limits calculation of incident rates. Players from previously disadvantaged communities in particular suffered the consequences of limited public health care resources and no financial compensation

Impact of a primary school-based nutrition and physical activity intervention on learners in Kwazulu-Natal, South Africa: A pilot study

Background. The opportunity for children to be physically active during school hours is rapidly decreasing in selected schools. This study evaluated the effects of a nutrition and physical activity (NAP) intervention incorporated within the school curriculum. Study design and methods. A prospective empirical pilot study with an intervention and an assessment of pre- and post-intervention fitness. Learners completed a NAP questionnaire and participated in a battery of fitness tests before and after intervention. Setting. A purposive sample of four primary schools in KwaZulu-Natal was selected by the provincial Department of Health. Interventions. The NAP intervention was designed to introduce various methods of physical activity and healthy nutritional habits within the school's existing curriculum. Classroom-based intervention materials were developed to provide cost-effective and, more importantly, a sustainable intervention. Results. Post-intervention results showed a significant increase (p<0.05) in the average number of sports participated in by each learner during physical education / life orientation periods. Learners were motivated to participate in physical activity including games and sports during break times. A general increase in after-school activities from pre- to post-intervention per learner was noted. Conclusion. A school-based physical activity and nutrition intervention programme has the potential to increase the physical activity of learners and to a lesser degree their nutritional behaviour

Standing up against office sitting: A study protocol.

BACKGROUND: Sedentary behaviour is associated with cardiometabolic diseases amongst office-bound workers, mostly through extended sitting and engaging in low-energy-demanding activities during work hours. The aim of this study is to assess the effectiveness of standing desks and healthy messages on cardiovascular parameters in a cohort of office-based workers and to explore the perceptions of these workers about the suitability of this intervention to lower occupation-related sedentariness. METHODS/DESIGN: The protocol will use a mixed-methods study design. Phase 1 of this study is a 12-month, single blinded, randomised controlled trial, which will include baseline, 3-month, 6-month and 12-month post-intervention assessments of plausible cardiometabolic risk biomarkers in office-bound workers at a South African credit and information management company. These biomarkers include anthropometry, sedentary behaviour and physical activity, sleep duration, blood pressure, glucose, glycated haemoglobin (HbA1c), lipid profile and cardiorespiratory fitness. Participants will be randomised into an intervention or control group. The intervention group will be provided with an adjustable sit-stand desk and receive weekly health-promoting messages for the intervention period. Phase 2 will use focus group discussions conducted post-intervention to explore the study participants' perceptions of the effectiveness of the intervention. Cardiometabolic risk biomarkers and changes in these variables will be compared between the intervention group and the control group at the four time points using descriptive and inferential statistics. DISCUSSION: Regression analysis will be undertaken to determine the association of cardiometabolic risk biomarkers with cardiometabolic diseases. A thematic content analysis approach will be used to explore emerging themes from focus group discussions. PROTOCOL IDENTIFICATION: Pan African Clinical Trial Registry, PACTR201911656014962

"The thing is, kids don't grow the same": Parent perspectives on preschoolers' weight and size in Soweto, South Africa.

The prevalence of overweight and obesity is high among preschool age (3-5 years) children in South Africa, and children in urban low-income settings are particularly at risk. A better understanding of how parents or caregivers of young children perceive children's weight and size, as well as contextual factors influencing perceptions, is needed to inform interventions. The aim of this study was to examine how parents of preschool children in Soweto, South Africa, view childhood obesity, and to situate these perspectives in the context of the home environment in which preschool age children in Soweto live. Semi-structured in-depth interviews were conducted with 16 parents in four neighbourhoods of Soweto. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following a contextualist approach. Three themes were developed: growing differently, the 'right' way to be, and weight is not health. These themes capture parents' views on complex and reportedly inevitable causes of obesity, ideas about acceptable and preferred body sizes, and the low priority of weight per se compared to health. The findings suggest that childhood obesity prevention in South Africa needs to be done in a non-stigmatising way that recognises environmental and contextual factors, such as parents' limited sense of agency in relation to their children's health and weight, and concrete resource constraints. Environmental barriers to healthy behaviours need to be addressed in order to overcome the coexisting challenges of childhood undernutrition and obesity in urban low-income South African settings

Preparing for operation GRITROCK : military medical ethics challenges encountered in the planning stages of the UK Ebola response mission

In early September 2014, Médecins sans Frontières (MSF) took the unusual step of calling on governments to deploy military, as well as civilian, assets to help combat the Ebola Virus Disease (EVD) epidemic raging in West Africa (MSF, 2014). The UK government announced a package of aid in response to the outbreak, including the deployment of military experts, targeted primarily on Sierra Leone. (Gov.UK 2014) The scale of the outbreak and the responses to it attracted comment from many quarters and raised ethical issues. We were interested in the ethical challenges that would confront the troops on the ground in Sierra Leone, particularly those who were healthcare professionals. We successfully secured UK funding council research funds to explore these challenges. During the preparatory stages of this project, however, it became clear that ethical decisions had also been made during the planning stages of the deployment in anticipation of issue that may be faced on the deployment. These planning issues are of interest in their own right, even though they fell outside the aims of our project, and we explore of some these in this chapter

Can public sector community health workers deliver a nurturing care intervention in South Africa? The Amagugu Asakhula feasibility study.

BACKGROUND: Nurturing care interventions have the potential to promote health and development in early childhood. Amagugu Asakhula was designed to promote developmentally important dietary and movement behaviours among children of preschool age (3-5 years) in South Africa. An initial formative study in Cape Town found the intervention to be feasible and acceptable when delivered by community health workers (CHWs) linked to a community-based organisation. This study evaluated the delivery of the Amagugu Asakhula intervention by CHWs linked to a public sector primary health care facility in Soweto, as this mode of delivery could have more potential for sustainability and scalability. METHODS: A qualitative design was utilised to assess feasibility, acceptability, adoption, appropriateness, implementation, fidelity and context. CHWs (n = 14) delivered the intervention to caregivers (n = 23) of preschool-age children in Soweto over 6 weeks. Following the completion of the intervention, focus group discussions were held with CHWs and caregivers. Further data were obtained through observations, study records and key informant interviews (n = 5). Data were analysed using deductive thematic analysis guided by a process evaluation framework. RESULTS: The delivery of the Amagugu Asakhula intervention through CHWs linked to a primary health care facility in Soweto was not found to be feasible due to contextual challenges such as late payment of salaries influencing CHW performance and willingness to deliver the intervention. CHWs expressed dissatisfaction with their general working conditions and were thus reluctant to take on new tasks. Despite barriers to successful delivery, the intervention was well received by both CHWs and caregivers and was considered a good fit with the CHWs' scope of work. CONCLUSIONS: Based on these findings, delivery of the Amagugu Asakhula intervention is not recommended through public sector CHWs in South Africa. This feasibility study informs the optimisation of implementation and supports further testing of the intervention's effectiveness when delivered by CHWs linked to community-based organisations. The present study further demonstrates how implementation challenges can be identified through qualitative feasibility studies and subsequently addressed prior to large-scale trials, avoiding the wasting of research and resources

Enhanced or hindered research benefits? A realist review of community engagement and participatory research practices for non-communicable disease prevention in low- and middle-income countries.

Introduction: Community engagement and participatory research are widely used and considered important for ethical health research and interventions. Based on calls to unpack their complexity and observed biases in their favour, we conducted a realist review with a focus on non-communicable disease prevention. The aim was to generate an understanding of how and why engagement or participatory practices enhance or hinder the benefits of non-communicable disease research and interventions in low- and middle-income countries. Methods: We retroductively formulated theories based on existing literature and realist interviews. After initial searches, preliminary theories and a search strategy were developed. We searched three databases and screened records with a focus on theoretical and empirical relevance. Insights about contexts, strategies, mechanisms and outcomes were extracted and synthesised into six theories. Five realist interviews were conducted to complement literature-based theorising. The final synthesis included 17 quality-appraised articles describing 15 studies. Results: We developed six theories explaining how community engagement or participatory research practices either enhance or hinder the benefits of non-communicable disease research or interventions. Benefit-enhancing mechanisms include community members’ agency being realised, a shared understanding of the benefits of health promotion, communities feeling empowered, and community members feeling solidarity and unity. Benefit-hindering mechanisms include community members’ agency remaining unrealised and participation being driven by financial motives or reputational expectations. Conclusion: Our review challenges assumptions about community engagement and participatory research being solely beneficial in the context of non-communicable disease prevention in low- and middle-income countries. We present both helpful and harmful pathways through which health and research outcomes are affected. Our practical recommendations relate to maximising benefits and minimising harm by addressing institutional inflexibility and researcher capabilities, managing expectations on research, promoting solidarity in solving public health challenges and sharing decision-making power