Teaching ethical issues in health care: Incorporating a philosophy of care into undergraduate health programs at the University of the Western Cape

CONTEXT: There is a growing emphasis on ethics education in undergraduate and postgraduate curricula of the health professions. Approximately five hundred and eighty two health science students participate annually on an interdisciplinary core course i.e. Introduction to Philosophy of Care (IPOC). OBJECTIVES: To describe in detail the IPOC course and to determine the students' perceptions and experiences of the course. METHODS: A survey was conducted and variables were rated on a 5-point Likert scale. Students also completed an open ended questionnaire to assess their learning and participation in the small group work. RESULTS: Lectures and small group work (28%), assignments (25%) and independent community visit (15%) were rated as the preferred method of teaching. Two thirds (77.5%) were satisfied with the course objectives, 83.4 % reported that they could apply the information and skills learnt to other courses, 81.9% stated that the course made them reconsider many of their former attitudes about care and that they gained a good understanding of the interdisciplinary partnership in care (87.8%). DISCUSSION: Developing a philosophy of care is an important aspect of a progressive health professional education. Staff development in the field of ethics is crucial to develop expertise and sustain programmes. The faculty has overcome the attitudinal, administrative and logistical barriers associated with interdisciplinary teaching and learning. However, to implement interdisciplinary programmes in the final year, where professional identity and turf is most powerful remains a challenge. CONCLUSION: Students clearly support the IPOC course as an important interdisciplinary core course in their undergraduate health professional education

Moving from conversation to commitment: Optimising school-based health promotion in the Western Cape, South Africa

Background: Recent evaluation of the Interdisciplinary Health Promotion (IHP) course offered by the University of the Western Cape (UWC) at schools revealed that the needs expressed by the schools had not changed in the last five years. Objectives: This paper describes the process that was undertaken to identify specific interventions that would have an impact on the schools and, in turn, the broader community, and provides an overview of the interventions conducted in 2011 - 2012. Methods: A stakeholder dialogue explored notions of partnership between the university and the schools, sustainability of health promotion programmes in the schools, and social responsiveness of the university. An action research design was followed using the nominal group technique to gain consensus among the stakeholders as to which interventions are needed, most appropriate and sustainable. Results: A comprehensive plan of action for promoting health in schools was formulated and implemented based on the outcome of the stakeholder dialogue. Conclusion: The study's findings reiterate that an ongoing dialogue between schools and higher education institutions is imperative in building sustainable partnerships to respond to health promotion needs of the school community.Department of HE and Training approved lis

Risk factors for chronic non communicable diseases in Mombasa, Kenya: epidemiological study using WHO stepwise approach

OBJECTIVE: To describe the prevalence and distribution patterns of the major common risk factors for non communicable diseases among the people living in Mombasa, Kenya. METHODS: Using the WHO STEPwise approach, risk factors for non communicable diseases were analyzed for 305 people aged between 13 to 67 years. The study sample was arrived at through convenient stratification of the population according to age and setting followed by random selection of the participants. RESULTS: The most common individual risk factors registered were physical inactivity, hypertension and overweight/obesity accounting for 42%, 24% and 11% of the sample respectively. Participants who possessed a single risk factor profile were 42% and those who had multiple risk factors were approximately 17%. Hypertension and physical inactivity were the most common multiple risk factor pattern possessed by 7.5% of the participants who had at least one of the investigated risk factors for CNCDs. Socio-demographic characteristics including male gender, increasing age, being a student and low socio-economic status were found to be positive predictors of CNCDs CONCLUSION: The burden of CNCDs risk factors is unequally distributed among Mombasa residents. The poorest quintile posses the worst risk factor profile compared to their privileged counterparts. The implementation of WHO STEPwise approach was feasible since it revealed a comprehensive picture of the at-risk groups thus forming a vital baseline framework for target specific and cost-effective CNCDs control and prevention interventions.Web of Scienc

Occupational therapy graduates’ reflections on their ability to cope with primary healthcare and rural practice during community service

BACKGROUND: Occupational therapy graduates are expected to deliver service in public health facilities using a primary healthcare approach (PHC) during their community service year. There is limited literature available about their experiences in this context. OBJECTIVE: This study explored the experiences of novice occupational therapy graduates and the extent to which their curriculum had prepared them for practice in PHC settings. METHODS: This qualitative exploratory study used purposive sampling to recruit thirty nine novice occupational therapy graduates. Using audio-recorded semi-structured interviews and a focus group discussion data were collected to explore participants’ experience of work and the extent to which their undergraduate programme had prepared them for primary healthcare practice. The data was analyzed thematically. FINDINGS: Occupational therapy graduates expressed challenges in applying the PHC approaches for practice in resource-restricted rural settings. They required additional skills to communicate in the local indigenous language, to understand the various beliefs of the local communities and to manage change in these settings. They were well prepared for basic clinical skills as a need for urban-based ethical practice. RELEVANCE TO CLINICAL PRACTICE: Curriculum planners need to review the teaching of communication skills and introduce students to strategies for change management. More inter-professional collaboration and service-learning in rural primary healthcare settings will prepare them better for rural and PHC settings.DHE

The school, a viable educational site for interdisciplinary health promotion

An interdisciplinary health promotion module, using the community-based teaching approach, is offered by the University of the Western Cape (UWC). Schools in Delft, a poor socio-economic area with high unemployment, crime and a range of social problems, are used as the teaching sit

Challenges of academic healthcare leaders in a higher education context in South Africa

Universities are in a highly competitive environment, needing strong academic leadership. Some heads of departments have been appointed into leadership positions in a healthcare faculty after having been mere academics for a few years. They are more likely to experience challenges. This study aimed to explore the views and understanding of heads of departments in a healthcare faculty on being appointed as academic leaders in a higher education context in South Africa. A qualitative design using 12 individual unstructured interviews was conducted with all the heads of departments in a health sciences faculty. Open coding was conducted and two themes emerged, focusing on the varied skills needed for academic leadership positions and developing leadership skills amongst senior academics. The findings indicated that development of senior academics in leadership should be undertaken by a knowledgeable professional in formal or informal settings, to encourage mentorship and more regular group meetings, while addressing the core role of a leader. Implications of these findings for a faculty of health sciences and suggestions for leadership succession in future are discussed

Challenges experienced by community health workers and their motivation to attend a self-management programme

Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme

Assessment of risk factors for Non-Communicable diseases among a cohort of community health workers in Western Cape, South Africa

Community Health Workers (CHWs) have been identified as the key health professionals to drive the agenda of the prevention of health risk behaviours, linked to noncommunicable diseases (NCDs) in South Africa. They are regarded as the agents of change, who will provide impetus to the achievement of the health behaviour goals, set out by the South African National Department of Health1 . However, this cohort, may suffer from an array of NCDs. There are various risk factors that influence the health of individuals and contribute to NCDs, including modifiable and non-modifiable risk factors, which cannot be changed, or altered by an intervention, such as age, family history, gender and ethnicity2,3. Modifiable risk factors have been classified as behavioural, physical, and biological4 . Globally, NCDs are responsible for 80% of premature deaths in LMICs5,6. In response to the NCD pandemic, the World Health Organisation (WHO) set a global target in 2012, which was aimed at reducing premature deaths, caused by NCDs, by 25%, by the year 20257 . However, this goal will require drastic, immediate, and targeted approaches that address the root causes of NCDs. South Africa has followed the global trend, and evidence depicts an increase in NCDs8 , with a 27% probability of dying between the ages of 30 and 70 years, as a result of cardiovascular diseases (CVDs), diabetes, cancers, or chronic respiratory conditions7,9. This is similar to other countries such as India (26%), Philippines (28%), Democratic People’s Republic of Korea (27%), Mali (26%), Russian Federation (30%), Ukraine (28%) , Tajikistan (29%), Fiji (31%), Afghanistan (31%) and Armenia (31%)9 In the Western Cape, the prevalence of chronic diseases of lifestyle raises major concerns about the communities’ health risk behaviour. The Burden of Disease Survey for the Western Cape, which was released on 24 April 2017, reported that NCDs contributed to 61% of deaths in the Western Province1

Reflection on an interprofessional community-based participatory research project

BACKGROUND. A collaborative interprofessional research project that involved community members was beneficial to community development. OBJECTIVE. To draw upon the experiences of academics relating to their involvement in an interprofessional community-based participatory research (CBPR) project. METHODS. A Delphi study was applied as a self-reflective evaluation process to reach consensus on the lessons learnt from participation in a CBPR project. Round one of the Delphi employed closed-ended questions and the responses were analysed descriptively using Microsoft Excel (USA). The second round consisted mainly of open-ended questions and responses, and was analysed qualitatively. Ethical clearance was obtained from the University of the Western Cape research committee. RESULTS. Based on round one of the Delphi study, it became evident that recognition of the community as a unit of identity, addressing health from physical, emotional and social perspectives and formation of long-term commitments were the CBPR principles most applied. Disseminating information to all partners and facilitation of the collaborative equitable involvement of all partners in all phases of the research were the principles least applied. Themes that emerged from the second round of the Delphi included the identification of clear objectives based on the needs of the community, a shift from identification of the needs of the community to the implementation of strategies, and the creation of capacity-building opportunities for all stakeholders. CONCLUSION. In a reflection on the research process, the interprofessional team of academics found that the basics of CBPR should be attended to first. A focus on clear objectives, implementation strategies and capacity building is important in CBPR.DHE

Towards tailored teaching: using participatory action research to enhance the learning experience of Longitudinal Integrated Clerkship students in a South African rural district hospital

Background: The introduction of Stellenbosch University’s Longitudinal Integrated Clerkship (LIC) model as part of the undergraduate medical curriculum offers a unique and exciting training model to develop generalist doctors for the changing South African health landscape. At one of these LIC sites, the need for an improvement of the local learning experience became evident. This paper explores how to identify and implement a tailored teaching and learning intervention to improve workplace-based learning for LIC students. Methods: A participatory action research approach was used in a co-operative inquiry group (ten participants), consisting of the students, clinician educators and researchers, who met over a period of 5 months. Through a cyclical process of action and reflection this group identified a teaching intervention. Results: The results demonstrate the gaps and challenges identified when implementing a LIC model of medical education. A structured learning programme for the final 6 weeks of the students’ placement at the district hospital was designed by the co-operative inquiry group as an agreed intervention. The post-intervention group reflection highlighted a need to create a structured programme in the spirit of local collaboration and learning across disciplines. The results also enhance our understanding of both students and clinician educators’ perceptions of this new model of workplace-based training. Conclusions: This paper provides practical strategies to enhance teaching and learning in a new educational context. These strategies illuminate three paradigm shifts: (1) from the traditional medical education approach towards a transformative learning approach advocated for the 21st century health professional; (2) from the teaching hospital context to the district hospital context; and (3) from block-based teaching towards a longitudinal integrated learning model. A programme based on balancing structured and tailored learning activities is recommended in order to address the local learning needs of students in the LIC model. We recommend that action learning sets should be developed at these LIC sites, where the relevant aspects of work-place based learning are negotiated