An assessment of nurses’ participation in Health Promotion: a knowledge, perception, and practice perspective

Abstract Background: Health promotion (HP) at the population level serves to improve health inequalities, enhance the quality of life, and ensures the provision of healthcare and related services. This  has an impact on the increasing burden of preventable diseases that healthcare workers are daily faced with.  Nurses at all levels are charged with the task of ensuring patients receive HP services. However, their competence in addressing the challenge of the rising level of preventable diseases and health inequality  deserves further exploration. This study aimed to assess the influence of HP knowledge and perceptions in nurses in the practice of Health Promotion. Methodology: The study was conducted using a self-administered questionnaire comprising of 22 structured questions. Respondents were randomly sampled from nurses in a tertiary hospital. Questions bordered on respondents’ demographics, knowledge, perception, and practice of HP. Responses were retrieved and analysed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp, 2019. Results: A total of 184 nurses participated in the survey comprising 82.6% (n=152) females, 7.6% (n=14) males, and 9.8% (n=18) that chose not to disclose their gender. Bivariate analysis showed a statistically significant relationship between demographics and nurses possessing adequate knowledge to provide HP services. Statistically significant relationships were found amongst the following variables: ‘A holistic knowledge of disease pathology and processes are vital for effective care of patients’ and ‘education of patients on medication’ p=0.001, ‘awareness of importance of educating patients about their condition’and ‘patients encouraged to engage in healthy lifestyle’ p=<0.001, and ‘awareness of importance of educating patients about their condition and ‘health promotion is a waste of time’ p=<0.001. Conclusion: Data showed that nurses’ knowledge regarding HP had a strong influence on their perception of HP. Their perception of HP in turn strongly influenced their practice of the same. Therefore, rigorous efforts must be made by  governmental agencies, and organizations involved in healthcare worker training and nursing accreditation, to ensure the HP curriculum is well incorporated in nursing undergraduate training and sustained in service

Evaluation of health promotion roles and services offered by health workers in the Nelson Mandela Bay Municipality of Eastern Cape, South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.Background: Various factors affect the role of healthcare workers (HCWs) in health promotion (HP). The Nelson Mandela Bay Municipality (NMBM) public health service is overstretched and there is minimal evidence of health promoting healthcare services. This research project evaluated the roles and services of HCWs on HP as well as the views of patients regarding the HP services they received from HCWs in the municipality. Methods: A phased quantitative cross-sectional study was conducted to address the study aim and objectives. In phase one, 495 HCWs randomly sampled from 23 healthcare facilities in NMBM completed a structured questionnaire. In phase two, 500 patients completed a structured questionnaire regarding the quality of HP services received using the interview method. Descriptive and inferential analyses were conducted using StataIC 15. Results: Three groups of indicators classified as facility related indicators (FRI), healthcare workers’ related indicators (HRI), and outcome related indicators (ORI) emerged for measuring HP. The study identified thirteen categories of enablers and eight categories of hindrances. Eleven enablers and six hindrances were associated with tertiary hospitals, and none was recorded for the other health care levels. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28 - 3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23 - 0.62) were the predictors of HP and disease prevention (DP) enablers among medical doctors. On the other hand, ‘healthcare facilities promoting treatment more than DP’ (Coeff: 2.03, 95% CI: 1.30-3.14) and ‘absence of practice guidelines incorporating HP’ (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers (AHWs), respectively. Furthermore, most of the HCWs (75.78%; n=363) reported absence of coordinated HP training for staff in their facilities. Similarly, the attitude that ‘HP is a waste of time’ (adjusted Coeff 0.51, 95% CI 0.31 - 0.83) influenced the practice for AHWs. Results of the second phase study were categorized into three phases namely - pre-admission phase (PAP), admission phase (ADP), and post admission phase (POP). The ADP showed that patients’ health behaviours improved by 1.54 times by their interactions with nurses compared to their interactions with medical doctors. Conclusion: This study shows that the healthcare system is more committed to biomedical care as against health promotion services at all levels of healthcare. The implementation of HP services requires changes in HCWs behaviour, patients’ attitude and very importantly, structural reorganization and reprioritization

Prevalence of locoregional recurrence and survival post-treatment of head and neck cancers in Africa: a systematic review and meta-analysisResearch in context

Summary: Background: Recurrent cancers of the head and neck are associated with poor survival outcome. Yet, their burden in Africa is not reliably known. We therefore aimed to estimate the prevalence of recurrence and the 5-year overall survival among patients treated for head and neck cancers (HNC) in Africa. Method: In this systematic review and meta-analysis, we searched four electronic databases (Pubmed, CINAHL, MEDLINE, and Web of Science) and the grey literature for studies reporting the prevalence of HNC recurrence and 5-year overall survival post treatment, published between January 1, 2002, and December 31, 2022. We contacted corresponding authors of relevant studies. Searches were extended to reference lists of review articles and other relevant sources for potentially eligible studies. Each record was assessed for inclusion or exclusion by two independent reviewers. Records with individual-level data on recurrence and survival conducted in Africa were included while exclusion was based on the study design and availability of relevant data. Data were independently extracted by three reviewers from eligible studies, and summary estimates were sought. Our primary outcomes were recurrence and 5-year overall survival of patients who have been treated for HNC, and our secondary outcomes included risk factors, tumor site, squamous cell histology, clinical stage of tumor, and treatment options received. Only records selected for primary outcomes were assessed for secondary outcome data extraction. Random-effects meta-analysis was conducted for each outcome. Meta-regression models were used in addressing sample heterogeneity among the studies. Protocol for this study was registered with PROSPERO, CRD42022372307. Findings: This systematic review and meta-analysis returned 3998 records, yielding 28 included studies after exclusion. Eighteen studies reported on the prevalence of HNC recurrence while 24 articles reported on the 5-year overall survival. Of the pooled total study population, 7199 (70.5%) of 10,218 patients were males while 2603 (25.5%) were females. We found that the prevalence of HNC recurrence was 15.4% (I2 = 96.2%; 95% CI: 9.5–22.3; n = 3214; k = 18), and the 5-year overall survival was 54.4% (I2 = 99.5%; 95% CI: 40.1–68.4; n = 9798; k = 24). We also found that the prevalence of smoking and alcohol consumption as risk factors for HNC were 42.6% (I2 = 98.8%; 95% CI: 25.2–61.0; n = 4374; k = 15) and 35.8% (I2 = 98.9%; 95% CI: 21.7–51.4; n = 4110; k = 11) respectively. The pooled current prevalence for advanced HNC (clinical stages III-IV) was 80.0% (I2 = 99.2%; 95% CI: 68.6–89.5; n = 7624; k = 18) compared to 12.2% (I2 = 96.4%; 95% CI: 6.2–19.8; n = 7624; k = 18) in early disease (clinical stages I-II). Interpretation: The results showed significantly high prevalence of cancer recurrence, poor 5-year overall survival and very high prevalence of advanced cancers at time of diagnosis. This study provides robust evidence for strategies towards prompt diagnosis and appropriate management of HNC to improve patients’ outcome in the African continent. Funding: This study was not supported by any funding