Comparing patient satisfaction with primary health care services in the Free State and Gauteng provinces

BACKGROUND Patients constitute the majority of healthcare users at the Primary Health Care level (PHC) in South Africa where these services are free at the point of entry. Patient satisfaction surveys provide information about the quality of health care services and what is needed to improve them. There is a dearth of knowledge on the factors influencing patient satisfaction with PHC clinic services. OBJECTIVE This study compared patient satisfaction with PHC Services in the Free State and Gauteng Provinces. METHODS Secondary data analysis was conducted on cross sectional survey data obtained from the Research on the State of Nursing Project run by the Centre for Health Policy (RESON-CHP) in 2012. Systematic random sampling was used to target 1110 adult patients attending Antiretroviral (ART), hypertension, diabetes and Tuberculosis services. Caregivers of children attending child health and well-baby clinic were also sampled. Patients completed a pre-tested satisfaction survey with questions on facility evaluation, experience with health care providers and medication received. A scoring scale was developed to measure satisfaction. Factors influencing satisfaction were measured using multiple logistic regression analysis. The data was weighted and analysed using STATA version 13. RESULTS A total of 1096/1110 respondents responded to the patient satisfaction survey signifying a 98.8% response rate. The majority of respondents were females (over 60%) in both provinces. Over 90% of patients were satisfied with PHC services in both provinces. The factors associated with satisfaction in Gauteng and Free State were time spent waiting for consultation (OR Gauteng 4.5 CI 1.68-12.12; Free State 4.84 CI 1.01-23.1), nurses listened (OR Gauteng 6.18 CI 2.02-18.89; Free State 5.2 CI 1.15-23.64), being given information on condition (OR Gauteng 8.14 CI 3-22.08; Free State 10.17 CI 2.52-41.14) and being treated politely (OR Gauteng 22.95 CI 5.3-99.36; Free State 22.03 CI 4.6-105.31). Having privacy respected came out as a significant factor in Free State (OR 5.5 CI 1.05-28.8). CONCLUSIONS High levels of satisfaction with PHC services were experienced by study participants in both provinces. The on-going PHC revitalisation reforms could leverage on maintaining or improving the factors associated with patient satisfaction. Satisfied patients adhere to treatment plans and have better health seeking behaviour which translates to improved clinical outcomes. Nurses should therefore continue listening, respecting and treating their patients with politeness. We recommend that suggestion boxes be made available for patients to contribute their suggestions as this is important for channelling feedback to providers about patient centred care. There is also need to have efficient work schedules to reduce patient waiting times. Keywords: Primary Health Care; Patient Satisfaction; Province; Gauteng ; Free State; South Afric

Strategies to facilitate safe sexual practices in adolescents through integrated health systems in selected districts of Zimbabwe

PhDPHDepartment of Public HealthBackground: Zimbabwe has the highest teenage pregnancy rate in Sub-Saharan Africa. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome prevalence in adolescents that are from tribes that perform cultural initiations and subscribe to certain norms are higher than the national prevalence, which is estimated at 12% (18% and 13.6% respectively) in Zimbabwe. Indigenous Health Systems and Modern Health Systems in Zimbabwe run parallel, thereby introducing challenges in managing adolescent sexual health due to conflicts. Aim: This study sought to develop strategies to facilitate the integration of Indigenous Health Systems and Modern Health System in Mberengwa and Umguza districts. The specific objectives were to: Explore Indigenous Knowledge that influences sexual experiences of adolescents; Assess the role played by different stakeholders in communities that influence adolescent development and sexual experiences; Establish the extent of influence of Indigenous Health Systems and Modern Health Systems on adolescent sexual behaviours; Develop strategies that leverage on empirical evidence to enhance Health Systems performance regarding the management of adolescent sexual issues, and to Validate the developed strategies. Methods: This research was conducted in two phases. The first phase utilised a concurrent triangulation mixed methods design with both qualitative and quantitative approaches. The findings from the qualitative and quantitative approaches were merged through a comparison of findings side by side. The second phase focused on developing and validating strategies that facilitated the integration of Indigenous Health Systems and Modern Health Systems. The Strengths, Weaknesses, Opportunities, and Threats analysis was applied to interfaced findings from phase one. The Basic Logic and the Build, Overcome, Explore, and Minimise models was used to develop strategies based on the Strengths, Weaknesses, Opportunities, and Threats findings. The developed strategies were validated by applying the Delphi technique and administration of checklist to selected key stakeholders through organised workshops. Results: Through the qualitative inquiry, key attributes, antecedents, and consequences of Health System Strategies on Adolescent Sexual Health were identified. Strategies to Improve Adolescent Sexual Health outcomes were also identified. It was also observed that different stakeholders play varied roles in the upbringing and support of adolescents. However, there are viii contradicting teachings from the Indigenous Health System and Modern Health System. Findings also showed that it was possible to integrate these two systems. However, there were foreseen logistical challenges and clashes in the values and belief systems of the two systems. Umguza district had a significantly higher prevalence of pregnancies, Sexually Transmitted Infections, and a higher number of adolescents who were engaging in sexual activities. Predictors of Sexually Transmitted Infections and pregnancies were the sex of respondent, tribe, sexual encounters, age, and religion. Furthermore, a total of five strategies were proposed to facilitate this integration, and these included revival of committees that were inclusive of all stakeholders; allocating Indigenous Health System space in clinics to work in; establishing adolescent-friendly clinics; intensifying information dissemination on sexual health-related issues; and developing clear Terms of Reference and procedures to govern this integration and ensure it is a success. During strategy validation, experts suggested minor changes to one strategy, and agreed with the other four strategies. The majority of key stakeholders (97%) endorsed the proposed strategies. The strategies were, therefore, refined and presented as per the suggestions of these consulted actors.NR

Oral Pre-exposure Prophylaxis Uptake and Acceptability Among Men Who Have Sex With Men: A Scoping Review of the Literature

Despite the global effort to end the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) epidemic as a global threat by 2030, the rate of new HIV infections worldwide remains unacceptably high among men who have sex with men, hence the need to use pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection. This population has an increased risk of getting HIV; thus, it is imperative to assess the uptake and acceptability of PrEP. This study investigated the willingness, availability, accessibility, and knowledge and identified barriers and facilitators to using PrEP among this population. A scoping literature review search was conducted on research papers published in English and focused on men who have sex with men and their use of PrEP. These were independently screened and coded. Of about 1,202 literature sources, 55 were included in the study. Findings reported that the uptake and acceptability of PrEP were influenced by knowledge and perception of being high-risk. Generally, PrEP uptake and understanding were high in North America, Latin America, and Europe and low in Asia and Africa. Low uptake and acceptability have been largely attributed to fear of side effects, societal stigma, cost, and perception of not being at risk. Noted facilitators to PrEP use include education, availability of free pills, support groups, and friendly health care facilities. Health intervention programs to increase the use of PrEP must be backed by appropriate legal and regulatory frameworks

Towards a framework for embedding doctorateness in research proposals

Doctorate graduates are expected to contribute original knowledge and possess advanced skills essential for addressing complex problems. Embedding doctorateness in doctorate programmes could help ensure that the productivity of doctoral research is explicitly demonstrated. Doctorateness represents independent scholarship, the transition from knowledge consumption to knowledge creation, original scholarly contribution, and research integrity. A research proposal is the backbone of a doctoral journey, as it acts as an academic development plan for supervisors and students. Hence, understanding the role of supervisors in enabling doctorateness in preparing a research proposal is essential for improving student satisfaction and competencies in their academic development. Here, we develop a framework for facilitating doctorateness in preparing a research proposal and provide recommendations on supervisor functions

Effectiveness of peer to peer strategy in reducing accidents and injuries at a selected platinum mine in Zimbabwe

The selected mining company implemented the ''Peer to Peer'' strategy in 2008 to fast track achievement of zero tolerance to injuries and fatalities incidents at its workplace. Our study, therefore, sought to assess the effectiveness of this strategy in reducing accidents and injuries at this selected platinum mine in Zimbabwe. A mixed-method cross-sectional survey was conducted on 32-day shift employees using a semi-structured questionnaire with closed and open-ended questions. Furthermore, incident trend analysis was done on data obtained from the records from 2004 to 2017. Covert observations were then employed to triangulate findings from data collected using the questionnaire on practices. The tests Hotelling, Chi-square, time series plots, and Multiple Logistic Regressions were employed to compare the variables of interest before and after implementing the peer to peer strategy. There was a significant drop in the number of incidents after implementing the peer to peer strategy. There was no association between tested demographic characteristics and the level of employees' knowledge of the strategy. Employees were afraid to implement the strategy to their superiors fully. Findings pointed out that this strategy was effective despite being part of a cocktail of strategies. There was a vast decrease in the rate of occurrence of incidents after the implementation of this strategy. However, there is a need for engagement to address the subordinate management dynamics that was observed to be a threat in the comprehensive implementation of this strategy