African Journal of Primary Health Care & Family Medicine最新文献

Primary care researchers often turn to qualitative methodologies to explore people's perspectives and experiences. Phenomenology is appropriate when the focus is on lived experiences, rather than ideas, beliefs, opinions or perceptions. Phenomenology has its roots in German philosophy and the social sciences, and doctoral students as well as researchers in the health sciences may struggle to understand the paradigm and apply it practically. This article attempts to make sense of the paradigm and two of its key threads, namely descriptive and interpretive phenomenology. The key principles of both approaches and the practical methodological steps are outlined. In addition, examples are given, and the two approaches are compared. Finally, the article discusses trustworthiness and quality criteria in phenomenology.

Background:  The South African government signed the National Health Insurance (NHI) Bill into effect on 15th of May 2024 to ensure that all citizens have access to high-quality healthcare, regardless of their financial situation. While this initiative will impact all healthcare professionals, there is limited information on how speech-language therapists (SLTs) perceive its implementation in South Africa.

Aim:  The study aimed to explore the knowledge, attitudes and perceptions of SLTs in the public and private healthcare sectors related to service provision regarding the implementation of the NHI.

Setting:  This study was conducted virtually via Zoom (Zoom Video Communication, San Jose, California, United States) and Teams (Microsoft Teams, 2017) with SLTs in their respective settings in South Africa.

Methods:  The descriptive, qualitative research design involved virtual semi-structured interviews with 10 SLTs. NVivo software (QSR International, Victoria, Australia) was used to analyse the data, as guided by Tesch's content analysis method.

Results:  Eleven sub-themes emerged related to the three themes of knowledge (4 sub-themes), attitudes (4 sub-themes) and perceived impact (3 sub-themes) of NHI implementation on SLT services.

Conclusion:  The study highlights SLTs' knowledge, gaps and concerns about the impact of NHI implementation on their profession, emphasising the personal and professional areas that need to be addressed for its successful rollout.Contribution: Understanding SLTs' opinions will help address their concerns during the planning stages of integrating them into the NHI. This will lead to an equitable distribution of sufficient practitioners and ensure that many people benefit from its implementation.

In Uganda, family medicine training was started in 1989 to train an all-round generalist able to provide comprehensive care at a district hospital. Since then, the training programme has undergone several changes to cater for the needs of communities in a changing world. Very low numbers of applicants and poor understanding of the discipline have been a persistent challenge. Availability of non-family physician champions, family physician role models and collaborative networks are key to development of family medicine.

Background:  Dry eye disease (DED) is a growing public health problem because of excessive time spent on digital devices as a risk factor. The diagnosis of DED should not only be based on the objective clinical measures but also on symptoms reported by patients. Clinicians should not rely on establishing symptoms using open verbal questioning during the case history but should quantify patient symptoms using a validated questionnaire.

Aim:  To compare the patient-reported symptoms of DED as assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment in Dry Eye (SANDE).

Setting:  An optometry clinic.

Methods:  Ocular Surface Disease Index and SANDE questionnaires were administered to 40 participants. Participants completed all questionnaires in a non-randomised order. The correlation between the questionnaires' scores was determined and the Bland-Altman plot was used to assess the agreement between the two questionnaires.

Results:  The mean scores for OSDI and SANDE were 37.85 ± 23.79 and 38.83 ± 26.39, respectively. The Spearman correlation between the two questionnaires was 0.7, p  0.01. The mean difference between OSDI and SANDE was -0.97 (95% Confidence Interval [CI]: [-7.04 to 5.09]). The Bland-Altman analysis between OSDI and SANDE showed a mean clinical difference (bias) of -0.98.

Conclusion:  The SANDE questionnaire can be used as a dry eye symptom assessment as it is highly correlated to the OSDI questionnaire.Contribution: Because the OSDI and SANDE questionnaires showed a significant correlation and negligible score differences, this suggests that the SANDE questionnaire has the potential to provide clinicians with a short and quick measure of DED symptoms.

The integration of mental health into the management of non-communicable diseases (NCDs) is crucial, particularly in low-resource settings like Ghana. This is a report of an integrated care project in primary care for the management of patients with hypertension and type 2 diabetes mellitus. This quality improvement project involved screening, providing information and education about common warning signs for mental health problems, and available health personnel from whom patients can seek help. This practice quality improvement project was executed in a primary care hospital in Ghana under the World Organization of Family Doctors (WONCA) Integrating Care Leadership and Advocacy Programme. Adult patients with hypertension and/or type 2 diabetes mellitus were screened using the 4-item Patient Health Questionnaire (PHQ-4) tool for anxiety and depression. The project screened 205 patients, of which 39 (19%) were found to have either anxiety and/or depression and were managed appropriately. The findings underscore the importance of integrating mental health care into the management of non-communicable diseases. Additionally, integration is essential to enhancing access to appropriate interventions and decreasing fragmentation in the delivery of care. This approach improves access to comprehensive care, reduces treatment fragmentation, lowers healthcare costs, fosters better patient satisfaction through holistic treatment, and reduces the stigma associated with mental health issues. This paper gives support to the feasibility of this integration in primary care settings. Several benefits have been demonstrated, showing the necessity of such integration in primary care settings, and advocating for policy with detailed guidelines for integrating mental health into non-communicable disease care in Ghana.

Background:  Iron deficiency anaemia in young children is a major problem globally, particularly in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends preventive oral iron supplements to reduce the prevalence of iron deficiency and anaemia in high-prevalence settings.

Aim:  To conduct a qualitative evidence synthesis exploring the factors influencing the acceptability, feasibility and equity of preventive oral iron supplementation in young children for the Global Evidence, Local Adaptation (GELA) project, which supports the development of evidence-informed, locally relevant guideline recommendations in three sub-Saharan countries.

Method:  We searched MEDLINE, Epistemonikos, CINAHL and PsycInfo from inception to 07 July 2023 for eligible studies. We synthesised the data using thematic analysis and assessed the methodological quality of the studies (using an adaptation of the Critical Appraisal Skills Programme tool) and confidence in the review findings (using GRADE-CERQual).

Results:  We included six studies, five from LMICs. Findings indicated knowledge and perceptions about iron supplementation, as well as relationships with intervention providers, can have a beneficial or detrimental influence on caregiver acceptance (moderate to high confidence); caregiver acceptance may be negatively affected by a lack of reliable information but can potentially be enhanced through community-based education (moderate confidence); healthcare workers' knowledge, resources and support may improve the feasibility of intervention provision (moderate confidence) and socio-economic challenges around access to the intervention may adversely affect equity (low confidence).

Conclusion:  A complex interplay of contextual factors may impact the provision and uptake of preventive oral iron supplementation in young children.Contribution: This work provides insights into how preventative oral iron supplementation might be contextually tailored.

Background:  In many countries, the core functions of primary care (PC) continue to perform poorly and therefore need improvement, guided by interventions developed in collaboration with key stakeholders.

Aim:  This paper reports on the co-design of an intervention guided by the findings of the Primary Care Assessment Tool (PCAT) survey.

Setting:  The setting for the study was a rural Ugandan district.

Methods:  This was part of a multi-stage mixed methods study to evaluate the use of the PCAT in improving primary care performance. Key stakeholders in primary care system were purposively identified to participate in the design of the intervention. The intervention co-design involved presentation and discussion of the PCAT findings, two rounds of root cause analysis, selection of intervention focus area, design of the actual intervention and planning of implementation.

Results:  Ongoing care was selected for intervention among the poorly performing primary care core functions. Community members' low awareness of the available services and low affiliation to their local primary health care (PHC) facility were identified as major contributors to the poor performance of ongoing care. Community dialogues as form of community engagement were selected as an intervention to improve the core primary care functions.

Conclusion:  The PCAT can generate findings to guide the development of interventions at the facility and district level to potentially improve the core functions of primary care.Contribution: A co-design process helped to navigate the pathway from the findings to the intervention design and its implementation strategy.

Road Traffic Incidents (RTIs) are a major public health concern worldwide, particularly in low-income to middle-income regions such as sub-Saharan Africa. Data from sub-Saharan Africa suggests that the public transport industry accounts for the majority of fatal crashes that contribute to the high mortality and morbidity associated with RTIs. In this viewpoint, we advocate for integrated and comprehensive evidence-based health and safety interventions to address the challenge of RTIs in the public transport industry in sub-Saharan Africa. We provide evidence on the magnitude of the problem drawing on the state of mortality and morbidity and reported challenges associated with RTIs in the minibus taxi industry in South Africa as this is the most common mode of public transport in the region.

Background:  Gastric cancer (GC) diagnosis and care data in South Africa (SA) is sparse, and SA has a high GC mortality rate. Mapping the GC care pathway is needed to explore its efficacy in association with the SA GC burden and mortality.

Aim:  The study aims to map the GC care pathway in SA from diagnosis to management by healthcare professionals (HCPs) involved in the GC patient journey and explore barriers and facilitators to the effective flow of the GC care pathway.

Setting:  Interviews conducted with South African HCPs were the data source used in this article for analysis. General physicians (GP) were the first contact point with chain-referral sampling sourcing other clinicians.

Methods:  Interviews were conducted via Microsoft Teams (MS Teams) and Google Meet with qualitative analyses via MAXQDA.

Results:  Themes identified were GC care pathway processes, public versus private healthcare system differences and care pathway challenges. Multidisciplinary team (MDT) care is practised for GC in SA, starting with the GP or nurse followed by gastroenterologist (GI), surgeon and pathologist. Thereafter, nurses, dieticians and palliative care specialists are involved. Healthcare sector differences are diagnosis time, GC staging, HCP and treatment access. Challenges include low GC index of suspicion by primary care clinicians (PCC) and Helicobacter pylori (H. pylori) detection.

Conclusion:  A MDT approach for optimal treatment and patient care may be the best method for prolonged life.Contribution: A South African national consensus for GC care via a MDT, emphasising early diagnosis to aid in a robust treatment plan for improved patient outcomes is warranted.