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

Effective primary healthcare is essential in developing countries but faces several challenges, including the lack of standardised training across decentralised sites. In response to unsatisfactory registrar examination outcomes in 2013, the Department of Family Medicine at the University of the Witwatersrand in South Africa introduced a blended teaching and learning programme. The aim of the new programme was to level the playing field by providing uniform online resources on a course site on the university's learning management system. The uniform online resources would be integrated into the teaching programme. A team consisting of the registrar-training-programme coordinator, an educationalist and five family-medicine consultants from different districts began reviewing the curriculum, selecting appropriate resources and developing the course site. The blended programme was developed and implemented using a phased, participatory research action approach, including phases of evaluation and redesign. Since the implementation of the blended-learning programme in 2017, registrar outcomes have improved, but this has not been the only success attributed to the programme. The programme also resulted in an enhanced focus on teaching and learning, especially among those involved in its development. We share the lessons gleaned from our experiences, emphasising the need for adequate training and teamwork if we are to use technology appropriately and effectively to address the difficulties associated with decentralised training in developing countries.

Background:  Implementing evidence-informed clinical practice recommendations is important for managing chronic musculoskeletal pain (CMSP) to address the multidimensional impact of the condition. Successful implementation of recommendations requires understanding the multiple context factors that influence CMSP management in different settings.

Aim:  This study aims to explore contextual factors that could influence the implementation of evidence-informed clinical practice recommendations for the primary health care of adults with CMSP.

Setting:  The study focused on the primary health care (PHC) sector in Cape Town, South Africa.

Methods:  A qualitative descriptive study was conducted. A multidisciplinary panel of 13 local health care professionals participated in focused group discussions. The participants considered multimodal clinical recommendations derived from published clinical practice guidelines. In four focus group discussions (three or four members per group), the panel generated and documented context factors that would influence implementing the recommendations in practice. Inductive content analysis was performed to identify categories and themes.

Results:  The five contextual themes generated indicated health care system organisation, human resource requirements, provider practice patterns, patient empowerment and integration into policy as imperative for the successful implementation of recommendations.

Conclusion:  There are diverse context factors that could influence the implementation of clinical recommendations for managing CMSP in PHC settings. Identifying these factors as barriers or facilitators is beneficial for developing effective knowledge translation strategies.Contribution: The study findings indicate that an integrated systems approach supported by health care policy and multisectoral collaboration is needed to successfully implement clinical recommendations to address the impact of CMSP.

In 2013, Ethiopia launched its first Family Medicine (FM) residency programme at Addis Ababa University (AAU). The University of Toronto's Department of Family and Community Medicine (DFCM) was invited to support Addis Ababa University's Department of Family Medicine's (AAU-FM) educational programme activities forming the Toronto Addis Ababa Academic Collaboration in Family Medicine (TAAAC-FM). This paper describes the TAAAC-FM partnership, a capacity-strengthening initiative that focuses on four key levers of academic engagement and transformation: education offerings for AAU-FM trainees, partnership preparation of DFCM faculty, fostering AAU-FM faculty development and leadership, and lastly scholarship, knowledge sharing and mentorship. Toronto Addis Ababa Academic Collaboration in Family Medicine operates on principles of respect, flexibility and cultural sensitivity. Monthly virtual meetings and annual in-person faculty visits fostered curriculum support, teaching and leadership training, ensuring that the programme remained responsive to evolving needs. The partnership has contributed to a Community of Practice (CoP) to advance FM in Ethiopia, promoting shared learning. Addis Ababa University's Department of Family Medicine faculty leads in various roles, engages with global FM communities, and contributes to policy development, demonstrating significant progress in FM education and leadership. Looking ahead, TAAAC-FM aims to adapt its efforts based on the capacity built with AAU-FM, continue faculty development, and strengthen linkages within the global healthcare community. The partnership's success underscores the importance of collaborative, culturally informed high-low resource setting approaches to FM training and healthcare system strengthening, offering valuable insights for similar initiatives.

Reflective writing and keeping portfolios during rural hospital attachments has been shown to give medical students more confidence, better communication skills and clinical competence, thereby making them stronger adult learners. The role of supervisors as facilitators of learning during Community-based Education rural site visits is critical. The University of Zimbabwe Faculty of Medicine and Health Sciences established faculty development workshops to train supervisors to be better able to support students in becoming active learners and critical thinkers, giving them constructive feedback, and encouraging them to look for positive outcomes during their rural attachments. These educational skills were new to most supervisors, requiring a culture change from the usual didactic approaches. Educators had to learn about adult learning theories, the constructivist approach to knowledge creation, role-modelling and methods of assessment that were empowering for students. They were encouraged to form communities of practice through the faculty development process of training and assessment and to consider how to develop research and scholarship in documenting their experiences as facilitators and learning partners with their students and colleagues. These activities enhanced their professional identity formation as scholars, educators and facilitators. Their exposure to the functioning of rural hospitals, partly through narratives of the students' reflective writing, enabled them to develop a greater appreciation of the potential of primary care and the district health services as the foundation of the Zimbabwe health system. Future benefits could include application of this training to other health professional programmes, as part of interprofessional education.

Background:  Community health workers (CHWs) play an important role in health promotion through health campaigns and home visits, and provide linkage to care and support patient management. In the informal settlements, CHWs identify health challenges and help residents to access healthcare facilities.

Aim:  This study aimed to explore the perception held by the community members regarding CHWs' contribution to health promotion in Melusi informal settlements within the Tshwane district.

Setting:  The study was conducted in Melusi informal settlement situated in Pretoria west in South Africa.

Methods:  Descriptive exploratory qualitative research methods were used, with open and closed-ended questions during individual interview sessions. Participants were purposefully selected in collaborating with the community leaders and using CHWs' data to identify individuals with direct interaction with CHWs.

Results:  Participants praised CHWs' communication skills, engagement strategies, and ability to provide valuable health services. Community members expected CHWs to provide healthcare services, educational support, advocacy for health issues and guidance on well-being. Barriers such as community resistance, a lack of privacy and difficulties in reaching households were noticed. However, CHWs were commended for their impact on well-being, offering health services, emergency support, food assistance and improved healthcare accessibility.

Conclusion:  The study indicates that community members have positive perceptions of CHWs. This highlights the significant role of CHWs in promoting health and well-being within the community.Contribution: This study provides insights into community perceptions of CHWs in informal settlements, emphasising their impact on community well-being. It provides a basis for their effectiveness and support in delivering health services in the informal settlement.

In South Africa and internationally, the alignment of health professions education programme with primary healthcare (PHC) policies is seen to promote the training of fit-for-purpose graduates who can adequately respond to the demands of patient and community needs. This article seeks to describe the development of a tool to assess the degree of PHC in an undergraduate medical curriculum. In defining what is meant by PHC, four dimensions of PHC were identified for the purpose of designing the tool, namely values underpinning PHC, principles of PHC, a generalist focus of the programme, and the level of care that the programme is delivered at. The tool also sought to assess how the content in these dimensions is covered in the curriculum and to which depth students are required to engage. The perspectives that were considered were: what content was being covered, what pedagogy was used, in which context it was being taught and how it was being assessed. For each of these aspects, the dimensions are assessed using an amended Miller's pyramid to assess the expectations of outcomes for the curriculum. The tool is presented and the article reflects on the use of the tool in a process of assessing a medical curriculum.

Background:  Although some evidence is available from low- and middle-income countries, no South African data are available on how women experience healthcare during treatment for an incomplete miscarriage.

Aim:  This study sets out to explore and describe the experiences of healthcare among women who suffered an incomplete spontaneous miscarriage in the Witzenberg subdistrict, a rural area in the Western Cape province of South Africa.

Setting:  Witzenberg subdistrict, Western Cape province, South Africa.

Methods:  This study used a descriptive exploratory qualitative study design. In-person interviews were held with women who experienced a miscarriage. Interviews followed a semi-structured format by a single interviewer to explore the various aspects involving experiences of healthcare.

Results:  Eight interviews were conducted and analysed. The five themes that arose from transcribed data were: (1) a need for safety, (2) pain management, (3) moderating behaviours and attitudes, (4) disorienting healthcare systems and (5) abandonment. Several factors contributed to the loss of physical and emotional safety in the emergency centre environment. Timeous emotional and pharmacological pain management were found to be a gap while patients awaited care. Clear communication and staff attitude were found to be integral to the patient's experience and could avoid the perception of abandonment.

Conclusion:  There is a universal need for basic respectful, supportive and safe care in patients who attend an emergency centre for early pregnancy complications in rural South African. Specific focus should be given to clear communication and appropriate emotional support during and after the miscarriage.Contribution: This study can be used as a guide to improve services by ensuring respectful, transparent, informed, and appropriate continuity of care.

Background:  Although people living with HIV (PLWH) now have a longer life expectancy due to antiretroviral therapy, several factors impact their health-related quality of life (HRQoL). Understanding the dimensions and determinants of HRQoL among PLWH is crucial to developing solutions to improve their overall wellbeing.

Aim:  This research aimed to explore the HRQoL and its associated factors among PLWH in Lagos, Nigeria.

Setting:  Seven HIV testing and treatment centres in Lagos.

Methods:  A cross-sectional survey was conducted with 385 participants. Socio-demographic and HRQoL data were obtained using questionnaires and the Medical Outcomes Study HIV Health Survey (MOS-HIV). Logistic regression models were used to identify variables that were associated with quality of life.

Results:  The physical health summary and mental health summary scores measured by the MOS-HIV were 54.2 ± 5.3 and 56.3 ± 6.7, respectively. Being married, having higher levels of education, shorter duration of HIV and higher income levels were significantly associated with better HRQoL. The duration of HIV was found to have an inversely proportional influence on the quality of life of PLWH, both in physical health (χ2 = 9.477, p = 0.009) and mental health (χ2 = 11.88, p = 0.004) dimensions.

Conclusion:  The HRQoL of PLWH in Lagos, Nigeria was relatively low. Education, duration of HIV, marital status and income level are predictors of HRQoL.Contribution: This study is valuable for healthcare professionals and policymakers, providing them with essential information to tailor interventions and allocate resources effectively to improve the overall wellbeing of PLWH in Nigeria.

Background:  Embracing women's experiences in decision-making is imperative for continuity in effective coordination of maternal and neonatal health (MNH); women are the end users within the care ecosystem. Through women's continuous feedback, skilled birth attendants (SBAs) and the healthcare system get to understand emerging issues based on their needs and preferences.

Aim:  The purpose of this article is to describe women's experiences of continuity for effective coordination of care through the transitions in the MNH continuum in Kenya.

Setting:  The study was conducted in selected counties of Kenya based on birth rates per woman as follows: Wajir (7.8) Narok (6.0) Kirinyaga (2.3) and Nairobi (2.7) (1). The clients were interviewed concerning their experiences of the MNH continuum of care in English and Kiswahili.

Methods:  An interpretive hermeneutic phenomenological approach was used to construct the experiences of women of continuity during transitions in the MNH continuum for effective care coordination. Twelve participants were interviewed between January and April 2023. Atlas ti 22 software was used for data analysis.

Results:  Four women experiences were highlighted: Women unawareness of preconception care, use of prenatal care, labour, birthing and postpartum flow and the women's view on the MNH continuum.

Conclusion:  The women reported their segmental and transitional experience of the MNH continuum as one that did not consistently meet their needs and preferences in order for them to fully agree that the continuum enhanced continuity for effective coordination. They felt that they experienced continuity in some segments while in some they did not.Contribution: The embrace of women's experience of their needs and preferences through the MNH continuum (segments and transitional segments) through the lens of continuity for effective coordination is timely towards the improvement of maternal and neonatal care by 2030.

Background:  Decentralising medical school training enhances curriculum relevance, exposing students to generalist patient care in diverse contexts.

Aim:  The aim of the study was to understand the student experiences of learning during their 7-week Family Medicine rural rotation.

Setting:  Final year medical students who had completed their Family Medicine rotation in November 2022.

Methods:  A qualitative study involving 24 final year students (four semi- structured interviews and four focus group discussions [4 x 5 students]). All interviews were recorded, transcribed verbatim and analysed thematically.

Results:  Analysis revealed positive learning experiences and identified the following themes: taking responsibility for learning, the generalist context, teaching and learning in context and managing the learning environment.

Conclusion:  Active participation in hospital activities, exposure to disorientating dilemmas that challenged assumptions and reflection on these experiences led to transformative learning and knowledge co-construction.Contribution: The study contributes to the discussion and reinforces the advantages of distributed, experiential training, highlighting the positive impact of meaningful participation and transformative learning opportunities.