Browsing by Author "Abrahams, Nina"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Open Access
    Factors that influence patient empowerment in inpatient chronic care: Early implementation experience with a diabetes care intervention in South Africa
    (2018) Abrahams, Nina; Gilson, Lucy; Levitt, Naomi
    The burden of non-communicable diseases is growing rapidly globally and especially in low and middle-income countries. However, health systems around the world are not appropriately prepared for this increase in need for chronic care. Research suggests that health models that emphasise self-management and empowering patients to care actively for their disease are integral in non-communicable disease treatment as patients live with their disease well beyond contact with health services. Adherence and health-seeking behaviour literature suggest multiple factors within the lives of patients and within health systems that enhance or constrain patient empowerment interventions. However, in depth understanding of these factors are lacking in the South African context and especially in the inpatient setting as most research focuses on the role of primary care. This research used interviews with stakeholders in an upcoming inpatient diabetes intervention as a lens to qualitatively explore empowerment factors in further detail within the South African inpatient context. The study highlights multiple barriers to patient empowerment, namely the low socio-economic contexts of many South Africans who then struggle to access appropriate healthcare information and services and often have financial and emotional priorities that take precedence over their chronic illness. In addition, health services are bound by a shortage of resources and staff and ineffective communication systems which affects health professionals’ ability to implement patient empowerment strategies. It also highlights the unique barriers found in inpatient care as the hospital emphasises short-term acute treatment – losing potential engagement time with patients. The study suggests that patient and provider contexts make encouraging patient engagement in long term chronic care difficult. However, knowledge of these factors can be harnessed to improve chronic care interventions in low- and middle-income countries.
  • Thumbnail Image
    Item
    Open Access
    Factors that influence patient empowerment in inpatient chronic care: early thoughts on a diabetes care intervention in South Africa
    (2019-12-05) Abrahams, Nina; Gilson, Lucy; Levitt, Naomi S; Dave, Joel A
    Abstract Background The burden of non-communicable diseases is growing rapidly in low- and middle-income countries. Research suggests that health interventions that aim to improve patient self-management and empower patients to care actively for their disease will improve health outcomes over the long-term. There is, however, a gap in the literature about the potential role of the inpatient setting in supporting chronic care. This is particularly important in low-and-middle income countries where hospitals may be a rare prolonged point of contact between patient and health provider. The aim of this small scale, exploratory study was to understand what factors within the inpatient setting may affect patients’ feelings of empowerment in relation to their chronic disease care and provides recommendations for future inpatient-based interventions to support self-management of disease. Methods This study was based in a public, academic hospital in South Africa. Eighteen qualitative, semi-structured interviews were conducted with multiple participants with experience of diabetes care: inpatients and health professionals such as nurses, endocrinologists, and dieticians. Findings were analysed using a broad, exploratory, thematic approach, guided by self-management and chronic care literature. Results Interviews with both patients and providers suggest that patients living in low socio-economic contexts are likely to struggle to access appropriate healthcare information and services, and may often have financial and emotional priorities that take precedence over their chronic illness. Younger people may also be more dependent on their family and community, giving them less ability to take control of their disease care and lifestyle. In addition, hospital care remains bound by an acute care model; and the inpatient setting of focus is characterised by perceived staff shortages and ineffective communication that undermine the implementation of patient empowerment-focused interventions. Conclusions Patient and provider contexts are likely to make supporting patient engagement in long-term chronic care difficult in lower income settings. However, knowledge of these factors can be harnessed to improve chronic care interventions in South Africa and other similar countries.
  • Thumbnail Image
    Item
    Open Access
    What do we know about preventing school violence? A systematic review of systematic reviews
    (Taylor & Francis, 2017-01-30) Lester, Soraya; Lawrence, Cayleigh; Ward, Catherine L
    Many children across the world are exposed to school violence, which undermines their right to education and adversely affects their development. Studies of interventions for school violence suggest that it can be prevented. However, this evidence base is challenging to navigate. We completed a systematic review of interventions to reduce four types of school violence: (a) peer violence; (b) corporal punishment; (c) student-on-teacher violence and (d) teacher-on-student violence. Reviewers independently searched databases and journals. Included studies were published between 2005 and 2015; in English; considered school-based interventions for children and measured violence as an outcome. Many systematic reviews were found, thus we completed a systematic review of systematic reviews. Only systematic reviews on interventions for intimate partner violence (IPV) and peer aggression were found. These reviews were generally of moderate quality. Research on both types of violence was largely completed in North America. Only a handful of programmes demonstrate promise in preventing IPV. Cognitive behavioral, social-emotional and peer mentoring/mediation programmes showed promise in reducing the levels of perpetration of peer aggression. Further research needs to determine the long-term effects of interventions, potential moderators and mediators of program effects, program effects across different contexts and key intervention components.