OpenUCT :: Browsing by Author "Colvin, Christopher J"

Browsing by Author "Colvin, Christopher J"

Now showing 1 - 20 of 38

Open Access
“A case study evaluating the effectiveness of adherence clubs in Gugulethu as a strategy for mobilizing and engaging men in HIV treatment”
(2022) Ncube, Petronella; Colvin, Christopher J; Mbokazi, Nonzuzo
The existing global literature shows that men living with HIV need efficient antiretroviral treatment (ART) delivery. Adherence clubs (ACs) have been identified as one way to improve retention of stable patients living with Human Immunodeficiency Virus (HIV). ACs are among several strategies that have been said to potentially assist in the engagement and mobilization of men in HIV services. However, very few have been evaluated to see whether they are effective in this regard. This qualitative study examines the facilitating factors that help retain and engage men in HIV services by trying to understand the perceived effectiveness of the Adherence Club in Gugulethu. The study employs a qualitative approach to explore the facilitating factors which help retain and engage men in HIV services. A total of 12 participants participated in in-depth telephonic interviews. The participants included stakeholders of the AC such as the health workers (facilitators, nurse, community health worker (CHW) and adherence counsellors), men attending the club and family members who are indirectly involved in supporting participants engagement in the AC as patients. Interviews were conducted in IsiXhosa and for data analysis, they were translated to English, and a thematic analysis was done. The findings show facilitating factors in all stages of the socio-ecological model with the patient level being the vital stage which allows for the integration of other level factors. This study shows that when men properly utilize the different resources provided for their HIV treatment, their engagement and retention in the AC improves. It is therefore key for policy makers to consider planning for male-focused health services to ensure that men view health services as spaces which are inclusive and tailored for them to improve their engagement and retain them in health services.
Open Access
A multidimensional approach to inform family planning needs, preferences and behaviours amongst women in South Africa through body mapping
(2019-11-06) Harries, Jane; Constant, Deborah; Wright, Vanessa; Morroni, Chelsea; Müller, Alex; Colvin, Christopher J
Abstract Background In recent decades there have been great improvements in the reproductive health of women in low- and middle-income countries and increases in the use of modern contraceptive methods. Nonetheless, many women are not able to access information, contraceptive technologies and services that could facilitate preventing unintended pregnancies and planning the number and timing of desired pregnancies. In South Africa, the contraceptive prevalence rate is 64.6%. However, this relatively high contraceptive prevalence rate masks problems with quality contraceptive service delivery, equitable access, and women’s ability to correctly and consistently, use contraceptive methods of their choice. This study set out to understand the specific family planning and contraceptive needs and behaviours of women of reproductive age in South Africa, through a lived experience, multisensory approach. Methods Participatory qualitative research methods were used including body mapping workshops amongst reproductive aged women recruited from urban and peri urban areas in the Western Cape South Africa. Data including body map images were analysed using a thematic analysis approach. Results Women had limited biomedical knowledge of the female reproductive anatomy, conception, fertility and how contraceptives worked, compounded by a lack of contraceptive counseling and support from health care providers. Women’s preferences for different contraceptive methods were not based on a single, sensory or experiential factor. Rather, they were made up of a composite of sensory, physical, social and emotional experiences underscored by potential for threats to bodily harm. Conclusions This study highlighted the need to address communication and knowledge gaps around the female reproductive anatomy, different contraceptive methods and how contraception works to prevent a pregnancy. Women, including younger women, identified sexual and reproductive health knowledge gaps themselves and identified these gaps as important factors that influenced uptake and effective contraceptive use. These knowledge gaps were overwhelmingly linked to poor or absent communication and counseling provided by health care providers. Body mapping techniques could be used in education and communication strategies around sexual and reproductive health programmes in diverse settings.
Open Access
Abortion services in South Africa : challenges and barriers to safe abortion care : health care providers' perspectives
(2010) Harries, Jane; Colvin, Christopher J
Unsafe abortion is a preventable phenomenon and continues to be a major public health problem in many countries especially in the developing world. Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion, and a shortage of trained and willing abortion providers. The dearth of abortion providers undermines the availability of safe, legal abortion, and has serious implications for women's access to abortion services and health service planning.
Open Access
Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series
(BioMed Central, 2018-01-25) Lewin, Simon; Booth, Andrew; Glenton, Claire; Munthe-Kaas, Heather; Rashidian, Arash; Wainwright, Megan; Bohren, Meghan A; Tunçalp, Özge; Colvin, Christopher J; Garside, Ruth; Carlsen, Benedicte; Langlois, Etienne V; Noyes, Jane
The GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. Confidence in the evidence from qualitative evidence syntheses is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. CERQual provides a systematic and transparent framework for assessing confidence in individual review findings, based on consideration of four components: (1) methodological limitations, (2) coherence, (3) adequacy of data, and (4) relevance. A fifth component, dissemination (or publication) bias, may also be important and is being explored. As with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach for effectiveness evidence, CERQual suggests summarising evidence in succinct, transparent, and informative Summary of Qualitative Findings tables. These tables are designed to communicate the review findings and the CERQual assessment of confidence in each finding. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. Papers 3, 4, 5, 6, and 7 in this series discuss each CERQual component, including the rationale for including the component in the approach, how the component is conceptualised, and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table. The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes but is also relevant to guideline development agencies, primary qualitative researchers, and implementation scientists and practitioners.
Open Access
Applying GRADE-CERQual to qualitative evidence synthesis findings–paper 6: how to assess relevance of the data
(BioMed Central, 2018-01-25) Noyes, Jane; Booth, Andrew; Lewin, Simon; Carlsen, Benedicte; Glenton, Claire; Colvin, Christopher J; Garside, Ruth; Bohren, Meghan A; Rashidian, Arash; Wainwright, Megan; Tunςalp, Özge; Chandler, Jacqueline; Flottorp, Signe; Pantoja, Tomas; Tucker, Joseph D; Munthe-Kaas, Heather
Background: The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual’s relevance component. Methods: We developed the relevance component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual relevance component within several qualitative evidence syntheses before agreeing on the current definition and principles for application. Results: When applying CERQual, we define relevance as the extent to which the body of data from the primary studies supporting a review finding is applicable to the context (perspective or population, phenomenon of interest, setting) specified in the review question. In this paper, we describe the relevance component and its rationale and offer guidance on how to assess relevance in the context of a review finding. This guidance outlines the information required to assess relevance, the steps that need to be taken to assess relevance and examples of relevance assessments. Conclusions: This paper provides guidance for review authors and others on undertaking an assessment of relevance in the context of the CERQual approach. Assessing the relevance component requires consideration of potentially important contextual factors at an early stage in the review process. We expect the CERQual approach, and its individual components, to develop further as our experiences with the practical implementation of the approach increase.
Open Access
Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 2: how to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table
(BioMed Central, 2018-01-25) Lewin, Simon; Bohren, Meghan; Rashidian, Arash; Munthe-Kaas, Heather; Glenton, Claire; Colvin, Christopher J; Garside, Ruth; Noyes, Jane; Booth, Andrew; Tunçalp, Özge; Wainwright, Megan; Flottorp, Signe; Tucker, Joseph D; Carlsen, Benedicte
Background: The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on making an overall assessment of confidence in a review finding and creating a CERQual Evidence Profile and a CERQual Summary of Qualitative Findings table. Methods: We developed this guidance by examining the methods used by other GRADE approaches, gathering feedback from relevant research communities and developing consensus through project group meetings. We then piloted the guidance on several qualitative evidence syntheses before agreeing on the approach. Results: Confidence in the evidence is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. Creating a summary of each review finding and deciding whether or not CERQual should be used are important steps prior to assessing confidence. Confidence should be assessed for each review finding individually, based on the judgements made for each of the four CERQual components. Four levels are used to describe the overall assessment of confidence: high, moderate, low or very low. The overall CERQual assessment for each review finding should be explained in a CERQual Evidence Profile and Summary of Qualitative Findings table. Conclusions: Structuring and summarising review findings, assessing confidence in those findings using CERQual and creating a CERQual Evidence Profile and Summary of Qualitative Findings table should be essential components of undertaking qualitative evidence syntheses. This paper describes the end point of a CERQual assessment and should be read in conjunction with the other papers in the series that provide information on assessing individual CERQual components.
Open Access
Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 3: how to assess methodological limitations
(BioMed Central, 2018-01-25) Munthe-Kaas, Heather; Bohren, Meghan A; Glenton, Claire; Lewin, Simon; Noyes, Jane; Tunçalp, Özge; Booth, Andrew; Garside, Ruth; Colvin, Christopher J; Wainwright, Megan; Rashidian, Arash; Flottorp, Signe; Carlsen, Benedicte
Abstract Background The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual’s methodological limitations component. Methods We developed the methodological limitations component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual methodological limitations component within several qualitative evidence syntheses before agreeing on the current definition and principles for application. Results When applying CERQual, we define methodological limitations as the extent to which there are concerns about the design or conduct of the primary studies that contributed evidence to an individual review finding. In this paper, we describe the methodological limitations component and its rationale and offer guidance on how to assess methodological limitations of a review finding as part of the CERQual approach. This guidance outlines the information required to assess methodological limitations component, the steps that need to be taken to assess methodological limitations of data contributing to a review finding and examples of methodological limitation assessments. Conclusions This paper provides guidance for review authors and others on undertaking an assessment of methodological limitations in the context of the CERQual approach. More work is needed to determine which criteria critical appraisal tools should include when assessing methodological limitations. We currently recommend that whichever tool is used, review authors provide a transparent description of their assessments of methodological limitations in a review finding. We expect the CERQual approach and its individual components to develop further as our experiences with the practical implementation of the approach increase.
Open Access
Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 4: how to assess coherence
(BioMed Central, 2018-01-25) Colvin, Christopher J; Garside, Ruth; Wainwright, Megan; Munthe-Kaas, Heather; Glenton, Claire; Bohren, Meghan A; Carlsen, Benedicte; Tunçalp, Özge; Noyes, Jane; Booth, Andrew; Rashidian, Arash; Flottorp, Signe; Lewin, Simon
Background: The GRADE-CERQual (Grading of Recommendations Assessment, Development and EvaluationConfidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE working group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) relevance, (3) coherence and (4) adequacy of data. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual’s coherence component. Methods: We developed the coherence component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual coherence component within several qualitative evidence syntheses before agreeing on the current definition and principles for application. Results: When applying CERQual, we define coherence as how clear and cogent the fit is between the data from the primary studies and a review finding that synthesises that data. In this paper, we describe the coherence component and its rationale and offer guidance on how to assess coherence in the context of a review finding as part of the CERQual approach. This guidance outlines the information required to assess coherence, the steps that need to be taken to assess coherence and examples of coherence assessments. Conclusions: This paper provides guidance for review authors and others on undertaking an assessment of coherence in the context of the CERQual approach. We suggest that threats to coherence may arise when the data supporting a review finding are contradictory, ambiguous or incomplete or where competing theories exist that could be used to synthesise the data. We expect the CERQual approach, and its individual components, to develop further as our experiences with the practical implementation of the approach increase.
Open Access
Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 5: how to assess adequacy of data
(BioMed Central, 2018-01-25) Glenton, Claire; Carlsen, Benedicte; Lewin, Simon; Munthe-Kaas, Heather; Colvin, Christopher J; Tunçalp, Özge; Bohren, Meghan A; Noyes, Jane; Booth, Andrew; Garside, Ruth; Rashidian, Arash; Flottorp, Signe; Wainwright, Megan
Background: The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations; (2) coherence; (3) adequacy of data; and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual’s adequacy of data component. Methods: We developed the adequacy of data component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual adequacy of data component within several qualitative evidence syntheses before agreeing on the current definition and principles for application. Results: When applying CERQual, we define adequacy of data as an overall determination of the degree of richness and the quantity of data supporting a review finding. In this paper, we describe the adequacy component and its rationale and offer guidance on how to assess data adequacy in the context of a review finding as part of the CERQual approach. This guidance outlines the information required to assess data adequacy, the steps that need to be taken to assess data adequacy, and examples of adequacy assessments. Conclusions: This paper provides guidance for review authors and others on undertaking an assessment of adequacy in the context of the CERQual approach. We approach assessments of data adequacy in terms of the richness and quantity of the data supporting each review finding, but do not offer fixed rules regarding what constitutes sufficiently rich data or an adequate quantity of data. Instead, we recommend that this assessment is made in relation to the nature of the finding. We expect the CERQual approach, and its individual components, to develop further as our experiences with the practical implementation of the approach increase.
Open Access
Attitudes, knowledge and beliefs around homosexuality: exploring the views of 5th year medical students
(2016) Sopitshi, Athenkosi; Muller, Alexandra; Colvin, Christopher J
Introduction: Discrimination from health workers has been found to be a deterrent for lesbian, gay, bisexual and transgender (LGBTI) people seeking healthcare. Despite these findings, LGBTI-focused healthcare remains understated in medical training and university curricular. Learning about medical students' attitudes can provide useful ways of identifying interventions to capacitate health professionals to address LGBTI health. Methods: This study is a mixed methods study, data were collected using a 25 item homophobia scale with additional questions designed for the South African context, and focus group discussions with semi-structured questions. Results: 157 Medical students in the 5th year class at a university in the Western Cape, South Africa completed the survey, 20 of them formed part of three focus group discussions. Outcomes showed significant gaps in student's curriculum in the area of LGBTI health which influenced their lack of knowledge and preparedness. Considering that homophobia and heterosexism remain widespread in the students' contexts, the findings point to generally favourable views of LGBTI people. In this respect, two thirds of the participants indicated that they are not bothered by seeing same-sex partners together and 64% felt that homosexuality was not immoral and showed support for LGBTI rights. The qualitative findings indicate that a contributing factor in shifting their attitudes based on their own perspectives was a change in environments from their hometowns to university. Students showed a keen interest in early integration of LGBTI health in their curriculum which is encouraging. Conclusion: Medical training needs to be responsive and intentional about addressing student attitudes towards LGBTI people, as this has implications on the students' perceived competency and affects the quality of healthcare they deliver.
Open Access
Barriers to adherence in patients failing second-line antiretroviral treatment in a township in South Africa: a qualitative research study
(2012) Barnett, Whitney; Colvin, Christopher J
The recent scale-up of ART coverage in resource-limited settings has greatly improved access to treatment. However, literature indicates that patients on ART have high rates of non-adherence (32% to 67%), virological failure (5.2%, to 47%) and resistance to ARVs (5.4% to 80%). These patients are failing first- and second-line ART, leaving no treatment options for successful virus suppression. Yet, literature addressing facilitators and barriers faced by patients on secondline ART is scarce. This study examined factors affecting adherence to second-line ART from the perspective of clinic staff as well as second-line failure patients, assessing both individual and structural barriers. Research was conducted at a large primary-care clinic in Khayelitsha, a periurban township in Cape Town, South Africa. A literature review was conducted to present 1) rates of non-adherence, virological failure and resistance and 2) to present known facilitators & barriers faced by patients on ART, with a specific focus on second-line patients. The literature was found via PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), with a preference for studies in low and middle income countries and those including second-line ART populations. The primary research used participants who were drawn from an MSF-run program to support patients failing second-line treatment.
Open Access
Breaking Bars: An investigation into how performance art as an intervention program inside prison may lead to a behavior change among male gang members in Cape Town, South Africa
(2018) Lingaas, Ingebjørg; Colvin, Christopher J
Violence has been declared a public health problem by the World Health Organisation (1996). Violence prevention strategies are actively used in efforts to rehabilitate offenders during their incarceration, and are intended to prepare them for reintegration into society and to prevent recidivism. Given the lack of research undertaken on violence prevention strategies in the gang-ridden context of Cape Town, South Africa, this dissertation looks at a prison intervention programme, Help I am Free, that uses performance arts as a case study to investigate the potential impacts of such intervention strategies. The paper does so by outlining the experiences of five male gang members before, during, and after their time in prison. Using a cross-sectional qualitative research design, the dissertation explores participants’ life histories and seeks to shed light on the ways in (and degrees to) which such programmes may influence the men’s attitudes towards themselves and others, and the likelihood of their successful reintegration into society. The theoretical frameworks used draw on applied theatre theories, social-cognitive theories, and theories of masculinities. The paper argues that programmes such as Help I am Free may impact participants’ perceptions of self and others strongly, and may also lead to an increased sense of self-worth and motivation to change lifestyle. However, it also indicates the limitations of the programme to achieve sustained success, given the structural barriers which afflict South Africa. The paper outlines a number of challenges that the men face while on parole, and concludes that while prison intervention programmes, and art programmes specifically, may trigger a sense of healing and encourage more positive notions of self, there are more comprehensive strategies in post-release urgently needed in order to prevent recidivism and to achieve authentic social re-integration.
Open Access
Caregivers readiness to disclose HIV status : experiences and challenges of child disclosure in South Africa
(2016) Tapscott, Kimberley; Colvin, Christopher J; Swartz, Alison
Disclosure of HIV status to children is a challenging process for caregivers, as it involves discussing a highly stigmatised disease, which may cause psychological stress to a child. Despite the benefits of disclosing, rates of HIV disclosure remain low as caregivers face various obstacles preventing them from disclosing, and this can have long-lasting effects on the treatment adherence of HIV-positive children. This qualitative study explored the perspectives and experiences of caregivers, in order to understand their readiness to disclose HIV status to their children, and address the factors that assist and hinder the process. Caregivers of HIV positive children (aged 5-15 years) participated in two focus group discussions (11 in each), and in-depth interviews were conducted with eight additional caregivers. Two healthcare workers and 10 NGO staff were also interviewed. Three key themes emerged from the data: caregivers' avoidance or delay of disclosure, factors related to caregivers' motivations to disclose, and caregiver's perception of child readiness for disclosure. The findings support the view that caregiver readiness is a key element of child disclosure. The research identified how caregivers can be educated about the benefits of disclosure, and be guided to take responsibility for the process. As there is a lack of context-specific and culturally-sensitive recommendations for child disclosure in South Africa, this research can be used to broaden the case base to inform the development of standardised guidelines that will assist caregivers to effectively communicate and manage the process of HIV disclosure with their children.
Open Access
Coming of age in Khayelitsha: gendered identity, sexual partnerships and the transition to adulthood
(2017) Swartz, Alison; Colvin, Christopher J; Harrison, Abigail
The lives of young people in Khayelitsha are characterised by a series of intersecting challenges. These include inadequate access to education, limited opportunities to find gainful employment, exposure to violence and the risk of contracting HIV. Several conventional avenues of transition to adulthood, for example achieving financial independence, moving out of the parental home or getting married, remain unavailable to many. The majority thus find themselves in a situation of waithood, an interminable period between childhood and adulthood characterised by extreme uncertainty. This thesis takes up questions of what it means to be a young man or woman navigating towards adulthood in this context of socioeconomic marginalisation. In particular, it explores the ways that youth negotiate the tensions between the structures that shape their lives and their opportunities for agency within the domains of gendered identities and sexual partnerships. Public health research and intervention with youth tends to rely more heavily on approaches underpinned by individual-level behaviour change theories, with lesser albeit growing attention paid to the structural forces that shape young lives. This thesis aims to balance the reading of individuals' capacity for agency in decision-making, with the broader structural forces that shape their life trajectories. To this end, a longitudinal, ethnographic approach was employed to capture nuances of context and experience as they unfolded and shifted through time and space. The data presented here is drawn from 18 months of ethnographic fieldwork with young people in the neighbourhood of Town Two, Khayelitsha, primarily collected between 2014 and 2015. Youth transition to adulthood is explored in the two interrelated domains of gendered identity and sexual partnerships. Within these domains, living up to individual and social ideals associated with masculinity and femininity is persistently challenging. Faced with these challenges, young people employ creative and dynamic strategies in their endeavours to maximize the precarious gains they make in their transition towards adulthood. Broadly speaking, these strategies include those linked to their physical bodies, sexual and social networks and the ways that they invoke ideas about what it means to be a young South African citizen. The findings highlight that in their transitions to adulthood, youth in Khayelitsha are neither complete victims, nor entirely free agents with the capacity to radically change their circumstances. This thesis ends by offering some recommendations about how public health programming might take into account the lived experiences of youth as they navigate the transition to adulthood in this context.
Open Access
Community health workers in Khayelitsha : motivations and challenges as providers of care and players within the health system
(2012) Swartz, Alison; Colvin, Christopher J
Community health workers (CHWs) play an important role in health care in South Africa and similar countries, but relatively little is known about CHW motivations and experiences in the provision of care. This thesis considers these issues in three parts: 1. A protocol for a study of community health work in Khayelitsha, an impoverished peri-urban settlement near Cape Town, which is home to a number of ‘flagship’ public health interventions aimed at HIV/AIDS and TB. 2. A review of literature on community health work exploring naturalistic versus economistic discourses around care work, and the complex intersections of these discourses. 3. An ethnographic account of CHWs who provide a wide range of community-based care work in Khayelitsha.
Open Access
Conscientious objection and its impact on abortion service provision in South Africa: a qualitative study
(2014-02-26) Harries, Jane; Cooper, Diane; Strebel, Anna; Colvin, Christopher J
Abstract Background Despite abortion being legally available in South Africa after a change in legislation in 1996, barriers to accessing safe abortion services continue to exist. These barriers include provider opposition to abortion often on the grounds of religious or moral beliefs including the unregulated practice of conscientious objection. Few studies have explored how providers in South Africa make sense of, or understand, conscientious objection in terms of refusing to provide abortion care services and the consequent impact on abortion access. Methods A qualitative approach was used which included 48 in-depth interviews with a purposively selected population of abortion related health service providers, managers and policy influentials in the Western Cape Province, South Africa. Data were analyzed using a thematic analysis approach. Results The ways in which conscientious objection was interpreted and practiced, and its impact on abortion service provision was explored. In most public sector facilities there was a general lack of understanding concerning the circumstances in which health care providers were entitled to invoke their right to refuse to provide, or assist in abortion services. Providers seemed to have poor understandings of how conscientious objection was to be implemented, but were also constrained in that there were few guidelines or systems in place to guide them in the process. Conclusions Exploring the ways in which conscientious objection was interpreted and applied by differing levels of health care workers in relation to abortion provision raised multiple and contradictory issues. From providers’ accounts it was often difficult to distinguish what constituted confusion with regards to the specifics of how conscientious objection was to be implemented in terms of the Choice on Termination of Pregnancy Act, and what was refusal of abortion care based on opposition to abortion in general. In order to disentangle what is resistance to abortion provision in general, and what is conscientious objection on religious or moral grounds, clear guidelines need to be provided including what measures need to be undertaken in order to lodge one’s right to conscientious objection. This would facilitate long term contingency plans for overall abortion service provision.
Open Access
Defining and conceptualising data harmonisation: a scoping review protocol
(BioMed Central, 2018-12-06) Schmidt, Bey-Marrié; Colvin, Christopher J; Hohlfeld, Ameer; Leon, Natalie
Abstract Background Data harmonisation is an important intervention to strengthen health systems functioning. It has the potential to enhance the production, accessibility and utilisation of routine health information for clinical and service management decision-making. It is important to understand the range of definitions and concepts of data harmonisation, as well as how its various social and technical components and processes are thought to lead to better health management decision-making. However, there is lack of agreement in the literature, and in practice, on definitions and conceptualisations of data harmonisation, making it difficult for health system decision-makers and researchers to design, implement, evaluate and compare data harmonisation interventions. This scoping review aims to synthesise (1) definitions and conceptualisations of data harmonisation as well as (2) explanations in the literature of the causal relationships between data harmonisation and health management decision-making. Methods This review follows recommended methodological stages for scoping studies. We will identify relevant studies (peer-reviewed and grey literature) from 2000 onwards, in English only, and with no methodological restriction, in various electronic databases, such as CINAHL, MEDLINE via PubMed and Global Health. Two reviewers will independently screen records for potential inclusion for the abstract and full-text screening stages. One reviewer will do the data extraction, analysis and synthesis, with built-in reliability checks from the rest of the team. We will use a combination of sampling techniques, including two types of ‘purposeful sampling’, a methodological approach that is particularly suitable for a scoping review with our objectives. We will provide (a) a numerical synthesis of characteristics of the included studies and (b) a narrative synthesis of definitions and explanations in the literature of the relationship between data harmonisation and health management decision-making. Discussion We list potential limitations of this scoping review. To our knowledge, this scoping review will be the first to synthesise definitions and conceptualisations of data harmonisation in the literature as well as the underlying explanations in the literature of the causal links between data harmonisation and health management decision-making.
Open Access
Engagement and understanding: pregnant adolescents and health information in Freedom Park
(2016) Stevens-Uninsky, Maya; Colvin, Christopher J
Adolescent and young adult pregnancy is a major sexual health issue for vulnerable young women in South Africa. Beginning by examining the origins of adolescent pregnancy in South Africa, this paper then proceeds to examine the various sources of health information accessible to adolescent women, and how said information is used. Finally, it examines the disconnect between know ledge and use of health information, and the role this plays in high levels of adolescent pregnancy. This independent research examines how adolescent women in the South African township of Mitchells Plain, Cape Town (specifically the neighbourhood of Freedom Park) understand and engage with the limited health information at their disposal. Through a qualitative research process resulting in interview analysis, this article explores how vulnerable young women internalize, believe, and use health information, in order to better understand the causes of adolescent pregnancy and risky sexual behaviour. Participants were adolescent (18 -¬‐ 20) women, who were residents of Freedom Park, (a neighbourhood in Mitchells Plain) and were either pregnant or had a child. Demographic screening tools (n=31) were used to select participants for semi -¬‐ structured interviews (n=30). Interviews were later transcribed verbatim, and analyzed using NVIVO. In this Freedom Park sample, the ability of young women to internalize and act upon information about sexuality and health varied depending on who proffered that information and how those individuals were perceived by the recipient. In the research, three key factors emerged as impacting the internalization and later use of reproductive health information. First, for both sources of health information and for recipients, life experience s played a critical role in making information more relatable and therefore easier to internalize, believe and use. Second, the perceived trustworthiness of the source of information made the knowledge more believable and relevant to the recipient. Finally, high levels of comfort in discussing sexual health with the source of information made information more easily internalized, while fear of negative judgment from sources reduced comfort and discussions of sexual health. The research suggests that efforts to reduce instances of adolescent pregnancy in South Africa should pay close attention to who delivers information about health and sexuality. To be effective, young women should feel they share experiences with, trust in, and are comfort able with sources of information. Future research should pursue how improving adolescent's engagement with health information through feelings of belonging, self ‐ efficacy, and empowerment can improve understanding, trust, and utilization of health information.
Open Access
Factors affecting men's movement through the HIV cascade in the public health services in Cape Town: Perspectives and experiences of health care providers
(2017) Madzima, Rutendo; Colvin, Christopher J; Schmidt, Bey-Marrié
The Human Immunodeficiency (HIV) epidemic in South Africa is disproportionately distributed by gender. Although women lead in the number of infections they are at an advantage when it comes to seeking and receiving care. Men's poor health seeking behaviour finds them seeking care late, testing at lower rates, defaulting from treatment and eventually having worse health outcomes. More men than women fail to enter and stay in the HIV cascade of care. The HIV cascade is a metaphor used to describe the steps that include HIV testing, initiation of antiretroviral therapy (ART), adherence, viral suppression and good health outcomes. As health care providers (HCPs) are the ones who interact directly with men in the health system their view of the factors that hinder men's movement through the HIV cascade are valuable to better understanding how men interact with the care system. In this research semi-structured interviews were held with eleven HCPs working with HIV positive patients (6 women, 5 men) across 2 health facilities and 1 non-governmental organisation (NGO) within the Klipfontein sub-district. Health care workers were found to share some of the more commonly held notions regarding the barriers men face in HIV care. However, their experiences offer some challenging ideas and the health systems appears to be realising the need to tailor HIV services to the needs of men. The experiences and perspectives of HCPs should be further explored and the findings used to influence health policies and clinical practice.
Open Access
Factors influencing male involvement in prevention of mother-to-child transmission services in Khayelitsha, Cape Town, South Africa
(2011) Ladur, Alice Norah; Colvin, Christopher J; Stinson, Kathryn
This study sought to explore the role of men in the prevention of mother-to-child transmission services in Khayelitsha, South Africa. Two focus group discussions were held with 25 men of unknown status and one focus group discussion held with 12 HIV-positive women in the community. In-depth interviews were also conducted with four HIV-positive couples and five service providers purposely sampled from the community and a health facility, respectively.