Browsing by Author "Heap, Marion"
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- ItemOpen AccessAntenatal health promotion via short message service at a Midwife Obstetrics Unit in South Africa: a mixed methods study(BioMed Central, 2014-08-21) Lau, Yan K; Cassidy, Tali; Hacking, Damian; Brittain, Kirsty; Haricharan, Hanne J; Heap, MarionAbstract Background Adequate antenatal care is important to both the health of a pregnant woman and her unborn baby. Given South Africa’s high rate of cellphone penetration, mobile health interventions have been touted as a potentially powerful means to disseminate health information. This study aimed to increase antenatal health knowledge and awareness by disseminating text messages about clinic procedures at antenatal visits, and how to be healthy during pregnancy. Methods Participants recruited were pregnant women attending a primary health care facility in Cape Town. A controlled clinical trial was carried out where the intervention group (n = 102) received text messages staggered according to the week of pregnancy at the time of recruitment. The control group (n = 104) received no text messages. These text messages contained antenatal health information, and were delivered in English, Xhosa or Afrikaans, according to the preference of each participant. A baseline knowledge questionnaire with nine questions was administered prior to the intervention. The same questionnaire was used with added health-related behaviour questions for the intervention group at exit. A modified intention-to-treat analysis was done. To compare the control and intervention group’s knowledge, Fisher’s exact tests and two-sample t-tests tests were carried out for binary and continuous outcomes, respectively. A focus group of seven participants from the intervention group was then conducted to gain more insight into how the text messages were perceived. Results There was substantial loss to follow-up during the study with only 57% of the participants retained at exit. No statistically significant difference was detected between the control and intervention group in any of the nine knowledge questions at exit (all p > 0.05). Responses from the focus group indicated that the text messages acted as a welcome reminder and a source of positive motivation, and were perceived as extended care from the health care provider. Conclusions While the intervention failed to improve antenatal health knowledge, evidence from self-reported behaviour and the focus group suggests that text messages have the potential to motivate change in health-seeking behaviour. One should be mindful of loss to follow-up when rolling out mobile health interventions in developing country settings. Trial registration Pan African Clinical Trials Registry PACTR201406000841188 . Registered 3 June 2014.
- ItemOpen AccessHealth promotion via SMS improves hypertension knowledge for deaf South Africans(BioMed Central, 2017-08-18) Haricharan, Hanne Jensen; Heap, Marion; Hacking, Damian; Lau, Yan KwanBackground: Signing Deaf South Africans have limited access to health information. As a result, their knowledge about health is limited. Cell phone usage in South Africa is high. This study aimed to assess whether a short message service (SMS)-based health promotion campaign could improve Deaf people’s knowledge of hypertension and healthy living. Additionally, the study aimed to assess the acceptability of using SMSs for health promotion targeting Deaf people. Methods: A baseline questionnaire assessed participants’ knowledge about hypertension before an SMS-based information campaign was conducted. After the campaign, an exit questionnaire was conducted, containing the same questions as the baseline questionnaire with additional questions about general acceptability and communication preferences. Results were compared between baseline and exit, using McNemar’s test, paired t-test and Wilcoxon signed-rank test. Focus groups aimed to get further information on the impact and acceptability of SMSs. The focus groups were analysed using inductive thematic analysis. Results: The campaign recruited 82 participants for the baseline survey, but due to significant loss-to-follow-up and exclusions only 41 participants were included in the analysis of the survey. The majority (60%) were men. Eighty percent were employed, while 98% had not finished high school. The campaign showed a statistically significant improvement in overall knowledge about hypertension and healthy living amongst participants. Six individual questions out of 19 also showed a statistically significant improvement. Despite this, participants in focus groups found the medical terminology difficult to understand. Several ways of improving SMS campaigns for the Deaf were identified. These included using using pictures, using ‘signed’ SMSs, combining SMSs with signed drama and linking SMS-campaigns to an interactive communication service that would enable the Deaf to pose questions for clarification. Focus groups suggested that participants who were hypertensive during the campaign adopted a healthier lifestyle. Conclusion: SMSs were effective in improving Deaf people’s knowledge of hypertension and healthy living. However, SMS-campaigns should be cognizant of Deaf people’s unique needs and communication preference and explore how to accommodate these. Trial registration: The research was registered with the Pan African Clinical Trial Registry on December 1, 2015. Identification number: PACTR201512001353476.
- ItemOpen AccessHow is palliative care part of the right to health? The South African evidence(2019) Gwyther, Elizabeth; London, Leslie; Heap, MarionPalliative care is an appropriate and compassionate response to the needs of patients with life threatening illness. International human rights law establishes palliative care as part of the right to health. But what does this mean in practice? How is palliative care part of the right to health at the country level and in everyday patient experience? This thesis addresses this question with evidence from South Africa. South Africa is important for a number of reasons. The government, despite the country’s progressive Constitution (No 108, 1996) which entrenches the right of access to health care has yet to take responsibility for palliative care. Most recently, the South African government co-sponsored the World Health Assembly (2014) resolution on palliative care and thus has a commitment to implementing the resolution. The thesis employs General Comment 14 on the Right to Health to frame the four nested studies that were carried out to address the key research question. General Comment 14 (2000), adopted by the United Nations Committee on Economic, Social and Cultural Right, describes the normative content of the right to health (Article 12 International Covenant on Economic, Social and Cultural Rights) to include four overlapping elements – availability, accessibility acceptability and quality. Aim of the research: to evaluate current provision of palliative care in South Africa in terms of the Human Rights considerations of availability, accessibility and quality. Study One commences the thesis by estimating the need for palliative care in South Africa. Using mortality data for 2010 for conditions determined a priori to require palliative care, approximately 0.52% of the population were estimated to require palliative care, which translates into an average need of 698.5 persons per 100000 or 1 in 143 people every year. While this is a considerable burden, it is also likely to be a significant under-estimate, given limitations to the methods identified in the study. Study Two examines availability of services to meet the need for palliative care. A survey was completed by 131 palliative care organisations between March 2011 and October 2011. Only 3% of services were located within the public sector. The estimated number of patients who received care during the year was 46,347. This is approximately 18% of the need identified earlier in Study One. Availability of morphine, as a marker for palliative care, was found to be dependent on employment of and level of palliative care training of doctors and was especially poorly supplied in the rural areas. Thus, the availability of Palliative Care appears to be limited by health system factors. Study Three investigates access to palliative care in Cape Town, via two pathways 1) referral of patients requiring palliative care and 2) palliative care in their current care settings. A prospective cohort study over six months followed up 162 participants from three groups: 1) patients with metastatic cancer; 2) patients living with HIV with a CD4 count of < 200 cells/mm3 ; and3) patients diagnosed with motor neuron disease (MND). A questionnaire and a validated patient-reported outcome scale, the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS), was administered at first visit. Thereafter participants were followed up telephonically once a month. Few patients (5%)were referred to palliative care services even though a significant number of patients died during the course of the study, indicating a failure to access palliative care when needed. Patient outcomes for people living with HIV improved significantly whereas the majority of patient outcomes in the cancer and MND groups did not improve. Thus, the accessibility of palliative care to patients already in the health system appears to be poor, except when palliative care is integrated into primary care, as is the case for patients with HIV on ARV treatment. Study Four evaluated the quality of care delivered to patients requiring palliative care in accredited hospice and non-hospice non-governmental services in five of the nine provinces of South Africa. A survey was conducted with 459 patient participants and 253 family members who were followed up over a 4-6 week period. Perceptions of quality care were explored through narrative questions and patient-reported outcomes were assessed using the APCA African POS. The results show significant improvement in patient reported outcome measures in both hospice and non-hospice groups, with pain and worry showing the most improvement. Content analysis of the narrative questions identified 5 themes: Quality of Care, Place of care, Staff values and attitudes, Information-sharing and Problems experienced by participants Conclusion: The thesis presents evidence that despite nominal commitment by the state, palliative care is not yet implemented as part of the right to health in South Africa. The need is great but availability of palliative care services is insufficient to meet the need. Access is poor even where palliative care is available but is facilitated by integration of palliative care into primary care services. However, when access is achieved, quality of care is generally good and patient outcomes improve over time with evidence that palliative care values patients as individuals. The study considers concepts relating to dignity and human rights in health as core to both human rights and palliative care. Implications: In South Africa, the planned National Health Insurance Policy lists palliative care as a service in the primary health care setting. In addition, a National Palliative Care Policy has been approved with strategies to integrate palliative care into public health facilities. As General Comment 14 has proved useful for the thesis, for the future, it may also provide a framework to monitor state accountability on the basis of Availability, Accessibility, Acceptability, and Quality of palliative care that can be transferred to other countries.