Browsing by Author "Kathard, H"

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    A case study of factors influencing primary healthcare Continuity of Care for persons with disabilities
    (2024) Padayachee, Thesandree; Kathard, H
    Background: “Continuity of Care” refers to how a patient experiences care over time and is considered to be a central pillar in the delivery of high-quality person-centred healthcare. In South Africa (SA), persons with disabilities experience a range of structural barriers to health services and even when access to health services is realised, poorly integrated health systems and services, limited human resources and poor awareness of the needs of persons with disabilities result in unmet healthcare needs. Given the rapidly transforming healthcare context of SA and the adoption of policies towards the realisation of universal health coverage, an understanding of how the health system is responding to the “Continuity of Care” needs of persons with disabilities through policy and practice is valuable step towards realising the goal of integrated people-centred health systems; particularly in the delivery of primary healthcare (PHC). Objectives: The study aimed to explore factors influencing “Continuity of Care” for persons with disabilities within the PHC context. Experiences and expectations of persons with disabilities were explored, relevant policies governing PHC and “Continuity of Care” were analysed and health systems responsiveness was explored to understand what influences “Continuity of Care” for persons with disabilities. Method: This exploratory case study used a critical social theory and a health policy and systems approach to better understand how primary healthcare “Continuity of Care” for persons with disabilities can be strengthened. The Conceptual Framework for Health Systems Responsiveness (Mirzoev & Kane, 2017) informed the case study design by exploring how persons with disabilities experienced “Continuity of Care” and supported a deeper understanding of health systems gaps through perspectives of service providers in responding to the “Continuity of Care” needs of persons with disabilities. The study was conducted within the context of the SA primary healthcare policy and implementation in an urban suburb in the city of Durban, KwaZulu Natal in South Africa. The study included multiple data collection methods including interviews, focus group discussions, document reviews and analysis of relevant policies using an adapted EquiFrame (Amin, 2011). Qualitative data was analysed thematically using inductive and deductive analysis. Results: Participants with disabilities were found to experience primary healthcare discontinuity resulting from known factors such as lack of reliable and accessible transport, negative attitudes of health facility staff and sub-optimal management of clinic and outreach services. New insights that were found to negatively affect “Continuity of Care” for persons with disabilities included the combined influences of institutional distrust; the medical model as a legacy of apartheid; incoherence in policies supporting “Continuity of care” and poor user-centred design practices in the delivery of new innovations that were unresponsive to the needs of persons with disabilities. Positive influences on “Continuity of Care” included emergent community leadership, family resilience to navigate through treatment uncertainty and supportive servant leadership styles of healthcare providers. Conclusion: The study points to the need for an expanded understanding of “Continuity of Care” for persons with disabilities within an African paradigm where care continuity extends beyond the health facility and with a stronger emphasis on community driven models of care that respect the role and influence of traditional health practitioners and cultural practices. More research is needed to better understand institutional distrust and how traditional western models of healthcare can be reshaped to deliver services.
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    Open Access
    A case study of how a centre-based preschool programme for children who are blind/visually impaired supports early multilingual communication development
    (2023) Kamedien, Layla; Kathard, H
    Communication development is an essential part of a child's development – socially, academically, and vocationally. For children with visual impairment/blindness (VI/B), the literature indicates that opportunities supporting early communication development can benefit a child with VI/B. Speech-language therapists' (SLTs) core focus on communication is instrumental in supporting children to develop their communication. However, little is known about the practices which support the communication development of children with VI/B. The study therefore aimed to explore and describe how the centre-based preschool programme at the League of the Friends of the Blind (LOFOB) in Cape Town supported early multilingual communication development. A qualitative case study design was used to explore and describe the programme's knowledge, values, principles, skills, and practices. Semi-structured interviews were conducted with key stakeholders, along with classroom observations and document reviews of key government policies, principles and standards. Thematic analysis was used to analyse and interpret findings. During this process a key informant with VI was used to assist with the interpretation of the data. The findings are presented as a narrative and accompanying individual vignettes. The narrative explores the activities and opportunities available for multilingual communication support. While the individual vignettes describe the knowledge, values, principles and skills that inform the practices of the programme. Key themes that emerged from thematic analysis of the data include an inclusive approach to encourage multilingual engagements and support, a structured programme that focussed on capabilities, and a committed team offering support. The study argued that there is an opportunity for the SLT profession to rethink how communication is typically supported and shifting from a focus on pathology to communication supports that explore capabilities and inclusion.
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    Open Access
    Distortion product otoacoustic emissions: towards reliable and valid early identification and monitoring of hearing in adults receiving ototoxic medication
    (2023) Petersen, Lucretia; Kathard, H
    Background: Multidrug-resistant tuberculosis (MDR-TB) patients receive aminoglycosides as part of their treatment. These drugs are ototoxic, and can cause permanent damage to the cochlea, resulting in a debilitating hearing loss, which has a negative impact on an individual's quality of life. Early detection and management of an ototoxic hearing loss can minimise the impact of the hearing loss on the person's social, emotional, and vocational wellbeing. While patients with MDR-TB are often very ill, it might be ideal to use an objective test that does not require active participation from the patient. In this way, the reliability and validity of the test will not be affected by the patient's state. Distortion product otoacoustic emissions (DPOAEs) at 2f1-f2 are a viable option, as it evaluates cochlear function, specifically the outer hair cells, which are affected first by ototoxic medication. Method: This thesis used a sequential study design aimed to determine the DPOAE stimulus parameters that yield (a) the highest level and the most reliable, sensitive and specific DPOAEs reported in the literature, (b) the highest level and the most reliable DPOAEs in healthy, normally hearing adults, and (c) the most sensitive and specific DPOAEs in participants with MDR-TB patients receiving ototoxic medication. High frequency pure tone audiometry (defined in this thesis as frequencies > 8 kHz) was used as the gold standard. Descriptive statistics, the intraclass correlation coefficient, Pearson's correlation coefficient and mixed model analyses were used to analyse the data. Results: Systematic review: The results of the systematic review indicated an L1/L2 setting of 75/75 dB SPL and f2/f1 value from 1.20 to 1.22 yielded the highest level DPOAEs. The systematic review results for stimulus parameters that yielded the highest test-retest reliability, sensitivity and specificity were inconclusive. Preliminary study with healthy normal hearing participants: The results of the preliminary study in healthy, normal-hearing participants indicated that the highest levels of DPOAEs were elicited with L1/L2 intensity levels of 65/65 and 65/55 dB SPL, and f2/f1 ratios of 1.18, 1.20 and 1.22, as determined by mixed model analyses (p < 0.05). These same stimulus parameters yielded the most reliable DPOAEs in both ears, as determined by intraclass correlation coefficient analysis. Main study with healthy, normal-hearing participants: Descriptive statistics and mixed model analysis showed stimulus intensity levels L1/L2 of 65/55 dB SPL, and f2/f1 ratios of 1.18 and 1.20, elicited the largest DPOAEs. The ratio of 1.20 yielded the largest DPOAEs < 5000 Hz and f2/f1 ratio of 1.18 the largest DPOAEs ≥ 5000 Hz. The second highest DPOAE levels were elicit by L1/L2 = 65/65 dB SPL and f2/f1 = 1.18. The test-retest reliability in this sample was not influenced by changing the stimulus parameters, and DPOAEs were only unreliable at an f2 frequency of 8 000 Hz. Study in participants with MDR-TB: Results in participants with MDR-TB receiving ototoxic medication indicated that the highest levels of DPOAEs were elicited with L1/L2 = 65/55 and an f2/f1 ratio of 1.18 at f2 ≥ 5000 Hz, followed by 65/65 and 1.18. For f2 < 5000 Hz, stimulus intensities of L1/L2 = 65/55 and an f2/f1 ratio of 1.20 yielded the largest DPOAE levels. Relating to sensitivity and specificity, the stimulus parameter combination of 65/55 dB and 1.18 detected the highest number of ears with outer hair cell damage in participants with MDR-TB receiving ototoxic medication. Conclusion: It should be considered to use an f2/f1 ratio of 1.18 for f2 ≥ 5000 Hz and 1.20 for f2 < 5000 Hz when monitoring for ototoxicity, to assist with early identification of outer hair cell damage, in conjunction with high frequency pure tone audiometry. This finding needs to be confirmed in a larger sample of participants with MDR-TB receiving ototoxic medication.
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    Open Access
    How can the process of professional identity formation of a gender-affirming practitioner inform medical curriculum change?
    (2024) De Vries, Elsje; Kathard, H
    Background Transgender and gender diverse people experience significant health disparities. Health professionals are generally not adequately prepared by current curricula to provide gender-affirming, holistic care that is respectful of patients' gender identity. Therefore, this study asks the question: How can the professional identity formation of a gender-affirming practitioner inform medical curriculum change? Methodology The objectives of the study were to: a. Analyse the process of professional identity formation of gender-affirming health care practitioners and students, using narrative interviews. b. Illuminate how medical curriculum change can enable gender-affirming professional identity formation. A critical research paradigm using the conceptual lens of professional identity formation was adopted. Case study design and narrative inquiry were the complementary methodological frameworks used. The study was conducted in two phases. In Phase One, six health care practitioners and nine medical students described their shared their experiences of becoming gender-affirming practitioners through narrative interviews. A narrative analysis was conducted and represented as stories. In phase two these stories were shared with medical educators in a group engagement to facilitate their reflections on gender-affirming curriculum change. Reflexive thematic analysis was used to analyse this discussion. Regulatory policy and university curriculum documents were analysed. Other data sources were participant reflective journals from phase one and the researcher's reflective journal. Findings from each phase were combined for the case study analysis using a critical lens. Findings The process of professional identity formation is described as a journey of becoming over time rather than a destination. Being gender-affirming entails providing holistic care, confronting pathologising perspectives, seeing the human first, and shifting power to enable patient participation. The present learning environment at medical schools is not conducive to the development of a gender-affirming practitioner, given the gap between the intended and experienced curriculum. Conclusion A gender-affirming approach offers a new perspective of how power dynamics may shift to create a more enabling environment for the development of a genderaffirming professional identity. Curriculum change can facilitate this approach by integrating gender-affirming healthcare into the medical curriculum with a focus on attitudes, cultural humility and incorporating the voices of transgender and gender diverse people