Browsing by Author "Malan, Megan"
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- ItemOpen AccessPatient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study(2021-05-12) van der Westhuizen, Claire; Malan, Megan; Naledi, Tracey; Roelofse, Marinda; Myers, Bronwyn; Stein, Dan J; Lahri, Sa’ad; Sorsdahl, KatherineAbstract Background Screening, brief intervention and referral to treatment (SBIRT) programmes have resulted in generally positive outcomes in healthcare settings, particularly for problem alcohol use, yet implementation is hampered by barriers such as concerns regarding the burden on healthcare professionals. In low-resourced settings, task-sharing approaches can reduce this burden by using non-professional healthcare workers, yet data are scarce regarding the outcomes and acceptability to patients within a SBIRT service. This study aims to evaluate patient-reported outcomes, patient acceptability, perceived benefits and recommendations for improving a task-shared SBIRT service in South African emergency centres (ECs). Methods This mixed methods study incorporates quantitative substance use screening and patient satisfaction data collected routinely within the service at three hospitals, and qualitative semi-structured interviews with 18 EC patient beneficiaries of the programme exploring acceptability and perceived benefits of the programme, as well as recommendations to improve the service. Approximately three months after the acute EC visit, a sub-sample of patients were followed up telephonically to assess patient-reported satisfaction and substance use outcomes. Results Of the 4847 patients eligible for the brief intervention, 3707 patients (76%) used alcohol as their primary substance and 794 (16%) used cannabis. At follow-up (n = 273), significant reductions in substance use frequency and severity were noted and over 95% of patients were satisfied with the service. In the semi-structured interviews, participants identified the non-judgemental caring approach of the counsellors, and the screening and psychoeducation components of the intervention as being the most valuable, motivating them to decrease substance use and make other positive lifestyle changes. Study participants made recommendations to include group sessions, market the programme in communities and extend the programme’s reach to include a broader age group and a variety of settings. Conclusions This task-shared SBIRT service was found to be acceptable to patients, who reported several benefits of a single SBIRT contact session delivered during an acute EC visit. These findings add to the SBIRT literature by highlighting the role of non-professional healthcare workers in delivering a low-intensity SBIRT service feasible to implement in low-resourced settings.
- ItemOpen AccessPredictors of consent to cell line creation and immortalisation in a South African schizophrenia genomics study(BioMed Central, 2018-07-11) Campbell, Megan M; de Vries, Jantina; Mqulwana, Sibonile G; Mndini, Michael M; Ntola, Odwa A; Jonker, Deborah; Malan, Megan; Pretorius, Adele; Zingela, Zukiswa; Van Wyk, Stephanus; Stein, Dan J; Susser, EzraBackground Cell line immortalisation is a growing component of African genomics research and biobanking. However, little is known about the factors influencing consent to cell line creation and immortalisation in African research settings. We contribute to addressing this gap by exploring three questions in a sample of Xhosa participants recruited for a South African psychiatric genomics study: First, what proportion of participants consented to cell line storage? Second, what were predictors of this consent? Third, what questions were raised by participants during this consent process? Methods 760 Xhose people with schizophrenia and 760 controls were matched to sex, age, level of education and recruitment region. We used descriptive statistics to determine the proportion of participants who consented to cell line creation and immortalization. Logistic regression methods were used to examine the predictors of consent. Reflections from study recruiters were elicited and discussed to identify key questions raised by participants about consent. Results Approximately 40% of participants consented to cell line storage. The recruiter who sought consent was a strong predictor of participant’s consent. Participants recruited from the South African Eastern Cape (as opposed to the Western Cape), and older participants (aged between 40 and 59 years), were more likely to consent; both these groups were more likely to hold traditional Xhosa values. Neither illness (schizophrenia vs control) nor education (primary vs secondary school) were significant predictors of consent. Key questions raised by participants included two broad themes: clarification of what cell immortalisation means, and issues around individual and community benefit. Conclusions These findings provide guidance on the proportion of participants likely to consent to cell line immortalisation in genomics research in Africa, and reinforce the important and influential role that study recruiters play during seeking of this consent. Our results reinforce the cultural and contextual factors underpinning consent choices, particularly around sharing and reciprocity. Finally, these results provide support for the growing literature challenging the stigmatizing perception that people with severe mental illness are overly vulnerable as a target group for heath research and specifically genomics studies.
- ItemOpen AccessThe prevalence and predictors of intimate partner violence among women attending a midwife and obstetrics unit in the Western Cape(2017) Malan, Megan; Sorsdahl, Katherine; Spedding, Maxine, FBackground: Intimate partner violence (IPV) during pregnancy is a common phenomenon across the world. The present study sought to determine the prevalence and predictors of intimate partner violence among pregnant women attending a midwife and obstetrics unit in the Western Cape. Methods: A convenience sample of a hundred and fifty pregnant women (n= 150) attending antenatal appointments at the Mitchell's Plain Midwife and Obstetrics Unit (MOU) were asked to participate in this study. Consenting women participated in an interview where they were asked questions concerning interpersonal violence and other psychosocial constructs, such as history of childhood trauma, exposure to community violence, depressive symptoms and alcohol use. Frequency distributions and descriptive statistics were calculated for categorical and continuous variables. Multivariable logistic models were developed to control for socio-demographics and psychosocial constructs. The first model was based on report of any form of IPV over the previous 12 months, while the remaining three models investigated the disaggregated forms of IPV: physical abuse, sexual abuse and emotional abuse. Results: Overall, the lifetime and 12-month prevalence rate for any IPV was 45% and 32%, respectively. For 12-month IPV, 32% reported general abuse, 29% physical and 20% reported being sexually abused. After adjusting for the effects of the other variables in the model, depressive symptoms, and reporting that this pregnancy was unplanned were significantly associated with the reporting of any IPV in the past 12 months. Looking specifically at 12 months general IPV, women who had depressive symptoms were more likely to experience some form of general IPV (OR= 6.42, CI 2.51-16.41) than women not at risk. Also, women of 'coloured' race were more likely to experience general IPV than Black African respondents (OR= 1.46, 95% CI 0.64-3.34). The model exploring associations for 12-month physical IPV found women who were at risk for depression were more likely to experience physical IPV (OR= 4.42, CI 1.88-10.41) than women not at risk, while the model exploring associations for 12-month sexual IPV found that women who reported experiencing community violence were more likely to report sexual IPV than women who reported no exposure to community violence (OR= 3.85, CI 1.14-13.08). Conclusion: This is the first study, which illustrates high prevalence rates of IPV among pregnant woman at Mitchells Plain MOU. A significant association was found between 12-month IPV and unintended pregnancy. Also, woman who are at risk for depression were found to have an increased chance of experiencing both general and physical IPV. Sexual IPV was associated with high levels of exposure to community violence. Further prospective studies in different centres are needed to address generalisability and the effect of IPV on maternal and child outcomes. Greater recognition of IPV in pregnancy could contribute to improved antenatal care, as well as enhanced policy development for appropriate intervention strategies. Key Words: Intimate partner violence; Interpersonal violence; Domestic violence; Abuse; Pregnancy; Antenatal; Postnatal depression and Community violence