Browsing by Subject "non-communicable diseases"

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    Open Access
    A prospective study exploring the experience of rehabilitation health professionals in implementing the 5 A`s strategy in addressing risk factors for non-communicable diseases
    (2025) Vearey, Gillion; Maart, Soraya; Amosun, Seyi Ladele
    Background: The growing epidemic of non-communicable diseases (NCDs) has a significant impact globally and locally in South Africa, not only on mortality rates, but also morbidity; increasing the risk of disability and decreasing the quality of life of people affected by these diseases. Behaviour Change interventions such as Motivational Interviewing (MI) and Five A's (5A's), have been developed and implemented to address the four behavioural risk factors causing NCDs. Method: A mixed method was used to 1) assess the use of MI in a South African context to address health risks for NCD`s through a scoping review, 2) assess the Scale of Staff Valence(SSV) in using MI in routine patient consultations by making us of a cross-sectional survey and an adapted Staff Valence questionnaire, and 3) the experience of Rehabilitation Health Professionals (RHPs) in implementing MI in a focus group discussion. Results: The original search identified 22 articles for the scoping review, 11 articles were excluded by title, 2 were excluded by abstract and 1 excluded by full text, 8 articles were included in the review. All the studies were based in the Western Cape Province. Diabetes and CVD were the most common conditions discussed. Most studies delivered training over 3-4days with 2 or more days of follow-up. Outcomes showed benefits of being more equipped to deliver MI to patients with NCDs, however barriers such as appropriate venues, buy in from other staff, and difficulties building rapport with some patients were also reported. Fifteen RHPs participated in this study, with 11 RHPs having more than 5 years' experience in their professional field. For the SSV scores, where a higher score reflects a positive result, for capability the average score was 28 (80%) with a standard deviation (SD) 2.4 under opportunity the average score was 66 (86%) with SD 6.6; and under motivation average score was 31 (90%) with SD 2.2. There was a statistical difference in opportunity across the level of experience (p< 0.05). These high scores confirm RHPs staff readiness in implementing behaviour change. Two themes emerged following the qualitative analysis of the RHPs' experiences in implementing the 5A's approach, namely 1) quality of the 5A's which developed from challenges and benefits of this framework as well as the impact of improved knowledge around behaviour change, and 2) impact of the clinical setting which compared the range of clinical settings RHPs practice in and the contact time available to implement the 5A's. Discussion and Conclusion MI and the 5A's can be considered a feasible approach to addressing health risk behaviours related to NCDs in South Africa. RHPs discussed the value and benefits of training and equipping in behaviour change strategies. However, barriers and challenges do exist, such as the limited patient contact time and the stage of behaviour change of each patient, influencing the effectiveness of this approach; especially in an acute setting. RHPs practicing in a subacute or outpatient setting are better suited to implement such an approach considering their contact time to build rapport with patients. These RHPs may be a more appropriate study population for future research. The 5A's framework and motivational interviewing can have a significant impact on NCDs in SA, further research is required to determine the long-term effects of such interventions.
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    Open Access
    Fidelity and costs of implementing the integrated chronic disease management model in South Africa
    (2021) Lebina, Limakatso; Alaba, Olufunke; Oni, Tolullah; Kawanga, Mary
    Background: The health systems in many low-middle income countries are faced with an increasing number of patients with non-communicable diseases within a high prevalence of infectious diseases. Integrated chronic disease management programs have been recommended as one of the approaches to improve efficiency, quality of care and clinical outcomes at primary healthcare level. The South African Department of Health has implemented the Integrated Chronic Disease Management (ICDM) Model in Primary Health care (PHC) clinics since 2011. Some of the expected outcomes on implementing the ICDM model have not been achieved, and there is a dearth of studies assessing implementation outcomes of chronic care models, especially in low-middle income countries. This thesis aims to assess the degree of fidelity, moderating factors of fidelity and costs associated with the implementation of the ICDM model in South African PHC clinics. Methods: The study was a cross-sectional study design using mixed methods and following the process evaluation conceptual framework. A total of sixteen PHC clinics in the Dr. Kenneth Kaunda (DKK) health district of the North West Province as well as the West Rand (WR) health district of the Gauteng Province, that were ICDM pilot sites were included in the study. The degree of fidelity in the implementation of the ICDM model was evaluated using a fidelity criterion from the four major components of the ICDM model as follows: facility reorganization, clinical supportive management, assisted self-support and strengthening of the support systems. In addition, the implementation fidelity framework was utilized to guide the assessment of ICDM model fidelity moderating factors. The data on fidelity moderating factors were obtained by interviewing 30 purposively selected healthcare workers. The abbreviated Denison Organizational Culture (DOC) survey was administered to 90 healthcare workers to assess the impact of three cultural traits (involvement, consistency and adaptability) on fidelity. Cost data from the provider's perspective were collected in 2019. The costs of implementing the ICDM model current activities for three (facility reorganization, clinical supportive management and assisted self-management) components and additional costs of implementing with enhanced fidelity were estimated. Costs data was collected from budget reviews, interviews with management teams, and other published data. Descriptive statistics were used to describe participants and clinics. Fidelity scores were summarized using medians and proportions and compared by facilities and health districts. Qualitative data were analysed thematically. Pearson correlation coefficient was utilized to assess the association between fidelity and culture. The annual ICDM model implementation costs per PHC clinic and patient per visit were presented in 2019 US dollars. Results: The 16 PHC clinics had comparable patient caseload, and a median of 2430 (IQR: 1685-2942) patients older than 20 years received healthcare services in these clinics over six months. The overall implementation fidelity of the ICDM model median score was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The highest clinic fidelity score was 86% (136/158), while the lowest was 66% (104/158). The fidelity scores for the four components of the ICDM model were very similar. A patient flow analysis indicated long (2-5 hours) waiting times and that acute and chronic care services were combined onto one stream. Interviews with healthcare workers revealed that the moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). Participants also indicated that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. The overall mean score for the DOC was 3.63 (SD = 0.58), the involvement cultural trait had the highest (3.71; SD = 0.72) mean score, followed by adaptability (3.62; SD = 0.56), and consistency (3.56; SD = 0.63). Although there were no statistically significant differences in cultural scores between PHC clinics, culture scores for all three traits were significantly higher in WR (involvement 3.39 vs 3.84, p= 0.011; adaptability 3.40 vs 3.73, p= 0.007; consistency 3.34 vs 3.68, p= 0.034). The mean annual cost of implementing the ICDM model was $148 446.00 (SD: $65 125.00) per clinic, and 84% ($124 345.00) was for current costs while additional costs for higher fidelity accounted for were 16% ($24 102.00). The mean cost per patient per visit was $6.00 (SD:$0.77). Conclusion: There was some variability of fidelity scores on the components of the ICDM model by PHC clinics, and there are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Organizational culture needs to be purposefully influenced to enhance adaptability and consistency cultural traits of clinics to enhance the ICDM model's principles of coordinated, integrated, patient-centred care. Small additional costs are required to implement the ICDM model with higher fidelity. Recommendations: Interventions to enhance the fidelity of chronic care models should be tailored to specific activities that have low degree of adherence to the guidelines. Addressing some of the moderating factors like training and mentoring of staff members, role clarification and supply chain management could contribute to enhanced fidelity. Organizational culture enhancements to ensure that the prevailing culture is aligned with the planned quality advancements is recommended prior to the implementation of new innovative interventions. Further research on the cost-effectiveness of the ICDM model in middle-income countries is recommended.
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    Open Access
    Has Food Security and Nutritional Status Improved in Children 1–<10 Years in Two Provinces of South Africa between 1999 (National Food Consumption Survey) and 2018 (Provincial Dietary Intake Study (PDIS))
    (Multidisciplinary Digital Publishing Institute, 2022-01-18) Steyn, Nelia P.; Nel, Johanna H.; Drummond, Linda; Malczyk, Sonia; Senekal, Marjanne
    The 1999 National Food Consumption Survey in South Africa showed that food insecurity (hunger) was prevalent in households with children aged one to <10 years. A repeat of the survey in two provinces: Gauteng (GTG) and the Western Cape (WC) was undertaken in 2018. Results showed that in all domains (living areas) in GTG, food shortage prevalence decreased between 1999 and 2018, from 55.0% to 29.6% in urban informal areas, from 34.1% to 19.4% in urban formal areas and from 42.1% to 15.6% in rural areas. While the prevalence of food shortage in urban formal areas in the WC remained similar in 2018, prevalence decreased from 81.8% to 35.7% in urban informal areas and from 38.3% to 20.6% in rural areas. Energy and macronutrient intakes improved significantly in GTG between 1999 and 2018 but not in the WC; intakes were significantly higher in the WC at both time points. The only significant change in stunting, wasting, overweight and obesity prevalence was that 7–<10-year-olds in GTG were significantly more likely to be wasted (BAZ < 2SD) in 2018 than in 1999 (20.2% versus 6.9% respectively). In the WC, 1–3-year-olds were significantly more likely to be obese in 2018 than in 1999 (8.1% versus 1.7% respectively) and 7–<10-year-olds were less likely to be stunted (14.5% versus 4.9% respectively). There were significant negative correlations between the hunger score and dietary variables in both provinces in 1999. In GTG in 2018, only the correlation with fat intake remained while there were still several significant correlations in WC in 2018. Changes in top 12 energy contributors reflect a shift to high or moderate energy foods low in nutrients from 1999 to 2018. Nutrient dense (high micronutrients, low energy/g) foods (e.g., fruit) fell off the list in 2018. Logistic regression analyses reflect the importance for food security of having a parent as head of the household and/or caregiver, and parents having grade 12 or higher education and being employed. We conclude that food security nutritional status indicators improved amongst 1–<10-year-old children especially in GTG between 1999 and 2018. However, the shift to poorer food choices and increase in wasting in older children and overweight in younger children are of concern.
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    Open Access
    Physical activity levels, perceived barriers, and facilitators among office-based workers in Grootfontein, Namibia
    (2024) Nyazika, Blessing; Maart, Soraya; Gradidge, Philippe
    Introduction Physical activity is known to reduce the risk of non-communicable diseases (NCDs), mortality, and healthcare costs. However, physical inactivity remains high worldwide, increasing the NCD disease burden risk. Office workers have reported high physical inactivity levels during and after working hours. Previous studies have investigated the efficacy of various physical activity interventions to break sedentary behaviour in this population. There is limited data on physical activity among office-based workers in Namibia. Understanding their perceptions of physical activity will help inform interventions and policies to enhance participation. Aim The aim of this study was to assess physical activity levels, barriers, and facilitators among office-based workers in Grootfontein, Namibia. Methods A An explanatory-sequential mixed-methods study was conducted, and 217 office workers were surveyed using the Global Physical Activity Questionnaire to assess their physical activity levels. The questionnaire included sections on demographic details, work, travel, leisure-based physical activity, and daily sitting time. Semi structured interviews were carried out with 26 participants from the surveyed sample to understand their barriers and facilitators of physical activity. Results The mean age of the participants was 38 years. Female participants made up 63% of the surveyed sample. The majority of the participants had over five years of employment experience, and the average daily sitting time was 8 hours. Sixty-four percent of office workers were physically active, and 65% of them were either overweight or obese. The mean BMI of the participants was 28.2 kg/m². Four themes were generated from the thematic analysis of qualitative data. Office workers were aware of what physical activity entails but had varied opinions on the recommended guidelines. Time constraints were cited as the main barrier while they were motivated to participate in physical activity for health and self-care reasons. Office workers suggested the provision of more facilities and support in the workplace and community for increased participation in physical activity. Conclusion The majority of participants in the study were physically active, but they were either overweight or obese. A multi-factorial approach to a healthy lifestyle is necessary in addition to physical activity.
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    The association between nutrition and physical activity knowledge and weight status of primary school educators
    (2014) Dalais, Lucinda; Abrahams, Zulfa; Steyn, Nelia P; de Villiers, Anniza; Fourie, Jean M; Hill, Jillian; Lambert, Estelle V; Draper, Catherine E
    The purpose of this study was to investigate primary school educators' health status, knowledge, perceptions and behaviour regarding nutrition and physical activity.Thus, nutrition and physical activity knowledge, attitudes, behaviour and risk factors for the development of non-communicable diseases of 155 educators were assessed in a cross-sectional survey. Height, weight, waist circumference, blood pressure and random glucose levels were measured. Twenty percent of the sample had normal weight (body mass index (BMI, kg/m2) < 25), 27.7% were overweight (BMI> 25 to < 30) and 52.3% were obese (BMI < 30). Most of the participants were younger than 45 years (54.2%), females 78.1%, resided in urban areas (50.3%), with high blood pressure (> 140/90 mmHg: 50.3%), and were inactive (48.7%) with a high waist circumference (> 82 cm: 57.4%). Educators' nutrition and physical activity knowledge was poor. Sixty-nine percent of educators incorrectly believed that eating starchy foods causes weight gain and only 15% knew that one should eat five or more fruit and/or vegetables per day. Aspects of poor nutritional knowledge, misconceptions regarding actual body weight status, and challenges in changing health behaviours, emerged as issues which need to be addressed among educators. Educators' high risk for developing chronic non-communicable diseases (NCDs) may impact on educator absenteeism and subsequently on school functioning. The aspects of poor nutrition and physical activity knowledge along with educators' high risk for NCD development may be particularly significant not merely in relation to their personal health but also the learners they teach.