Caregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation

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dc.contributor.authorJones, Caroline H Den_ZA
dc.contributor.authorWard, Alisonen_ZA
dc.contributor.authorHodkinson, Peter Wen_ZA
dc.contributor.authorReid, Stephen Jen_ZA
dc.contributor.authorWallis, Lee Aen_ZA
dc.contributor.authorHarrison, Sianen_ZA
dc.contributor.authorArgent, Andrew Cen_ZA
dc.date.accessioned2016-04-13T12:36:15Z
dc.date.available2016-04-13T12:36:15Z
dc.date.issued2016en_ZA
dc.description.abstractPurpose Understanding caregivers' experiences of care can identify barriers to timely and good quality care, and support the improvement of services. We aimed to explore caregivers' experiences and perceptions of pathways to care, from first access through various levels of health service, for seriously ill and injured children in Cape Town, South Africa, in order to identify areas for improvement. METHODS: Semi-structured, qualitative interviews were conducted with primary caregivers of children who were admitted to paediatric intensive care or died in the health system prior to intensive care admission. Interviews explored caregivers' experiences from when their child first became ill, through each level of health care to paediatric intensive care or death. A maximum variation sample of transcripts was purposively sampled from a larger cohort study based on demographic characteristics, child diagnosis, and outcome at 30 days; and analysed using the method of constant comparison. RESULTS: Of the 282 caregivers who were interviewed in the larger cohort study, 45 interviews were included in this qualitative analysis. Some caregivers employed 'tactics' to gain quicker access to care, including bypassing lower levels of care, and negotiating or demanding to see a healthcare professional ahead of other patients. It was sometimes unclear how to access emergency care within facilities; and non-medical personnel informally judged illness severity and helped or hindered quicker access. Caregivers commonly misconceived ambulances to be slow to arrive, and were concerned when ambulance transfers were seemingly not prioritised by illness severity. Communication was often good, but some caregivers experienced language difficulties and/or criticism. CONCLUSIONS: Interventions to improve child health care could be based on: reorganising the reception of seriously ill children and making the emergency route within healthcare facilities clear; promoting caregivers' use of ambulances and prioritising transfers according to illness severity; addressing language barriers, and emphasising the importance of effective communication to healthcare providers.en_ZA
dc.identifier.apacitationJones, C. H. D., Ward, A., Hodkinson, P. W., Reid, S. J., Wallis, L. A., Harrison, S., & Argent, A. C. (2016). Caregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation. <i>PLoS One</i>, http://hdl.handle.net/11427/18854en_ZA
dc.identifier.chicagocitationJones, Caroline H D, Alison Ward, Peter W Hodkinson, Stephen J Reid, Lee A Wallis, Sian Harrison, and Andrew C Argent "Caregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/18854en_ZA
dc.identifier.citationJones, C. H., Ward, A., Hodkinson, P. W., Reid, S. J., Wallis, L. A., Harrison, S., & Argent, A. C. (2016). Caregivers’ experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation. PloS one, 11(3), e0151606. doi:10.1371/journal.pone.0151606en_ZA
dc.identifier.ris TY - Journal Article AU - Jones, Caroline H D AU - Ward, Alison AU - Hodkinson, Peter W AU - Reid, Stephen J AU - Wallis, Lee A AU - Harrison, Sian AU - Argent, Andrew C AB - Purpose Understanding caregivers' experiences of care can identify barriers to timely and good quality care, and support the improvement of services. We aimed to explore caregivers' experiences and perceptions of pathways to care, from first access through various levels of health service, for seriously ill and injured children in Cape Town, South Africa, in order to identify areas for improvement. METHODS: Semi-structured, qualitative interviews were conducted with primary caregivers of children who were admitted to paediatric intensive care or died in the health system prior to intensive care admission. Interviews explored caregivers' experiences from when their child first became ill, through each level of health care to paediatric intensive care or death. A maximum variation sample of transcripts was purposively sampled from a larger cohort study based on demographic characteristics, child diagnosis, and outcome at 30 days; and analysed using the method of constant comparison. RESULTS: Of the 282 caregivers who were interviewed in the larger cohort study, 45 interviews were included in this qualitative analysis. Some caregivers employed 'tactics' to gain quicker access to care, including bypassing lower levels of care, and negotiating or demanding to see a healthcare professional ahead of other patients. It was sometimes unclear how to access emergency care within facilities; and non-medical personnel informally judged illness severity and helped or hindered quicker access. Caregivers commonly misconceived ambulances to be slow to arrive, and were concerned when ambulance transfers were seemingly not prioritised by illness severity. Communication was often good, but some caregivers experienced language difficulties and/or criticism. CONCLUSIONS: Interventions to improve child health care could be based on: reorganising the reception of seriously ill children and making the emergency route within healthcare facilities clear; promoting caregivers' use of ambulances and prioritising transfers according to illness severity; addressing language barriers, and emphasising the importance of effective communication to healthcare providers. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0151606 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Caregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation TI - Caregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation UR - http://hdl.handle.net/11427/18854 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0151606en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/18854
dc.identifier.vancouvercitationJones CHD, Ward A, Hodkinson PW, Reid SJ, Wallis LA, Harrison S, et al. Caregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation. PLoS One. 2016; http://hdl.handle.net/11427/18854.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Emergency Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2016 Jones et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAmbulancesen_ZA
dc.subject.otherMedical doctorsen_ZA
dc.subject.otherChild healthen_ZA
dc.subject.otherHealth care facilitiesen_ZA
dc.subject.otherPediatricsen_ZA
dc.subject.otherSepsisen_ZA
dc.subject.otherLanguageen_ZA
dc.subject.otherNursesen_ZA
dc.titleCaregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigationen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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