Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study

Stofberg, Anronel

Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Background: Chronic wounds impose a significant burden on health systems, as delayed access to care contributes to poorer clinical outcomes and increased healthcare costs. These delays are particularly pronounced within resource-constrained systems such as the South African public healthcare system. Identifying barriers to accessing care can contribute to developing interventions to optimise pathways to chronic wound care. Aim: To map existing services, resources, and referral pathways for chronic wounds at each level of care and identify barriers to accessing care in the Khayelitsha health district. Methods: A mixed methods study was conducted in the Khayelitsha health district between November 2020 and May 2021. Quantitative data was obtained through surveys in all 12 healthcare facilities offering chronic wound care across three levels of care. Qualitative data was gathered through semi-structured individual interviews with 10 chronic wound care providers and 10 patients. The Four Delays framework (seeking, reaching, receiving, and remaining in care) was utilised to identify and map barriers to accessing care. Results: Nine overlapping barriers were identified, each contributing to multiple delays across all three levels of care. Seeking care was delayed by personal beliefs and the fear of amputation. Reaching care was delayed by transportation costs and safety concerns. Receiving care was delayed by chronic wound care provider and stock shortages, together with the non-utilisation of treatment and referral protocols. Remaining in care was delayed by deficient health information and lengthy waiting times at healthcare facilities. Conclusion: This study underscores the complexity of pathways to chronic wound care and emphasises the need for a holistic approach to improve access. Key recommendations include: (1) community health education campaigns, (2) subsidies for transportation to healthcare facilities, (3) increasing the nursing workforce, and (4) ensuring adherence to treatment and referral protocols.