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

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dc.contributor.advisorGithaiga, Jennifer
dc.contributor.advisorChu, Kathryn
dc.contributor.authorStofberg, Anronel
dc.date.accessioned2026-01-28T12:49:29Z
dc.date.available2026-01-28T12:49:29Z
dc.date.issued2025
dc.date.updated2026-01-28T12:48:04Z
dc.description.abstractBackground: 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.
dc.identifier.apacitationStofberg, A. (2025). <i>Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/42737en_ZA
dc.identifier.chicagocitationStofberg, Anronel. <i>"Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025. http://hdl.handle.net/11427/42737en_ZA
dc.identifier.citationStofberg, A. 2025. Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study. . University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/42737en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Stofberg, Anronel AB - 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. DA - 2025 DB - OpenUCT DP - University of Cape Town KW - chronic wound care KW - public health KW - healthcare access KW - barriers to care KW - Four Delays framework KW - mixed methods KW - Khayelitsha KW - South Africa LK - https://open.uct.ac.za PB - University of Cape Town PY - 2025 T1 - Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study TI - Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study UR - http://hdl.handle.net/11427/42737 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/42737
dc.identifier.vancouvercitationStofberg A. Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study. []. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2025 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/42737en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectchronic wound care
dc.subjectpublic health
dc.subjecthealthcare access
dc.subjectbarriers to care
dc.subjectFour Delays framework
dc.subjectmixed methods
dc.subjectKhayelitsha
dc.subjectSouth Africa
dc.titleIdentifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMSc
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