Faculty of Community & Health Sciences
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The Faculty of Community and Health Sciences (CHS) is committed to excellence in education and training, research and community service which promotes a progressive primary health care approach in an inter-professional manner.
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Recent Submissions
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Frantz, Jose; Rowe, Michael (Health and Medical Publications Group, 2013)[more][less]
Abstract: Background. Evidence-based practice (EBP) is the process by which a clinician evaluates the quality of evidence before applying it in the management of a patient. Many practitioners struggle to integrate this research-based evidence into their professional practice. Blogs have been identified as useful pedagogical tools that can facilitate the sharing of ideas and clinical experiences among peers to reflect on diverse learning experiences. Objectives. A qualitative research design was used to examine the use of reflective blogging to teach the process of EBP in physiotherapy. Methods. A conveniently selected group of postgraduate students who were registered for an EBP module participated in the study. Blogging was used to teach the process of EBP in physiotherapy using Kolb's cycle as a guiding and an evaluative framework. Students reflected on and shared their learning experiences in ways that exposed the limits of their understanding around certain concepts. Results. The results reflect how students moved from assisted to independent performance by identifying gaps in their own understanding and finding the answers themselves. Conclusion. Reflective blogging was found to be a valuable tool for promoting meaningful learning activities among participants and assisted students in making sense of their shared experiences. It was also an effective tool to be used in teaching the process of EBP. URI: http://hdl.handle.net/10566/615 Files in this item: 1
FrantzBloggingPhysiotheraphy2013.pdf (1.131Mb) -
Rowe, Michael; Frantz, Jose; Bozalek, Vivienne (BioMed Central, 2013)[more][less]
Abstract: Background: While there is evidence to suggest that teaching practices in clinical education should include activities that more accurately reflect the real world, many educators base their teaching on transmission models that encourage the rote learning of knowledge and technical skills. Technology-mediated instruction may facilitate the development of professional attributes that go beyond “having” knowledge and skills, but there is limited evidence for how to integrate technology into these innovative teaching approaches. Methods: This study used a modified Delphi method to help identify the professional attributes of capable practitioners, the approaches to teaching that may facilitate the development of these attributes, and finally, how technology could be integrated with those teaching strategies in order to develop capable practitioners. Open-ended questions were used to gather data from three different expert panels, and results were thematically analysed. Results: Clinical educators should not view knowledge, skills and attitudes as a set of products of learning, but rather as a set of attributes that are developed during a learning process. Participants highlighted the importance of continuing personal and professional development that emphasised the role of values and emotional response to the clinical context. To develop these attributes, clinical educators should use teaching activities that are learner-centred, interactive, integrated, reflective and that promote engagement. When technology-mediated teaching activities are considered, they should promote the discussion of clinical encounters, facilitate the sharing of resources and experiences, encourage reflection on the learning process and be used to access content outside the classroom. In addition, educational outcomes must drive the integration of technology into teaching practice, rather than the features of the technology. Conclusions: There is a need for a cultural change in clinical education, in which those involved with the professional training of healthcare professionals perceive teaching as more than the transmission of knowledge and technical skills. Process-oriented teaching practices that integrate technology as part of a carefully designed curriculum may have the potential to facilitate the development of capable healthcare graduates who are able to navigate the complexity of health systems and patient management in ways that go beyond the application of knowledge and skills. URI: http://hdl.handle.net/10566/595 Files in this item: 1
RoweTeachnology-MediatedTeaching2013.pdf (185.7Kb) -
Willemse, Juliana; Kortenbout, Elma (AOSIS OpenJournals, 2012)[more][less]
Abstract: The practice of community health nursing (CHN) may enhance the life experiences of families and communities, particularly amongst the poor and socially marginalised. CHN provides for a deeper understanding of the health status of families living within communities, for example, where and how they live, their cultural context and their ability to identify resources available to assist with their health care (Allender, Rector & Warner 2010:17). This qualitative phenomenological study reflects on the self-reported lived experiences of undergraduate CHN students at the University of the Western Cape in the City of Cape Town, South Africa. These students conducted a family health assessment (FHA) learning task at the homes of families within communities. Purposive and convenience sampling was used by students who had conducted an FHA. Fourteen students agreed to participate in the study, of whom nine were interviewed, two withdrew and the remaining three were not interviewed since no new data were emerging during interviews, indicating that saturation had been reached. During in-depth interviews with seven female and two male students, data for the exploration of the lived experiences was gathered through the following question: ‘How did you experience the FHA?’ Field notes were taken and used to capture non-verbal communication of participants. The focus of the study was to explore the lived experiences of students and not those of the family on whom the FHA was completed. Data collected were categorised into themes, guided by the systematic data analysis process of Tesch (1990) cited in Cresswell (2003:192). Four themes emerged: challenges of family selection, challenges of safety, socio-cultural challenges and academic challenges experienced by the participants. This study will inform future research and curriculum planning for CHN education in a multifaceted context. URI: http://hdl.handle.net/10566/588 Files in this item: 1
WillemseNursesAssessment2012.pdf (427.8Kb) -
Leon, Natalie; Schneider, Helen; Daviaud, Emmanuelle (BioMed Central, 2012)[more][less]
Abstract: Background: Mobile phone technology has demonstrated the potential to improve health service delivery, but there is little guidance to inform decisions about acquiring and implementing mHealth technology at scale in health systems. Using the case of community-based health services (CBS) in South Africa, we apply a framework to appraise the opportunities and challenges to effective implementation of mHealth at scale in health systems. Methods: A qualitative study reviewed the benefits and challenges of mHealth in community-based services in South Africa, through a combination of key informant interviews, site visits to local projects and document reviews. Using a framework adapted from three approaches to reviewing sustainable information and communication technology (ICT), the lessons from local experience and elsewhere formed the basis of a wider consideration of scale up challenges in South Africa. Results: Four key system dimensions were identified and assessed: government stewardship and the organisational, technological and financial systems. In South Africa, the opportunities for successful implementation of mHealth include the high prevalence of mobile phones, a supportive policy environment for eHealth, successful use of mHealth for CBS in a number of projects and a well-developed ICT industry. However there are weaknesses in other key health systems areas such as organisational culture and capacity for using health information for management, and the poor availability and use of ICT in primary health care. The technological challenges include the complexity of ensuring interoperability and integration of information systems and securing privacy of information. Finally, there are the challenges of sustainable financing required for large scale use of mobile phone technology in resource limited settings. Conclusion: Against a background of a health system with a weak ICT environment and limited implementation capacity, it remains uncertain that the potential benefits of mHealth for CBS would be retained with immediate large-scale implementation. Applying a health systems framework facilitated a systematic appraisal of potential challenges to scaling up mHealth for CBS in South Africa and may be useful for policy and practice decision-making in other low- and middle-income settings. URI: http://hdl.handle.net/10566/552 Files in this item: 1
LeonHealthSystem2012.pdf (230.9Kb) -
Moshabela, Mosa; Schneider, Helen; Silal, Sheetal; Cleary, Susan (BioMed Central, 2012)[more][less]
Abstract: Background: In low-resource settings, patients’ use of multiple healthcare sources may complicate chronic care and clinical outcomes as antiretroviral therapy (ART) continues to expand. However, little is known regarding patterns, drivers and consequences of using multiple healthcare sources. We therefore investigated factors associated with patterns of plural healthcare usage among patients taking ART in diverse South African settings. Methods: A cross-sectional study of patients taking ART was conducted in two rural and two urban sub-districts, involving 13 accredited facilities and 1266 participants selected through systematic random sampling. Structured questionnaires were used in interviews, and participant’s clinic records were reviewed. Data collected included household assets, healthcare access dimensions (availability, affordability and acceptability), healthcare utilization and pluralism, and laboratory-based outcomes. Multiple logistic regression models were fitted to identify predictors of healthcare pluralism and associations with treatment outcomes. Prior ethical approval and informed consent were obtained. Results: Nineteen percent of respondents reported use of additional healthcare providers over and above their regular ART visits in the prior month. A further 15% of respondents reported additional expenditure on self-care (e.g. special foods). Access to health insurance (Adjusted odds ratio [aOR] 6.15) and disability grants (aOR 1.35) increased plural healthcare use. However, plural healthcare users were more likely to borrow money to finance healthcare (aOR 2.68), and incur catastrophic levels of healthcare expenditure (27%) than non-plural users (7%). Quality of care factors, such as perceived disrespect by staff (aOR 2.07) and lack of privacy (aOR 1.50) increased plural healthcare utilization. Plural healthcare utilization was associated with rural residence (aOR 1.97). Healthcare pluralism was not associated with missed visits or biological outcomes. Conclusion: Increased plural healthcare utilization, inequitably distributed between rural and urban areas, is largely a function of higher socioeconomic status, better ability to finance healthcare and factors related to poor quality of care in ART clinics. Plural healthcare utilization may be an indication of patients’ dissatisfaction with perceived quality of ART care provided. Healthcare expenditure of a catastrophic nature remained a persistent complication. Plural healthcare utilization did not appear to influence clinical outcomes. However, there were potential negative impacts on the livelihoods of patients and their households. URI: http://hdl.handle.net/10566/547 Files in this item: 1
MoshabelaAntiretroviralTherapy2012.pdf (419.5Kb)