Experiences of community service nurses regarding supervision and support from professional nurses in primary health care clinics in Nelson Mandela Bay
- Authors: Zambodla, Ayanda
- Date: 2020
- Subjects: Primary health care -- South Africa
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/46456 , vital:39604
- Description: Community servicenursesinSouthAfricaarenewly qualified nurses who have to undertake a one-year community service rotation in public healthcare facility. Recently qualified, they are not yet competent to work alone and require supervision Theobjectiveofthisstudywastoexploreanddescribetheexperiencesofcommunity service nurses with regards to the supervision and support they received from professional nurses at primary healthcare clinics inNelsonMandelaBay.The researcher utilised a qualitative research approach, with an explorative, descriptive and contextual research design inorder to achieve the objectives of this study. The research population comprised community service nurses who had completed their one-year community serviceduringthe2016-2017cycleinaprimary healthcarefacilityinNelsonMandelaBay.Purposivesamplingwasusedtoselectthe research sample. Data collection was done by conducting 10semi-structured interviews. Descriptive field notes supplemented the data. Tesch’smethod of qualitative data analysis was employed to analyse the data. Ethical considerations were applied throughout the study. Trustworthiness of the study was maintained by applyingGuba’s criteria of credibility, transferability, dependability and confirmability. Two main themes emerged from the study. Theme1 focused on the participant's experiences regarding the diverse needs related to the community service placement at primary healthcare clinics. Theme2 related to the participants expressed experiences with regard to social interaction during community service at primary healthcare clinics. The findings of the study enabled recommendations to be made for nursing practice, education and research.
- Full Text:
- Date Issued: 2020
- Authors: Zambodla, Ayanda
- Date: 2020
- Subjects: Primary health care -- South Africa
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/46456 , vital:39604
- Description: Community servicenursesinSouthAfricaarenewly qualified nurses who have to undertake a one-year community service rotation in public healthcare facility. Recently qualified, they are not yet competent to work alone and require supervision Theobjectiveofthisstudywastoexploreanddescribetheexperiencesofcommunity service nurses with regards to the supervision and support they received from professional nurses at primary healthcare clinics inNelsonMandelaBay.The researcher utilised a qualitative research approach, with an explorative, descriptive and contextual research design inorder to achieve the objectives of this study. The research population comprised community service nurses who had completed their one-year community serviceduringthe2016-2017cycleinaprimary healthcarefacilityinNelsonMandelaBay.Purposivesamplingwasusedtoselectthe research sample. Data collection was done by conducting 10semi-structured interviews. Descriptive field notes supplemented the data. Tesch’smethod of qualitative data analysis was employed to analyse the data. Ethical considerations were applied throughout the study. Trustworthiness of the study was maintained by applyingGuba’s criteria of credibility, transferability, dependability and confirmability. Two main themes emerged from the study. Theme1 focused on the participant's experiences regarding the diverse needs related to the community service placement at primary healthcare clinics. Theme2 related to the participants expressed experiences with regard to social interaction during community service at primary healthcare clinics. The findings of the study enabled recommendations to be made for nursing practice, education and research.
- Full Text:
- Date Issued: 2020
A theoretical study on primary health care services within a South African context
- Mkalipi, Thembinkosi Delport
- Authors: Mkalipi, Thembinkosi Delport
- Date: 2018
- Subjects: Primary health care -- South Africa , Health facilities -- South Africa Clinics -- South Africa
- Language: English
- Type: Thesis , Masters , MPA
- Identifier: http://hdl.handle.net/10948/32193 , vital:31979
- Description: Primary health care (PHC) is a system introduced to bring health services closer to communities. It was introduced with its challenges such as the management and treatment of various illnesses including HIV, TB and STI’s which have affected certain communities. The non-communicable diseases which require the attention of PHC institutions still face numerous challenges including the referral system and clinics with limited medicine. The study revealed that there are limited measures in place to deal with communities in rural areas who require medical assistance from government. Further challenges identified from the study included human resource management, supply chain management, finance and other administrative support systems. The inadequate funding of the Department of Health appears to be directly related to adequate service delivery problems. The study adopted a qualitative research methodology which incorporated an extensive desktop analysis and literature review approach. No human participants were involved. Health legislation is an important enabler and a necessary component of health policy. Research has shown that since 1995 when the first edition of the review appeared, South Africa has been engaged in a constant process of public health law reform and despite significant gains, some legislative processes have stalled. Examples include the certificate of need provided for in the National Health Act, the introduction of compulsory continuing professional development for pharmacists, the recognition of specialist nurses as prescribers, and the introduction of international benchmarking for medicinal processes. The process of introducing NHI remains contested with the legislative component, still under developed. Although NHI will in due course be a game changer and there has been some strengthening of the health service in the NHI pilot district to date, in general, implementation has been slower than anticipated in the NHI green paper released in August 2011. The NHI white paper indicated that public health care spending was likely to increase substantially over the next 15years from 4% to 6% of the GDP. Several mechanisms for raising revenue have been proposed, including some combination of an increase of VAT or payroll tax, or an increase of personal income tax. NHI also has the potential to improve efficiencies in the overall health system through improved pooling, strategic purchasing, medicine price reduction through central procurement, redistribution, improved quality in the public sector and providing greater access to general practitioners. Development of, and amendment to the relevant health technology assessment policy and legislative frameworks are needed in order to inform appropriate universal health coverage and to align with the 2015 NHI white paper Addressing social determinants is the cornerstone of the National Department of Health’s primary health care system. A engineering strategy, and an approach that is embedded in the country’s national development plan is needed. However the translation of this policy commitment to programmatic action at different levels in the health system and in partnership with other sectors remains elusive Evidence indicate that South African patients face challenges in accessing heath care particularly those from rural areas. The main challenge is the lack of a coordinated strategy to ensure continuous access to treatment, cure and support for chronic conditions. This study has shown that the private for profit hospital sector is well resourced and caters to a population that is wealthier, urban and more likely to be formerly employed. The public hospital sector catering to the majority of South Africans, faces lower human resourcing ratios, financial constraints and ageing infrastructure. The ideal clinic realisation and maintenance programme was assigned in response to the current deficiencies in the quality of primary health care services and to lay a strong foundation for the implementation of national health insurance. There is an urgent need to develop cohesive, sustainable systems to support evidence based decisions on appropriate regime choices, while minimizing risks associated with medication. This study has shown the importance of a robust national PV system in order to reduce the significant burden of drug induced diseases, to inform treatment policies with real world evidence, to improve outcomes of common diseases, such as HIV, TB, hypertension, and diabetes through optimal therapeutic management, and to ensure the safety of large scale therapeutic interventions such as vaccines, especially when newly introduced. Results from the study suggest that there is a failure by policy-makers to adequately address the challenges faced by PHC institutions. There also appears to be a backlog in terms of the promulgation of enabling legislation to address certain of the challenges. The Department of Health has a number of draft policies which are negatively affecting the level of service delivery. The study revealed that the challenges include, inter alia, inadequate budgeting, staff shortages, aging infrastructure, the non-availability of certain medicines in hospitals, a poor referral system with limited measures in place to address HIV, TB and STI’s as well as non-communicable treatments.
- Full Text:
- Date Issued: 2018
- Authors: Mkalipi, Thembinkosi Delport
- Date: 2018
- Subjects: Primary health care -- South Africa , Health facilities -- South Africa Clinics -- South Africa
- Language: English
- Type: Thesis , Masters , MPA
- Identifier: http://hdl.handle.net/10948/32193 , vital:31979
- Description: Primary health care (PHC) is a system introduced to bring health services closer to communities. It was introduced with its challenges such as the management and treatment of various illnesses including HIV, TB and STI’s which have affected certain communities. The non-communicable diseases which require the attention of PHC institutions still face numerous challenges including the referral system and clinics with limited medicine. The study revealed that there are limited measures in place to deal with communities in rural areas who require medical assistance from government. Further challenges identified from the study included human resource management, supply chain management, finance and other administrative support systems. The inadequate funding of the Department of Health appears to be directly related to adequate service delivery problems. The study adopted a qualitative research methodology which incorporated an extensive desktop analysis and literature review approach. No human participants were involved. Health legislation is an important enabler and a necessary component of health policy. Research has shown that since 1995 when the first edition of the review appeared, South Africa has been engaged in a constant process of public health law reform and despite significant gains, some legislative processes have stalled. Examples include the certificate of need provided for in the National Health Act, the introduction of compulsory continuing professional development for pharmacists, the recognition of specialist nurses as prescribers, and the introduction of international benchmarking for medicinal processes. The process of introducing NHI remains contested with the legislative component, still under developed. Although NHI will in due course be a game changer and there has been some strengthening of the health service in the NHI pilot district to date, in general, implementation has been slower than anticipated in the NHI green paper released in August 2011. The NHI white paper indicated that public health care spending was likely to increase substantially over the next 15years from 4% to 6% of the GDP. Several mechanisms for raising revenue have been proposed, including some combination of an increase of VAT or payroll tax, or an increase of personal income tax. NHI also has the potential to improve efficiencies in the overall health system through improved pooling, strategic purchasing, medicine price reduction through central procurement, redistribution, improved quality in the public sector and providing greater access to general practitioners. Development of, and amendment to the relevant health technology assessment policy and legislative frameworks are needed in order to inform appropriate universal health coverage and to align with the 2015 NHI white paper Addressing social determinants is the cornerstone of the National Department of Health’s primary health care system. A engineering strategy, and an approach that is embedded in the country’s national development plan is needed. However the translation of this policy commitment to programmatic action at different levels in the health system and in partnership with other sectors remains elusive Evidence indicate that South African patients face challenges in accessing heath care particularly those from rural areas. The main challenge is the lack of a coordinated strategy to ensure continuous access to treatment, cure and support for chronic conditions. This study has shown that the private for profit hospital sector is well resourced and caters to a population that is wealthier, urban and more likely to be formerly employed. The public hospital sector catering to the majority of South Africans, faces lower human resourcing ratios, financial constraints and ageing infrastructure. The ideal clinic realisation and maintenance programme was assigned in response to the current deficiencies in the quality of primary health care services and to lay a strong foundation for the implementation of national health insurance. There is an urgent need to develop cohesive, sustainable systems to support evidence based decisions on appropriate regime choices, while minimizing risks associated with medication. This study has shown the importance of a robust national PV system in order to reduce the significant burden of drug induced diseases, to inform treatment policies with real world evidence, to improve outcomes of common diseases, such as HIV, TB, hypertension, and diabetes through optimal therapeutic management, and to ensure the safety of large scale therapeutic interventions such as vaccines, especially when newly introduced. Results from the study suggest that there is a failure by policy-makers to adequately address the challenges faced by PHC institutions. There also appears to be a backlog in terms of the promulgation of enabling legislation to address certain of the challenges. The Department of Health has a number of draft policies which are negatively affecting the level of service delivery. The study revealed that the challenges include, inter alia, inadequate budgeting, staff shortages, aging infrastructure, the non-availability of certain medicines in hospitals, a poor referral system with limited measures in place to address HIV, TB and STI’s as well as non-communicable treatments.
- Full Text:
- Date Issued: 2018
Perceptions, knowledge and attitude of primary health care staff on the implementation of an ideal clinic strategy
- Authors: Messiahs, Avril
- Date: 2018
- Subjects: Primary health care -- South Africa , Clinics -- South Africa Nurses -- South Africa -- Attitudes
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: http://hdl.handle.net/10948/32204 , vital:31985
- Description: The study sought to understand the perceptions, knowledge and attitude of primary healthcare (PHC) staff with the implementation of the ideal clinic strategy (ICS). The ICS is a new standard of healthcare process implemented by the South African Department of Health (SA DoH) at PHC level in both private and public sector. This study however only focuses on the public sector. The ICS is implemented in accordance with the guidelines stipulated in the SA DoH Strategic Plan 2014 – 2019. The study utilised a quantitative methodological approach to investigate the research question. Ethics clearance was obtained from the Nelson Mandela University and the National Department of Health to conduct the study in 10 clinics that were identified as ideal clinics in the rolling out of the ICS. The sample consisted of 48 clinical and 146 non-clinical staff within primary healthcare (PHC) facilities of the elected 10 clinics. One hundred and ninety-four (194) questionnaires were therefore distributed to these staff members, but only 135 usable questionnaires were returned. This translated into a response rate of 69.6%. The empirical results showed that: - most participants were knowledgeable about the implementation of the ICS; - females were more knowledgeable about the strategy than males, although the difference was not significant; - male participants were however more engaged with the ICS than females; - clinical staff members were perceived to be more engaged in the implementation of the ICS than the non-clinical staff; - more than half of the participants (53.5%) perceived the implementing the ICS as not being easy; and - more females than males perceived the implementation of ICS as being easy. The study provides important recommendations based on the above-mentioned findings.
- Full Text:
- Date Issued: 2018
- Authors: Messiahs, Avril
- Date: 2018
- Subjects: Primary health care -- South Africa , Clinics -- South Africa Nurses -- South Africa -- Attitudes
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: http://hdl.handle.net/10948/32204 , vital:31985
- Description: The study sought to understand the perceptions, knowledge and attitude of primary healthcare (PHC) staff with the implementation of the ideal clinic strategy (ICS). The ICS is a new standard of healthcare process implemented by the South African Department of Health (SA DoH) at PHC level in both private and public sector. This study however only focuses on the public sector. The ICS is implemented in accordance with the guidelines stipulated in the SA DoH Strategic Plan 2014 – 2019. The study utilised a quantitative methodological approach to investigate the research question. Ethics clearance was obtained from the Nelson Mandela University and the National Department of Health to conduct the study in 10 clinics that were identified as ideal clinics in the rolling out of the ICS. The sample consisted of 48 clinical and 146 non-clinical staff within primary healthcare (PHC) facilities of the elected 10 clinics. One hundred and ninety-four (194) questionnaires were therefore distributed to these staff members, but only 135 usable questionnaires were returned. This translated into a response rate of 69.6%. The empirical results showed that: - most participants were knowledgeable about the implementation of the ICS; - females were more knowledgeable about the strategy than males, although the difference was not significant; - male participants were however more engaged with the ICS than females; - clinical staff members were perceived to be more engaged in the implementation of the ICS than the non-clinical staff; - more than half of the participants (53.5%) perceived the implementing the ICS as not being easy; and - more females than males perceived the implementation of ICS as being easy. The study provides important recommendations based on the above-mentioned findings.
- Full Text:
- Date Issued: 2018
Assessment of the quality of primary health care services rendered at Moses Mabida Clinic
- Authors: Tsetswa, Mncedisi Patrick
- Date: 2009
- Subjects: Primary health care -- South Africa , Health facilities
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: vital:8727 , http://hdl.handle.net/10948/880 , Primary health care -- South Africa , Health facilities
- Description: Health is a basic human right enshrined in the South African Constitution. It is the responsibility of government to ensure that the nation is healthy because good health is a prerequisite for social and economic development as well as an outcome of that process. Special attention on the healthcare needs of rural communities should be given because these communities were the worst affected by the legacy of the apartheid regime. Moses Mabida community is no exception. Since the advent of democracy, work has been done to ensure that adequate primary health care services are delivered to previously disadvantaged communities such as Moses Mabida. To monitor progress on health care service delivery, evaluation of these services is needed. The evaluation of these services will help identify the strengths and weaknesses so as to come up with quality improvement strategies, hence this study. This study takes form of an assessment survey involving a literature review and a survey of members of the Moses Mabida community who depend on the clinic for their health care needs. The literature identified best practice models of primary health care and these were used as an analytic tool to determine to what extent the primary health care services at Moses Mabida comply with national and international standards. It has been shown that the primary health care services at Moses Mabida Clinic largely comply with national and international standards although several recommendations have been presented for consideration.
- Full Text:
- Date Issued: 2009
- Authors: Tsetswa, Mncedisi Patrick
- Date: 2009
- Subjects: Primary health care -- South Africa , Health facilities
- Language: English
- Type: Thesis , Masters , MBA
- Identifier: vital:8727 , http://hdl.handle.net/10948/880 , Primary health care -- South Africa , Health facilities
- Description: Health is a basic human right enshrined in the South African Constitution. It is the responsibility of government to ensure that the nation is healthy because good health is a prerequisite for social and economic development as well as an outcome of that process. Special attention on the healthcare needs of rural communities should be given because these communities were the worst affected by the legacy of the apartheid regime. Moses Mabida community is no exception. Since the advent of democracy, work has been done to ensure that adequate primary health care services are delivered to previously disadvantaged communities such as Moses Mabida. To monitor progress on health care service delivery, evaluation of these services is needed. The evaluation of these services will help identify the strengths and weaknesses so as to come up with quality improvement strategies, hence this study. This study takes form of an assessment survey involving a literature review and a survey of members of the Moses Mabida community who depend on the clinic for their health care needs. The literature identified best practice models of primary health care and these were used as an analytic tool to determine to what extent the primary health care services at Moses Mabida comply with national and international standards. It has been shown that the primary health care services at Moses Mabida Clinic largely comply with national and international standards although several recommendations have been presented for consideration.
- Full Text:
- Date Issued: 2009
An exploration of health professional's perceptions of the role of clinical psychologists
- Authors: Zitianellis, Marina Sophia
- Date: 2005
- Subjects: Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3091 , http://hdl.handle.net/10962/d1002601 , Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Description: The South African government has initiated the transformation of health services in the country towards primary health care (PHC) in order to provide comprehensive care to individuals and families. The move to PHC involves an increased need for collaboration between health professionals. It is proposed that for effective team-work to take place, an understanding of the roles and functions of team members is imperative in providing quality mental health care. This study explored health professionals’ perceptions of the role and function of clinical psychologists working as part of a health care team in a community context. Three focus groups and three individual interviews were conducted with social workers, nurses and doctors. The data was then processed and analysed using a grounded theory method. The research highlighted the importance of knowledge, and how this affects referrals, perceptions, inter-professional relations and the perceived usefulness of clinical psychology and clinical psychologists. What is of significance is the potential power that the health professionals have as gatekeepers between the general public and clinical psychologists.
- Full Text:
- Date Issued: 2005
- Authors: Zitianellis, Marina Sophia
- Date: 2005
- Subjects: Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3091 , http://hdl.handle.net/10962/d1002601 , Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Description: The South African government has initiated the transformation of health services in the country towards primary health care (PHC) in order to provide comprehensive care to individuals and families. The move to PHC involves an increased need for collaboration between health professionals. It is proposed that for effective team-work to take place, an understanding of the roles and functions of team members is imperative in providing quality mental health care. This study explored health professionals’ perceptions of the role and function of clinical psychologists working as part of a health care team in a community context. Three focus groups and three individual interviews were conducted with social workers, nurses and doctors. The data was then processed and analysed using a grounded theory method. The research highlighted the importance of knowledge, and how this affects referrals, perceptions, inter-professional relations and the perceived usefulness of clinical psychology and clinical psychologists. What is of significance is the potential power that the health professionals have as gatekeepers between the general public and clinical psychologists.
- Full Text:
- Date Issued: 2005
Psychiatric problems in the primary health care context: a study in the Border-Kei area
- Authors: Cook, Jacqueline
- Date: 1996
- Subjects: Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2954 , http://hdl.handle.net/10962/d1002463 , Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Description: A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.
- Full Text:
- Date Issued: 1996
- Authors: Cook, Jacqueline
- Date: 1996
- Subjects: Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2954 , http://hdl.handle.net/10962/d1002463 , Primary health care -- South Africa , Mental health services -- South Africa , Black people -- Mental health -- South Africa
- Description: A clinic survey was undertaken to investigate the nature of psychiatric problems experienced by the primary health care (PHC) patient population in the Bisho-King William's Town area of the Eastern Cape Region. The study took as its point of departure research findings which attest to the high rate of psychiatric distress amongst this population group in different parts of the world and ohservations regarding the form of presentation in terms of physical complaints. Hypotheses posited relationships between psychiatric problems experienced by patients attending PHC clinics in the study area and four types of variables, namely; somatic complaints, socio-demographic characteristics, patterns of health service utilisation and patient satisfaction with health services. Using a quasi-experimental descriptive approach, a two-stage screening procedure sorted the patient sample into three groups on the basis of the degree of psychiatric symptomatology experienced. The triangulation of the results of between-groups analyses with case materials recorded during psychiatric interviewing provided for an ethnographic account of the cultural experience of distress in the study area. The screening process used standard instruments, the Self-Reporting Questionnaire (SRQ) in the first stage and the Present State Examination (PSE) in the second stage. A pilot study was conducted prior to the fieldwork for the main study. Using the SRQ, thirteen psychiatric paticnts and 31 general PHC patients were sampled for the pilot study and 148 PHC patients were sampled for the main study. Using the PSE, 11 and 57 PSE interviews were conducted in the pilot and main studies respectively. Between-groups analyses used chi-square and F-statistics to investigate possible associations with identified patient correlates (P<0.5). These were socio-demographic, utilisation and satisfaction variables, measured by a separate face-valid self-response instrument compiled for the purposes of this study. Psychiatric symptomatology was found to be statistically significantly related to age, marital status and educational level. Further, patients experiencing more psychiatric symptomatology reported significantly more illnesses requiring treatment, longer consultation periods and a greater number of sick bed days. No statistically significant relationships were found between psychiatric symptomatology and number of children, number of failures at school, amount of treatment utilised, number of consultations, or patient satisfaction with services. Descriptive analyses of symptom and syndrome profiles found certain somatic complaints to be particularly prevalent amongst the patient sample. These include headaches and various tension pains, decreased energy levels and digestive problems. Qualitative analysis of interview data found that many somatic and psychiatric problems experienced constitute culturally defined and meaningful experiences, especially 'umbilini' (or nerves), 'ufufunyana' (a possession state), and accusations of witchcraft. Interpretation of complaints from the local traditional healing perspective, revealed a more complex mode of communication between patients and the health delivery system than may be accounted for in terms of a simple biomedical model. The interpretive analysis in the study showed that some forms of presentation incorporating somatic symptoms, such as 'nerves' may he viewed as help seeking behaviour of the socially unempowered. Implications of the results are discussed in relation to the need for improved identification and management of psychiatric distress at PHC level facilitated by a better developed referral network and closer interaction between biomedical and anthropological perspectives.
- Full Text:
- Date Issued: 1996
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