Health promotion services for patients having non-comminicable diseases: Feedback from patients and health care providers in Cape Town, South Africa

BMC Public Health

Carl J Lombard²  Naomi S Levitt¹  Nelia P Steyn³  Whadi-ah Parker³ 

[1] Diabetes and Endocrine Unit, Department of Medicine, University of Cape Town, Obervatory, 7925, South Africa;Biostatistics Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, Cape Town, South Africa;Centre for the Study of the Social and Environmental Determinants of Nutrition, Population Health, Health Systems and Innovation, Human Sciences Research Council, Private Bag X9182, Cape Town, 8000, South Africa

关键词: Lifestyle modification;    Chronic diseases of lifestyle;    Health education methods;    Health education materials;    Patient preferences;   

Others  :  1163472
DOI  :  10.1186/1471-2458-12-503

 received in 2012-04-04, accepted in 2012-06-21,  发布年份 2012

【 摘 要 】

Background

Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs) at primary health care (PHC) facilities in Cape Town, an audit was undertaken.

Methods

A multi-centre cross-sectional study was undertaken to interview patients (n = 580) with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14) and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach.

Results

Blood pressure measurement (97.6%) was the most common diagnostic test used, followed by weight measurement (88.3%), urine (85.7%) and blood glucose testing (80.9%). Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%), health educator (8.8%) and nutrition advisor (4.8%). Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance.

Conclusion

The majority of patients attending PHC facilities want to receive lifestyle modification education. There is not however, one specific method that can be regarded as the gold standard. Patients’ preferences regarding health education methods differ, and they are more likely to be susceptible to methods that do not involve much reading. Health education materials such as posters, pamphlets and booklets should be used to supplement information received during counselling or support group sessions.

【 授权许可】

   
2012 Parker et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]WHO: Global Strategy on Diet. Physical Activity and Health, Geneva; 2004. Accessed November 18th 2009, http://www.who.int/dietphysicalactivity.org webcite
• [2]Chopra M, Steyn K, Lambert EV: Western Cape burden of disease reduction project::vol 6 of 7. Decreasing the burden of cardiovascular disease. Department of Health, Pretoria; 2007.
• [3]Goodman GR, Zwarensyein MF, Roninson II, Levit NS: Staff knowledge, attitudes and practices in public sector primary care of diabetes in Cape Town. S Afr Med J. 1997, 87(3):305-309.
• [4]Moore H, Adamson AJ, Gill T, Waine C: Nutrition and the health care agenda. Fam Pract. 2000, 17(2):197-202.
• [5]Jallinoja P, Pilvikki A, Kuronen R, Nissinen A, Talja M, Uutela A, Patja K: The dilemma of patient responsibility for lifestyle change: Perceptions among primary care physicians and nurses. Scand J Prim Health Care 2007, 25:244-249.
• [6]Aira M, Kauhanen J, Larivaara P, Rautio P: Factors influencing inquiry about patients’ alcohol consumption by primary health care physicians: qualitative semi-structured interview study. Fam Pract 2003, 20:270-275.
• [7]Wens J, Vernweire E, van Royen P, Sabbe B, Denekens J: GP’s perspectives of type 2 diabetes patients’ adherence to treatment: A qualitative analysis of barriers and solutions. BMC Fam Pract 2005, 6:20. BioMed Central Full Text
• [8]Alberti H, Boudriga N, Nabli M: Primary care management of diabetes in a low/middle income country: A multi-method, qualitative study of barriers and facilitators to care. BMC Fam Pract 2007, 8:63. BioMed Central Full Text
• [9]Douglas F, Torrance N, van Teijlingen E, Meloni S, Kerr A: Primary care staff's views and experiences related to routinely advising patients about physical activity, A questionnaire survey. BMC Public Health. 2006, 6:138. BioMed Central Full Text
• [10]Kolasa KM: “Images” of nutrition in medical education and primary care. Am J Clin Nutr 2001, 73:1006.
• [11]van Dillen SME, Hiddink GJ, Koelen MA, de Graaf C, van Woerkum CMJ: Understanding nutrition communication between health professionals and consumers: development of a model for nutrition awareness based on qualitative consumer research. Am J Clin Nutr 2003, 77(suppl):1065S-1072S.
• [12]Hiddink GJ, Hausvast JG, van Woerkum CM, Fieren CJ, van’t Hof MA: Consumer’s expectations about nutrition guidance: the importance of primary care physicians. Am J Clin Nutr 1997, 65(Suppl):1974S-9S.
• [13]Serra-Majem LL, Calvo JR, Male ML, Ribas L, Lainez P: Population attitudes towards changing dietary habits and reliance on general practitioners in Spain. Eur J Clin Nutr 1999, 53(Suppl 2):S58-S61.
• [14]Buttriss JL: Food and nutrition: Attitudes, beliefs and knowledge in the United Kingdom. Am J Clin Nutr 1997, 65((6) Suppl):1985S-1995S.
• [15]Pelto GH, Santos I, Goncalves H, Victora C, Martines J, Habicht JP: Nutrition counselling training changes physician behaviour and improves caregiver knowledge acquisition. J Nutr. 2004, 134:357-362.
• [16]Westa R, McNeillb A, Rawe M: Smoking cessation guidelines for health professionals: an update. Thorax 2000, 55:987-999.
• [17]Thun M: Improving the treatment of tobacco dependence. Br Med J 2000, 321:311.
• [18]Harris SS, Caspersen CJ, DeFriese GH, Estes EH: Physical activity counselling for healthy adults as a primary preventive intervention in the clinical setting. JAMA 1989, 261:3590.
• [19]Allen SS, Harris IB, Kofron PM, Anderson DC, Bland CJ, Dennis T, Satran L, Miller WJ: A comparison of knowledge of medical students and practicing primary care physicians about cardiovascular risk assessment and intervention. Prev Med 1992, 21(4):436-48.
• [20]Lancaster T, Stead LF: Physician advice for smoking cessation. The Cochrane Database of Systematic Reviews 2004., (4)
• [21]Peiss B, Kurleto B, Rubenfire M: Physicians and nurses can be effective educators in coronary risk reduction. Gen Intern Med. 1995, 10(2):77-81.
• [22]Kreuter MW, Chheda SG, Bull FC: How does physician advice influence patient behaviour? Evidence for a priming effect. Arch Fam Med. 2000, 9(5):426-433.
• [23]Egede LE: Lifestyle Modification to improve blood pressure control in individuals with diabetes. Is physician advice effective? Diabetes Care. 2003, 26(3):602-607.
• [24]Tripp-Reimar T, Choi E, Skemp Kelley L, Enslein JC: Cultural barriers to care: inverting the problem. Diabetes Spectrum 2001, 14:13-22.
• [25]Berry LL, Parish JT, Janakiraman R, Ogburn-Russell L, Couchman GR, Rayburn WL, Grisel J: Patients’ commitment to their primary physician and why it matters. Ann Fam Med 2008, 6(1):6-13.
• [26]Lukoschek P, Fazzari M, Marantz P: Patient and physician factors predict patients’ comprehension of health information. Patient Education and Counselling 2003, 50:201-210.
• [27]Boult L, Boult C: Underuse of physician services by older Asian-americans. J Am Geriatr Soc. 1995, 43:408-411.
• [28]Tom-Orme L: Traditional beliefs and attitudes about diabetes among Navajos and Utes. In Diabets as a Disease of Civilization: The Impact of Culture Change on Indigenous Peoples. Edited by Joe JR, Young RS. Mouton de Gruyter, New York; 1993:272-291.
• [29]Wong C: Models of prevention or management programmes targeted to specific ethnic elders: Chinatown Health Centre. In Diabetes Among Elders: Ethnic Considerations. Edited by Llorens LA, Hikoyeda N, Yeo G. Stanford Geriatric Education Centre, Stanford; 1992:70-72.
• [30]Puoane T, Fourie JM, Shapiro M, Rosling L, Tshaka NC, Oelefse A: ‘Big is beautiful’ – an exploration with urban black community health workers in a South African township. S Afr J Clin Nutr 2005, 18(1):6-15.
• [31]Nthangeni G, Steyn NP, ALbetrs M, Steyn K, Levitt NS, Laubscher R, Bourne L, Dick J, Temple N: Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health care services. Public Health Nutr 2002, 5(2):329-338.
• [32]Bradshaw D, Groenewald P, Laubscher R, Nannan N, Nojilana B, Norman R, Pieterse D, Schneider M, Bourne DE, Timaeus IM, Dorrington R, Johnson L: Initial burden of disease estimates for South Africa, 2000. S Afr Med J 2003, 93(9):682-686.
• [33]Shafer S: Diabetes type 2--complete food management program. American Diabetes Association, New York; 2001. Alcohol. Retrieved April 29, 2004, from: http://www.diabetes.org/utils/printthispage.jsp?PageID=TYPE1DIABETES3_232989 webcite
• [34]SAInfo:Health care in South Africa.  ,  ;  . Available at http://www.southafrica.info/about/health/health.htm webcite (21/4/2012)
• [35]Bailie R, Si D, Dowden M, O’Donoghue L, Connors C, Robinson G, Cunningham J, Weeramanthri T: Improving organisational systems for diabetes care in Australian indigenous communities. BMC Health Services Research 2007, 7:67. BioMed Central Full Text