The perceptions and perspectives of patients and health care providers on chronic diseases management in rural South Africa: a qualitative study

BMC Health Services Research

Hilde Bastiaens⁵  Jesicca Fraeyman⁴  Herman Meulemans²  Sewela EP Modjadji¹  Marianne Alberts¹  Jean-Pierre Van Geertruyden³  Eric Maimela³ 

[1] Department of Medical Sciences, Public Health and Health Promotion, University of Limpopo, Turfloop campus, Private Bag X1106, Sovenga 0727, South Africa;Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa;International Health Unit, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium;Research group Medical Sociology and Health Policy, University of Antwerp, Universiteitsplein 1, Wilrijk, 2600, Belgium;Department of Primary and Interdisciplinary care, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium

关键词: Qualitative research;    Nurses;    Trainings;    Medication supply;    Knowledge;    Chronic patients;    Chronic disease management;   

Others  :  1171121
DOI  :  10.1186/s12913-015-0812-5

 received in 2014-09-15, accepted in 2015-03-23,  发布年份 2015

【 摘 要 】

Background

Preventive health care represents the future for health care delivery in South Africa to improve management of chronic diseases as this has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. Individual person’s health is unique, as they move in and out of chronic and acute health care phases, there is need to integrate chronic and acute care constructs to improve continuity of care and maximize health and improve wellbeing. The aim of this study was to determine the perceptions and perspectives of chronic patients’ and nurses regarding chronic disease management in terms of barriers, facilitators and their experiences.

Methods

To meet our aim we used qualitative methods involving the collection of information by means of focus group discussions in Dikgale Health and Demographic Surveillance System (HDSS). All data was recorded, transcribed verbatim and analysed using data-driven thematic analysis.

Results

Our study showed that chronic disease patients have a first contact with health care professionals at the primary health care level in the study area. The main barriers mentioned by both the health care workers and chronic disease patients are lack of knowledge on chronic diseases, shortage of medication and shortage of nurses in the clinics which causes patients to wait for a long periods in a clinic. Health care workers are poorly trained on the management of chronic diseases. Lack of supervision by the district and provincial health managers together with poor dissemination of guidelines has been found to be a contributing factor to lack of knowledge in nurses among the clinics within the study area. Both patients and nurses mentioned the need to involve community health workers and traditional healers and integrate their services in order to early detect and manage chronic diseases in the community.

Conclusions

Nurses and chronic disease patients mentioned similar barriers to chronic disease management. Concerted action is needed to strengthen the delivery of medications at the clinics, improve the chronic disease knowledge for both nurses and patients by conducting in-service trainings or workshops, increase the involvement of community health workers and establish a link (through formal referral system) with traditional healers.

【 授权许可】

   
2015 Maimela et al.; licensee BioMed Central.

【 参考文献 】

• [1]Liddy C, Johnston S, Irving H, Nash K: The community connection model: implementation of best evidence into practice for self-management of chronic diseases. Public Health 2013, 127:538-45.
• [2]Nolte S, Elsworth GR, Sinclair AJ, Osborne RH: The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey. Patient Educ Couns 2007, 65:351-60.
• [3]Willison KD, Williams P, Andrews GJ: Enhancing chronic disease management: a review of key issues and strategies. Complement Ther Clin Pract 2007, 13:232-9.
• [4]Kim EJ, Yoon SJ, Jo MW, Kim HJ: Measuring the burden of chronic diseases in Korea in 2007. Public Health 2013, 127:806-13.
• [5]Beaglehole R, Epping-Jordan J, Patel V, Chopra M, Ebrahim S, Kidd M, et al.: Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. Lancet 2008, 372:940-9.
• [6]Siantz E, Aranda MP: Chronic disease self-management interventions for adults with serious mental illness: a systematic review of the literature. Gen Hosp Psychiatry 2014, 36:233-44.
• [7]Leidy NK, Kimel M, Ajagbe L, Kim K, Hamilton A: Designing trials of behavioural interventions to increase physical activity in patients with COPD: Insights from the chronic disease literature. Respir Med 2014, 108:472-81.
• [8]Osborne RH, Elsworth GR, Whitfield K: The health education impact questionnaire (heiQ): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns 2007, 66:192-201.
• [9]Thorne SE, Harris SR, Mahoney K, Con A, McGuinness L: The context of health care communication in chronic illness. Patient Educ Couns 2004, 54:299-306.
• [10]Haidet P, Kroll TL, Sharf BF: The complexity of patient participation: lessons learned from patients’ illness narratives. Patient Educ Couns 2006, 62:323-9.
• [11]Bastiaens H, van Royen P, Pavlic DR, Raposo V, Baker R: Older people’s preferences for involvement in their own care: a qualitative study in primary health care in 11 European countries. Patient Educ Couns 2007, 68:33-42.
• [12]Lorig KR, Hurwicz M, Sobel D, Hobbs M, Ritter PL: A national dissemination of an evidence-based self-management program: a process evaluation study. Patient Educ Couns 2005, 59:69-79.
• [13]Kangovi S, Grande D, Carter T, Barg F, Rogers M, Glanz K, et al. The use of participatory action research to design a patient-centered community health worker care transitions intervention. Healthcare. 2014;2(2):136–144.
• [14]Ozkal K, Tekkaya C, Cakiroglu J, Sungur S: A conceptual model of relationships among constructivist learning environment perceptions, epistemological beliefs, and learning approaches. Learn Indiv Differ 2009, 19:71-9.
• [15]Lauvergeon S, Burnand B, Peytremann-Bridevaux I: Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders. BMC Health Serv Res 2012, 12:176. BioMed Central Full Text
• [16]Boateng W: Evaluating the efficacy of focus group discussion (FGD) in qualitative social research. Int J Bus Soc Sci 2012, 3:7.
• [17]Kitzinger J: Qualitative research. Introducing focus groups. BMJ 1995, 311:299-302.
• [18]Kanjala C, Alberts M, Byass P, Burger S. Spatial and temporal clustering of mortality in Digkale HDSS in rural northern South Africa. Glob Health Action. 2010;3: doi:10.3402/gha.v3i0.5236.
• [19]Petty NJ, Thomson OP, Stew G: Ready for a paradigm shift? Part 2: Introducing qualitative research methodologies and methods. Man Ther 2012, 17:378e384.
• [20]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [21]Vadiee M, The UK: “Expert patient program” and self-care in chronic disease management: an analysis. Eur Geriatr Med 2012, 3:201-5.
• [22]de-GraftAkins A, Boynton P, Atanga LL: Developing effective chronic disease interventions in Africa: insights from Ghana and Cameroon. Global Health 2010, 6:6. BioMed Central Full Text
• [23]Jordan JE, Briggs AM, Brand CA, Osborne RH: Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach. MJA 2008, 189:S9-13.
• [24]Beran D, Yudkin JS: Diabetes care in sub-Saharan Africa. Lancet 2006, 368:1689-95.
• [25]Mayosi BM, Flisher AJ, Lallo UG, Sitas F, Tollman SM, Bradshaw D. The burden of non-communicable diseases in South Africa. Health in South Africa 4. The Lancet. 2009. www.thelancet.com Published online August 25, 2009 doi:10.1016/S0140-6736(09)61087-4.
• [26]Wagner EH, Austin BT, Von Korff M: Improving outcomes in chronic illness. Manag Care Q 1996, 4(2):12-25.
• [27]Wagner EH, Austin BT, Von Korff M: Organizing care for patients with chronic illness. Milbank Q 1996, 74:511-44.
• [28]Calkins E, Boult C, Wagner EH, Pacala J: New Ways to Care for Older People: Building Systems Based on Evidence. Springer, New York; 1999.
• [29]Mngqundaniso N, Peltzer K: Traditional healers and nurses: a qualitative study on their role on sexually transmitted infections including HIV and aids in Kwa Zulu Natal, South Africa. Afr J Trad CAM 2008, 5(4):380-6.
• [30]Kengne AP, Mchiza ZJ, Amoah AGB, Mbanya J: Cardiovascular diseases and diabetes as economic and developmental challenges in Africa. Prog Cardiovasc Dis 2013, 56:302-13.
• [31]Morrin L, Britten J, Davachi S, Knight H: Alberta healthy living ProgrameA model for successful integration of chronic disease management services. Can J Diabetes 2013, 37:254-9.
• [32]West JF: Public health program planning logic model for community engaged Type 2 diabetes management and prevention. Eval Program Plann 2014, 42:43-9.
• [33]Kruk ME, Porignon D, Rockers PC, Van Lerberghe W: The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Soc Sci Med 2010, 70:904-11.
• [34]South African declaration on the prevention and control of non-communicable diseases. http://www.health.uct.ac.za/usr/health/research/groupings/cdia/downloads/SA_NCD_Declaration.pdf.