Philosophiae Doctor - PhD (Nursing)

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Acceptance and commitment therapy in the prevention of mother to child transmission of HIV program among pregnant women living with HIV in South Western States of Nigeria
(University of the Western Cape, 2017) Ishola, Adeyinka Ganiyat; Chipps, Jennifer
The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) program using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. The study used a quantitative approach using a Solomon four-group (two intervention and two control groups) randomised design to evaluate the impact of an acceptance and commitment therapy program. The study population was 132 randomly selected (33 per site), HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. Two were Intervention and two were Control sites which functioned as Intervention and Control groups. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling.
Development of a health education programme for self-management of Type 2 diabetes in Edo State, Nigeria
(University of the Western Cape, 2016) Afemikhe, Juliana Ayafegbeh; Chipps, Jennifer; Kooste, K.
Diabetes is a chronic, metabolic disease that requires lifelong medical management, health education and self-management. According to a World Health Organisation report, there is a global increase in the prevalence of diabetes and even more so in the low-and middle-income countries, specifically Nigeria, which has the highest number of people with diabetes in the African region of the World Health Organisation. As a global issue, the positive health outcomes of diabetes are tied to health education and self-management of the disease and using the health resources of nations. However, in the context of limited resources in Nigeria, there is a need for improvement of health education in self-management of Type 2 diabetes. Health education that is provided in some Nigerian health facilities is reported to be unstructured, without patients’ active participation, not tailored to the needs and the interests of the patients and limited collaboration between multi-disciplinary professionals. In this context, the aim of the study was to develop a structured health education programme for self-management of patients with Type 2 diabetes, to facilitate the quality of the lives of these patients .An adapted intervention mapping framework provided a structured process for development of an evidenced based programme. A mixed method approach was followed. In the first phase of the study an exploratory descriptive qualitative research design was followed. A purposive sampling approach was used in selecting (i) participants, who were patients with Type 2 diabetes and (ii) health-care professionals working in two health-care institutions in Benin City, Edo State, Nigeria. In phase 1, Step1 of the research was a situation analysis, which consisted of conducting 30 semi-structured interviews with patients; observation of nurses providing health education; and five focus group discussions with health-care professionals (nurses, dieticians and social workers). Qualitative data analysis was accomplished through using Tesch’s (1990) steps of analysis to identify themes and categories. The situation analysis revealed, firstly, that there was a lack in the knowledge and self-management of Type 2 diabetes among patients. Secondly, that the health-care professionals acknowledged their collective role in health education and were burdened with the patients who were non-adherent to self-management. The result also revealed the necessity to change from a traditional teaching method to a structured educational process that is patient-centred. The second phase of the research was the stage of developing the educational programme through collaboration with the stakeholders (health-care professionals and patients with Type 2 diabetes) using the findings from the data-analysis of the first phase supported with literature. In phase 2, Step 2 was to develop matrices from the data analysis in Phase 1 for the programme. Step 3 added theory-based intervention methods and practical applications to the preliminary program and in Step 4 the programme was described. This was followed in Step 5 by preparing health-care professionals for offering the programme to patients and implementing and evaluating the programme. The evaluation of the programme was by means of a quantitative pilot study in which a pre-post-test in a quasi-experiment was conducted with 28 patients and qualitative interviews after the program and post intervention interviews with the participants. The evaluation showed that the program was effective in meeting its objectives. In Step 6 a plan for the adoption, implementation, sustainability and evaluation of future implementations was developed.
Development of a screening protocol for depresion in antenatal clinics in Malawi
(University of the Western Cape, 2017) Chorwe-Sungani, Genesis; Chipps, Jennifer
Depression is a source of significant disease burden of pregnant women although protocols for screening antenatal depression are lacking in Malawi. This research study aimed at developing a screening protocol for depression in antenatal clinics in Malawi. This thesis reports data from 4 studies to develop a screening protocol for antenatal depression, one peer reviewed published paper, one peer reviewed accepted paper and two papers submitted to peer reviewed journals.
Development of a user centered mobile phone diabetes self-management intervention for people with type-2 diabetes in the ho municipality of Ghana
(University of the Western Cape, 2022) Johnson, Beatrice Bella; Chipps, Jennifer
Self-management remains a key goal for people living with Type-2 diabetes but globally has been an ongoing challenge. The inefficiencies of traditional health education approaches to diabetes care, concerns about the skills deficit and the technological explosion of mobile phone use have provided an opportunity for technologically driven innovations to facilitate selfmanagement of diabetes. Mobile phones are emerging as a tool for healthcare delivery and access to mobile phones is on the increase in the Low- and Middle-Income Countries (LMICs). The related low cost of mobile technology, especially text and voice messaging, has been reported to offer effective options for managing non-communicable diseases and highlighted the need to test this in the self-management of Type-2 diabetes.
The development of palliative care protocols for the emergency and oncology nurses in the government hospitals of the Western Cape
(University of the Western Cape, 2019) February, Christine; Arunachallam, Sathasivan; Chipps, Jennifer
Background: Palliative care is specialised health care to support people living with a terminal illness, and their families. Palliative care aims to prevent and relieve suffering, to help people to live as well as possible until they die, and to support the processes of dying and bereavement. Palliative care is holistic care provided by Emergency and Oncology Nurses caring for cancer patients. Palliative care protocols for Professional Nurses working in Emergency Units and Oncology Departments are not always posted or in full view in the government hospitals of the Western Cape. The researcher had noted that the development of a palliative care protocol would be unique in its use at the three targeted government hospitals. Aims and Objectives: This study focused on the development and implementation of palliative care protocols for Emergency and Oncology Nurses in the targeted government hospitals of the Western Cape, i.e., protocols could be beneficial for cancer patients and their families. The overall aim of the research was to develop applied palliative care protocols for Emergency and Oncology Nurses to provide best practice palliative care nursing for Oncology Patients who may present at any one of three Western Cape Provincial Hospitals.
Integrated mobile phone interventions for adherence to antiretroviral treatment in clients with HIV infection in Accra, Ghana
(University of the Western Cape, 2017) Dzansi, Gladys; Chipps, Jennifer
Mobile phone interventions such as text messaging have been used to improve treatment adherence globally and in sub-Saharan Africa. Nevertheless, integrated mobile phone intervention for adherence support in Ghana, has not been greatly extensively explored. An explanatory integrated mixed method research approach was employed within the context of a pragmatic paradigm to conduct a study in three phases. In phase one; a randomised control trial was done to determine the effect of mobile phone intervention on adherence in a two groups (Intervention and Control). Respondents (n = 362) age 18-60 years, HIV seropositive, with access to mobile phone were recruited and followed-up for six months. The Control group received standard care while the Intervention group received standard care, alarm prompting, weekly text messages and monthly voice calls. The implementation of interventions was based on King's transactional model of goal attainment while the logic model was used for intervention evaluation. Primary (overall adherence: Self-report, visual analogue, pill identification, pill count) and secondary (CD4 count and Body Mass Index) outcomes were measured at baseline, month three and month six. In phase two, individual interviews were conducted with six clients and two health professionals; three focus group discussions were held with participants from the Intervention group at month six.
A model of community engagement in the prevention of maternal health complications in rural communities of Cross River State, Nigeria
(University of the Western cape, 2016) Nsemo, Alberta David; Chipps, Jennifer
Pregnancy-related poor maternal health and maternal death remain major problems in most Nigerian states including Cross River State. The acute impact of these problems is borne more heavily by rural communities where the majority of births take place at home unassisted or assisted by unskilled persons. These problems are due to a mixture of problem recognition and decision-making during obstetric emergencies leading to delayed actions. Every pregnancy faces risk, and prenatal screening cannot detect which pregnancy will develop complications. If the goal of reducing maternal morbidity/mortality is to be achieved, increasing the number of women receiving care from a skilled provider (doctor/nurse/midwife) during pregnancy, delivery, and post-delivery and prompt adequate care for obstetric complications has been identified as the single most important intervention. One of the strategies identified in many countries is engaging and working with individuals, families, and communities as partners to improve the quality of maternal healthcare. This strategy is thought to remove the barriers that dissuade women from using the services that are available, empowering the community members to increase their influence and control of maternal health, promote ownership and sustenance, as well as increase access to skilled care. The aim of the study: The overall aim of this PhD study was to develop a model of community engagement to facilitate the prevention of maternal health complications in the rural areas of Cross River State, Nigeria. To develop this model, the study specifically sought to: 1. Understand the current situation in Cross River State by exploring the knowledge gap of women of child-bearing age (pregnant and new mothers) regarding obstetric danger signs, birth preparedness and complication readiness, delivery practices of women, the action of family/community members, and the role of community-based maternal health initiatives, if any, in emergencies, as well as explore participants’ opinions on actions to be taken by the community to promote the utilisation of orthodox healthcare facilities by rural women of Cross River State (Phase 1). 2. Engage community members through a participatory approach (Photovoice) to highlight problems regarding pregnancy and birth practices, identify possible solutions, and make recommendations on communities’ roles in the prevention of maternal health complications (Phase 2). The older women of the study communities were also engaged to verify and validate the findings from phases 1 & 2 analyses. 3. Develop a model of community engagement to improve maternal health literacy by increasing knowledge on early detection of obstetric complications, birth preparedness, complication readiness, and improved access to skilled birth attendance (Phase 3). Methods: The study was conducted using a qualitative descriptive research approach that combined qualitative semi-structured interviews and focus group discussions within the Photovoice participatory approach. Purposive sampling was employed to select 20 participants, 10 each from the Idundu (Community A) and Anyanganse (Community B) rural communities of Akpabuyo Local Government Area of Cross River State, Nigeria. The participants comprised pregnant women and new mothers (babies aged 12 months and younger) who met the eligibility criteria. Data collection was by means of semi-structured interviews (Phase1), focused group discussions and Photovoice (Phase 2). Trustworthiness of the data was ensured by means of applying Guba’s model of credibility, transferability, and authenticity. The ethical principles of respect for human dignity, beneficence, confidentiality, and justice were applied throughout the study. The Citizenship Healthcare and Socio-Ecological Logic models were used to direct the study. Permission was obtained from participants for all the phases of the study while approval for the study was obtained from the Senate Higher Degrees Committee of the University of the Western Cape and the Cross River State Ministry of Health Ethical Committee. Data was analysed using Tesch’s method of content analysis. Based on the findings of Phases 1 & 2 of the study, themes emerged that were then validated by the older women in the study communities. The model was then developed by means of the four steps of the theory generation process. Step one was concept development that consisted of the identification, definition, validation, classification, and verification of the main and related concepts. Step two was model development consisting of the sub-steps, namely model guidelines and definitions. The communities’ stakeholders were engaged at this phase to verify and validate the concepts, as well as contribute to the drafting of the model guidelines and the definitions. Step three was a model description whereby the structure, definition, relation statements, and the process of the model were described. A visual application of the model that depicts the main concepts, the process, and the context was shown. Step four dealt with the development of guidelines for the operation of the model. A critical reflection of the model was done using Chinn and Kramer’s five criteria for model evaluation. Results: The study revealed that Idundu and Anyanganse’s rural women have limited knowledge of obstetric danger signs and very few of them acknowledged the importance of hospital delivery. They also exhibited poor understanding of what birth preparedness and complication readiness entailed. There was a high preference for traditional birth attendant care during pregnancy and delivery with their reasons being belief and trust in traditional birth attendants, a long standing tradition to deliver with them, assumptions that orthodox healthcare is expensive, poor attitude of healthcare providers towards women, unavailability of 24-hour services in healthcare facilities, fear of hospital procedures and operations, communal living in traditional birth attendant’s homes, spirituality in traditional birth attendant services, and the consideration of proximity to service points. These factors exacerbated the delays in seeking care and in referrals for skilled care in phases of emergency. The study also revealed that in the study communities, heavy household chores carried out by pregnant women is culturally accepted and seen as exercise to ease labour, there is lack of proper information regarding maternal and child health issues, men are sole decision-makers, they are ignorant of availability of free treatment in health centres, there is an ignorance regarding care of the new-born, and a lack of community structures to support women’s health. Based on the above findings, the women made the following suggestions towards finding a solution: improving maternal health literacy, increasing spirituality in service delivery, involving of husbands in antenatal care for proper information on maternal health issues, accessing community support through the use of community structures (town announcers, women groups, churches, etc.) with the purpose of emphasising facility delivery, constitution of influential groups to monitor the activities of pregnant women to ensure utilisation of skilled attendants, access to healthcare through free services and availability of providers, trust of health services, and traditional birth attendant training/traditional birth attendant facility collaboration. A total of eight concepts were identified from the concluding statements of steps 1 & 2, and used to develop the Maternal Health-Community Engagement Model (MH-CEM). These were: maternal health literacy, spirituality in healthcare, integrated traditional birth attendants’ role (value, training, and traditional birth attendants/hospital collaboration), trust in health services (by addressing previous experiences, attitude, and fear), improving access to healthcare, culturally acceptable care, husbands’ involvement in women’s health issues, and community support. These concepts formed the core components for the Maternal Health-Community Engagement Model which was developed as the main recommendation to address the core concepts. Central to this Model was the Community Engagement Group (CEG) which was established during the process of engaging the community stakeholders in validating the concepts and drawing up of the guidelines for the Model development. Conclusions and Recommendations: It is believed that the activities of the Community Engagement Group may bring about improved maternal health literacy, a process for working with traditional birth attendants through training and re-orienting them to be promoters of facility delivery when appropriate, and a model for involving husbands, and indeed the entire community, in maternal health issues. Limitations were identified and recommendations for nursing practice, education, and research concluded the study.

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