Browsing by Author "Bheekie, Angeni"
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Item An assessment of current practice patterns of TB/HIV at primary healthcare clinics in the Western Cape and a needs assessment for clinic-based training among final year pharmacy students(University of the Western Cape, 2010) Tokosi, Abiola Oluwatoyin Iyabode; Bheekie, AngeniTuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinic based training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. Aims The primary and secondary aims of the study were to: • Assess current practice patterns of TBI/HIV at primary healthcare clinics in the Western Cape, • Assess the need for a clinic-based TBIHIV training among final year pharmacy students in UWC. Objectives To achieve the primary aim the researcher; 1. Conducted a baseline study at Ravensmead Community Health Centre(CHC) to assess current TBIHIV practice among HCP's and co-infected patients, 2. Assessed current practice patterns at Delft South ARV clinic and Elsies River TB clinic (pre-intervention), 3. Designed and implemented a clinic-based TBIHIV intervention tool for potential use by pharmacists at Delft South and Elsies River clinics (intervention phase), 4. Evaluated patient receptivity of the intervention tool amongst patients at Delft South and Elsies River clinics (post-intervention phase). Results and discussion Findings from the baseline study indicate the need for involvement of a trained pharmacist in TB and HIV management. Even though three-quarters (77.8%; 14) of the patients preferred receiving their TB information from the clinic nurse, almost two-thirds (63.2%; 12) of the patients believed that pharmacists assisted with their treatment provision. Patient data obtained from the clinic record card showed that almost two-thirds of the patients reported that they had experienced side effects (64.4%); the therapy of more than one-quarter (26.4%) showed drug-drug interactions and onset of adverse effects (1.1 %). Post-intervention, the data showed that patients' viewed the pharmacist's role more positively. Almost all responses (97.5%; 39) favoured the services of a pharmacist in the clinic. In conclusion, findings from the post-intervention patient study clearly underpin that a clinic-based role for the pharmacist is imminent. All seven (100%) of the experimental students passed the assessment and had marks in the range between 26 and 45 and more than three-quarters (78.4 %; 29) of the control students passed with marks within this range. Conclusion A trained pharmacist would be competent to work alongside nursing staff in optimizing care provision in the clinical management of TB and HIV in patients. The existing clinic based TB/HIV programme could be supplemented with theoretical concepts in the final year of undergraduate pharmacy training.Item An assessment of current practice patterns of TB/HIV at primary healthcare clinics in the Western Cape and a needs assessment for clinic-based training among final year Pharmacy students(University of the Western Cape, 2010) Tokosi, Oluwatoyin Iyabode Abiola; Bheekie, Angeni; School of PharmacyTuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored.Item An assessment of social accountability among South African pharmacy schools from public domain information(AFAHPER-SD, 2017) Bheekie, Angeni; Van Huyssteen, MeaGlobal health education reform requires training institutions to align their education, service and research activities with the values of social accountability, which include relevance, equity, quality and effectiveness. The alignment with these values aims to ensure graduates who are competent to meet society’s priority health needs, especially those of marginalised and underserved communities. This study aimed to qualitatively assess the alignment of activities of the nine South African pharmacy schools with the values of social accountability from information and evidence available in the public domain. Data were collected from pharmacy schools’ websites, and related publications and newsletters. Information was grouped into predetermined categories representing the different values of social accountability. A scoring rubric was adapted that assessed the alignment of the information and evidence collected to the values of relevance equity and quality. Each pharmacy school’s information was initially reviewed and scored by three independent reviewers. Each of the reviewers cross-checked each other’s allocated scores and any variations in scores were settled via consensus between the reviewers. The information of six pharmacy schools was assessed. For relevance, pharmacy schools scored over 50% and above for all their activities. For equity, schools showed most variation in their educational activities, and least variation in their service activities. For quality, schools showed most consistency with education and service activities but most variation occurred in the quality of services. Information from the public domain may be useful in assessing social accountability. The depth of information that schools could share publicly remains a key question.Item Comparative evaluation of pharmacy students’ knowledge and skills in maternal and child health: Traditional versus integrated curriculum(MDPI, 2022) Egieyeh, Elizabeth Oyebola; Bheekie, Angeni; van Huyssteen, Mea: Reducing maternal and child mortality is a health priority in South Africa. Therefore, health professional education should produce graduates that can meet these needs. This study compared the maternal and child health (MCH) knowledge and skills of cohorts of final-year students exposed to a traditional (in 2017 and 2018) and integrated (2019) curriculum using a 34-item questionnaire. Between the 2019 and 2017 cohorts, ANOVA and post hoc analysis showed significant differences in the reproductive and sexual health component which was dispersed in the second and final years of study (p = 0.007, Mean Difference (MD) = 8.3) andneonatal and child care (p = 0.000, MD = 15). while it was only in maternal and antenatal care (p = 0.009, MD = 10.0) for the 2019 and 2018 cohorts. Significant differences were observed in participants’ average mean scores (p = 0.000 for 2018 and 2017). The highest mean scores were recorded by the 2019 cohort in the three assessments. A onesample t-test showed the highest mean differences in the reproductive and sexual health components (p = 0.000; MD 2017 = 12.4, MD 2018 = 14.8, MD 2019 = 20.7). Overall, the integrated MCH curriculum and the longitudinal dispersion of content enhanced students’ knowledge and skills.Item Continuous professional development for public sector pharmacists in South Africa: A case study of mapping competencies in a pharmacists’ preceptor programme(MPDI, 2020) van Huyssteen, Mea; Bheekie, Angeni; Srinivas, Sunitha CLifelong learning among healthcare practitioners is crucial to keep abreast of advances in therapeutic and service delivery approaches. In South Africa, continuous professional development (CPD) was mandated (2019) for re-registration of pharmacists to illustrate their learning according to the South African Pharmacy Council’s (SAPC) competency standards. This paper uses a preceptor programme linked to the University of the Western Cape School of Pharmacy’s service learning programme to map the competencies employed by pharmacist preceptors in primary care public healthcare facilities in Cape Town in an attempt to encourage completion of their annual CPDs and strengthening the academic-service partnership. Competencies identified were divided into input competencies related to the preceptor’s role in designing and implementing the educational programme in their facilities and assisting students to complete their prescribed learning activities, and output/outcome competencies that emerged from preceptors identifying the facility needs and employing their input competencies. Input competencies pertained to education, leadership, patient counselling, collaborative practice and human resources management. Output competencies related to pharmaceutical infrastructure, quality assurance, professional and health advocacy, primary healthcare, self-management and patient-centred care.Item Design, implementation and evaluation of a model for service-learning in pharmacy (slip) at a Tertiary hospital(2009) Parker, Mariam B.; Butler, N.C.; Bheekie, AngeniBackground In recent years the focus of pharmacy practice has changed from being primarily ‘drugcentred to’ one which is ‘patient-centred’ (El-Awady et al., 2006, p.1). Developments in pharmacy curricula worldwide are reflecting this change. Pharmacy courses no longer concentrate primarily on theoretical content, but increasingly on the ability of students to apply their theoretical knowledge in practice.The South African Pharmacy Council (SAPC) requires that pharmacy education and training in South Africa equips pharmacists for the roles they will take on in practice. In order to accomplish this, the SAPC has prescribed competency unit standards for entry level pharmacists which may serve as a guide for pharmacy educators. A significant challenge in pharmacy education is the application of theory in practice settings(Bucciarelli et al., 2007), which possibly affects the ability of entry-level pharmacists to meet the SAPC unit standard competencies. The dire shortage of pharmacists in public sector health settings further emphasizes the need for a level of competency of entry level pharmacists so that they may enter the workplace ready to serve the medicine related needs of society.Service-learning is defined as experiential learning in which students engage in structured activities that address community needs and promote learning. The purpose of this study was to design, implement and evaluate a Service-learning in Pharmacy (SLIP) intervention which is intended to serve as a generic model which can be used in tertiary hospital pharmacies. The SLIP intervention aimed to promote student learning by providing opportunities for students to engage in structured activities, while simultaneously alleviating pharmacy workload.Methods: The study was directed to UWC final year pharmacy students and pharmacists employed at a hospital pharmacy. Qualitative and quantitative research methods were used in evaluating this pre- and post-intervention enquiry. Qualitative evaluation methods included pre- and post- focus group discussions with students to assess student knowledge and expectations of SLIP. Covert observation of pharmacists was used to assess current views and receptivity toward student activities during the SLIP course. Quantitative evaluation methods included pre- and post-intervention student competency assessments in areas of hospital pharmacy practice (compounding, dispensing and clinic/ward pharmacy), and pre- and post-intervention questionnaires which assessed pharmacists’ views and receptivity toward SLIP. Results Students (n=16) and pharmacists (n=9) who were involved in the intervention comprised the study cohort.Qualitative: Pre-intervention, students indicated a lack of confidence and apprehension toward SLIP. Pharmacy managers were anxious about lack of time and space and the additional burden of training students. Post- intervention, students experienced a sense of professionalism and could connect with varied theoretical knowledge. They were both enthusiastic about this style of learning (“saw the pharmacy profession with new eyes”) and realized the need for more skills development in clinical pharmacy. Pharmacists’ receptivity to SLIP increased once student contribution to service delivery became evident.Quantitative: Student competency in areas of hospital pharmacy practice increased as a result of their participation in the Tygerberg SLIP model. Students also made a valuable contribution to service delivery at Tygerberg hospital pharmacy. This was quantified as the total number of services in compounding (n= 807), dispensing (n=2090) and clinic/ward services (n= 37). Conclusion:The SLIP intervention resulted in improved perceptions and receptivity of pharmacists to service learning initiatives. Students’ level of competency increased in hospital pharmacy practice and they contributed to service delivery at Tygerberg hospital pharmacy. Further studies are needed to evaluate the impact of the SLIP model on patient care and health outcomes.Item The development and evaluation of the Objective Structured Dispensing Examination (OSDE) for use in an undergraduate pharmacy training programme(University of the Western Cape, 2004) Frieslaar, Denise Eleanor; Syce, James A.; Bheekie, Angeni; Faculty of ScienceItem Development and implementation of an integrated framework for undergraduate pharmacy training in maternal and child health at a South African university(MPDI, 2021) Egieyeh, Elizabeth Oyebola; Bheekie, Angeni; van Huyssteen, MeaThe South African Pharmacy Council (SAPC) regulates undergraduate pharmacy education and pharmacy practice. The SAPC Good Pharmacy Practice manual describes the role of pharmacists in maternal and child health (MCH) in line with the recommendation of international health regulatory bodies. However, baseline study findings in 2017 supported literature from around the world that indicated a need for curriculum review and integration to address the knowledge and skills gap in pharmacists’ MCH training. This paper describes the development and implementation of an integrated framework for MCH training across the four years of a Bachelor of Pharmacy program. The intervention included didactic lectures, skills practical on infant growth assessment, and an experiential learning component at primary health care clinics and pharmacies. Knowledge and skills assessment on contraception, maternal and antenatal care, and neonatal and child care were carried out pre, eight weeks post, and two years post intervention using the same questionnaire. ANOVA and post hoc analyses showed that participants’ knowledge and skills increased post intervention but decreased significantly two years later except in contraception where students experienced longitudinal integration of the MCH component. Generally, participants performed above the university average except in maternal and antenatal care.Item Development, implementation and evaluation of a diabetes educational outreach inervention for pharmacists(University of the Western Cape, 2007) Molosiwa, Emmanuel; Bheekie, Angeni; Faculty of ScienceIncreasing diabetes prevalence rates, poor involvement of and limited knowledge among health care professionals in disease management, and poor implementation of guidelines are barriers to quality diabetes care. This thesis aimed to develop, implement and evaluate an on-site diabetes pharmacotherapy program for public sector pharmacists. Qualitative and quantitative research methods were used inthe pre- and post-intervention study.Item The development, implementation and evaluation of an integrated framework for undergraduate pharmacy education in maternal and child health at the University of the Western Cape(University of the Western Cape, 2022) Egieyeh, Elizabeth Oyebola; Bheekie, AngeniThe high rate of maternal and child mortality is a global health concern. Nationally, it is one of South Africa’s quadruple disease burdens. The Sustainable Development Goal 3, 2030 targets related to maternal and child health (MCH) were implemented to reduce the rate of mortality. The interventions that led to reducing mortality rates during the Millennium Development Goals era, such as improved access to quality healthcare services and skilled healthcare workers, need to be scaled up and accelerated to achieve the SDG 3 targets. As easily accessible frontline healthcare workers, pharmacists play an essential role in the continuum of care for MCH as guided by international and local regulatory health bodies. However, studies have shown that pharmacists feel ill-prepared and uncomfortable rendering MCH services, attributed to most pharmacy schools’ curriculum content and teaching methods.Item The effectiveness of using text and pictograms on oral rehydration, dry-mixture sachet labels(AOSIS, 2021) Heyns, Jeanne; van Huyssteen, Mea; Bheekie, AngeniMedication labels are often the only information available to patients after obtaining medication from a healthcare practitioner. Pictograms are graphic symbols that have shown to increase understanding of medicine use instructions. To compare the accuracy of the interpretation of medicine use instructions from two different oral rehydration (OR) dry-mixture sachet labels – the control ‘routine textonly’ label and an experimental label with ‘text-and-pictograms’. Participants were recruited from waiting rooms in public primary health care (PHC) facilities in Cape Town. Method: Each participant was required to answer six questions about OR preparation. Response accuracy was determined by comparing the participant’s answer to the actual information written on the relevant label. Afterwards, participants could offer their opinion about the label and ways to improve their understanding.Item Exploring a participatory multi-stakeholder engagement approach to address chronic medicine use(University of the Western Cape, 2023) Nfurayase, Bonheur Parfaite; Bheekie, AngeniBackground: In South Africa, chronic diseases (CD) fall into the quadruple burdens of diseases. In 2018 the World Health Organization (WHO) reported that chronic diseases were responsible for more than fifty percent of premature deaths. This report followed South Africa’s announcement in 2016 that CDs accounted for forty-nine percent of all total deaths. Globally and locally in South Africa, many progressive policies, strategic documents and interventions to address CDs remain commendable. However, the prevalence and burden of CDs on national healthcare systems and community health is concerning. Consequently, newer and revised approaches and strategies prioritising multi-government and multi-stakeholder collaborations are gaining popularity. Moreover, Participatory Action Research (PAR) and its founding principles as an approach to addressing healthcare issues are gaining momentum. Disappointingly such approaches within chronic disease contexts remain underexplored in South Africa. Bearing these considerations in mind, we explored the use of a Participatory multi-stakeholder engagement approach to address chronic medicine use issues (CMU) within an underserved community in the Western Cape. Our collaborative research project commenced in 2018 in a unique research setting that boasted pre-established partnerships between a pharmacy School and its services partners (NGO and CHWs). These service partners connected the School to surrounding communities through one of their experiential learning programmes, Service Learning in Pharmacy (SLiP).Item Exploring practising pharmacy graduates’ views on improving the effectiveness of pharmacy education at the University of the Western Cape, South Africa(HEALTH & MEDICAL PUBLISHING GROUP, 2019) van Huyssteen, Mea; Bheekie, AngeniSouth African health professional education institutions have a mandate to produce graduates who are able to address priority needs of the healthcare system and larger society. However, evidence of the effective use of public resources by health education institutions is not routinely collected. Practising graduates are a target audience who could provide part of this evidence. To explore the views of University of the Western Cape (UWC) pharmacy graduates on the effectiveness of pharmacy education in relation to their current and anticipated practice aspirations. A cross-sectional electronic survey was administered to UWC pharmacy graduates through the university’s alumni office network. Twenty-five graduates responded, of whom 60% were male (average age 38.9 (standard deviation 9.52) years). One of the strongest themes that emerged was the need for exposing pharmacy students from early on in the curriculum to a broad range of pharmacy and healthcare sectors and addressing real issues in these changing and complex environments. Graduates stressed the importance of the development of generic skills, such as interpersonal skills, leadership, advocacy and innovative problem-solving, which are necessary to effect positive change through collaborative and equitable approaches.Item Exploring the implications of a needs-based pharmacy education framework modelled on population health: Perspective from a developing country(MDPI, 2019) Bheekie, Angeni; Van Huyssteen, Mea; Coetzee, RenierGlobally, health education reform is directing efforts to strengthen the health system through collaboration between health education and health services. However, collaborative efforts vary between developed and developing countries as the health needs, economic constraints, and resource availability differs. In developing countries, resource allocation is weighed in favor of interventions that will benefit the majority of the population. The question that emerges is: How could health education, service, and research activities be (re-)aligned to optimize return on investment for the health system and society at large? This paper proposes a needs-based pharmacy educational approach by centralizing population health for a developing country like South Africa. Literature on systems-based approaches to health professional education reform and the global pharmacy education framework was reviewed. A needs-based pharmacy educational approach, the population health model which underpins health outcome measurements to gauge an educational institution’s effectiveness, was contextualized.Item The hidden curriculum of work-based learning for pharmacy students in public sector pharmacies in South Africa(International Pharmaceutical Federation, 2017) Van Huyssteen, Mea; Bheekie, AngeniBACKGROUND: The work-based learning environment encompasses a dynamic space where the implementation of theoretical knowledge and skills may prove to be at odds with routine service delivery practices, known as the hidden curriculum. OBJECTIVE: To describe incidents reflective of the hidden curriculum of fourth year pharmacy students from work-based learning experiences at public healthcare facilities. METHOD: A qualitative, descriptive study was conducted. Data from written student reflection reports were thematically analysed. RESULTS: From 35 reports, three primary themes including time, binaries, and students’ personal histories, influenced interactions in the workplace. These themes illustrated how the students’ professional and personal traits interlocked with historical, structural and cultural influences in the workplace as well as larger society. CONCLUSION: Uncovering of the hidden curriculum revealed that the students’ ability to navigate workload pressure, polarisation between groups and their own biases are crucial to firstly survive, and secondly to learn in the workplace.Item “I just kept quiet”: Exploring equity in a service-learning programme(International Association for Research on Service-Learning and Community Engagement (IARSLCE), 2016) Bheekie, Angeni; Van Huyssteen, Mea; Rae, Nicolette; Swartbooi, CindySocial justice underpins the sustainable development goal of health for all. In developing countries, social injustices are particularly severe and widespread, demanding critical and immediate attention. This article describes a qualitative, descriptive study that investigated pharmacy students’ responses to incidents of social injustice following their service-learning experiences in public-sector primary healthcare facilities in Cape Town, South Africa. Data were gathered from written reflection reports and then thematically analyzed using the pedagogy of discomfort as an interpretive framework. Themes were categorised according to students’ habitual responses to incidents of social injustice, how they interpreted their responses, and how they could promote social justice in the workplace as future healthcare professionals. Findings demonstrated students’ inability to take action and revealed that silence was the most common response to incidents of discrimination. These results highlight the ways in which the structural constraints of the societal status quo can perpetuate inequity. Study limitations include bias from students self-reports and their narrow understanding of structural barriers in the work-place. Intergenerational dialogue and advocacy is crucial across South African higher education to understand widespread social injustices. Embedding a critical approach to service-learning in the African context needs exploration.Item Medicine Runners: A community-initiated solution to chronic medicine access in underserved communities(Medpharm, 2018) Boswell, Dominique; Conradie, Sharon; Keshave, Bindia; Khan, Tasneem; Mngadi, Sinegugu; Tebeile, Lefa; Van Huyssteen, Mea; Bheekie, Angeni; Kiewiets, DamarisPatient access to chronic medicines is crucial in optimising disease management. With the introduction of a decentralised chronic dispensing unit, stable patients qualify to have access to their chronic medicines away from health facilities at alternative distribution points in the community. The aim of such decentralised chronic medicine ‘parcel’ collection points is to minimise patient load at healthcare facilities. However, non-collection of medicine parcels creates added workload for pharmacy staff and poses a financial burden on the health system. At the University of the Western Cape, following a workshop with community members as part of the service learning in pharmacy (SLiP) programme (2017), medicine runners (collectors) emerged as a theme. Medicine runners are a community-initiated solution to deliver chronic medicine parcels closer to the homes of vulnerable patients. They are community members who fetch medicine parcels either from the facility, or from a collection point, for delivery closer to the patient’s home. Final year pharmacy students (n=6) participated in the workshop to engage with various role-players (n=19) to ascertain how the medicine runners services could be regulated within existing pharmaceutical services. Students were further concerned about the integrity of the medicines during delivery. Upon reflection, students felt that reciprocal accountability between the pharmacy professionals and medicine runners should be incorporated into the delivery framework. Evidence from a pharmacy alumnus who shared experiences on innovative community-based delivery interventions, exemplified adherence to good pharmacy practice rules.Item Medicine therapy management for diabetic club Patients at a primary health care clinic: exploring a Potential role for pharmacists(University of the Western Cape, 2019) Sonday, Farhaana; Bheekie, AngeniDiabetes mellitus is a complex chronic condition and has become a major public health concern worldwide. Many diabetic patients are accessing primary health care (PHC) clinics for diabetes care. Diabetic patients who are considered stable are referred to chronic diseases of lifestyle club at the PHC facility. Effective management of this chronic condition requires a multidisciplinary team approach to diabetes care. Pharmacists are not often included in a multidisciplinary team and would consist of doctors, nurses and dieticians. Teams may be expanded and require specialist healthcare members’ expertise who can assist in the management of this disease, for example, ophthalmologists and podiatrists. Adherence to standard treatment guidelines (STGs) for the management of diabetes by healthcare professionals at a primary care level can improve glycemic control, decrease health costs and reduce the development of long-term diabetic complications.Item Pharmacist educational outreach for improved primary care of asthma in children(University of the Western Cape, 2001) Bheekie, Angeni; Zwarenstein, M FUnderdiagnosis and undertreatment of asthma in children are barriers to optimal health care delivery and health, incurring substantial costs to both the families and health services. A tailored multifaceted educational outreach intervention ("academic detailing") was designed and implemented among private sector general practitioners (GPs) serving a poor working class urban community in Cape Town, South Africa. The intervention aimed to improve primary care childhood asthma by promoting the adoption of guideline-based key messages. The effectiveness of the intervention was tested in a randomised controlled trial, Chestiness and Asthma in Mitchell's Plain (CHAMP) (Zwarenstein 1999). This thesis describes the design, implementation and qualitative evaluation of the outreach intervention. Methods Qualitative interviews and quantitative sample surveys were conducted among GPs to identify and measure the prevalence of perceived barriers to optimal asthma care in children. A trained pharmacist visited GPs twice, promoting eight evidence-based primary care messages to overcome barriers to optimal care for asthma in children. The messages focused on key diagnostic indicators, a treatment algorithm based on severity, cost of drug therapies, inhaler and spacer use, and preventive treatment. These messages were formatted into attractive promotional material. The first visit promoted use of the messages, the second reinforced adoption in routine practice and assessed GPs' responses using unobtrusive qualitative data collection methods. The dialogue was tailored to each GP's needs. Results Thirty-two GPs received the intervention. All but one consented to both visits. At the first visit responses were varied. A few GPs were confused or suspicious; most were in agreement with the messages but seemed passive towards implementation; a few were keen to adopt the messages into their routine practice. Response at first visit was not predictive of use as assessed at the second. At the second visit, most GPs claimed that they personally agreed with and used the messages, with a large minority less enthusiastic. Conclusion The intervention appears to have been broadly accepted as evident from GPs' acceptance of the outreach pharmacist, but reports of complete adoption of the messages and use of the kit were less prevalent. This finding is consistent with and helps to explain the improved health outcomes of children with asthma in the CHAMP trial. The combination of qualitative and quantitative research methods was effective in identifying and assessing GPs' barriers. Further, the combination helped to confirm the determinants for the intervention. Unobtrusive qualitative methods provided valuable insight into GP behaviour in routine setting. Additional studies conducted in public sector pnmary care settings and for other diseases are needed to confirm the wider acceptability and effectiveness of multifaceted outreach interventions aimed at improving professional practice. Such an intervention in our study setting seemed successful for childhood asthma.Item Pharmacy perspectives in the design and implementation of a mobile cellular phone application as a communication aid for dispensing medicines to deaf people in the South African context(University of the Western Cape, 2015) Parker, Mariam B.; Bheekie, Angeni; Tucker, William D.South Africa's White Paper for the transformation of the health care system in South Africa (DOH, 2007) acknowledges major disparities and inequalities as a result of an imprint by apartheid policies. In its transition to democracy, health promotion strategies have been initiated to address these disparities. However, such strategies have been narrowed and "favoured target audiences that are literate, urban-based and who have easy access to print and audio-visual media" (DOH, 1997). This implies that many vulnerable and marginalised groupings in South Africa, including the Deaf community are excluded from health promotion endeavours. Deaf people in South Africa communicate using South African Sign Language (SASL) and majority of the Deaf community exhibit poor literacy levels. Deafness is a significant communication barrier which limits a Deaf person's prospect to attain the best possible health care (Barnett, et al 2011). Various means of communication including spoken language, written instructions and the use of pictograms are used by healthcare workers to communicate health-related information. For many members of the Deaf community who communicate primarily in sign language, these methods are a sub-standard and prevent the attainment of optimum therapeutic outcomes. With regard to pharmaco-therapeutic services, Deaf people cannot hear the spoken language used by pharmacists during patient counselling, and their compromised functional literacy hinders the ability to read instructions on medicine labels. With both the spoken and written means of communication compromised, the Deaf patient's ability to comprehend instruction by pharmacists on how to use their medicines is inadequate and as a result, a Deaf patient may leave the pharmacy with medicine, but a poor understanding of how to use the medicine safely and effectively. Previous researchers have worked on building a technology base, including industrial design and computer science expertise to conceptualize the groundwork of a mobile phone application called SignSupport to facilitate communication between medical doctors and Deaf individuals. The particulars of the pharmacy scenario however, require a pharmacy-specific device to be of use in the dispensing of medicines to a Deaf patient in a pharmacy. The over-arching goal of this thesis is to design and evaluate a mobile phone application to facilitate the communication of medicine instructions between a Deaf patient and a pharmacist. Qualitative, participatory action research and community-based co-design strategies were directed toward Deaf participants, senior pharmacy students and pharmacists to create a prototype of the afore-mentioned mobile phone application. Preliminary results indicated that the application was suitable to pharmacists and Deaf community. Furthermore, both sets of users approved the overall design and were receptive to and keen on the practical uses of the application. Inadequacies pointed out by the Deaf community and pharmacists were addressed as an iterative modification to the prototype and culminated in version 2 which was deployed in an actual hospital pharmacy in 2015. Hospital usability studies generated largely positive results from both Deaf users and pharmacists, indicating that SignSupport is able to facilitate communication between pharmacists and Deaf patients. Next steps include advancing the application to a market–ready version that is downloadable and available as an application on the play stores of commercially available smart phones.