Browsing by Author "Levitt, Naomi"

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    Development of an integrated model of care for use by community health workers working with chronic non-communicable diseases in Khayelitsha, South Africa
    (University of the Western Cape, 2018) Tsolekile, Lungiswa Primrose; Puoane, Thandi; Schneider, Helen; Levitt, Naomi
    Non-communicable diseases (NCD) continue to be a public health concern globally and contribute to the burden of disease. The formal health system in developing countries lacks the capacity to deal with these NCD as it is overburdened by communicable diseases. Thus, community health workers (CHWs) have been suggested as a solution for alleviating the burden for primary health facilities, by extending NCD care to the community. This thesis aims to develop an integrated model of care for CHWs working with patients with non-communicable diseases by describing and exploring current CHW roles, knowledge and practices in relation to community-based NCD care. The specific objectives for this study included 1) the exploration of the NCD roles of generalist CHWs in the context of a limited resource urban setting; 2) determining the NCD-related knowledge of CHWs, and factors influencing this in a limited resource urban setting and 3) a comparison of actual and envisaged roles in the management and prevention of NCD using the integrated chronic diseases management model (ICDM) as a benchmark, and propose key competencies and systems support for NCD functions of CHWs in South Africa Mixed methods were used to achieve the objectives of this study. First, a qualitative enquiry was conducted using observations to respond to the first objective. A quantitative cross-sectional design was then used to achieve the second objective, and a questionnaire was used to interview CHWs. A comparison of findings from both the quantitative and qualitative studies with policy guidelines was undertaken to address the third objective.
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    Exploring the association between body image, body fat, and total cardiovascular disease risk among adults in a rural and an urban community of South Africa
    (University of the Western Cape, 2017) Okop, Kufre Joseph; Puoane, Thandi; Levitt, Naomi
    Background: Obesity is increasing worldwide, and cultural perception of body image is considered an important contributor to the obesity epidemic among black Africans. Aim: To explore the association between body image perceptions and perceived obesity threat, change in adiposity, and total cardiovascular disease (CVD) mortality risk. Study Design: This is a mixed-methods study embedded in the PURE longitudinal cohort study involving adults aged 35-78 years in South Africa. Data Collection/Analysis: This included analysis of baseline cross-sectional data, the conduct of a qualitative study and a cross-sectional follow-up survey. Sex-specific logistic regression models of excessive adiposity were determined. Body image perception indexes were obtained based on 'Feel- Ideal' difference (FID) and 'Feel-Actual' discordance (FAD). Bivariate analyses and analysis of variance were used to determine the relationships between body image and adiposity, annual changes in weight and adiposity. The correlations between body image indexes (FID and FAD) and total 10- year CVD risk score were determined – controlling for possible confounders. Qualitative data was managed with ATLAS-ti software and analysed thematically. Results: The prevalence of excessive body fat at baseline and at 5-year follow-up based on body fat percent were 96.0% and 79.6% for women, and 44.3% and 62.2% for men respectively. The majority of the obese (85%) and overweight (79%) participants underestimated their weight, and weight discordance status was inversely associated with the willingness to lose weight. Mean total 10-year CVD risk score was 18.7%, and 61% of men and 26% of women with body mass index (BMI) ≥ 25 kg/m2 had CVD risk scores ≥ 20%. Bivariate analyses indicated that FID and FAD were significantly associated with annual changes in weight and adiposity. FAD index had a significant but weak correlation with total CVD risk score (r = 0.13, p-value = 0.001) when adjusted for covariates. Conclusion: Body image discordance was associated with an annual change in adiposity, total 10- year CVD risk scores, and there was poor obesity risk perception, and low motivation towards weight loss among predominantly obese black adults with negative body image. Interventions to reduce obesity need to address negative body image, poor obesity risk perception, self-efficacy and motivation towards weight loss.
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    Perceptions of body size, obesity threat and the willingness to lose weight among black South African adults: a qualitative study
    (BioMed Central, 2016) Okop, Kufre Joseph; Mukumbang, Ferdinand C.; Mathole, Thubelihle; Levitt, Naomi; Puoane, Thandi
    BACKGROUND: The obesity epidemic is associated with rising rates of cardiovascular disease (CVD) among adults, particularly in countries undergoing rapid urbanisation and nutrition transition. This study explored the perceptions of body size, obesity risk awareness, and the willingness to lose weight among adults in a resource-limited urban community to inform appropriate community-based interventions for the prevention of obesity. METHOD: This is a descriptive qualitative study. Semi-structured focus group discussions were conducted with purposively selected black men and women aged 35–70 years living in an urban South African township. Weight and height measurements were taken, and the participants were classified into optimal weight, overweight and obese groups based on their body mass index (Kg/m2). Participants were asked to discuss on perceived obesity threat and risk of cardiovascular disease. Information on body image perceptions and the willingness to lose excess body weight were also discussed. Discussions were conducted in the local language (isiXhosa), transcribed and translated into English. Data was analysed using the thematic analysis approach. RESULTS: Participants generally believed that obesity could lead to health conditions such as heart attack, stroke, diabetes, and hypertension. However, severity of obesity was perceived differently in the groups. Men in all groups and women in the obese and optimal weight groups perceived obesity to be a serious threat to their health, whereas the overweight women did not. Obese participants who had experienced chronic disease conditions indicated strong perceptions of risk of obesity and cardiovascular disease. Obese participants, particularly men, expressed willingness to lose weight, compared to the men and women who were overweight. The belief that overweight is ‘normal’ and not a disease, subjective norms, and inaccessibility to physical activity facilities, negatively influenced participants’ readiness to lose weight. CONCLUSION: Low perception of threat of obesity to health particularly among overweight women in this community indicates a considerable challenge to obesity control. Community health education and promotion programmes that increase awareness about the risk associated with overweight, and improve the motivation for physical activity and maintenance of optimal body weight are needed.
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    Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa – a qualitative study
    (BioMed Central, 2018) Muhwava, Lorrein Shamiso; Murphy, Katherine; Zarowsky, Christina; Levitt, Naomi
    BACKGROUND: Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders’ perspectives on the barriers to – and opportunities for – delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant’s first year of life. METHODS: Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa’s two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures. RESULTS: The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers. CONCLUSION: Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.
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    Role of community health workers in type 2 diabetes mellitus self-management: A scoping review
    (PLOS, 2018) Egbujie, Bonaventure Amandi; Delobelle, Peter Arthur; Levitt, Naomi; Puoane, Thandi; Sanders, David; van Wyk, Brian
    Background: Globally the number of people with Type 2 diabetes mellitus (T2DM) has risen significantly over the last few decades. Aligned to this is a growing use of community health workers (CHWs) to deliver T2DM self-management support with good clinical outcomes especially in High Income Countries (HIC). Evidence and lessons from these interventions can be useful for Low- and Middle-Income countries (LMICs) such as South Africa that are experiencing a marked increase in T2DM prevalence. Objectives: This study aimed to examine how CHW have been utilized to support T2DM self-management globally, their preparation for and supervision to perform their functions. Method: The review was guided by a stepwise approach outlined in the framework for scoping reviews developed by Arksey and O’Malley. Peer reviewed scientific and grey literature was searched using a string of keywords, selecting English full-text articles published between 2000 and 2015. Articles were selected using inclusion criteria, charted and content analyzed. Results: 1008 studies were identified of which 54 full text articles were selected. Most (53) of the selected studies were in HIC and targeted mostly minority populations in low resource settings. CHWs were mostly deployed to provide education, support, and advocacy. Structured curriculum based education was the most frequently reported service provided by CHWs to support T2DM self-management. Support services included informational, emotional, appraisal and instrumental support. Models of CHW care included facility linked nurse-led CHW coordination, facility-linked CHW led coordination and standalone CHW interventions without facility interaction. Conclusion: CHWs play several roles in T2DM self-management, including structured education, ongoing support and health system advocacy. Preparing and coordinating CHWs for these roles is crucial and needs further research and strengthening.
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    Role of community health workers in type 2 diabetes mellitus self-management: A scoping review
    (PlOS ONE, 2018) Egbujie, Bonaventure Amandi; Delobelle, Peter Arthur; Levitt, Naomi; Puoane, Thandi; Sanders, David; van Wyk, Brian
    Globally the number of people with Type 2 diabetes mellitus (T2DM) has risen significantly over the last few decades. Aligned to this is a growing use of community health workers (CHWs) to deliver T2DM self-management support with good clinical outcomes especially in High Income Countries (HIC). Evidence and lessons from these interventions can be useful for Low- and Middle-Income countries (LMICs) such as South Africa that are experiencing a marked increase in T2DM prevalence. This study aimed to examine how CHW have been utilized to support T2DM self-management globally, their preparation for and supervision to perform their functions. The review was guided by a stepwise approach outlined in the framework for scoping reviews developed by Arksey and O’Malley. Peer reviewed scientific and grey literature was searched using a string of keywords, selecting English full-text articles published between 2000 and 2015. Articles were selected using inclusion criteria, charted and content analyzed.