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Browsing by Author "Van Wyk, Brian"

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Asking the experts: Using cognitive interview techniques to explore the face validity of the mental wellness measure for adolescents living with HIV
(MDPI, 2023) Orth, Zaida; Van Wyk, Brian
There has been an increased focus on the mental health of adolescents living with HIV (ALHIV), because evidence shows that poor mental health outcomes are associated with lower rates of adherence and retention in HIV care. However, the research to date has predominantly focused on addressing mental health problems and reducing symptoms of mental illness rather than strengthening mental wellness [positive mental health]. Consequently, little is known about the critical mental wellness indicators that should be targeted in services for ALHIV. There is a need for valid and appropriate measures of mental wellness to drive research and provide evidence on the mental wellness needs of ALHIV that would inform service delivery as well as the monitoring and evaluation of treatment outcomes. To this end, we developed the Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV) for ALHIV in the South African context. In this paper, we report on the findings from a cognitive interview study with nine ALHIV aged 15–19 years receiving treatment at a public healthcare facility in the Cape Metropole, South Africa.
Challenges faced by midwives in implementing the prevention of mother to child transmission programme during the post-natal period at Khayelitsha Community Health Clinic, Western Cape Province.
(University of the Western Cape, 2016) Paul, Unathi Mecia; Kwaleyela, C.N.; Van Wyk, Brian
Background: In the South Africa, the number of HIV- positive pregnant women is rising and has resulted in more than 70,000 babies being born with HIV infection annually since the year 2000. In response to the escalating number of HIV-positive pregnant women, the Department of Health of South Africa, decided, in 2002, to implement the Prevention of Mother to Child Transmission (PMTCT) programme at 18 pilot sites in the country. An effective PMTCT programme could reduce the incidences of maternal and child mortalities in the country. An evaluation of the effectiveness of the PMTCT programme that was done in 2010 showed that, although the programme was rendered effectively during pregnancy and labour, there were still irregularities that appeared, especially during the postnatal period. Khayelitsha was the first pilot site in South Africa to provide Antiretroviral Therapy and initiate the Nurse Initiated Management of Antiretroviral Therapy (NIMART) at primary care level in the public sector. Midwives are the health professionals who render the PMTCT services to HIV-positive mothers and their babies until six weeks post-delivery. They have managed to test almost 100% of pregnant women during the antenatal period and the HIV-positive women were started on the PMTCT programme during their first visit. Aim: The aim of this study was to explore the challenges that midwives faced in rendering care to postnatal HIV-positive mothers enrolled in the PMTCT programme at the Khayelitsha Community Health Clinic in the Western Province of South Africa. Method: An exploratory design and qualitative approach was followed. The study population consisted of midwives who were rendering PMTCT services to HIV-positive mothers and their infants during the postnatal period. Purposive sampling was conducted until data saturation was reached. Six participants were included in the sample. The participants were informed about the study by means of an Information Sheet, advised that the study was voluntary and reminded that they could withdraw from the study at any time, without prejudice. In-depth, unstructured individual interviews were conducted with each of the participants. With the permission of participants, an audio tape recorder was used during the interviews to collect data, while the researcher took field notes to supplement and verify the voice recordings, after the interviews. The seven steps of Colaizzi were used to analyse the data. Six themes and sixteen sub-themes emerged during the data analysis. Trustworthinesswas maintained by using the criteria of Guba’s model, i.e. credibility, transferability, conformability and dependability. Permission to conduct the study was obtained from the appropriate ethical committees; the Department of Health, the Khayelitsha Community Health Clinic, as well as, the Senate Research Committee of the University of the Western Cape. Participants were asked to sign Informed Consent forms before participating in the study. The ethical principles of privacy, anonymity, withdrawal, confidentiality and consent were strictly adhered to. Findings: The study found several challenges faced by midwives while implementing the PMTCT programme during the postnatal period. These challenges included: the shortage of NIMART-trained staff attending to the high number of clients per day; the lack of manpower with data base systems to trace mothers who did not come back after delivery; and mothers who did not come back for postnatal appointments because of denial, non-disclosed HIV status and socioeconomic reasons. Furthermore, the participants also reported on midwives experiencing ‘burnout’ as a result of the hectic working environment at the Khayelitsha Community Health Clinic. Recommendations: There is an urgent need for all midwives in the MOU’s to be NIMART-trained. NIMART should be standardize and be the part of the curriculum that taught in all the tertiary institutions and be updated in a yearly basis as part of the in-service training or education for all practising midwives. The South African Government should introduce home visits in the PMTCT programme. Data-bases of all MOU’s and facilities that offer PMTCT services need to be synchronized and these MOU’s and facilities should all follow the same PMTCT guidelines. Further research should be done on the same topic at other clinics and MOU’s that render the PMTCT programme in the Western Cape.
Development of neonatal nursing care clinical competency-based assessment tool for Nurse-midwife technicians in CHAM nursing colleges, Malawi
(University of the Western Cape, 2015) Phuma, Ellemes Everret; Van Wyk, Brian; Adejumo, Oluyinka
Literature has shown that Malawi is experiencing a shortage of qualified healthcare providers, with the greatest burden on maternal and neonatal health. The majority of health service providers are Nurse-Midwife Technicians (NMT), contributing to 87% of the nursing and midwifery workforce. However, research has shown that the NMTs lack the ability to transfer skills into different clinical settings. It was not known what competencies were taught in Christian Health Association of Malawi colleges to equip the NMTs with clinical competence in neonatal nursing practice and how the clinical teachers assisted these NMTs to acquire the competencies. Furthermore, there was no documentation on the availability of a clinical competency-based assessment tool to validate the NMTs’ achievement of clinical competence in neonatal nursing. The purpose of this study was to develop a neonatal nursing care clinical competency-based assessment tool to validate NMTs’ achievement of clinical competence in CHAM nursing colleges. The competency, outcomes and performance assessment (COPA) model and the skills acquisition model were the conceptual frameworks used as the foundation of the study. The study adopted a sequential mixed method approach in which both qualitative and quantitative methods were utilized. Data collection was conducted using focus group discussions, document review and cross-sectional survey. The design and development model developed by Reeves (2006) and steps to development of assessment tools identified by the Department of Training and Workforce Development (2012) guided the study and development of the competency-based assessment tool. The study was conducted in eight CHAM nursing colleges. The researcher employed purposive, convenient and proportional stratified sampling to select the participants. Ethics clearance was obtained from the University of Western Cape and the National Health Sciences Ethical Research Committee in Malawi, prior to data collection. The data collection involved 31 midwifery clinical teachers and 140 third year students for the FGD and 48 midwifery clinical teachers and 195 third year students for the cross section survey. Document analysis was conducted at all the eight nursing colleges. The qualitative data was analysed using content analysis with Atlas.ti 7 and the quantitative data was analysed using descriptive analysis with SPSS 22. The research findings showed that the NMTs were taught basic nursing skills to enable them provide basic care to the health newborn baby. However, there were inadequate clinical assessments done to validate the NMT’s achievement of clinical competence in this setting. In addition, the clinical teachers used skills checklists to evaluate the NMTs clinical performance on specific procedures. The outcome of this study was the establishment of neonatal nursing clinical competencies, and development of a neonatal nursing care clinical competency-based assessment tool for the validation of NMT’s achievement of clinical competence. The tool provides a framework for neonatal nursing clinical teaching and assessments as well as tracking of the NMT’s clinical performance in this setting. It is recommended that training institutions should reinforce mechanisms to track the students’ clinical experience and performance assessments using this tool to ensure quality student outcomes. Furthermore, the clinical teachers should be oriented on the use of the developed assessment tool for familiarisation; thereby enhancing consistency and objectivity in the students’ performance assessments.
An empowerment programme for women on breast self-examination towards the prevention of breast cancer in Iddo Local Government, Oyo State, South-west Nigeria
(University of the Western Cape, 2015) Hanson, Victoria Funmilayo; Van Wyk, Brian
Cancer is a major public health concern in both developed and developing countries; it accounts for 13% of all deaths globally, of which 70% occur in middle- and low-income countries. In Nigeria, over 10 000 cancer deaths and 250 000 new cases of cancer are recorded yearly. Breast cancer is the second most common cancer worldwide, after lung cancer. It is the most common type of cancer diagnosed in women and the most common cause of death worldwide. Late detection and diagnosis of breast cancer leads to high mortality rate. In Nigeria certain cultural taboos are associated with breast cancer, which lead to poor information dissemination to women in rural communities. Breast self-examination (BSE) provides an inexpensive method for early detection of breast tumours. Knowledge and awareness about Breast Self-Examination are critical to promote consistent practices when the people concerned are empowered with the needed information to acquire the knowledge and skills which will inform practice of any health issue. In Nigeria it was reported that the number of women at risk of breast cancer increased progressively from 24.5 million in 1990 to about 40 million in 2010. This number is projected to rise to over 50 million by 2020, should the trend continue unabated. The current study explored the understandings of breast cancer and prevention, with particular emphasis on BSE practice among rural women, and developed an empowerment programme to promote uptake of this practice in a rural community in a south-western state of Nigeria. The study was framed in the Health Belief Model and Kieffer’s empowerment process. Participatory action research was used as study design and approach; and utilized both qualitative and qualitative methods. The sample for quantitative phase comprised 345 women aged 20 to 60 years, selected from 5 communities using a cross-sectional procedure. Data gathering instrument was a questionnaire. Summative statistics were calculated using the SPSS program. The sample for qualitative phase comprised of 95 women who were selected from the respondents to the quantitative phase. The data was collected through focus group discussion. The qualitative data was subjected to thematic analysis. Three themes that emerged for qualitative analysis which are: knowledge/awareness of BSE, practice and appeal for intervention, and misconception and fear. The survey results showed that a large proportion of the respondents (75.1% and 76.5%) had low levels of knowledge about BSE and did not practice BSE. Also, about 77% of the respondents expressed one form of barrier or another to BSE practice. However, despite these inadequacies, 87% of the respondents were ready and willing to improve their health if empowered with the right information and motivation. The empowerment program informed by the quantitative and qualitative phases and the stages of change with the full participation of the women. The program consisted of hands-on physical demonstrations, BSE pamphlets, and mnemonic songs were identified media of disseminating knowledge and practice of BSE. These media became the platforms for the empowerment programme developed for the women. A day was also set aside, just as is done for immunisation, for BSE practice and other women’s health issues to promote the prevention of breast cancer in the community. The “Physical demonstration” intervention resulted in an increase in the correct BSE practice from 23.5% at the beginning of the study, to 85.3% post the intervention. The “other intervention” resulted in 80% to 94.7% of participating women being able to practice correct physical step-by-step performance of BSE. The participatory approach contribute to a high levels of participation by women in Iddo local Government which led to the increase in the correct Breast Self–Examination as stated above.
Exploration of experiences of patients with the adverse-drug effects of multidrug-resistant tuberculosis treatment in a primary health care facility in the Western Cape
(University of the Western Cape, 2017) Tinzi, Siphokuhle; Van Wyk, Brian; Linda, N.
Multidrug resistant TB (MDR-TB) is a form of TB caused by bacteria (germs) that are resistant to the usual drugs that are used to treat "normal" TB. The duration of treatment for MDR-TB is a maximum of 22 months. People with MDR-TB are treated in specialized tertiary hospitals and in out-patient clinics in the PHC facilities. The treatment includes a six months injectable phase with a wide range of TB drugs. The adverse effects of MDR-TB drugs are among the worst side effects ever reported by patients. The aim of the current study was to explore the experiences of adverse effects of MDR-TB treatment amongst patients in a primary health care facility in the Western Cape. An explorative qualitative study design was used to explore the experiences of patient with the adverse effects of MDR-TB treatment in a primary health care facility in the Western Cape. In depth interviews were conducted with 12 MDR-TB patients. Data analysis was done by using the Tesch's method of content analysis. The study revealed that participating MDR-TB patients experienced various emotional, financial, physical and social challenges. Participants explained that the experience of being on MDR-TB treatment is emotionally draining; the pain and discomfort of the adverse effect of treatment makes a person to feel anxious and depressed. Financially they depended on social grants because they had to stop working after starting treatment. They could not function well physically because of the toxic nature of the adverse effects of treatment; which resulted in fatigue, dizziness and burning sensation on the feet and hands. They were faced with a lot of stigma from the community and even family members because of their illness. The study also revealed that in spite of the challenges and obstacles the participants were all motivated to complete their treatment and get cured. It is recommended that more support structures be made available for patients who are being treated for MDRT-TB such as; psychotherapy, social support and counselling on health education. Provision needs to be made for patients who are receiving daily injection; for it to be given in their homes. Health care providers treating MDR-TB patients need to do home visits together with MDR-TB adherence counsellors, to monitor the physical wellbeing of patients at home. This will also provide patients with the platform to discuss their health concerns in a more accommodative and relaxed environment. New drug regimen with fewer tablets and less treatment duration is needed for MDR-TB.
HIV patients’ perceptions of mobile technology support in Nelson Mandela Bay, Eastern Cape
(University of Western Cape, 2021) Mofokeng, Dalene; Van Wyk, Brian
South Africa has one of the largest HIV and AIDS burdens in the world, with an estimated7.52 million people living with HIV in 2018. The antiretroviral therapy (ART) programme is the biggest and most costly programme in the country, with 3.7 million people enrolled as of 2017. The success of antiretroviral therapy is dependent on adherence to medication and long-term retention in care. It has been reported that support groups can improve the treatment adherence of patients and their retention in care. However, enrolment in adherence support groups is voluntary, and the abovementioned success thereof is dependent on the commitment of the patient to active participation in the group. It is estimated that about 80% of adults and young people own at least one mobile phone, which makes this technology suitable to improve communication and enhance interaction amongst support group members.
Integration in South Africa: a study of changes in the community health system
(University of the Western Cape, 2014) Parr, Jennifer Simone; Van Wyk, Brian
In the thesis, I analyse a facilitated pilot project of integration of health care services at the community-level. The importance of the thesis is justified by three reasons: firstly integration and the creation of a district health system, as envisaged under Primary Health Care, is promoted as the solution to the health inequalities inherited from Apartheid in South Africa. However, many pilot integration projects have failed and analysing a failed project from an anthropological perspective provides valuable insight. Secondly a renewed interest in Primary Health Care, as the World Health Report of 2008 sets out, also makes this a pertinent pursuit from an international viewpoint. Thirdly the human experience is often ignored in health reform literature. I argue that anthropology can provide valuable insight into integration processes in a health system. Because anthropology explores the human experience, it provides a detailed understanding of the changes in a community health system and their impact on all role players. The data presented in the thesis were collected in an ethnographic communitylevel study in one township urban South Africa between October 1999 and October 2002. This makes this it a historical piece of work to a degree. I describe and critically analyse the facilitated process from the start of the project in October 1999 till its disintegration in failure in June 2001. I also describe and analyse the findings from community research conducted in 2002. For the analysis, firstly I build upon Scott�s concepts of dominance and resistance from his book Dominance and the Arts of Resistance to construct a framework. I argue that to understand a change process fully requires considering the historical context, the international arena, the present context and the facilitator.
Knowledge, beliefs and practice about sexual concurrent partnering amongst education students at a tertiary institution in rural Namibia
(Universty of the Western Cape, 2010) Shilongo, Lydia; Van Wyk, Brian
Background: In an attempt to avert the HIV/AIDS epidemic, more research has been conducted to determine why the epidemic is more devastating in Southern African countries than anywhere else in the world. Heterosexual transmission is believed to be driving the epidemic in many sub-Saharan African countries. Recent research has indicated that having concurrent sexual partners is one of the factors contributing to the fast spread of HIV transmission in this region. Aim: This study aimed to describe the level of knowledge about the risk of HIV transmission posed by concurrent sexual partnering as well as beliefs and practices about concurrent partnering among education students at the Rundu College of Education(RCE) in the Kavango region of Namibia. Concurrent partnering was defined as a situation where a person has more than one sexual partner at the same time, during the twelve months preceding the study.
Measuring Mental Wellness of Adolescents: A Systematic Review of Instruments
(Front. Psycho, 2022) Orth, Zaida; Moosajee, Faranha; Van Wyk, Brian
Objective: Mental health is critical to the healthy development of adolescents. However, mental health encompasses more than the absence of mental illness; and should include indicators of mental wellness. A critical review of available mental wellness instruments for adolescents were conducted to identify operational definitions of mental wellness concepts for this population group. Method: A systematic review of literature published between 2000 and 2020 was done to identify mental wellness instruments for adolescent populations. The review followed the PRISMA operational steps. Results: We identified 2,543 articles from the search strategy and screened titles and abstracts for eligibility. After appraisal, 97 studies were included in the qualitative synthesis; of which, 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.
On the road to HIV/AIDS competence in the household: Building a health-enabling environment for people living with HIV/AIDS
(MPDI, 2015) Masquillier, Caroline; Wouters, Edwin; Van Wyk, Brian
When aiming to provide chronic disease care within the context of human resource shortages, we should not only consider the responsibility of the individual person living with HIV/AIDS (PLWHA) but also the capacity of the social environment to actively encourage a lifestyle that fosters health. In this social environment, extensive efforts are thus required to increase HIV/AIDS knowledge, reduce stigma, stimulate HIV testing, improve health care-seeking behavior, and encourage safe sexual practices—described in the literature as the need for AIDS competence. In accordance with socio-ecological theory, one cannot restrict the research focus to communities, as AIDS competence studies should also incorporate the intermediate household level. In responding to this research need, the aim of this article is to conceptualize an “HIV/AIDS competent household” based on qualitative interviews and focus group discussions conducted in a township on the outskirts of Cape Town, South Africa. Our results show that a household’s supportive response to disclosure allows a patient to live openly as HIV positive in the household concerned.
Participatory action research approach to address the poor water, sanitation and hygiene conditions in an informal urban settlement in Windhoek, Namibia
(University of Western Cape, 2020) Mulondo, Michael; Van Wyk, Brian
Water, sanitation and hygiene (WASH) are fundamental to health and are regarded as a fundamental human right for survival, dignity, productivity, reproductive health and happiness. In low socio-economic communities and settings, especially those who are residing in informal urban settlements, where appropriate WASH interventions are not in place, the risks of mortality and morbidity from especially infectious disease are high. A participatory action research (PAR) study was conducted to address the poor WASH conditions in the Havana informal urban settlement in Windhoek, Namibia. The study comprises of four phases.
Perceptions and experiences of health care workers on the use of electronic medical records at two health centres in Livingstone, Zambia
(University of the Western Cape, 2017) Moomba, Kaala; Van Wyk, Brian
Health information systems (HIS) have much to offer in managing healthcare costs and in improving the quality of care for patients. However, the adoption of HIS can cause problems to health professionals in terms of efficiency as well as to the entire health organization in terms of acceptability and adaptability. The development of a national Information and Communication Technology (ICT) policy in Zambia was initiated in 2001 through an extensive consultation process which involved academics and civil society organizations. The aim of using ICT is to improve the quality of health service delivery at local levels. Maramba and Mahatma Gandhi Clinics are the largest primary health care (PHC) clinics in Livingstone and have been prioritized for the implementation of an electronic medical record (EMR) system. The current study explored health care workers' perceptions and experiences of the use of ICTbased EMR and factors that could determine acceptability of EMR at Maramba and Mahatma Gandhi clinics to feed into future program improvement.
Realist evaluation of the antiretroviral treatment adherence club programme in selected primary healthcare facilities in the metropolitan area of Western Cape Province, South Africa: a study protocol
(BMJ Publishing Group, 2016) Mukumbang, Ferdinand C.; Van Belle, Sara; Marchal, Bruno; Van Wyk, Brian
INTRODUCTION: Suboptimal retention in care and poor treatment adherence are key challenges to antiretroviral therapy (ART) in sub-Saharan Africa. Communitybased approaches to HIV service delivery are recommended to improve patient retention in care and ART adherence. The implementation of the adherence clubs in the Western Cape province of South Africa was with variable success in terms of implementation and outcomes. The need for operational guidelines for its implementation has been identified. Therefore, understanding the contexts and mechanisms for successful implementation of the adherence clubs is crucial to inform the roll-out to the rest of South Africa. The protocol outlines an evaluation of adherence club intervention in selected primary healthcare facilities in the metropolitan area of the Western Cape Province, using the realist approach. METHODS AND ANALYSIS: In the first phase, an exploratory study design will be used. Document review and key informant interviews will be used to elicit the programme theory. In phase two, a multiple case study design will be used to describe the adherence clubs in five contrastive sites. Semistructured interviews will be conducted with purposively selected programme implementers and members of the clubs to assess the context and mechanisms of the adherence clubs. For the programme’s primary outcomes, a longitudinal retrospective cohort analysis will be conducted using routine patient data. Data analysis will involve classifying emerging themes using the contextmechanism- outcome (CMO) configuration, and refining the primary CMO configurations to conjectured CMO configurations. Finally, we will compare the conjectured CMO configurations from the cases with the initial programme theory. The final CMOs obtained will be translated into middle range theories. ETHICS AND DISSEMINATION: The study will be conducted according to the principles of the declaration of Helsinki (1964). Ethics clearance was obtained from the University of the Western Cape. Dissemination will be done through publications and curation.
Rethinking mental health wellness among adolescents living with HIV in the African context: An integrative review of mental wellness components
(Frontiers Media, 2022) Orth, Zaida; Van Wyk, Brian
Adolescents living with HIV (ALHIV) are considered to be at heightened risk for developing mental health problems in comparison to their peers due to the burden of living with a stigmatized condition and managing a chronic condition. Poorer mental health outcomes among ALHIV are associated with lower rates of adherence to anti-retroviral therapy (ART). It is necessary to improve mental wellness among ALHIV as this acts as a bu􀀀er against developing mental health problems which, if left untreated can evolve into mental health disorders. Research on mental wellness concepts among ALHIV is underdeveloped which is associated with a lack of appropriate measures of mental wellness. We conducted an integrative review to conceptualize mental wellness and consider the critical components for measuring mental wellness in ALHIV.
Two-year retention in care for adolescents on antiretroviral therapy in Ehlanzeni district, South Africa: a baseline cohort analysis
(Taylor ad Francis, 2022) Okonji, Emeka F; Van Wyk, Brian; Mukumbang, Ferdinand C
Adolescents living with HIV (ALHIV) struggle to remain engaged in HIV-related care and adhere to antiretroviral treatment (ART) due to a myriad of physical, psychological and cognitivedevelopmental challenges. We report on the profile of ALHIV aged 10–19 years on ART and the clinical factors associated with their retention in care. A retrospective cohort analysis was conducted with 16,108 ALHIV, aged 10–19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Anonymised data were obtained from electronic medical records (Tier.net). Trends in retention in care among adolescents on ART was described using Kaplan-Meier survival estimates. Cox proportional analysis was performed to identify factors associated with retention in care over 2 years. More than half (53%) were females, and median duration on ART was 8 months. Retention in care among adolescents at months 6, 12, 18 and 24 was 90.5%, 85.4%, 80.8% and 76.2%, respectively. After controlling for confounders, risk of dying or lost to follow up increased for female adolescents (aHR = 1.28, 95% CI 1.10–1.49); being initiated on ART while pregnant (aHR = 2.72, 95% CI 1.99–3.69); history of TB infection (aHR = 1.71, 95% CI 1.10–2.65); and started ART at age 10–14 years (aHR = 2.45, 95% CI 1.96–3.05), and 15–19 years (aHR = 9.67, 95% CI 7.25–12.89). Retention in care among adolescents on ART over two-year period was considerably lower than the UNAIDS 2030 target of 95%. Of particular concern for intervention is the lower rates of retention in care among females and pregnant adolescents and starting ART between the ages of 10 and 19 years. Family or caregivers and peer support groups centred interventions designed to promote early initiation and retention in care through early case identification are needed.

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