An ergonomics approach to understanding perceived barriers to the provision of high-quality healthcare: a Sarah Baartman District clinics case study
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
- Date Issued: 2020
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
- Date Issued: 2020
An intracategorical intersectional framework for understanding ‘supportability’ in womxn’s narratives of their pregnancy
- Authors: Kalyanaraman, Yamini
- Date: 2019
- Subjects: Pregnancy -- Psychological aspects -- South Africa , Prenatal care -- South Africa , Pregnant women -- South Africa -- Psycology , Medical care -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/96647 , vital:31304
- Description: In South Africa, the current Maternal Mortality Ratio (MMR) is 135 per 100,000 live births, with a long way to go before it can achieve the Sustainable Development Goal (SDG) global target of under 70 per 100,000 live births by 2030. This research project focuses on the narratives of pregnant womxn in the Eastern Cape Province, using an intracategorical intersectional framework and Macleod’s ‘supportability’ model as a base. The study aims to locate womxn’s pregnancies within the interweaving biological, psychological, social, economic, cultural and political contexts within which they occur, while focusing specifically on the aspect of ‘supportability’. Through purposive sampling and snowballing methods, the research team recruited participants who were 18 years and older, in or past the second trimester of their pregnancy, and able to access antenatal care. Research data were produced using photo-elicitation techniques on 92 photographs and narratives from 32 interviews. An intersectional thematic analysis was used to generate themes, which highlighted different aspects that enabled or hindered pregnancy ‘supportability’. In accordance with prior research, it was revealed that womxn found emotional and tangible support the most beneficial. Findings from this study reveal the interconnectedness between a womxn’s personal (emotional, physical and cognitive) experiences of pregnancy, the micro-interactions of support (un)available from partners, family, friends, healthcare workers, workplaces and community members, and the macrostructures of socioeconomic policies, religiosity, cultural practices and healthcare systems. For example, gendered perceptions (a macro-structure) influence the instrumental support provided by partners (a micro-interaction), which impacts the womxn’s well-being (personal). Certain themes that emerged from the different narratives were: the importance of making available pregnancy-related information to the womxn; a desire for non-judgement and acceptance of their pregnancies within their community; and the need for adequate communication in microinteractions. The findings of this research also indicate that, despite the financial tensions inherent in each womxn’s life, the participants were driven by overarching hopes for their child’s future.
- Full Text:
- Date Issued: 2019
- Authors: Kalyanaraman, Yamini
- Date: 2019
- Subjects: Pregnancy -- Psychological aspects -- South Africa , Prenatal care -- South Africa , Pregnant women -- South Africa -- Psycology , Medical care -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/96647 , vital:31304
- Description: In South Africa, the current Maternal Mortality Ratio (MMR) is 135 per 100,000 live births, with a long way to go before it can achieve the Sustainable Development Goal (SDG) global target of under 70 per 100,000 live births by 2030. This research project focuses on the narratives of pregnant womxn in the Eastern Cape Province, using an intracategorical intersectional framework and Macleod’s ‘supportability’ model as a base. The study aims to locate womxn’s pregnancies within the interweaving biological, psychological, social, economic, cultural and political contexts within which they occur, while focusing specifically on the aspect of ‘supportability’. Through purposive sampling and snowballing methods, the research team recruited participants who were 18 years and older, in or past the second trimester of their pregnancy, and able to access antenatal care. Research data were produced using photo-elicitation techniques on 92 photographs and narratives from 32 interviews. An intersectional thematic analysis was used to generate themes, which highlighted different aspects that enabled or hindered pregnancy ‘supportability’. In accordance with prior research, it was revealed that womxn found emotional and tangible support the most beneficial. Findings from this study reveal the interconnectedness between a womxn’s personal (emotional, physical and cognitive) experiences of pregnancy, the micro-interactions of support (un)available from partners, family, friends, healthcare workers, workplaces and community members, and the macrostructures of socioeconomic policies, religiosity, cultural practices and healthcare systems. For example, gendered perceptions (a macro-structure) influence the instrumental support provided by partners (a micro-interaction), which impacts the womxn’s well-being (personal). Certain themes that emerged from the different narratives were: the importance of making available pregnancy-related information to the womxn; a desire for non-judgement and acceptance of their pregnancies within their community; and the need for adequate communication in microinteractions. The findings of this research also indicate that, despite the financial tensions inherent in each womxn’s life, the participants were driven by overarching hopes for their child’s future.
- Full Text:
- Date Issued: 2019
Establishing baseline data of Cradock and Tarkastad’s communities’ disease profile ahead of hydraulic fracturing and shale gas development
- Authors: Olivera, Shanene
- Date: 2019
- Subjects: Medical care -- South Africa -- Eastern Cape , Diseases -- South Africa -- Eastern Cape South Africa -- Eastern Cape -- Statistics, Medical Surveys
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/43088 , vital:36734
- Description: The South African government is investigating alternative ways to address the electricity crisis and has identified fracking as an alternative energy source. Specific areas have been identified for the implementation of Shale Gas Development. Various research studies have connected fracking to the incidence of certain diseases. Since Cradock and Tarkastad have been identified as prospective areas for the implementation of fracking, the primary aim of this study was to determine the disease profile of the community members in Cradock and Tarkastad. This baseline data could be utilised at a later stage as a benchmark when similar studies are conducted after the implementation of Shale Gas Development in these communities. A quantitative approach utilising a comparative descriptive survey design was adopted to conduct this study. The research population comprised all community members in Cradock and Tarkastad. A multi-staged sampling process was applied namely, cluster, convenient and stratified random sampling process; 489 respondents were included in the research sample. Two structured questionnaires and checklists were developed and administered by Registered Nurses, who were recruited as fieldworkers, to collect the data for the study. One questionnaire and checklist were designed and used for the age groups five-year and under population (n=43), and the other questionnaire and checklist were used for the over five-year population group (n=446). This allowed for the establishment of a disease profile of all ages in both areas. Descriptive and inferential statistics were used to analyse the data, and a pilot study was conducted before the primary study. The results of the study revealed the current disease profile in Tarkastad and Cradock. One of the objectives of the study was to compare the prevalence of diseases and abnormalities found in Cradock and Tarkastad. Thereafter the disease profiles were combined in a single profile for both Cradock and Tarkastad. Statistical analysis among the five-year-old and under population group indicated significant associations between area and physiological status, birthweight and physical conditions identified and monthly household income and physiological status (p<0.05). The over five-year-old population group revealed a greater significance between the independent and dependent variable categories than in the age group five years and under. The study revealed that South Africa’s burden of disease is evident in these findings with HIV/AIDS topping the list. The prevalence rates of HIV/AIDS and Hypertention are higher than the national prevalence rates, in Cradock and Tarkastad. It was also worthwhile to mention that Tarkastad faces more socio-economic challenges compared to Cradock. Recommendations were made for nursing practice, nursing education and further development of nursing research based on the research findings.
- Full Text:
- Date Issued: 2019
- Authors: Olivera, Shanene
- Date: 2019
- Subjects: Medical care -- South Africa -- Eastern Cape , Diseases -- South Africa -- Eastern Cape South Africa -- Eastern Cape -- Statistics, Medical Surveys
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: http://hdl.handle.net/10948/43088 , vital:36734
- Description: The South African government is investigating alternative ways to address the electricity crisis and has identified fracking as an alternative energy source. Specific areas have been identified for the implementation of Shale Gas Development. Various research studies have connected fracking to the incidence of certain diseases. Since Cradock and Tarkastad have been identified as prospective areas for the implementation of fracking, the primary aim of this study was to determine the disease profile of the community members in Cradock and Tarkastad. This baseline data could be utilised at a later stage as a benchmark when similar studies are conducted after the implementation of Shale Gas Development in these communities. A quantitative approach utilising a comparative descriptive survey design was adopted to conduct this study. The research population comprised all community members in Cradock and Tarkastad. A multi-staged sampling process was applied namely, cluster, convenient and stratified random sampling process; 489 respondents were included in the research sample. Two structured questionnaires and checklists were developed and administered by Registered Nurses, who were recruited as fieldworkers, to collect the data for the study. One questionnaire and checklist were designed and used for the age groups five-year and under population (n=43), and the other questionnaire and checklist were used for the over five-year population group (n=446). This allowed for the establishment of a disease profile of all ages in both areas. Descriptive and inferential statistics were used to analyse the data, and a pilot study was conducted before the primary study. The results of the study revealed the current disease profile in Tarkastad and Cradock. One of the objectives of the study was to compare the prevalence of diseases and abnormalities found in Cradock and Tarkastad. Thereafter the disease profiles were combined in a single profile for both Cradock and Tarkastad. Statistical analysis among the five-year-old and under population group indicated significant associations between area and physiological status, birthweight and physical conditions identified and monthly household income and physiological status (p<0.05). The over five-year-old population group revealed a greater significance between the independent and dependent variable categories than in the age group five years and under. The study revealed that South Africa’s burden of disease is evident in these findings with HIV/AIDS topping the list. The prevalence rates of HIV/AIDS and Hypertention are higher than the national prevalence rates, in Cradock and Tarkastad. It was also worthwhile to mention that Tarkastad faces more socio-economic challenges compared to Cradock. Recommendations were made for nursing practice, nursing education and further development of nursing research based on the research findings.
- Full Text:
- Date Issued: 2019
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