Dalena van Rooyen

Help-seeking behaviour, barriers to care and experiences of care among persons with depression in Eastern Cape, South Africa

BACKGROUND Little is known about the help-seeking behaviour and barriers to care among people with depression in poor resource settings in Sub-Saharan Africa. METHODS This is a cross-sectional population-based study including 977 persons aged 18-40 living in the Eastern Cape Province in South Africa. The prevalence of depression was investigated with the help of a questionnaire (the Mini International Neuropsychiatric Interview). Several socio-economic variables, statements on help-seeking and perceptions of earlier mental health care were included. Data collection was performed from March to July 2012. RESULTS The prevalence of depression was 31.4%. People aged 18-29 and those with no or low incomes were less likely to seek help. Promotive factors for help-seeking included having social support and tuberculosis comorbidity. Of all people with depression in this sample, 57% did not seek health care at all even though they felt they needed it. Of the variety of barriers identified, those of most significance were related to stigma, lack of knowledge of their own illness and its treatability as well as financial constraints. LIMITATION Recall bias may be present and the people identified with depression were asked if they ever felt so emotionally troubled that they felt they should seek help; however, we do not know if they had depression at the time they referred to. CONCLUSIONS Depression is highly prevalent among young adults in the Eastern Cape Province, South Africa; however, many do not seek help. Health planners should increase mental health literacy in the communities and improve the competence of the health staff.

Perceptions of nursing students regarding responsible use of social media in the Eastern Cape

Background Social media have become a popular communication system that has transformed communication from the traditional to the Web-based model. Because social media use has no limitations to place and time, it is now used extensively at clinical facilities. Social media use is becoming a popular activity amongst students at Nursing Education Institutions (NEI) in South Africa. However, lack of accountability and unethical use of social media by nursing students in South Africa has been reported. Objectives The aim of the study was to explore and describe the perceptions of nursing students regarding responsible use of social media. Methods A qualitative, descriptive, explorative and contextual research design was used to explore and describe the perceptions of nursing students regarding the responsible use of social media. Twelve nursing students registered for the undergraduate nursing degree were purposely selected and interviewed individually using a semi-structured interview method. Results The results of this research study demonstrate that nursing students use social media irresponsibly. Nursing students experience blurred boundaries between personal and professional lines and lack accountability when using social media. Conclusion The extensive use of social media in the clinical environment, by healthcare students, requires a joint effort by Nursing Education Institutions and healthcare facilities to ensure that social media are used in an ethically acceptable manner. The implementation of the recommendations of this research study could positively influence legally and ethically acceptable use of social media at healthcare facilities.

Experiences of teenage pregnancy among Xhosa families

OBJECTIVES to explore and describe the experiences of teenage pregnancy among Xhosa families, and, depending on the results of the study, to recommend a strategy to assist midwives to enhance pregnancy outcomes. DESIGN a qualitative, explorative, descriptive, phenomenological and contextual research design. In-depth face-to-face interviews were performed to collect data. PARTICIPANTS 10 pregnant teenagers, eight mothers, two fathers, seven grandmothers and three grandfathers from the same families were interviewed independently and privately. FINDINGS pregnant teenagers experienced emotional turmoil as they strived to cope with their pregnancy, and experienced a change in their relationships with significant others due to expectations that were not met and role confusion which led to crisis. Parents experienced overwhelming emotions due to the unexpected pregnancy of their child, and loss of control as the pregnancy could not be reversed. Grandparents of pregnant teenagers experienced the pregnancy as a family disturbance, and acknowledged that healing should take place in the family. KEY CONCLUSIONS teenage pregnancy was experienced differently by different generations within the same family, but all the experiences culminated in anger that hampered the necessary parental support for the pregnant teenager. Lack of support during pregnancy can easily affected the well-being of the unborn child, as teenagers are not supervised and experience acute emotional stress. Intervention by a midwife could help to relieve the teenagers stress and optimise the pregnancy outcome.

Endotracheal tube cuff pressure management in adult critical care units

Background. The monitoring of endotracheal tube (ETT) cuff pressure in intubated patients is important in preventing complications related to cuff over- and under-inflation. Objectives. To explore and describe the existing practice related to ETT cuff pressure management by professional nurses in adult critical care units (CCUs) in the public and private healthcare sectors. Method. A quantitative survey was used. Data were collected from professional nurses from adult CCUs in the public and private healthcare sectors in the Nelson Mandela Metropole, Eastern Cape, South Africa, using a structured self-administered questionnaire based on a literature review. Results. The survey response was 75% (100/134). Practice variances included the frequency of cuff pressure monitoring: only 52% of respondents performed cuff pressure measurements every 6 - 12 hours; 32% reported performing measurements at 2 - 4 hourly intervals; 15% only assessed cuff pressure when a leak occurred; and 1% never monitored cuff pressure. Of the 100 respondents, 37% used the cuff pressure measurement (CPM) method, 24% used the palpation method or listened to air leaks, and 22% used minimal occlusive volume (MOV). None of the respondents used the minimal leak technique (MLT). Only 20% of the respondents maintained cuff pressures at 18 - 22 mmHg. Thirty-one per cent indicated that they still performed the practice of cuff deflation and re-inflation before and after suctioning. There were incongruities related to the management of air leaks and the amount of air instilled. Conclusion. Practice variances were noted among the professional nurses, especially in the private healthcare sector. The lack of evidence-based clinical decision-making related to cuff pressure management in mechanically ventilated patients was evident. Best practice recommendations need to be used effectively when performing ETT cuff pressure management, to reduce practice variance, standardise safe patient care, and minimise complications.

Allopathic and traditional health practitioners' collaboration.

Background Professional collaboration between traditional and allopathic health practitioners in South Africa is proposed in the Traditional Health Practitioners Act and could benefit and complement healthcare delivery. Objectives To explore and describe the collaborative relationship between allopathic and traditional health practitioners regarding the legalisation of traditional healing, and these health practitioners’ views of their collaborative and professional relationship, as role-players in the healthcare delivery landscape in South Africa. Methods A qualitative design was followed. The research population comprised 28 participants representing three groups: allopathic health practitioners (n = 10), traditional healers (n = 14), and traditional healers who are also allopathic health practitioners (n = 4). Purposive and snowball sampling was used. Data collection involved unstructured interviews, a focus group interview and modified participant observation. Results Results indicate both allopathic and traditional health practitioners experienced negative attitudes towards each other. Mutual understanding (in the form of changing attitudes and communication) was considered crucial to effective collaboration between these two health systems. Participants made suggestions regarding capacity building. Conclusions Considering realities of staff shortages and the disease burden in South Africa, facilitating collaboration between allopathic and traditional health practitioners is recommended. Recommendations could be used to develop strategies for facilitating professional collaboration between traditional and allopathic health practitioners in order to complement healthcare delivery.

Culturally competent patient–provider communication in the management of cancer: An integrative literature review

Background Managing cancer in a multicultural environment poses several challenges, which include the communication between the patient and the healthcare provider. Culture is an important consideration in clinical care as it contributes to shaping patients’ health-related values, beliefs, and behaviours. This integrative literature review gathered evidence on how culturally competent patient–provider communication should be delivered to patients diagnosed with cancer. Design Whittemore and Knafls approach to conducting an integrative literature review was used. A number of databases were systematically searched and a manual search was also conducted. Specific inclusion and exclusion criteria were set and documents were critically appraised independently by two reviewers. Thirty-five documents were included following these processes. Data extraction and synthesis followed and were also independently verified. Results Various strategies and personal characteristics and attitudes for culturally competent communication were identified. The importance of culturally competent healthcare systems and models for culturally competent communication were also emphasised. The findings related to all themes should be treated with caution as the results are based mostly on low-level evidence (Level VII). Conclusions More rigorous research yielding higher levels of evidence is needed in the field of culturally competent patient–provider communication in the management of cancer. Most of the available literature was classified as non-research evidence. The themes that emerged do, however, provide some insight into how culturally competent patient–provider communication may be delivered in order to improve treatment outcomes in patients diagnosed with cancer.

Posttraumatic Stress Disorder and Barriers to Care in Eastern Cape Province, South Africa

A range of barriers to seeking mental health care in low- and middle-income countries has been investigated. Little, however, is known of the barriers to care and help-seeking behavior among people with posttraumatic stress disorder (PTSD) in low- and middle-income countries. This was a population-based study including 977 people aged 18-40 years from the Eastern Cape Province in South Africa. Current PTSD was assessed by using a diagnostic questionnaire (Mini International Psychiatric Interview). An additional questionnaire captured socioeconomic and health-related data. The prevalence of current PTSD was 10.8%. Only 48.1% of people with current PTSD accessed health care services. Younger people aged 18 to 29 years were less likely to seek health care, OR = 0.36, 95% CI [0.15, 0.85]. People earning a salary or wage, OR = 2.91, 95% CI [1.26, 6.71]; and those with tuberculosis, OR = 11.63, 95% CI [1.42, 95.56], were more likely to seek health care. A range of barriers to seeking care were identified, the most striking being stigma and a lack of knowledge regarding the nature and treatment of mental illness. People with current PTSD may seek help for other health concerns and brief screening means those affected may be readily identified.

SELF-MANAGEMENT EXPERIENCES IN PERSONS LIVING WITH DIABETES MELLITUS TYPE 2

Diabetes mellitus (DM) is a progressive disease which has the potential of negatively affecting virtually all the systems of the body, causing debilitating and life-threatening complications if blood glucose levels are not controlled. A high level of self-management is required in order to control blood glucose levels and prevent or delay the onset of complications which may have severe physical, psychological and financial implications for the individuals and their families. As no research on the experiences of persons living with the condition was previously conducted in Nelson Mandela Bay, South Africa, a qualitative, descriptive, exploratory and contextual study was conducted between January and April 2009. Nineteen participants from both the private and public health care sectors were recruited making use of purposive sampling. The following themes emerged from the data collection: persons living with DM experience a wide range of emotions on initial diagnosis; gradually they experience an acceptance and acknowledgment of their condition; persons living with DM have definite opinions on the concept of self-management; persons living with DM acknowledge both positive and negative factors which influence self-management and expressed views on how professional nurses can assist them in achieving self-management. Recommendations included allowing persons living with DM to take a leading role in decisions regarding management of their condition. They should make periodic reinforcements of their lifestyle modifications as part of an ongoing patient education process. Qualified Diabetes Nurse Educators should be employed at health care facilities, both in the public and private sector. Finally, specialized courses covering all areas of management of DM should be more readily available to health care workers.

Prevalence and socioeconomic characteristics of alcohol disorders among men and women in the Eastern Cape Province, South Africa

There is growing concern about alcohol problems in low- and middle-income countries. More research is required, particularly among the younger generation. The aim of this study was to investigate the prevalence of alcohol disorders and associated socioeconomic characteristics among young men and women living in the Eastern Cape Province, South Africa. This was a cross-sectional population-based study of 977 participants (52% male and 48% female) aged 18-40, the majority of whom lived in low-income areas. Data collection was carried out in 2012 by trained fieldworkers. The Mini International Neuropsychiatric Interview (DSM-IV) was used to investigate the prevalence of alcohol dependence (increased tolerance to alcohol, failed attempt to cut down, risk of physical and mental effects) and alcohol abuse (harmful use, consistent intoxication, risk behaviour, physically hazardous, social problems). A high 12-month prevalence of alcohol dependence was found (26.5% in total; 39.0% among men and 19.1% among women) as well as of alcohol abuse (9% in total; 19.0% among men and 6.0% among women). Few socioeconomic differences emerged among the men, except older men (OR 1.94, CI 1.11-3.42) and those supported by social grants (OR 2.28, CI 1.06-4.93), who presented higher odd ratios for alcohol dependence than the reference groups. Among the women, more differences emerged: women who were widowed/single (OR 2.35, CI 1.20-4.62), had no education (OR 3.41, CI 1.04-11.21), had a low income (OR 3.26, CI 1.55-6.80) and had no social support from friends when ill presented higher odd ratios (OR 1.73, CI 1.07-2.80). In the adjusted model, marital status and low income remained statistically significant. With regard to alcohol abuse, fewer socioeconomic differences emerged. Interventions need to address the early onset of alcohol misuse in order to meet both current needs and long-standing mental and physical illness.

Strategies and challenges for communicating the diagnosis of cancer in cross-cultural clinical settings—Perspectives from South African healthcare professionals

ABSTRACT Communicating the diagnosis of cancer in cross-cultural clinical settings is a complex task. This qualitative research article describes the content and process of informing Zulu patients in South Africa of the diagnosis of cancer, using osteosarcoma as the index diagnosis. We used a descriptive research design with census sampling and focus group interviews. We used an iterative thematic data analysis process and Gubas model of trustworthiness to ensure scientific rigor. Our results reinforced the use of well-accepted strategies for communicating the diagnosis of cancer. In addition, new strategies emerged which may be useful in other cross-cultural settings. These strategies included using the stages of cancer to explain the disease and its progression and instilling hope using a multidisciplinary team care model. We identified several patients, professionals, and organizational factors that complicate cross-cultural communication. We conclude by recommending the development of protocols for communication in these cross-cultural clinical settings.