Margaret S. Westaway

The effects of social support on health, well-being and management of diabetes mellitus: a black South African perspective

Objectives To determine the underlying dimensions of a social support measure and investigate the effects of social support on health, well-being and management of diabetes mellitus (metabolic control and blood pressure (BP) control). Design A cross-sectional, analytical design was used with a structured questionnaire, comprising demographic characteristics, the MOS Social Support Survey scale and the health perceptions and mental health sub-scales from the SF-20. Setting Two outpatient diabetes mellitus clinics in Pretoria, South Africa. Participants Over a three-month period, the questionnaire was administered to 263 black diabetes mellitus outpatients (174 women and 89 men), aged between 16 and 89 years. The majority of patients (91%) were diagnosed as type 2 diabetes mellitus. Only 22% of the patients had acceptable metabolic control (HbA1c<8.0%), in comparison with 46% who had good BP control (130/85 mmHg). There were significant differences between the clinics on BP control: participants from clinic 1 had better BP control than participants from clinic 2. Results Principal components analysis, followed by an orthogonal (VARIMAX) rotational solution, resulted in two social support factors accounting for 78.9% of the variance. The first factor was labelled socio-emotional support, due to the emphasis on close caring relationships. The second factor was concerned with the more tangible aspects of social support, such as the provision of assistance. Coefficient alpha was 0.97 (socio-emotional support), 0.95 (tangible support) and 0.97 (overall social support). Patients with lower levels of social support had poorer general health and well-being than patients with higher levels of social support. Controlling for clinic, patients with controlled BP had significantly more socio-emotional and tangible support than patients with poor BP control. Conclusions The study demonstrated that: (1) socio-emotional and tangible support were the underlying dimensions of social support; (2) socio-emotional support is an important determinant of health and well-being; and (3) social support is beneficial for one aspect of diabetes mellitus management, namely, BP control.

The impact of chronic diseases on the health and well-being of South Africans in early and later old age

This paper examines the impact of chronic disease status on health and well-being of South Africans in early and later old age. A structured questionnaire, comprising demographic characteristics, self-reported chronic disease status, an 18-item health problems scale and the health and well-being sub-scales from the SF-12 was used to collect data from 400 black, 101 Indian, 107 white and 102 colored residents of Greater Pretoria, South Africa. One hundred and ninety (27%) reported no chronic disease, 181 (25%) had hypertension alone, 179 (25%) had hypertension combined with one or more other chronic diseases and 160 (23%) had other chronic diseases without hypertension. There were no significant differences on health and well-being by race, language, gender or marital status. However, there were significant race, age group and gender effects on chronic disease status. Controlling for these factors, the no chronic disease group had significantly better health and well-being than the other three groups; the group with hypertension alone also had better health and well-being than the chronic disease groups with and without hypertension. It was concluded that chronic diseases combined with and without hypertension were more detrimental to health and well-being than no chronic disease or hypertension alone.

Management of diabetes mellitus in outpatient facilities is achieving poor results

846 To the Editor: In South Africa, prevalence rates for diabetes mellitus (DM) are rising at an alarming rate. In addition, South African diabetic patients suffer from high rates of obesity, poor blood pressure (BP) control and poor glycaemic control. In order to monitor management of DM, records were examined for 149 patients (76 black and 73 white) attending one of two Tshwane (formerly greater Pretoria) facilities for routine outpatient treatment. Body mass index (BMI), BP and HbA1c results were used to ascertain management of DM. Controlled BMI was defined as < 25 kg/m, controlled systolic and diastolic BP as < 130/85 mmHg and glycaemic control as HbA1c results < 7.0%.

Investigating the psychometric properties of the Rosenberg Self-Esteem Scale for South African residents of Greater Pretoria

Interviewers administered the Rosenberg Self-Esteem scale (RSES) to five groups of Black (formal township and informal settlement), White, Indian, and mixed race adult residents of Greater Pretoria. The results demonstrated that the RSES was psychometrically sound for the five groups. The minimal effects of sociodemographic characteristics on global self-esteem showed that the RSES and its two dimensions, self-competence (SC) and self-liking (SL), were suitable in this setting. All five groups scored above the theoretical midpoint of the RSES, indicating that generally positive self-evaluations appear to be universal. The relationships between positively and negatively worded items, SC, and SL attested to the following: internal structure reliability, congruence between positive and negative items, no negative biases in response, and concordance between SC and SL dimensions. The significant differences between informal settlement residents and the other four groups on global self-esteem, positively and negatively worded items, and SC and SL were possibly due to physiological needs taking precedence over higher order needs.

Aspects of environmental quality of life that affect neighbourhood satisfaction in disadvantaged and advantaged Johannesburg communities

To ascertain which aspects of environmental quality of life affect neighbourhood satisfaction, a study was conducted with 303 tenure allocated residents of an informal settlement in Soweto, 160 residents of a squatter camp in the same informal settlement, and 375 black and 358 white residents of a middle-class Johannesburg suburb. Respondents rated their satisfaction with housing, public schools, public clinics, public transport, roads, personal safety, street lighting, household refuse removal, jobs, local government and the neighbourhood. Black suburbanites tended to be more satisfied than the other three groups with most of these aspects. Stepwise multiple regression analyses revealed that housing and personal safety accounted for 45 per cent (informal settlement), 21 per cent (squatter camp), 33 per cent (black suburbanites), and 28 per cent (white suburbanites) of the variance in neighbourhood satisfaction. The findings substantiated the importance of housing and personal safety in both disadvantaged and advantaged communities.

Rheumatoid arthritis functional disability in a public health care clinic

Median scores for public and private health care patients with RA in the USA range between 1 and 1.25 3 compared with 1.6 for South African public health care patients, 4 indicating more severe disability in our public health care sector. Although the goal of health care for patients with RA is to maximise functioning in everyday life, functional disability is rarely assessed in South African public health care facilities. Owing to staff shortages and resources, patient overload and poor staff morale in South African public health facilities, routine administration of the HAQ-DI by existing staff is extremely difficult to implement. We administered the HAQ-DI to a consecutive sample of 108 outpatients with RA at Pretoria Academic Hospital.

Investigating the health-related quality of life (HRQOL) of surface and underground mine workers at a South African platinum mine

To the Editor: Health-related quality of life (HRQOL) in the workplace is receiving increasing attention, probably because of findings that better functioning, general health and wellbeing and lower levels of pain are associated with higher productivity, dependability and creativity, overall higher work quality and lower absenteeism. 1-2 However, no research has been conducted on HRQOL in the South African mining industry. In order to rectify this omission, a study was conducted with 275 male miners, performing surface and underground duties at one platinum mine, to ascertain their functioning, general health, wellbeing and level of pain. Ages ranged between 20 and 61 years (mean 40.3 years, standard deviation (SD) 9.6 years). Education ranged between none and 12 years (mean 7.4 years, SD 3.5 years). Age was negatively related (p 0.05). These findings suggested that underground duties are physically, but not mentally, more demanding than surface work.