Motshedisi B. Sabone

Impediments for the uptake of the Botswana government's male circumcision initiative for HIV prevention.

Botswana remains one of the countries with high prevalence of HIV infection with a population prevalence rate of 17.6 in 2008. In 2009, the Ministry of Health launched male circumcision as an additional strategy to the already existing HIV preventive efforts. The purpose of this paper is to share what the participants of a survey to evaluate a short-term male circumcision communication strategy in seven health districts of Botswana reported as impediments for the programs uptake. Qualitative data were obtained from 32 key informants and 36 focus group discussions in 2011. Content analysis method was used to analyze data and to derive themes and subthemes. Although male circumcision was generally acceptable to communities in Botswana, the uptake of the program was slow, and participants attributed that to a number of challenges or impediments that were frustrating the initiative. The impediments were organized into sociocultural factors, knowledge/informational factors, and infrastructural and system factors.

The Promotion of Mental Health Through Cultural Values, Institutions, and Practices: A Reflection on Some Aspects of Botswana Culture

Botswana has seen rapid socioeconomic development since the 1970s that has contributed to the erosion of the values, institutions, and practices that are believed to be supportive of mental health. In this paper, the author argues that the aspects of culture that are supportive of mental health have been diluted by the process of urbanization and the interactions of Batswana (the indigenous people of Botswana) with other cultural groups, particularly those from the western hemisphere. The paper further highlights some of the values, institutions, and practices native to Botswana and describes how they promote mental health. Lastly, recommendations for reviving the cultural values, institutions, and practices of Botswana are discussed.

Using qualitative methods for course evaluation: a case study from Botswana.

This article is a report of a qualitative evaluation of a course on human immunodeficiency virus/acquired immunodeficiency syndrome carried out jointly by faculty from Botswana and the United States at a university in Botswana. It demonstrates the importance of both international nurse educator expertise in impacting a major pandemic and the use of qualitative methods for course evaluation.

Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care

&NA; Health literacy is important for access to and quality of HIV care. While most models of health literacy acknowledge the importance of the patient–provider relationship to disease management, a more nuanced understanding of this relationship is needed. Thematic analysis from 28 focus groups with HIV‐experienced patients (n = 135) and providers (n = 71) identified a long‐term and trusting relationship as an essential part of HIV treatment over the continuum of HIV care. We found that trust and relationship building over time were important for patients with HIV as well as for their providers. An expanded definition of health literacy that includes gaining a patients trust and engaging in a process of health education and information sharing over time could improve HIV care. Expanding clinical perspectives to include trust and the importance of the patient–provider relationship to a shared understanding of health literacy may improve patient experiences and engagement in care.

Glycaemic index of selected staple carbohydrate-rich foods commonly consumed in Botswana

Abstract Objectives: Data on the glycaemic index (GI) of foods commonly consumed in Botswana are lacking. The present study aimed to evaluate the GI of some of the staple carbohydrate-rich foods eaten in Botswana. Design, setting and subjects: Fifty university student volunteers were divided into five groups. Members of each group consumed different test foods based on wheat, maize, sorghum, millet and morama beans to supply 50 g of available carbohydrate after 10-12 hours of overnight fasting. GI was determined using a standard method with white bread. Outcome measures: The GI values were calculated after measuring blood glucose levels before and after ingestion at 0, 15, 30, 45, 60, 90 and 120 minutes. Results: The results showed a clear variation in the GI values for the same food when consumed by different individuals. In addition, variations were observed in the GI values of test foods based on the same material. On average, wheat-based foods exhibited the highest GI values (103.1), followed by millet-based foods (95.3), sorghum-based foods (92.5), maize-based foods (9.1) and morama-based foods (86.4). Of the tested food, mapakiwa (wheat-based) had the highest GI (110.6) whereas roasted morama had the lowest GI (82.8). Conclusion: These results could form the basis of dietary advice to consumers, and particularly patients with diabetes. Further studies are needed on more of the commonly consumed foods in Botswana.

Language and Culture in Health Literacy for People Living with HIV: Perspectives of Health Care Providers and Professional Care Team Members

Low health literacy has been linked to inadequate engagement in care and may serve as a contributor to poor health outcomes among people living with HIV and AIDS. The purpose of this paper was to examine the perspectives of health care providers and professional care team members regarding health literacy in HIV disease. A secondary data analysis was conducted from a qualitative study aimed at understanding factors that help an HIV positive person to manage their HIV disease. Data were collected from sites in Botswana, the US, and Puerto Rico. In the parent study, data were collected through focus group discussions with 135 people living with HIV, 32 HIV health care providers (HCPs), and 39 HIV professional care team members (PCTMs). SPSS was used to analyze quantitative data while ATLAS.ti was used to analyze qualitative data. The findings from analyses of the perspectives of HCPs/PCTMs suggested that linguistic and cultural factors were important themes in the exchange of HIV information between health care providers and PLHIV. These themes included ineffective communication, health seeking behavior, cultural facilitators, and complementary and alternative/traditional healing methods. Thus, this study suggests that language and culture have a major role in health literacy for PLHIV.

A qualitative description of service providers’ experiences of ethical issues in HIV care:

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.

The Dynamics, Dilemmas and Complexities of AIDS: The Cultural Context of Botswana

AIDS permeates all aspects of the lives of individuals, families and the society at large. In addition, it is beset with dynamics, dilemmas and complexities that have a bearing on peoples psychosocial health. However, AIDS presents a wealth of learning opportunities to affected people and to governments. Using Botswana as an exemplar, the author explores the way AIDS has transformed the way of life of a people through the challenges and the opportunities that it presents. The author reflects on the interface of AIDS and mental illness. The paper concludes with recommendations for the way forward.