Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans

Background: One of the most important primary health challenges currently affecting older people in South Africa (SA) is the increasing prevalence of non-communicable disease (NCD). Research is needed to investigate the current state of care and self-management support available to older diabetic patients in SA and the potential for interventions promoting self-management and community involvement. Aim: This study aimed to review current policies, programmes and any other interventions as they relate to older people with diabetes with a view to assess the potential for the development of a self-management programme for older persons attending public sector primary health care services in Cape Town, South Africa. Setting: Eighteen community health centres (CHCs) formed the sampling frame for the study. Methods: This study aimed to review current policies and programmes as they relate to older people with diabetes. It involved a documentary review and qualitative individual interviews with key informants in the health services and Department of Health. Results: Several national initiatives have sought to advance the health of older people, but they have only been partially successful. There are however multiple efforts to re-orientate the health-care system to focus more effectively on NCDs, which benefit older patients with diabetes. The establishment of community-based services to provide self-management support, promote health and ease access to medicine helps overcome many of the commonly cited barriers to care experienced by older patients. What may be equally important is that practitioners gain the communication skills and educational resources to effectively educate and counsel patients on lifestyle behaviour change and self-care management. Conclusion: This article alerts policy-makers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older diabetic patients. Many of these would also be applicable to older patients with other chronic conditions

Knowledge and perceptions of risk for cardiovascular disease: findings of a qualitative investigation from a low-income peri-urban community in the Western Cape, South Africa

Background: South Africa currently faces an increasing burden of cardiovascular disease. Although referred to clinics after community screening initiatives; few individuals who are identified to be at high risk for developing cardiovascular disease attend. Low health literacy and risk perception have been identified as possible causes. We investigated the knowledge and perceptions about risk for cardiovascular disease in a community.Method: We conducted a series of focus group discussions with individuals from a low incomeperi-urban community in the Western Cape; South Africa. Different methods of presenting risk were explored. The data were organised into themes and analysed to find associations between themes to provide explanations for our findings.Results: Respondents' knowledge of cardiovascular disease and its risk factors varied; but most were familiar with the terms used to describe cardiovascular disease. In contrast; understanding of the concept of risk was poor. Risk was perceived as a binary concept and evaluation of different narrative and visual methods of presenting risk was not possible.Conclusion: Understanding cardiovascular disease and its risk factors requires a different set of skills from that needed to understand uncertainty and risk. The former requires knowledge of facts; whereas understanding of risk requires numerical and computational skills. Without a better understanding of risk; risk assessments for cardiovascular disease may fail in this community