Knowledge, skills, and training of community health workers to contribute to interprofessional education: a scoping review.

A scoping review of 32 publications was conducted with the aim of mapping literature to determine what is known about the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Interprofessional education, as a pedagogical approach, prepares health professions students to serve patients in collaboration with other health professionals to improve patient outcomes. All over the world, the role of community health workers is vital for its support of community service and community health outcomes. However, no evidence could be found on the knowledge, skills, and training of community health workers that contribute to interprofessional education. The knowledge that community health workers need to contribute to interprofessional education, as reported by the literature, relates to case management, communication, health education, recordkeeping and referrals. Skills, such as critical thinking, interprofessional collaboration, and various clinical procedures, were noted. Training approaches reported included the use of technology such as mobile phones and web-based learning. The scoping review improved our understanding of the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Applying a fit-for-purpose approach, and building on existing knowledge, skills, and training, could fast-track the contribution of community health workers to interprofessional education.

Self-management practices for preventing complications of type II diabetes mellitus in low and middle-income countries: A scoping review.

Introduction: The projected increase in the prevalence of diabetes mellitus globally is expected to hit the low and middle income countries the hardest. The majority of the day to day disease management activities needed to achieve glycaemic control and improve the quality of life among patients with diabetes mellitus falls on the patient and/or their families. Determining the self-management practices by patients with diabetes mellitus can help develop interventions that can enhance these practices and help prevent complications. Objective: The current study aimed to explore the self-management practices of patients with type II diabetes mellitus in low and middle-income countries to prevent complications. Design: A scoping review was conducted using the Joanna Briggs Institute approach to conducting scoping reviews. The context of the review was low and middle income countries with the core concept being self-management practices for prevention of complications. Methods: Articles in Scopus databases and on the EBSCOHost platform were searched, as were their reference lists. If abstracts met inclusion criteria, full articles were downloaded and data extracted. The review included original research studies, published in the English language. The research studies included in the review were conducted between the year 2000 to 2022 among patients diagnosed with type II diabetes mellitus. Results: This search yielded 823 articles; after deduplication, twelve studies were included in the final list. Four categories of self-management practices for preventing complications of type II diabetes mellitus were identified. The categories are i) acquisition of diabetes-related knowledge, ii) essential skills to manage diabetes mellitus, iii) lifestyle modification, and iv) availability of psychological support and follow-up. Conclusions: Most diabetes care is dependent on patients' self-management levels. The studies reviewed in this article show that patients are capable of adequate self-management when practices are tailored to their needs. Registration: The scoping review protocol was registered in the Fig Share platform on 17th January 2022 under the digital object identifier https://doi.org/10.38140/ufs.17206751.

Health literacy of Sesotho-speaking patients diagnosed with chronic conditions in South Africa.

BACKGROUND: Health literacy influences patients' health outcomes, as their ability to read, interpret and apply health information associated with health-related decision-making. These decision-making skills need to be made up by patients diagnosed with chronic conditions - also Sesotho-speaking patients receiving treatment in public primary health care environments. AIM: The study aimed to assess the health literacy of Sesotho-speaking patients diagnosed with chronic conditions and to establish the associations between the sociodemographic data of patients and items of a health literacy test. SETTING: This study was conducted in public healthcare (PHC) facilities in the Free State province, South Africa. METHODOLOGY: A quantitative descriptive cross-sectional design involved conveniently sampled patients with chronic conditions (n = 264) who were being treated at PHC facilities (n = 12) in the Setsoto subdistrict and who completed the Sesotho Health Literacy test during a structured interview. Descriptive statistics were calculated per group and compared by means of chi-square or Fisher's exact test and Kruskal-Wallis test. RESULTS: Test results indicate high literacy levels in 35.6% (n = 94), moderate health literacy levels in 43.6% (n = 115) and low health literacy levels in 20.8% (n = 55) of participants. No association (p = 0.14) was found between health literacy level and gender or chronic conditions or between health literacy level and the participants' inability to read due to poor eyesight (p = 0.21). Positive associations (p ≤ 0.01) were established between a health literacy level and age and between health literacy level and education: participants with a South African School Grade Level 9-12 (p ≤ 0.01) had higher health literacy levels. CONCLUSION: Healthcare providers caring for Sesotho-speaking patients need to be sensitive about their patients' health literacy levels, as it may play a role in their health outcomes.Contribution: The value of the findings reported lies in the possibility of rapidly appraising the health literacy levels of a large indigenous population in South Africa diagnosed with chronic conditions.

Experiences of Postnatal Mothers with Healthcare Providers in Rural Kenya: Insights from Applying the Mmogo Method.

PURPOSE: To explore the experiences of postnatal mothers with health care providers during postnatal care in rural Kenya. DESIGN: This was a visual-based narrative inquiry study that applied the Mmogo method® - a visual projective data-collection method. METHODS: The participants were women (n=26) receiving postnatal care at purposively sampled rural health facilities (n=4) in Laikipia County Kenya. FINDINGS: Two themes emerged from this study. First, the mothers had positive experiences with health care providers. Secondly, the mothers expressed expectations to enhance future experiences with health care providers. CONCLUSIONS: Mothers had positive experiences and various expectations to enhance future experiences with health care providers that related to their postnatal needs. The mothers proposed the possible use of mobile phones by health care providers to meet their health education needs as well as receive psychological support. CLINICAL EVIDENCE: Health care providers can use mobile phone devices to call and address some of the postnatal needs during the postnatal period.

Interactive workshops as a learning and teaching method for primary healthcare nurses.

BACKGROUND: Traditionally, learning by and teaching for primary healthcare (PHC) nurses use didactic, teacher-centred approaches. Hence, the feasibility of interactive workshops in non-threatening PHC environments to refresh nurses' knowledge on patient care needs exploring. AIM: To describe interactive workshops as a learning and teaching method for PHC nurses. SETTING: Primary healthcare clinics. METHODS: Systematic literature search followed by an exploratory experimental pre or post-test control group design. Random clinic sampling (n = 26) led to clinic inclusion at the control (n = 5) and experimental (n = 5) sites. Nurses (n = 42) were conveniently selected for the control (n = 21) and experimental (n = 21) groups. Experimental participants (n = 21) attended interactive workshops (n = 5) where various strategies were applied, whilst addressing key diabetes messages. Both groups completed a questionnaire aligned to diabetes messages pre- and post-workshop. Additionally, a Likert scale questionnaire was posed to the experimental group post-workshop. Data was analysed statistically and presented as descriptive statistics, frequencies and percentages. RESULTS: Articles reviewed (n = 20) identified types of interactive activities, role players, learning content covered, feasibility and duration of the interactive workshops. Pre or post-testing results of the workshops participants indicate improved knowledge related to peripheral sensation (0.03) and (< 0.01). Results from the questionnaire revealed participants' satisfaction with the interactive workshops. CONCLUSION: Interactive workshops as a learning and teaching method could lead to change in knowledge, and participant satisfaction. However, using a combination of interactive workshops and other teaching modalities may enhance learning and teaching further. CONTRIBUTION: Interactive workshops are a feasible instructional method during refresher courses for healthcare providers.

A diabetes peer support intervention: Patient experiences using the Mmogo-method®.

BACKGROUND: Self-management is the backbone of diabetes care. For the patient with type 2 diabetes, this implies making decisions about a healthy diet, regular exercise and taking treatment appropriately. Some patients may experience barriers to the self-management of diabetes, such as lack of support. In this respect, peer support has been identified as a promising strategy in the self-management of diabetes. AIM: The study aimed to explore the experiences of adults with type 2 diabetes who took part in a diabetes peer support intervention in the Free State, South Africa. Such information may lead to the development of practical methods for diabetes self-management and control. METHODS: Twelve purposively sampled Sesotho-speaking women (aged 51-84 years) participated in the Mmogo-method®, a visual-based narrative enquiry. Textual data from audio recordings of discussions, visual data from photographs of constructions and field notes were triangulated and analysed thematically. RESULTS: Participants described the peer support intervention as very valuable. They regarded community health workers as an important source of support. Three themes emerged from the intervention: positive lifestyle changes, continuous support, and improved confidence and sense of connectedness. This was a significant finding reported in patients with diabetes, as it will contribute to successfully sustaining effective self-management behaviour. CONCLUSIONS: Peer support for patients with type 2 diabetes appeared to be a valued intervention, as participants related well to community health workers, who are ideally positioned in the healthcare system to provide the service.

Interest in Communication Technology by Rural Caregivers of Adolescents with Mental Health Issues in South Africa: The Mmogo-Method®.

Caregivers determine the level of care adolescents with mental issues receive; however, caregivers' own needs are often unmet. Communication technology can be tailored to address these challenges, especially in a rural environment. This study aimed to explore caregivers' interest in using communication technology to provide support to address challenges. This study involved a visual-based narrative inquiry that gathered data through the Mmogo-method®. Three (n = 3) groups were held with rural caregivers (n = 17) of adolescents with mental health issues in a rural area in the Free State province of South Africa during 2017. Three themes captured challenges confronting caregivers, namely, psychosocial, social resources, and informational challenges. Interest in communication technology was captured in a fourth theme. The findings indicate that communication technology can address caregivers' challenges by providing support and information to caregivers in rural areas. Communication technology, including mobile phones, electronic devices, and the Internet, has transformed healthcare services and proved to be valuable in resource constraint environments.

Self-management in face-to-face peer support for adults with type 2 diabetes living in low- or middle-income countries: a systematic review.

BACKGROUND: Peer support has been recognised as a promising strategy to improve self-management in patients living with chronic conditions, such as Type 2 diabetes (T2D). The purpose of the review was to synthesise the best available evidence on face-to-face peer support models for adults with T2D in low and middle-income countries (LMICs). METHODS: We searched Medline, Cumulative Index to Nursing and Allied Health, Literature Academic Search Ultimate, PsycINFO, CAB Abstracts, Health Source: Nursing/Academic Edition, SPORTDiscus, Africa-Wide Information, MasterFILE Premier, SocINDEX, ERIC, PsycARTICLES, Open Dissertations, Communication & Mass Media Complete, Health Source-Consumer Edition and Google Scholar for the period January 2000 to December 2017. Reference list checking and contact with authors were additional sources of data. Screening of papers, critical appraisal and data extraction were carried out independently by at least two reviewers. RESULTS: From 3092 abstracts retrieved from database searches, data was extracted from 12 papers. There was no consistency in design, setting, outcomes or measurement instruments amongst the papers. The papers were associated with improvements in various clinical and behavioural outcomes. Diabetic patients and community health workers (CHWs) were identified as two common face-to-face peer support models. The recruitment and selection of diabetic patients as peer supporters focused on patients from the community, with good glycaemic control and/or leadership skills, who were recommended by healthcare professionals. Recruitment of CHWs as peer supporters was done from an existing infrastructure of CHWs in the community and, thus, selection criteria were poorly described. The training of peer supporters featured as an important component, highlighting who provided training and the duration and content covered in training. Motivational interviewing was the most common theory basis of training used in the peer support interventions. Face-to-face, group and/or individual-based peer support was often supplemented by other peer support methods. The supervision of peer supporters was generally poorly described. CONCLUSIONS: The comprehensive synthesis of the best available evidence has led to new insights regarding face-to-face peer support as a self-management strategy for patients with T2D in LMICs. Face-to-face peer support may be implemented in innovative ways to improve the quality of life of patients with T2D. TRIAL REGISTRATION: PROSPERO trial registry number, CRD 42018103261 .

Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review.

BACKGROUND: Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues. OBJECTIVE: The study aimed to answer the question: "What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology." METHODS: A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools. RESULTS: The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction. CONCLUSIONS: The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers' needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed.

mHealth communication to strengthen postnatal care in rural areas: a systematic review.

BACKGROUND: Postnatal care (PNC) in rural areas is characterised by low uptake, with possible effect on maternal and neonatal mortality rates. Mobile health (mHealth) communication has been proposed to promote the uptake of health services; however, there is limited information on how mHealth can strengthen PNC in rural areas. The objective of this review was to gather the best available evidence regarding mHealth communication to strengthen PNC in rural areas. METHODS: Studies published between 1 January 2008 and 31 August 2018 were searched in electronic databases hosted by EBSCO Host. Reference list checking and contact with authors were also done. Critical appraisal of the eligible studies was also done. RESULTS: The results of 11 articles were synthesised to report the determinants of PNC uptake. Determinants were aligned to the Integrative Model of Behaviural Prediction (IMBP). One-way mobile phone messaging was the most common type of mHealth communication used. mHealth communication influenced mothers' intentions, skills, and environmental constraints associated with uptake of PNC. Intentions were influenced by attitudes, perceived norms and self-efficacy. Positive attitudes, as well as changed attitudes toward PNC practices were observed. Perceived norms that were enhanced were delivery at a health facility with immediate PNC, seeking of reinforcement and professional health support of newborn care practices, and male partner support. Improved self-efficacy was demonstrated by mothers who attended scheduled appointments and they were confident with regard to newborn care practices. Skills for PNC that were improved included cord care, thermal care, appropriate breastfeeding and problem-solving. The environmental constraints faced and which were addressed in the studies included inaccessibility, unavailability and unaffordability of PNC services in rural areas. CONCLUSIONS: Results from the literature included in this study show that one-way mobile phone messaging is the common type of mHealth communication used to strengthen PNC in rural areas. mHealth communication can influence intentions, skills and environmental constraints as determinants of PNC uptake. mHealth communication is recommended to strengthen PNC in rural areas. To widen the evidence, more studies in the field of mHealth communication that report a variety of both maternal and neonatal outcomes are needed.

Development of a Sesotho health literacy test in a South African context.

BACKGROUND: Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. AIM: The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. SETTING: The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. METHODS: Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. RESULTS: The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman-Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. CONCLUSION: The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries.

Perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa.

BACKGROUND: This study researched the perceptions of patients diagnosed with diabetes concerning diabetes-related health communication strategies in the Free State province in South Africa. The prolongation and quality of life of patients diagnosed with diabetes are affected by lifestyle choices. An enabler of risk reduction is health communication which informs, influences and motivates individuals to adopted health-focused lifestyles. AIM: This study sought to describe the perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa. SETTING: This study was carried out in primary health care centres and community health care centres within the Free State province in South Africa. METHODS: A qualitative, descriptive and exploratory research design was used in this study. Thirty-four patients diagnosed with type two diabetes for at least a year were purposively included in this study. Semi-structured interviews in Afrikaans, English, Sotho and Xhosa were conducted. Data analysis was through inductive reasoning and thematic analysis. RESULTS: The majority of the respondents were older women having been diagnosed with diabetes for more than 5 years, with at least primary school education and of diverse South African ethnicities. The main prompting questions operationalised the term 'perception', probing their feelings, experiences and knowledge of health-related communication strategies as presented by a variety of information sources. After recording interviews, data were analysed according to themes, categories and sub-categories. CONCLUSIONS: The study highlights factors that encourage patients to seek help and foster attitudes of compliance. Practical problems regarding the management of diabetes are underlined. The role of family, as well as the patient-caregiver relationship, in the acceptance and management of the disease is revealed. Societal perception of male symptomology is shown. The study offers information to stakeholders and health care workers for continued successful management of diabetes in communities.

Perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa

Background: This study researched the perceptions of patients diagnosed with diabetes concerning diabetes-related health communication strategies in the Free State province in South Africa. The prolongation and quality of life of patients diagnosed with diabetes are affected by lifestyle choices. An enabler of risk reduction is health communication which informs, influences and motivates individuals to adopted health-focused lifestyles. Aim: This study sought to describe the perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa. Setting: This study was carried out in primary health care centres and community health care centres within the Free State province in South Africa. Methods: A qualitative, descriptive and exploratory research design was used in this study. Thirty-four patients diagnosed with type two diabetes for at least a year were purposively included in this study. Semi-structured interviews in Afrikaans, English, Sotho and Xhosa were conducted. Data analysis was through inductive reasoning and thematic analysis. Results: The majority of the respondents were older women having been diagnosed with diabetes for more than 5 years, with at least primary school education and of diverse South African ethnicities. The main prompting questions operationalised the term 'perception', probing their feelings, experiences and knowledge of health-related communication strategies as presented by a variety of information sources. After recording interviews, data were analysed according to themes, categories and sub-categories. Conclusions: The study highlights factors that encourage patients to seek help and foster attitudes of compliance. Practical problems regarding the management of diabetes are underlined. The role of family, as well as the patient­caregiver relationship, in the acceptance and management of the disease is revealed. Societal perception of male symptomology is shown. The study offers information to stakeholders and health care workers for continued successful management of diabetes in communities

Perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa

Background: This study researched the perceptions of patients diagnosed with diabetes concerning diabetes-related health communication strategies in the Free State province in South Africa. The prolongation and quality of life of patients diagnosed with diabetes are affected by lifestyle choices. An enabler of risk reduction is health communication which informs, influences and motivates individuals to adopted health-focused lifestyles.Aim: This study sought to describe the perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa.Setting: This study was carried out in primary health care centres and community health care centres within the Free State province in South Africa.Methods: A qualitative, descriptive and exploratory research design was used in this study. Thirty-four patients diagnosed with type two diabetes for at least a year were purposively included in this study. Semi-structured interviews in Afrikaans, English, Sotho and Xhosa were conducted. Data analysis was through inductive reasoning and thematic analysis.Results: The majority of the respondents were older women having been diagnosed with diabetes for more than 5 years, with at least primary school education and of diverse South African ethnicities. The main prompting questions operationalised the term 'perception', probing their feelings, experiences and knowledge of health-related communication strategies as presented by a variety of information sources. After recording interviews, data were analysed according to themes, categories and sub-categories.Conclusions: The study highlights factors that encourage patients to seek help and foster attitudes of compliance. Practical problems regarding the management of diabetes are underlined. The role of family, as well as the patient­caregiver relationship, in the acceptance and management of the disease is revealed. Societal perception of male symptomology is shown. The study offers information to stakeholders and health care workers for continued successful management of diabetes in communities

Development of a Sesotho health literacy test in a South African context

Background: Research shows that poor health literacy (HL) can be a threat to health and health care. Health literacy is under-researched and poorly understood in developing countries, including South Africa, because of the absence of language and context-specific HL tests. Aim: The researchers aimed to develop an appropriate HL test for use among South African public health service users with Sesotho as their first language. Setting: The test was developed in the Free State Province of South Africa, for use among Sesotho speakers. Methods: Mixed methods were employed to develop the Sesotho Health Literacy Test (SHLT). The process of developing the test was carried out in distinctive methodological steps. Results: The stepwise process set out by identifying abstracts (n = 206) referring to HL tests. Sourcing of HL tests followed a tapered process resulting in the use of 17 HL tests. Elements within a conceptual framework guided HL test item selection (n = 47). Two Delphi sessions assisted in reaching consensus regarding final HL test items (n = 40). The readability testing of the SHLT tested 4.19 on the Coleman­Liau Index score. A context-suitable and comprehensive SHLT ensued from this work. Conclusion: The SHLT assessment instrument development creates a platform for HL testing among Sesotho first language speakers in South Africa. The context-sensitive methodology is entrenched in a theoretical framework, distributing HL test items between identified competencies and related skill dimensions and domains. The methodology can be applied to the development of HL tests for other languages and population groups in developing countries

A framework to expand public services to children with biomedical healthcare needs related to HIV in the Free State, South Africa.

The study undertook the development of a framework for expanding the public services available to children with biomedical healthcare needs related to HIV in South Africa. The study consisted of various component projects which were depicted as phases. The first phase was a descriptive quantitative analysis of healthcare services for children exposed to or infected by HIV, as rendered by the public health sector in the Free State Province. The second stage was informed by health policy research: a nominal group technique with stakeholders was used to identify strategies for expanding the healthcare services available to these children. The third phase consisted of workshops with stakeholders in order to devise and validate a framework for the expansion. The theory of change logic model served as the theoretical underpinning of the draft framework. Triangulated data from the literature and the preceding two phases of the study provided the empirical foundation. The problem identified was that of fragmented care delivered to children exposed to or infected with HIV, due to the 'over-verticalization' of programmes. A workshop was held during which the desired results, the possible factors that could influence the results, as well as the suggested strategies to expand and integrate the public services available to HIV-affected children were confirmed. Thus the framework was finalised during the validation workshop by the researchers in collaboration with the stakeholders.