Trends in socio-demographic characteristics and substance use among high school learners in a selected district in Limpopo Province, South Africa.

BACKGROUND: Substance use is an escalating public health problem in South Africa resulting in risky behaviours and poor educational attainment among adolescents. There is a huge battle to overcome substance use among learners as more drugs become easily available with the mean age of drug experimentation reported to be at 12 years of age. It is important to continuously understand the trends in substance use in order to assess if there are positive changes and provide evidence for the development of context-specific effective interventions. This paper outlines the prevalence of substance use among selected high schools in a district in Limpopo province. METHODS: To determine the prevalence of substance use among selected high school learners in a district in Limpopo Province, a cross-sectional school survey of 768 learners was conducted. Data was analysed using SPSS v 26. Descriptive analysis was used to describe the independent and dependent variables and Chi-Square test was used to investigate associations between demographic characteristics and substance use among high school learners. RESULTS: The most abused substances by learners were alcohol (49%), cigarettes (20.8%) and marijuana (dagga/cannabis) (16.8%). In a lifetime, there was a significant difference (P < 0.05) in cigarette smoking with gender, school, and grade; with more use in males (14.2%) than females (7.6%); in urban schools (14.6) than peri-urban (6.7%) and more in Grade 12 (6.4%). There was a significant difference (P < 0.05) in alcohol use with more use in Grade 10 (12.6%) and varied use among male and female learners but cumulatively more alcohol use in females (27.7%). Drug use varied, with an overall high drug use in urban schools (20.7%). CONCLUSIONS: Substance use is rife among high school learners in the district and health promotion initiatives need to be tailored within the context of socio-demographic characteristics of learners including the multiple levels of influence such as peer pressure, poverty, unemployment and child headed families. Additional research is required to investigate the factors leading to a notable gradual increase in use among female learners and into the environmental and family settings of learners in influencing substance use.

Using the modified Delphi technique to develop a framework for interprofessional education during international electives in health professions training institutions in Sub-Saharan Africa.

Background: International electives provide a learning platform where interprofessional education and collaborative practice (IPECP) skills can be cultivated. However, hardly any frameworks to guide the implementation of interprofessional education (IPE) during international electives, especially in the context of low-income settings have been published. To address this gap, this study used the modified Delphi approach to develop an IPE framework guide for international electives to be used by health professions training institutions in Sub-Saharan Africa. Methods: A rapid literature review and a study among students and faculty in four African health professional training institutions were done to inform the process. This was followed by the modified Delphi technique that used three Delphi rounds with a panel of eight experts to build consensus on the final framework for IPE during international electives. The level of consensus was set at ≥70% on each of the statements in all rounds. Results: Out of the 52 statements in round 1 (n = 37, 71%) reached consensus while (n = 15, 29%) of the statements did not reach consensus and were discussed in round 2. Round 2 led to 42 statements to be utilized for round 3. In round 3, all statements (42) reached a consensus and an IPE framework to guide the implementation of international electives was developed. The framework consists of three sections. Section one highlights the various IPECP competencies to be gained by learners in the areas of teamwork, interprofessional communication, roles and responsibilities of interprofessional collaborative practice, values and ethics of interprofessional collaboration, and reflection and evaluation of oneself and the team. Section two gives guidance on the structuring of the IPE international electives in health professional training institutions. This includes subsections on operational/institutional needs, acculturation considerations, teaching strategies, assessment strategies, mode of delivery, and public health considerations. Section three consists of the various practical guides and approaches that health professional training institutions could use according to what works best in their setting. Conclusion: The modified Delphi technique was an adequate approach to aid the development of an IPE framework to guide implementation during international electives in various health professional training institutions.

Challenges experienced by community health workers and their motivation to attend a self-management programme.

BACKGROUND: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours. AIM: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme. SETTING: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa. METHODS: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis. RESULTS: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective. CONCLUSION: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.

A vibrant reflection of the revised integrated school health policy with a lens on substance use.

Substance use is rife amongst adolescents, including learners. Learners are easily exposed to substances with onset as early as 10 years and average age of drug experimentation is 12 years in South Africa. This results in many negative health and social outcomes, a challenge as far as the achievement of global, regional and national goals such as quality education. The revised Integrated School Health Policy (ISHP) is a policy operating within the school environment aiming to address health and social barriers of learners and improve optimal health, comprising a vague action component on substance use prevention. This article is an opinion piece, which uses the Walt and Gilson model as an operational framework to analyse the revised ISHP within the lens of substance use. It assesses the four interrelated aspects: policy context, policy content, policy actors, and the policy process. The ISHP is placed within schools where adolescents are found and has the potential to reduce many health challenges such as substance use amongst learners. However, some issues are left to chance, such as health education on substance use prevention stated to only begin at Grade 4 (10 years), little mention of parental involvement, limited interplay amongst actors, limited investment in upskilling educators on dealing with substance use, scarce resources for implementation in all developmental phases and provinces to address substance use. Intervention can be more comprehensive with an intersectoral political approach needed to ensure that implementation addresses all multiple levels of influence of substance use amongst learners and the numerous health and social barriers.

Exploring interprofessional teamwork at a tertiary public hospital in South Africa.

The landscape of health in South Africa has changed dramatically with the unprecedented rise in the burden of disease. Public health care facilities struggle to provide quality, patient-centered care to patients with complex health needs. Interprofessional teamwork is strongly advocated to improve the quality and patient-centeredness of care. This study explored the barriers and facilitators of interprofessional teamwork amongst health professionals working at a tertiary level public hospital in South Africa. The study employed a qualitative, descriptive, exploratory design. Data were collected during three focus group discussions with 14 purposively selected participants from several health professions. Barriers such as high patient turnover, lack of human resources, time, hierarchy, referral process, lack of knowledge of the roles and scopes of practice, negative attitudes, communication inefficiencies, language barriers, and professional jealousy were found to impede interprofessional teamwork. Facilitators of interprofessional teamwork included increased human resources, communication technology, respect, and relationship building. Although health professionals understand the barriers and facilitators of interprofessional teams in the provision of patient care, this study concludes that interprofessional capacity building is needed for successful interprofessional teamwork at a tertiary level public hospital setting.

Towards tailored teaching: using participatory action research to enhance the learning experience of Longitudinal Integrated Clerkship students in a South African rural district hospital.

BACKGROUND: The introduction of Stellenbosch University's Longitudinal Integrated Clerkship (LIC) model as part of the undergraduate medical curriculum offers a unique and exciting training model to develop generalist doctors for the changing South African health landscape. At one of these LIC sites, the need for an improvement of the local learning experience became evident. This paper explores how to identify and implement a tailored teaching and learning intervention to improve workplace-based learning for LIC students. METHODS: A participatory action research approach was used in a co-operative inquiry group (ten participants), consisting of the students, clinician educators and researchers, who met over a period of 5 months. Through a cyclical process of action and reflection this group identified a teaching intervention. RESULTS: The results demonstrate the gaps and challenges identified when implementing a LIC model of medical education. A structured learning programme for the final 6 weeks of the students' placement at the district hospital was designed by the co-operative inquiry group as an agreed intervention. The post-intervention group reflection highlighted a need to create a structured programme in the spirit of local collaboration and learning across disciplines. The results also enhance our understanding of both students and clinician educators' perceptions of this new model of workplace-based training. CONCLUSIONS: This paper provides practical strategies to enhance teaching and learning in a new educational context. These strategies illuminate three paradigm shifts: (1) from the traditional medical education approach towards a transformative learning approach advocated for the 21(st) century health professional; (2) from the teaching hospital context to the district hospital context; and (3) from block-based teaching towards a longitudinal integrated learning model. A programme based on balancing structured and tailored learning activities is recommended in order to address the local learning needs of students in the LIC model. We recommend that action learning sets should be developed at these LIC sites, where the relevant aspects of work-place based learning are negotiated.

Expectations of youth victims of violence regarding health care professionals leading them to wellness in South Africa.

BACKGROUND: Many youth victims of violence report for treatment at the health care facilities in the Western Cape Province of South Africa. It was unclear what the youth expected regarding how they could be led towards wellness by health care professionals following an incident of violence (R1.1). OBJECTIVES: This study sought to explore and describe the expectations of the youth victims of violence with regards to health care professionals (R1.2) leading them to wellness in a selected rural community. METHOD: A qualitative, exploratory, descriptive and contextual design was used. Nine focus group discussions were conducted with 58 (23 males, 35 females) purposefully selected youth victims of violence between the ages of 15 and 19. Data analysis was done through open coding. Ethics clearance was received from the University Ethics Committee prior to the study being conducted. RESULTS: Findings indicated that the youth victims of violence expect the health care professionals (professional nurses, doctors and social workers) working in their community to act as role models, demonstrate a professional attitude, provide health education, provide confidential counselling services, and establish school and community outreach programmes. CONCLUSION: This study provides evidence that youth victims of violence have important expectations from health care professionals concerning their wellness. Hence, health care professionals should focus on designing and implementing interventions targeting these expectations.

Expectations of youth victims of violence regarding health care professionals leading them to wellness in South Africa

Background: Many youth victims of violence report for treatment at the health care facilities in the Western Cape Province of South Africa. It was unclear what the youth expected regarding how they could be led towards wellness by health care professionals following an incident of violence (R1.1). Objectives: This study sought to explore and describe the expectations of the youth victims of violence with regards to health care professionals (R1.2) leading them to wellness in a selected rural community. Method: A qualitative; exploratory; descriptive and contextual design was used. Nine focus group discussions were conducted with 58 (23 males; 35 females) purposefully selected youth victims of violence between the ages of 15 and 19. Data analysis was done through open coding. Ethics clearance was received from the University Ethics Committee prior to the study being conducted. Results: Findings indicated that the youth victims of violence expect the health care professionals (professional nurses; doctors and social workers) working in their community to act as role models; demonstrate a professional attitude; provide health education; provide confidential counselling services; and establish school and community outreach programmes. Conclusion: This study provides evidence that youth victims of violence have important expectations from health care professionals concerning their wellness. Hence; health care professionals should focus on designing and implementing interventions targeting these expectations

Interprofessional exemplars for health professional programmes at a South African university.

There are promising shifts towards transforming health professions education in South Africa, which include the development of interprofessional education undergraduate curricula. Interprofessional education was conceived as a means to improve quality of care by bringing together professions to learn and work in teams, thereby overcoming negative stereotypes and understanding and valuing the roles of the different health care professions. This paper aims to advance the agenda of transforming health professions education by showcasing the development of exemplars of interprofessional education offered in the Faculty of Community and Health Sciences at the University of the Western Cape in order to assist other higher education institutions in the process of developing interprofessional curricula. Each exemplar encompasses a range of interactive learning methods. Lessons learnt include the need for a common framework for interprofessional education; "buy in" and a mind-set change of academics and institutional structures to support and operationalize interprofessional education.

The school, a viable educational site for interdisciplinary health promotion.

BACKGROUND: An interdisciplinary health promotion module, using the community-based teaching approach, is offered by the University of the Western Cape (UWC). Schools in Delft, a poor socio-economic area with high unemployment, crime and a range of social problems, are used as the teaching site. AIM: To assess the status of the health promotion initiatives in schools where students were placed. METHOD: A self-administered structured questionnaire for teachers and principals. Variables included were demographic data, views of health promotion, health promotion activities at the school, barriers and opportunities to implement health promotion activities. RESULTS: A response rate of 68.75 % (n = 55) for teachers and 100 % (n = 4) for principals was obtained. Most (87%) teachers felt that health promotion has a place within the curriculum. They reportedly focused on topics related to health within the school curriculum. Partners, such as public health nurses, university students, and a pharmaceutical company, offer additional health promotion initiatives. These include general health checks, HIV/AIDS information, adolescent health and dental health. Barriers to initiate and sustain programmes include lack of resources, insufficient staff training, lack of commitment by both teaching staff and the community, insufficient time, the heavy workload of teachers, and communication problems as a result of language barriers. Only 36% of teachers felt the school environment was conducive to learning. CONCLUSION: Health promotion initiatives in the schools concerned are uncoordinated, erratic, based on the resources that the school has access to at a given time and the demands of the curriculum.