The influence of clinic care on perceptions and knowledge of non-communicable diseases and physical activity from a low-resourced community: a mixed-method study.

BACKGROUND: Health promotion for the management of risk factors for non-communicable diseases (NCDs) is an integral part of standard care in South Africa. Most persons presenting with NCDs utilise public primary health care centres for disease management. This mixed-methods study aimed at expanding current understanding of the the influence of standard clinic care (usual care) on perceptions and knowledge of risk factors for NCDs and physical activity (PA) among persons from a low-resourced community. Qualitatively the perceptions of women from a low-resourced community about risk factors for NCDs and PA were explored throughout 24-weeks of standard clinic care. Parallel quantitative data was collected to describe changes in risk factors for NCDs and trends in self-reported knowledge about risk factors of NCDs and PA. METHOD: A convergent-parallel mixed-methods research design was used. The study was carried out in a public primary health care setting, in the North West Province, South Africa. From a convenience sample of 100 participants, 77 African women aged between 34 and 79 years were recruited for the study. Data were collected at three time-points including baseline, 12 weeks, and 24 weeks of a standard clinic care health-promotion programme. The qualitative data was collected during focus group discussions, and the quantitative data included questionnaires on knowledge of physical activity and risk factors for NCDs as well as anthropometric and biological measurements. Qualitative and quantitative data were analysed independently for each phase and then consolidated for interpretation. All data was collected in the same setting. RESULTS: Participants' initial understanding and perceptions of NCD risk factors were poor. Qualitative findings showed that participants knew little about the specific physical activity they could engage in and the role of PA in NCD management. Participants preferred low-intensity activities. Heart-disease knowledge improved significantly at 12 weeks intervention compared to baseline MD = -3.655, p < 0.001. There were improvements in PA knowledge at 12 weeks from baseline MD = -0.625 p = 0.02. There were significant weight (MD = 1.420, p = 0.002) and waist circumference reductions (MD = 0.621, p = 0.02) from baseline to 24 weeks. CONCLUSION: Standard clinic care improved knowledge of physical activity and risk factors for NCDs, but perceptions of risk factors for NCDs and PA were unchanged. This study offers insight into the perceptions held by women from a low-resource setting and how future interventions to manage and prevent NCDs should be structured. TRIAL REGISTRATION: PACTR201609001771813 .

Intervenções em Psicanálise - Século XXI / Psychoanalytic Interventions - 21st Century / Intervenciones en Psicoanálisis - Siglo XXI

O texto trabalha a questão das intervenções psicanalíticas pelo ângulo das pressões que o mundo em que vivemos impõe ao seu homem e à prática analítica atual. Considera-se clínica psicanalítica as intervenções orientadas pelo método interpretativo da Psicanálise, com sua função terapêutica, mesmo aquelas que não seguem o enquadre da clínica padrão de consultório. Apresentam-se dois exemplos de intervenções em clínica extensa.

This paper deals with the matter of psychoanalytic interventions from the angle of the pressures the world we live in applies to its man and to current analytic practice. The interventions oriented by the psychoanalytic interpretative method, which implies therapeutic function, are considered psychoanalytic clinic, even those procedures that do not follow the traditional setting rules. The paper presents two examples of extensive clinic intervention.

El texto trabaja la cuestión de las intervenciones psicoanalíticas pensadas desde el ángulo de las presiones que el mundo en que vivimos impone a su hombre y a la práctica analítica actual. Considera clínica psicoanalítica a las intervenciones que siguen el método interpretativo de Psicoanálisis, con su función terapéutica, incluso en los casos en que no siguen el encuadre de la clínica estándar de consultorio. Presenta dos ejemplos de intervenciones en clínica extensa.