The reported prevalence of aircrew fatigue and the contributing factors within the South African aviation industry
- Authors: Blair, Dylan Ross
- Date: 2022-10-14
- Subjects: Fatigue , Flight crews , Fatigue in the workplace , Sleep deprivation , Sleep-wake cycle , Air travel Safety measures , Airlines South Africa
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/362762 , vital:65360
- Description: Fatigue in aviation results from the complex interaction of various factors (both work and non-work-related) that are important to understand when attempting to manage it. Managing fatigue effectively is important given that it has and continues to influence crew wellness and aviation safety. One of the ways of managing fatigue is through appropriately designed Flight Time Limitations (FTLs) however; in South Africa there have been calls from the unions and the crew to update these in line with the latest science and operational demands and insights. Doing this requires the generation of context specific data, which this thesis aimed to provide as an initial step. Firstly, this study aimed to explore the reported prevalence of fatigue across the South African aviation industry. Secondly, it elucidated what factors (both work and non-work related) crew perceived contributed to fatigue and lastly, the crew‟s perceptions regarding the current FTLs were explored. Methods: To realize the aims of the study, an online survey was developed using existing literature initially, and through consulting with and getting information from aviation industry stakeholders and other experts in the field of aviation and fatigue. This consultation (which occurred over a number of iterations of the survey) ensured that there was a balance between the scientific and the actual operational perspectives on how best to explore crew perceptions around fatigue. The finalized survey was divided into five parts: part one was consent to participate; part two included questions pertaining to the participants‟ demographic information; part three included questions pertaining to the crews‟ perceptions around fatigue (its prevalence, its impact on safety and how it affected crew); part four explored crew‟s perceptions on fatigue contributory factors, both work and non-work related; finally part five included questions pertaining to crew perceptions about the current South African FTLs, specifically their concerns, suggestions for improvement and any aspects they considered as fatigue mitigating. The survey was made available via the South African Civil Aviation Authority‟s (SACAA) website as well as via the industry stakeholder‟s networks that encouraged all crew across the different sectors of the industry to participate. All numerical data collected were analysed descriptively through inferential statistics, while the qualitative data were analysed using thematic analysis. Results: 194 participants completed the survey, 167 were from cockpit and 27 were from the cabin crew. The results of the study highlight that there is a high perceived prevalence of fatigue. The crew also recognized that fatigue is a significant safety risk, but less indicated that fatigue interfered with their ability to do their duties. Crew reported that the length of duties, number of sectors flown, insufficient sleep at night, early sign-on‟s, late sign-offs, working too many consecutive days in a row, inadequate or irregular sleep before and during periods of duty, night flying, bad weather, severe turbulence, having young children or dependents to look after, financial stress, extended commuting to get to and from work, and poor diet were some of the work and non-work-related contributory factors to fatigue. In line with these findings, questions around the perceived concerns about the current FTLs revealed that crew were concerned about unclear definitions of the civil aviation regulations (CARs), the lack of control of disruptive rostering schedules, periods of high workload due to the number of sectors flown per duty, the length of duty periods and effects of being on standby duty, inadequate rest between duties and strings of duty. The crew also had concerns regarding the Flight Duty Periods (FDPs) where the crew were concerned with the flying limits being used as targets by the operators, a lack of science applied to the FDPs, and that the current FDPs are outdated. The recommendations included limiting disruptive rostering schedules by altering standby provisions for the crew, instilling a block roster schedule, disallowing double signing on and off on the same day, and reducing split shifts. The crew also recommended adjusting duty durations by adjusting daily and monthly limits, tapering duty lengths, but also limiting discretionary extensions. Increasing rest provision was another recommendation suggested by the crew and included increasing the number of rest days off as well as the minimum hours of rest between duties needs to be increased. The fatigue mitigating aspects were minimal if any. Conclusion: Overall the study revealed that there is a high perceived prevalence of fatigue within this sample of the South African aviation industry and that the concerns outlined by crew around the contributory factors to fatigue are consistent with previous research, but also reflect the unique operating context of South Africa. This study serves as a base from which to explore more specific areas of the crew working time that are disruptive to sleep. This may help operator‟s roster duties in a more predictable way to limit the incidence of fatigue, while also offering the opportunity for the regulator and other stakeholders to focus their efforts on how to better design the current FTLs to limit the prevalence and risks associated with crew fatigue. , Thesis (MSc) -- Human Kinetics and Ergonomics, 2022
- Full Text:
- Date Issued: 2022-10-14
- Authors: Blair, Dylan Ross
- Date: 2022-10-14
- Subjects: Fatigue , Flight crews , Fatigue in the workplace , Sleep deprivation , Sleep-wake cycle , Air travel Safety measures , Airlines South Africa
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/362762 , vital:65360
- Description: Fatigue in aviation results from the complex interaction of various factors (both work and non-work-related) that are important to understand when attempting to manage it. Managing fatigue effectively is important given that it has and continues to influence crew wellness and aviation safety. One of the ways of managing fatigue is through appropriately designed Flight Time Limitations (FTLs) however; in South Africa there have been calls from the unions and the crew to update these in line with the latest science and operational demands and insights. Doing this requires the generation of context specific data, which this thesis aimed to provide as an initial step. Firstly, this study aimed to explore the reported prevalence of fatigue across the South African aviation industry. Secondly, it elucidated what factors (both work and non-work related) crew perceived contributed to fatigue and lastly, the crew‟s perceptions regarding the current FTLs were explored. Methods: To realize the aims of the study, an online survey was developed using existing literature initially, and through consulting with and getting information from aviation industry stakeholders and other experts in the field of aviation and fatigue. This consultation (which occurred over a number of iterations of the survey) ensured that there was a balance between the scientific and the actual operational perspectives on how best to explore crew perceptions around fatigue. The finalized survey was divided into five parts: part one was consent to participate; part two included questions pertaining to the participants‟ demographic information; part three included questions pertaining to the crews‟ perceptions around fatigue (its prevalence, its impact on safety and how it affected crew); part four explored crew‟s perceptions on fatigue contributory factors, both work and non-work related; finally part five included questions pertaining to crew perceptions about the current South African FTLs, specifically their concerns, suggestions for improvement and any aspects they considered as fatigue mitigating. The survey was made available via the South African Civil Aviation Authority‟s (SACAA) website as well as via the industry stakeholder‟s networks that encouraged all crew across the different sectors of the industry to participate. All numerical data collected were analysed descriptively through inferential statistics, while the qualitative data were analysed using thematic analysis. Results: 194 participants completed the survey, 167 were from cockpit and 27 were from the cabin crew. The results of the study highlight that there is a high perceived prevalence of fatigue. The crew also recognized that fatigue is a significant safety risk, but less indicated that fatigue interfered with their ability to do their duties. Crew reported that the length of duties, number of sectors flown, insufficient sleep at night, early sign-on‟s, late sign-offs, working too many consecutive days in a row, inadequate or irregular sleep before and during periods of duty, night flying, bad weather, severe turbulence, having young children or dependents to look after, financial stress, extended commuting to get to and from work, and poor diet were some of the work and non-work-related contributory factors to fatigue. In line with these findings, questions around the perceived concerns about the current FTLs revealed that crew were concerned about unclear definitions of the civil aviation regulations (CARs), the lack of control of disruptive rostering schedules, periods of high workload due to the number of sectors flown per duty, the length of duty periods and effects of being on standby duty, inadequate rest between duties and strings of duty. The crew also had concerns regarding the Flight Duty Periods (FDPs) where the crew were concerned with the flying limits being used as targets by the operators, a lack of science applied to the FDPs, and that the current FDPs are outdated. The recommendations included limiting disruptive rostering schedules by altering standby provisions for the crew, instilling a block roster schedule, disallowing double signing on and off on the same day, and reducing split shifts. The crew also recommended adjusting duty durations by adjusting daily and monthly limits, tapering duty lengths, but also limiting discretionary extensions. Increasing rest provision was another recommendation suggested by the crew and included increasing the number of rest days off as well as the minimum hours of rest between duties needs to be increased. The fatigue mitigating aspects were minimal if any. Conclusion: Overall the study revealed that there is a high perceived prevalence of fatigue within this sample of the South African aviation industry and that the concerns outlined by crew around the contributory factors to fatigue are consistent with previous research, but also reflect the unique operating context of South Africa. This study serves as a base from which to explore more specific areas of the crew working time that are disruptive to sleep. This may help operator‟s roster duties in a more predictable way to limit the incidence of fatigue, while also offering the opportunity for the regulator and other stakeholders to focus their efforts on how to better design the current FTLs to limit the prevalence and risks associated with crew fatigue. , Thesis (MSc) -- Human Kinetics and Ergonomics, 2022
- Full Text:
- Date Issued: 2022-10-14
The role of cooperatives in local economic development in Buffalo City Metropolitan Municipality: A participatory monitoring and evaluation approach
- Gxabuza, Fundiswa https://orcid.org/0000-0003-2654-7365
- Authors: Gxabuza, Fundiswa https://orcid.org/0000-0003-2654-7365
- Date: 2021-06
- Subjects: Cooperative societies , Economic development , Participatory monitoring and evaluation (Project management)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/20273 , vital:45645
- Description: The goal to halve unemployment in South Africa by 2014 has remained, to date, elusive. In the particular case of the Eastern Cape Province, the challenge of combating unemployment is even more daunting, as it currently faces high unemployment rates. However, while there is evidence that initiatives to promote employment generation could be reinforced through Local Economic Development (LED) and, in particular, cooperatives, not much has been reported on how cooperatives contribute in minimising unemployment in the Province. The Department of Trade and Industry (DTI) points to the inadequacy of the Monitoring and Evaluation (M&E) of cooperatives as a critical challenge that has largely remained unaddressed. The inadequacy of M&E in respect to the role of cooperatives in employment and LED has affected cooperatives, generally, and those operating in the Eastern Cape, particularly. This study argues for a participatory approach to relevant M&E frameworks and, thus, presents a participatory monitoring and evaluation (PM&E) framework for evaluating cooperatives’ impact on LED. The testable framework for PM&E is partially derived from participatory action research (PAR) methodologies, where the researcher and cooperatives identify and define the problem to be solved. The thesis then develops the framework by integrating PM&E and PAR approaches in the evaluation of cooperatives’ role in employment creation and LED. By reviewing relevant literature, this study identified, assessed, and synthesized important elements for its suggested framework. Research on cooperatives has tended to focus on their role as agents of development, and much has already focussed on sharing relevant lessons learnt. Fewer studies have, by contrast, focussed on an engaged methodology for the evaluation of cooperatives’ efforts in development. The findings of this current study show that a PM&E/PAR framework must be a joint effort of all affected parties; where the researcher and/or facilitator assumes the role of a change agent, and where participants are leaders of the movement in the course for action. This study was based in East London, and the target population consisted of primary cooperatives. Primary cooperatives are defined by the Buffalo City Integrated Cooperative Development Strategy (BCMM ICDS, 2016) are cooperative that have at least five members, and whose aim is providing employment to said members. The research design for this study was exploratory and inductive. As noted previously, this study adopted a qualitative research approach that combined PAR and PM&E. Two sets of data collection were utilised, namely focus group interviews (FGIs) and an emailed questionnaire (EQ). The FGIs were conducted with the overall study population, namely 14 cooperatives. The EQ was given to specific individual participants, namely senior government and municipal officials who are responsible for the noted cooperatives. The underlying theoretical framework for this research was empowerment, agency, and the theory of community development. A qualitative data analysis was utilised based on the translation of meaning not frequency. The search for meaning elicited rich insights pertaining to participants’ views and interpretations. In all, this study established that the participating Eastern Cape cooperatives have not yet achieved their desired contributory role of promoting LED; specifically, in terms of job creation. , Thesis (DPhil) -- Faculty of Management and Commerce, 2021
- Full Text:
- Date Issued: 2021-06
- Authors: Gxabuza, Fundiswa https://orcid.org/0000-0003-2654-7365
- Date: 2021-06
- Subjects: Cooperative societies , Economic development , Participatory monitoring and evaluation (Project management)
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/20273 , vital:45645
- Description: The goal to halve unemployment in South Africa by 2014 has remained, to date, elusive. In the particular case of the Eastern Cape Province, the challenge of combating unemployment is even more daunting, as it currently faces high unemployment rates. However, while there is evidence that initiatives to promote employment generation could be reinforced through Local Economic Development (LED) and, in particular, cooperatives, not much has been reported on how cooperatives contribute in minimising unemployment in the Province. The Department of Trade and Industry (DTI) points to the inadequacy of the Monitoring and Evaluation (M&E) of cooperatives as a critical challenge that has largely remained unaddressed. The inadequacy of M&E in respect to the role of cooperatives in employment and LED has affected cooperatives, generally, and those operating in the Eastern Cape, particularly. This study argues for a participatory approach to relevant M&E frameworks and, thus, presents a participatory monitoring and evaluation (PM&E) framework for evaluating cooperatives’ impact on LED. The testable framework for PM&E is partially derived from participatory action research (PAR) methodologies, where the researcher and cooperatives identify and define the problem to be solved. The thesis then develops the framework by integrating PM&E and PAR approaches in the evaluation of cooperatives’ role in employment creation and LED. By reviewing relevant literature, this study identified, assessed, and synthesized important elements for its suggested framework. Research on cooperatives has tended to focus on their role as agents of development, and much has already focussed on sharing relevant lessons learnt. Fewer studies have, by contrast, focussed on an engaged methodology for the evaluation of cooperatives’ efforts in development. The findings of this current study show that a PM&E/PAR framework must be a joint effort of all affected parties; where the researcher and/or facilitator assumes the role of a change agent, and where participants are leaders of the movement in the course for action. This study was based in East London, and the target population consisted of primary cooperatives. Primary cooperatives are defined by the Buffalo City Integrated Cooperative Development Strategy (BCMM ICDS, 2016) are cooperative that have at least five members, and whose aim is providing employment to said members. The research design for this study was exploratory and inductive. As noted previously, this study adopted a qualitative research approach that combined PAR and PM&E. Two sets of data collection were utilised, namely focus group interviews (FGIs) and an emailed questionnaire (EQ). The FGIs were conducted with the overall study population, namely 14 cooperatives. The EQ was given to specific individual participants, namely senior government and municipal officials who are responsible for the noted cooperatives. The underlying theoretical framework for this research was empowerment, agency, and the theory of community development. A qualitative data analysis was utilised based on the translation of meaning not frequency. The search for meaning elicited rich insights pertaining to participants’ views and interpretations. In all, this study established that the participating Eastern Cape cooperatives have not yet achieved their desired contributory role of promoting LED; specifically, in terms of job creation. , Thesis (DPhil) -- Faculty of Management and Commerce, 2021
- Full Text:
- Date Issued: 2021-06
The design and evaluation of targeted patient-centred health information to improve knowledge and behavioural outcomes in tuberculosis patients with limited literacy
- Authors: Patel, Sonal
- Date: 2015
- Subjects: Tuberculosis Patients , Health literacy , Patient education , Communication in medicine , Picture-writing
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/194071 , vital:45420 , DOI 10.21504/10962/194071
- Description: South Africa carries a significant TB burden as evidenced in the 2013 statistics which report 450 000 new active TB cases and 890 000 TB-related mortalities. For successful treatment outcomes, 90% adherence is necessary, but many patients prematurely discontinue treatment due to poor knowledge and understanding of their complex TB medicines. Patient education is pivotal in improving knowledge, health literacy and behavioural outcomes such as health information seeking, self-efficacy and adherence. In the under-resourced South African healthcare system, time and capacity to adequately counsel patients are limited. The value of written medicine information (WMI) to supplement the verbal information provided by healthcare professionals (HCPs) has been widely investigated but minimal South African research is available. Current WMI distributed in South Africa is mainly generated by pharmaceutical manufacturers and is complex, incomprehensible and undesirable to patients. TB-related WMI focuses mainly on the disease, with little information relating to TB medicines and their use. The overall aim of this project was to improve patient knowledge about their TB medicines through the use of a simple illustrated patient information leaflet (PIL). Objectives to achieve this aim included: investigation of the medicine information seeking behaviour (MISB) of long term patients attending public health sector facilities; the development and validation of a medicine literacy test (MLT) to identify patients with limited health literacy requiring additional support and counselling; the development and evaluation of a patient-centred illustrated PIL for first-line TB treatment; the assessment of self-efficacy and adherence using modified versions of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) and Morisky 8-item Medicine Adherence Scale (MMAS-8), respectively, and the investigation of the impact of the PIL on patient knowledge and these health-related behaviours. Six focus group discussions (FGDs) conducted in 34 isiXhosa-speaking patients with limited formal education taking long-term treatment explored themes related to information needs, information-seeking practices and awareness of and ability to utilize information sources. Codes were analysed and potential themes and subthemes were identified and refined. The findings of this study reflected a passive, disempowered patient due to both patient-related and systemic healthcare factors. Poor awareness of information sources, lack of health-related knowledge, stigma and lack of awareness of the importance of appropriate medicine-related knowledge contributed to a lack of information-seeking practice. Patients neither asked questions nor were encouraged to do so. All expressed an unmet need for information and a desire for receiving relevant, appropriate, written medicine-related information. Feedback from this phase of the study was used to inform the development of the targeted patientcentred PIL. A double-sided A4 PIL containing information about TB medicines was designed giving careful consideration to content, format and layout features. Twenty five pictograms were designed through a rigorous, iterative design process and were included in the PIL that was evaluated in a randomised control trial (RCT) conducted amongst 120 TB patients attending a high burden TB clinic in South Africa. Interviews were conducted in either isiXhosa or Afrikaans via a trained interpreter. Patients were randomly allocated to either a control (standard care) or an experimental group (standard care plus brief counselling using the PIL). Two interviews were conducted using a prepared questionnaire; one at baseline followed by a 4-week follow-up. Baseline data included demographics, medicine literacy test, health information sources, knowledge of TB medicines, self-reported adherence and self-efficacy. Data collected at the 4-week follow-up interview included TB knowledge, self-reported adherence, self-efficacy, opinion of TB medicine information and interpretation of pictograms. Data were analysed using t-test, correlations, chi-square and ANOVA tests at a 0.05 level of significance. The PIL was successful in improving patient knowledge of the disease, TB medicine-taking, side effects, drug-resistant TB and HIV and TB co-infection. At baseline, there was no significant difference in the overall mean percentage knowledge score between the control and experimental groups (p=0.074). At follow-up, the percentage knowledge score for the experimental group increased significantly from 59.0% to 84.6% (p<0.001) and showed a significantly higher score than the control group (p<0.001), displaying evidence of the impact of the PIL as a counselling tool on patient knowledge. The PIL generated a highly positive response in the experimental group who indicated that they had referred to the leaflet over the last month and that it had played an important role in improving their TB medicine-related knowledge. This was reflected in the experimental group knowledge score of greater than 80% for almost three quarters of the patients whereas only 14% in the control group achieved this score. Patients appreciated the inclusion of pictograms and strongly felt that they helped them to recall and understand the textual PIL content. The study found that patients want side effect information and, interestingly, did not perceive the presentation of side effects in pictorial form to constitute a risk factor for nonadherence. Use of the illustrated PIL (experimental group) resulted in a significant improvement in patient self-efficacy (p=0.002), but showed no effect on self-reported adherence (p=0.563). Neither self-efficacy nor adherence was influenced by gender, age or education. An education effect on knowledge was only observed in the control group at baseline. The newly developed MLT was shown to be a valid and reliable tool and a moderate, positive and significant correlation was noted between the MLT score and baseline TB medicine-related knowledge in both the control and experimental groups. As there is a paucity of studies investigating the influence of take-home written leaflets on TB medicine knowledge and on patient behaviour, this study represents a significant knowledge contribution. It is the first study to report the development and evaluation of a patient-centred PIL to address the dearth of available TB medicine information. The use of targeted user-friendly, illustrated information leaflets can be a valuable counselling aid to improve patient knowledge and self-efficacy, particularly among patients with limited literacy. However, careful consideration of the design and content, with input from the endusers at all stages of the process, will optimise its effectiveness. The proposed framework for the development and implementation of patient-centred health and medicines information in a developing country context presented in this thesis could be used as a theoretical basis for informing the development of effective information materials targeting other disease states. Local patients taking TB medicines identified nurses, WMI and media as their current sources of information but they expressed a strong desire to know more about their treatment. Targeted public health interventions that focus on medicine-taking information and behaviours and encourage patients to adopt a more active, questioning role in health consultations could improve health literacy and empower patients in their medicine-taking practices. , Thesis (PhD) -- Faculty of Pharmacy, Pharmacy, 2015
- Full Text:
- Date Issued: 2015
- Authors: Patel, Sonal
- Date: 2015
- Subjects: Tuberculosis Patients , Health literacy , Patient education , Communication in medicine , Picture-writing
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/194071 , vital:45420 , DOI 10.21504/10962/194071
- Description: South Africa carries a significant TB burden as evidenced in the 2013 statistics which report 450 000 new active TB cases and 890 000 TB-related mortalities. For successful treatment outcomes, 90% adherence is necessary, but many patients prematurely discontinue treatment due to poor knowledge and understanding of their complex TB medicines. Patient education is pivotal in improving knowledge, health literacy and behavioural outcomes such as health information seeking, self-efficacy and adherence. In the under-resourced South African healthcare system, time and capacity to adequately counsel patients are limited. The value of written medicine information (WMI) to supplement the verbal information provided by healthcare professionals (HCPs) has been widely investigated but minimal South African research is available. Current WMI distributed in South Africa is mainly generated by pharmaceutical manufacturers and is complex, incomprehensible and undesirable to patients. TB-related WMI focuses mainly on the disease, with little information relating to TB medicines and their use. The overall aim of this project was to improve patient knowledge about their TB medicines through the use of a simple illustrated patient information leaflet (PIL). Objectives to achieve this aim included: investigation of the medicine information seeking behaviour (MISB) of long term patients attending public health sector facilities; the development and validation of a medicine literacy test (MLT) to identify patients with limited health literacy requiring additional support and counselling; the development and evaluation of a patient-centred illustrated PIL for first-line TB treatment; the assessment of self-efficacy and adherence using modified versions of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) and Morisky 8-item Medicine Adherence Scale (MMAS-8), respectively, and the investigation of the impact of the PIL on patient knowledge and these health-related behaviours. Six focus group discussions (FGDs) conducted in 34 isiXhosa-speaking patients with limited formal education taking long-term treatment explored themes related to information needs, information-seeking practices and awareness of and ability to utilize information sources. Codes were analysed and potential themes and subthemes were identified and refined. The findings of this study reflected a passive, disempowered patient due to both patient-related and systemic healthcare factors. Poor awareness of information sources, lack of health-related knowledge, stigma and lack of awareness of the importance of appropriate medicine-related knowledge contributed to a lack of information-seeking practice. Patients neither asked questions nor were encouraged to do so. All expressed an unmet need for information and a desire for receiving relevant, appropriate, written medicine-related information. Feedback from this phase of the study was used to inform the development of the targeted patientcentred PIL. A double-sided A4 PIL containing information about TB medicines was designed giving careful consideration to content, format and layout features. Twenty five pictograms were designed through a rigorous, iterative design process and were included in the PIL that was evaluated in a randomised control trial (RCT) conducted amongst 120 TB patients attending a high burden TB clinic in South Africa. Interviews were conducted in either isiXhosa or Afrikaans via a trained interpreter. Patients were randomly allocated to either a control (standard care) or an experimental group (standard care plus brief counselling using the PIL). Two interviews were conducted using a prepared questionnaire; one at baseline followed by a 4-week follow-up. Baseline data included demographics, medicine literacy test, health information sources, knowledge of TB medicines, self-reported adherence and self-efficacy. Data collected at the 4-week follow-up interview included TB knowledge, self-reported adherence, self-efficacy, opinion of TB medicine information and interpretation of pictograms. Data were analysed using t-test, correlations, chi-square and ANOVA tests at a 0.05 level of significance. The PIL was successful in improving patient knowledge of the disease, TB medicine-taking, side effects, drug-resistant TB and HIV and TB co-infection. At baseline, there was no significant difference in the overall mean percentage knowledge score between the control and experimental groups (p=0.074). At follow-up, the percentage knowledge score for the experimental group increased significantly from 59.0% to 84.6% (p<0.001) and showed a significantly higher score than the control group (p<0.001), displaying evidence of the impact of the PIL as a counselling tool on patient knowledge. The PIL generated a highly positive response in the experimental group who indicated that they had referred to the leaflet over the last month and that it had played an important role in improving their TB medicine-related knowledge. This was reflected in the experimental group knowledge score of greater than 80% for almost three quarters of the patients whereas only 14% in the control group achieved this score. Patients appreciated the inclusion of pictograms and strongly felt that they helped them to recall and understand the textual PIL content. The study found that patients want side effect information and, interestingly, did not perceive the presentation of side effects in pictorial form to constitute a risk factor for nonadherence. Use of the illustrated PIL (experimental group) resulted in a significant improvement in patient self-efficacy (p=0.002), but showed no effect on self-reported adherence (p=0.563). Neither self-efficacy nor adherence was influenced by gender, age or education. An education effect on knowledge was only observed in the control group at baseline. The newly developed MLT was shown to be a valid and reliable tool and a moderate, positive and significant correlation was noted between the MLT score and baseline TB medicine-related knowledge in both the control and experimental groups. As there is a paucity of studies investigating the influence of take-home written leaflets on TB medicine knowledge and on patient behaviour, this study represents a significant knowledge contribution. It is the first study to report the development and evaluation of a patient-centred PIL to address the dearth of available TB medicine information. The use of targeted user-friendly, illustrated information leaflets can be a valuable counselling aid to improve patient knowledge and self-efficacy, particularly among patients with limited literacy. However, careful consideration of the design and content, with input from the endusers at all stages of the process, will optimise its effectiveness. The proposed framework for the development and implementation of patient-centred health and medicines information in a developing country context presented in this thesis could be used as a theoretical basis for informing the development of effective information materials targeting other disease states. Local patients taking TB medicines identified nurses, WMI and media as their current sources of information but they expressed a strong desire to know more about their treatment. Targeted public health interventions that focus on medicine-taking information and behaviours and encourage patients to adopt a more active, questioning role in health consultations could improve health literacy and empower patients in their medicine-taking practices. , Thesis (PhD) -- Faculty of Pharmacy, Pharmacy, 2015
- Full Text:
- Date Issued: 2015
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