An ergonomics approach to understanding perceived barriers to the provision of high-quality healthcare: a Sarah Baartman District clinics case study
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
Get sleep or get stumped: sleep behaviour in elite South African cricket players during competition
- Authors: McEwan, Kayla
- Date: 2020
- Subjects: Sleep -- Physiological aspects , Cricket players -- Health and hygiene , Cricket players -- South Africa -- Health and hygiene , Cricket -- Health aspects
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/147950 , vital:38696
- Description: Introduction: Good sleep behaviour is associated with achieving optimal athletic performance and reducing the risk of injury. Elite cricket players have unique physical and cognitive demands, and must accommodate for congested competition and travel schedules (all of which increase the risk of disruptive sleep). Further, the political pressures and socioeconomic barriers in South African cricket could affect the sleep of the country’s elite players. Previous research in cricket has focussed on the impact that nutrition, equipment specifications, movement physiology and psychology could elicit on performance (where many professional teams hire support staff to supervise these disciplines); however, there is limited empirical application of sleep research in elite cricket players. Therefore, this study aimed to characterise the sleep behaviours of elite South African cricket players during periods of competition and investigate the relationship between pre-match sleep and cricket performance. Methods: A longitudinal field-based investigation was implemented to monitor the sleep behaviour of 26 elite South African cricket players (age: 28.6 ± 4.0 years; height: 1.8 ± 0.1 m; weight: 85.7 ± 10.8 kg; elite experience: 3.7 ± 4.0 years) during home and away competitive tours. The Morningness-Eveningness Questionnaire and Athlete Sleep Behaviour Questionnaire were administered to identify chronotype and poor sleep behaviours. Players completed an altered version of the Core Consensus Sleep Diary every morning post-travel, pre-match and post-match. Linear mixed model regression was used to compare differences in sleep variables between time-periods, match venues, player roles, match formats, sleep medication and racial groups. Spearman’s correlation (rs) was used to assess the relationship of substance use (alcohol and caffeine), age, elite experience and match performance with selected sleep indices. Statistical significance for all measures was accepted at p < 0.05. Hedge’s (g) were used as the measure of effect size. Results: Light-emitting technology use, effects of travel, late evening alcohol consumption and muscle soreness were the main factors that impacted sleep. Post-match total sleep time (06:31 ± 01:09) was significantly (p < 0.05) shorter compared to post-travel (07:53 ± 01:07; g = 1.19 [0.81;1.57]) and pre-match (08:43 ± 01:03; g = 1.97 [1.55;2.39]) total sleep time. Post-travel sleep onset latency and sleep efficiency were significantly (p < 0.05) shorter (g = 0.74 [0.29;1.29]) and higher (g = 1.35 [0.76;1.94]) at home than away. Although not significant (p > 0.05), allrounders took longer to fall asleep (g = 0.90 [0.23;1.57]), obtained less total sleep (0.76 [0.29;1.42]) and had lower morning freshness scores (g = 1.10 [0.42;1.78]) the night before a match compared to batsmen. Wake after sleep onset and get up time were moderately longer (g = 0.61 [0.22;1.26]) and later (g = 0.62 [0.27;1.17]) before. Twenty20 matches compared to One-Day International matches respectively. Further, sleep duration significantly declined from pre-match to post-match during the multi-day Test format (p = 0.04, g= 0.75 [0.40;1.12]). Late alcohol consumption was significantly (p < 0.05) correlated with a decrease in total sleep time, regardless of match venue (home: rs (49) = -0.69; away: rs (27) = -0.57). During the away condition, an increase in age was significantly associated with longer wake after sleep onset durations (rs (13) = 0.52, p = 0.0003), while greater elite experience was significantly associated with longer total sleep time (rs (72) = 0.36, p = 0.02). The non-sleep medication group took significantly longer to fall asleep compared to the sleep medication group during the first week of the away condition (p = 0.02, g = 0.75 [0.25;1.26]) particularly on nights following transmeridian travel. Although not significant ( p > 0.05), Asian/Indian players had moderately longer sleep onset latencies (g = 1.07 [0.66;1.47]), wake after sleep onset durations (g = 0.86 [0.42;1.29]), and lower subjective sleep quality (g = 0.86 [0.46;1.26]) and morning freshness scores (g = 0.89 [0.47;1.27]) compared to Whites. Similarly, Black Africans had moderately lower subjective sleep quality scores compared to Whites (g = 0.71 [0.43;0.97]). Longer sleep onset latencies and shorter total sleep times were significantly (p < 0.05) associated with poorer One-Day International (rs (28) = -0.57) and Test (rs (12) = 0.59) batting performances respectively. Higher subjective sleep quality scores were significantly associated with better Twenty20 bowling economies (rs (8) = -0.52). Discussion: There was no evidence of poor pre-match sleep behaviour, irrespective of venue; however, the most apparent disruption to sleep occurred post-match (similar to that found in other team-sports). Most disparities in sleep between match venues existed post-travel, with better sleep behaviour observed during the home condition. The differences in sleep patterns found in all three match formats were expected given the variations in format scheduling and duration. Although sleep medication was shown to promote better sleep, its long-term effectiveness was limited. The results promote the implementation of practical strategies aimed to reduce bedtime light-emitting technology use, late evening alcohol consumption and muscle pain. Inter-individual sleep behaviour was found between player roles, age, experience level and race. Moderate associations existed between sleep and markers of batting performance, specifically for the longer, strategic formats of the game. Conclusion: The current study provided new insight of the sleep behaviour in elite South African cricket players during competition. Individualized sleep monitoring practices are encouraged, with specific supervision over older, less experienced players as well as the racial minorities and allrounders of the team. The poor post-match sleep behaviour, together with the sleep and performance correlations, provide ideal opportunities for future interventions to focus on match recovery and the use sleep monitoring as a competitive advantage.
- Full Text:
- Authors: McEwan, Kayla
- Date: 2020
- Subjects: Sleep -- Physiological aspects , Cricket players -- Health and hygiene , Cricket players -- South Africa -- Health and hygiene , Cricket -- Health aspects
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/147950 , vital:38696
- Description: Introduction: Good sleep behaviour is associated with achieving optimal athletic performance and reducing the risk of injury. Elite cricket players have unique physical and cognitive demands, and must accommodate for congested competition and travel schedules (all of which increase the risk of disruptive sleep). Further, the political pressures and socioeconomic barriers in South African cricket could affect the sleep of the country’s elite players. Previous research in cricket has focussed on the impact that nutrition, equipment specifications, movement physiology and psychology could elicit on performance (where many professional teams hire support staff to supervise these disciplines); however, there is limited empirical application of sleep research in elite cricket players. Therefore, this study aimed to characterise the sleep behaviours of elite South African cricket players during periods of competition and investigate the relationship between pre-match sleep and cricket performance. Methods: A longitudinal field-based investigation was implemented to monitor the sleep behaviour of 26 elite South African cricket players (age: 28.6 ± 4.0 years; height: 1.8 ± 0.1 m; weight: 85.7 ± 10.8 kg; elite experience: 3.7 ± 4.0 years) during home and away competitive tours. The Morningness-Eveningness Questionnaire and Athlete Sleep Behaviour Questionnaire were administered to identify chronotype and poor sleep behaviours. Players completed an altered version of the Core Consensus Sleep Diary every morning post-travel, pre-match and post-match. Linear mixed model regression was used to compare differences in sleep variables between time-periods, match venues, player roles, match formats, sleep medication and racial groups. Spearman’s correlation (rs) was used to assess the relationship of substance use (alcohol and caffeine), age, elite experience and match performance with selected sleep indices. Statistical significance for all measures was accepted at p < 0.05. Hedge’s (g) were used as the measure of effect size. Results: Light-emitting technology use, effects of travel, late evening alcohol consumption and muscle soreness were the main factors that impacted sleep. Post-match total sleep time (06:31 ± 01:09) was significantly (p < 0.05) shorter compared to post-travel (07:53 ± 01:07; g = 1.19 [0.81;1.57]) and pre-match (08:43 ± 01:03; g = 1.97 [1.55;2.39]) total sleep time. Post-travel sleep onset latency and sleep efficiency were significantly (p < 0.05) shorter (g = 0.74 [0.29;1.29]) and higher (g = 1.35 [0.76;1.94]) at home than away. Although not significant (p > 0.05), allrounders took longer to fall asleep (g = 0.90 [0.23;1.57]), obtained less total sleep (0.76 [0.29;1.42]) and had lower morning freshness scores (g = 1.10 [0.42;1.78]) the night before a match compared to batsmen. Wake after sleep onset and get up time were moderately longer (g = 0.61 [0.22;1.26]) and later (g = 0.62 [0.27;1.17]) before. Twenty20 matches compared to One-Day International matches respectively. Further, sleep duration significantly declined from pre-match to post-match during the multi-day Test format (p = 0.04, g= 0.75 [0.40;1.12]). Late alcohol consumption was significantly (p < 0.05) correlated with a decrease in total sleep time, regardless of match venue (home: rs (49) = -0.69; away: rs (27) = -0.57). During the away condition, an increase in age was significantly associated with longer wake after sleep onset durations (rs (13) = 0.52, p = 0.0003), while greater elite experience was significantly associated with longer total sleep time (rs (72) = 0.36, p = 0.02). The non-sleep medication group took significantly longer to fall asleep compared to the sleep medication group during the first week of the away condition (p = 0.02, g = 0.75 [0.25;1.26]) particularly on nights following transmeridian travel. Although not significant ( p > 0.05), Asian/Indian players had moderately longer sleep onset latencies (g = 1.07 [0.66;1.47]), wake after sleep onset durations (g = 0.86 [0.42;1.29]), and lower subjective sleep quality (g = 0.86 [0.46;1.26]) and morning freshness scores (g = 0.89 [0.47;1.27]) compared to Whites. Similarly, Black Africans had moderately lower subjective sleep quality scores compared to Whites (g = 0.71 [0.43;0.97]). Longer sleep onset latencies and shorter total sleep times were significantly (p < 0.05) associated with poorer One-Day International (rs (28) = -0.57) and Test (rs (12) = 0.59) batting performances respectively. Higher subjective sleep quality scores were significantly associated with better Twenty20 bowling economies (rs (8) = -0.52). Discussion: There was no evidence of poor pre-match sleep behaviour, irrespective of venue; however, the most apparent disruption to sleep occurred post-match (similar to that found in other team-sports). Most disparities in sleep between match venues existed post-travel, with better sleep behaviour observed during the home condition. The differences in sleep patterns found in all three match formats were expected given the variations in format scheduling and duration. Although sleep medication was shown to promote better sleep, its long-term effectiveness was limited. The results promote the implementation of practical strategies aimed to reduce bedtime light-emitting technology use, late evening alcohol consumption and muscle pain. Inter-individual sleep behaviour was found between player roles, age, experience level and race. Moderate associations existed between sleep and markers of batting performance, specifically for the longer, strategic formats of the game. Conclusion: The current study provided new insight of the sleep behaviour in elite South African cricket players during competition. Individualized sleep monitoring practices are encouraged, with specific supervision over older, less experienced players as well as the racial minorities and allrounders of the team. The poor post-match sleep behaviour, together with the sleep and performance correlations, provide ideal opportunities for future interventions to focus on match recovery and the use sleep monitoring as a competitive advantage.
- Full Text:
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