Development and validation of a health literacy measure for limited literacy public sector patients in South Africa
- Authors: Marimwe, Chipiwa
- Date: 2018
- Subjects: Health literacy -- South Africa , Patient education -- South Africa , Communication in medicine -- South Africa , Health literacy -- Social aspects -- South Africa , Poor -- Medical care -- South Africa , Analysis of variance , Multidimensional Screener of Functional Health Literacy (MSFHL)
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/62661 , vital:28227
- Description: The growing complexity of healthcare demands greater patient involvement and skills to navigate this complex system. It has therefore become increasingly important to identify individuals with inadequate health literacy, by using efficient, short and reliable measures for doing so. Most research on the development and validation of health literacy tests has been conducted in high-income countries, with very little reported from low-and middle-income countries (LMICs). Existing health literacy measures have come under scrutiny for their lack of cultural sensitivity, bias towards certain population groups and failure to acknowledge health literacy as a multidimensional concept. These measures usually have limited application in LMICs due to the significantly different structuring of healthcare systems, they overlook the extreme discrepancies in educational levels, and rely too heavily on the ability to read health information. No health literacy data for South Africa are available, and only a few health literacy-based research papers have been published in this country. The aim of the study was to develop and validate a health literacy measure that is contextually and culturally appropriate to measure health literacy in limited literacy public sector patients in South Africa. An Item Bank of 30 questions was developed with the input of a diverse expert consultant panel, and included skills-based and self-reported questions which ensured cultural, contextual and educational level appropriateness. The Information and Support for Health Actions Questionnaire (ISHA-Q) is a health literacy measure developed to assess health literacy for LMICs which includes 14 core scales. These were useful in ensuring coverage of a range of health literacy constructs within the Item Bank. The 30 questions were then allocated to one of three health literacy domains: Procedural knowledge, Factual knowledge and Access to healthcare, health services and social support. Ethical approval for the study was obtained. The questions were translated into isiXhosa and underwent pilot testing. Following pilot testing, 120 isiXhosa first-language speakers, at least 18 years old, who attended public sector facilities and had a maximum 12 years of education were recruited from a primary healthcare clinic in Grahamstown. An interpreter was trained and he participated in all interviews. A questionnaire was used to collect data on the 30-question Item Bank. The Multidimensional Screener of Functional Health Literacy (MSFHL) was used as the primary comparator.The second phase of the study involved the refinement of the 30 questions in the Item Bank, which involved a multi-stage process. Data were analysed statistically using t-test, correlations, chi-square and ANOVA tests at a 5% level of significance, in order to identify problematic questions. Item Response Theory was used to ascertain difficulty and discriminatory ability of the questions. Each question was further subjected to in-depth interrogation by a panel of healthcare professionals to ensure that questions were supported by the conceptual framework and the definitions of health literacy adopted for this study. The number of questions was reduced from 30 to 12, and formed the new Health Literacy Test - Limited Literacy (HELT-LL). To validate the HELT-LL, 210 patients with the same inclusion criteria as previously noted, were recruited from four primary healthcare clinics in the Eastern Cape Province. Individual interviews were conducted with the assistance of the interpreter to collect sociodemographic data as well as data from the HELT-LL, the primary comparator (MSFHL), and a secondary comparator which was a South African modified version of the Newest Vital Sign (NVS-SA). The HELT-LL was re-administered to 40 patients in a follow-up interview two weeks later. The HELT-LL categorised only 17.6% of the patients as having adequate health literacy, just over a third with inadequate health literacy, and the majority with marginal health literacy. Questions in the cognitively demanding Procedural knowledge domain were the most poorly answered, with a mean score of 48.6±24.9%. Patients had great difficulty performing the basic numeric tasks in this domain. The overall mean score for the HELT-LL was 52.8±18.4%, compared with the more cognitively demanding NVS-SA with a mean of 28.6±21.1%, and clearly illustrated the impact of the strategy to include in the HELT-LL a variety of questions with differing cognitive load. The MSFHL, which is based on demographic characteristics and perceived difficulties with reading and writing, had an overall mean score of 44.4±26.2%. Demographic characteristics including age, education and English literacy, were found to be good predictors of limited health literacy, with significant correlations being found between these variables and the mean HELT-LL score. An acceptable value for Cronbach’s alpha, excellent test-retest reliability and excellent concurrent validity show that the HELT-LL is a valid and reliable measure of health literacy in our target population. As there is a paucity of health literacy research emanating from developing countries, this study presents a significant contribution to literature. It is the first study to report the development and validation of a health literacy measure to address the dearth of available health literacy measures applicable for South Africa. If implemented for use in clinical settings and for research purposes, it could provide valuable South African health literacy data which could inform the development of interventions focusing on improving health literacy and health outcomes.
- Full Text:
- Authors: Marimwe, Chipiwa
- Date: 2018
- Subjects: Health literacy -- South Africa , Patient education -- South Africa , Communication in medicine -- South Africa , Health literacy -- Social aspects -- South Africa , Poor -- Medical care -- South Africa , Analysis of variance , Multidimensional Screener of Functional Health Literacy (MSFHL)
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/62661 , vital:28227
- Description: The growing complexity of healthcare demands greater patient involvement and skills to navigate this complex system. It has therefore become increasingly important to identify individuals with inadequate health literacy, by using efficient, short and reliable measures for doing so. Most research on the development and validation of health literacy tests has been conducted in high-income countries, with very little reported from low-and middle-income countries (LMICs). Existing health literacy measures have come under scrutiny for their lack of cultural sensitivity, bias towards certain population groups and failure to acknowledge health literacy as a multidimensional concept. These measures usually have limited application in LMICs due to the significantly different structuring of healthcare systems, they overlook the extreme discrepancies in educational levels, and rely too heavily on the ability to read health information. No health literacy data for South Africa are available, and only a few health literacy-based research papers have been published in this country. The aim of the study was to develop and validate a health literacy measure that is contextually and culturally appropriate to measure health literacy in limited literacy public sector patients in South Africa. An Item Bank of 30 questions was developed with the input of a diverse expert consultant panel, and included skills-based and self-reported questions which ensured cultural, contextual and educational level appropriateness. The Information and Support for Health Actions Questionnaire (ISHA-Q) is a health literacy measure developed to assess health literacy for LMICs which includes 14 core scales. These were useful in ensuring coverage of a range of health literacy constructs within the Item Bank. The 30 questions were then allocated to one of three health literacy domains: Procedural knowledge, Factual knowledge and Access to healthcare, health services and social support. Ethical approval for the study was obtained. The questions were translated into isiXhosa and underwent pilot testing. Following pilot testing, 120 isiXhosa first-language speakers, at least 18 years old, who attended public sector facilities and had a maximum 12 years of education were recruited from a primary healthcare clinic in Grahamstown. An interpreter was trained and he participated in all interviews. A questionnaire was used to collect data on the 30-question Item Bank. The Multidimensional Screener of Functional Health Literacy (MSFHL) was used as the primary comparator.The second phase of the study involved the refinement of the 30 questions in the Item Bank, which involved a multi-stage process. Data were analysed statistically using t-test, correlations, chi-square and ANOVA tests at a 5% level of significance, in order to identify problematic questions. Item Response Theory was used to ascertain difficulty and discriminatory ability of the questions. Each question was further subjected to in-depth interrogation by a panel of healthcare professionals to ensure that questions were supported by the conceptual framework and the definitions of health literacy adopted for this study. The number of questions was reduced from 30 to 12, and formed the new Health Literacy Test - Limited Literacy (HELT-LL). To validate the HELT-LL, 210 patients with the same inclusion criteria as previously noted, were recruited from four primary healthcare clinics in the Eastern Cape Province. Individual interviews were conducted with the assistance of the interpreter to collect sociodemographic data as well as data from the HELT-LL, the primary comparator (MSFHL), and a secondary comparator which was a South African modified version of the Newest Vital Sign (NVS-SA). The HELT-LL was re-administered to 40 patients in a follow-up interview two weeks later. The HELT-LL categorised only 17.6% of the patients as having adequate health literacy, just over a third with inadequate health literacy, and the majority with marginal health literacy. Questions in the cognitively demanding Procedural knowledge domain were the most poorly answered, with a mean score of 48.6±24.9%. Patients had great difficulty performing the basic numeric tasks in this domain. The overall mean score for the HELT-LL was 52.8±18.4%, compared with the more cognitively demanding NVS-SA with a mean of 28.6±21.1%, and clearly illustrated the impact of the strategy to include in the HELT-LL a variety of questions with differing cognitive load. The MSFHL, which is based on demographic characteristics and perceived difficulties with reading and writing, had an overall mean score of 44.4±26.2%. Demographic characteristics including age, education and English literacy, were found to be good predictors of limited health literacy, with significant correlations being found between these variables and the mean HELT-LL score. An acceptable value for Cronbach’s alpha, excellent test-retest reliability and excellent concurrent validity show that the HELT-LL is a valid and reliable measure of health literacy in our target population. As there is a paucity of health literacy research emanating from developing countries, this study presents a significant contribution to literature. It is the first study to report the development and validation of a health literacy measure to address the dearth of available health literacy measures applicable for South Africa. If implemented for use in clinical settings and for research purposes, it could provide valuable South African health literacy data which could inform the development of interventions focusing on improving health literacy and health outcomes.
- Full Text:
Medicine use in swallowing-impaired patients: Pharmacists’ knowledge, practice and information needs
- Authors: Masilamoney, Mehrusha
- Date: 2018
- Subjects: Deglutition disorders , Drugs -- Administration , Oral medication -- Administration , Pharmacists -- Practice , South African Pharmacy Council
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/61940 , vital:28086
- Description: Dysphagia, or swallowing impairment, is a growing problem that affects 13.5% of the general population. The ability to swallow is essential for patients taking oral medicines, so this presents a challenge for swallowing-impaired (SI) patients as tablets and capsules will usually require modification prior to ingestion. Pharmacists should play a central role in advising SI patients about their medicine use, as well as problems that may impact on safety, adherence and therapeutic outcome. However, little is known about pharmacists’ level of knowledge, their practice and their information needs when dealing with SI patients and their use of medicines. The aim of this study was to investigate pharmacist knowledge, practice and information needs relating to the support of SI patients and their medicine-related needs. The study design included both quantitative and qualitative methods. A quantitative questionnaire was developed to collect data on the knowledge, practice and information needs of pharmacists and was piloted in 10 pharmacists, which resulted in minor modifications. The questionnaire was converted to a web-based survey and emailed to all pharmacists registered with the South African Pharmacy Council. Two knowledge scores were generated by summating correct responses: knowledge of dysphagia (KOD) and knowledge of medicine use (KOMU) in SI patients. Correlation analysis was used to investigate the strength of the relationship between specific variables with KOD and KOMU using the Pearson correlation coefficient. Qualitative semi-structured interviews were conducted with pharmacists from community, hospital and primary healthcare clinics in both a small town and a major metropole. The aim was to gain deeper understanding of issues arising from the survey, and to explore preferences for topic-specific information materials. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. A total of 439 pharmacists responded to the survey, with 67% being females.The mean KOD score out of a maximum score of 10 was 6.1 ± 1.8. KOD was inadequate (<5) in just over one-third (37.8%) of pharmacists. The mean KOMU score achieved (maximum score 17) was 9.4 ± 2.0, with inadequate knowledge (<10) being established in just over two-thirds of pharmacists (70.8%). Age, length of registration as a pharmacist, and years of practice in a setting with direct patient interaction were significantly but weakly correlated with KOMU, whereas KOD showed no significant association with these variables. Qualification significantly influenced both KOD and KOMU; the highest group with adequate knowledge had either a Masters or a PharmD degree. Fewer than half the pharmacists (44%) never ask patients about their swallowing ability, and most (86%) reported no knowledge of locally available viscosity enhancers. Almost all pharmacists were interested in receiving information materials on assisting SI patients with their medicine use. Three major themes emerged from the semi-structured interviews. Pharmacists recognised their knowledge deficit and felt that lack of both undergraduate training and formal training during practice, as well as limited exposure to SI patients, were contributing factors. Barriers to their practice with SI patients included lack of time, lack of institutional support and lack of easily accessible references on the pharmacists’ role in supporting medicine use in SI patients. Lastly, most pharmacists were not prepared to take ownership of medicine-related problems in SI patients and had conflicting opinions of the pharmacists’ role, usually shifting the responsibility of medicine use in SI patients to nurses. This is the first study to investigate pharmacist knowledge of medicine use in SI patients. The findings indicate that pharmacists do not have the requisite knowledge when dealing with SI patients and their medicine-taking issues despite being the most highly trained healthcare professionals in this field. Lack of undergraduate training, in-house training and limited exposure to SI patients were reported to contribute to poor knowledge. Current practice revealed that there appears to be poor communication among different healthcare professionals, pharmacists were reluctant to work with and/or train nurses on appropriate medicine use in SI patients, and there appeared to be ambiguity surrounding the role of a pharmacist. This research identified that pharmacists regard this topic to be highly relevant to their everyday practice and are keen to receive more information and training relating to this area of study. Information materials were designed and will be made accessible to all pharmacists registered in South Africa.
- Full Text:
Medicine use in swallowing-impaired patients: Pharmacists’ knowledge, practice and information needs
- Authors: Masilamoney, Mehrusha
- Date: 2018
- Subjects: Deglutition disorders , Drugs -- Administration , Oral medication -- Administration , Pharmacists -- Practice , South African Pharmacy Council
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/61940 , vital:28086
- Description: Dysphagia, or swallowing impairment, is a growing problem that affects 13.5% of the general population. The ability to swallow is essential for patients taking oral medicines, so this presents a challenge for swallowing-impaired (SI) patients as tablets and capsules will usually require modification prior to ingestion. Pharmacists should play a central role in advising SI patients about their medicine use, as well as problems that may impact on safety, adherence and therapeutic outcome. However, little is known about pharmacists’ level of knowledge, their practice and their information needs when dealing with SI patients and their use of medicines. The aim of this study was to investigate pharmacist knowledge, practice and information needs relating to the support of SI patients and their medicine-related needs. The study design included both quantitative and qualitative methods. A quantitative questionnaire was developed to collect data on the knowledge, practice and information needs of pharmacists and was piloted in 10 pharmacists, which resulted in minor modifications. The questionnaire was converted to a web-based survey and emailed to all pharmacists registered with the South African Pharmacy Council. Two knowledge scores were generated by summating correct responses: knowledge of dysphagia (KOD) and knowledge of medicine use (KOMU) in SI patients. Correlation analysis was used to investigate the strength of the relationship between specific variables with KOD and KOMU using the Pearson correlation coefficient. Qualitative semi-structured interviews were conducted with pharmacists from community, hospital and primary healthcare clinics in both a small town and a major metropole. The aim was to gain deeper understanding of issues arising from the survey, and to explore preferences for topic-specific information materials. All interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. A total of 439 pharmacists responded to the survey, with 67% being females.The mean KOD score out of a maximum score of 10 was 6.1 ± 1.8. KOD was inadequate (<5) in just over one-third (37.8%) of pharmacists. The mean KOMU score achieved (maximum score 17) was 9.4 ± 2.0, with inadequate knowledge (<10) being established in just over two-thirds of pharmacists (70.8%). Age, length of registration as a pharmacist, and years of practice in a setting with direct patient interaction were significantly but weakly correlated with KOMU, whereas KOD showed no significant association with these variables. Qualification significantly influenced both KOD and KOMU; the highest group with adequate knowledge had either a Masters or a PharmD degree. Fewer than half the pharmacists (44%) never ask patients about their swallowing ability, and most (86%) reported no knowledge of locally available viscosity enhancers. Almost all pharmacists were interested in receiving information materials on assisting SI patients with their medicine use. Three major themes emerged from the semi-structured interviews. Pharmacists recognised their knowledge deficit and felt that lack of both undergraduate training and formal training during practice, as well as limited exposure to SI patients, were contributing factors. Barriers to their practice with SI patients included lack of time, lack of institutional support and lack of easily accessible references on the pharmacists’ role in supporting medicine use in SI patients. Lastly, most pharmacists were not prepared to take ownership of medicine-related problems in SI patients and had conflicting opinions of the pharmacists’ role, usually shifting the responsibility of medicine use in SI patients to nurses. This is the first study to investigate pharmacist knowledge of medicine use in SI patients. The findings indicate that pharmacists do not have the requisite knowledge when dealing with SI patients and their medicine-taking issues despite being the most highly trained healthcare professionals in this field. Lack of undergraduate training, in-house training and limited exposure to SI patients were reported to contribute to poor knowledge. Current practice revealed that there appears to be poor communication among different healthcare professionals, pharmacists were reluctant to work with and/or train nurses on appropriate medicine use in SI patients, and there appeared to be ambiguity surrounding the role of a pharmacist. This research identified that pharmacists regard this topic to be highly relevant to their everyday practice and are keen to receive more information and training relating to this area of study. Information materials were designed and will be made accessible to all pharmacists registered in South Africa.
- Full Text:
Evaluation of the acceptability of ambulatory blood pressure monitoring in a semi-rural, Eastern Cape population
- Authors: Chiwanza, Farisai
- Date: 2017
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/59161 , vital:27447
- Description: Expected release date-April 2019
- Full Text:
- Authors: Chiwanza, Farisai
- Date: 2017
- Language: English
- Type: text , Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/59161 , vital:27447
- Description: Expected release date-April 2019
- Full Text:
Community care workers in TB care: identifying and meeting their information needs
- Authors: Okeyo, Ida L A
- Date: 2016
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/4211 , vital:20633
- Description: According to the 2015 World Health Organisation global tuberculosis report, South Africa had 155,473 new TB cases in the last year, 61% of whom were HIV-positive. The tuberculosis (TB) epidemic in South Africa has resulted in the increasing use of community care workers (CCWs) for the management and supervision of TB patients on treatment. CCWs are increasingly being deployed to address the shortages of healthcare workers. CCWs supervising TB patients often act as information providers, advising and counselling patients on general care and medication use. Their effectiveness depends on appropriate knowledge, adequate training and access to good quality information about TB and TB medicines. The hypothesis for this study was that user-friendly, simple, illustrated information can enhance TB knowledge of CCWs, as well as serve as a practice tool in facilitating their counselling and education of patients. A conceptual framework was used to guide the development of an intervention to test this hypothesis through the following objectives: exploring the roles and TB information needs of CCWs working with TB patients; evaluating baseline TB knowledge and health literacy levels of CCWs; developing simple, illustrated information materials to address CCW TB information needs; and assessing the influence of the information materials on TB knowledge and practice of CCWs. Six CCWs from Grahamstown Hospice and 25 CCWs from six primary healthcare clinics in Grahamstown participated in the study, which was conducted in three main phases. Phase 1 began with focus group discussions and individual semi-structured interviews with 14 CCWs to explore their perceptions regarding their roles in TB care and their information needs. This was followed by individual interviews with all 31 CCWs using a structured questionnaire to collect quantitative data on health literacy and establish baseline TB knowledge. For Phase 2, the design of an A5 booklet was informed by the findings from Phase 1 and contained information about TB and TB medication. Pictograms were designed using a rigorous, iterative design process and were included in the booklet which was translated into isiXhosa and Afrikaans. The booklets were individually distributed to CCWs during an information session in which the topics in the booklet were discussed. Three months after completion of Phase 2, individual follow-up interviews were conducted with all CCWs to measure post-intervention TB knowledge. Focus group discussions or semi-structured interviews were conducted with 19 of the CCWs to explore the role and impact of the information materials on everyday CCW practice. Qualitative data were transcribed and analysed thematically by developing codes and identifying themes. Quantitative results were analysed using the t-test, Pearson Chi-square and a Z-test of proportions at a 0.05 level of significance. The conceptual framework provided a useful lens through which to view, and reflect on, the interaction between the elements of the healthcare system in relation to the results obtained. CCWs associated their roles in TB control with helping patients and having an impact in patients’ lives which they perceived as being meaningful. The good relationships with patients noted by study CCWs, as well as the appreciation they received from patients, contributed to their confidence and belief that they were well positioned and able to positively influence health outcomes. This study found that CCWs in the healthcare system were disadvantaged by the lack of support and supervision, deficiencies in training and lack of information materials, all of which reflect a negative interaction between CCWs with the healthcare system. Use of the booklet resulted in an improvement in CCW knowledge about the disease, TB medication, MDR and XDR-TB and HIV/AIDS and TB co-infection. The mean knowledge score significantly increased from 76.1% at baseline to 85.4% at follow up showing that the use of the booklet had a positive impact on TB knowledge. Poor knowledge areas were identified as being related to TB medication-related knowledge and drug-resistant TB, highlighting the need for additional intervention to improve knowledge in these areas. The health literacy level of CCWs, which was assessed using the modified Newest Vital Signs– South Africa test, showed that the majority of CCWs had only marginal health literacy, indicating the need for wider assessment of health literacy within CCWs, and the need to tailor training and information materials to cater for their health literacy levels. The pictorial-based, simple booklet tailored for CCWs was also found to enhance confidence in decision making, and reduce their uncertainty when confronted with difficult care scenarios. CCWs were enthusiastic about the inclusion of pictograms which were reported to enhance recall of TB information and understanding of text. The booklet also served as a patient educational tool, where it reportedly improved communication and had a positive effect on the CCW-patient interpersonal relationship. The simplicity of the booklet and the inclusion of pictograms resulted in a user-friendly appealing information source for patients. Factors contributing to the success of the booklet can be attributed to paying attention to CCW information needs, involving CCWs in the design process, translating the booklet into local dialect, ensuring simplicity of the text and including pictograms that had undergone a rigorous design process. This study was the first to design TB information materials targeted specifically for CCWs that were also suitable as patient education materials. The study demonstrated that these information materials can have a positive outcome on CCW roles in TB care by improving their knowledge and facilitating patient communication and education.
- Full Text:
- Authors: Okeyo, Ida L A
- Date: 2016
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10962/4211 , vital:20633
- Description: According to the 2015 World Health Organisation global tuberculosis report, South Africa had 155,473 new TB cases in the last year, 61% of whom were HIV-positive. The tuberculosis (TB) epidemic in South Africa has resulted in the increasing use of community care workers (CCWs) for the management and supervision of TB patients on treatment. CCWs are increasingly being deployed to address the shortages of healthcare workers. CCWs supervising TB patients often act as information providers, advising and counselling patients on general care and medication use. Their effectiveness depends on appropriate knowledge, adequate training and access to good quality information about TB and TB medicines. The hypothesis for this study was that user-friendly, simple, illustrated information can enhance TB knowledge of CCWs, as well as serve as a practice tool in facilitating their counselling and education of patients. A conceptual framework was used to guide the development of an intervention to test this hypothesis through the following objectives: exploring the roles and TB information needs of CCWs working with TB patients; evaluating baseline TB knowledge and health literacy levels of CCWs; developing simple, illustrated information materials to address CCW TB information needs; and assessing the influence of the information materials on TB knowledge and practice of CCWs. Six CCWs from Grahamstown Hospice and 25 CCWs from six primary healthcare clinics in Grahamstown participated in the study, which was conducted in three main phases. Phase 1 began with focus group discussions and individual semi-structured interviews with 14 CCWs to explore their perceptions regarding their roles in TB care and their information needs. This was followed by individual interviews with all 31 CCWs using a structured questionnaire to collect quantitative data on health literacy and establish baseline TB knowledge. For Phase 2, the design of an A5 booklet was informed by the findings from Phase 1 and contained information about TB and TB medication. Pictograms were designed using a rigorous, iterative design process and were included in the booklet which was translated into isiXhosa and Afrikaans. The booklets were individually distributed to CCWs during an information session in which the topics in the booklet were discussed. Three months after completion of Phase 2, individual follow-up interviews were conducted with all CCWs to measure post-intervention TB knowledge. Focus group discussions or semi-structured interviews were conducted with 19 of the CCWs to explore the role and impact of the information materials on everyday CCW practice. Qualitative data were transcribed and analysed thematically by developing codes and identifying themes. Quantitative results were analysed using the t-test, Pearson Chi-square and a Z-test of proportions at a 0.05 level of significance. The conceptual framework provided a useful lens through which to view, and reflect on, the interaction between the elements of the healthcare system in relation to the results obtained. CCWs associated their roles in TB control with helping patients and having an impact in patients’ lives which they perceived as being meaningful. The good relationships with patients noted by study CCWs, as well as the appreciation they received from patients, contributed to their confidence and belief that they were well positioned and able to positively influence health outcomes. This study found that CCWs in the healthcare system were disadvantaged by the lack of support and supervision, deficiencies in training and lack of information materials, all of which reflect a negative interaction between CCWs with the healthcare system. Use of the booklet resulted in an improvement in CCW knowledge about the disease, TB medication, MDR and XDR-TB and HIV/AIDS and TB co-infection. The mean knowledge score significantly increased from 76.1% at baseline to 85.4% at follow up showing that the use of the booklet had a positive impact on TB knowledge. Poor knowledge areas were identified as being related to TB medication-related knowledge and drug-resistant TB, highlighting the need for additional intervention to improve knowledge in these areas. The health literacy level of CCWs, which was assessed using the modified Newest Vital Signs– South Africa test, showed that the majority of CCWs had only marginal health literacy, indicating the need for wider assessment of health literacy within CCWs, and the need to tailor training and information materials to cater for their health literacy levels. The pictorial-based, simple booklet tailored for CCWs was also found to enhance confidence in decision making, and reduce their uncertainty when confronted with difficult care scenarios. CCWs were enthusiastic about the inclusion of pictograms which were reported to enhance recall of TB information and understanding of text. The booklet also served as a patient educational tool, where it reportedly improved communication and had a positive effect on the CCW-patient interpersonal relationship. The simplicity of the booklet and the inclusion of pictograms resulted in a user-friendly appealing information source for patients. Factors contributing to the success of the booklet can be attributed to paying attention to CCW information needs, involving CCWs in the design process, translating the booklet into local dialect, ensuring simplicity of the text and including pictograms that had undergone a rigorous design process. This study was the first to design TB information materials targeted specifically for CCWs that were also suitable as patient education materials. The study demonstrated that these information materials can have a positive outcome on CCW roles in TB care by improving their knowledge and facilitating patient communication and education.
- Full Text:
Adherence to antiretroviral therapy in children in Zimbabwe: a randomized control trial to validate a new self-reported adherence monitoring tool
- Authors: Mugore, Linnetie
- Date: 2014
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/54734 , vital:26607
- Description: Background: Among children taking antiretroviral therapy (ART), self-reports have been widely reported to over-estimate adherence levels. Pill count adherence levels are often lower than self-reported levels, with unannounced home pill count adherence being lower than facility based pill count adherence. There is often poor agreement between pill count adherence levels and those measured using other objective adherence measuring methods such as Medication Event Monitoring Systems (MEMS®), which is widely viewed as the gold standard for adherence measurement. Objectives: The aim of this study was to design and evaluate a new self-reported paediatric adherence monitoring tool, assess the feasibility of using pill count methods in monitoring adherence and identify challenges to reporting adherence among children on ART in rural and urban Zimbabwe. Methods A dual centre, superiority, parallel design RCT was conducted to evaluate the newly-developed visually- and verbally-cued „past 10 days‟ tool for the assessment of adherence in children on ART at two sites in Zimbabwe; Harare Central Children‟s Hospital in an urban setting, and Murambinda Mission Hospital, a rural site. Child-caregiver pairs presenting to one of these facilities for the child‟s review of ART and refill of the medication were recruited, signed informed consent obtained, and were randomised for self-reported adherence monitoring into either the experimental group („new 10-day tool‟) or the control group („PACTG-style‟ self-report tool). Data (demographic, socioeconomic, and reported adherence) were collected in individual interviews with child-caregiver pairs. Additional adherence monitoring methods used for both groups included the Morisky-8-Item Medication Adherence Scale (MMAS-8) and a facility based pill count. FGDs were held with groups of caregivers and groups of children ≥13 years of age to understand reasons for non-adherence as well as issues around reporting non-adherence. Superiority testing was conducted by comparing adherent proportions and their confidence intervals (95% CI). Further concurrent validity test was done using the Mann-Whitney U test to evaluate the relationship between the new tool and the MMAS-8 scores. Agreement between the child and caregiver reports of adherence was used as a test of reliability of the new tool using the kappa statistic. Socio-demographic, clinical and care-related factors associated with adherence were identified using reported adherence in both child and caregiver groups in a logistic regression model. Two pill count methods were assessed for feasibility using the proportions of children with complete data for calculating adherence levels, and their CI and a comparison of the two methods, a routinely-used method and one that incorporated the reported residual quantity (RRQ) of medication at last refill. Results : Analysis included 245 child-caregiver pairs, 123 in the experimental group and 122 in the control group. The median age for children was 9 years. In the experimental group, adherence by caregiver and child reports ranged from 94.3% - 98.4% and 78.4% - 96.1%, and those in the control group ranged from 89.2% - 97.5% and 71.2% - 98.1%, respectively. There was no significant difference between adherence levels in the two groups. Adherence levels measured by both the experimental and control tools were found to be associated with MMAS-8 adherence levels (p <0.05). Agreement between child- and caregiver-reported adherence was moderate though significant (kappa; 0.407, p <0.05). Only about half of the children had adequate data to compute pill counts. Proportions adherent at 95% cut-off were 39% by the „routine pill count‟ and 58% by the „Pill count RRQ‟. Being an orphan was associated with child reported-adherence whereas use of non-human reminders, having a maternal relative as a primary caregiver and knowledge of dose frequency, were all associated with caregiver-reported adherence. Major causes of non-adherence mentioned during the FGDs included interference of medication administration times with scheduling of routine socio-economic activities and lack of support from some non-biological caregivers. Reporting of non-adherence appeared to be hampered by perceptions of negative reactions by healthcare workers to these reports and by caregivers being unaware that the child missed some doses. Conclusions: The „new 10-day tool‟ was not shown to be superior to the „PACTG-style tool‟ in detecting non-adherence, however this new tool was found to be a valid and reliable adherence monitoring tool that included a moderately long recall period of 10 days, can be applied without the need for the respondent to remember names of individual medicines in the
- Full Text:
- Authors: Mugore, Linnetie
- Date: 2014
- Language: English
- Type: text , Thesis , Doctoral , PhD
- Identifier: http://hdl.handle.net/10962/54734 , vital:26607
- Description: Background: Among children taking antiretroviral therapy (ART), self-reports have been widely reported to over-estimate adherence levels. Pill count adherence levels are often lower than self-reported levels, with unannounced home pill count adherence being lower than facility based pill count adherence. There is often poor agreement between pill count adherence levels and those measured using other objective adherence measuring methods such as Medication Event Monitoring Systems (MEMS®), which is widely viewed as the gold standard for adherence measurement. Objectives: The aim of this study was to design and evaluate a new self-reported paediatric adherence monitoring tool, assess the feasibility of using pill count methods in monitoring adherence and identify challenges to reporting adherence among children on ART in rural and urban Zimbabwe. Methods A dual centre, superiority, parallel design RCT was conducted to evaluate the newly-developed visually- and verbally-cued „past 10 days‟ tool for the assessment of adherence in children on ART at two sites in Zimbabwe; Harare Central Children‟s Hospital in an urban setting, and Murambinda Mission Hospital, a rural site. Child-caregiver pairs presenting to one of these facilities for the child‟s review of ART and refill of the medication were recruited, signed informed consent obtained, and were randomised for self-reported adherence monitoring into either the experimental group („new 10-day tool‟) or the control group („PACTG-style‟ self-report tool). Data (demographic, socioeconomic, and reported adherence) were collected in individual interviews with child-caregiver pairs. Additional adherence monitoring methods used for both groups included the Morisky-8-Item Medication Adherence Scale (MMAS-8) and a facility based pill count. FGDs were held with groups of caregivers and groups of children ≥13 years of age to understand reasons for non-adherence as well as issues around reporting non-adherence. Superiority testing was conducted by comparing adherent proportions and their confidence intervals (95% CI). Further concurrent validity test was done using the Mann-Whitney U test to evaluate the relationship between the new tool and the MMAS-8 scores. Agreement between the child and caregiver reports of adherence was used as a test of reliability of the new tool using the kappa statistic. Socio-demographic, clinical and care-related factors associated with adherence were identified using reported adherence in both child and caregiver groups in a logistic regression model. Two pill count methods were assessed for feasibility using the proportions of children with complete data for calculating adherence levels, and their CI and a comparison of the two methods, a routinely-used method and one that incorporated the reported residual quantity (RRQ) of medication at last refill. Results : Analysis included 245 child-caregiver pairs, 123 in the experimental group and 122 in the control group. The median age for children was 9 years. In the experimental group, adherence by caregiver and child reports ranged from 94.3% - 98.4% and 78.4% - 96.1%, and those in the control group ranged from 89.2% - 97.5% and 71.2% - 98.1%, respectively. There was no significant difference between adherence levels in the two groups. Adherence levels measured by both the experimental and control tools were found to be associated with MMAS-8 adherence levels (p <0.05). Agreement between child- and caregiver-reported adherence was moderate though significant (kappa; 0.407, p <0.05). Only about half of the children had adequate data to compute pill counts. Proportions adherent at 95% cut-off were 39% by the „routine pill count‟ and 58% by the „Pill count RRQ‟. Being an orphan was associated with child reported-adherence whereas use of non-human reminders, having a maternal relative as a primary caregiver and knowledge of dose frequency, were all associated with caregiver-reported adherence. Major causes of non-adherence mentioned during the FGDs included interference of medication administration times with scheduling of routine socio-economic activities and lack of support from some non-biological caregivers. Reporting of non-adherence appeared to be hampered by perceptions of negative reactions by healthcare workers to these reports and by caregivers being unaware that the child missed some doses. Conclusions: The „new 10-day tool‟ was not shown to be superior to the „PACTG-style tool‟ in detecting non-adherence, however this new tool was found to be a valid and reliable adherence monitoring tool that included a moderately long recall period of 10 days, can be applied without the need for the respondent to remember names of individual medicines in the
- Full Text:
Design and evaluation of illustrated information leaflets as an educational tool for low-literate asthma patients
- Authors: Wrench, Wendy Merle
- Date: 2012 , 2012-10-08
- Subjects: Asthma -- South Africa -- Study and teaching , Asthmatics -- South Africa -- Education
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3867 , http://hdl.handle.net/10962/d1016236
- Description: Asthma is a chronic non-communicable disease associated with an increase in morbidity, mortality and economic burden. Globally 300 million people have asthma and it is estimated that one in every 250 deaths worldwide are due to asthma. South Africa has the highest asthma prevalence (8.1%) in Africa and the disease is 18th in the top 20 causes of death. Inadequate home management, poor availability of health care, and poor transport and emergency services are recognised as important contributing factors. Patients with a low level of education and limited literacy skills may be unable to understand instructions on frequency and use of asthma medicines, which could result in unintentional non-adherence leading to serious complications and increased health care costs. The aim of this study was to investigate the impact of a tailored educational intervention on low-literate patients with asthma. Objectives to achieve this aim included designing patient information leaflets (PILs) containing information on asthma, management of asthma and asthma therapy, and using the PILs to educate low-literate asthma patients. A before-andafter intervention type design evaluated self-reported selected health-related quality of life measures, self-reported self-efficacy, knowledge of asthma and asthma management, knowledge of the use of metered dose inhalers (MDIs) and MDI technique. The acceptability and understanding of the tailored PILs was also investigated. Two simple, readable PILs containing pictograms were developed in English and then translated into isiXhosa, the home language of the majority of the target population. Various guidelines on the design of health-related information for people with low-literacy were consulted and input on the design was received from health care providers, patients and graphic artists. A pilot study was conducted at a local primary health care (PHC) clinic to evaluate the PILs and final modifications to the PILs were made based on feedback received. For the main study, patients were recruited from the KwaNonqubela PHC clinic in Alexandria in the Eastern Cape, South Africa. Patients were 18 years or older, dependent on public sector health care facilities, diagnosed with asthma, prescribed a MDI (beclomethasone and/or salbutamol) for at least one month and English or isiXhosa-speaking. The exclusion criterion for patients in this study was involvement in any other asthma educational intervention during the period of study. Interviewer-led structured questionnaires were administered to 55 patients at the baseline and follow-up. Data collected include demographics, brief medical history and current asthma medications. Self-efficacy and iii health-related quality of life were assessed. Knowledge of asthma and asthma management was evaluated, and the use of beclomethasone and/or salbutamol metered dose inhalers was assessed. The PIL ‘Understanding asthma and trigger factors of asthma’ formed part of the educational intervention to explain asthma and aspects related to its management. Inhaler technique was evaluated and corrected using the PIL ‘How to use your pump’ together with a demonstration of correct technique by the investigator. Follow-up interviews were conducted approximately four weeks after baseline. PIL acceptability, readability and understanding of each pictogram were investigated at follow-up only. The educational intervention resulted in a significant increase in mean knowledge of asthma from 52.7% at baseline to 75.5% at follow-up. Gender was not associated with knowledge, but there was a significant age effect at baseline only, with the younger patients achieving better knowledge results. In both phases, patients with higher education had improved scores. A significant increase (2.4% to 38.6%) in the number of patients taking the minimum recommended adult dose of beclomethasone was noted but it is a matter of concern that the majority of patients were taking less than this. Patient self-reports suggested a significant increase in adherence, with the number of patients taking beclomethasone daily increasing from 33.3% to 61.3%. Self-reported management and control of asthma improved and this was reflected by the enhanced HRQOL results. MDI technique also improved significantly with an increase in the mean number of correct steps from 4.6 ± 2.2 to 7.9 ± 2.7. Education had a significant effect on MDI technique with more errors associated with lower educational status. There were no significant age or gender effects on the total number of correct steps in either phase. The illustrated PILs were received favourably with the majority of literate patients reporting that they were easy to read. Patients commented positively on the inclusion of pictograms and stated that the pictograms had served as aids in the understanding of asthma, trigger factors of asthma and correct MDI technique. The results of this study show that specially designed illustrated PILs can be an effective tool in educating low-literate patients with asthma. , Adobe Acrobat Pro 11.0.0 Paper Capture Plug-in
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- Authors: Wrench, Wendy Merle
- Date: 2012 , 2012-10-08
- Subjects: Asthma -- South Africa -- Study and teaching , Asthmatics -- South Africa -- Education
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3867 , http://hdl.handle.net/10962/d1016236
- Description: Asthma is a chronic non-communicable disease associated with an increase in morbidity, mortality and economic burden. Globally 300 million people have asthma and it is estimated that one in every 250 deaths worldwide are due to asthma. South Africa has the highest asthma prevalence (8.1%) in Africa and the disease is 18th in the top 20 causes of death. Inadequate home management, poor availability of health care, and poor transport and emergency services are recognised as important contributing factors. Patients with a low level of education and limited literacy skills may be unable to understand instructions on frequency and use of asthma medicines, which could result in unintentional non-adherence leading to serious complications and increased health care costs. The aim of this study was to investigate the impact of a tailored educational intervention on low-literate patients with asthma. Objectives to achieve this aim included designing patient information leaflets (PILs) containing information on asthma, management of asthma and asthma therapy, and using the PILs to educate low-literate asthma patients. A before-andafter intervention type design evaluated self-reported selected health-related quality of life measures, self-reported self-efficacy, knowledge of asthma and asthma management, knowledge of the use of metered dose inhalers (MDIs) and MDI technique. The acceptability and understanding of the tailored PILs was also investigated. Two simple, readable PILs containing pictograms were developed in English and then translated into isiXhosa, the home language of the majority of the target population. Various guidelines on the design of health-related information for people with low-literacy were consulted and input on the design was received from health care providers, patients and graphic artists. A pilot study was conducted at a local primary health care (PHC) clinic to evaluate the PILs and final modifications to the PILs were made based on feedback received. For the main study, patients were recruited from the KwaNonqubela PHC clinic in Alexandria in the Eastern Cape, South Africa. Patients were 18 years or older, dependent on public sector health care facilities, diagnosed with asthma, prescribed a MDI (beclomethasone and/or salbutamol) for at least one month and English or isiXhosa-speaking. The exclusion criterion for patients in this study was involvement in any other asthma educational intervention during the period of study. Interviewer-led structured questionnaires were administered to 55 patients at the baseline and follow-up. Data collected include demographics, brief medical history and current asthma medications. Self-efficacy and iii health-related quality of life were assessed. Knowledge of asthma and asthma management was evaluated, and the use of beclomethasone and/or salbutamol metered dose inhalers was assessed. The PIL ‘Understanding asthma and trigger factors of asthma’ formed part of the educational intervention to explain asthma and aspects related to its management. Inhaler technique was evaluated and corrected using the PIL ‘How to use your pump’ together with a demonstration of correct technique by the investigator. Follow-up interviews were conducted approximately four weeks after baseline. PIL acceptability, readability and understanding of each pictogram were investigated at follow-up only. The educational intervention resulted in a significant increase in mean knowledge of asthma from 52.7% at baseline to 75.5% at follow-up. Gender was not associated with knowledge, but there was a significant age effect at baseline only, with the younger patients achieving better knowledge results. In both phases, patients with higher education had improved scores. A significant increase (2.4% to 38.6%) in the number of patients taking the minimum recommended adult dose of beclomethasone was noted but it is a matter of concern that the majority of patients were taking less than this. Patient self-reports suggested a significant increase in adherence, with the number of patients taking beclomethasone daily increasing from 33.3% to 61.3%. Self-reported management and control of asthma improved and this was reflected by the enhanced HRQOL results. MDI technique also improved significantly with an increase in the mean number of correct steps from 4.6 ± 2.2 to 7.9 ± 2.7. Education had a significant effect on MDI technique with more errors associated with lower educational status. There were no significant age or gender effects on the total number of correct steps in either phase. The illustrated PILs were received favourably with the majority of literate patients reporting that they were easy to read. Patients commented positively on the inclusion of pictograms and stated that the pictograms had served as aids in the understanding of asthma, trigger factors of asthma and correct MDI technique. The results of this study show that specially designed illustrated PILs can be an effective tool in educating low-literate patients with asthma. , Adobe Acrobat Pro 11.0.0 Paper Capture Plug-in
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Illustrated medicines information for HIV/AIDS patients: influence on adherence,self-efficacy and health outcomes
- Authors: Barford, Kirsty-Lee
- Date: 2012
- Subjects: AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa , AIDS (Disease) -- Patients -- South Africa , HIV-positive persons -- South Africa , AIDS (Disease) -- Study and teaching -- South Africa , Antiretroviral agents -- South Africa , Communication in medicine -- South Africa , Communication in public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3863 , http://hdl.handle.net/10962/d1015678
- Description: South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.
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- Authors: Barford, Kirsty-Lee
- Date: 2012
- Subjects: AIDS (Disease) -- Treatment -- South Africa , HIV infections -- Treatment -- South Africa , AIDS (Disease) -- Patients -- South Africa , HIV-positive persons -- South Africa , AIDS (Disease) -- Study and teaching -- South Africa , Antiretroviral agents -- South Africa , Communication in medicine -- South Africa , Communication in public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3863 , http://hdl.handle.net/10962/d1015678
- Description: South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.
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An illustrated information leaflet for low-literate HIV/AIDS patients on antiretroviral therapy : design, development and evaluation
- Authors: Ramela, Thato
- Date: 2009
- Subjects: Antiretroviral agents -- South Africa HIV-positive persons -- Care -- South Africa AIDS (Disease) -- Study and teaching -- South Africa HIV infections -- Treatment -- South Africa AIDS (Disease) -- Treatment -- South Africa AIDS (Disease) -- Africa, Sub-Saharan -- Statistics Communication in medicine -- South Africa Communication in public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3834 , http://hdl.handle.net/10962/d1007563
- Description: South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.
- Full Text:
- Authors: Ramela, Thato
- Date: 2009
- Subjects: Antiretroviral agents -- South Africa HIV-positive persons -- Care -- South Africa AIDS (Disease) -- Study and teaching -- South Africa HIV infections -- Treatment -- South Africa AIDS (Disease) -- Treatment -- South Africa AIDS (Disease) -- Africa, Sub-Saharan -- Statistics Communication in medicine -- South Africa Communication in public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3834 , http://hdl.handle.net/10962/d1007563
- Description: South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.
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The South African community pharmacist and Type 2 Diabetes Mellitus a pharmaceutical care intervention
- Authors: Hill, Peter William
- Date: 2009
- Subjects: Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3760 , http://hdl.handle.net/10962/d1003238 , Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Description: Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.
- Full Text:
- Authors: Hill, Peter William
- Date: 2009
- Subjects: Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3760 , http://hdl.handle.net/10962/d1003238 , Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Description: Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.
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Competing interests and change within the pharmacy education system in South Africa
- Authors: Allan, Lucie
- Date: 2006
- Subjects: Pharmacy -- South Africa Pharmacy -- Study and teaching -- South Africa Pharmacy -- Practice -- South Africa Community pharmacy services -- South Africa Community health services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3741 , http://hdl.handle.net/10962/d1003219
- Description: This thesis provides a historical account of the emergence of the pharmacy education system in South Africa, and an analysis of the influence of competing interest groups over the pharmacy education curriculum. It provides a critical evaluation of structural-consensus and micro-interpretive approaches to medical and pharmacy education, and sets out a macrointerpretive account of pharmacy education in South Africa. Following Margaret Archer (1979) it analyzes three forms of negotiation between competing interest groups in their efforts to change the pharmacy curriculum; these are political manipulation, external transaction and internal initiation. The thesis argues that whilst the private sector interest group (comprising of retail, wholesale and manufacturing pharmacy) dominated the pharmacy education system until 1994, since then a newly emerged government interest group has begun to compete for educational control. The priorities pursued by this interest group have consistently reflected the objectives set out in the ANC National Health Plan of 1994. The thesis maintains that given its frustration over the non-implementation of the ANC’s health policy objectives, the government interest group is likely to resort to direct political manipulation by passing legislation to alter the content of the current pharmacy curriculum. Such changes would seek to ensure that the syllabus more accurately reflects the ANC Plan’s community health and primary health care objectives. The thesis asserts that such an outcome (of direct political manipulation of the curriculum) is not inevitable, and can be avoided through a process of internally initiated change. It presents the findings of an interpretive case study into how the Rhodes University Community Experience Programme (CEP) influenced final year pharmacy students’ perceptions of the role of the pharmacist. The students’ comments were collected by means of focus group interviews, participant observation and documentary analysis. Whilst the CEP did not successfully transform their concept of the pharmacist’s role, it did succeed in influencing students’ understanding of the notions of community pharmacy and primary health care in line with the government interest group’s health objectives. This thesis concludes that internally initiated change within the pharmacy education system, would be preferable to that imposed through external political manipulation, as such change would be more likely to preserve the independent professional interests of pharmacy academics.
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- Authors: Allan, Lucie
- Date: 2006
- Subjects: Pharmacy -- South Africa Pharmacy -- Study and teaching -- South Africa Pharmacy -- Practice -- South Africa Community pharmacy services -- South Africa Community health services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:3741 , http://hdl.handle.net/10962/d1003219
- Description: This thesis provides a historical account of the emergence of the pharmacy education system in South Africa, and an analysis of the influence of competing interest groups over the pharmacy education curriculum. It provides a critical evaluation of structural-consensus and micro-interpretive approaches to medical and pharmacy education, and sets out a macrointerpretive account of pharmacy education in South Africa. Following Margaret Archer (1979) it analyzes three forms of negotiation between competing interest groups in their efforts to change the pharmacy curriculum; these are political manipulation, external transaction and internal initiation. The thesis argues that whilst the private sector interest group (comprising of retail, wholesale and manufacturing pharmacy) dominated the pharmacy education system until 1994, since then a newly emerged government interest group has begun to compete for educational control. The priorities pursued by this interest group have consistently reflected the objectives set out in the ANC National Health Plan of 1994. The thesis maintains that given its frustration over the non-implementation of the ANC’s health policy objectives, the government interest group is likely to resort to direct political manipulation by passing legislation to alter the content of the current pharmacy curriculum. Such changes would seek to ensure that the syllabus more accurately reflects the ANC Plan’s community health and primary health care objectives. The thesis asserts that such an outcome (of direct political manipulation of the curriculum) is not inevitable, and can be avoided through a process of internally initiated change. It presents the findings of an interpretive case study into how the Rhodes University Community Experience Programme (CEP) influenced final year pharmacy students’ perceptions of the role of the pharmacist. The students’ comments were collected by means of focus group interviews, participant observation and documentary analysis. Whilst the CEP did not successfully transform their concept of the pharmacist’s role, it did succeed in influencing students’ understanding of the notions of community pharmacy and primary health care in line with the government interest group’s health objectives. This thesis concludes that internally initiated change within the pharmacy education system, would be preferable to that imposed through external political manipulation, as such change would be more likely to preserve the independent professional interests of pharmacy academics.
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Using experiential learning to facilitate pharmacy students' understanding of patients' medication practice in chronic illness
- Authors: Williams, Kevin F
- Date: 2006
- Subjects: Chronic diseases -- Chemotherapy Chronically ill -- Care Pharmacy -- Study and teaching Pharmacy -- Practice Social medicine Health -- Sociological aspects Diseases -- Sociological aspects Health -- Psychological aspects
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:1322 , http://hdl.handle.net/10962/d1003955
- Description: This study originates from experiences which led me to question the way pharmacists are equipped to advise and support the medicine-taking practice of patients using chronic medication. The study offers a critical theoretical consideration of underlying perspectives informing pharmacy education. I propose following a critical realist ontological perspective, a social realist understanding of social structure and human agency, and a sociocultural epistemology. Based on these perspectives, I consider a sociological critique of ‘health’, ‘disease’, ‘illness’ and ‘sickness’ perspectives on medicine-taking, and of pharmacy as a profession. I then propose an experiential learning approach, with an emphasis on developing reflexivity through affective learning. I follow this with an illustrative case study. Following a critical discourse analysis of student texts from the case study, I conclude that there is evidence that experiential learning may prove useful in developing pharmacy students’ reflexive competency to support the provision of pharmaceutical care to patients using chronic medications.
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- Authors: Williams, Kevin F
- Date: 2006
- Subjects: Chronic diseases -- Chemotherapy Chronically ill -- Care Pharmacy -- Study and teaching Pharmacy -- Practice Social medicine Health -- Sociological aspects Diseases -- Sociological aspects Health -- Psychological aspects
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:1322 , http://hdl.handle.net/10962/d1003955
- Description: This study originates from experiences which led me to question the way pharmacists are equipped to advise and support the medicine-taking practice of patients using chronic medication. The study offers a critical theoretical consideration of underlying perspectives informing pharmacy education. I propose following a critical realist ontological perspective, a social realist understanding of social structure and human agency, and a sociocultural epistemology. Based on these perspectives, I consider a sociological critique of ‘health’, ‘disease’, ‘illness’ and ‘sickness’ perspectives on medicine-taking, and of pharmacy as a profession. I then propose an experiential learning approach, with an emphasis on developing reflexivity through affective learning. I follow this with an illustrative case study. Following a critical discourse analysis of student texts from the case study, I conclude that there is evidence that experiential learning may prove useful in developing pharmacy students’ reflexive competency to support the provision of pharmaceutical care to patients using chronic medications.
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Exploring health literacy assessment : the relexicalisation of a health literacy test from the U.S. for application in a South African population
- La Rose, Christopher Michael
- Authors: La Rose, Christopher Michael
- Date: 2004
- Subjects: Rapid Estimate of Adult Literacy in Medicine , Educational tests and measurements , Literacy -- South Africa--Evaluation , Health education -- South Africa -- Evaluation
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2373 , http://hdl.handle.net/10962/d1005708 , Rapid Estimate of Adult Literacy in Medicine , Educational tests and measurements , Literacy -- South Africa--Evaluation , Health education -- South Africa -- Evaluation
- Description: The Rapid Estimate of Adult Literacy in Medicine (REALM) is a standardised health literacy test developed in the United States that has been previously administered and researched in South Africa (Lecoko, 2000). It is an objective vocabulary test which uses item recognition of 66 health-related words where recognition is measured by pronunciation. It is designed as a screening instrument to identifY the health literacy levels of patients in clinics. Lecoko (2000) found the REALM to be largely inapplicable in a South African setting, in that only eight out of the 66 words could be deemed acceptable, in that they could be either both adequately pronounced and adequately comprehended or both inadequately pronounced and inadequately comprehended. This may have occurred for a number of reasons, including the administration of the test in a population for whom English is a second or other language, and inaccurate measurement of pronunciation and comprehension of words, with a key problem being that the choice of words in the original REALM may not accurately represent the range of conditions and issues in a South African healthcare setting. This thesis was therefore premised on the principled relexicalisation of the REALM, that replacement of the words used in the test, using a sample gathered from health information and promotion texts in local clinics, would improve its applicability. In this regard, an exhaustive sample was gathered and analysed and 66 new words were chosen. The test was also modified to include a more principled approach to pronunciation and comprehension issues, and to account for language proficiency differences in administering an English language test in an English second language population. This modified test, referred to as the REALM-M was administered to a group of respondents who were statistically similar to the group to whom the REALM had originally been administered, and the results were compared. It was found that relexicalisation increased the number of acceptable words on the test from eight to 38. However, researching the key discourses surrounding health literacy and comparing these with current discourses about literacy beyond the field of health care revealed that despite improved content validity over the REALM, the REALM-M lacked construct validity. This provided the opportunity to discuss the discourses of health literacy and to suggest the application of alternative paradigms in this field.
- Full Text:
- Authors: La Rose, Christopher Michael
- Date: 2004
- Subjects: Rapid Estimate of Adult Literacy in Medicine , Educational tests and measurements , Literacy -- South Africa--Evaluation , Health education -- South Africa -- Evaluation
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2373 , http://hdl.handle.net/10962/d1005708 , Rapid Estimate of Adult Literacy in Medicine , Educational tests and measurements , Literacy -- South Africa--Evaluation , Health education -- South Africa -- Evaluation
- Description: The Rapid Estimate of Adult Literacy in Medicine (REALM) is a standardised health literacy test developed in the United States that has been previously administered and researched in South Africa (Lecoko, 2000). It is an objective vocabulary test which uses item recognition of 66 health-related words where recognition is measured by pronunciation. It is designed as a screening instrument to identifY the health literacy levels of patients in clinics. Lecoko (2000) found the REALM to be largely inapplicable in a South African setting, in that only eight out of the 66 words could be deemed acceptable, in that they could be either both adequately pronounced and adequately comprehended or both inadequately pronounced and inadequately comprehended. This may have occurred for a number of reasons, including the administration of the test in a population for whom English is a second or other language, and inaccurate measurement of pronunciation and comprehension of words, with a key problem being that the choice of words in the original REALM may not accurately represent the range of conditions and issues in a South African healthcare setting. This thesis was therefore premised on the principled relexicalisation of the REALM, that replacement of the words used in the test, using a sample gathered from health information and promotion texts in local clinics, would improve its applicability. In this regard, an exhaustive sample was gathered and analysed and 66 new words were chosen. The test was also modified to include a more principled approach to pronunciation and comprehension issues, and to account for language proficiency differences in administering an English language test in an English second language population. This modified test, referred to as the REALM-M was administered to a group of respondents who were statistically similar to the group to whom the REALM had originally been administered, and the results were compared. It was found that relexicalisation increased the number of acceptable words on the test from eight to 38. However, researching the key discourses surrounding health literacy and comparing these with current discourses about literacy beyond the field of health care revealed that despite improved content validity over the REALM, the REALM-M lacked construct validity. This provided the opportunity to discuss the discourses of health literacy and to suggest the application of alternative paradigms in this field.
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Applicability of a health literacy test from the U.S. in a South African population
- Lecoko, Motlalepule Lebogang Elizabeth
- Authors: Lecoko, Motlalepule Lebogang Elizabeth
- Date: 2001 , 2013-04-29
- Subjects: Literacy , Literacy -- South Africa , Literacy -- Ability testing , Reading -- Ability testing
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3824 , http://hdl.handle.net/10962/d1005931 , Literacy , Literacy -- South Africa , Literacy -- Ability testing , Reading -- Ability testing
- Description: This thesis investigates the suitability and applicability of a health literacy test from the U.S. in a black, Xhosa-speaking, South African population. The concept of literacy is a controversial one which has been much debated, as it is not easy to classifY people as simply either literate or illiterate. As a result there are a number of definitions of literacy that vary with purpose and culture, but the most common one is that a person is literate if he/she can read and write. Estimating literacy from years of schooling is an inexpensive method but is also unreliable, since people generally read 3 to 5 grades below their stated educational level. This method affords little insight into the ability of patients to adequately function in a health care enviromnent, an ability which is referred to as functional health literacy. A number of health literacy tests such as the REALM (Rapid Estimate of Adult Literacy in Medicine) test have been developed to assess this skill. The REALM test is a word recognition test which places people into a relevant grade range estimate according to the number of words pronounced correctly. It appears to assume understanding of the word if the person is able to read that word correctly. In this project 125 black Xhosa-speaking respondents of varying educational levels who were literate in English were interviewed with the aid of an interpreter. Comprehensive demographic data were collected. Respondents were first asked to read all 66 words aloud during which time pronunciation was checked, and thereafter they were asked to explain each word. It was found that the ability to automatically decode and read the words did not necessarily guarantee comprehension of these words. Many of the words proved to be unfamiliar to the majority of the Xhosa respondents who were able to pronounce them correctly, but could not explain them. These tended to be phonetically transparent words which were therefore more accessible to the unfamiliar reader. This research has proven to be of great value in helping identify such words which should be substituted with simpler words for use in health information materials. A number of words could neither be pronounced nor understood by the population majority and, interestingly, a small group of words could not be pronounced but were satisfactorily explained by some respondents. The results showed an extremely poor correlation between the stated educational level and the REALM grade range estimate. This emphasizes the inappropriateness of years of formal schooling as an indicator of functional health literacy. The criteria were established for deciding cases in which the REALM test could be applied (or succeeds) and when it is inapplicable (or fails). It was found to be inapplicable in 41% of cases which clearly indicates that, in its current form, it is not a valid, reliable test to use in determining health literacy in this English second language population. It can, however, be used as a basis fur the development of a more appropriate test. Recommendations for future research direction are presented and an alternative structure for a health literacy test is suggested. , KMBT_363 , Adobe Acrobat 9.53 Paper Capture Plug-in
- Full Text:
- Authors: Lecoko, Motlalepule Lebogang Elizabeth
- Date: 2001 , 2013-04-29
- Subjects: Literacy , Literacy -- South Africa , Literacy -- Ability testing , Reading -- Ability testing
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3824 , http://hdl.handle.net/10962/d1005931 , Literacy , Literacy -- South Africa , Literacy -- Ability testing , Reading -- Ability testing
- Description: This thesis investigates the suitability and applicability of a health literacy test from the U.S. in a black, Xhosa-speaking, South African population. The concept of literacy is a controversial one which has been much debated, as it is not easy to classifY people as simply either literate or illiterate. As a result there are a number of definitions of literacy that vary with purpose and culture, but the most common one is that a person is literate if he/she can read and write. Estimating literacy from years of schooling is an inexpensive method but is also unreliable, since people generally read 3 to 5 grades below their stated educational level. This method affords little insight into the ability of patients to adequately function in a health care enviromnent, an ability which is referred to as functional health literacy. A number of health literacy tests such as the REALM (Rapid Estimate of Adult Literacy in Medicine) test have been developed to assess this skill. The REALM test is a word recognition test which places people into a relevant grade range estimate according to the number of words pronounced correctly. It appears to assume understanding of the word if the person is able to read that word correctly. In this project 125 black Xhosa-speaking respondents of varying educational levels who were literate in English were interviewed with the aid of an interpreter. Comprehensive demographic data were collected. Respondents were first asked to read all 66 words aloud during which time pronunciation was checked, and thereafter they were asked to explain each word. It was found that the ability to automatically decode and read the words did not necessarily guarantee comprehension of these words. Many of the words proved to be unfamiliar to the majority of the Xhosa respondents who were able to pronounce them correctly, but could not explain them. These tended to be phonetically transparent words which were therefore more accessible to the unfamiliar reader. This research has proven to be of great value in helping identify such words which should be substituted with simpler words for use in health information materials. A number of words could neither be pronounced nor understood by the population majority and, interestingly, a small group of words could not be pronounced but were satisfactorily explained by some respondents. The results showed an extremely poor correlation between the stated educational level and the REALM grade range estimate. This emphasizes the inappropriateness of years of formal schooling as an indicator of functional health literacy. The criteria were established for deciding cases in which the REALM test could be applied (or succeeds) and when it is inapplicable (or fails). It was found to be inapplicable in 41% of cases which clearly indicates that, in its current form, it is not a valid, reliable test to use in determining health literacy in this English second language population. It can, however, be used as a basis fur the development of a more appropriate test. Recommendations for future research direction are presented and an alternative structure for a health literacy test is suggested. , KMBT_363 , Adobe Acrobat 9.53 Paper Capture Plug-in
- Full Text:
Assessment of amoxycillin suppositories
- Authors: Webster, Jessica Angela
- Date: 1997
- Subjects: Solid dosage forms , Suppositories , Amoxicillin
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3802 , http://hdl.handle.net/10962/d1003280 , Solid dosage forms , Suppositories , Amoxicillin
- Description: The investigations in this dissertation have been 'conducted to investigate the formulation and analysis of a paediatric amoxycillin suppository. The oral administration of antibiotics to young children can at times be roblematic. Compliance is sometimes poor because of a sore throat, nausea, vomiting, a high fever or a dislike for the taste or smell of the medicine:- In-such cases the rectal administration of an antibiotic could provide an alternative route of administration that avoids some of the problems that affect oral administration. Difficulties associated with rectal administration are bioavailability, local irritation, acceptability to patients and rejection of the dosage form. Few data, however, are available on the usefulness in children of suppositories in general, and antibiotic suppositories in particular. The areas of investigation have included the formulation of an amoxycillin suppository in various fatty bases, the quantitation of amoxycillin in both aqueous solution and human serum, assessment of stability of amoxycillin in stored aqueous and biological samples, in vitro drug release testing of suppositories, and bioavailability and pharmacokinetics following administration to human subjects of capsule, suppository, oral suspension and rectal suspension dosage forms. Suppositories containing 250 mg amoxycillin were prepared in theobroma oil and in the semisynthetic bases Witepso[ W35, Suppocire A32, Novata BD and Novata 299. The in vitro release characteristics of amoxycillin from these lipophilic suppository formulations were investigated using the USP rotating basket method. The dissolution of a drug from a solid dosage unit is an important parameter affecting drug bioavialability. High Performance Liquid Chromatography (HPLC) was used as the main analytical technique. An original HPLC method for analysis of amoxycillin in aqueous solution, using ultraviolet detection at 230 nm was develcfped. The validated method was a~plied to the determination of the stability of aqueous amoxycillin solutions, and was utilized to determine the amount of drug released during dissolution testing. Differential scanning calorimetry (DSC) is a technique commonly used in preformulation studies. Dissolution testing was used in conjunction with DSC to select a suppository base suitable for formulation with amoxycillin trihydrate. An HPLC method for analysis of amoxycillin in human serum using UV detection at 230 nm is presented. The method involves a solid phase extraction procedure followed by chromatography on a reversed phase column. The limit of sensitivity of 0.3 ILg/mL in serum is sufficiently sensitive to monitor serum concentrations of amoxycillin in humans after the administration of a single 250 mg oral dose. Pharmacokinetic parameters were calculated from data obtained following the administration of a capsule and oral suspension. These parameters were consistent with previously published results. Following administration of a lipophilic suppository and a rectal suspension, to human volunteers, it was concluded that amoxycillin trihydrate is not readily absorbed from the rectum. Further investigations into the modification of the suppository dosage form with absorption enhancers to improve rectal absorption of amoxycillin, as well as elucidation of the mechanism of absorption of the drug, could assist in improving this formulation so that it is suitable for paediatric use.
- Full Text:
- Authors: Webster, Jessica Angela
- Date: 1997
- Subjects: Solid dosage forms , Suppositories , Amoxicillin
- Language: English
- Type: Thesis , Masters , MSc
- Identifier: vital:3802 , http://hdl.handle.net/10962/d1003280 , Solid dosage forms , Suppositories , Amoxicillin
- Description: The investigations in this dissertation have been 'conducted to investigate the formulation and analysis of a paediatric amoxycillin suppository. The oral administration of antibiotics to young children can at times be roblematic. Compliance is sometimes poor because of a sore throat, nausea, vomiting, a high fever or a dislike for the taste or smell of the medicine:- In-such cases the rectal administration of an antibiotic could provide an alternative route of administration that avoids some of the problems that affect oral administration. Difficulties associated with rectal administration are bioavailability, local irritation, acceptability to patients and rejection of the dosage form. Few data, however, are available on the usefulness in children of suppositories in general, and antibiotic suppositories in particular. The areas of investigation have included the formulation of an amoxycillin suppository in various fatty bases, the quantitation of amoxycillin in both aqueous solution and human serum, assessment of stability of amoxycillin in stored aqueous and biological samples, in vitro drug release testing of suppositories, and bioavailability and pharmacokinetics following administration to human subjects of capsule, suppository, oral suspension and rectal suspension dosage forms. Suppositories containing 250 mg amoxycillin were prepared in theobroma oil and in the semisynthetic bases Witepso[ W35, Suppocire A32, Novata BD and Novata 299. The in vitro release characteristics of amoxycillin from these lipophilic suppository formulations were investigated using the USP rotating basket method. The dissolution of a drug from a solid dosage unit is an important parameter affecting drug bioavialability. High Performance Liquid Chromatography (HPLC) was used as the main analytical technique. An original HPLC method for analysis of amoxycillin in aqueous solution, using ultraviolet detection at 230 nm was develcfped. The validated method was a~plied to the determination of the stability of aqueous amoxycillin solutions, and was utilized to determine the amount of drug released during dissolution testing. Differential scanning calorimetry (DSC) is a technique commonly used in preformulation studies. Dissolution testing was used in conjunction with DSC to select a suppository base suitable for formulation with amoxycillin trihydrate. An HPLC method for analysis of amoxycillin in human serum using UV detection at 230 nm is presented. The method involves a solid phase extraction procedure followed by chromatography on a reversed phase column. The limit of sensitivity of 0.3 ILg/mL in serum is sufficiently sensitive to monitor serum concentrations of amoxycillin in humans after the administration of a single 250 mg oral dose. Pharmacokinetic parameters were calculated from data obtained following the administration of a capsule and oral suspension. These parameters were consistent with previously published results. Following administration of a lipophilic suppository and a rectal suspension, to human volunteers, it was concluded that amoxycillin trihydrate is not readily absorbed from the rectum. Further investigations into the modification of the suppository dosage form with absorption enhancers to improve rectal absorption of amoxycillin, as well as elucidation of the mechanism of absorption of the drug, could assist in improving this formulation so that it is suitable for paediatric use.
- Full Text:
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