Issue 4, 2001 Health SA Gesondheid - Volume 6,
Health SA Gesondheid 6, pp 3 –13 (2001)
The idea of community participation in health and research can be found in all major international and national declarations, including South Africa. Researchers are no longer perceived as having the right to exercise monopoly on conducting and explaining their research, but are perceived to have a duty to empower the research participants and the community to understand their own situation and become a collaborative partner in the research process. In an emerging democratic South Africa there has been a shift from paternalism to recognition of the right to information and autonomy and it is within this framework where the day-to-day realities of clinical health research are confronted. Representatives of relevant local communities should be full participants in planning, implementing and overseeing research in health care. The purpose of this review article is to explore and describe the notion of community participation in clinical health research, the complexities and challenges thereof and the paradigm shift of closing the gap between theory and practice, researcher and community in clinical health research. A new research paradigm is described to accommodate the principles of community participation. It is recommended that a perception survey be conducted among various role-players/stakeholders on their understanding and expectations in relation to community participation in clinical health research, the development of a model and the formulation of standards in this regard.
Gemeenskapsbetrokkenheid in gesondheid en in navorsing word internasionaal en nasionaal, insluitende Suid-Afrika, in verskeie verklarings van voorneme gereflekteer. Navorsers het nie meer die reg om &apos;n monopolie oor die uitvoering en verduideliking van hul navorsing te handhaaf nie, maar het &apos;n plig om die deelnemers aan navorsing en die gemeenskap te bemagtig om hul eie rol in navorsing te verstaan ten einde &apos;n gelykwaardige deelnemer in die navorsingsproses te wees. Te midde van &apos;n ontwikkelende Suid-Afrikaanse demokrasie, is daar &apos;n verskuiwing vanaf paternalisme na die erkenning van die reg tot inligting en outonomie. Binne hierdie raamwerk word die dag-tot-dag realiteite van navorsing ook gekonfronteer. Verteenwoordigers van relevante plaaslike gemeenskappe behoort volle deelnemers in die beplanning, implementering en monitering van navorsing in gesondheidsorg te wees. Die doel met hierdie artikel is om die verskynsel van gemeenskapsbetrokkenheid in kliniese navorsing te verken en te beskryf, insluitende die kompleksiteite en uitdagings daaraan verbonde en die paradigmaskuif wat benodig word om die gaping tussen die teorie en praktyk, navorsing en gemeenskap in kliniese navorsing aan te spreek. &apos;n Nuwe paradigma om die beginsels van gemeenskapsbetrokkenheid in kliniese navorsing te akkomodeer, word beskryf. Daar word aanbeveel dat &apos;n persepsie-opname uitgevoer word om die rolspelers se begrip en verwagtinge ten opsigte van gemeenskapsdeelname in kliniese navorsing te ondersoek en om &apos;n model vir gemeenskaps-deelname in kliniese navorsing te ontwikkel.
Synergy between indigenous knowledge systems, modern health care system and scientific research - a vision for the 21st century
Health SA Gesondheid 6, pp 14 –20 (2001)
Research already conducted in African countries indicates that the majority of patients still seek help from the traditional indigenous health care systems. This is an indication that, to achieve the goals of Health Care for All in the 21 st century, there is a need to acknowledge the role played by indigenous health practitioners as well as those practising complementary health care methods. <BR>The aim of the theme "African renaissance" is to focus on the renewal of African roots, which in health care is without doubt the indigenous health care methods. Although the government has already put in place mechanisms to accommodate this field of health practice, some critics still feel that the methods for diagnosis, treatment, medication as well as the training and certification are not scientific enough. It is therefore eminent that sustainable health care development that can benefit all the people of this country should harness a synergy between indigenous health care systems, scientific research and modern health care methods. This article attempts to address the historical evolution of health care methods in South Africa, its effect on the community as well as challenges facing the health professions.
Navorsing wat reeds in Afrikalande onderneem is, dui aan dat die meerderheid pasiënte steeds hulp soek vanaf die tradisioneel inheemse gesondheidsorgsisteme. Dit dien as aanduiding dat, ten einde die doelwitte van Gesondheidsorg vir Almal in die 21ste eeu te bereik, daar &apos;n behoefte is om die rol wat inheemse gesondheidsorgpraktisyns speel, te erken. Dieselfde geld vir diegene wat komplimentêre gesondheidsorg metodes beoefen. <BR>Die doelwit van die tema "Africa Rennaissance" is om te fokus op die herlewing van Afrika wortels, wat in die gesondheidsorg gewis dui op inheemse gesondheidsorgmetodes. Alhoewel die regering reeds meganismes ingestel het om hierdie veld van gesondheidsorgpraktyke te akkomodeer, is sekere kritici steeds van mening dat die metodes wat aangewend word vir diagnose, behandeling, medikasie sowel as opleiding en sertifisering, wetenskaplik nie voldoende is nie. Dit is daarom eminent dat ten einde gesondheidsorgontwikkeling vol te hou tot voordeel van al die mense in hierdie land, dit nodig is om die sinergieë wat bestaan tussen inheemse gesondheidsorgsisteme, wetenskaplike navorsing en moderne gesondheidsorgmetodes, met mekaar in te weef. Hierdie artikel poog om die historiese evolusie van gesondheidsorgmetodes in ons land, die effek daarvan op die gemeenskap, sowel as die uitdagings wat die gesondheidsorgprofessies in die gesig staar, aan te spreek.
Health SA Gesondheid 6, pp 21 –36 (2001)
The purpose with this research is to formulate standards for nursing agencies in South Africa. The researcher was approached by the Association of Nursing Agencies in South Africa (ANASA) to assist them with the development of a quality/accreditation programme for nursing agencies. An exploratory and descriptive quantitative research design was employed. A structured two-phase model was utilised consisting of a developmental and a quantification phase for the development of standards and criteria. A series of four workshops were held during which a framework for the standards was developed, draft standards were formulated, refined and exposed to a quantification phase where the Content Validity Index (CVI) of the standards and criteria were determined in relation to relevance, clarity and implementation in reality. The representatives at these workshops consisted of nursing agency managers (N=22) who hold membership with ANASA and attended their meetings. A high CVI rating was obtained with regard to the relevance and clarity of the standards and criteria. Some standards and many criteria are not yet being implemented in the nursing agencies resulting in a lower CVI rating in this regard. The final set of standards was exposed to a group of stakeholders for final validation purposes, by means of sufficient consensus debate. The standards and criteria were reflected in an evaluation guide/instrument and pilot tested by means of a moc survey in a nursing agency in Gauteng. It is recommended that these standards and criteria, as reflected by means of an evaluation guide, be utilised by the nursing agencies and that the South African Nursing Council use them for licensing and continuous accreditation of nursing agencies in South Africa. Due to the fact that the participants were ANASA members, other nursing agencies were excluded and national representation of the participants/validators can therefore not be claimed.
Die doel met hierdie navorsing is om standaarde vir verpleegagentskappe in Suid-Afrika te formuleer. Die navorser is deur die vereniging van verpleegagentskappe in Suid-Afrika (Association of Nursing Agencies in South Africa: ANASA) genader om hulle behulpsaam te wees met die ontwikkeling van &apos;n gehalte/ akkrediteringsprogram vir verpleegagentskappe. &apos;n Verkennende, beskrywende kwantitatiewe navorsingsontwerp is nagevolg. &apos;n Gestruktureerde twee-fase model is benut, bestaande uit &apos;n ontwikkelings-en kwantifiseringsfase vir die ontwikkeling van die standaarde en kriteria. &apos;n Reeks van vier werkswinkels is gehou waartydens &apos;n konseptuele raamwerk vir die standaarde ontwikkel is, voorlopige standaarde opgestel, verfyn en aan &apos;n gekwantifiseerde fase onderwerp is waartydens die inhoudsgeldigheidsindeks ten opsigte van relevansie, duidelikheid en realiteit bepaal is. Die verteenwoordigers by hierdie werkswinkels het uit verpleegagentskapbestuurders (N=22) bestaan wat lede van ANASA is en hul vergaderings bygewoon het. &apos;n Hoë inhoudsgeldigheidsindeks ten opsigte van relevansie en duidelikheid is verkry. Sommige standaarde en heelwat kriteria word nog nie in die verpleegagentskappe toegepas nie met &apos;n gevolglike lae inhoudsgeldigheidsindeks wat vir realiteit bereik is. Die finale stel standaarde en kriteria is aan rolspelers blootgestel vir die finale validering van die standaarde by wyse van toereikende konsensusdebat. Hierdie standaarde is in die vorm van &apos;n evaluasie-instrument gereflekteer en by wyse van &apos;n loodsstudie in &apos;n agentskap in Gauteng uitgetoets. Daar word aanbeveel dat die standaarde en kriteria, wat in die vorm van &apos;n evaluasiegids gereflekteer word, deur verpleegagentskappe benut word en dat die Suid-Afrikaanse Raad op Verpleging die standaarde vir lisensiëring en volgehoue akkreditering van verpleegagentskappe in Suid-Afrika gebruik. Weens die feit dat die deelnemers/valideerders ANASA lede is, is ander verpleegagentskappe uitgesluit en kan die navorser nie aanspraak op nasionale verteenwoordiging maak nie.
A holistic approach to the treatment of irritable bowel syndrome
L.M. Dolan and
Health SA Gesondheid 6, pp 37 –46 (2001)
The purpose of this study is to investigate the effects of a holistic intervention approach to the management of Irritable Bowel Syndrome (IBS). The sample consisted of 70 South African women who were diagnosed with IBS. The sample was divided into four groups. Group 1 (n = 13) received IBS medication and holistic psychotherapy, Group 2 (n = 23) received IBS medication only, Group 3 (n = 13) received holistic psychotherapy only and Group 4 (n = 21) received no treatment until the study was completed. During the intervention phase the relevant participants received one-hour holistic psychotherapy per week for eight to twelve weeks. Medication as a treatment continued uninterrupted depending on each client&apos;s unique symptom patterns. The results of the study indicate that Group 1, who received IBS medication and holistic psychotherapy and Group 3 (holistic psychotherapy only) improved most in term of IBS symptom severity. Thus it is concluded that a holistic approach for the treatment of IBS is indicated, depending on the nature and severity of symptoms as well as each individual&apos;s contextual situation. This study facilitates a framework for psychologists who are working with clients with IBS or any other mind-body illness.
Die doelwit van die studie is om die effek van &apos;n holistiese benadering tot die bestuur van Prikkelbare Dermsindroom ("Irritable Bowel Syndrome") te ondersoek. Die steekproef het bestaan uit 70 Suid-Afrikaanse vroue wat gediagnoseer is met Prikkelbare Dermsindroom. Die steekproef is in vier groepe verdeel. Groep 1 (n = 13) het medikasie en holistiese psigoterapie ontvang, Groep 2 (n = 23) het slegs medikasie ontvang, Groep 3 (n = 13) het slegs holistiese psigoterapie ontvang en Groep 4 (n = 21) het geen behandeling ontvang totdat die studie afgehandel is nie. Gedurende die intervensiefase het die betrokke deelnemers holistiese psigoterapie ontvang vir een uur per week, vir agt tot twaalf weke. Medikasie as behandeling het deurentyd voortgegaan afhangende van elke kliënt se unieke patroon van simptome. Die resultate van die studie dui aan dat Groep 1, wat medikasie en holistiese psigoterapie ontvang het asook Groep 3 (slegs holistiese psigoterapie) die meeste verbetering ten opsigte van die ernstigheid van simptome getoon het. Die studie verskaf &apos;n raamwerk vir sielkundiges wat met kliënte werk met Prikkelbare Dermsindroom of enige ander liggaam-gees siekte.
D.L. Labadarios and
Health SA Gesondheid 6, pp 47 –58 (2001)
Malnutrition is a public health problem in South Africa, especially among rural black children. Intakes below 67% of the Recommended Dietary Allowance (RDA) are common for calcium, iron, zinc, selenium, vitamin A, C, D, E, riboflavin, niacin and vitamin B6. Key nutrients for growth and development include calcium, iron, zinc, vitamin A, folate and other B-vitamins. Calcium is essential for bone mineralisation during the adolescent growth spurt. Iron deficiency is associated with impaired growth, delayed psychomotor development and impaired immunity. Zinc is associated with normal growth, bone mineralisation and neuropsychological function. Vitamin A is essential for normal growth, eyesight and immunity. Folate is necessary for the development of new cells, especially during phases of accelerated growth. Other B-vitamins are linked to a variety of behavioural and cognitive outcomes. Factors compromising the nutritional status of children include amongst others, an inadequate nutrient intake due to poverty, inadequate nutrition education, diarrhoeal diseases, teenage dieting and allergies. To ensure optimal growth and development, strict diets should be discouraged and sound meal patterns should be encouraged, including starting the day with breakfast, and eating a variety of foods to ensure adequate intakes of nutrients and fibre. Regular physical activity promotes a healthy body weight and normal bone mineralisation.
Mikronutriënt innames laer as 67% van die Aanbevole Dieettoelae (ADT) is algemeen vir kalsium, yster, sink, selenium, vitamien A, C, D, E, riboflavien, niasien en vitamien B6. Belangrike nutriënte vir groei en ontwikkeling sluit kalsium, yster, sink, vitamien A, folaat en ander B-vitamiene in. Kalsium is essensieel vir beenmineralisering tydens die adolessente snelgroeifase. Ystertekort word met belemmerde groei geassosieer, asook met vertraagde psigomotoriese ontwikkeling en verswakte immuniteit. Sink word met normale groei, beenmineralisering en neuropsigologiese funksie geassosieer. Vitamien A is essensieel vir normale groei, sig en immuniteit. Folaat is nodig vir die ontwikkeling van nuwe selle, veral tydens fases van versnelde groei. Ander B-vitamiene speel &apos;n rol in &apos;n verskeidenheid gedrags- en kognitiewefunksies. Faktore wat die voedingstatus en gesondheid van kinders kan benadeel, sluit &apos;n onvoldoende nutriëntinname as gevolg van onder andere, armoede, onvoldoende voedingsvoorligting, diaree, tienerdiëte en allergieë in. Om optimale groei en ontwikkeling te verseker, moet streng diëte en oorslaan van maaltye ontmoedig word en &apos;n gebalanseerde maaltydpatroon gevestig word. Ontbyt moet gereeld geëet word, tesame met &apos;n verskeidenheid voedselsoorte, om voldoende innames van nutriënte en vesel te verseker. Gereelde fisiese aktiwiteit bevorder &apos;n gesonde liggaamsgewig en normale beenmineralisering.
Healthy dietary practices among black South African university students
Health SA Gesondheid 6, pp 59 –65 (2001)
The aim of the study was to investigate five healthy dietary behaviours among black South African University students. The sample consisted of 370 (46.7%) males and 423 (53.3%) females in the age range of 18 to 25 years (M age 21.0 years, SD=3.48). Results indicate that the incidence of these healthy dietary habits was low. Significant differences with healthy dietary habits were identified for gender, dieting status, dietary health beliefs, internal health locus of control, and risk awareness, but not for age, weight, residential background, socioeconomic status, and health value. Logistic regression with health beliefs, dieting status, gender and knowledge were only significant predictors for a few healthy dietary habits. In conclusion, results give insights into dietary health behavior practices and the factors that influence them, which have practical implications for dietary health promotion.
Die doel van die navorsing was om vyf gesonde dieet gedragstyle van swart Suid-Afrikaanse studente na te vors. Die steekproef het bestaan uit 370 (46.7%) manstudente en 423 (53%) vroulike studente in die ouderdomsgroep 18 tot 25 jaar (gemiddelde ouderdom 21.0 jaar en standaardafwyking 3.48 jaar). Die resultate dui daarop dat die insidensie van die gesonde dieetgewoontes baie laag was. Beduidende verskille is ten opsigte van die volgende faktore bevind: geslag, dieetstatus, gesonde gelowe oor dieet, interne lokus van kontrole en risiko bewustheid maar nie vir ouderdom, gewig, residensiële omgewing, sosio-ekonomiese status en gesondheid nie. Logistieke regressie ten opsigte van gesondheidsgelowe, dieet status, geslag en kennis was slegs ten opsigte van enkele dieetgewoontes beduidende voorspellers. Ter samevatting kan gesê word dat die resultate insig gebring het ten opsigte van gesonde dieetpraktyke en die faktore wat daarin &apos;n rol speel en die praktiese implikasies vir die bevordering van gesonde dieet.
Health SA Gesondheid 6, pp 66 –70 (2001)
No institution is immune to the impact of technological change. The introduction of cable television and satellite broadcasting has resulted in an increase in employing the technology in question for educational purposes. Computers and communication technologies are merging globally, and technology such as Telematic Education is being used in the best possible way by the University of Pretoria to support its service delivery mechanisms. <BR>Telematic Education refers to a comprehensive system of flexible learning. It includes all modes of education, as well as low and high technological methods. Although nurses/lecturers have been confronted with the fast development of technology for many years, it has been in clinical practice mostly. Professional nurses need to develop professionally in non-clinical specialities as well. Continued education by means of a distant education method will serve as an academic solution to professional nurses in the rural areas of South Africa. <BR>Lecturers who teach by means of telematic education are required to be skilled, selfconfident, and should also be flexible. The twenty-first century will indeed see many changes, with lecturers, students and preceptors joined together in dialogue to question, demonstrate, and participate actively in the learning process. All of this will happen without students having to set foot in a classroom.
Geen instansie is immuun teen tegnologiese veranderinge nie. Die bekendstelling van satelliet en kabeltelevisie het gelei tot &apos;n vermeerderde gebruik van tegnologie vir onderwyskundige doeleindes. Daar is &apos;n samesmelting van rekenaar en kommunikasie tegnologie wêreldwyd en tegnologie soos Telematiese Onderwys word deur die Universiteit van Pretoria gebruik op die mees geskikte wyse om hul dienslewerings sisteme te ondersteun. <BR>Telematiese onderrig verwys na &apos;n omvattende sisteem van fleksileer. Dit sluit alle modi van onderwys, sowel as lae en hoë tegnologiese metodes in. Verpleegkundiges/dosente word al jare deur tegnologie gekonfronteer, maar hoofsaaklik in die kliniese praktyk. Verpleegkundiges/dosente moet egter ook tegnologie as deel van hul professionele ontwikkeling in nie-kliniese areas sien. Voortgesette onderwys by wyse van afstandsonderrig dien as &apos;n oplossing vir verpleegkundiges in die landelike gebiede van Suid-Afrika. <BR>Telematiese onderrig vereis van dosente om kundig en plooibaar te wees, asook die medium met selfvertroue te gebruik. Die een-en-twintigste eeu sal verseker baie veranderinge meebring, soos dosente, studente en preseptore saamkom in debatvoering ten einde te bevraagteken, demonstreer en aktief deelneem in die leerproses. Dit kan alles plaasvind sonder dat die dosent of die student fisies in die klaskamer is.
Methodological issues involved in conducting qualitative research on support for nurses directly involved with women who chose to terminate their pregnancy
Health SA Gesondheid 6, pp 71 –78 (2001)
The purpose of this article is to describe the methodological issues involved in conducting qualitative research to explore and describe nurses&apos; experience of being directly involved with termination of pregnancies and developing guidelines for support for these nurses. The article points out the sensitivity and responsibility that researchers must have when engaging in qualitative research of this nature. While conducting this research, several methodological challenges were identified. Four specific challenges identified will be addressed in this paper. These are: the issue of research versus therapeutic interviewing; adhering to specific research ethics, as this was a very sensitive topic of research; dissemination of research results to make it accessible to all nurses as well as the broader community; and the operationalisation of the support guidelines in practice for nurses in need of support.
Health SA Gesondheid 6, pp 79 –81 (2001)
National Conference organised by the South African Association of Women Graduates (SAWG), UCT Medical School, Cape Town, 2 - 4 February 2001 : report
Health SA Gesondheid 6, pp 82 –84 (2001)
Visit to Copenhagen : 6-16 June 2001 : report
Health SA Gesondheid 6, pp 85 –88 (2001)