Browsing by Author "Malan, Zelra"

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    African primary care research : current situation, priorities and capacity building
    (AOSIS Publishing, 2014-12) Mash, Robert; Essuman, Akye; Ratansi, Riaz; Goodyear-Smith, Felicity; Von Pressentin, Klaus; Malan, Zelra; Van Lancker, Marianne; De Maeseneer, Jan
    Introduction: The Sixth PRIMAFAMED (Primary Health Care/Family Medicine Education Network) workshop on ‘Capacity Building and Priorities in Primary Care Research’ was held in Pretoria, South Africa (SA), from 22 to 24 June 2014. Delegates from the following countries attended the workshop: Ghana, Nigeria, Uganda, Kenya, Tanzania, Sudan, Malawi, Zimbabwe, Botswana, Namibia, SA, Zambia, Ethiopia, Rwanda, Mozambique, Swaziland, Belgium, and Denmark (Figure 1). Delegates were from established or emerging departments of family medicine and primary care in these countries. The central theme of the workshop was primary care research – the current situation, the priorities for research and the need for capacity building. This report gives a summary of the consensus on these matters that emerged from the workshop. The motivation for the conference was derived in part from the involvement of Professor Bob Mash (SA) and Professor Olayinka Ayankogbe (Nigeria) in the World Organization of Family Doctors (WONCA) Global Working Party on Primary Care Research, which has a goal of promoting primary care research.
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    Development of a training programme for primary care providers to counsel patients with risky lifestyle behaviours in South Africa
    (AOSIS Publishing, 2015-06) Malan, Zelra; Mash, Bob; Everett-Murphy, Kathy
    Background: We are facing a global epidemic of non-communicable disease (NCDs), which has been linked with four risky lifestyle behaviours. It is recommended that primary care providers (PCPs) provide individual brief behaviour change counselling (BBCC) as part of everyday primarycare, however currently training is required to build capacity. Local training programmes are not sufficient to achieve competence. Aim: This study aimed to redesign the current training for PCPs in South Africa, around a new model for BBCC that would offer a standardised approach to addressing patients’ risky lifestyle behaviours. Setting: The study population included clinical nurse practitioners and primary care doctors in the Western Cape Province. Methods: The analyse, design, develop, implement and evaluate (ADDIE) model provided a systematic approach to the analysis of learning needs, the design and development of the training programme, its implementation and initial evaluation. Results: This study designed a new training programme for PCPs in BBCC, which was based on a conceptual model that combined the 5As (ask, alert, assess, assist and arrange) with a guiding style derived from motivational interviewing. The programme was developed as an eight-hour training programme that combined theory, modelling and simulated practice with feedback, for either clinical nurse practitioners or primary care doctors. Conclusion: This was the first attempt at developing and implementing a best practice BBCC training programme in our context, targeting a variety of PCPs, and addressing different risk factors.
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    Improving the quality of care for female rape survivors at Scottish Livingstone Hospital, Molepolole, Botswana : a quality improvement cycle
    (AOSIS, 2020) Debley, Orleans A.; Malan, Zelra
    Background: Rape is prevalent in Botswana, but there has been limited research undertaken to improve the quality of healthcare for female rape survivors in this clinical setting. Research can not only influence the health outcomes of victims but also has the potential to inform policy. Aim: The aim of this study was to improve the quality of care for female rape survivors in Scottish Livingstone Hospital, Molepolole, Botswana. Setting: The setting is Scottish Livingstone Hospital, Molepolole, Botswana. Methods: This study was a qualitative cycle, using the normal steps of performing a baseline audit of clinical practice, planning and implementing changes and re-audit. Results: A total of 124 patient records were audited, comprising 62 patient records at baseline and re-audit. The mean age of victims was 23 years and the age category with the highest incidence of rape ranged between 12 and 20 years, constituting 47% of patients’ records. During the baseline audit, only one out of 10 structural standards was met, while at re-audit eight structural standards were fully met. Although none of the process standards were met during both audits, statistically significant improvements in performance (p < 0.05) were shown in six out of 10 criteria at re-audit. Conclusion: The quality of care for female rape survivors is suboptimal in our setting. However, simple interventions to improve the structure in place for patients and upskilling the entire practice team to align care to current international standards can improve the overall quality of healthcare.
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    Improving the quality of clinical training in the workplace : implementing formative assessment visits
    (South African Academy of Family Physicians, 2019-12-09) Mash, Bob; Malan, Zelra; Blitz, Julia; Edwards, Jill
    Family physicians have a key role to play in strengthening district health services in South Africa. There are a number of barriers to the supply of these specialists in family medicine, one of which is the quality of workplace-based training and low pass rate in the national exit examination. The South African Academy of Family Physicians in collaboration with the Royal College of General Practitioners has adopted a short course to train clinical trainers and a process of formative assessment visits (FAVs) for clinical trainers in the workplace. Training programmes have struggled to implement the FAVs and this article reports on the experience at Stellenbosch University and the issues identified. Clinical trainers who participated in FAVs mostly set developmental goals for themselves that focused on improving the learning environment and consolidating personal skills in training and assessment. The FAVs were beneficial for the family physician trainers, their managers and the academic family physicians at the university. The tools and process for conducting the FAVs may be of value to other programmes. Conclusion: Although overall transmission is low with the PMTCT programme, the majority of remaining HIV infections among children under two years could be prevented by addressing the modifiable factors identified in this study.
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    Perceptions about family-centred care among adult patients with chronic diseases at a general outpatient clinic in Nigeria
    (Publishers version, 2018-10) Yakubu, Kenneth; Malan, Zelra; Colon-Gonzalez, Maria C.; Mash, Bob
    Background: Few studies in Africa have described patients’ perceptions about family-centred care (FCC). Aim: The aim of this study was to explore perceptions of FCC among patients with chronic diseases. Setting: The study was conducted at a general outpatient clinic (GOPC) in Jos, north-central Nigeria. Methods: We used a mixed-methods phenomenological study design and conducted structured and semi-structured interviews with 21 adult patients with chronic diseases at a general outpatient clinic in north-central Nigeria. Results: Patients described FCC using progressive levels of family engagement including the doctor inquiring about history of similar disease in the family, information sharing with family members and fostering of family ties. They described current family involvement in their care as either inquiring about their health, accompanying them to the clinic or offering material or social support and health advice. Also, patients considered the value of FCC based on how it meets information needs of the family, influences individual health behaviour and addresses family dynamics. Those who were literate and older than 50 years of age favoured FCC during history taking. Those who were literate, aged lesser than 50 years and had poor disease control showed preference for FCC during treatment decision-making. Conclusion: The acceptability of FCC is a complex synthesis of age, socio-economic status, literacy and disease outcomes. Patients older than 50 years, with good treatment outcomes, and those without formal education may need further education and counselling on this approach to care.
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    Proceedings of the 13th annual conference of INEBRIA
    (Biomed Central, 2016-09) Watson, Rod; Morris, James; Isitt, John; Barrio, Pablo; Ortega, Lluisa; Gual, Antoni; Conner, Kenneth; Stecker, Tracy; Maisto, Stephen; Paroz, Sophie; Graap, Caroline; Grazioli, Veronique S.; Daeppen, Jean-Bernard; Collins, Susan E.; Bertholet, Nicolas; McNeely, Jennifer; Kushnir, Vlad; Cunningham, John A.; Crombie, Iain K.; Cunningham, Kathryn B.; Irvine, Linda; Williams, Brian; Sniehotta, Falko F.; Norrie, John; Melson, Ambrose; Jones, Claire; Briggs, Andrew; Rice, Peter; Achison, Marcus; McKenzie, Andrew; Dimova, Elena; Slane, Peter W.; Grazioli, Véronique S.; Collins, Susan E.; Paroz, Sophie; Graap, Caroline; Daeppen, Jean-Bernard; Baggio, Stephanie; Dupuis, Marc; Studer, Joseph; Gmel, Gerhard; Magill, Molly; Grazioli, Veronique S.; Tait, Robert J.; Teoh, Lucinda; Kelty, Erin; Geelhoed, Elizabeth; Mountain, David; Hulse, Gary K.; Renko, Elina; Mitchell, Shannon G.; Lounsbury, David; Li, Zhi; Schwartz, Robert P.; Gryczynski, Jan; Kirk, Arethusa S.; Oros, Marla; Hosler, Colleen; Dusek, Kristi; Brown, Barry S.; Finnell, Deborah S.; Holloway, Aisha; Wu, Li-Tzy; Subramaniam, Geetha; Sharma, Gaurav; Wallhed Finn, Sara; Andreasson, Sven; Dvorak, Robert D.; Kramer, Matthew P.; Stevenson, Brittany L.; Sargent, Emily M.; Kilwein, Tess M.; Harris, Sion K.; Sherritt, Lon; Copelas, Sarah; Knight, John R.; Mdege, Noreen D.; McCambridge, Jim; Bischof, Gallus; Bischof, Anja; Freyer-Adam, Jennis; Rumpf, Hans-Juergen; Fitzgerald, Niamh; Scholin, Lisa; Toner, Paul; Böhnke, Jan R.; Veach, Laura J.; Currin, Olivia; Dongre, Leigh Z.; Miller, Preston R.; White, Elizabeth; Williams, Emily C.; Lapham, Gwen T.; Bobb, Jennifer J.; Rubinsky, Anna D.; Catz, Sheryl L.; Shortreed, Susan; Bensley, Kara M.; Bradley, Katharine A.; Milward, Joanna; Deluca, Paolo; Khadjesari, Zarnie; Watson, Rod; Fincham-Campbell, Stephanie; Drummond, Colin; Angus, Kathryn; Bauld, Linda; Baumann, Sophie; Haberecht, Katja; Schnuerer, Inga; Meyer, Christian; Rumpf, Hans-Jürgen; John, Ulrich; Gaertner, Beate; Barrault-Couchouron, Marion; Béracochea, Marion; Allafort, Vincent; Barthelemy, Valerie; Bonnefoi, Herve; Bussieres, Emmanuel; Garguil, Veronique; Auriacombe, Marc; Saint-Jacques, Marianne; Dorval, Michel; M’Bailara, Katia; Segura-Garcia, Lidia; Ibanez-Martinez, Nuria; Mendive-Arbeloa, Juan M.; Anoro-Perminger, Manel; Diaz-Gallego, Pako; Pinar-Mateos, M. Angeles; Colom-Farran, Joan; Deligianni, Marianthi; Yersin, Bertrand; Adam, Angeline; Weisner, Constance; Chi, Felicia; Lu, Wendy; Sterling, Stacy; Kraemer, Kevin L.; McGinnis, Kathleen A.; Fiellin, David A.; Skanderson, Melissa; Gordon, Adam J.; Robbins, Jonathan; Zickmund, Susan; Korthuis, P. T.; Edelman, E. J.; Hansen, Nathan B.; Cutter, Christopher J.; Dziura, James; Fiellin, Lynn E.; O’Connor, Patrick G.; Maisto, Stephen A.; Bedimo, Roger; Gilbert, Cynthia; Marconi, Vincent C.; Rimland, David; Rodriguez-Barradas, Maria; Simberkoff, Michael; Justice, Amy C.; Bryant, Kendall J.; Berman, Anne H.; Shorter, Gillian W.; Bray, Jeremy W.; Barbosa, Carolina; Johansson, Magnus; Hester, Reid; Campbell, William; Souza Formigoni, Maria L. O.; Andrade, Andre L. M.; Sartes, Laisa M. A.; Sundström, Christopher; Eék, Niels; Kraepelien, Martin; Kaldo, Viktor; Fahlke, Claudia; Hernandez, Lynn; Becker, Sara J.; Jones, Richard N.; Graves, Hannah R.; Spirito, Anthony; Diestelkamp, Silke; Wartberg, Lutz; Arnaud, Nicolas; Thomasius, Rainer; Gaume, Jacques; Grazioli, Veronique; Fortini, Cristiana; Malan, Zelra; Mash, Bob; Everett-Murphy, Katherine; Grazioli, Veronique S.; Studer, Joseph; Mohler-Kuo, M.; Bertholet, Nicolas; Gmel, Gerhard; Doi, Lawrence; Cheyne, Helen; Jepson, Ruth; Luna, Vanesa; Echeverria, Leticia; Morales, Silvia; Barroso, Teresa; Abreu, Angela; Aguiar, Cosma; Stewart, Duncan; Abreu, Angela; Brites, Riany M.; Jomar, Rafael; Marinho, Gerson; Parreira, Pedro; Seale, J. P.; Johnson, J. A.; Henry, Dena; Chalmers, Sharon; Payne, Freida; Tuck, Linda; Morris, Akula; Goncalves, Catia; Besser, Bettina; Casajuana, Cristina; Lopez-Pelayo, Hugo; Balcells, Maria M.; Teixido, Lidia; Miquel, Laia; Colom, Joan; Hepner, Kimberly A.; Hoggatt, Katherine. J.; Bogart, Andy; Paddock, Susan. M.; Hardoon, Sarah L.; Petersen, Irene; Hamilton, Fiona L.; Nazareth, Irwin; White, Ian R.; Marston, Louise; Wallace, Paul; Godfrey, Christine; Murray, Elizabeth; Sovinova, Hana; Csemy, Ladislav
    ENGLISH SUMMARY : Meeting abstracts.
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    The psychometric properties of a tool to assess brief behaviour change counselling in South Africa
    (AOSIS, 2020-12) Fouche, Jani; Mash, Robert; Malan, Zelra
    Background: Primary care providers should be competent in brief behaviour change counselling (BBCC). A new model of BBCC was developed in South Africa. Tools are needed for training and research to evaluate BBCC. Aim: To evaluate the validity and reliability of a tool to assess BBCC. Setting: Primary care providers in Western Cape, South Africa. Methods: Exploratory sequential mixed methods included initial qualitative feedback from an expert panel to assess validity, followed by quantitative analysis of internal consistency, inter- and intra-rater reliability. Six raters assessed 33 randomly selected audiotapes from a repository of 123 tapes of BBCC at baseline and 1 month later. Results: Changes to the existing tool involved item changes, added items and grammatical as well as layout changes. The 'Assessment of Brief Behavioural Change Counselling' tool (ABC tool) had good overall internal consistency (Cronbach's alpha 0.955), inter-rater (intra-class correlation coefficient [ICC] 0.813 at follow-up) and intra-rater reliability (Pearson's correlation 0.899 and p 0.001). Sub-scores for the Assist (ICC 0.784) and Arrange (ICC 0.704) stages had lower inter-rater reliability than the sub-scores for Ask (ICC 0.920), Alert (ICC 0.925) and Assess (ICC 0.931) stages. Conclusion: The ABC tool is sufficiently reliable for the assessment of BBCC. Minor revisions may further improve the reliability of the tool, particularly for the sub-scores measuring Assist and Arrange. The ABC tool can be used in clinical training or research studies to assess fidelity to this model of BBCC.
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    Qualitative evaluation of primary care providers experiences of a training programme to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa
    (BioMed Central, 2015-08) Malan, Zelra; Mash, Robert; Everett-Murphy, Katherine
    Background: The global epidemic of non-communicable disease (NCDs) has been linked with four modifiable risky lifestyle behaviours, namely smoking, unhealthy diet, physical inactivity and alcohol abuse. Primary care providers (PCPs) can play an important role in changing patient’s risky behaviours. It is recommended that PCPs provide individual brief behaviour change counselling (BBCC) as part of everyday primary care. This study is part of a larger project that re-designed the current training for PCPs in South Africa, to offer a standardized approach to BBCC based on the 5 As and a guiding style. This article reports on a qualitative sub-study, which explored whether the training intervention changed PCPs perception of their confidence in their ability to offer BBCC, whether they believed that the new approach could overcome the barriers to implementation in clinical practice and be sustained, and their recommendations on future training and integration of BBCC into curricula and clinical practice. Methods: This was a qualitative study that used verbal feedback from participants at the beginning and end of the training course, and twelve individual in-depth interviews with participants once they had returned to their clinical practice. Results: Although PCP’s confidence in their ability to counselling improved, and some thought that time constraints could be overcome, they still reported that understaffing, lack of support from within the facility and poor continuity of care were barriers to counselling. However, the current organisational culture was not congruent with the patient-centred guiding style of BBCC. Training should be incorporated into undergraduate curricula of PCPs for both nurses and doctors, to ensure that counselling skills are embedded from the start. Existing PCPs should be offered training as part of continued professional development programmes. Conclusions: This study showed that although training changed PCPs perception of their ability to offer BBCC, and increased their confidence to overcome certain barriers to implementation, significant barriers remained. It is clear that to incorporate BBCC into everyday care, not only training, but also a whole systems approach is needed, that involves the patient, provider, and service organisation at different levels.
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    A situational analysis of training for behaviour change counselling for primary care providers, South Africa
    (AOSIS Publishing, 2015-03) Malan, Zelra; Mash, Bob; Everett-Murphy, Katherine
    Background: Non-communicable diseases and associated risk factors (smoking, alcohol abuse, physical inactivity and unhealthy diet) are a major contributor to primary care morbidity and the burden of disease. The need for healthcare-provider training in evidence-based lifestyle interventions has been acknowledged by the National Department of Health. However, local studies suggest that counselling on lifestyle modification from healthcare providers is inadequate and this may, in part, be attributable to a lack of training. Aim: This study aimed to assess the current training courses for primary healthcare providers in the Western Cape. Setting: Stellenbosch University and University of Cape Town. Methods: Qualitative interviews were conducted with six key informants (trainers of primary care nurses and registrars in family medicine) and two focus groups (nine nurses and eight doctors) from both Stellenbosch University and the University of Cape Town. Results: Trainers lack confidence in the effectiveness of behaviour change counselling and in current approaches to training. Current training is limited by time constraints and is not integrated throughout the curriculum – there is a focus on theory rather than modelling and practice, as well as a lack of both formative and summative assessment. Implementation of training is limited by a lack of patient education materials, poor continuity of care and record keeping, conflicting lifestyle messages and an unsupportive organisational culture. Conclusion: Revising the approach to current training is necessary in order to improve primary care providers’ behaviour change counselling skills. Primary care facilities need to create a more conducive environment that is supportive of behaviour change counselling.
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    The state of family medicine training programmes within the Primary Care and Family Medicine Education network
    (2020-08-11) von Pressentin, Klaus B.; Besigye, Innocent; Mash, Robert; Malan, Zelra
    The 2019 Primary Care and Family Medicine Education network (Primafamed) meeting in Kampala, Uganda, included a workshop that aimed to assess the state of postgraduate family medicine training programmes in the Primafamed network. Forty-six people from 14 African and five other countries were present. The evaluation of programmes or countries according to the stages of change model was compared to a previous assessment made 5 years ago. Most countries have remained at the same stage of change. Two countries appeared to have reversed their readiness to change as Rwanda moved from relapse to pre-contemplation and Mozambique moved from action to contemplation. Malawi, Zambia and Zimbabwe increased their readiness to change and moved from contemplation to action. Countries in the region remain quite diverse in terms of their commitment to family medicine training. Within Primafamed, it is possible for countries with a more advanced stage of change to assist countries with an earlier stage. Primafamed is also supported by a variety of partners outside of Africa. Five years after the previous country-level assessment, family medicine in Africa continues to span across all levels of the stages of change model. Stage-matched interventions aligned with the needs of individual countries should follow. Consequently, this workshop report will serve as a mandate and compass for Primafamed’s actions over the next few years, aimed at designing and delivering these interventions. As reiterated in the 2019 Kampala commitment, we should continue developing the discipline of family medicine (the medical ‘specialty’ of primary care), through alignment of our training programmes to the health needs in the African region.