Browsing by Author "Coetzee, Marisa"

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    The influence of contextual factors on knee osteoarthritis self-management and education interventions in rural settings of the Western Cape
    (Stellenbosch : Stellenbosch University, 2019-04) Coetzee, Marisa; Morris, Linzette D.; Enright, Marlie; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY : Background: Musculoskeletal (MSK) disorders are a global health concern, and the effect of MSK related disability is amplified in rural areas where the community members are affected by their environmental and social situation. The implementation of a self-management and education programme could improve the health outcomes of individuals in these settings, however, the recommendations in the current evidence-based clinical practice guidelines lack description and contextual information. Understanding the specific context could improve the uptake of these clinical guidelines, and therefore improve patient care and health outcomes. Aim: The aim of this particular study was to describe the contextual factors that could influence the implementation of a self-management and education programme for people with knee OA living in the rural settings of the Western Cape. Method: A descriptive and exploratory qualitative research method with a phenomenological approach was used to conduct this study. In-depth semi-structured individual interviews and focus group discussions were the chosen mode of data collection. Eighteen participants with knee OA were interviewed individually, and 19 community health care workers participated in three area specific focus group, providing collateral information about the community and their health related behaviour. The first two individual interviews were used as pilot interviews, therefore the data of the remaining 16 individual interviews were used along with the focus group data for analysis. The transcribed and translated interviews were coded using the coding software Atlast.ti, after which a deductive data analysis approach was followed. Results: The results showed that the current services offered to individuals with knee OA living in the rural areas of the Western Cape are insufficient in addressing their concerns and managing their symptoms. Various rehabilitation needs have been identified in these areas of which information and exercise needs were the most prominent. The needs identified could be addressed by a self-management and education programme within these communities. However, contextual barriers and facilitators have been identified as possible aspects which could influence the implementation of a self-management and education programme. Personal factors such as ownership, compliance and social isolation as well as environmental factors such as the community attitudes, continuity of care and available transport could have an impact on the uptake and success of a self-management and education programme. Conclusion: This study found that when compared to current clinical practice guidelines, the services offered to people living with knee OA are not sufficient and that there is a need for education and exercise. A self-management programme are the ideal intervention to address the needs of the people living with knee OA in rural areas of the Western Cape. However, this study identified certain contextual factors that has to be considered when planning and implementing such a programme, and a feasibility study should be considered to ascertain the strategy for implementation in these areas.
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    Rehabilitation needs in individuals with knee OA in rural Western Cape, South Africa : an exploratory qualitative study
    (Cambridge University Press, 2020) Coetzee, Marisa; Giljam-Enright, Marlie; Morris, Linzette Deidre
    Background: Current clinical practice guidelines have suggested that each individual with knee osteoarthritis (OA) should receive three core treatments from their health care provider. These core treatments comprise of exercise, education and weight loss. Identification of the health care and rehabilitation needs of individuals with knee OA in rural areas are imperative for focusing service delivery in a specific context in order to empower the individual. The aim of this study was to explore the rehabilitation needs of individuals with knee OA living in rural Western Cape in order to identify the gaps in services offered and inform rehabilitation programmes in these settings. Methods: Semi-structured in-depth individual interviews were performed on 16 individuals with knee OA living in rural settings of the Western Cape, South Africa. A deductive data analysis approach was used and the needs of the individuals were identified and categorised for interpretation and comparison with the reported services received. Findings: The three major themes identified were ‘I would like to know more’, ‘There’s not much support from the clinic’ and ‘I don’t feel myself anymore’. These themes relate to the lack of disease-specific education, barriers in the health systems and service delivery resulting in individuals lack of self-worth and poor mental wellbeing. The results revealed the integral relationship between health care systems, service delivery and the effect on patient wellbeing. Conclusion: The rehabilitation needs of individuals with knee OA in rural areas advocates for addressing barriers in rural primary health care system such as adequate human resources, referral systems and continuity of care. This will allow for a comprehensive, person-centred and context-specific multidisciplinary approach focused on empowering individuals with knee OA through disease-specific education, improving functional participation and symptom management strategies. This could improve the social inclusion and mental wellbeing of individuals living with knee OA.