Browsing by Author "Mash, Bob"
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- ItemAcademy calls on South Africans to vaccinate(AOSIS, 2021-10) Mash, BobCoronavirus disease 2019 (COVID-19) vaccine hesitancy in South Africa has been fuelled by conspiracy theories and misinformation. Unfortunately, some of this misinformation has come from health professionals, the most notable recent example being Dr Susan Vosloo, a cardiothoracic surgeon in Cape Town. However, family physicians have also been seen to promote unproven treatments such as ivermectin and even nebulised colloidal silver.
- ItemAfrican primary care research : choosing a topic and developing a proposal(AOSIS Publishing, 2014-02) Mash, BobThis is the first in a series of articles on primary care research in the African context. The aim of the series is to help build capacity for primary care research amongst the emerging departments of family medicine and primary care on the continent. Many of the departments are developing Masters of Medicine programmes in Family Medicine and their students will all be required to complete research studies as part of their degree. This series is being written with this audience in particular in mind – both the students who must conceptualise and implement a research project as well as their supervisors who must assist them. This article gives an overview of the African primary care context, followed by a typology of primary care research. The article then goes on to assist the reader with choosing a topic and defining their research question. Finally the article addresses the structure and contents of a research proposal and the ethical issues that should be considered.
- ItemAfrican primary care research : participatory action research(AOSIS Publishing, 2014-03) Mash, BobThis article is part of the series on African primary care research and focuses on participatory action research. The article gives an overview of the emancipatory-critical research paradigm, the key characteristics and different types of participatory action research. Following this it describes in detail the methodological issues involved in professional participatory action research and running a cooperative inquiry group. The article is intended to help students with writing their research proposal.
- ItemAfrican primary care research : performing surveys using questionnaires(AOSIS Publishing, 2014-05) Govender, Indiran; Mabuza, Langalibalele, H.; Ogunbanjo, Gboyega, A.; Mash, BobThe aim of this article is to provide practical guidance on conducting surveys and the use of questionnaires for postgraduate students at a Masters level who are undertaking primary care research. The article is intended to assist with writing the methods section of the research proposal and thinking through the relevant issues that apply to sample size calculation, sampling strategy, design of a questionnaire and administration of a questionnaire. The article is part of a larger series on primary care research, with other articles in the series focusing on the structure of the research proposal and the literature review, as well as quantitative data analysis.
- ItemAfrican primary care research : qualitative data analysis and writing results(AOSIS Publishing, 2014-06) Mabuza, Langalibalele H.; Govender, Indiran; Ogunbanjo, Gboyega, A.; Mash, BobThis article is part of a series on African primary care research and gives practical guidance on qualitative data analysis and the presentation of qualitative findings. After an overview of qualitative methods and analytical approaches, the article focuses particularly on content analysis, using the framework method as an example. The steps of familiarisation, creating a thematic index, indexing, charting, interpretation and confirmation are described. Key concepts with regard to establishing the quality and trustworthiness of data analysis are described. Finally, an approach to the presentation of qualitative findings is given.
- ItemAfrican primary care research : quality improvement cycles(AOSIS Publishing, 2014-04) Van Deventer, Claire; Mash, BobImproving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal.
- ItemAfrican primary care research : quantitative analysis and presentation of results(AOSIS Publishing, 2014-06) Mash, Bob; Ogunbanjo, Gboyega, A.This article is part of a series on Primary Care Research Methods. The article describes types of continuous and categorical data, how to capture data in a spreadsheet, how to use descriptive and inferential statistics and, finally, gives advice on how to present the results in text, figures and tables. The article intends to help Master’s level students with writing the data analysis section of their research proposal and presenting their results in their final research report.
- ItemAfrican primary care research : reviewing the literature(AOSIS Publishing, 2014-02) Ross, Andrew; Mash, BobThis is the second article in the series on African primary care research. The article focuses on how to search for relevant evidence in the published literature that can be used in the development of a research proposal. The article addresses the style of writing required and the nature of the arguments for the social and scientific value of the proposed study, as well as the use of literature in conceptual frameworks and in the methods. Finally, the article looks at how to keep track of the literature used and to reference it appropriately.
- ItemAfrican primary care research : writing a research report(AOSIS Publishing, 2014-06) Couper, Ian; Mash, BobPresenting a research report is an important way of demonstrating one’s ability to conduct research and is a requirement of most research-based degrees. Although known by various names across academic institutions, the structure required is mostly very similar, being based on the Introduction, Methods, Results, Discussion format of scientific articles. This article offers some guidance on the process of writing, aimed at helping readers to start and to continue their writing; and to assist them in presenting a report that is received positively by their readers, including examiners. It also details the typical components of the research report, providing some guidelines for each, as well as the pitfalls to avoid. This article is part of a series on African Primary Care Research that aims to build capacity for research particularly at a Master’s level.
- ItemAssessment of the impact of family physicians in the district health system of the Western Cape, South Africa(AOSIS Publishing, 2014-12) Swanepoel, Meyer; Mash, Bob; Naledi, TraceyBackground: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape. Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method. Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers. Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.
- ItemAvailability, functionality and access of blood pressure machines at the points of care in public primary care facilities in Tororo district, Uganda(AOSIS, 2021-01) Besigye, Innocent K.; Okuuny, Vicent; Armstrong-Hough, Mari; Katahoire, Anne R.; Sewankambo, Nelson K.; Mash, Bob; Katamba, AchillesBackground: Early diagnosis of hypertension prevents a significant number of complications and premature deaths. In resource-variable settings, diagnosis may be limited by inadequate access to blood pressure (BP) machines. We sought to understand the availability, functionality and access of BP machines at the points of care within primary care facilities in Tororo district, Uganda. Methods: This was an explanatory sequential mixed-methods study combining a structured facility checklist and key informant interviews with primary care providers. The checklist was used to collect data on availability and functionality of BP machines within their organisational arrangements. Key informant interviews explored health providers’ access to BP machines. Results: The majority of health facilities reported at least one working BP machine. However, Health providers described limited access to machines because they are not located at each point of care. Health providers reported borrowing amongst themselves within their respective units or from other units within the facility. Some health providers purchase and bring their own BP machines to the health facilities or attempted to restore the functionality of broken ones. They are motivated to search the clinic for BP machines for some patients but not others based on their perception of the patient’s risk for hypertension. Conclusion: Access to BP machines at the point of care was limited. This makes hypertension screening selective based on health providers’ perception of the patients’ risk for hypertension. Training in proper BP machine use and regular maintenance will minimise frequent breakdowns.
- ItemBarriers to accessing cervical cancer screening among HIV positive women in Kgatleng district, Botswana : a qualitative study(Public Library of Science, 2018) Matenge, Tjedza G.; Mash, BobBackground: Low and middle-income countries have a greater share of the cervical cancer burden, but lower screening coverage, compared to high-income countries. Moreover, screening uptake and disease outcomes are generally worse in rural areas as well as in the HIV positive population. Efforts directed at increasing the screening rates are important in order to decrease cancer-related morbidity and mortality. This study aimed to explore the barriers to women with HIV accessing cervical cancer screening in Kgatleng district, Botswana. Methods: A phenomenological qualitative study utilising semi-structured interviews with fourteen HIV positive women, selected by purposive sampling. The interviews were transcribed verbatim and the 5-steps of the framework method, assisted by Atlas-ti software, was used for qualitative data analysis. Results:Contextual factors included distance, public transport issues and work commitments. Health system factors highlighted unavailability of results, inconsistent appointment systems, long queues and equipment shortages and poor patient-centred communication skills, particularly skills in explanation and planning. Patient factors identified were lack of knowledge of cervical cancer, benefits of screening, effectiveness of treatment, as well as personal fears and misconceptions. Conclusion: Cervical cancer screening was poorly accessed due to a weak primary care system, insufficient health promotion and information as well as poor communication skills. These issues could be partly addressed by considering alternative technology and one-stop models of testing and treating.
- ItemClimate change, the threat of collapse and the opportunity for transformation(Health and Medical Publishing Group (HMPG), 2012-03) Mash, BobAround the world there are many examples of previous human societies that have collapsed and disappeared. Societies that once flourished and seemed invincible, but which are now no more, include Great Zimbabwe in Africa, Easter Island in the Pacific Ocean, Mycenaean Greece and Minoan Crete in Europe and the Maya cities of Central America. Professor Swilling, in the opening article of this issue of CME, presents us with a picture of global society that is breaching the absolute limits of environmental sustainability in several interconnected ways, of which climate change is only one. We face a global ‘polycrisis’ that is already impacting on public health and which challenges us to revise our global economic system, approach to sustainable development and collective lifestyle. It is a planetary crisis that requires a transformative response on a global level, but which will impact individuals in communities on every continent.
- ItemCommunity-orientated primary care : a scoping review of different models, and their effectiveness and feasibility in sub-Saharan Africa(BMJ, 2019) Mash, Bob; Ray, Sunanda; Essuman, Akye; Burgueno, EduIntroduction: Community-orientated primary care (COPC) is an approach to primary healthcare (PHC) that originated in South Africa and contributed to the formulation of the Declaration of Alma-Ata 40 years ago. Despite this, PHC remains poorly developed in sub-Saharan African countries. There has been a resurgence of interest in strengthening PHC systems in the last few years and identifying key knowledge gaps. COPC has been an effective strategy elsewhere, most notably Brazil. This scoping review investigated COPC in the sub-Saharan African context and looked for evidence of different models, effectiveness and feasibility. Methods: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Studies were grouped into five categories: historical analysis, models, implementation, educational studies and effectiveness. Results: A total of 1997 publications were identified and 39 included in the review. Most publications were from the last 5 years (n = 32), research (n = 27), from South Africa (n = 27), focused on implementation (n = 25) and involving case studies (n = 9), programme evaluation (n = 6) or qualitative methods (n = 10). Nine principles of COPC were identified from different models. Factors related to the implementation of COPC were identified in terms of governance, finances, community health workers, primary care facilities, community participation, health information and training. There was very little evidence of effectiveness of COPC. Conclusions: There is a need for further research to describe models of COPC in Africa, investigate the appropriate skills mix to integrate public health and primary care in these models, evaluate the effectiveness of COPC and whether it is included in training of healthcare workers and government policy.
- ItemA comprehensive model for intimate partner violence in South African primary care : action research(BioMed Central, 2012-11) Joyner, Kate; Mash, BobBackground: Despite extensive evidence on the magnitude of intimate partner violence (IPV) as a public health problem worldwide, insubstantial progress has been made in the development and implementation of sufficiently comprehensive health services. This study aimed to implement, evaluate and adapt a published protocol for the screening and management of IPV and to recommend a model of care that could be taken to scale in our underdeveloped South African primary health care system. Methods: Professional action research utilised a co-operative inquiry group that consisted of four nurses, one doctor and a qualitative researcher. The inquiry group implemented the protocol in two urban and three rural primary care facilities. Over a period of 14 months the group reflected on their experience, modified the protocol and developed recommendations on a practical but comprehensive model of care. Results: The original protocol had to be adapted in terms of its expectations of the primary care providers, overly forensic orientation, lack of depth in terms of mental health, validity of the danger assessment and safety planning process, and need for ongoing empowerment and support. A three-tier model resulted: case finding and clinical care provision by primary care providers; psychological, social and legal assistance by ‘IPV champions’ followed by a group empowerment process; and then ongoing community-based support groups. Conclusion: The inquiry process led to a model of comprehensive and intersectoral care that is integrated at the facility level and which is now being piloted in the Western Cape, South Africa.
- ItemThe contribution of family physicians to surgical capacity at district hospitals in South Africa(2021-10-27) Hendriks, Hans; Adeniji, Adeloye; Jenkins, Louis; Mash, BobThe World Health Organization states that essential, cost-effective surgical care should be delivered at district hospitals. In South Africa significant skills gap exist at district hospitals, particularly in the area of surgery and anaesthesia. These small to moderate sized hospitals are too small to support a range of full time specialists even if they could be recruited and were cost-effective. Family physicians (FPs) are trained in the clinical skills required for district hospitals and primary health care. Clinical associates have also been introduced to perform procedures at district hospitals. This report illustrates the contribution of a FP to surgical care at Zithulele Hospital in the Eastern Cape. Family physicians not only bring the necessary clinical skills set but also increase the confidence and capacity of the whole team. Outreach and support by surgeons, as well as continuing professional development, are important. Surgical and anaesthetic skills must be developed together. Family physicians also bring leadership and clinical governance skills that ensure the inputs to support surgery, such as equipment and information systems are available. The contribution of FPs to surgery and district hospitals is overlooked in both policy and practice. Human resources for health policy should recognise their contribution and increase the numbers available and FP posts at district hospitals. There is also a need to update the package of emergency and essential surgical procedures in policy.
- ItemCost and consequence analysis of the healthy choices at work programme to prevent non-communicable diseases in a commercial power plant, South Africa(AOSIS, 2020) Schouw, Darcelle D.; Mash, BobBackground: The workplace is an ideal setting for the implementation of a health promotion programmes to prevent non-communicable diseases (NCD). There are limited resources assigned to workplace health promotion programmes in low-and middle-income countries (LMIC). Aim: This study aimed to conduct a cost and consequence analysis of the Healthy Choices at Work programme. Setting: This study was conducted at a commercial power plant in South Africa. Methods: Incremental costs were obtained for the activities of the Healthy Choices at Work programme over a two-year period. A total of 156 employees were evaluated in the intervention, although the effect was experienced by all employees. An annual health risk factor assessment at baseline and follow up evaluated the consequences of the programme. Results: The total incremental costs over the two-year period accumulated to $4015 for 1743 employees. The cost per employee on an annual basis was $1.15 and was associated with a −10.2mmHg decrease in systolic blood pressure, −3.87mmHg in diastolic blood pressure, −0.45mmol/l in total cholesterol and significant improvement in harmful alcohol use, fruit and vegetable intake and physical inactivity (p < 0.001). There was no correlation between sickness absenteeism and risk factors for NCDs. Conclusion: The cost to implement the multicomponent HCW programme was low with significant beneficial consequences in transforming the workplace environment and reducing risks factors for NCDs. Findings of this study will be useful for small, medium and large organisations, the national department of health, and similar settings in LMICs.
- ItemDevelopment of a portfolio of learning for postgraduate family medicine training in South Africa : a Delphi study(BioMed Central, 2012-03) Jenkins, Louis; Mash, Bob; Derese, AnselmeBackground Within the 52 health districts in South Africa, the family physician is seen as the clinical leader within a multi-professional district health team. Family physicians must be competent to meet 90% of the health needs of the communities in their districts. The eight university departments of Family Medicine have identified five unit standards, broken down into 85 training outcomes, for postgraduate training. The family medicine registrar must prove at the end of training that all the required training outcomes have been attained. District health managers must be assured that the family physician is competent to deliver the expected service. The Colleges of Medicine of South Africa (CMSA) require a portfolio to be submitted as part of the uniform assessment of all registrars applying to write the national fellowship examinations. This study aimed to achieve a consensus on the contents and principles of the first national portfolio for use in family medicine training in South Africa. Methods A workshop held at the WONCA Africa Regional Conference in 2009 explored the purpose and broad contents of the portfolio. The 85 training outcomes, ideas from the WONCA workshop, the literature, and existing portfolios in the various universities were used to develop a questionnaire that was tested for content validity by a panel of 31 experts in family medicine in South Africa, via the Delphi technique in four rounds. Eighty five content items (national learning outcomes) and 27 principles were tested. Consensus was defined as 70% agreement. For those items that the panel thought should be included, they were also asked how to provide evidence for the specific item in the portfolio, and how to assess that evidence. Results Consensus was reached on 61 of the 85 national learning outcomes. The panel recommended that 50 be assessed by the portfolio and 11 should not be. No consensus could be reached on the remaining 24 outcomes and these were also omitted from the portfolio. The panel recommended that various types of evidence be included in the portfolio. The panel supported 26 of the 27 principles, but could not reach consensus on whether the portfolio should reflect on the relationship between the supervisor and registrar. Conclusion A portfolio was developed and distributed to the eight departments of Family Medicine in South Africa, and the CMSA, to be further tested in implementation.
- ItemDevelopment 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, KathyBackground: 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.
- ItemThe development of distance education for general practitioners on common mental disorders through participatory action research(Stellenbosch : Stellenbosch University, 2002-03) Mash, Bob; De Villiers, P.; Meulenberg-Buskens, I.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.