Theses and dissertations (Health Sciences)
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Item Radiation therapists’ experiences of disruptions in radiotherapy service delivery during the Covid-19 pandemic at public oncology hospitals in KwaZulu-Natal, South Africa(2024) Tshoke, Lesego; Nkosi, Pauline BusisiweBackground The novel coronavirus (COVID-19) rapidly impacted all human life following its escalation to a pandemic status in early March 2020. This viral pandemic severely affected the world’s developed and developing countries, resulting in disruptions within healthcare delivery systems, including radiotherapy. Although the government guidelines and restrictions to mitigate the risk of viral transmission were implemented, radiotherapy departments were amongst multiple departments forced to promptly adjust in order to encourage continuous clinical care. However, to provide this service, radiation therapists work closely together and in close proximity to their patients. These inherent working conditions resulted in changes in the number of treatments for some patients, clinical working patterns and conventional radiotherapy practice during the pandemic era. This challenge was faced by numerous radiotherapy departments globally, hence there is a need to explore how radiation therapists in South Africa coped to ensure continuous clinical service delivery. Aim The aim of this study was to explore radiation therapists’ lived experiences of the COVID-19 pandemic disruptions on their radiotherapy service delivery at public oncology hospitals in the KwaZulu-Natal (KZN) province, and ultimately recommend strategies to support them to cope with the changes due to the pandemic. Methodology To conduct this research, the researcher employed a constructivist paradigm and a qualitative phenomenological approach. Criterion purposive sampling was used to select two public oncology hospitals, whereby the critical case sampling selected a radiotherapy manager as well as simulator, planning and treatment machine radiation therapists from each to constitute a minimum sample size of ten. Findings The study interview data was analysed using Colaizzi’s Seven-step Method of data analysis to identify themes which were then presented as findings. This resulted in four major themes that revealed the radiation therapists’ common narrative during the COVID-19 pandemic as: Changes in hospital settings, working conditions, radiation therapists’ practices and wellbeing; barriers to radiotherapy service delivery; facilitators to radiotherapy service; and support needed. Conclusion and recommendations In exploring radiation therapists’ lived experiences of disruptions in radiotherapy service delivery in a developing country such as South Africa, there can be strategies that aid in supporting radiation therapists to continue providing clinical service delivery. As part of the recommendations to attain this, the study brought forth managerial training, similar study conduction to validate study, interviewing of patients, psychological support to employees concerned, educational programmes for both patients and employees, remote treatment planning for radiation therapists, as well as routine screening for concerned employees.Item The perceptions and experiences of chiropractic students with regards to objective structured clinical examinations at a South African University of Technology(2024) Vawda, Nabeel; Varatharajullu, DesireeBACKGROUND A vast amount of literature has contributed to the topic of students’ perceptions and experiences of objective structured clinical examination (OSCE). Many of these studies address the challenges that students face during those examinations, but few discuss the perceptions and experiences that university students may face before, during, and after the OSCE. In the realm of chiropractic education, abundant literature exists about the chiropractic field, as well as the curriculum and the accreditation of chiropractic education around the world. Noteworthy, unlike other healthcare professional programmes, literature regarding the perceptions and experiences of the chiropractic student with regard to the OSCEs in the course, and how that experience affects their clinical competence in the programme and future is scarce. This study recorded the perceptions and experiences of chiropractic students at a selected South African university of technology regarding the format, use and testing of the OSCE. AIM To explore the perceptions and experiences of chiropractic students towards the OSCE at a South African university of technology. METHOD A qualitative, exploratory, descriptive approach was utilised for this research. A purposive sample of 20 chiropractic students who have been examined in minimum of three OSCEs were interviewed. Their perceptions and experiences regarding the OSCEs were obtained through semi-structured interviews. A total of three key questions, each relating to how students feel before, during, and after the OSCE process were used to stimulate a discussion. The data were recorded electronically and thereafter transcribed verbatim. Thematic analysis was used to interpret the data. RESULTS The participants indicated that, for the most part, the OSCE is valued but, to some extent, could be tailored closer to the chiropractic scope of practice. This meant that while they were taught adequately, they were not fully prepared for the OSCEs as they did not adequately simulate real world clinical scenarios in the field of chiropractic. The examiners demeanour also played a substantial role in the participants’ experiences of the OSCEs. The participants indicated that their experiences were negative, stressful, and full of anxiety due to the format of the OSCEs, with its time constraints and difficulties with the examiners who were testing them. Another factor which contributed to the participants’ experiences of the OSCEs was the way they were being tested. The participants felt they were being examined differently to the way in which they were taught as many of the examiners were external clinicians. In contrast, the participants also mentioned that they benefitted from the OSCEs with regard to learning how to work well under pressure and building confidence, allowing them to be better prepared for clinical practice. The participants recommended that the OSCEs should be closer aligned with the chiropractic scope of practice, that the format of the OSCE be changed, and the time limit per a station increased. CONCLUSION This is the first South African study to document the perceptions and experiences of chiropractic students regarding the OSCEs at a South African university of technology. These perceptions and experiences were based on a variety of internal and external factors in relation to the university, chiropractic course, and examiners of the OSCEs. While the participants acknowledged and appreciated the positive aspects of the OSCEs, they provided constructive feedback on different aspects to help improve the experiences of the OSCE for chiropractic students. For many of the participants, the overall experience of the OSCEs was negative and they felt it could be significantly improved in the chiropractic course. It is advisable for educational institutions and stakeholders within chiropractic education to leverage the findings of this study to improve chiropractic education in South Africa.Item Perceptions and experiences of elderly patients receiving chiropractic care in the Durban Metropolitan area(2024) Claire de Lange, Holly; Varatharajullu, DesireeBackground: The elderly population experience a significant musculoskeletal burden. Both the population and their healthcare burdens are expected to increase due to the elderly’s extended life expectancies. This escalating healthcare burden falls to the public healthcare sector, on which the majority of the population relies in the South African context. The current experiences of elderly individuals in this public system are poor due to the disease centred approach implemented in care. Chiropractic care implements a patient-centred approach to healthcare which is more suitable to meet the needs of this vulnerable population. Chiropractic care effectively manages musculoskeletal conditions; however, it remains largely underutilised by the public. In South Africa, Chiropractic Care’s public presence is limited to two university clinics due to the outdated legislature restricting the profession in the public healthcare sector. This limits the public exposure to Chiropractic Care’s non-invasive and non-pharmacological approach for managing musculoskeletal pain. There is limited research in both the local and international contexts into the perceptions and experiences towards Chiropractic Care from the elderly’s perspective, therefore demonstrating the value of additional research into this topic. Aim: This study aimed to explore the perceptions and experiences of elderly individuals receiving Chiropractic Care in the Durban Metropolitan area. Method: This qualitative study was conducted utilising an exploratory, descriptive approach. A random-purposive sampling of 11 elderly individuals with at least one previous Chiropractic Care experience was implemented. Semi-structured interviews were performed to provide insights into the perceptions and experiences of this population. Thematic analysis was performed using the Tesch method. Results: Thematic analysis extracted six themes, including understanding of Chiropractic Care; factors influencing the pursuit of Chiropractic Care; the impact of care on the elderly experience; insights provided through lifetime experiences; the impacts of age on the elderly experience; and the attraction of an alternative healthcare approach. Conclusion: This analysis indicated that although understanding of Chiropractic Care was limited by this population, all elderly participants shared positive perceptions of Chiropractic Care. A lack of language eloquence was observed when participants discussed Chiropractic terminology. New Chiropractic Care experiences have the potential to change the previous negative perceptions, while misinformation can be combated through patient education. Recommendation-based pursuit of Chiropractic Care is insufficient, and a focus on exposing new individuals to Chiropractic Care through alternative methods, such as community outreach, should be prioritised. The patient-centred approach in Chiropractic Care created a positive healthcare experience for the elderly individuals in this study. The elderly felt age had minimal impact on the Chiropractic Care they were provided, compared to the age based discrimination they experienced in the mainstream public sector. When the clinical care provided to the elderly is substandard, the negative perceptions of ageing and the ability to successfully access care are reinforced. Chiropractic care was viewed by the elderly as a superior healthcare alternative to the pharmacological and surgical options they were traditionally offered.Item The perceptions and experiences of Chiropractic Master’s students on practicing evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal(2023) Tayob, Tasmiya; Varatharajullu, DesireeEvidence-based practice (EBP) integrates the best available research evidence in conjunction with clinical expertise with the consideration of patient values. A well-trained clinician should pose clinically relevant questions and access the clinically relevant literature to find, appraise, and use the best valuable evidence in routine clinical care. Patients who receive evidence-based therapy have better outcomes in comparison to patients who do not. Globally, EBP is accepted as a basis of healthcare professional education, which was initially used in medicine, but now extends to allied health professions. In order to achieve the best patient outcomes, healthcare professions should effectively incorporate adequate knowledge, skills and attitudes towards EBP into education programmes. The implementation of EBP is regarded as a key competence for the improvement of healthcare quality. Numerous professions have implemented EBP, such as nursing, physiotherapy, occupational therapy, social care, pharmacy, physical therapy, dietetics, podiatry, radiography, orthotics, speech and hearing therapy, psychology and chiropractic. Evidence-based practice has had an increasing impact on chiropractic education and its implementation in chiropractic care. The importance of EBP is essential as its implementation is a requirement at the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC). Students are required to use EBP when managing and treating patients during their clinical practicum and, thus, it is essential that students are knowledgeable in EBP and know how to use it adequately. Aim of the study The aim of this study was determine the perceptions and experiences of registered Chiropractic Master’s students on the implementation of evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal, South Africa. Methodology This study utilised a qualitative, exploratory and descriptive design. Purposive sampling was used, interviewing 14 Chiropractic Master’s students who have been clinically active for more than four months at a chiropractic teaching clinic in KwaZulu-Natal. Their perceptions and experiences with regard to the implementation of EBP were obtained through semi-structured interviews, which consisted of three key questions, encouraged by relevant probes. The data collected were stored electronically and then transcribed verbatim. Thereafter, the transcripts were coded and analysed by the researcher in order to identify themes along with relevant subthemes. The coded data were then interpreted by the researcher using the previously identified themes and sub-themes. Results There were four main themes identified in this study, namely perceptions and necessity regarding the roles of EBP; undergraduate education and its role in the implementation of EBP; the importance of clinical experience in the implementation of EBP; and the implementation of EBP. Overall, students had a positive perception with regard to EBP with some students reporting limitations to its practice, along with positive perceptions. The students believed that the chiropractic training at the DUT CDC provided a solid foundation but a lack of training in multiple aspects was found. These aspects are discussed comprehensively, including the insufficient training in theoretical and clinical aspects, as well as for pre-clinical preparation. In addition, limitations and barriers were identified, as well as measures of improvement in order to enhance the implementation of EBP were suggested. Conclusion In South Africa, this study is the first to explore the perceptions and experiences of Chiropractic Master’s students on the practice of EBP at a teaching clinic in KwaZulu Natal. The perceptions and experiences were based on various aspects, such as knowledge, application, skills, proficiency, confidence, support structures, training and challenges. Although Chiropractic Master’s students had positive perceptions regarding the implementation of EBP and found the chiropractic training at the DUT to have provided a solid foundation, there were suggested methods of improvement for the chiropractic curriculum to enhance the implementation of EBP. A lack of undergraduate training regarding EBP was one of the key factors that students found to have hindered a more efficient practice of an evidence-based approach. Therefore, it is recommended that the findings of this study be of aid to the Durban University of Technology Chiropractic Department to enhance the quality of the chiropractic curriculum by re-evaluating the context in which the concept of an evidence-based approach was set out in order to encourage EBP by students and consider a different, more coherent method of implementation.Item Investigating the perceptions and experiences of parents and guardians regarding paediatric Homoeopathic care received from Homoeopaths in the eThekwini Municipality(2022-09-29) Strauss, Tylah; Hall, Cornelia Maria; Erwin, KiraBackground: Homoeopathy is a Complementary and Alternative Medicine (CAM) therapy that is based on the law of similars – “Let Likes be Cured by Likes" – whereby substances that are capable of causing diseases in healthy people can be used in an infinitesimal dose as remedies to treat the similar disorder in someone who is ill. Globally homoeopathy is receiving greater recognition nowadays, particularly for its use in children. This is a result of parents seeking out treatments which they believe to be more tailored and "natural". However, this same trend is not mirrored in a South African setting. Despite there being a greater recognition of homoeopathy, the research on homoeopathy in South Africa (especially paediatric homoeopathy) is scarce and overseas trends cannot be extrapolated to a South African population. Therefore, this study aimed to fill a gap in the literature by exploring and describing the perceptions and experiences of parents and legal guardians regarding paediatric homoeopathy care received from homoeopaths in the eThekwini Municipality. Objectives: The aim of the study was to investigate the perceptions and experiences of parents and legal guardians regarding paediatric homoeopathic care received from homoeopaths in the eThekwini Municipality. Methods: A qualitative study was conducted using semi-structured interviews. This study was conducted on 12 parents regarding paediatric homoeopathy care received from one of the homoeopaths in the eThekwini Municipality. The interviews began with a 'grand tour' question followed by other approved questions to gauge these perceptions and experiences. The interviews were conducted in English and later transcribed verbatim. The transcripts were analysed using Tesch's 8-step approach to qualitative research, whereby specific recurring themes are extracted from the data. Results: A total of 12 participants were interviewed. Four major themes emerged from the data: perceptions of homoeopathy, experiences of homoeopathy, challenges to homoeopathy and their possible solutions, homoeopathy versus allopathy, and an unplanned emergent theme of motherhood. The participants had varying levels of knowledge of homoeopathy depending on their level of connection (i.e. those with a close friend/relative who was in the profession had a better understanding). There were uniform perceptions of homoeopathy being "natural", "gentle", allusions to the law of similars and principle of the minimum dose, individualistic treatment and the stimulation of the vital force in order to allow the body to heal itself. Homoeopathic medication had perceptions of having no side-effects, having the ability to treat a wide array of conditions, and difficult dosages to adhere to. The overall experiences of homoeopathy were exceedingly positive. The participants commented on the thoroughness of the consult, the need for the practitioner to delve deep to find out the cause for the disease, the availability of the practitioner and the empathy and care felt. Awareness and education to the public, public access of OTC homoeopathic remedies, multi-disciplinary approach to paediatric management and integration into public healthcare proved to be the most beneficial solutions. When comparing homoeopathy to allopathy, we see that the homoeopathic holistic approach (whereby all symptoms are considered and there is an attempt to treat on more than just the physical plane) is preferred, there is a great mistrust with the pharmaceutical industry and participants wanted to be active participants in selecting which form of healthcare they chose. Mothers proved to be a valuable source in gaining awareness and mouth-to-mouth referral; their role in paediatric healthcare is paramount. Conclusion: Overall there were positive perceptions and experiences of homoeopathy, however, greater effort needs to be placed on education of the public, building relationships with other professionals and integration into public health care. Future studies should assess a wider catchment area, include quantitative research to get statistical evidence of efficacy, conduct in-person interviews to assure the quality of the data and include the role of mothers in future paediatric healthcare. Recommendations for the homoeopathic community include making information accessible to patients, increasing awareness of homoeopathy to the public and building inter-professional relationships and integrating into public healthcare.Item Patient management experiences of individuals attending a homoeopathic community health centre(2021-12-01) Mhlongo, Bukiwe Nothando Princess; Ngobese-Ngubane, Jabulile C.; Couchman, IngridDurban University of Technology (DUT) set up a homeopathic satellite centre in cooperation with Lifeline Ukuba Nesibindi Homeopathic Community Health Centre (UNHCHC) in 2004. UNHCHC is a centre for teaching students doing their Bachelor's and Master's degree in Technology in Homoeopathy. UNHCHC offers free primary services to patients by homeopathic students and is situated less than a kilometer away from DUT. Patient management at this facility involves the following: maintenance or improvement of health via the prevention, diagnosis and treatment of disease, illness, injury, and other physical and mental impairments. It also includes communication, empathy, examination, evaluation, prognosis, and intervention. This encompasses the interaction, from intake to discharge, between the patient and UNHCHC. Patient experience includes the range of interactions that patients have with the health care system, including their care through health plans, and from doctors, nurses and staff, physician practices, and other healthcare facilities. Hence it was vital that the experiences of patients attending this homeopathic community health centre be evaluated. The study that was conducted by Dube (2015) analyzing patients' perceptions of their first homeopathic consultation at the UNHCHC, respondents determined that the homeopathic consultation was rather different from what they were accustomed to. The difference that was noted by respondents included friendliness, professionalism, deep, thorough attentive case taking and physical examinations. In contrast, Ndlovu (2015) found that patients were dissatisfied with service delivery offered in public hospitals around iLembe Municipality in KwaZulu-Natal. This research was conducted to determine and compare differences in patient management in allopathic versus homeopathic consultations, including how patients were treated in each. Methodology An adaptation of a quantitative, descriptive, cross-sectional analysis was used to guide the study. A questionnaire with both closed- and open-ended questions was used to obtain data from 100 consenting participants. The participants must have had a consultation with a homeopath before answering the questionnaire. Participants attending UNHCHC for the first time had to wait until after a consultation in order to participate, while those arriving for follow up visits were able to participate before or after consultation. The data were encoded and entered by the researcher onto an Excel spreadsheet, and then imported into Excel® XP™ 2016 and SPSS® v25 for Windows™ for analysis. Results Data from this study indicate that there was a significant level of satisfaction with the following areas of homeopathic consultation: time management, consultation and level of hygiene. Patients also perceived homeopathic medicine as safer, with less side-effects and more easily available than allopathic medication. The data also showed a high level of dissatisfaction with services rendered by public hospitals and clinics compared to those rendered by UNHCHC. The majority (91%) of patients said that given the option, they would consult with homeopaths, and would like homeopathy to be integrated into the public health sector. Of the participants, 81% said they would like homeopathy to be integrated into the public healthcare sector as this would help alleviate the pressure faced by this sector, especially regarding the shortage of doctors.