Faculty of Health Sciences
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Item Exploring the interrelationships between physical function, functional exercise capacity, and exercise self-efficacy in persons living with HIV(SAGE Publications, 2024) Nokes, Kathleen M.; Sokhela, Dudu G.; Orton, Penelope Margaret; Samuels, William Ellery; Phillips, J. Craig; Tufts, Kimberly Adams; Perazzo, Joseph D.; Chaiphibalsarisdi, Puangtip; Portillo, Carmen; Schnall, Rebecca; Hamilton, Mary Jane; Dawson-Rose, Carol; Webel, Allison R.While physical activity can mitigate the metabolic effects of HIV disease and HIV medications, many HIV-infected persons report low levels of physical activity. Purpose: To determine if there were differences between the subjective and objective assessments of physical activity while controlling for sociodemographic, anthropometric, and clinical characteristics. Setting/sample: A total of 810 participants across eight sites located in three countries. Measures: Subjective instruments were the two subscales of Self-efficacy for Exercise Behaviors Scale: Making Time for Exercise and Resisting Relapse and Patient-Reported Outcomes Measurement Information System, which measured physical function. The objective measure of functional exercise capacity was the 6-minute Walk Test. Analysis: Both univariate and multivariant analyses were used. Results: Physical function was significantly associated with Making Time for Exercise (β = 1.76, p = .039) but not with Resisting Relapse (β = 1.16, p = .168). Age (β = −1.88, p = .001), being employed (β = 16.19, p < .001) and race (βs = 13.84–31.98, p < .001), hip–waist ratio (β = −2.18, p < .001), and comorbidities (β = 7.31, p < .001) were significant predictors of physical functioning. The model predicting physical function accounted for a large amount of variance (adjusted R2 = .938). The patterns of results predicting functional exercise capacity were similar. Making Time for Exercise self-efficacy scores significantly predicted functional exercise capacity (β = 0.14, p = .029), and Resisting Relapse scores again did not (β = −0.10, p = .120). Among the covariates, age (β = −0.16, p < .001), gender (β = −0.43, p < .001), education (β = 0.08, p = .026), and hip–waist ratio (β = 0.09, p = .034) were significant. This model did not account for much of the overall variance in the data (adjusted R2 = .081). We found a modest significant relationship between physical function and functional exercise capacity ( r = 0.27). Conclusions: Making Time for Exercise Self-efficacy was more significant than Resisting Relapse for both physical function and functional exercise capacity. Interventions to promote achievement of physical activity need to use multiple measurement strategies.Item Exploring intersectionality and HIV stigma in persons receiving HIV care in nurse-led public clinics in Durban, South Africa(Elsevier BV, 2023) Sokhela, Dudu Gloria; Orton, Penelope Margaret; Nokes, Kathleen M.; Samuels, William E.Background: Although stigma associated with South African people living with HIV has declined since the 1980s when HIV/AIDS was first identified, it still persists. Stigma is associated with poor health outcomes and avoidance of interactions with healthcare systems. The HIV stigma framework distinguishes three HIV-related self-stigma mechanisms. Aims: The aims of this study were to explore intersectionality between HIV-stigma mechanisms and selected sociodemographic as well as HIV factors, and interrelationships between three HIV-related self-stigma mechanisms. Setting and method: This study was a secondary analysis of data collected from a cross-sectional sample of people receiving HIV-related primary health care at different municipal clinics in Durban, South Africa (N = 100). Results: The average participant was Black African, female, unemployed, with a monthly income below R2 500, most had completed primary school. No sociodemographic or HIV-related factors were significantly related to total or subscale HIV stigma scores. Respondents reported experiencing (enacted) no stigmatization, did not expect to experience (anticipated) much stigmatization from their social interactions with family, community, healthcareworkers, and reported no strong stigmatizing beliefs about themselves (internalized). Conclusion: Intersectionality did not identify any particular socio-demographic or HIV-related factor associated with greater HIV stigma. Participants reported low HIV stigma arising from interactions with healthcare and social service providers or families. Although no socio-demographic or HIV-related factors were significantly associated with HIV stigma mechanisms in this relatively homogeneous sample, being marginalized can nevertheless result from living with other differences compared to societal norms and result in particular vulnerability when living with HIV/AIDS.Item Factors related to functional exercise capacity amongst people with HIV in Durban, South Africa(AOSIS, 2021-04-29) Orton, Penelope Margaret; Sokhela, Dudu Gloria; Nokes, Kathleen M.; Perazzo, Joseph D.; Webel, Allison R.BackgroundPeople with HIV (PWH), who engage in regular physical activity, have improved fitness, muscular strength, body composition, health-related quality of life and mental health symptoms, but PWH have amongst the lowest physical activity levels of those with any chronic health condition. Furthermore, there is scant evidence examining these relationships in PWH in Africa.Aim
To address these critical gaps, this cross-sectional descriptive research study examined the relationships between demographic, HIV-related, anthropometric factors, neighbourhood walkability and physical activity, amongst PWH in Durban, South Africa.Setting
Respondents (N = 100) were receiving primary healthcare in six eThekwini nurse-run municipal clinics.Methods
Self-reported socio-demographic data were collected, and HIV-related medical data were extracted from respondent's medical charts. Height and weight were measured to calculate the body mass index (BMI, kg/m2); neighbourhood walkability was measured on the Neighbourhood Environment scale; and physical activity, specifically functional exercise capacity, was measured by the 6-min walk test (6MWT).Results
On average, respondents were black African, female, approximately 38 years old and unemployed; men were of normal weight whilst women were overweight. Only 65% of the respondents reached the age- and sex-predicted distance during the 6MWT. Correlational analyses did not reveal any significant relationships between the functional exercise capacity and socio-demographic, HIV-related factors or anthropometric measures.Conclusion
South African PWH do not reach their predicated walking distance on the 6MWT. Engaging community agencies to promote walking as both a means of transportation and leisure physical activity may decrease the risks of a sedentary lifestyle and improve progression towards recommended physical activity targets.Item Creating an instrument to measure perceptions about access to health-related higher education programmes in South Africa(Stellenbosch University, 2020-12-04) Orton, Penelope Margaret; Essack, Sabhia; Nokes, Kathleen M.; Brysiewicz, PetraBackground: The South African government has created countless policies that support the need to admit and graduate students who had been excluded from health-science programmes in higher education settings during the apartheid era. Objective: to develop a questionnaire that could be used by various stakeholders to obtain their perceptions about access to health sciences education in higher education settings. Method: A mixed methods design was used; the qualitative stage allowed for the identification of themes while the quantitative stage used measurement theory, to develop an instrument based on those themes. Results: The overarching theme was Achieving equity of access for success is multi-factorial and has diverse & complex challenges and eight sub-themes emerged which were used to create a 17-item questionnaire that has good content validity and reliability (Cronbach alpha=.767). Conclusion: Further psychometric testing with larger, more diverse samples will result in a refined instrument that can be administered to various stakeholder groups, such as current and potential health sciences students and faculties, and used in programme evaluation. Health science programmes can use the instrument to measure access within different disciplines and possible changes over time as innovations are piloted. Different health sciences programmes can be compared and contrasted and objective data can be used to make systematic organizational changes.Item Perceptions of the use of technology in a blended learning occupational health nursing programme in Durban, South Africa(Technique (Pty) Ltd, 2015-05) Orton, Penelope Margaret; Nokes, Kathleen M.; Scott, P. J.; Hickey, D. E.Blended learning refers to an educational strategy that combines face-to-face classroom instruction with on-line learning. This teaching strategy was introduced into an occupational health nursing (OHN) programme at the Durban University of Technology in 2011. Because computer literacy might be a challenge for mature nursing students, a programme evaluation using a mixed method design was conducted to assess perceptions of the blended learning programme. Both quantitative data from cohorts of fi rst and second year OHN students and qualitative data from all of the lecturers teaching in the programme were collected. Computer anxiety was signifi -cantly higher for fi rst-year students compared to second-year students (p< 0.001). Lecturers also indicated barri-ers to using on-line technology for teaching. Interventions need to be developed to decrease computer anxiety.Item Perceptions of facilitators using case-based educational strategies in a nursing management decentralized program in South Africa(Post Academic Publications, 2013-06) Nkosi, Zethu; Pillay, Padmini; Nokes, Kathleen M.Background: Case-based education has a long history in the disciplines of education, business, law and the health professions. Research suggests that students who learn via a case-based method have advanced critical thinking skills and a greater ability for application of knowledge in practice. In medical education, case-based methodology is widely used to facilitate knowledge transfer from theoretical knowledge to application in patient care. Nursing education has also adopted case-based methodology to enhance learner outcomes and critical thinking. Objectives: The objective of this study was to explore the perceptions of case-based facilitators in a decentralised nursing management education program located in Durban, South Africa. Methods: This descriptive, exploratory study used focus groups to examine perceptions of facilitators (N=15) using case-based education in a nursing management program. Results: The average facilitator was female, between 41 and 50 years of age, working part-time, educated with a baccalaureate degree, working as a professional nurse between 11 and 20 years, and slightly more than half had worked as a facilitator 3 or more years. The three major themes emerged were related to the student learners, the learning environment, and using facilitation to teach the programme. Conclusion: Decentralised nursing management educational programs can meet the needs of nurses who are located in remote areas which are characterised by poor transportation patterns and limited resources and have great need for quality healthcare services.Item Introduction of a blended teaching strategy in an occupational health nursing education programme(Occupational Health Southern Africa, 2012-09) Orton, Penelope Margaret; Nokes, Kathleen M.The purpose of this case study is to describe the use of a blended learning strategy to address some of the challenges experienced by adult nursing students in a specialised occupational health nursing course. These students are generally employed on a full-time basis and have a number of competing responsibilities that may impact on their studies. Blended learning using e-learning and face-to-face problem-based learning was identi- fied as a useful educational strategy to address some of the challenges faced by these students in furthering their education. A blended learning strategy addresses the main assumptions of adult education, including self-directed learning, experience as a resource for learning, readiness to learn, problem-centred orientation with immediacy of application, and internal motivation. This educational strategy is recommended for adult learners and a formal evaluation of this blended learning method is planned.Item Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa(AOSIS, 2013-07-05) Sokhela, Dudu Gloria; Makhanya, Jabulile Nonhlanhla; Sibiya, Maureen Nokuthula; Nokes, Kathleen M.Background: Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service. Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Conclusion: Effective health communication strategies contribute to positive experiences by health care users and these can be effected by: (1) involvement of health care providers in planning the construction of health facilities to give input about patient flow, infection prevention and control and provision of privacy, (2) effective complaints mechanisms for users to ensure that complaints are followed up and (3)encouraging users to arrive at the facility throughout the day, rather than the present practice where all users arrive at the clinic early in the morning.