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Faculty of Health Sciences

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    The knowledge, attitudes and perceptions of qualified chiropractors and physiotherapists in South Africa regarding the other professional practice
    (2022) Ravidutt, Micaela; Maharaj, Sonill Sooknunan; Prince, Cleo
    Chiropractors and physiotherapists treat patients that present with similar conditions. Arising from this, a sense of competition is perceived between these professionals, as both professions use similar methods of treatment when providing care to their patients. However, chiropractors and physiotherapists may belong to different health paradigms which influences how each profession approaches patient management. There is also an overlap between the roles of each profession in providing healthcare, as the methods of managing patients seem to be similar. This requires an investigation into the knowledge, attitudes and perceptions of qualified chiropractors and physiotherapists in South Africa regarding the other professional practice. This could potentially determine possible misconceptions and myths that the two professions have of each other’s practice. If identified and corrected, this could influence awareness within a multidisciplinary setting to enhance and promote holistic patient-centred care. Aim The aim of this study was to determine the knowledge, attitudes and perceptions of qualified chiropractors and physiotherapists in South Africa regarding the other professional practice. Methodology The research conducted was a quantitative study with a descriptive design which targeted qualified chiropractors and physiotherapists in South Africa. The research tool was an online questionnaire administered through an online platform named the QuestionPro Survey, which included questions and statements relating to the knowledge, attitudes and perceptions of the two professions regarding the other professional practice to meet the objectives of the study. The minimum sample size required for this study comprised of 116 chiropractors and 128 physiotherapists. The data obtained from each group were analysed separately and then a comparative analysis was done. An alpha value of 0.05 and a margin of error of 0.085 were assumed. Results Chiropractors and physiotherapists in South Africa generally demonstrated good knowledge, positive attitudes, and positive perceptions toward the other profession. Both professions were familiar with the other profession’s scope of practice. Chiropractors achieved a mean knowledge score of 75.7%, whereas physiotherapists obtained 59.7% on their knowledge of the examinations performed by the other profession. Chiropractors obtained an average score of 85.3% and physiotherapists achieved 72.0% on their knowledge of the treatment modalities that the other profession may perform for a patient. Both professions had good knowledge about the conditions that the other profession may treat, with chiropractors having achieved a mean knowledge score of 82.4% and physiotherapists having obtained a score of 77.3%. A total of 75.0% of chiropractors and 72.1% of physiotherapists considered the other profession to be competent in examining neuromusculoskeletal conditions. More chiropractors (82.8%) than physiotherapists (70.0%) believed the other profession to be competent in treating neuromusculoskeletal conditions. Each profession acknowledged the role of the other profession within the South African healthcare system. Of the sampled professions, 81.9% of chiropractors and 55.3% of physiotherapists had referred patients to the other profession. It was found that 69.8% of chiropractors, compared to 32.1% of physiotherapists, had patients referred to them by the other profession. A total of 69.0% of chiropractors and 55.3% of physiotherapists were in agreement that they would like to work closely with the other profession. Conclusion In South Africa, chiropractors and physiotherapists had good knowledge and positive attitudes and perceptions of each other’s practices. There also appeared to be a referral relationship between these professions. However, the challenges between the professions were limited and there was insufficient inter-professional awareness and exposure when practicing within the different health paradigms. Therefore, inter-professional education between chiropractors and physiotherapists of their practices as part of the university curriculum within a multidisciplinary team should be enhanced and encouraged. This would enhance and encourage inter-professional relationships between the two professions, thus promoting the delivery of holistic patient-centred care.
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    Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy
    (National Inquiry Services Center (NISC), 2018-03) Ngwenya, Nothando; Gumede, Dumile; Shahmanesh, Maryam; McGrath, Nuala; Grant, Alison; Seeley, Janet
    Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesion and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful.
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    An exploration of patient perception of the aesthetic presentation and physical characteristics of homeopathic medicine
    (2022-05-13) Nengovhela, Muphulusi; Alwar, Vanishree; Maharaj, Madhueshwaree
    Background The British Homeopathic Association (2020) claims that homeopathy is a natural form of medicine used by over 200 million people across the globe to treat both acute and chronic conditions. It is based on a principle known as like cures like, which simply means that a substance that can produce symptoms of disease when administered in a healthy individual, can be given in a minimal dose to treat the same symptoms in the diseased individual (Burns and Burns 2002). Homeopathy was discovered in the 1800s by the German physician Dr. Samuel Hahnemann. Hahnemann homeopathically prepared remedies in different physical forms (liquid, solid, and semi-solid form) and dispensed and stored them in a neutral brown glass bottle (Kayne 2006). In the present day, various forms of homeopathic medicines are dispensed to patients in different types of aesthetic presentations and in different colours. However, there is a lack of studies aimed to explore patients' perception of the aesthetic presentation and physical characteristics of homeopathic medicine. Aim of the study This study aimed to explore the patient perception of the aesthetic presentation and physical characteristics of homeopathic medicine. Methodology A qualitative, explorative, and descriptive design was employed. A convenience sampling method was used. Twelve semi-structured interviews were conducted at the DUT main homeopathic community health centre (HCHC) and one selected homeopathic private practice. Data collection took place until a point of saturation was reached, but three additional participants were recruited after this point to confirm data saturation.Data were analysed using thematic analysis guided by Tesch’s eight steps of data analysis (Tesch 1990 cited in Creswell 2009). Results Patients' perceptions regarding the aesthetic presentation and the physical characteristics of homeopathic medicine were grouped into four major themes and several subthemes. The four major themes were: package appearance, package preference, physical characteristics and medium type preference. These themes emerged from homeopathic patients' responses. Participants discussed the appearance of the packages and expressed perception with regard to the sizes, shapes, colours and the lids of the packages. Dissatisfaction regarding the paper packages, the breakability of glass packages and the impact of plastic packages on land pollution were discussed by the majority of the participants. Amber bottles and glass vials were the most preferred packaging for medication by participants. Regarding the physical characteristics of the homeopathic medicine, participants outlined the challenges they encounter while swallowing pills. Homeopathic medications were perceived as tasting sweet, too sweet and bitter. Participants were unhappy with the powder medications as it was perceived by them that powder forms do not exert any therapeutic effect and it was also expressed that they were unfamiliar with granule forms of medications. Conclusion This study explores patients' perception of the aesthetic presentation and the physical characteristics of homeopathic medicine. Feedback regarding the types of medicine and packaging was discussed. Dissatisfaction with some of the packaging and physical characteristics of homeopathic medicines was expressed by the participants, but participants also provided constructive feedback on the areas needing improvement. The main recommendation is that the paper packages used for packaging powders should be replaced with plastic packaging.
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    A model for the integration of homeopathy into the public healthcare system in the province of KwaZulu-Natal, South Africa
    (2020-06-10) Majola, Sindile Fortunate; Nkosi, P. B.
    Background The public healthcare system in South Africa services the majority of its population, as many are unable to afford the services that exist in the private sector. Due to this momentous task of servicing millions of South Africans, the public sector has become overburdened with many issues. Some of the issues that plague this sector include a lack of resources, insufficiency of personnel and financial constraints due to over-usage. Based on this context, the introduction of complementary alternative medicine, such as homoeopathy, into the public healthcare system exists as one of the potential resolutions to this burdened healthcare sector. Aim The aim of the study was to gather data, both descriptive and statistical, from healthcare professionals in KZN in order to develop a model for integrating homoeopathy into the public healthcare system. Methodology The researcher conducted a mixed methods study using an explanatory sequential design. Thus, the study was conducted in two Phases. Phase 1 employed quantitative measurement tools, where data was collected from medical doctors, nurses and homoeopaths through paper-and-pen/ electronic surveys. This data was analysed using version 25 of the SPSS software. Phase 2 incorporated measurement tools, where data was collected from Chief Operating Officers as well as nursing managers through semi-structured interviews. This data was analysed using Tesch’s eight steps of data analysis. The data from both phases was then compared and contrasted to formulate a model for integration. Findings Based on the current circumstances that exist in South Africa, it was established from the results of the study that the integration of homoeopathy into the public healthcare system would be complex in nature, due to the changes that would need to be made in both the public and private sectors. Albeit a model of integration was developed, based on the limitations identified in this study, further research needs to be conducted to investigate this phenomenon.
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    A comparison of the perceptions, use and barriers to evidence based practice by chiropractors and general practitioners in the eThekwini municipality
    (2018) Koekemoer, Caitlyn; O'Connor, Laura; Padayachy, Keseri
    Background: Medicine was the first profession to embrace evidence-based practice (EBP) and has subsequently been the leading profession with its implementation. Many other healthcare professions, including chiropractic, have since embraced the EBP movement. Despite this acceptance, many practitioners report difficulty implementing it into practice. This study aimed to compare the perceptions, use and barriers to EBP by chiropractors and general practitioners (GPs) in private practice within the eThekwini municipality. Method: The study utilised a quantitative paradigm and a cross-sectional descriptive survey design. Once the Durban University of Technology (DUT) Institutional Research Ethics Committee (IREC) approval was obtained, chiropractors (n = 101) and GPs (n = 289) in private practice within the eThekwini municipality were invited to participate. A pre- validated questionnaire and letter of information and consent were administered by electronic mail or hand delivery. The data was analysed using SPSS Version 24.0, (IBM, Armonk NY, U.S.A.) and Statgraphics Centurion (Statgraphics Technologies Inc, Warrenton, Virginia, U.S.A.). A p-value <0.05 was considered as statistically significant. Descriptive and inferential statistics such as cross-tabulations, chi-squared and fisher‘s exact tests were utilised. Results: A 50.5% (n = 51) response rate from the chiropractor respondents and 50.9% (n = 147) with regards to the GP respondents was achieved with respondents having an overall positive perception of EBP, its necessity, use and benefit in patient care. The respondents also displayed a willingness to adopt and improve their use of and skills in EBP. The GP respondents‘ perceptions were more favourable towards the necessity of the application of EBP and the use of literature and research findings in daily practice when compared to those of the chiropractic respondents. The majority of respondents from both professions reported to read and use scientific literature and databases on a regular basis. Most of the GP respondents read scientific literature two to five times per week, while less than half of the chiropractic respondents reported to do the same. The greatest barrier to the use of EBP reported by both professions was insufficient time with significantly more GPs than chiropractors reporting it as their top barrier. Inability of the professional to generalise literature findings to their patient population and inability of the professional to apply research findings to individual patients with unique characteristics were the next main barriers experienced by both professions. Significantly more chiropractic than GP respondents ranked their inability to apply research findings to individual patients with unique characteristics as their top barrier to EBP. Lastly, significantly more chiropractic than GP respondents ranked a lack of collective support among their colleagues in their facility as their greatest barrier to EBP. Conclusion and Recommendations: Both professions were found to have a positive perception of EBP and to be utilising scientific literature and databases regularly. A lack of time was the greatest barrier to the use of EBP, a finding similar to studies conducted with other healthcare professionals. Mechanisms need to be developed to aid practitioners to make time for EBP.
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    Knowledge, understanding and perception of parents towards the utilization of chiropractic treatment for paediatric patients in the Durban Metropolitan area
    (2016) Cawood, Hughnique; Basson, Petro Magdalena; Maharaj, Praveena
    INTRODUCTION: The utilization of complementary and alternative medicine (CAM) in the treatment of paediatric patients is increasing, especially the utilization of chiropractic treatment for children. However controversy exists regarding the reasons why parents may or may not choose to utilize chiropractic treatment for children. Parents are the gatekeepers to care as they consent to all treatment that is given to their children. Parents that have a lack of knowledge and understanding regarding chiropractic, as well as a negative perception regarding chiropractic treatment for children may be reluctant to choose chiropractic treatment as a treatment option. Both positive and negative opinions regarding chiropractic treatment have been identified in other populations in South Africa which emphasizes the need to explore the way parents feel about chiropractic treatment for children. A lack of knowledge and understanding of CAM has been identified as a reason for underutilization. Insight into the status of knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients in the Durban Metropolitan Area equips the profession to better understand how parents view chiropractic treatment for children. AIMS AND OBJECTIVES: The main aim of this research was to explore and describe the knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients. The outcomes of such a study can provide useful information which can serve as a baseline from which education and chiropractic treatment awareness can be built, as well as dispelling any misconceptions and myths regarding chiropractic treatment for children. RESEARCH DESIGN: An explorative, descriptive, qualitative research design was followed in this research. This research design was chosen in order to evaluate the knowledge, understanding and perception of parents regarding the utilization of chiropractic treatment for paediatric patients, within the Durban Metropolitan area. RESEARCH METHODOLOGY: Semi-structured interviews were conducted with participants of the Durban Metropolitan Area in order to determine the current knowledge, understanding and perception of parents regarding chiropractic treatment for paediatric patients within this area. Interviews were conducted with the participants until saturation was met, after which an additional five interviews were conducted. A total of 13 interviews were analyzed. The data was transcribed and coded by the researcher as well as a co-coder. NVivo software was utilized for the coding process. RESULTS: It was found that the participants had a lack of knowledge and understanding regarding chiropractic treatment for children. The participants felt that this lack of knowledge and understanding of chiropractic treatment for children left them unsure, resulting in the non-use of this form of treatment for their children. The participants were however not opposed to the utilization of chiropractic treatment for children; they felt fear and concern regarding chiropractic treatment as they felt they were uneducated regarding the outcome of the treatment, what the treatment would involve and the reasons why chiropractic treatment should be utilized for children. The participants mentioned that if they had increased knowledge and understanding they would feel more comfortable in utilizing chiropractic treatment for their children. The participants felt that they did not have the resources to learn more about chiropractic treatment and they showed interest in learning more about chiropractic treatment for children. Recommendations were made for further research and for the chiropractic profession regarding increasing the knowledge and understanding of parents regarding chiropractic treatment.
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    A study to explore the perceptions that South African chiropractors have regarding the perceived role and impact of research within the profession
    (2012) Gordon, Julani; Korporaal, Charmaine Maria
    The Chiropractic profession has made significant progress with regard to the production of high quality and clinically relevant research in the last 20 years. This correlates with a spike in development within the chiropractic profession as well as its acceptance by the medical fraternity and public. The responsibility for continuing this positive trend is dependent on the chiropractic graduates and practitioners of the future. Therefore, it is important to establish the current perceptions and utilization of research by Chiropractors, so that future research can be built around the needs and requirements of today’s practitioners, thereby ensuring the profession’s continued development and future in health care. The aim of this study was to determine the perceptions that Chiropractors have of research and its relevance / utilization in practice. Method: The study was a quantitative questionnaire based, self administered survey. The sample group included all Chiropractic practitioners currently practising in South Africa (N=515). Results: There was a response rate of 35% (n=174). The results indicated that the perception of research was very positive overall, with the strongest positive response being that research adds credibility to the profession. However, most respondents disagreed with the statement that chiropractors who had done research had an advantage above those who had not. There was a positive, albeit weak correlation between perceptions and utilization of research, indicating that as perceptions increased, so did utilization of research. The area of greatest concern was that even though a high degree of research utilization was reported by chiropractors, research was least likely to be used to change conditions, policies or practices in practice. v Conclusion: The most significant factors associated with positive perceptions and utilization were found to be publishing in a journal and receiving referrals from other health care practitioners. Chiropractors who indicated an interest in doing research again were also very positively linked to utilization. It would seem that even though chiropractors perceive research positively, their implementation into practice has some hurdles that impede the full integration of research into practice. As very few demographic and personal attributes of the South African chiropractor were found to be primarily responsible for low utilization of research in practice, it can be hypothesised that the factors impeding research implementation are most likely environmental in nature.
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    A survey to determine the knowledge and perceptions of biokineticists with respect to the chiropractic profession
    (2008) Naidoo, Magashri; Korporaal, Charmaine Maria
    Objective: To determine the current knowledge and perceptions of biokineticists with respect to the chiropractic profession in South Africa. Design: A descriptive design was utilized in a qualitative questionnaire in order to evaluate, in a structured manner, the knowledge and perceptions of biokineticists with respect to Chiropractic. Subjects: The total population size used in the study was 657 (response rate n=78; 11.87%). Outcome Measures: These were based on a questionnaire which addressed biokineticists knowledge of Chiropractic, interaction with Chiropractic, Chiropractic terminology and scope of Chiropractic practice. Results: Of the 657 questionnaires that were mailed, only 78 questionnaires were returned and this gave a response rate of 11.87%. The most frequent view or attitude towards chiropractic was that it had a valuable role in the health care system (64%). About 50% of the respondents believed chiropractors to be greatly competent in examination and diagnosis whilst 40% felt that chiropractors were moderately competent in examination and diagnosis. Nevertheless, the rate of communication between biokineticists and chiropractors was found to be quite high, in this study. All together, 67% of biokineticists had communicated with chiropractors. Of those that had communicated, the communication was rated as positive (94.4%). Of those who had referred patients to chiropractors, 41.8% had received treatment feedback reports and of those who had received reports, 68.8% said they were concise and valuable. Conclusion: The results of this study show that the mean knowledge score was 60%. Thus the overall knowledge of chiropractic was high. The only factor that significantly affected respondents’ knowledge was their self reported knowledge of chiropractic. In congruence with this, the most common attitude towards chiropractic was that it had a valuable role to play in the health care system (64%).
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    A study to determine the perceptions, attitudes and knowledge of selected South African pharmacists on the chiropractic profession
    (2008) Palmer, David Craig
    Pharmacists are seen as a trustworthy source of advice and information to many people. Their accessibility, approachability and availability enable them numerous opportunities to offer health education and advice in an informal environment. Patient use of and demand for complementary and alternative practitioners including chiropractors, continues to increase, however there have been no studies to determine the extent of the pharmacists knowledge and perceptions/attitudes towards these alternative practitioners. Thus the purpose of this study was to determine the current perceptions, attitudes and knowledge of selected South African pharmacists with respect to the chiropractic profession. This will provide a basis for future studies, as well as a knowledge base to facilitate greater understanding and co-operation between pharmacists and chiropractors.
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    An exploratory mixed-methods study to determine factors which may affect satisfaction levels of patients outside of a clinical setting
    (2007) Talmage, Grant L.; Korporaal, Charmaine Maria
    It has been shown that patient satisfaction evaluation is an excellent tool that may be used to determine whether practitioner services are meeting the needs of the general public. Furthermore, it has been observed that patients who were satisfied with their treatment behave differently to those who were dissatisfied with their levels of care, as patient’s who were satisfied with their levels of treatment are more likely to be compliant with their treatment regime and more likely to seek out similar care for the same condition in the future. With satisfaction having such an affect on patient’s behaviour toward practitioners and the treatment experience outcomes, it is imperative to understand the underlying factors that may affect the levels of satisfaction.