African
Journals Online
Health SA Gesondheid : interdisciplinary research journal
Volume 6, Issue 4, December 2001
Community participation in clinical health research - a new
research Paradigm
Frohlich, J.Botes, A.Muller, M.
3-13
Abstract: The idea of community participation in health
and research can be found in all major international and national
declarations, including South Africa. Researchers are no longer
perceived as having the right to exercise monopoly on conducting
and explaining their research, but are perceived to have a duty
to empower the research participants and the community to
understand their own situation and become a collaborative partner
in the research process. In an emerging democratic South Africa
there has been a shift from paternalism to recognition of the
right to information and autonomy and it is within this framework
where the day-to-day realities of clinical health research are
confronted. Representatives of relevant local communities should
be full participants in planning, implementing and overseeing
research in health care. The purpose of this review article is to
explore and describe the notion of community participation in
clinical health research, the complexities and challenges thereof
and the paradigm shift of closing the gap between theory and
practice, researcher and community in clinical health research. A
new research paradigm is described to accommodate the principles
of community participation. It is recommended that a perception
survey be conducted among various role-players/stakeholders on
their understanding and expectations in relation to community
participation in clinical health research, the development of a
model and the formulation of standards in this regard.
Gemeenskapsbetrokkenheid in gesondheid en in navorsing word
internasionaal en nasionaal, insluitende Suid-Afrika, in verskeie
verklarings van voorneme gereflekteer. Navorsers het nie meer die
reg om 'n monopolie oor die uitvoering en verduideliking van hul
navorsing te handhaaf nie, maar het 'n plig om die deelnemers aan
navorsing en die gemeenskap te bemagtig om hul eie rol in
navorsing te verstaan ten einde 'n gelykwaardige deelnemer in die
navorsingsproses te wees. Te midde van 'n ontwikkelende
Suid-Afrikaanse demokrasie, is daar 'n verskuiwing vanaf
paternalisme na die erkenning van die reg tot inligting en
outonomie. Binne hierdie raamwerk word die dag-tot-dag realiteite
van navorsing ook gekonfronteer. Verteenwoordigers van relevante
plaaslike gemeenskappe behoort volle deelnemers in die
beplanning, implementering en monitering van navorsing in
gesondheidsorg te wees. Die doel met hierdie artikel is om die
verskynsel van gemeenskapsbetrokkenheid in kliniese navorsing te
verken en te beskryf, insluitende die kompleksiteite en
uitdagings daaraan verbonde en die paradigmaskuif wat benodig
word om die gaping tussen die teorie en praktyk, navorsing en
gemeenskap in kliniese navorsing aan te spreek. 'n Nuwe paradigma
om die beginsels van gemeenskapsbetrokkenheid in kliniese
navorsing te akkomodeer, word beskryf. Daar word aanbeveel dat 'n
persepsie-opname uitgevoer word om die rolspelers se begrip en
verwagtinge ten opsigte van gemeenskapsdeelname in kliniese
navorsing te ondersoek en om 'n model vir gemeenskaps-deelname in
kliniese navorsing te ontwikkel.
Synergy between indigenous knowledge systems, modern health
care system and scientific research - a vision for the 21st
century
Mulaudzi, F.M.
14-20
Abstract: Research already conducted in African countries
indicates that the majority of patients still seek help from the
traditional indigenous health care systems. This is an indication
that, to achieve the goals of Health Care for All in the 21 st
century, there is a need to acknowledge the role played by
indigenous health practitioners as well as those practising
complementary health care methods.
The aim of the theme "African renaissance" is to focus
on the renewal of African roots, which in health care is without
doubt the indigenous health care methods. Although the government
has already put in place mechanisms to accommodate this field of
health practice, some critics still feel that the methods for
diagnosis, treatment, medication as well as the training and
certification are not scientific enough. It is therefore eminent
that sustainable health care development that can benefit all the
people of this country should harness a synergy between
indigenous health care systems, scientific research and modern
health care methods. This article attempts to address the
historical evolution of health care methods in South Africa, its
effect on the community as well as challenges facing the health
professions.
Navorsing wat reeds in Afrikalande onderneem is, dui aan dat die
meerderheid pasiënte steeds hulp soek vanaf die tradisioneel
inheemse gesondheidsorgsisteme. Dit dien as aanduiding dat, ten
einde die doelwitte van Gesondheidsorg vir Almal in die 21ste eeu
te bereik, daar 'n behoefte is om die rol wat inheemse
gesondheidsorgpraktisyns speel, te erken. Dieselfde geld vir
diegene wat komplimentêre gesondheidsorg metodes beoefen.
Die doelwit van die tema "Africa Rennaissance" is om te
fokus op die herlewing van Afrika wortels, wat in die
gesondheidsorg gewis dui op inheemse gesondheidsorgmetodes.
Alhoewel die regering reeds meganismes ingestel het om hierdie
veld van gesondheidsorgpraktyke te akkomodeer, is sekere kritici
steeds van mening dat die metodes wat aangewend word vir
diagnose, behandeling, medikasie sowel as opleiding en
sertifisering, wetenskaplik nie voldoende is nie. Dit is daarom
eminent dat ten einde gesondheidsorgontwikkeling vol te hou tot
voordeel van al die mense in hierdie land, dit nodig is om die
sinergieë wat bestaan tussen inheemse gesondheidsorgsisteme,
wetenskaplike navorsing en moderne gesondheidsorgmetodes, met
mekaar in te weef. Hierdie artikel poog om die historiese
evolusie van gesondheidsorgmetodes in ons land, die effek daarvan
op die gemeenskap, sowel as die uitdagings wat die
gesondheidsorgprofessies in die gesig staar, aan te spreek.
Standards for nursing agencies in South Africa
Muller, M.
21-36
Abstract: The purpose with this research is to formulate
standards for nursing agencies in South Africa. The researcher
was approached by the Association of Nursing Agencies in South
Africa (ANASA) to assist them with the development of a
quality/accreditation programme for nursing agencies. An
exploratory and descriptive quantitative research design was
employed. A structured two-phase model was utilised consisting of
a developmental and a quantification phase for the development of
standards and criteria. A series of four workshops were held
during which a framework for the standards was developed, draft
standards were formulated, refined and exposed to a
quantification phase where the Content Validity Index (CVI) of
the standards and criteria were determined in relation to
relevance, clarity and implementation in reality. The
representatives at these workshops consisted of nursing agency
managers (N=22) who hold membership with ANASA and attended their
meetings. A high CVI rating was obtained with regard to the
relevance and clarity of the standards and criteria. Some
standards and many criteria are not yet being implemented in the
nursing agencies resulting in a lower CVI rating in this regard.
The final set of standards was exposed to a group of stakeholders
for final validation purposes, by means of sufficient consensus
debate. The standards and criteria were reflected in an
evaluation guide/instrument and pilot tested by means of a moc
survey in a nursing agency in Gauteng. It is recommended that
these standards and criteria, as reflected by means of an
evaluation guide, be utilised by the nursing agencies and that
the South African Nursing Council use them for licensing and
continuous accreditation of nursing agencies in South Africa. Due
to the fact that the participants were ANASA members, other
nursing agencies were excluded and national representation of the
participants/validators can therefore not be claimed.
Die doel met hierdie navorsing is om standaarde vir
verpleegagentskappe in Suid-Afrika te formuleer. Die navorser is
deur die vereniging van verpleegagentskappe in Suid-Afrika
(Association of Nursing Agencies in South Africa: ANASA) genader
om hulle behulpsaam te wees met die ontwikkeling van 'n gehalte/
akkrediteringsprogram vir verpleegagentskappe. 'n Verkennende,
beskrywende kwantitatiewe navorsingsontwerp is nagevolg. 'n
Gestruktureerde twee-fase model is benut, bestaande uit 'n
ontwikkelings-en kwantifiseringsfase vir die ontwikkeling van die
standaarde en kriteria. 'n Reeks van vier werkswinkels is gehou
waartydens 'n konseptuele raamwerk vir die standaarde ontwikkel
is, voorlopige standaarde opgestel, verfyn en aan 'n
gekwantifiseerde fase onderwerp is waartydens die
inhoudsgeldigheidsindeks ten opsigte van relevansie, duidelikheid
en realiteit bepaal is. Die verteenwoordigers by hierdie
werkswinkels het uit verpleegagentskapbestuurders (N=22) bestaan
wat lede van ANASA is en hul vergaderings bygewoon het. 'n Hoë
inhoudsgeldigheidsindeks ten opsigte van relevansie en
duidelikheid is verkry. Sommige standaarde en heelwat kriteria
word nog nie in die verpleegagentskappe toegepas nie met 'n
gevolglike lae inhoudsgeldigheidsindeks wat vir realiteit bereik
is. Die finale stel standaarde en kriteria is aan rolspelers
blootgestel vir die finale validering van die standaarde by wyse
van toereikende konsensusdebat. Hierdie standaarde is in die vorm
van 'n evaluasie-instrument gereflekteer en by wyse van 'n
loodsstudie in 'n agentskap in Gauteng uitgetoets. Daar word
aanbeveel dat die standaarde en kriteria, wat in die vorm van 'n
evaluasiegids gereflekteer word, deur verpleegagentskappe benut
word en dat die Suid-Afrikaanse Raad op Verpleging die standaarde
vir lisensiëring en volgehoue akkreditering van
verpleegagentskappe in Suid-Afrika gebruik. Weens die feit dat
die deelnemers/valideerders ANASA lede is, is ander
verpleegagentskappe uitgesluit en kan die navorser nie aanspraak
op nasionale verteenwoordiging maak nie.
A holistic approach to the treatment of irritable bowel
syndrome
Pretorius, H.G.Stuart, A.D.Dolan, L.M.De Bruin, K.
37-46
Abstract: The purpose of this study is to investigate the
effects of a holistic intervention approach to the management of
Irritable Bowel Syndrome (IBS). The sample consisted of 70 South
African women who were diagnosed with IBS. The sample was divided
into four groups. Group 1 (n = 13) received IBS medication and
holistic psychotherapy, Group 2 (n = 23) received IBS medication
only, Group 3 (n = 13) received holistic psychotherapy only and
Group 4 (n = 21) received no treatment until the study was
completed. During the intervention phase the relevant
participants received one-hour holistic psychotherapy per week
for eight to twelve weeks. Medication as a treatment continued
uninterrupted depending on each client's unique symptom patterns.
The results of the study indicate that Group 1, who received IBS
medication and holistic psychotherapy and Group 3 (holistic
psychotherapy only) improved most in term of IBS symptom
severity. Thus it is concluded that a holistic approach for the
treatment of IBS is indicated, depending on the nature and
severity of symptoms as well as each individual's contextual
situation. This study facilitates a framework for psychologists
who are working with clients with IBS or any other mind-body
illness.
Die doelwit van die studie is om die effek van 'n holistiese
benadering tot die bestuur van Prikkelbare Dermsindroom
("Irritable Bowel Syndrome") te ondersoek. Die
steekproef het bestaan uit 70 Suid-Afrikaanse vroue wat
gediagnoseer is met Prikkelbare Dermsindroom. Die steekproef is
in vier groepe verdeel. Groep 1 (n = 13) het medikasie en
holistiese psigoterapie ontvang, Groep 2 (n = 23) het slegs
medikasie ontvang, Groep 3 (n = 13) het slegs holistiese
psigoterapie ontvang en Groep 4 (n = 21) het geen behandeling
ontvang totdat die studie afgehandel is nie. Gedurende die
intervensiefase het die betrokke deelnemers holistiese
psigoterapie ontvang vir een uur per week, vir agt tot twaalf
weke. Medikasie as behandeling het deurentyd voortgegaan
afhangende van elke kliënt se unieke patroon van simptome. Die
resultate van die studie dui aan dat Groep 1, wat medikasie en
holistiese psigoterapie ontvang het asook Groep 3 (slegs
holistiese psigoterapie) die meeste verbetering ten opsigte van
die ernstigheid van simptome getoon het. Die studie verskaf 'n
raamwerk vir sielkundiges wat met kliënte werk met Prikkelbare
Dermsindroom of enige ander liggaam-gees siekte.
Enriching diets for childhood mental and physical
development
Kruger, H.S.Labadarios, D.L.Dhansay, M.A.
47-58
Abstract: Malnutrition is a public health problem in South
Africa, especially among rural black children. Intakes below 67%
of the Recommended Dietary Allowance (RDA) are common for
calcium, iron, zinc, selenium, vitamin A, C, D, E, riboflavin,
niacin and vitamin B6. Key nutrients for growth and development
include calcium, iron, zinc, vitamin A, folate and other
B-vitamins. Calcium is essential for bone mineralisation during
the adolescent growth spurt. Iron deficiency is associated with
impaired growth, delayed psychomotor development and impaired
immunity. Zinc is associated with normal growth, bone
mineralisation and neuropsychological function. Vitamin A is
essential for normal growth, eyesight and immunity. Folate is
necessary for the development of new cells, especially during
phases of accelerated growth. Other B-vitamins are linked to a
variety of behavioural and cognitive outcomes. Factors
compromising the nutritional status of children include amongst
others, an inadequate nutrient intake due to poverty, inadequate
nutrition education, diarrhoeal diseases, teenage dieting and
allergies. To ensure optimal growth and development, strict diets
should be discouraged and sound meal patterns should be
encouraged, including starting the day with breakfast, and eating
a variety of foods to ensure adequate intakes of nutrients and
fibre. Regular physical activity promotes a healthy body weight
and normal bone mineralisation.
Mikronutriënt innames laer as 67% van die Aanbevole Dieettoelae
(ADT) is algemeen vir kalsium, yster, sink, selenium, vitamien A,
C, D, E, riboflavien, niasien en vitamien B6. Belangrike
nutriënte vir groei en ontwikkeling sluit kalsium, yster, sink,
vitamien A, folaat en ander B-vitamiene in. Kalsium is essensieel
vir beenmineralisering tydens die adolessente snelgroeifase.
Ystertekort word met belemmerde groei geassosieer, asook met
vertraagde psigomotoriese ontwikkeling en verswakte immuniteit.
Sink word met normale groei, beenmineralisering en
neuropsigologiese funksie geassosieer. Vitamien A is essensieel
vir normale groei, sig en immuniteit. Folaat is nodig vir die
ontwikkeling van nuwe selle, veral tydens fases van versnelde
groei. Ander B-vitamiene speel 'n rol in 'n verskeidenheid
gedrags- en kognitiewefunksies. Faktore wat die voedingstatus en
gesondheid van kinders kan benadeel, sluit 'n onvoldoende
nutriëntinname as gevolg van onder andere, armoede, onvoldoende
voedingsvoorligting, diaree, tienerdiëte en allergieë in. Om
optimale groei en ontwikkeling te verseker, moet streng diëte en
oorslaan van maaltye ontmoedig word en 'n gebalanseerde
maaltydpatroon gevestig word. Ontbyt moet gereeld geëet word,
tesame met 'n verskeidenheid voedselsoorte, om voldoende innames
van nutriënte en vesel te verseker. Gereelde fisiese aktiwiteit
bevorder 'n gesonde liggaamsgewig en normale beenmineralisering.
Healthy dietary practices among black South African
university students
Peltzer, K.
59-65
Abstract: The aim of the study was to investigate five
healthy dietary behaviours among black South African University
students. The sample consisted of 370 (46.7%) males and 423
(53.3%) females in the age range of 18 to 25 years (M age 21.0
years, SD=3.48). Results indicate that the incidence of these
healthy dietary habits was low. Significant differences with
healthy dietary habits were identified for gender, dieting
status, dietary health beliefs, internal health locus of control,
and risk awareness, but not for age, weight, residential
background, socioeconomic status, and health value. Logistic
regression with health beliefs, dieting status, gender and
knowledge were only significant predictors for a few healthy
dietary habits. In conclusion, results give insights into dietary
health behavior practices and the factors that influence them,
which have practical implications for dietary health promotion.
Die doel van die navorsing was om vyf gesonde dieet gedragstyle
van swart Suid-Afrikaanse studente na te vors. Die steekproef het
bestaan uit 370 (46.7%) manstudente en 423 (53%) vroulike
studente in die ouderdomsgroep 18 tot 25 jaar (gemiddelde
ouderdom 21.0 jaar en standaardafwyking 3.48 jaar). Die resultate
dui daarop dat die insidensie van die gesonde dieetgewoontes baie
laag was. Beduidende verskille is ten opsigte van die volgende
faktore bevind: geslag, dieetstatus, gesonde gelowe oor dieet,
interne lokus van kontrole en risiko bewustheid maar nie vir
ouderdom, gewig, residensiële omgewing, sosio-ekonomiese status
en gesondheid nie. Logistieke regressie ten opsigte van
gesondheidsgelowe, dieet status, geslag en kennis was slegs ten
opsigte van enkele dieetgewoontes beduidende voorspellers. Ter
samevatting kan gesê word dat die resultate insig gebring het
ten opsigte van gesonde dieetpraktyke en die faktore wat daarin
'n rol speel en die praktiese implikasies vir die bevordering van
gesonde dieet.
Telematic education: a reality in post-basic nursing
education
Meyer, S.M.
66-70
Abstract: No institution is immune to the impact of
technological change. The introduction of cable television and
satellite broadcasting has resulted in an increase in employing
the technology in question for educational purposes. Computers
and communication technologies are merging globally, and
technology such as Telematic Education is being used in the best
possible way by the University of Pretoria to support its service
delivery mechanisms.
Telematic Education refers to a comprehensive system of flexible
learning. It includes all modes of education, as well as low and
high technological methods. Although nurses/lecturers have been
confronted with the fast development of technology for many
years, it has been in clinical practice mostly. Professional
nurses need to develop professionally in non-clinical
specialities as well. Continued education by means of a distant
education method will serve as an academic solution to
professional nurses in the rural areas of South Africa.
Lecturers who teach by means of telematic education are required
to be skilled, selfconfident, and should also be flexible. The
twenty-first century will indeed see many changes, with
lecturers, students and preceptors joined together in dialogue to
question, demonstrate, and participate actively in the learning
process. All of this will happen without students having to set
foot in a classroom.
Geen instansie is immuun teen tegnologiese veranderinge nie. Die
bekendstelling van satelliet en kabeltelevisie het gelei tot 'n
vermeerderde gebruik van tegnologie vir onderwyskundige
doeleindes. Daar is 'n samesmelting van rekenaar en kommunikasie
tegnologie wêreldwyd en tegnologie soos Telematiese Onderwys
word deur die Universiteit van Pretoria gebruik op die mees
geskikte wyse om hul dienslewerings sisteme te ondersteun.
Telematiese onderrig verwys na 'n omvattende sisteem van
fleksileer. Dit sluit alle modi van onderwys, sowel as lae en
hoë tegnologiese metodes in. Verpleegkundiges/dosente word al
jare deur tegnologie gekonfronteer, maar hoofsaaklik in die
kliniese praktyk. Verpleegkundiges/dosente moet egter ook
tegnologie as deel van hul professionele ontwikkeling in
nie-kliniese areas sien. Voortgesette onderwys by wyse van
afstandsonderrig dien as 'n oplossing vir verpleegkundiges in die
landelike gebiede van Suid-Afrika.
Telematiese onderrig vereis van dosente om kundig en plooibaar te
wees, asook die medium met selfvertroue te gebruik. Die
een-en-twintigste eeu sal verseker baie veranderinge meebring,
soos dosente, studente en preseptore saamkom in debatvoering ten
einde te bevraagteken, demonstreer en aktief deelneem in die
leerproses. Dit kan alles plaasvind sonder dat die dosent of die
student fisies in die klaskamer is.
Methodological issues involved in conducting qualitative
research on support for nurses directly involved with women who
chose to terminate their pregnancy
Gmeiner, A.Van Wyk, S.Poggenpoel, M.Myburgh, C.
71-78
Abstract: The purpose of this article is to describe the
methodological issues involved in conducting qualitative research
to explore and describe nurses' experience of being directly
involved with termination of pregnancies and developing
guidelines for support for these nurses. The article points out
the sensitivity and responsibility that researchers must have
when engaging in qualitative research of this nature. While
conducting this research, several methodological challenges were
identified. Four specific challenges identified will be addressed
in this paper. These are: the issue of research versus
therapeutic interviewing; adhering to specific research ethics,
as this was a very sensitive topic of research; dissemination of
research results to make it accessible to all nurses as well as
the broader community; and the operationalisation of the support
guidelines in practice for nurses in need of support.
Die doel van hierdie artikel is om die metodologiese vraagstukke
te beskryf rondom die uitvoer van kwalitatiewe navorsing waar
verpleegkundiges se ervaring van hul direkte betrokkenheid by
terminasie van swangerskap verken en beskryf is. Die artikel
beklemtoon die sensitiwiteit en verantwoordelikheid wat navorsers
aan die dag moet lê wanneer kwalitatiewe navorsing van hierdie
aard uitgevoer word. Tydens die uitvoering van hierdie navorsing
is verskeie metodologiese uitdagings geïdentifiseer. Vier van
hierdie spesifieke uitdagings wat geïdentifiseer is, word in
hierdie artikel aangespreek, naamlik: die vraagstuk van navorsing
versus terapeutiese onderhoudvoering; voldoening aan spesifieke
navorsingsetiek, aangesien die onderwerp 'n baie sensitiewe saak
benader; disseminering van navorsingsresultate om dit toeganklik
te maak vir alle verpleegkundiges, sowel as die breër
gemeenskap; en die operasionalisering van die riglyne vir
ondersteuning aan verpleegkundiges in die praktyk wat sodanige
ondersteuning benodig.
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