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Browsing School of Public Health (ETDs) by Author "Hlungwani, Tinstwalo Mercy"

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    Factors that promote and impede treatment adherence of out-patient mental health care users at a psychiatric hospital in Johannesburg
    (University of the Witwatersrand, Johannesburg, 2024) Rowse, Savannah; Hlungwani, Tinstwalo Mercy
    Background: Neuropsychiatric disorders are ranked third in the overall burden of disease in South Africa and are chronic disorders. Adherence (and nonadherence) to treatment for severe mental illness is a multifaceted phenomenon that influences and is influenced by multiple factors in one’s environment and context. However, due to the magnitude of this burden of disease and policy agendas promoting deinstitutionalization through community- based care, higher levels of services in South Africa are grappling with the revolving door phenomenon. Aim: To explore factors that promote and impede treatment adherence from the perspectives of mental health care users (MHCUs) in an outpatient department (OPD) Tara Hospital, Johannesburg in 2022/2023. Setting: Tara Hospital is a public specialized psychiatric hospital situated in Hurlingham, Johannesburg and is classified as tertiary and quaternary hospital due to the level of specialised services provided. MHCUs are referred from other tertiary hospitals in the Johannesburg metropolitan district or referred from the private sector for specialized services. Methods: An explorative, descriptive, and contextual qualitative research study was conducted over the 2022/2023 period at Tara Hospital’s OPD. Purposive convenience sampling was used to recruit 18 participants aged 18-65 and diagnosed with severe mental illness. In-depth interviews (IDIs) using a semi structured interview guide were conducted, transcribed, and then analysed using MAXQDA software. Results: A thematic analysis was used to highlight the five dominant themes and their sub themes that emerged from the research. The five dominant themes included: experience of mental illness and adherence, experience of Tara OPD, promoters of adherence, barriers to adherence and stigma. MHCU demonstrate rich insight into their experience of their mental illness, diagnosis, medication, and relapse. Tara OPD is protective factor and positive influence on adherence for its service users. MHCU’s engage dynamically with their adherence and use an array of practical strategies that support their adherence as well as emphasizing the positive influence of social and institutional support. The barriers to adherence included substance use, stigma, poor social support, poor routines, and coping strategies. This stresses the dynamic interplay and role of each level of the socio-ecological model. Conclusion: Adherence to treatment for severe mental illness does not occur in a vacuum of a MHCU simply taking their medication, but there are multiple factors and influences that are important to consider