3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Developing field generated standards of practice for HIV/AIDS peer education programmes for South African youth.(2006-11-13T11:03:28Z) Michel, Barbara Jean;The focus of this action research study was to facilitate a field generated process to develop guidelines towards standards of practice for peer education. Peer education has been widely used across the globe and often in health oriented fields. In South Africa, peer education practice is marked by the lack of agreed standards and guidelines together with a lack of empirical evidence of its impact on beneficiary groups. The researcher consulted with over 200 individuals who are, in some way, connected or involved in the management of peer education or programmes focussing on youth. The research confirmed the lack of an agreed definition of peer education, the need for guidelines and eventually standards of practice for peer education. There was consensus that peer education was considered a ‘valuable strategy’ despite a chronic lack of reporting, monitoring and clear goals for most programmes. An additional challenge was the lack of evaluation of the benefit of peer education to beneficiaries. Programmes lack underpinning theories, and often are implemented in an attempt to ‘help’ communities in any way possible. Lack of a systemic approach and lack of agreed performance standards, perpetuates peer education interventions that fail due to avoidable challenges that could have been averted with more attention to planning and systematic organisation. The research proposes that with agreed standards and support to implement and build capacity at national and provincial level, peer education could become a flagship for the prevention, care and support to many communities, particularly where there is a chronic lack of resources.Item A Study to Determine if South African Medical Practitioners in Urban Areas Follow the Southern African Hypertension Society Guideline for the Treatment and Management of Uncomplicated Hypertension(2006-11-10T10:58:33Z) Van Niekerk, DiederikThe prescription habits of general practitioners are continually under the scrutiny of ethical critics. There are numerous factors that influence a practitioner’s decision as to which antihypertensive agents to prescribe for the treatment of hypertension. As outlined in various international and national guidelines for the management of hypertension, the recommended treatment depends on ethnicity, current life-style, diet, smoking, age, gender, family history and possible underlying or secondary conditions such as diabetes mellitus, heart failure, isolated systolic hypertension, myocardial infarction, pregnancy, and evidence of coronary artery disease (CAD), stroke or peripheral vascular disease. Currently the control of blood pressure in patients with hypertension is far from optimal with over 70% of hypertensive patients being reported as having imperfect control. A number of factors related to the patient, the practitioner or the medication may explain the high incidence of inadequate blood pressure control. One possible explanation for the poor control of blood pressure may be that practitioners fail to comply with the guidelines. Hence the aim of my study was firstly to determine whether a practitioner’s decision as to which medication to prescribe in the treatment of hypertension is influenced by the Southern African Hypertension Society Guidelines. Secondly, in an attempt to assess the validity of the results of the primary analysis, the actual prescription habits (MediCross® database) were assessed and compared to the general practitioner’s recall of their prescription habits. Questionnaires were distributed to 320 MediCross® practitioners and prescription habits were identified and substantiated by the screening of an existing MediCross® database. I chose as my sample MediCross® general practitioners, as they are demographically representative of all major urban areas in South Africa; likely to be open-minded to supporting research and answering questionnaires (as MediCross® is part of a Clinical Research Site Management Organisation); and I had access to the database of the prescriptions made by MediCross® practitioners hence enabling me to fulfil my second objective. However, it must be kept in mind that these practitioners are representative of general practitioners in urban areas only (as the title of my research report indicates). My results show that 33.1% adhere to the guidelines (when a non-conservative definition of diuretics is used); 27% have heard of the guidelines and have a copy of them. When asked to give their own opinion however, 39% thought they adhered to the guidelines. The results also show that ACE inhibitors are the most commonly prescribed drug class for uncomplicated hypertension but a comparison to a MediCross® database, of which the quality is questionable, does not support this. As the response rate to the questionnaires was only 24.7%, these results are only a pilot study; however they suggest that few general practitioners use the guidelines or even have a copy of the guidelines. This pilot study suggests that the guidelines need to be distributed more widely. Furthermore the general practitioners that responded to the questionnaire indicated that the management of hypertension is difficult in that there is no single treatment regimen appropriate for all populations and each different patient. It was also their view that clinical guidelines for the management of hypertension should more accurately reflect the uncertainty of when to initiate treatment and individual variation if they are going to take these guidelines seriously and comply with them.