Exploring psychosocial issues and coping strategies of health care providers at termination of pregnancy services in two South African provinces
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Date
2019
Authors
Teffo, Mantshi Elizabeth
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Abstract
Background: In South Africa, the implementation of the Choice on Termination of Pregnancy Act depends on the availability of willing, competent and responsive health care providers. However, there is a dearth of scholarly studies on the psychosocial issues faced by these providers, their coping strategies, and the availability of organisational support systems.
Objective: The aim of this PhD was to investigate the psychosocial issues and coping strategies of health care providers at termination of pregnancy (TOP) services in two South African provinces. The specific objectives were to: explore health care providers’ individual experiences of TOP provision, their workload and organisational factors that influence TOP provision; determine the coping strategies used by these health care providers; determine the mechanisms that exist within the organisation to help TOP providers cope with their work; and determine the views of managers on psychosocial support and/or programmes for TOP service providers.
Methods: During 2014 - 2015, a cross sectional, convergent parallel mixed methods study was conducted at all designated TOP facilities in Gauteng and North West Provinces. The methods combined the completion of a facility checklist; indepth interviews with 30 TOP providers; a survey of 103 TOP providers; a survey among 50 managers of TOP services or facilities, as well as indepth interviews with these managers. STATA® 13 and Microsoft Excel were used for quantitative data analysis, while Interpretative Phenomenological Analysis was used to analyse the qualitative data. The computer software, MAXQDA® 12 was used to support the qualitative data analysis.
Results: Only 77% of the 61 designated facilities on the national database were providing TOP services (Gauteng =28/32; North West = 19/29), and an additional four facilities not on the database were providing TOP services. Hence the total number of studied facilities was 51. The TOP provider survey obtained a response rate of 98%. The majority of TOP providers
were female (82%), professional nurses (70.9%), with a mean age of 43.4 (SD = 8.7). The overall compassion satisfaction score among TOP providers was high at 42 (SD = 5.5). The predictors of compassion satisfaction were finding work stimulating, the belief in making a difference, positive relationships with other nurses and years of TOP service (p<0.05). Burnout mean scores were average at 33 (SD = 4.0), with the belief in helping women to make informed choices a marginally significant predictor of burnout. The overall secondary traumatic stress (STS) mean score was average at 23 (SD = 6.8). Significant predictors of STS scores were finding work stimulating, the belief in women’s rights, the belief in allowing women to make informed choices, age and gender. TOP providers reported both positive coping strategies (support seeking, self -control, professionalism and belief systems), and negative coping strategies (silence and concealing emotions, work avoidance).
In Gauteng only two hospitals (12.5%), and in North West, only one hospital (10%) reported the availability of dedicated psychosocial support programmes. The majority of managers interviewed reported indifference or ambivalence about the availability of psychosocial programmes for TOP providers.
Conclusion: The psychosocial issues of TOP providers need prioritisation through supportive management, positive practice environments, and the development and implementation of effective and sustainable employee wellness programmes that enhance compassion satisfaction and reduce burnout and STS among these providers
Description
A thesis completed by published work
Submitted to the School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg,
in fulfillment of the requirements for the degree of
Doctor of Philosophy
Johannesburg, South Africa
April 2019
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Citation
Teffo, Mantshi Elizabeth, Exploring psycho-social issues and coping strategies of health care providers at termination of pregnancy services in two South African Provinces, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/28092>