Peter Delobelle

Objective: This study aimed to unravel experiences, identify barriers to self management of diabetes and hypertension and solicit solutions for enhancing chronic disease self management from patients and their healthcare providers. Design and Methods: This was a qualitative study which collected data from eight in-depth interviews conducted with healthcare providers and four focus group discussions among patients with type 2 diabetes and hypertension receiving chronic disease care from two health facilities in a large peri-urban Township in Cape Town, South Africa. The Self Management framework described by Lorig and Holman, based on work done by Corbin and Strauss was used to analyse the data Results: Patients experienced challenges across all three self management tasks of behavioural or medical management, role management and emotional management. Main challenges included poor patient self-control towards lifestyle modification, sub-optimal patient-provider and family partnerships and post-diagnosis grief-reactions by patients. Barriers experienced were stigma, socio-economic and cultural influences, provider-patient communication gaps, disconnect between facility-based services and patients lived experiences and inadequate community care services. Patients suggested empowering community-based solutions to strengthen their disease self-management including dedicated multidisciplinary chronic disease management services, counselling services, strengthened family support, patient buddy system, patient-led community projects and advocacy. Providers suggested contextualised communication using audio-visual technologies and patient-centred provider consultations. Conclusions: Patients experienced several barriers to self-management of their chronic disease. Community-based dedicated multidisciplinary chronic disease healthcare teams, chronic disease counselling services, patient-driven projects towards healthy lifestyle and diet, and advocacy are needed to improve patient self-management. This will contribute towards SDG 3

ABSTRACT Introduction Non-communicable diseases (NCDs) are increasingly prevalent in sub-Saharan Africa due to lifestyle changes related to urbanization and socio-economic, cultural and environmental factors. Strategies to reduce the impact of NCDs on human development are urgently needed but mostly rely on population-wide interventions for prevention. The healthy settings approach is considered crucial in driving health promotion in South Africa and may be applied to health services, including hospitals. In this case study a rural district hospital in the Limpopo Province was transformed into a Health Promoting Hospital (HPH) according to standards developed by WHO-Europe. Research design The project was designed as intervention study using a participatory action research design integrated with the PRECEDE-PROCEED model as framework for program planning, including a comprehensive needs assessment among a stratified random sample of hospital staff (n = 295), patients (n = 212) and their relatives (n = 63). A cross-sectional survey was conducted using previously validated instruments to assess health promotion and education needs and individual risk factors for NCDs, including alcohol and tobacco use, dietary patterns and physical activity. Results Results indicated evidence of NCD risks among all subgroups, and a need for health education and promotion with regard to healthy lifestyles was identified, in particular with regard to dietary behaviour. Hospital staff considered health promotion boards to be most effective for delivering health education messages, while patients and relatives preferred health communication through the in-house radio/TV, followed by group and individual health education. Impact Based on these results recommendations were made and HPH program activities informed, including health communication and promotion initiatives related to healthy lifestyles with active involvement of hospital management and staff. The program was found to be successful and considered a pilot project by Provincial health authorities, representing an advance for health promotion practice in the region.

This project aimed at transforming a rural District Hospital in the Limpopo Province of South Africa into a Health Promoting Hospital according to standards developed by WHO-Europe. The intervention used a diagnostic approach and baseline needs assessment of hospital staff, patients, and their relatives to identify health education and promotion needs. Activities included empowerment training and skills development, implementation of health education and promotion activities, and the integration of health-promoting standards and values in the hospital structure and culture. The project indicated applicability of the model in a resource-limited setting, based on staff empowerment, local leadership, and stakeholder engagement.

AimsTo explore the impact of diabetes on sexual relationships among men and women living with type 2 diabetes People living with type 2 diabetes (PLWD) and their partners in Cape Town, South Africa.MethodsAs part of a larger study developing an intervention to improve type 2 diabetes mellitus (T2DM) self management, we conducted in‐depth individual interviews with 10 PLWD and their partners without diabetes about experiences living with T2DM, between July 2020 and January 2021. We used inductive thematic analysis.ResultsBoth PLWD and partners felt that their sexual relationships and desires changed post‐diagnosis, in ways beyond biomedical issues. Although couples' reports on the quality of their sexual relationships were concordant, most participants had not communicated their sexual desires and concerns with each other, causing unhappiness and fears of disappointing or losing their partner. Participants felt uninformed about sexual dysfunction but had not discussed this with t...

Objective: This study aimed to unravel experiences, identify barriers to self management of diabetes and hypertension and solicit solutions for enhancing chronic disease self management from patients and their healthcare providers. Design and Methods: This was a qualitative study which collected data from eight in-depth interviews conducted with healthcare providers and four focus group discussions among patients with type 2 diabetes and hypertension receiving chronic disease care from two health facilities in a large peri-urban Township in Cape Town, South Africa. The Self Management framework described by Lorig and Holman, based on work done by Corbin and Strauss was used to analyse the data Results: Patients experienced challenges across all three self management tasks of behavioural or medical management, role management and emotional management. Main challenges included poor patient self-control towards lifestyle modification, sub-optimal patient-provider and family partnership...

Background Type 2 diabetes (T2D) is seriously burdening already fragile health systems in low-and middle-income countries and well-established primary care in high-income countries. Using the concept of reciprocal learning, the SMART2D project (Self-Management and Reciprocal learning for Type 2 Diabetes) has partnered with communities and health facilities to improve diabetes-related outcomes. Methods We selected a rural setting in Uganda; an urban township in South Africa; and disadvantaged suburbs in Sweden. The reciprocal learning process was structured through three learning cycles, using the Evidence Integration Triangle: 1) problem clarification and developing a common Theory of Change; 2) development and contextualization of evidence-based intervention strategies; and 3) implementation and evaluation of the contextualized strategies to improve self-management. Central across all, is multi-level partnerships with local stakeholders. Results The differences between the settings highlighted specific needs and strengths, such as established community pathways for chronic care (HIV and AIDS) in Uganda and South Africa; and the predominantly facility-based care in Sweden. We identified opportunities for contextualisation, such as development of T2D treatment algorithms (Uganda); partnering with local governments and NGOs for community strategies (Sweden); and addressing the local food environment (South Africa). A common intervention framework comprising facility and community strategies was aligned to site-specific needs and is currently being implemented and evaluated in 'real-life setting' using an adaptive implementation trial. Conclusions The three selected settings have very different baseline characteristics and needs. The reciprocal learning process allows for knowledge transfer and application and enabled the development of contextualized intervention strategies tailored to address the needs of each setting through local stakeholder participation. Reciprocal learning across diverse settings can address the global nature of diabetes challenge and enable deeper contextualization of evidence-based strategies through local stakeholder participation. Background Public policies have a direct impact on most determinants of health. As such, there is an ever-growing interest in the field to understand policy-making processes and determinants. Conceptually, public health relevant models on policy-making range from very rational and instrumental to mostly political and power-based. Objective: We conducted a sequential mixed method project to gain a deeper understanding of policy-making processes related to improving healthcare system performance in Quebec (Canada). We explored the hypothesis that inter-group divergences in policy preferences explained the observed incapacity to implement programmatically sound policy solutions to pervasive performance problems. Methods The research design was an exploratory sequential design divided into two phases: in-depth interviews with key stakeholder representatives in the healthcare system, followed by an open question survey among different groups of administrators and professionals, physicians, nurses, and pharmacists. Data were analyzed narratively and graphically using an innovative method derived from social network analysis and graph theory. Results Rather than divergence, the results showed striking intergroup convergence around what appeared to be a programmatically sound policy package aimed at strengthening primary care delivery capacities. Conclusions These results are interpreted in light of elitist political science perspectives on the policy process. They suggest that the incapacity to reform the system might be explained by one or two influential interest groups' having a de facto veto in policy-making.

Non-communicable diseases (NCDs) are the leading cause of death globally and they are on the rise both in low- and middle-income countries, with South Africa being no exception. Implicated in this upward trend in the country is an observed change in diet – a transition from traditional foods, to what has come to be known as the ‘western’ diet, i.e. more energy-dense, processed foods, more foods of animal origin, and more added sugar, salt and fat. Increasingly, international research links rapidly changing food environment with escalating chronic disease, i.e. it implicates population-level dietary change over individual factors such as knowledge, attitudes and behaviours. Environmental and/or policy interventions can be some of the most effective strategies for creating healthier food environments.
This chapter explores the link between the rise in diet-related NCDs, their proximal determinants (specifically an observed change in diet patterns), contributing environmental factors, what is currently being done or recommended to address this internationally, and the most relevant national-level policies for South Africa.
The authors conclude that to improve dietary patterns and reduce chronic diseases in South Africa will require a sustained public health effort that addresses environmental factors and the conditions in which people live and make choices. Overall, positive policies have been made at national level; however, many initiatives have suffered from a lack of concerted action. Key actions will be to reduce the intake of unhealthy foods and make healthy foods more available, affordable and acceptable in South Africa.