Browsing by Author "Stewart, Rene."

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A qualitative understanding of the health-seeking behaviour of adult in-patients with multi-drug resistant tuberculosis in a public health sector setting.
(2000) Valjee, Sachet Rabindranath.; Bhagwanjee, Anil Mohanlal.; Stewart, Rene.
Aim: This study aims to provide a qualitative understanding of the health-seeking behaviour of adult in-patients with multidrug-resistant tuberculosis in a public health sector setting. Methodology: A qualitative methodological approach was used in this study since it allows for an in-depth investigation and understanding of the health-seeking behaviour of MDR-TB patients. The study is seated in the arena of ethnographic inquiry, since ethnography investigates human behaviour as it is understood and experienced within a particular subtext and given reality, as it is created by the people of concern. In this regard, ethnography deals with developing an understanding of shared systems of meaning in societies that share similar social and cultural characteristics and can be applied to the study of any isolated group who have something in common. A total of four (4) 90-minute focus groups discussions were conducted with adult MDR-TB in-patients, comprising two male and two female groups. The data transcripts were analysed thematically in order to identify commonalties and variances among the responses of participants. Comparative analyses were made across the variable gender. Findings: The findings are discussed within the context of relevant empirical literature and theory, including the Health Belief Model, Health Locus of Control Theory and the Theory of Reasoned Action. These findings were constructed temporally in terms of pre-admission, admission and post-admission behaviour. What has emerged in this study is that health-seeking behaviours that are traditionally defined as "poor patient adherence" and " treatment delay" are mediated by a number of variables operating in both institutional and community contexts. At a community level, large-scale community ignorance and lack of knowledge of MDR-TB, social stigma, conflation of TB and MDR-TB and the lack of recognition of symptoms coalesce to produce poor treatment adherence and treatment delays. This situation is exacerbated by cultural practices that result in patients using dual healing systems and multiple remedies. The net result for TB sufferers is the advent of MDR-TB. At an institutional level a hierarchical biomedical bureaucracy conspires to produce a hostile, disempowering and inhumane experience for MDR-TB in-patients, which further compromises adherence behaviour and positive health actions. Recommendations: Within the context of a number of systemic recommendations, a range of practical patient-centered and staff centered interventions are suggested, followed by recommendations for future research and an appraisal of the limitations of this study.
Toward access, success and equity in health science education : a KwaZulu-Natal case study.
(1999) Stewart, Rene.; Brookes, David W.; Bhagwanjee, Anil Mohanlal.; Joubert, Robin Wendy Elizabeth.
Aim: This study aims to generate recommendations for enhancing the access and success of historically disadvantaged students to health science education at UDW, based on barriers identified within diverse schooling contexts and local conditions at UDW. Methodology: A case study approach was used to select five former DET schools within the DFR to constitute the sample of historically disadvantaged schools for this study. In order to capture the specific ecological milieu, social and cultural conditions pertaining to rural, urban and informal settlement contexts, three schools were strategically selected from each of these contexts (i.e. Sobonakhona, Ilanga and Inhlanhlayethu High schools respectively). In addition, two former DET schools that displayed relatively high achievement rates were also selected (i.e. Vukuzakhe and Zwelibanzi High schools), in order to contextually understand how barriers to positive educational outcomes might be overcome. A multistage sampling procedure was used to sample 40 standard seven and 40 standard ten scholars from each of the selected schools (n=400) and a purposive sampling procedure was used to obtain a sample of teaching staff involved in career counselling and/or science education in each school (n=16). In addition, saturation sampling was employed to obtain a sample of second year African students in the Faculties of Health Sciences and Dentistry at UDW (n=73). A combination of quantitative and qualitative data collection methods was employed, with questionnaires being administered to standard seven and ten scholars as well as to historically disadvantaged health science students. In addition, a total of five focus groups were conducted with teaching staff from each of the selected schools. Results and discussion: It was evident that a complex and interwoven web of factors impacted on the access and success of historically disadvantaged students in health science education at UDW, including, inter alia, inadequate school instructional resources; limited community economic resources; a paucity of educational opportunities and experiences in the home environment; poverty status; low levels of self-efficacy in academic skill; inadequate school career counselling; university selection procedures with a eurocentric bias; adjustment difficulties in the transition from secondary to tertiary education; financial difficulties; a paucity of 'in-group' academic role models; inadequate ADPs and negative conditions in campus student residences. These results are discussed and interpreted within the context of relevant empirical literature as well as a taxonomy derived from over 60 multivariate school-effects studies undertaken in developing countries, comprising four dimensions, viz. ecology, milieu, social system and culture. Conclusions: On the basis of the findings of this study, recommendations for enhancing the access and success of historically disadvantaged students to health science education at UDW are offered. While these recommendations pertain to a broad range of stakeholders, including the Education Ministry, the schooling sector and higher education institutions, particular attention is paid to the development of practical recruitment, selection and retention strategies to be employed by UDW and its Faculty of Health Sciences. Finally, the limitations of the study are discussed and recommendations for future research in this field are offered. KEY terms: access, success and equity; historically disadvantaged; health science education; educational outcomes.