Evaluation of health promotion roles and services offered by health workers in the Nelson Mandela Bay Municipality of Eastern Cape, South Africa.

Abstract

Background: Various factors affect the role of healthcare workers (HCWs) in health promotion (HP). The Nelson Mandela Bay Municipality (NMBM) public health service is overstretched and there is minimal evidence of health promoting healthcare services. This research project evaluated the roles and services of HCWs on HP as well as the views of patients regarding the HP services they received from HCWs in the municipality. Methods: A phased quantitative cross-sectional study was conducted to address the study aim and objectives. In phase one, 495 HCWs randomly sampled from 23 healthcare facilities in NMBM completed a structured questionnaire. In phase two, 500 patients completed a structured questionnaire regarding the quality of HP services received using the interview method. Descriptive and inferential analyses were conducted using StataIC 15. Results: Three groups of indicators classified as facility related indicators (FRI), healthcare workers’ related indicators (HRI), and outcome related indicators (ORI) emerged for measuring HP. The study identified thirteen categories of enablers and eight categories of hindrances. Eleven enablers and six hindrances were associated with tertiary hospitals, and none was recorded for the other health care levels. Collaboration among disciplines and organizations (Coeff: 2.16, 95% CI: 1.28 - 3.66) and programme planning (Coeff: 0.375, 95% CI: 0.23 - 0.62) were the predictors of HP and disease prevention (DP) enablers among medical doctors. On the other hand, ‘healthcare facilities promoting treatment more than DP’ (Coeff: 2.03, 95% CI: 1.30-3.14) and ‘absence of practice guidelines incorporating HP’ (Coeff: 2.79, 95% CI: 1.66-4.70) were the predictors of HP and DP hindrances among medical doctors and allied health workers (AHWs), respectively. Furthermore, most of the HCWs (75.78%; n=363) reported absence of coordinated HP training for staff in their facilities. Similarly, the attitude that ‘HP is a waste of time’ (adjusted Coeff 0.51, 95% CI 0.31 - 0.83) influenced the practice for AHWs. Results of the second phase study were categorized into three phases namely - pre-admission phase (PAP), admission phase (ADP), and post admission phase (POP). The ADP showed that patients’ health behaviours improved by 1.54 times by their interactions with nurses compared to their interactions with medical doctors. Conclusion: This study shows that the healthcare system is more committed to biomedical care as against health promotion services at all levels of healthcare. The implementation of HP services requires changes in HCWs behaviour, patients’ attitude and very importantly, structural reorganization and reprioritization.