Strategies to implement competencies as it relates to a competency framework in a dental undergraduate curriculum: A systematic review.

INTRODUCTION: Worldwide, dental schools are underpinned by approved competency frameworks or competency statements developed for specific contexts or countries. Literature are replete with competencies required and assessed within this frameworks however limited literature that guides the incorporation of competencies and implementation of the competencies related to the competency framework in dental curricula. MATERIALS AND METHODS: A systematic review design was used. The research question addressed for this systematic review was: What are the strategies used to develop core competencies undergraduate dental curricula? Databases included in the searches were: MEDLINE(ebscoHost), Science Direct, MEDLINE(Pubmed), Wiley Online Library, ERIC. A meta-synthesis analysis consisting of a descriptive meta-synthesis to critically analyse and discuss emerging themes from the findings of the six included studies were completed. RESULTS AND DISCUSSION: Strategies used to develop core competencies were divided into four components namely organizational structure, faculty development, teaching strategies and assessment strategies. To consider a holistic approach to develop core competencies, changes in the organizational structure needs to be in place first. With the appropriate organizational structure in place, faculty development to implement competency strategies would be more supported and feasible. From the findings of the included articles, faculty development regarding teaching strategies and assessment methods were considered necessary to implement core competencies in a dental curriculum. CONCLUSION: A strong relationship between the suggested implementation strategies from this systematic review findings and the multifaceted approach for the CanMEDS exist. Teaching and assessments, faculty development strategies are common strategies. Surprisingly, organisational structure changes were not included as implementation strategy of CanMEDS.

Challenges experienced by community health workers and their motivation to attend a self-management programme.

BACKGROUND: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours. AIM: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme. SETTING: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa. METHODS: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis. RESULTS: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective. CONCLUSION: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.

Perceptions, attitudes and understanding of health professionals of interprofessional practice at a selected community health centre.

BACKGROUND: Despite being identified as a solution to the challenges related to healthcare service delivery, the incorporation of interprofessional practice (IPP) into clinical practice has been limited. To implement an interprofessional model of healthcare, successfully, health professionals need to have an understanding of IPP and its related content. AIM: The aim of this study was to explore and describe the health professionals' perceptions, attitudes and understanding of IPP at a selected community health centre. SETTING: This study was conducted at a primary healthcare facility in the Western Cape, South Africa. METHODS: Ethical clearance and permission to conduct the study was obtained from all relevant stakeholders. Four focus group discussions were conducted with health professionals at the facility. Themes, codes and categories were highlighted from the transcripts of the audiotape-recorded data. FINDINGS: The findings suggest that health professionals do not have an understanding of IPP, and are thus unable to apply it practically. The health professionals perceived certain healthcare processes in the facility as barriers to the integration of practices. In addition, the health professionals expressed the need for interprofessional relationships, creation of opportunities for IPP, and communication to transform the current practice. CONCLUSION: To implement IPP into this facility, effectively, the authors of this study recommend that facility management implement campaigns for and training on, the transition to IPP, staff induction programmes and regular meetings.

Clarifying the role of clinical supervisors according to physiotherapists at a higher education institution.

BACKGROUND: The roles of doctors and nurses in clinical supervision and clinical education are well defined. The role of the physiotherapist in clinical education has not been clearly defined. OBJECTIVES: The aim of this study was to define and clarify the views and experiences of physiotherapy clinical supervisors regarding clinical education and their role in contributing to student learning. METHODS: This qualitative exploratory study targeted 17 physiotherapy clinical supervisors, employed in a physiotherapy department, at a local university in the Western Cape. Twelve of the 17 participants agreed to participate in the study. Data were collected by means of in-depth audio-taped interviews, at a time convenient for the participants. Each transcript was read individually by the first author and notes made in the margins to highlight interesting concepts that emerged. The different types of concepts were listed and categorised, while common categories were grouped into themes. RESULTS: Based on the results, the clinicians' role is viewed as a valuable asset in clinical education, embodying the role of an educator, mentor, role model and communicator. Clinical supervisors discussed their roles in terms of understanding the importance of clinical supervision, providing guidance within a clinical setting, role modelling and professionalism. Although clinical supervisors play a significant role, they experienced a few challenges including role clarification and students' lack of knowledge. CONCLUSION: This study highlights that clinical supervisors and clinicians fulfil significant roles in assisting students to integrate theoretical and clinical knowledge. CLINICAL IMPLICATIONS: Understanding the expectations of clinical supervisors in supporting clinical education is important for higher education institutions and the clinical sector.

Knowledge about modifiable risk factors for non-communicable diseases adults living with HIV in Rwanda.

BACKGROUND: Non-communicable diseases (NCD) are of international public health concern. Of more concern are people living with HIV (PLHIV), who have the increased risk of developing NCDs, such as hypertension, stroke and diabetes. Research has revealed that there is a relationship between knowledge of NCD risk factors and risk perceptions in the general population. Therefore, an assessment of PLHIV's NCD risk factors knowledge is quite critical, to design effective NCD prevention programmes. OBJECTIVE: To assess the level of knowledge of modifiable risk factors for NCDs and its associated factors among adults living with HIV in Rwanda. METHODS: A cross-sectional quantitative design was used to collect the data. The study targeted PLHIV who visited the out-patients' public health centres in three purposively selected provinces of Rwanda. The knowledge assessment questionnaire relating to risk factors for chronic diseases of lifestyle was used to collect the data. Data were analysed using SPSS version 23. RESULTS: Of the 794 respondents, 64.6% were women, and the mean age was 37.9 (±10.8) years. The results revealed that the majority of the respondents (65.0%) had low levels of knowledge about NCD risk factors, while some (35.6%) were of the opinion that they had a low risk of contracting NCDs. Good knowledge was significantly associated with high educational status, a low CD4+ cell count (< 350 cells/mm3) and normotension. CONCLUSION: The current study findings highlight the need for comprehensive health education, to raise awareness of non-communicable diseases' risk factors for adults living with HIV in Rwanda.

Perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape.

BACKGROUND: Understanding caregivers' views on rehabilitation services is important as it may assist in informing healthcare services and patient management. OBJECTIVES: The aim of this study was to explore caregivers' perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field. METHOD: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts. RESULTS: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery. CONCLUSION: Based on the participants' feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention.

Health-related quality of life and associated factors in adults living with HIV in Rwanda.

In Rwanda, as in other sub-Saharan African (SSA) countries, life expectancy of people living with HIV (PLWH) has increased dramatically as a result of combined antiretroviral therapy (cART). People living with HIV can now live longer but with increasing rates of non-communicable diseases (NCDs). Thus, prevention of NCD comorbidities in PWLHI is crucial to maintain and gain health-related benefits and to maximise the health-related quality of life (HRQOL) in the long-term management of PLWH. This study determines the association between physical and mental health-related dimensions of quality of life (QOL) with behavioural and biological risk factors, after controlling socio-demographic and HIV-related factors in adults living with HIV in Rwanda. A cross-sectional study using the WHO STEPwise approach and Kinyarwanda version of the MOS-HIV Health Survey, risk factors for NCDs and HRQOL were analysed for 794 PLWH, both HIV+ on ART and ART-naïve. Multiple regression analysis was used to examine the relationship between CMD risk factors and physical health and mental health summary scores. A total of 794 participants were interviewed. The mean age of the sample was 37.9 (±10.8) years and the majority of the participants were women (n = 513; 64.6%). About 16.2% reported daily smoking, 31.4% reported harmful alcohol use and 95% reported insufficient consumption of vegetables and fruits while 26.1% reported being physically inactive. 18.4% were overweight 43.4% had abdominal obesity, i.e. waist-hip-ratio (WHR) ≥0.95 in males and 0.85 in females. High blood pressure (HBP), i.e. systolic blood pressure (SBP) of ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg was 24.4%. The results reveal that mean physical health summary and mental health summary score values were 63.96 ± 11.68 and 53.43 ± 10.89, respectively. While participants indicated that tobacco users and those who had abdominal obesity reported poor mental HRQOL, physical inactivity and hypertension have a negative impact on physical HRQOL. In addition, certain socio-demographic and HIV-related variables - specifically being unmarried, lack of HIV disclosure and low CD4 count (less 350 cell counts /mm3) - were associated with significantly lower mental and physical dimensions of quality of life. The results of this study reveal that behavioural and biological risk factors for NCDs were significantly associated with a lower HRQOL. These research findings also suggest that the assessment of the association between behavioural and biological risk factors for NCDs and a HRQOL provides opportunities for targeted counselling and secondary prevention efforts, so that health care providers can implement strategies that have a significant impact on the HRQOL.

Cracking the nut of service-learning in nursing at a higher educational institution.

BACKGROUND: The readiness of academics to engage in the service-learning (SL) institutionalisation process is not accentuated in research on SL institutionalisation in South Africa. The argument has been advanced that SL scholarship and willingness of key stakeholders are crucial for SL institutionalisation at the academic programme level. AIM: The research focus of the study being reported here was on readiness of respondents to embed SL in the curricula of the nursing programme. METHOD: This study used a quantitative, exploratory and descriptive design. A self-administered structured questionnaire was used to collect data from a stratified sample comprising 34 respondents. The data were analysed for descriptive statistics using SPSS 19. RESULTS: The demographic profile of the respondents indicated that 31 (66%) were between 31 and 50 years old; 36 (75.16%) had a minimum of 10 years' nursing experience; 19 (39.6%) had a master's degree, two (4.2%) had a doctorate; and 29 (60.4%) had been employed by the school for a maximum of five years. The results indicated that the nurse educators were in need of SL capacity-building because 9 (18.8%) had limited or no knowledge of SL and 24 (50%) confused SL with other forms of community engagement activities. However, only 15 (33%) of the clinical supervisors and 13 (27%) of the lecturers indicated a willingness to participate in such a programme. CONCLUSION: The school was not ready to embed SL in the academic programme because of a lack of SL scholarship and willingness to remediate the identified theory-practice gaps.

The impact of a faculty development programme for health professions educators in sub-Saharan Africa: an archival study.

BACKGROUND: In 2008 the sub-Saharan FAIMER Regional Institute launched a faculty development programme aimed at enhancing the academic and research capacity of health professions educators working in sub-Saharan Africa. This two-year programme, a combination of residential and distance learning activities, focuses on developing the leadership, project management and programme evaluation skills of participants as well as teaching the key principles of health professions education-curriculum design, teaching and learning and assessment. Participants also gain first-hand research experience by designing and conducting an education innovation project in their home institutions. This study was conducted to determine the perceptions of participants regarding the personal and professional impact of the SAFRI programme. METHODS: A retrospective document review, which included data about fellows who completed the programme between 2008 and 2011, was performed. Data included fellows' descriptions of their expectations, reflections on achievements and information shared on an online discussion forum. Data were analysed using Kirkpatrick's evaluation framework. RESULTS: Participants (n=61) came from 10 African countries and included a wide range of health professions educators. Five key themes about the impact of the SAFRI programme were identified: (1) belonging to a community of practice, (2) personal development, (3) professional development, (4) capacity development, and (5) tools/strategies for project management and/or advancement. CONCLUSION: The SAFRI programme has a positive developmental impact on both participants and their respective institutions.

The prevalence of intimate partner violence in the family: a systematic review of the implications for adolescents in Africa.

BACKGROUND: Intimate partner violence (IPV) and its multiple effects are well documented in Western research, but these are not adequately described in Africa. The effects of IPV on adolescent health and well-being are not conclusive. OBJECTIVE: The aim of this review was to systematically appraise prevalence studies conducted on the African continent to establish the prevalence of IPV and the implications of exposure on adolescents in Africa. METHODS: A comprehensive search was conducted in May 2012 for the previous 10 years, using databases such as Ebscohost (Medline, CINAHL, PsyArticles), Directory of Open Access Journals (DOAJ), Project Muse and BioMed Central and also specific journals Lancet, and JSTOR. Two reviewers independently evaluated the methodological quality of the studies reviewed. RESULTS: Seven eligible epidemiological studies were included in this review. Five of the studies were conducted in South Africa, one in Liberia, and another was a multi-country study that included Egypt, Kenya, Malawi, Rwanda and Zambia. The prevalence of IPV in African countries ranged from approximately 26.5% to 48%. All studies reported exposure to family violence during childhood. CONCLUSION: The findings support the global burden of IPV. There is also a need for standardized tools to determine IPV in Africa and a clear definition that can be used in research to allow comparison with future IPV studies. In addition, the studies point to a need for interventions focusing on adolescents exposed to family violence.

Barriers to and facilitators of rehabilitation services for people with physical disabilities: A systematic review.

BACKGROUND: As health care practitioners, it is important to have an understanding of the common barriers to and facilitators of the rehabilitation services we provide. OBJECTIVES: This article aimed to review the relevant literature regarding barriers to and facilitators of rehabilitation services for people with disabilities. METHOD: Articles for the period 1990-2010 using descriptors related to rehabilitation services, barriers, facilitators and the physically disabled population were retrieved for this review. RESULTS: A total of 19 article titles were identified from references of other articles but following application of the inclusion criteria selected for this review, only six articles were chosen. Five of these articles were qualitative studies and one was a quantitative study. Barriers and facilitators regarding rehabilitation services highlighted by participants in the studies included a perception that health professionals have a lack of understanding of rehabilitation for people with disabilities and there was a lack of information sharing from health professionals about the rehabilitation process. On the other hand some participants reported that health professionals demonstrated confidence in the disability and rehabilitation process during consultation and highlighted that their needs were met by the rehabilitation professionals. CONCLUSION: Even though there were few studies highlighting the barriers to and facilitators of rehabilitation services, they highlighted that there are gaps in the process of rehabilitation services provided. It would be advisable for health professionals to take cognisance of the issues highlighted in this study in order to make rehabilitation services more effective.

Health promotion needs of physically disabled individuals with lower limb amputation in Rwanda.

PURPOSE: The objectives of the study were to identify the health-related behaviors among physically disabled individuals with lower limb amputation resident in Rwanda, the factors that influenced these behaviors, and the major issues that should be targeted in health promotion programs for physically disabled individuals with lower limb amputation. METHOD: A cross-sectional survey, utilizing a self-administered questionnaire, was carried out among 334 lower limb amputees who volunteered to take part in the study. In addition, a sub-sample of 15 participants was purposely selected for in-depth face-to-face interviews. RESULTS: Many participants did not engage in physical exercises (64.7%). Others abused alcohol on daily basis (14.4%), smoked 11-20 cigarettes daily (13.2%), and used recreational drugs such as marijuana, opium and cocaine (9.6%). There were significant associations between the age group of the participants and participation in exercises (P=0.001), and consuming alcohol, tobacco and recreational drugs (P=0.001). In-depth interviews revealed factors influencing the behavior of participants. CONCLUSIONS: Participants were found to be at risk of secondary complications because of poor lifestyle choices. There is a need to develop and promote wellness-enhancing behaviors in order to enhance the health status of physically disabled individuals in Rwanda who have lower limb amputations.