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1.
Int J Health Care Qual Assur ; 21(6): 611-24, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19055270

RESUMO

PURPOSE: The paper's aim is to determine the role of non-profit organizations (NPOs) in filling possible gaps in primary health care (PHC) service provision. DESIGN/METHODOLOGY/APPROACH: District (n = 10) and sub-district needs (n = 14) analyses were conducted in five South African provinces. In each case, the district/sub-district manager was interviewed using a semi-structured interview guide. FINDINGS: The service gaps identified were understaffing/lack of capacity, difficulty in retaining and recruiting staff, service disparities, inaccessibility of services/low-service utilisation and limited funding. It was believed that NPOs could fill these gaps. About 83 per cent perceived the relationship between government and NPOs as good. Contract monitoring, quality of service, communication and quality control were said to be unsatisfactory. The majority of sub-districts (11) indicated that they provided supplies to NPOs; 50 per cent perceived the relationship between the sub-districts and NPOs as good or very good. NPOs have critical role to play in PHC service delivery. ORIGINALITY/VALUE: The study provides critical information required to make informed effective strategic decisions that support district/sub-district performance and sustainability in a decentralized health system.


Assuntos
Acesso aos Serviços de Saúde , Programas Nacionais de Saúde , Organizações sem Fins Lucrativos , Atenção Primária à Saúde , Coleta de Dados , Disparidades em Assistência à Saúde , Humanos , Entrevistas como Assunto , População Rural , África do Sul , População Urbana
2.
Ethn Health ; 10(1): 73-89, 2005 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-15841588

RESUMO

OBJECTIVES: To determine the underlying dimensions of a social support measure and investigate the effects of social support on health, well-being and management of diabetes mellitus (metabolic control and blood pressure (BP) control). DESIGN: A cross-sectional, analytical design was used with a structured questionnaire, comprising demographic characteristics, the MOS Social Support Survey scale and the health perceptions and mental health sub-scales from the SF-20. SETTING: Two outpatient diabetes mellitus clinics in Pretoria, South Africa. PARTICIPANTS: Over a three-month period, the questionnaire was administered to 263 black diabetes mellitus outpatients (174 women and 89 men), aged between 16 and 89 years. The majority of patients (91%) were diagnosed as type 2 diabetes mellitus. Only 22% of the patients had acceptable metabolic control (HbA1c < 8.0%), in comparison with 46% who had good BP control (130/85 mmHg). There were significant differences between the clinics on BP control: participants from clinic 1 had better BP control than participants from clinic 2. RESULTS: Principal components analysis, followed by an orthogonal (VARIMAX) rotational solution, resulted in two social support factors accounting for 78.9% of the variance. The first factor was labelled socio-emotional support, due to the emphasis on close caring relationships. The second factor was concerned with the more tangible aspects of social support, such as the provision of assistance. Coefficient alpha was 0.97 (socio-emotional support), 0.95 (tangible support) and 0.97 (overall social support). Patients with lower levels of social support had poorer general health and well-being than patients with higher levels of social support. Controlling for clinic, patients with controlled BP had significantly more socio-emotional and tangible support than patients with poor BP control. CONCLUSIONS: The study demonstrated that: (1) socio-emotional and tangible support were the underlying dimensions of social support; (2) socio-emotional support is an important determinant of health and well-being; and (3) social support is beneficial for one aspect of diabetes mellitus management, namely, BP control.


Assuntos
/psicologia , Diabetes Mellitus/psicologia , Apoio Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul/epidemiologia , Inquéritos e Questionários
5.
Int J Qual Health Care ; 15(4): 337-44, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12930049

RESUMO

OBJECTIVES: Based on Donabedian's structure, process, and outcome model, this study was conducted to identify the underlying dimensions of patient satisfaction for diabetic patients and determine the effects of demographic characteristics and health status on these dimensions. DESIGN: A cross-sectional analytical research design was used with a questionnaire, comprising demographic characteristics, the general and mental health items from the SF-20, and a 25-item patient satisfaction scale. SETTING AND STUDY PARTICIPANTS: The questionnaire was administered to 263 South African black diabetic outpatients from the diabetic clinics at two hospitals. There were 174 females and 89 males, aged between 16 and 89 years (mean = 53.5, sd = 13.9). The average number of years of schooling was 6.3 (sd = 4.1). Main outcome measure. A reliable and valid patient satisfaction scale. RESULTS: Factor analysis was conducted on the patient satisfaction scale and two factors, accounting for 71.6% of the variance, were extracted. The major items on Factor I were support, consideration, friendliness, and encouragement, labelled the interpersonal dimension. Factor II emphasized availability of a seat and toilet in the waiting area and cleanliness, labelled the organizational dimension. The two factors had very good reliability coefficients: 0.85 (organizational) and 0.98 (interpersonal). Multi-trait scaling showed that all items exceeded the item convergent (r > 0.40) and discriminant (Z > 1.96) validity criteria. Patients in poor general health were significantly less satisfied (P = 0.007) with the organizational quality of their care than patients in good health; patients in poor mental health were significantly less satisfied (P = 0.04) with the interpersonal quality of their care than patients in good mental health. CONCLUSIONS: The findings provided support for Donabedian's model. They demonstrated that attributes of providers and settings are major components of patient satisfaction, and showed that the scale is a reliable and valid measure of patient satisfaction for this South African population.


Assuntos
Diabetes Mellitus/psicologia , Nível de Saúde , Relações Hospital-Paciente , Relações Interpessoais , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente , Qualidade da Assistência à Saúde/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus/etnologia , Diabetes Mellitus/terapia , Análise Fatorial , Feminino , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , África do Sul/epidemiologia
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