Filling the language gap: the feasibility of communication resources used in the provision of healthcare for HIV/AIDS and tuberculosis in the Eastern Cape, South Africa
- Authors: Von Witt, Nathalia Jane
- Date: 2025-04-02
- Subjects: Communication in community health services South Africa Eastern Cape , Language and languages South Africa Eastern Cape , Multilingualism , Medical care South Africa , Communication in public health , Health literacy
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/478504 , vital:78192 , DOI 10.21504/10962/478504
- Description: South Africa has the largest number of Human Immunodeficiency Virus (HIV)-positive people in the world, the third-highest rate of Tuberculosis (TB) infections, and the second-highest rate of Multi-Drug Resistant TB (MDR-TB) globally, with up to 60% of HIV-positive healthcare users (HCUs) infected with TB as a co-infection. Both HIV/AIDS and TB require strict medicines adherence for disease management or treatment respectively; however, this is often not attained, and as such these statistics also represent lives affected by or lives lost to these diseases. Moreover, in South Africa, up to 80% of healthcare consultations are conducted through a second language. Despite language policies suggesting the contrary, African languages are neglected in healthcare provision in South Africa. This perpetuates inequalities within the South African healthcare system by limiting HCUs understanding of and agency in their own healthcare and maintaining a barrier to more effective treatment. Such language barriers may also result in HCUs defaulting on treatment. Added to this, the fear and mistrust arising from language power dynamics contributes to high rates of avoidance behaviour. This research therefore aimed to (a) explore how healthcare professionals (HCPs) and HCUs communicate when they are not fluent in the same language in care for HIV/AIDS and TB patients; (b) develop practical and feasible strategies that would enable HCPs to address language barriers in their consultations for HIV and TB and (c) to empirically evaluate these strategies in a pilot feasibility trial in the Eastern Cape. The first aim (a) concerning the problem of language barriers in healthcare consultations was addressed through identifying communication barriers experienced by HCPs in South Africa, exploring the strategies used to navigate or alleviate these barriers, creating and implementing communication resources, and analysing the effects of these resources on HCPs’ communication. A selective narrative review was conducted (Chapter 2) to identify the main communication problems experienced by HCPs and HCUs, as well as the main communication strategies and resources used by HCPs to reduce these communication problems. This was further explored by conducting two needs analyses with HCPs (n=31) in South Africa, and specifically in the Eastern Cape, which revealed differing perspectives on health communication and confirmed HCPs’ need for communication resources. For the second aim (b), existing communication resources were reviewed and selected or further developed following a Participatory Action Research approach, and then (c) empirically evaluated in a pilot feasibility trial with six healthcare sites in the Eastern Cape. Both the needs analyses and the pilot feasibility trial were adapted to employ an online or blended approach due to COVID-19-related limitations. The feasibility and acceptability of both the study protocol and the proposed communication resources were evaluated. Three major findings emerged from this research. First, this research echoed existing literature confirming that HCPs do not have the support they need at a structural level. Second, while it was found that there is no one-size-fits-all solution for resources and training to improve HCP-HCU communication, it was noted that the most appropriate resources are those that are flexible, and those that support HCPs’ language learning. HCPs who were already sensitive to communication barriers and were already taking steps to improve their second language (L2) proficiency also took initiative to use the resources in ways other than those suggested in order to best support the communication needs of them and the HCUs they consulted. Third, and linked to the second finding, it was found that communication resources that covered conditions including, but not limited to, HIV and TB were more appropriate. HCPs who used the resources showed a small, although not statistically significant, increase in communication satisfaction, satisfaction with resource support, and trust after using the resources for one month. Although implementation problems were encountered in some settings of the intervention, it was found that this intervention has the potential to be further evaluated in a larger, multi-site randomised controlled trial (RCT). These findings inform recommendations which are made to improve the feasibility of such a study in order to conduct an RCT; to further develop the resources in order to enhance communication between HCPs and HCUs both in HIV and TB consultations and in other fields of healthcare; and to implement a similar intervention at the university level and as Continuing Medical Education. The insights gained into HCPs’ support for language support resources, which resources were used, and particularly how they were used, are significant for taking actionable steps in supporting HCPs’ provision of more equitable healthcare in multilingual South Africa. , Thesis (PhD) -- Faculty of Humanities, Languages and Literatures, 2025
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- Date Issued: 2025-04-02
Interlingual and intercultural communication discordances as impediments to the provision of quality public healthcare services: cases of Cecilia Makiwane Hospital, Nkqubela Chest Hospital and Frere Hospital
- Authors: Hlitane, Nkosekaya
- Date: 2024-04-04
- Subjects: Language, Universal , Intercultural communication , Communication in public health , Communication Social aspects , Communication and culture South Africa
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/435501 , vital:73163
- Description: This study seeks to explore interlingual and intercultural discordances between clinicians and patients during treatment processes in selected public hospitals in the Eastern Cape. The two languages under investigation are English and isiXhosa. Intercultural communication refers to a phenomenon in which people who speak different native languages are engaged in a conversation (Gudykunst 1993). , Thesis (MA) -- Faculty of Humanities, School of Languages and Literatures, 2024
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- Date Issued: 2024-04-04
M-health user experience framework for the public healthcare sector
- Authors: Ouma, Stella
- Date: 2013
- Subjects: Communication in public health , Public health -- South Africa , Wireless communication systems in medical care
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:9827 , http://hdl.handle.net/10948/d1020793
- Description: The public healthcare sectors within developing nations face a lot of challenges because of constrained resources available to them. The South African public healthcare sector is no different. Although it serves the majority of the South African population, most of the financial resources are directed towards the private sector, which serves very few individuals when compared to the public healthcare sector. Apart from that, other challenges that the National Department of Health has to deal with include the lack of sufficiently trained healthcare employees who can work on the different levels of the public healthcare sector, as well as the burden of diseases such as HIV and Aids, tuberculosis and other chronic diseases. In order to improve service delivery, the National Department of Health is introducing Information and Communications Technology interventions that can increase efficiency and reduce costs, thereby improving the quality of service delivery. This research delivers an m-health application user experience framework to be proposed to the National Department of Health in South Africa, in order to assist in scaling up of m-health applications. The m-health applications that can benefit the South African population if scaled up successfully include those that can be used in remote data collection, treatment and compliance, accessing patients records, remote monitoring, communication and training for healthcare workers and applications that can be used for education and awareness. The study focused on three domains: the Human-Computer Interaction domain, public healthcare domain and Health Informatics domain. The proposed framework was realized by investigating mobile user experience components, mobile health requirements and the South African public healthcare domain components that contribute to the m-health user experience framework. This research was conducted through the interpretivist philosophy. Due to the exploratory nature of the study, an application of qualitative methodology was used. The conceptual theoretical framework was validated through a single case study approach by m-health user experience experts, who reside in South Africa. Data were analysed inductively. An m-health user experience framework was provided at the end of the study. An m-health user experience framework can assist the National Department of Health to look into design issues, address m-health requirements and put the domain needs in place, thus enabling the Department to successfully scale up implementations of m-health applications nationwide.
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- Date Issued: 2013