Evaluation of health promotion roles and services offered by health workers in the Nelson Mandela Bay Municipality of Eastern Cape, South Africa.
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Date
2022
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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.
Description
Doctoral Degree. University of KwaZulu-Natal, Durban.