Primary Health Care Education Research Articles

Evaluation of Patient Compliance, Knowledge, and Health Services among Diabetic Patients Admitted in the Internal Department of Kamal Odwan Hospital

Diabetes mellitus is a chronic disorder characterized by hyperglycemia andthe late development of vascular and neuropathic complications. Diabetes is best managed by multidisciplinary care team and overlapping skills: physician, specialist diabetes nurse, dietitian, and chiropodist. The aim of this study is to evaluate patient knowledge and compliance with treatment of diabetes. The study conducted in Kamal Odwan Hospital in Gaza between designed prospective studies in which all patients that are admitted to the internal medical department and diagnosed with diabetes alone or associated with other diseases were included in this study. The patients were filled questionnaire regarding their age, history of the disease and other variables. the data analyzed manually and the results is shown below.The results that patient education and knowledge is very poor and the patients visit the physicians only to take their medications without any follow up as measurement of blood glucose level or other investigations. Only 20% of patient knows about the disease and only 20% were educated by specialist I primary health care or physician. So we recommend increase the role of health education in primary health care and other centers to reduce the complications of diabetes.

Health Education: Curiosity As A Parameter Of The Freirian Model In Primary Care

INTRODUCTION: The educative actions in health promotion are intended to develop, in individuals, family and communities, the capacity for perception of their health needs and joint participation in their resolution, bearing in mind their possibilities. Education on the effectiveness of health promotion practices is an effective instrument, which has been implemented through different methodologies. The traditional health education model based on Paulo Freire’s philosophy is widely used in the Brazil Unified Health System. OBJECTIVE: Identify curiosity as a Freirian parameter of health education in primary care. METHODS: This is an descriptive qualitative study carried out in the municipality of Juazeiro do Norte, Ceara, Brazil. In all, 31 nurses from basic health units (UBS) and 12 users from the Unified Health System participated in a semi-structured and observational interview mediated by context interpretation in individuals who participated in educational groups. The organisation of the material collected for the search took place on the basis of Bardin’s proposal and the analysis was based on the epistemological characteristics of Paulo Freire. RESULTS: Traditional pedagogies were used during the development of the interviews. It was observed that the educational activities whith focus on disease are still an obstacle to promoting a critical awareness of users. Once the nurses were limited to this methodology and the users complied with the guidelines, favouring their naive curiosity, they followed the prescribed instructions mechanically and without understanding, possibly involving temporary behaviour changes. The curativist/biomedical model was used during these activities. Curiosity was expressed via clarifications and questions that arose during the health education activities. However, these clarifications were limited to the questions and answers that the users and professionals exchanged, which allowed for the transfer of information but did not stimulate the users to be reflective. CONCLUSION: Curiosity, described by Paulo Freire as the learning process designed to produce active, critical, and reflective individuals, still does not happen in primary healthcare.

Healthcare Practices by Mothers in the Limpopo Province of South Africa: Modeling the Case of the Mopani District

Child morbidity is high in some parts of South Africa though there are a lot of interventions available to reduce childhood mortality. Some mothers lack knowledge about these interventions and this increases maternal and childhood mortality. This study seeks to determine the level of knowledge and practice mothers in Mopani have about child healthcare practices, and to model the determinants. A 3-stage sample survey, including stratified random sampling, was conducted covering all the municipalities in the district. About 1820 women in the childbearing age (that is, 13 to 49 years) were sampled and interviewed using structured questionnaires. Chi-square tests were carried out on categorical variables, and logistic and multiple regression analyses were performed for confirmations. From statistical analyses (catreg, logistic and multiple regressions) the study concludes that the following variables correlate with practices of child healthcare in the district: age, education, employment and the number of children a woman has. For the improvement of child health and survival, the study recommends primary healthcare education, immunization, oral rehydration therapy and prenatal medical check-ups.

Undergraduate nurses reflections on Whatsapp use in improving primary health care education.

BackgroundThe global use of mobile devices with their connectivity capacity, and integrated with the affordances of social media networks, provides a resource-rich platform for innovative student-directed learning experiences.ObjectiveThe objective of this study was to review the experiences of undergraduate nurses on the improvement of primary health care education at a School of Nursing at a University in the Western Cape, South Africa, through the incorporation of a social media application, WhatsApp.MethodA qualitative, exploratory, descriptive, and contextual design was used to explore and describe data collected from a purposive sample of 21 undergraduate nursing students. The study population was engaged in a WhatsApp discussion group to enhance their integration of theory and clinical practice of the health assessment competency of the Primary Health Care Module. Participants submitted electronic reflections on their experiences in the WhatsApp discussion group via email on completion of the study. Thematic analysis of the qualitative data collected was done according to Tesch's (1990) steps of descriptive data analysis in order to identify the major themes in the study. The electronic reflections were analysed to explore their rich, reflective data.ResultsSeven themes were identified that included: positive experiences using the WhatsApp group; the usefulness of WhatsApp for integrating theory and clinical practice; the availability of resources for test preparation; opportunity for clarification; anonymity; exclusion of students as a result of the lack of an appropriate device, and the application caused the battery of the device to run flat quickly.ConclusionThe results of the experiences of students in the WhatsApp discussion group could be used to inform the use of social media applications in teaching and learning, with the purpose of enhancing the integration of the theory and clinical practice.

Interventions for the treatment of trachoma: an overview of Cochrane systematic reviews.

Trachoma is an infectious disease caused by the bacterium Chlamydia trachomatis. Infection with C. trachomatis produces characteristic changes to the inner surface of the eyelids, resulting in sequela that when left untreated, leads to vision impairment and blindness. Repeated trachoma infections can cause severe scarring of the inside of the eyelid and can cause the eyelashes to scratch the cornea (trichiasis). The objective of this overview was to synthesize the evidence from Cochrane systematic reviews regarding the treatment of trachoma, and to provide a brief and user-friendly front end for health professionals, researchers and policy makers. Face washing plus topical tetracycline eye ointment gave no additional protective benefit against active trachoma when compared with topical tetracycline eye ointment alone. Nor was any benefit conferred in the presence of severe trachoma. Primary health-care education was found to be effective in reducing the odds of active trachoma. Evidence of benefit from insecticide spray or provision of latrines away from living areas was inconclusive for active trachoma. Surgical interventions that involve full-thickness incision with tarsal rotation are more effective than alternate surgical procedures.

Family medicine training in sub-Saharan Africa: South-South cooperation in the Primafamed project as strategy for development.

Background.Health-care systems based on primary health care (PHC) are more equitable and cost effective. Family medicine trains medical doctors in comprehensive PHC with knowledge and skills that are needed to increase quality of care. Family medicine is a relatively new specialty in sub-Saharan Africa.Objective.To explore the extent to which the Primafamed South–South cooperative project contributed to the development of family medicine in sub-Saharan Africa.Methods.The Primafamed (Primary Health Care and Family Medicine Education) project worked together with 10 partner universities in sub-Saharan Africa to develop family medicine training programmes over a period of 2.5 years. A SWOT (strengths, weaknesses, opportunities and threats) analysis was done and the training development from 2008 to 2010 in the different partner universities was analysed.Results.During the 2.5 years of the Primafamed project, all partner universities made progress in the development of their family medicine training programmes. The SWOT analysis showed that at both national and international levels, the time is ripe to train medical doctors in family medicine and to integrate the specialty into health-care systems, although many barriers, including little awareness, lack of funding, low support from other specialists and reserved support from policymakers, are still present.Conclusions.Family medicine can play an important role in health-care systems in sub-Saharan Africa; however, developing a new discipline is challenging. Advocacy, local ownership, action research and support from governments are necessary to develop family medicine and increase its impact. The Primafamed project showed that development of sustainable family medicine training programmes is a feasible but slow process. The South–South cooperation between the ten partners and the South African departments of family medicine strengthened confidence at both national and international levels.

Prevention and control of micronutrient deficiencies in developing countries: current perspectives

Prevention and control of micronutrient deficiencies in developing countries: current perspectives Cristiana Berti,1 Mieke Faber,2 Cornelius M Smuts11Centre for Excellence in Nutrition, North-West University, Potchefstroom, South Africa; 2Non-communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South AfricaAbstract: Despite strategies employed to tackle micronutrient malnutrition, limited progress has been achieved in the developing countries. Of global concern are deficiencies in iron, vitamin A, zinc, folate, and iodine. This review aims to explore up-to-date scientific evidence on the effect of different micronutrient strategies on biomarkers and health outcomes, and for each strategy, to highlight strengths, limitations, and factors contributing to success or failure. PubMed/MEDLINE and EBSCO databases and Google-indexed scientific literature were searched for relevant articles and documents, limited to human studies reported since 2003. Evidence shows that the most cost-effective approaches to address symptoms of micronutrient malnutrition are targeted supplementation and/or fortification with iron, iodine, zinc, folic acid, vitamin A, and multimicronutrients, provided that households have access to primary health care and that there is consistent long-term coverage, monitoring, adequate marketing, and commercial commitment. Dietary diversification/modification interventions are probably the most sustainable strategies to address causes of deficiency, but permanent solutions are still required in controlling micronutrient malnutrition at both research and public health levels. Furthermore, many scientific gaps remain, hindering the development of robust public health guidance. These gaps are due to the paucity of well-designed community-based studies, lack of information on biological mechanisms behind relationships between micronutrients and outcomes, and inconsistent results. Further adequately powered long-term trials are needed to fill these gaps. Lessons learned from large-scale nutritional programs suggest that, for long-term improvements in nutrition and health, dietary strategies must integrate agricultural production with primary health care and female nutrition education and empowerment. They must also promote behaviors that support adequate intake, ensure availability of supply, and help to empower communities to become more self-reliant.Keywords: fortification, supplementation, sustainability, integrated nutritional programs, resource-poor populations, dietary diversification

Nursing students and mental health education in primary care

The University of Sao Paulo School of Nursing (EEUSP) went through a period of transition from undergraduate syllabus between the years 2009 and 2010. This change was made to integrate basic and clinical cycles and to reduce fragmentation of the disciplines. The mental health nursing education was included in many modules including the primary care. This qualitative study aimed to identify how the service offered to people with mental illness was performed by 20 undergraduate students in the context of primary care and how they were prepared. Data collection was conducted through semi-structured interviews, in August 2012, in EEUSP After thematic analysis, we separated in categories: Teaching-learning process, Basic Health Unit and Mental health-illness process. The socially constructed conception of madness added to the problems related to academic training may result in lack of preparation in nursing mental health care.

Collaborative Learning in Maternity and Child Health Clinics

The health and wellbeing problems of the families with children have become more complex today. Improving preventive services and facilitating an early intervention in health and wellbeing problems of the families are the main challenges. A better interprofessional collaboration (IPC) of the professionals is needed to maintain the well-being level of the families high. These are skills to be learned during undergraduate education. An interprofessional pair training (IPT) for maternity and child health clinics was implemented in collaboration with primary health care centre and two universities of Oulu to develop an interprofessional education (IPE) model for undergraduate level students. Fifth year medical students (n = 101) and fourth year public health nurses (n = 31) and teachers participated in the training program during 2010-2012. The study aimed at investigating students’ attitudes and readiness for interprofessional learning (IPL), at strengthening their professional skills and at gathering clients’ experiences. The interprofessional student pairs met with the client visits independently. One pair contacted three clients during the day. They examined and observed the examination of the other pair. The feedback was collected from the students and the clients. Students’ attitudes and readiness for IPL were assessed using RIPLS (Readiness for interprofessional learning scale). Both medical and nurse students attached great importance to teamwork and collaboration. Nurse students appreciated the learning of roles and responsibilities more important in comparison to the medical students. A tendency for stronger professional identity among medical student was noted. The clients’ expectations were fulfilled. The training periods gave valuable experience to develop IP pair training for collaborative practices in primary health care and undergraduate health care education. The study results are important for curriculum development as well.

The evolving role of nurses in primary care medical settings

The role of nurses in primary care is understudied. The purpose of this study was to describe the current registered nurse (RN) role in three Primary Care Networks (PCNs) in western Canada and to identify opportunities for optimal utilization of RNs in these settings. Case study methodology included interviews and document review. Although the RN role evolved during the study, most RNs focused on chronic disease management. Role ambiguity was evident between nurses and with interprofessional team members. Relationships of RNs to other providers, particularly physicians, impacted the enactment of the nursing role. Other barriers to role enactment included physician fee-for-service remuneration, management structures and processes, lack of access to electronic medical records and lack of previous opportunities to apply primary health-care education in the practice setting. Further work is needed to optimize the RN role in primary care to ensure maximum impact for patients, providers and the health system overall.

NURSING AND HEALTH EDUCATION IN PRIMARY CARE: AN EXPERIMENT IN THE NEIGHBORHOOD OF MOTHER LUIZA, NATAL-RN

Objetivo: Dialogar com o grupo de adolescentes e jovens acerca de Sexualidade e Planejamento Familiar. Metodos: Dinâmica de grupo inspirada na Pedagogia da Problematizacao de Paulo Freire. Resultados: A dinâmica e a oficina educativa realizada em um bairro da cidade do Natal/RN permitiu-nos observar que o elevado numero de duvidas e desinformacoes acerca da tematica proposta deve-se a ausencia de programas de atencao basica voltados para jovens nas Unidades Basica de Saude. Conclusao: Outro dado relevante observado nessa experiencia revelou a urgencia de uma maior aproximacao entre as areas da educacao e saude tanto nas Unidades de Saude, quanto nas escolas.

A New Model for Companion-Animal Primary Health Care Education

The majority of graduates from veterinary schools in the United States and Canada join companion-animal practices. In most schools, their clinical learning and client interaction experiences occurred primarily in referral teaching hospitals. These specialty hospitals play an essential role in the veterinary care continuum by providing advanced training, clinically-based research, and sophisticated diagnostics and procedures. However, they are not ideal as the principal setting for preparing veterinarians to bring value to the primary health care practices that they join. A new model for companion-animal primary health care education and service delivery has been developed at the Ontario Veterinary College, University of Guelph. The nine integrated programs, which have defined learning objectives and outcome assessments, include communication, nutrition, rehabilitation, behavior, welfare, One Health (ecosystem approach to health), preventive and general medicine, good citizenship, and research. The learning experience begins with first-year student veterinarians and takes place in a practice setting with paying clients from the community. Significantly, the students are learning in an environment that emphasizes the importance of the client experience, teamwork, and practice management while ensuring quality health care for patients. The future of companion-animal primary health care and the optimal preparation of veterinarians are critical issues for the veterinary colleges and profession. Enhanced research into new models for primary health care education and service delivery is urgently needed.

Estrategias pedagógicas basadas en Célestin Freinet para educar en salud

Medwave es una revista electrónica revisada por pares y de acceso gratuito, que contiene artículos originales de revisión sobre determinantes clínicos, sociales, políticos y económicos en salud, y de investigación en el ámbito clínico y biomédico. Medwave is an online-only, peer-reviewed and open Access biomedical general journal with original review articles con clinical, social, political and economic determinants of health, and research articles on clinical and biomedical aspects.

The benefits of a tailor‐made pilot primary health‐care course for Indigenous high school students in remote Queensland

This study highlights the benefits of a tailor-made course for an Indigenous high school in a remote North Queensland community. Qualitative research study using a Grounded Theory approach to allow thematic analysis of participant's responses to a researcher-administered, pre-defined, semistructured questionnaire. Remote community college in Abergowrie, North Queensland. Four male high school students and eight key stakeholders were interviewed over the telephone (n = 12). Thematic analyses of the feedback from students and stakeholders showed a variety of benefits from the course for Indigenous students: increased knowledge of health issues, greater awareness and interest in health career pathways, increased pride, self-esteem and self-confidence, positive role-modelling and leadership behaviour in the students, and hope for future career development. Weaknesses identified were mainly associated with a lack of resources and support for the course. This study demonstrates that a tailor-made primary health-care education course can create opportunities for Indigenous people to pursue health careers, promote health knowledge and leadership skills, inspire pride and self-esteem, and strengthen links within the community.

PERCEPTION OF NURSES ON HEALTH EDUCATION IN PRIMARY CARE

Objetivo: Avaliar a percepcao dos Enfermeiros sobre a Educacao em Saude na Atencao Basica, alem dos instrumentos utilizados e as acoes prestadas para promover a educacao em saude junto aos usuarios. Metodos: A pesquisa empirica realizou-se mediante entrevista e analisado qualitativamente atraves da tecnica de analise do discurso do sujeito coletivo. Resultados: Evidenciou-se que Educacao em Saude deve tornar-se regular na atencao basica e, para tal, necessita-se de investimentos na infraestrutura, organizacao nos cronogramas de atividades executaveis, na qualificacao e simplificacao dos materiais didaticos, estimulos a participacao e frequencia da comunidade e maior atuacao de todos os profissionais, alem de sua qualificacao, atraves de treinamentos. Conclusao: Ha necessidade de adicionar a equipe basica de saude da familia outros profissionais, pelo seu valor assistencial e, sobretudo, pelo conhecimento cientifico que somado aos demais conscientizara a populacao na importância de mudanca de habitos, a fim de prevenir danos e promover saude.

Educação para a promoção da saúde no contexto da atenção primária

To investigate whether the educational initiatives carried out in basic health units in Belo Horizonte, Minas Gerais, Brazil, follows the principles of health promotion. This descriptive study examined 33 educational health promotion initiatives to determine whether they were guided by five principles, used as categories of analysis: multicausality of the health-disease process, intersectoriality, social engagement, sustainability, and use of dialogic teaching methods (active participation of subjects in the learning process, planning the activity to generate new knowledge, and use of various teaching strategies). Structured observation was used for data collection. The frequency of each category was evaluated in each initiative. Multicausality was the most frequent category observed (73.0%), and intersectoriality the least frequent (9.0%). Regarding the use of dialogic methods, 38.0% of the initiatives promoted the active engagement of subjects, 6.0% promoted knowledge generation, and 40.0% employed a variety of teaching strategies. Most educational initiatives were not actively oriented toward health promotion, understood as the strengthening of autonomy and self-management of health processes, social engagement, and employment of dialogic teaching approaches. However, some progress has been made moving away from hegemonic models of education in primary health care.

Attitudes of psychologists and nurses toward suicide and suicide prevention in Ghana: A qualitative study

BackgroundOne way of preventing suicide has been increasing awareness among health care professionals of their own attitudes and taboos toward suicide and its prevention. ObjectiveThe purpose of this study was to understand the attitudes of health professionals toward suicidal behavior and its prevention in Ghana. MethodsA total of 17 informants (9 clinical psychologists and 8 emergency ward nurses) in an urban center were interviewed using a semi-structured interview guide. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. ResultsWe found that the attitudes of these health workers toward suicide and suicide prevention seemed to be transiting between morality and mental health. The psychologists generally saw suicide as a mental health issue, emphasized a caring and empathic view of suicidal persons and approached suicide prevention from a health-service point of view. Mental health education and improvements in primary health care were reported as practical approaches toward suicide prevention. The nurses on the other hand, held a moralistic attitude toward suicide as a crime, viewed suicide persons as blameworthy and approached suicide prevention from a proscriptive perspective. Informal approaches such as talking to people, strengthening the legal code against suicide and threatening suicidal persons with the religious consequences of the act were also indicated as practical approaches to suicide prevention. Educational level, clinical experience with suicidal persons, and religious values, are discussed as influencing the differences in attitudes toward suicide and suicide prevention between psychologists and nurses. ConclusionHealth workers in Ghana need training in suicidology to improve both knowledge and skills relevant for suicide prevention.

Continuing Progress in Primary Healthcare Education

Continuing Progress in Primary Healthcare Education

Master's level in primary health care education - students' and preceptors' perceptions and experiences of the alteration in the clinical areas

BackgroundMany Western European countries are undergoing reforms with changes in higher education according to the Bologna declaration for Higher European Education Area. In accordance with these changes, the Master's degree was introduced in specialist nurse education in Sweden in 2007, and as a result changed the curriculum and modified theoretical and clinical areas. The aim of this study was to investigate students' and preceptors' perceptions and experiences of Master's level education in primary health care with a focus on the clinical area.MethodsA descriptive design and qualitative approach was used. Interviews with ten students and ten preceptors were performed twice, before and after the clinical practice period. Interviews were audio-recorded, transcribed verbatim and themes formulated.ResultsStudents perceived alteration in the content of the education at the Master's level such as more independence and additional assignments. The preceptors perceived benefits with the Master's level but were unsure of how to transform theoretical and abstract knowledge into practice. Writing the Master's thesis was seen by students to take time away from clinical practice. For some students and preceptors the content of the Master's level clinical practice area was experienced as vague and indistinct. The students had not expected supervision to be different from earlier experiences, while preceptors felt higher demands and requested more knowledge. Both students and preceptors perceived that education at the Master's level might lead to a higher status for the nurses' profession in primary health care.ConclusionsStudents and preceptors experienced both advantages and disadvantages concerning the change in specialist nurse education in primary health care at the Master's level. The altered educational content was experienced as a step forward, but they also questioned how the new knowledge could be used in practice. The relevance of the Master's thesis was questioned. Supervision was seen by students as an introduction to the work of the district nurses' work. Preceptors perceived high demands and did not feel enough qualified for student supervision. Both groups considered it an advantage with the change in education that could result in higher status for nurses working in primary health care.

Australia's primary health care workforce — research informing policy

In 2008, the Australian Primary Health Care Research Institute (APHCRI) held a Primary Health Care Workforce Roundtable with practising clinicians, policymakers and researchers, which drew on Australian evidence in health care policy, systematic reviews, and expertise and experience of participants. Key recommendations for an adequate, sustainable and effective primary health care workforce that arose from the meeting included: simplifying the Medicare Benefits Schedule, which is unnecessarily complex and inflexible; effectively funding undergraduate and prevocational medical and nursing education and training in primary health care; developing career structure and training pathways for general practitioners and primary health care nurses; developing of functional primary health care teams; and using a blended funding model, comprising fee-for-service as well as capitation for patients with chronic or complex needs. A report from the meeting, detailing these policy options, was submitted to the National Health and Hospitals Reform Commission for inclusion in their deliberations.