Health Care In South Africa Research Articles

‘The doctor doesn’t understand Xhosa and the service user doesn’t understand English’ - exploring the role of security guards acting as informal interpreters in psychiatric care in South Africa

IntroductionAssigning qualified interpreters is considered one of the most effective approaches to facilitate communication in language-discordant encounters in mental healthcare. However, particularly in settings with fewer resources, they are not always available and informal practices are often used.ObjectiveThis study aimed to investigate informal interpreting practices in mental healthcare in South Africa, focusing on security guards (SGs) serving as interpreters.MethodsGuided interviews were conducted with SGs (n = 12) and mental healthcare providers (MHCPs) (n = 18) at a psychiatric hospital in South Africa. The interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach.ResultsDespite recognizing that SGs serving as interpreters is not an ideal solution to overcome language barriers and could potentially jeopardize the quality of treatment and its outcomes, MHCPs reported relying heavily on them due to the underrepresentation of South Africa’s linguistic diversity among them. Given the lack of formal interpreting services, the perceived racial, linguistic and socioeconomic similarities between SGs and some service users, as well as their immediate accessibility, were described as beneficial to providing a minimal level of care (e.g. obtaining information about service users’ backgrounds, getting an understanding of their symptoms, psychoeducation, explaining treatment options). Drawbacks reported are SGs being pulled away from their actual duties, experiencing emotional distress, juggling multiple sometimes conflicting roles, and the risk of incorrect interpretation, which could compromise ethical standards of care. Additionally, the complexity of power became apparent: While SGs hold little institutional power within the mental healthcare system, they become powerful figures when serving as interpreters.ConclusionIt can be assumed that MHCPs will resort to informal interpreting practices as long as effective alternatives are lacking. In doing so, risks such as reduced quality of care are accepted, and the consequences and effects on those serving as interpreters are neglected, which raises concerns from an ethical point of view.

A design thinking approach to developing an online curriculum in interprofessional education in health in South Africa

Background. The design of contemporary curricula in health professions education in South Africa (SA) is constantly evolving, as there is a need to ensure that students are adequately prepared to work in complex healthcare environments. The World Health Organization proposes that a way to accomplish this is through interprofessional education (IPE), where students from two or more professions learn from one another to improve health outcomes. Objectives. To reflect on the design of an introductory module of a postgraduate diploma in IPE in health at a historically disadvantaged institution in SA, where a student-centred approach to learning and teaching was adopted. Methods. Through an auto-ethnographic methodology, a design thinking approach was used to carefully construct and align an introductory module in IPE in the postgraduate programme. Considering the remote learning environment, this article also examines the importance of educational technologies in the design process of this online curriculum. Results. The results of this study demonstrated the process used in the design of an IPE module supported by the five stages of design thinking to critically appraise the student-centred approach to learning and teaching. The instructional design tools used for this module included the university’s learning management system, Google Suite, Flip, Google Jamboard, webinars, presentations, elevator speeches, quizzes and guest speakers. The end product was an interactive online module that was intentionally designed to be interactive and provide students with a core understanding of IPE. Conclusion. This article demonstrates how an IPE module with a focus on theories, models and concepts can provide the foundation for students to understand the importance of IPE to transform the future of healthcare in SA.

Investigating drivers of information technology governance in South African public healthcare sector

As organizations continue to heavily invest in Information Technology (IT), effective information technology governance is critical to make sure that IT spending leads to the fulfilment of organizational goals and delivery of expected value. The purpose of this study is to determine IT governance drivers in public healthcare in South Africa. The study applied exploratory mixed methods research, through semi-structured interviews and an online survey questionnaire with selected IT and business decision-makers. Data were analyzed through thematic data analysis, confirmatory factor analysis and correlation analysis. Through the lenses of the technology organization environment (TOE) framework, findings indicate that organizations are driven by internal and external context-based governance imperatives, which manifest as trigger events and pain points, necessitating new or changed IT governance policies. The implication is that organizations require specifically tailored IT governance strategies that respond to their specific governance needs. The study calls for policymakers and implementers to be conscious of their IT problem context. In the absence of IT governance drivers’ contextualization, organizations may fail to tailor IT governance initiatives, and risk investing in costly IT governance practices that do not address their specific needs. The study contributes to reflective and pragmatic IT governance approaches in developing economies.

Community-led monitoring and the role of Ritshidze in improving the quality of primary healthcare in South Africa.

Community-led monitoring (CLM) of health services is a mechanism of community participation and accountability that is increasingly advocated across the globe. In South Africa (SA), a large-scale community-led monitoring initiative called Ritshidze ('saving our lives') was established in 2019. Steered by a coalition of civil society organisations representing people living with HIV, Ritshidze monitors just over 400 primary healthcare (PHC) facilities in 8 provinces on a quarterly basis. In this piece we describe the purposes and design features and the five-step approach to CLM of the Ritshidze model. We also highlight some of the positive changes achieved, and reflect on possible reasons for successes. In doing so, we aim to draw attention to this significant national initiative and its potential as a mechanism of social accountability in SA.

The role of clinical associates in South Africa as a health workforce: A scoping review.

South Africa's health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers. This study mapped Clin-As' history and practice in South Africa, assessing their roles in the health workforce and offering recommendations. Following the framework outlined by Arksey and O'Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening. Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As' perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation. As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa's health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition.Contribution:This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.

Let the records speak: an exploration of rehabilitation services offered in primary healthcare, Johannesburg metropolitan district

BackgroundPrimary healthcare in South Africa aims to transform the national health system by emphasising community-based care and preventive strategies. However, rehabilitation services, particularly for individuals with disabilities and chronic non-communicable diseases, are often overlooked in primary healthcare. This study aimed to investigate the provision of primary healthcare rehabilitation services in the Johannesburg Metropolitan District by exploring client sociodemographics and variations in services provided by rehabilitation professionals.MethodsA retrospective review of clinic rehabilitation records from 2011 to 2020 was conducted at nine provincially funded community health centres (CHCs) offering rehabilitation services. Stratified sampling facilitated record selection based on rehabilitation service type and year. A specifically designed data extraction tool captured demographics, disabilities, rehabilitation received, and referral sources. Descriptive analysis used means, standard deviations, and frequencies.ResultsThe findings show a diverse client population with a wide age range, with a significant proportion falling into the < 5 years and 30–49 years age groups. Neuromusculoskeletal and movement-related disabilities were most prevalent, affecting approximately two-thirds of clients. Referral sources were often undocumented, and inconsistent discharge information with no record of patient follow up, highlighted the need for improved documentation practices. Clinic visits were the primary service delivery mode, followed by limited home visits and outreach services. Occupational therapy and physiotherapy were the most used services. Speech and language therapy services were underused, and some CHCs lacked audiology services. There were variations in the number of individual and group sessions provided by the different rehabilitation services, and there were age- and disability-specific differences in service use.ConclusionThis study offers insights into rehabilitation service provision in the Johannesburg Metropolitan District and enhances our understanding of rehabilitation services in primary healthcare settings. It underscores the importance of a multidisciplinary rehabilitation team to address diverse rehabilitation needs, improving documentation and discharge practices, expanding service delivery models, and reducing disparities in service use. The findings inform strategies for optimising service delivery, workforce, resource allocation, and intersectoral collaboration to ultimately enhance the quality and accessibility of integrated rehabilitation services.

Early Online: Vol. 114 No. 4

Maternal healthcare in South Africa faces huge private and public health systems challenges. A key challenge for policy makers is how to address the inappropriate patterns of obstetric care in the private sector and how to mobilise private sector resources to serve the broader population dependent on the public sector, without replicating those patterns of inappropriate care. Developing and implementing new obstetric care models that address these challenges and lend themselves to public private engagements could play a vital role in efforts to improve obstetric care in the country. Drawing on insights from research we carried out on the care and contracting models used by five rural district hospitals in the Western Cape Province to contract private general practitioners to provide caesarean delivery services, this article outlines a potential alternative private sector obstetric care model with the aim of stimulating discussion by all relevant stakeholders on the development of new obstetric models for improving obstetric care in the country.

A Decolonized Framework for a Medical Treatment Team Approach to Mental Healthcare in the South African Context

ABSTRACT Medical treatment teamwork is widely advocated as an approach for treating mentally ill patients because the diverse healthcare professionals constituting medical treatment teams all contribute specific expertise for patient care. Approximately 80 per cent of South Africans are influenced by sociocultural factors with reference to their mental health issues. Hence, a decolonial medical treatment team approach to mental healthcare could enable a medical treatment team to cater for important sociocultural aspects in mental healthcare. However, at present, there is no single model or theory that accommodates important aspects such as the medical treatment teamwork and sociocultural aspects that influence mental healthcare. A qualitative, multiple-case study was used for this study to investigate these issues. The conceptual framework was developed from literature and theories and thereafter empirically investigated at two sites, namely the South African Eastern Cape Hospitals of Cecilia Makiwane and Fort England, using three data collection methods that included face-to-face, semi-structured interviews, focus group discussions and official documents. Data were analyzed applying thematic analysis. The findings indicated that sociocultural considerations such as the patient’s culture and the role of their families in mental healthcare should be included in the healthcare process in order to facilitate decolonized effective mental healthcare in South Africa.

Factors Associated With Willingness to Pay for Primary Health Care Services in South Africa: A Cross-Sectional Survey of Medical Schemes Members.

The cost of healthcare is an issue of concern for both consumers and funders of healthcare in South Africa. The country spends approximately 8% of GDP on health care. Health care is financed through the public sector which covers 86% of the population and the private sector which covers 14% of the population. Medical schemes are the main source of healthcare financing in the private sector. Services covered by medical schemes include chronic diseases, emergencies, diagnosis, and treatment of a selected number of diseases. Primary health care services such as screening are limited. The aim of this study was to assess factors associated with members of medical schemes' willingness to pay for a primary health care package in the private sector. A cross-sectional survey was conducted amongst principal members of medical schemes between July and September 2020. All principal members with access to an online questionnaire were eligible to participate in this study. Logistic regression was used to identify factors associated with willingness to pay for primary health care services. A total of 6512 members of medical schemes participated in the study. Thirty-five percent of the participants were willing to pay for the primary health care package. Factors influencing willingness to pay included marital status, employment status, income and household size. The study highlights the need for policymakers to consider socioeconomic factors when designing health care policies.

Improving Access to Healthcare in South Africa through the National Health Insurance Scheme: A Hit or a Miss?

The South African healthcare system is plagued by inequalities at various levels. The National Health Insurance (NHI) Bill was recently passed by the National Assembly and has revived debate on whether the NHI can effectively bridge the gap between the rich and the poor in accessing healthcare services. This paper explores the effectiveness of the NHI as a healthcare system reform aimed at bridging the gap between the public and private sectors of South Africa’s two-tiered healthcare system. To assist policymakers in its effective implementation, the paper explores the constitutional obligations regarding the provision of healthcare services and offers an analysis of whether the NHI Bill meets constitutional muster. In its conclusion, the paper also suggests solutions to address the Bill’s shortcomings by including practical steps that can be taken to ensure that the vision of universal health coverage is achieved.

The complexities of trans women’s access to healthcare in South Africa: moving health systems beyond the gender binary towards gender equity

BackgroundPublic health research highlights the influence of socio-political biases shaping obstacles to fair healthcare access based on gender. South Africa has shown commitment to resolving gender imbalances in healthcare, historically emphasizing cisgender women’s challenges. However, research gaps exist in exploring how public health systems perpetuate disparities among gender-diverse persons, like trans women, who face exclusion due to their deviation from cisgender norms in healthcare. Critical, intersectionality-informed health research carries the potential to reveal the diversity of gendered healthcare experiences and expose the systems and processes that marginalize trans patients.MethodsThis study adopts a critical trans politics perspective to explore the socio-political forces limiting South African trans women's access to public healthcare. Using a critical narrative approach, the research asks:1) What narratives do South African trans women share about their experiences in health systems?2) What gendered societal structures, practices, and norms enable or hinder their inclusion in health systems?Over a period of two months in 2022, five South African adult trans women between the ages of 22 and 30 participated in 60 to 90-min long, semi-structured individual, telephonic interviews, focusing on participants' subjective experiences in healthcare.ResultsTrans women's narratives unveiled a culture of medical genderism in South African public healthcare, discriminating against patients whose gender misaligns with societal norms. This culture is represented by the trans women's experiences of their identities being structurally stigmatized and delegitimized when seeking healthcare, reflected in institutional policies, practices, and protocols consistently disregarding and misgendering them. Trans women’s systemic erasure was illustrated by the restricted professional knowledge, availability, and adoption of gender-affirming healthcare in a ciscentric public healthcare system prioritizing cisgender needs. The intersection of gender, race, and class dynamics compounded the obstacles faced in accessing healthcare.ConclusionsThis inquiry underscores the structural hurdles trans women face when accessing suitable public healthcare. It introduces a gender equity framework for trans inclusive healthcare, outlining implications for research, theory, policy, and practice. Toward the goal of embracing complexity and diversity, this framework, for example, promotes the rigorous absorption of trans persons and their healthcare experiences in gender-responsive programming, and encourages the development of a comprehensive understanding of gender equity from an intersectional perspective incorporating the unique needs and rights of trans healthcare seekers. The framework also offers practical guidance for cultivating health systems attuned to gender diversity (such as addressing medical genderism and recognizing the broad spectrum of identity at a policy level).

What do medical students and their clinical preceptors understand by primary health care in South Africa? A qualitative study

BackgroundThe definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that essential health care should be made accessible to individuals and their communities close to where they live and work. In 1992 Starfield articulated the four pillars of PHC: the patient’s first contact with healthcare, comprehensive care, coordinated care and continuous care. Using this literature guidance, this study sought to explore what undergraduate medical students and their clinical preceptors understood by PHC in four South African medical schools.MethodsA qualitative study using the phenomenological design was conducted among undergraduate medical students and their clinical preceptors. The setting was four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the clinical preceptors and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4–6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software.ResultsFour themes were identified in which there were similarities between the students and their preceptors regarding their understanding of PHC: (1) PHC as the patient’s first contact with the healthcare system; (2) comprehensive care; (3) coordination of care and (4) continuity of care. A further two themes were identified in which these two groups were not of similar understanding: (5) PHC as a level or an approach to healthcare and (6) the role of specialist clinical preceptors in PHC.ConclusionsMedical students and their clinical preceptors displayed an understanding of PHC in line with four pillars articulated by Starfield and the WHO definition of PHC. However, there remains areas of divergence, on which the medical schools should follow the guidance provided by the WHO and Starfield for a holistic understanding of PHC.

Development of a «people-centred approach» to realising healthcare by facilitating, patient participation in health attainment in South Africa and Ukraine

Object of this research is South Africa's healthcare system. South Africa's healthcare system faces numerous challenges that contribute to inadequate access to quality healthcare for its citizens. These challenges include a scarcity of healthcare workers, insufficient funding and resource allocation, a high burden of communicable and non-communicable diseases, as well as disparities in healthcare access and outcomes driven by socioeconomic status and geographic location. Consequently, many South Africans endure unfavourable health outcomes, limited availability of essential health services, and a prevailing sense of mistrust towards the healthcare system. Concurrently, Ukraine has encountered its own set of healthcare obstacles, including similar shortages of healthcare professionals, funding deficiencies, and disparities in healthcare access exacerbated by armed conflict. This study provides insights into the patient experience, utilizing Kolb's experiential learning theory. It employs qualitative and quantitative methods, including a questionnaire administered to conveniently sampled participants at Chris Hani Baragwanath hospital's HIV/AIDS unit. Data analysis using Excel and SPSS reveals a communication gap between healthcare workers and patients, highlighting the need for Department of Health training on communication and diversity. Finally, the implementation of consistent patient feedback mechanisms is essential for healthcare institutions to comprehend evolving patient needs, fostering the adoption of a «people-centred» approach to delivering high-quality healthcare services. By incorporating insights from Ukraine's challenges, this study not only addresses the specific healthcare obstacles faced by South Africa but also provides a broader perspective on healthcare issues across diverse contexts. These insights enable policymakers and healthcare professionals to identify potential solutions and work towards improving healthcare access and outcomes for all citizens, ensuring the overall health and well-being of the population of South Africa and other countries with similar challenges.

Opportunities for primary health care in South Africa - Reflections from the USA.

No abstract available.

Advance Care Planning in South Africa

South Africa (SA), an upper middle-income country, faces significant challenges, including severe inequality, poverty, high unemployment rates, unequal access to basic services, and a long history of human rights violations. It is a diverse nation with eleven official languages. The country also bears a heavy burden of communicable and non-communicable diseases, with many patients seeking healthcare services too late. Despite the pressing need, palliative care is still an emerging field in South Africa, with limited funding allocated for its integration.Advance Care Planning (ACP) is a recommended practice in SA for patients with serious illnesses while they are still in good health and can function independently. Non-Governmental Organizations (NGOs) in SA have played a significant role in integrating ACP planning within their settings through advocacy and training. ACP has been included in both formal academic training and training programs offered by NGOs. Additionally, research has been initiated to evaluate the acceptability and validity of the Serious Illness Conversation Guide within the cultural diversity and complexities of the SA context.Acceptance of ACP amongst SA healthcare workers and the public faces many challenges. Many South Africans still have a low level of trust and acceptance towards the public healthcare system. In many South African cultures discussing death and dying is considered culturally taboo. Traditional cultures interpret and apply the concept of individual autonomy differently. The philosophy of “Ubuntu”, which translates to “I am because we are”, is widely endorsed in the country, prioritising community needs over individual needs. It is, therefore, essential for healthcare professionals engaging in ACP conversations not to make assumptions about a person's preferences for communication, decision-making and care, based on external attributes. Instead, they should respectfully explore these preferences and be adaptable in their approach to ACP.The implementation of ACP in SA is still in its early stages, requiring further research to inform culturally sensitive approaches to advance care planning.

The role of modelling and analytics in South African COVID-19 planning and budgeting.

The South African COVID-19 Modelling Consortium (SACMC) was established in late March 2020 to support planning and budgeting for COVID-19 related healthcare in South Africa. We developed several tools in response to the needs of decision makers in the different stages of the epidemic, allowing the South African government to plan several months ahead. Our tools included epidemic projection models, several cost and budget impact models, and online dashboards to help government and the public visualise our projections, track case development and forecast hospital admissions. Information on new variants, including Delta and Omicron, were incorporated in real time to allow the shifting of scarce resources when necessary. Given the rapidly changing nature of the outbreak globally and in South Africa, the model projections were updated regularly. The updates reflected 1) the changing policy priorities over the course of the epidemic; 2) the availability of new data from South African data systems; and 3) the evolving response to COVID-19 in South Africa, such as changes in lockdown levels and ensuing mobility and contact rates, testing and contact tracing strategies and hospitalisation criteria. Insights into population behaviour required updates by incorporating notions of behavioural heterogeneity and behavioural responses to observed changes in mortality. We incorporated these aspects into developing scenarios for the third wave and developed additional methodology that allowed us to forecast required inpatient capacity. Finally, real-time analyses of the most important characteristics of the Omicron variant first identified in South Africa in November 2021 allowed us to advise policymakers early in the fourth wave that a relatively lower admission rate was likely. The SACMC's models, developed rapidly in an emergency setting and regularly updated with local data, supported national and provincial government to plan several months ahead, expand hospital capacity when needed, allocate budgets and procure additional resources where possible. Across four waves of COVID-19 cases, the SACMC continued to serve the planning needs of the government, tracking waves and supporting the national vaccine rollout.

Medical practitioners' knowledge and awareness of multiple myeloma at public hospitals, Gauteng, South Africa.

Multiple myeloma (MM) is a plasma cell malignancy associated with morbidity and mortality worldwide, and most patients are referred for specialist care very late with complications. The low index of suspicion among medical practitioners is among the reasons for the delay in MM diagnosis and management. This study aimed to determine the level of awareness and knowledge of MM among medical practitioners working in public hospitals of Tshwane Municipality, Gauteng Province, South Africa. A cross-sectional descriptive study on 74 doctors working in three district, one regional and one central hospital using a convenience sampling. Seventy-four medical practitioners participated in this study. Their median age was 37 years with an interquartile range of 43-30 years. The majority (85%) of the respondents were aware of MM, while 74% were knowledgeable regarding MM presentations and diagnostic investigations. The findings highlighted a high level of awareness and knowledge of MM among the study population, but almost all of the participants requested an educational information brochure on MM.Contribution:Medical practitioners have a high level of awareness of multiple myeloma; however, there is a discrepancy between this level of awareness and the delayed presentation of patients at the public hospitals. As primary healthcare in South Africa is nurse-driven, the study indicates that not all primary healthcare providers may be aware of this disease. Future awareness campaigns should target other primary healthcare providers, including nurses and private general practitioners.

What constitutes adequate legal protection for the collection, use and sharing of mobility and location data in health care in South Africa?

Mobile phone technology has been a catalyst that has added an innovative dimension in health care and created new opportunities for digital health services. These digital devices can be viewed as an extension of the person using them due to the deluge of personal information that can be collected and stored on them. Data collected on mobile phones are used extensively in health services and research. Personal, mobility and location data are constantly collected. The unique mobile phone architecture provides for an easy flow of data between various role players such as application developers and phone manufacturers. The collection, storage and sharing of personal information on mobile phones elicit various legal questions relating to the protection of privacy, consent, liability and the accountability of stakeholders such as health insurance providers, hospital groups and national departments of health. Significance: We analyse the major legal concerns of mobility and location data collection and processing through mobile phones in the context of health care and provide recommendations to develop data protection guidelines that are built on the principles of lawfulness, fairness and transparency. The issues explored are of relevance in an African context and to a broader international audience.

What social determinants will cause ethical challenges in geriatric care? Comments from South Africa.

Social determinants are defined as those nonmedical factors that influence health. Their influence is especially evident in vulnerable communities, such as the geriatric one. However, which social determinants will cause ethical challenges in geriatric healthcare in South Africa are not yet confirmed. This study first identified which social determinants influence geriatric care. The study then established which of these social determinants raises ethical challenges in geriatric care. Twenty statements were identified from the literature review and were grouped into 3 indexes, focusing respectively on i) a general view on public health and social determinants; ii) social determinants influencing geriatric people's health; iii) the consequences of social determinants on geriatric people's health. The rating was based on presenting the statements employing a 5- point Likert scale. The rating of statements confirmed the generally accepted view that social determinants impact geriatric people's health. The responses to the statements were an additional confirmation that the quality and access to healthcare services influence geriatric care and lead to ethical challenges. Matters such as corruption, limited resources, and the COVID-19 pandemic contribute to the influence of social determinants and the expected but failed ethical behavior toward the geriatric community. The geriatric community is vulnerable because of the ongoing social factors that have a negative impact on health, of which healthcare quality and provision are significant contributing factors. These factors contribute to ethical challenges in healthcare for the geriatric community.

Smile with diabetes: reflections on illness perception and diabetes management behaviors of adolescents in private health care in South Africa.

The association between illness perception and diabetes management has been well established in adults but is not clearly understood for adolescents. This article reflects on qualitative findings on illness perception from the perspective of adolescents, and suggests future research to operationalize findings. Qualitative document analysis was conducted on four research projects forming part of the Smile with Diabetes project, which aims to investigate psychosocial variables in diabetes management, including illness perception, within the adolescent and youth populations. Thematic analysis was used to derive four themes from the qualitative and review studies examined in the document analysis. The voices of the adolescents were evident as four prominent themes: 1) living with diabetes leads to a sense of being different; 2) integration of diabetes into identity is critical, but difficult to achieve; 3) fear of potential negative consequences motivates adherence to treatment; 4) diabetes management is difficult, but possible. The findings not only confirmed the importance of illness perception in the management of diabetes by adolescents, but also indicate that illness perceptions should be investigated from a developmental perspective, specifically taking identity development into consideration in this group. Adolescents should be made aware of how their thinking about diabetes and its management affects their experience of living with diabetes and its future management. This study further contributes to the literature by focusing on the patient's voice in understanding living with a chronic condition, and reassures that positive outcomes are possible when living with a chronic condition such as diabetes.