Perspectives Of Key Informants Research Articles

Innovations, contestations and fragilities of the health system response to COVID-19 in the Gauteng Province of South Africa.

Gauteng province, with 26.3% of South Africa's population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa's reported COVID-19 cases. The aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response. Using an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data. Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response. Gauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.

"It's extremely hard but it's not a burden": A qualitative study of family caregiving for people living with dementia in Vietnam.

BackgroundVietnam is one of the fastest-aging countries in the world with a rising number of people with Alzheimer’s disease and related dementias (ADRD). Families in Vietnam provide most of the care for persons living with dementia, yet our understanding of their experiences and needs is limited. This study examined the family caregiving experience in a semi-rural region outside of central Hanoi from the perspectives of family caregivers and other key informants.MaterialsSemi-structured interviews were conducted with 21 key stakeholders (12 family caregivers and 9 healthcare providers and community leaders). A descriptive, thematic analysis was conducted.ResultsQualitative data analysis revealed four themes related to the family caregiving experience: 1) perceptions of dementia symptoms as a normal part of aging rather than a disease, 2) caregiving as a moral and expected familial obligation, 3) patterns of caregiving that are heavily influenced by both gender and sibling order, and 4) multiple challenges or hardships, including time constraints, loss of income, increased social isolation, a toll on their perceived physical health, and emotional distress. Caregivers rejected the notion that caregiving was a “burden” and expressed their distress through terms such as frustration, sadness, and exhaustion.ConclusionsIn this low-resource setting, the stress of family caregiving may be amplified by lack of community resources, cultural stigma discouraging outside help-seeking, and economic impact of care provision. The study highlights the vulnerability and predicament of Vietnamese women who often face multiple challenges in their caregiving role as well as the urgent need for the development of community-based programs and supports.

Rising incidence and risks of floods in urban Ghana: Is climate change to blame?

The current policy and stakeholder debates suggest that climate change remains a risk factor for the rising urban floods situation in Ghana. However, there is a dearth of empirical works to explain the link between flood incidence and climatic-related factors. Using a long-term secondary climatic data, this paper analyses the extent to which climate change influences the incidence of floods in urban Ghana. In-depth qualitative analysis of the perspectives of households and key informants was carried out to complement the initial quantitative analysis in order to broaden the understanding of the risk factors of the worsening floods situation. The results have shown that the rising flood situation in Kumasi is largely independent of climate-induced increase in rainfall and current temperature patterns but strongly linked with anthropogenic factors, including unregulated urban expansion, inadequate drainage infrastructure, poor solid waste management practices, and weak institutional and regulatory regimes. Strengthening institutions, law enforcement and public education are important interventions to control the flood menace in Ghana.

Climate change and socioeconomic determinants are structural constraints to agency in diet-related non-communicable disease prevention in Vanuatu: a qualitative study

BackgroundPacific Island countries, many of which are low- and middle-income countries, have some of the highest rates of diet-related non-communicable diseases (DR-NCDs) globally. These countries also face some of the earliest and most significant impacts of climate change. Several pathways between climate change and DR-NCDs have been described in the literature; however, the scope is broad and lacks context specificity. This paper uses a case study of one Pacific Island country, Vanuatu, to investigate links between climate change and DR-NCDs.MethodsAn ethnographic qualitative research approach was used to share the lived experiences of community participants and to explore and contrast these with the perspectives of key informants at the national level. Data collection comprised thirty-two semi-structured interviews and community fieldwork in two villages using a mix of methods, including group workshops, informal conversations, and observations. Reflexive thematic analysis was conducted on both data sets.ResultsThis study found that DR-NCDs are a prominent health concern for ni-Vanuatu people and that structural determinants, including climate change, are the main driving forces for increased DR-NCD risk in the country. However, there was a lack of understanding of the links between climate change and DR-NCDs both at the community and national levels. Structural factors, such as social determinants and climate change, constrained individual and community agency in making optimal food and health choices and promoted the nutrition transition in Vanuatu. Despite the critical role of social determinants and climate change in driving DR-NCD risk, the responsibility for prevention and treatment was considered to rest mainly with the individual. A systems approach is advocated to grasp the complexity and interrelatedness of the causes of DR-NCD risk.ConclusionsThe interaction of structural determinants creates food and health environments that amplify the risk, burden, and consequences of DR-NCDs. It is recommended that the DR-NCD narrative in Vanuatu be re-framed with an emphasis on the range of structural determinants of DR-NCD risk. This will serve to enhance individual and collective agency to not only make healthy food and other behavioural choices but also to exercise agency to transform the structures in a culturally appropriate way.

Preparedness for Mitigating Noncommunicable Diseases in Gaindakot Municipality, Nepal: Perspectives of Key informants

Introduction: Non-communicable Diseases (NCDs) are the major public health problem that leads to high morbidity and mortality in the world including Nepal. Government of Nepal has launched the Multi-sectoral NCD Action Plan in 2014 and established NCD and Injuries Poverty Commission in 2016 for the management and control of NCDs nevertheless the implementation status and its outcomes are not identified till date at the local level.
 Objectives: To explore the preparedness of the local government for the prevention and control of NCDs at Gaindakot, Nawalpur, Nepal.
 Methodology: A qualitative study was conducted in the Gaindakot municipality; Nawalpur to document the key informant's perspectives on health system's preparedness to prevent the potential impacts of NCDs. Face to face Indepth interview was performed using open-ended questions. Interview guidelines were prepared on the basis of building blocks of health system. Information was processed basis on thematic analysis.
 Result: The study revealed that health section has NCD preparedness structure but need to strengthening for the better delivery of health services. The study highlights that screening services and the medicine for major NCDs like hypertension and diabetes were available at local level. Limited budget was allocated and health workforce was not trained for NCDs prevention and control. There was no reporting mechanism for NCD related data from local level.
 Conclusion: Basic medicine and screening services were provided from the local level to the selected NCDs such as hypertension and diabetes. There was no provision of reporting NCD related information and health workforce were not trained to respond NCDs. Local level health system strengthening is an urgent need to address the increasing burden of NCDs.

Policies and actions to reduce maternal mortality in Nepal: perspectives of key informants

Nepal made impressive progress in reducing maternal mortality until 2015. Since then, progress has stagnated, coinciding with Nepal’s transition to a federation with significant devolution in health management. In this context, we conducted key informant interviews (KII) to solicit perspectives on policies responsible for the reduction in maternal mortality, reasons for the stagnation in maternal mortality, and interventions needed for a faster decline in maternal mortality. We conducted 36 KIIs and analysed transcripts using standard framework analysis methods. The key informants identified three policies as the most important for maternal mortality reduction in Nepal: the Safe Motherhood Policy, Skilled Birth Attendant Policy, and Safe Abortion Policy. They opined that policies were adequate, but implementation was weak and ineffective, and strategies needed to be tailored to the local context. A range of health system factors, including poor quality of care, were identified by key informants as underlying the stagnation in Nepal’s maternal mortality ratio, as well as a few demand-side aspects. According to key informants, to reduce maternal deaths further Nepal needs to ensure that the current family planning, birth preparedness, financial incentives, free delivery services, abortion care, and community post-partum care programmes reach marginalised and vulnerable communities. Facilities offering comprehensive emergency obstetric care need to be accessible, and in hill and mountain areas, access could be supported by establishing maternity waiting homes. Social accountability can be strengthened through social audits, role models, and empowerment of health and management committees.

The quandary of adolescent HIV: Perspectives of key informants in Accra, Ghana

This study explored key informants’ perspectives about adolescents living with human immunodeficiency virus (HIV). Twenty-one participants were purposively selected and data were collected through face-to-face in-depth interviews using a semi-structured interview guide. The interviews were audio-recorded, transcribed, and analyzed to identify emerging themes. The findings indicated that adolescents living with HIV had concerns about disclosing their HIV status. Key informants reported that adolescents living with HIV’s responses to awareness about their status included anger, blame and social isolation. Also, it was found that the adolescents had challenges with adhering to scheduled medical appointments and the antiretroviral therapy. Evidence showed that financial constraints adversely affected adolescents’ clinic attendance and medication compliance. Several psychosocial support services (counseling, financial assistance, provision of basic needs, and cordial relationships) were identified by key informants as being available for adolescents living with HIV. Based on the findings of the study, conclusions were drawn and implications discussed.

Perceptions of Factors Leading to Teenage Pregnancy in Lindi Region, Tanzania: A Grounded Theory Study

High prevalence of teenage pregnancy in low-income countries impacts health, social, economic, and educational situations of teenage girls. To acquire better understanding of factors leading to high prevalence of teenage pregnancy in rural Lindi region, Tanzania, we explored perspectives of girls and key informants by conducting a facility-based explorative qualitative study according to the grounded theory approach. Participants were recruited from Mnero Diocesan Hospital using snowball sampling, between June and September 2018. Eleven pregnant teenagers, two girls without a teenage pregnancy, and eight other key informants were included. In-depth interviews (including photovoice) and field observations were conducted. Analysis of participant perspectives revealed five main themes: 1) lack of individual agency (peer pressure, limited decision-making power, and sexual coercion); 2) desire to earn money and get out of poverty; 3) dropping out of school contributing to becoming pregnant; 4) absence of financial, material, psychological, or emotional support from the environment; and 5) limited access to contraception. A majority of girls reported the pregnancy to be unplanned, whereas some girls purposely planned it. Our findings and the resulting conceptual framework contribute to a new social theory and may inform national and international policies to consider the needs and perspectives of teenagers in delaying pregnancy and promoting sexual and reproductive health in Tanzania and beyond.

Informal payments for family planning: prevalence and perspectives of women, providers, and health sector key informants in western Kenya

Informal payments are off-the-record financial transactions made by patients to their healthcare providers. Providers in low- and middle-income countries solicit informal payments from patients to purchase additional supplies, supplement wages, or for other reasons. Informal payments reduce equitable access to healthcare services and undermine efforts to ensure universal health coverage. This study used multiple data collection methods to estimate the prevalence of informal payments, describe the impact, and explore feasible solutions for curbing this practice in western Kenya. Facility-level data were collected in 60 public sector facilities (contributing 142 mystery client visits and, in a subsample of 10 facilities, 253 client-provider observations). We conducted 8 focus groups with current and prior contraceptive users, 19 key informant interviews, and 2 journey mapping workshops. Providers solicited informal payments in 25% of mystery client visits and 13% of client-provider observations; the median amount of money requested from mystery clients was 1 USD. Focus group and journey mapping participants reported informal payments are a financial barrier and contribute to unintended pregnancy; key informants suggested greater community monitoring of facilities is key for reducing this behaviour.

Assessing factors influencing smoking and smoking cessation within Chinese communities in the Greater Vancouver Area: A qualitative exploratory study.

INTRODUCTIONThe prevalence of smoking is high within Chinese-Canadian communities and there is a lack of culturally and linguistically appropriate smoking cessation resources and services. We aimed to ascertain factors affecting smoking and smoking cessation from the perspectives of current smokers and key informants.METHODSAs part of a multistage mixed-methods study taking place from January 2013 to June 2014, a qualitative exploratory study design was conducted applying a community-based participatory research approach. Focus groups and interviews were conducted with adult (aged ≥19 years) Chinese-Canadian current smokers (≥5 cigarettes per day for the past 30 days) and interviews were held with key informants in Vancouver, Canada. A constant comparison method was applied to code data, and an inductive approach was used to identify emergent themes.RESULTSIn all, 35 smokers from the target communities (11 female, 24 male) participated in 4 focus group sessions and 17 key informants (14 female, 3 male) were individually interviewed. Internal and external factors influencing smoking onset, continuation, and cessation from the perspectives of smokers and key informants were identified. Male smokers thought that the most influential factor influencing smoking initiation was social pressure, while female smokers thought that it was stress. Female smokers reported refraining from seeking cessation assistance due to a perceived negative image of female smokers within the community. Both key informants and participants indicated that involving friends and family in the quitting process may help to motivate smokers.CONCLUSIONSSmokers from Chinese-Canadian communities may benefit from linguistically appropriate and culturally relevant smoking cessation interventions that consider prevailing attitudes, perceptions, and beliefs. The knowledge gained may inform the development of future smoking cessation programs and resources for the target community, while our approach may be applicable to other ethnocultural or immigrant communities.

HRD professional education provision in the UK: past, present and future

ABSTRACT The professionalization of occupations has led to the increased demand for specialized knowledge in many fields, in response to which Higher Education (HE) institutions have provided professional education programmes. The purpose of this paper is to address a need for research into the history and current position of professional education in Human Resource Development (HRD) in the UK and to consider the problem of the extent to which HRD can be regarded as a profession. The paper reports findings from a mixed methods study comprising an audit of the postgraduate HRD programme provision in UK universities and a symposium at which the perspectives of key informants were captured. There is evidence of declining use of the term `HRD’ in programme titles, and of contestation and conflict between the professional education of HRD and Human Resource Management (HRM). The paper argues for regarding HRD as symbiotic in relation to HRM, rather than as a distinct profession. It identifies the implications of this conceptualization for professional education in the field and discusses the relevance of experience in the UK for HRD internationally.

Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study

BackgroundIntegrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework.MethodsA total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis.ResultsExperts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programmes into PHC following its initial rollout as a stand-alone programme in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructural issues (e.g., lack of rooms, small spaces) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to polymerase-chain reaction (PCR) testing and immunisation.ConclusionsDespite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT in PHC, especially postpartum. The results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.

"It's Not Too Aggressive": Key Features of Social Branding Anti-Tobacco Interventions for High-Risk Young Adults.

Purpose. Peer crowd-targeted campaigns are a novel approach to engage high-risk young adults in tobacco use prevention and cessation. We elicited the perspectives of young adult key informants to understand how and why two social branding interventions were effective: (1) "COMMUNE," designed for "Hipsters" as a movement of artists and musicians against Big Tobacco, and (2) "HAVOC," designed for "Partiers" as an exclusive, smoke-free clubbing experience. Design. Qualitative study (27 semistructured qualitative phone interviews). Setting. Intervention events held in bars in multiple U.S. cities. Participants: Twenty-seven key informants involved in COMMUNE or HAVOC as organizers (e.g., musicians, event coordinators) or event attendees. Measures. We conducted semistructured, in-depth interviews. Participants described intervention events and features that worked or did not work well. Analysis. We used an inductive-deductive approach to thematically code interview transcripts, integrating concepts from intervention design literature and emergent themes. Results: Participants emphasized the importance of fun, interactive, social environments that encouraged a sense of belonging. Anti-tobacco messaging was subtle and nonjudgmental and resonated with their interests, values, and aesthetics. Young adults who represented the intervention were admired and influential among peers, and intervention promotional materials encouraged brand recognition and social status. Conclusion. Anti-tobacco interventions for high-risk young adults should encourage fun experiences; resonate with their interests, values, and aesthetics; and use subtle, nonjudgmental messaging.

Health care providers\u2019 perspectives of diet-related non-communicable disease in South Africa

BackgroundIn South Africa, diet-related non-communicable diseases (dr-NCDs) place a significant burden on individuals, households and the health system. In this article, we investigate the experiences of eight key informants within the public sector health care system (nurse, doctor and dietician), in order to reflect on their experiences treating dr-NCDs.MethodsWe interviewed eight key informants who were central to the primary care service for at least 40,000 people living in a low-income neighbourhood of Cape Town, South Africa. In previous work, we had interviewed and conducted ethnographic research focused on dr-NCDs in the same neighbourhood. We then conducted a thematic analysis of these interviews.ResultsThe perspectives of key informants within the public sector therefore offered insights into tensions and commonalities between individual, neighbourhood and health systems perspectives. In particular, the rising prevalence of dr-NCDs alarmed providers. They identified changing diet as an important factor driving diabetes and high blood pressure in particular. Health care practitioners focused primarily on patients’ individual responsibility to eat a healthy diet and adhere to treatment. A marked lack of connection between health and social services at the local level, and a shortage of dieticians, meant that doctors provided rapid, often anecdotal dietary advice. The single dietician for the district was ill-equipped to connect dr-NCDs with the upstream determinants of health. While providers often had empathy and understanding of patients’ circumstances, their training and context had not equipped them to translate that understanding into a clinical context. Providers seemingly could not reconcile their empathy with their perception of dr-NCDs as a failure of prudence or responsibility by patients. Significant shortcomings within health systems and social services make reflexive practice very difficult.ConclusionsSupporting health care providers in understanding context, through approaches such as translational competency, while strengthening both health and social services, are vital given the high burden of NCDs in South Africa.

Board roles in Scottish football: an integrative stewardship-resource dependency theory

ABSTRACT Research question: This study investigates how boards of directors perceive their roles in Scottish football clubs. With previous studies focusing on amateur and non-profit sport organisations (primarily in Canada, Australia and New Zealand), this research answers the call for more research into board roles and in other sport contexts. Research methods: A qualitative design is adopted and 24 directors of Scottish football clubs are interviewed. Football club directors are a difficult to access population and this research represents a rare opportunity to understand the perspectives of key sport governance informants. Template analysis is employed. Results and findings: Findings show that perceived board roles fall into five categories: control, service, operations, resource co-optation and strategy. Organisational size was found to influence perceptions of board roles in Scottish clubs, while an apparent alignment of interests between owners and managers, and a subsequent reduction in agency cost, has implications for the control role. An integration of stewardship theory and resource-dependency theory is argued to provide a more holistic understanding of board roles in this context. Implications: The study responds to calls for a multi-theoretical approach to board roles research by developing an integrative stewardship-resource dependency theory. The integrated theory is argued to be useful in framing the complex dynamics of board roles in Scottish football. Future research is encouraged to assess whether the stewardship-resource dependency theory can provide an effective framework for understanding board roles in other sport settings.

The use of Facebook in the recruitment of foster carers: A dialogic analysis

Social media is becoming increasingly important for communication and community building, yet research on the use of social media by non‐profit organisations is limited and largely restricted to content analysis of social media comments. This article contributes to addressing this research gap, through a survey‐based study of the perspectives of key informants in U.K. Local Authority fostering teams on their use of social media. Specifically, it examines the extent to which the Facebook activity of local authority fostering teams is aligned with the principles of successful social media engagement, as represented by dialogic strategies and outcomes. A questionnaire on the use of Facebook was circulated to all local authority fostering teams in England. Findings suggest that although there is progress, many teams are at an early stage in their social media journey and that there is considerable variation between agencies. The limited evidence of engagement in relation to dialogic principles suggests that there is some adoption of a strategic approach. In particular, of the three dialogic principles associated with successful online engagement, two (updating and community building) were applied by about half of local authority fostering teams and the third (engagement) by just over a quarter.

Exploring African American and Latino Populations Perceptions of Parenting Education Programs: A Qualitative Assessment of Enablers and Barriers

Parenting education programs aim to enhance the quality of parenting. Preferences vary between African American and Latino parents, but the context is not well known, and the ethnic/racial differences may have implications for parenting education programs. Focus groups were conducted with seven African American and eight Latino parents, and semi-structured interviews with eight key informants. This qualitative assessment provided information to identify barriers and enablers to participation in parenting education programs. Enablers included parental interest in learning about the developmental stages of their children, the convenience of locations and times, and incentives. Minority parents desired to obtain adequate parenting education. The scarcity of culturally sensitive programs, transportation, affordability, and childcare were significant barriers. There were both significant similarities and differences between the two parent groups. From the perspectives of African American, Latino parents and key informants, a range of resources are necessary to enable the participation and the delivery of high-quality parenting education. The findings from our research will help address the unmet parenting education needs of African American and Latino parents. Future research should work to develop a tailored and culturally sensitive parenting education programs to reduce the divergence between parents and service providers.

Identifying strengths and weaknesses of the integration of biomedical and herbal medicine units in Ghana using the WHO Health Systems Framework: a qualitative study

BackgroundThe use of herbal medicines in developing countries has been increasing over the years. In Ghana, since 2011, the government has been piloting the integration of herbal medicine in 17 public hospitals. However, the strengths and the weaknesses of the integration have not been fully explored. The current study sought to examine the strengths and weaknesses of the integration using the WHO health systems framework.MethodsThis study used qualitative, exploratory study design involving interviews of 25 key informants. The respondents had experience in conducting herbal medicine research. Two key informants were medical herbalists practising in hospitals piloting the integration in Ghana. We used Framework analysis to identify the perspectives of key informants in regards to the integration. ResultsKey informants mostly support the integration although some noted that the government needs to support scale-up in other public hospitals. Among the strengths cited were the employment of medical herbalists, utilization of traditional knowledge, research opportunities, and efficient service delivery by restricting the prescription and use of fake herbal medicine. The weaknesses were the lack of government policies on implementing the integration, financial challenges because the National Health Insurance Scheme does not cover herbal medicine, poor advocacy and research opportunities, and lack of training of conventional health practitioners in herbal medicine.ConclusionsResearchers view the integration of the two healthcare systems–biomedicine, and herbal medicine– positively but it has challenges that need to be addressed. The integration could offer more opportunities for researching into herbal medicine. More training for conventional health professionals in herbal medicine could increase the chances of better coordination between the two units. Additionally, strong advocacy and publicity is needed to educate more people on the integration and the utilization of the services.

\u201cI attend at Vanguard and I attend here as well\u201d: barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases

BackgroundHIV and non-communicable disease (NCD) are syndemic within sub-Saharan Africa especially among older persons. The two epidemics interact with one another within a context of poverty, inequality and inequitable access to healthcare resulting in an increase in those aged 50 and older living with HIV and experiencing an NCD co-morbidity. We explore the challenges of navigating healthcare for older persons living with HIV and NCD co-morbidity.MethodsIn-depth semi-structured interviews were conducted with a small sample of older persons living with HIV (OPLWH). The perspectives of key informants were also sought to triangulate the evidence of OPLWH. The research took place in two communities on the outskirts of Cape Town, South Africa. All interviews were conducted by a trained interviewer and transcribed and translated for analysis. Thematic content analysis guided data analysis.ResultsOPLWH experienced an HIV-NCD syndemic. Our respondents sought care and accessed treatment for both HIV and other chronic (and acute) conditions, though these services were provided at different health facilities or by different health providers. Through the syndemic theory, it is possible to observe that OPLWH and NCDs face a number of physical and structural barriers to accessing the healthcare system. These barriers are compounded by separate appointments and spaces for each condition. These difficulties can exacerbate the impact of their ill-health and perpetuate structural vulnerabilities. Despite policy changes towards integrated care, this is not the experience of OPLWH in these communities.ConclusionsThe population living with HIV is aging increasing the likelihood that those living with HIV will also be living with other chronic conditions including NCDs. Thus, it is essential that health policy address this basic need to integrate HIV and NCD care.

Perspectives of Key Informants on Child Abuse: Qualitative Evidence from Northern Ghana

Drawing on Bronfenbrenner’s ecological systems theory, this study aimed to explore key informants’ views about child abuse. Using a qualitative research design, thirty key informants participated in the study. Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) were conducted to gather data, which were analyzed thematically. The findings of the study indicated that children were discouraged from being assertive. Also, it was found that key informants had knowledge of child abuse, the variant types, as well as perpetrators and victims of child abuse. Furthermore, different factors (poverty, cultural and religious beliefs, ignorance of child protection laws, among others) were described by key informants as underpinning the occurrence of child abuse. Moreover, evidence showed that generally, child abuse cases were not reported due to barriers, such as concerns about consequences of reporting, poverty, family ties, stigmatization and unavailability or lack of support systems. Based on the findings of the study, conclusions were drawn and implications discussed.