Socio-economic characteristics and career intentions of the WiSDOM health professional cohort in South Africa

Feasibility and acceptability of a contextualized physical activity and diet intervention for the control of hypertension in adults from a rural subdistrict: a study protocol (HYPHEN)

INTRODUCTION

In rural and remote South Africa, most strokes and ischaemic heart diseases are as a consequence of hypertension, which is a modifiable risk factor. The widely recommended therapeutic approaches to control hypertension are through physical activity and diet modifications. However, there is a lack of culturally sensitive community-based, lifestyle interventions to control hypertension among rural African adult populations. We designed an intervention which recommends adjusting daily routine physical activity and dietary behaviour of adults with hypertension. This study aims to evaluate the feasibility and acceptability of HYPHEN in a rural community setting.

METHODS

We aim to recruit 30 adult participants with a self-report hypertension diagnosis. A one-arm, prospective design will be used to assess the feasibility and acceptability of recruitment, uptake, engagement, and completion of the 10-week intervention. Recruitment rates will be assessed at week 0. Intervention uptake, engagement, and adherence to the intervention will be assessed weekly via telephone. Blood pressure, body mass index, waist-hip ratio, urinary sodium, accelerometer-measured physical activity, and 24-h diet recall will be assessed at baseline and at 10 weeks. Qualitative semi-structured interviews will be conducted at 10 weeks to explore feasibility and acceptability.

DISCUSSION

This study offers a person-centred, sociocultural approach to hypertension control through adaptations to physical activity and dietary intake. This study will determine whether HYPHEN is feasible and acceptable and will inform changes to the protocol/focus that could be tested in a full trial.

TRIAL REGISTRATION NUMBER

PACTR202306662753321.

Perspectives of the cohort of health professionals in the WiSDOM study on the learning environment, transformation, and social accountability at a South African University

BACKGROUND

The dearth of empirical research on transformative health professions education informed this study to examine the factors that influence the perspectives of the cohort of health professionals in the WiSDOM study on the learning environment, transformation, and social accountability at a South African university.

METHODS

WiSDOM, a prospective longitudinal cohort study, consists of eight health professional groups: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists, and physiotherapists. At study inception in 2017, participants completed a self-administered questionnaire that included four domains of selection criteria (6 items); the learning environment (5 items); redress and transformation (8 items); and social accountability (5 items). In the analysis, we, rescaled the original Likert scoring of 1 (strongly disagree) to 7 (strongly agree) to a new scale ranging from 0-10. We calculated the mean scores for each item and across items for the four domains, with low scores (0.00-1.99) classified as poor and high scores (8.00-10.00) as excellent. We used multiple linear regression analysis to compare the mean scores, while adjusting for different socio-demographiccharacteristics.

RESULTS

The mean age of the 501 eligible participants was 24.1 years; the majority female (72.9%), 45.3% self-identified as Black African; and 12.2% were born in a rural area. The domains of selection criteria and redress and transformation obtained mean scores of 5.4 and 5.3 out of 10 respectively, while social accountability and the learning environment obtained mean scores of 6.1 and 7.4 out of 10 respectively. Self-identified race influenced the overall mean scores of selection criteria, redress and transformation, and social accountability (p < 0.001). Rural birth influenced the perceptions on selection criteria, redress and transformation (p < 0.01).

CONCLUSION

The results suggest the need to create inclusive learning environments that foreground redress, transformation, and social accountability, while advancing the discourse on decolonised health sciences education.

Exploring reasons why South African dental therapists are leaving their profession: A theory-informed qualitative study

BACKGROUND

Dental therapy is a category of mid-level oral health professional that was introduced to address inequities in oral health service provision in South Africa within a constrained human resource for health context. However, low numbers of registered dental therapists and attrition threaten this strategy.

AIM

This study explored reasons for this attrition, building on the Hertzberg Two-Factor Theory.

METHODS

Through a qualitative exploratory study design, in-depth interviews were conducted with former dental therapists to explore their reasons for leaving the profession. They were recruited using snowball sampling. All interviews were audio recorded, transcribed verbatim, and coded in NVIVO12. A team of researchers applied thematic analysis to agree on themes and sub-themes, guided by Hertzberg's ideas of intrinsic and extrinsic factors.

FINDINGS

All 14 former dental therapists interviewed expressed their passion for the profession, even though their motivations to join the profession varied. Many of their reasons for leaving aligned with extrinsic and intrinsic factors defined in Hertzberg's Two-Factor Theory. However, they also spoke about a desire for a professional identity that was recognized and respected within the oral health profession, health system, and communities. This is a novel study contribution.

CONCLUSION

Dental therapist attrition in South Africa is mainly caused by job dissatisfaction and motivation issues resulting from health system level factors. While the Hertzberg Two-Factor Theory helped identify extrinsic and intrinsic factors at an individual level, we used the Human Resources for Health System Development Analytical Framework to identify solutions for dental therapist production, deployment, and retention. Addressing these issues will enhance retention and accessibility to oral health services in the country.

Clinical associate students' perceptions of factors that influence their developing professional identity: a qualitative study

BACKGROUND

New cadres of clinicians, known as clinical associates, physician assistants, or clinical officers have evolved globally within many health systems to broaden access to care by increasing human resources. The training of clinical associates started in 2009 in South Africa, entailing the attainment of knowledge, clinical skills, and attitude competencies. Less formal educational attention has been focused on the process of developing personal and professional identities.

METHOD

This study utilized a qualitative interpretivist approach to explore professional identity development. A convenient sample of 42 clinical associate students at the University of Witwatersrand in Johannesburg were interviewed using focus groups to explore their perceptions of factors that influenced their professional identity formation. A semi-structured interview guide was used in six focus group discussions, involving 22 first-year and 20 third-year students. The transcriptions from the focus group audio recordings were thematically analyzed.

RESULTS

The multi-dimensional and complex factors that were identified were organized into three overarching themes, identified as individual factors which derive from personal needs and aspirations, training-related factors consisting of influences from the academic platforms, and lastly, student perceptions of the collective identity of the clinical associate profession influenced their developing professional identity.

CONCLUSION

The newness of the identity of the profession in South Africa has contributed to dissonance in student identities. The study recognizes an opportunity for strengthening the identity of the clinical associate profession in South Africa through improving educational platforms to limit barriers to identity development and effectively enhancing the role and integration of the profession in the healthcare system. This can be achieved by increasing stakeholder advocacy, communities of practice, inter-professional education, and the visibility of role models.

Public vs. private job dilemma: Influencing factors in career selection for university graduates

The unprecedented growth of educated workforce following the economic development and diversity in workplace has widened the career choices of young people in Bangladesh. However, it intensifies a dilemma among the job seekers about determining their career goals, because career goals are often influenced by certain socio-demographic and cultural aspects. Hence, this cross-sectional study was designed to investigate the career choices of university students in Bangladesh and to identify its determinants. Administering a self-administered questionnaire (SAQ), data were collected from 422 students at a public university using the multistage stratified sampling. Data were analyzed by bivariate (chi-square) and multivariate (exploratory factor analysis and binary logistic regression) analyses. Findings suggest that the career choices of students vary regarding their gender, religion, and academic track. For example, female (AOR: 0.281; 95% CI: 0.144 to 0.547) and Muslim (AOR: 3.648; 95% CI: 1.765 to 7.542) students preferred public jobs, whereas students of commerce (AOR: 0.344; 95% CI: 0.144 to 0.820) went for private ones. Among socioeconomic issues, only the father's occupation had a substantial effect on career decisions (AOR: 0.347; 95% CI: 0.144 to 0.820). The career choice was also determined by the job prospects (AOR: 1.251; 95% CI: 1.161 to 1.347), preference of family (AOR: 1.238; 95% CI: 1.099 to 1.394), as well as job diversity (AOR: 0.879; 95% CI: 0.795 to 0.972). Based on the findings of this study, it is recommended that the government should address the trends and patterns of career choices of students through empirical research when formulating future educational and career-related policies in Bangladesh.

Demographic transformation of the physiotherapy profession in South Africa: A retrospective analysis of HPCSA registrations from 1938 to 2018

RATIONALE, AIM AND OBJECTIVE

The physiotherapy profession did not escape the effects of racially based segregatory practises. While numerous strategies and initiatives have been employed to redress the inequities of the past, the extent of demographic transformation within the physiotherapy profession in South Africa remains uncertain. Transformation is defined in this article as an intentional change aimed at addressing inequalities and the ultimate goal is for population group and gender profiles of higher education graduates to be representative of the national epidemiological profile. This paper describes the demographic patterns of Health Professions Council of South Africa (HPCSA) registered physiotherapists from 1938 to 2018.

METHOD

A retrospective record review of the HPCSA database from 1938 until 2018 was performed. De-identified data were extracted, coded and analyzed for descriptive purposes. Z-tests were used for analysis of proportion differences, along with P-values and 95% confidence intervals for interpretation.

RESULTS

In 2018, 7663 physiotherapists (6350 women and 1313 men) were registered with the HPCSA. Most registered physiotherapists (55.6%) were classified as white, followed by black (17.3%), coloured (10.3%) and Indian (9.8%). A progressive increase was found in the number of new registrations over time (1949-2018) by black (0.00%-24.38% of total new registrations), coloured (0.00%-15.47%) and Indian individuals (0.00%-10.03%), with a statistically significant increase in newly registered black therapists in the decade prior to 2018 (P = .005). Gender transformation appears to be occurring at a slower pace as the profession remains female-dominated (82.9% of registered physiotherapists in 2018).

CONCLUSION

There has been a steady transformation of the South African physiotherapy graduates composition regarding population categories and gender. However, it is clear that much more than selection criteria is needed to transform the profession in a way that is nationally representative, remain actively accountable for transformation and apt for local context.

Life satisfaction, life quality, and leisure satisfaction in health professionals

PURPOSE

This study was aimed to determine the relationships between life satisfaction, life quality, and leisure satisfaction in health professionals.

DESIGN AND METHODS

The study was conducted with 498 health professionals working in a city of the Central Anatolia Region, Turkey. Data were collected using Socio-Demographic Form, the Satisfaction with Life Scale, the Short Form of World Health Organization Quality of Life Questionnaire, and the Leisure Satisfaction Scale.

FINDINGS

There was a positive significant relationship between life satisfaction, life quality, and leisure satisfaction. As the level of leisure satisfaction of health professionals increases, the life satisfaction, and life quality also increase.

PRACTICE IMPLICATIONS

Rise in the level of leisure satisfaction is important to increase life satisfaction and improve life quality of health professionals. Therefore, leisure patterns and behaviors that increase leisure satisfaction should be integrated into daily lives of these professionals.

Methodological considerations in establishing and maintaining longitudinal health workforce studies: Lessons learned from the WiSDOM cohort in South Africa

BACKGROUND

Health workforce cohort studies are uncommon in low-and middle-income countries (LMICs), especially those in sub-Saharan Africa.

OBJECTIVE

Describe the methodology and lessons learned from establishing and maintaining the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) health professional cohort study in South Africa.

METHODS

WiSDOM is a prospective longitudinal cohort study that commenced in 2017. The cohort focuses on the eight professional groups of clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists and physiotherapists. Annual, electronic follow-up surveys have been conducted in 2018, 2019 and 2020 with informed consent. Key steps in establishing the WiSDOM cohort include consultation, communication and marketing, stakeholder feedback, resources and infrastructure. Retention strategies consist of an electronic database, detailed cohort contact information, cohort engagement, communication and feedback, short survey tools, and appropriate incentives.

RESULTS

We obtained an overall response rate of 89.5% at baseline in 2017, 79.6% in 2018, 68.3% in 2019 and 72.8% in 2020. The largest decline in response rates is for medical doctors: 66.0% response rate in 2018, 53.2% in 2019 and 58.2% in 2020. However, for each of the three follow-up surveys, we have obtained response rates in excess of 80% for clinical associates, dentists, nurses, oral hygienists, pharmacists and physiotherapists. Since baseline, the outright refusals have remained very low at 4.7%. The multiple logistic regression analysis showed that self-identified race was the only significant socio-demographic difference between medical doctor respondents and non-respondents. Black African doctors and Indian doctors were 2.0 and 2.6 times more likely respectively to respond than White doctors (p < 0.05).

CONCLUSION

Other LMICs can learn from WiSDOM's lessons of establishing and maintaining a health professional cohort that aims to generate new knowledge for health system transformation.