Background Communication problems in health care may arise as a result of healthcare providers focusing on diseases and their management, rather than people, their lives and their health problems. Patient-centred approaches to care are increasingly advocated by consumers and clinicians and incorporated into training for healthcare providers. The effects of interventions that aim to promote patient-centred care need to be evaluated. Objectives To assess the effects of interventions for healthcare providers that aim to promote patient-centred approaches in clinical consultations.

LHWs show promising benefits in promoting immunisation uptake and improving outcomes for acute respiratory infections and malaria, when compared to usual care. For other health issues, evidence is insufficient to justify recommendations for policy and practice. There is also insufficient evidence to assess which LHW training or intervention strategies are likely to be most effective. Further research is needed in these areas.

Our aim with this study was to explore the factors that contribute to tuberculosis patients' adherence and nonadherence to the Directly Observed Treatment Short Course strategy. A qualitative, phenomenological research design was used. Fifteen male and female participants between the ages of 18 and 57 years were recruited through purposive sampling at a primary care clinic located in a disadvantaged area, and in-depth interviews were conducted. The data analysis indicated that the factors found to influence adherence were social and economic resources; causal attributions assigned to TB; the social, cultural, economic, disease-related, and psychological challenges faced as a consequence of having TB; quality of health care received; use of the traditional healing system; and the participants' HIV status. Factors found to be associated with nonadherence included poverty, HIV co-infection, stigma, unsupportive social and work environments, and a high prevalence of helplessness and hopelessness.

Objective: To determine the dietary intake, practices, knowledge and barriers to dietary compliance of black South African type 2 diabetic patients attending primary health-care services in urban and rural areas. Design: A cross-sectional survey. Dietary intake was assessed by three 24-hour recalls, and knowledge and practices by means of a structured questionnaire (n ¼ 133 men, 155 women). In-depth interviews were then conducted with 25 of the patients to explore their underlying beliefs and feelings with respect to their disease. Trained interviewers measured weight, height and blood pressure. A fasting venous blood sample was collected from each participant in order to evaluate glycaemic control. Setting: An urban area (Sheshego) and rural areas near Pietersburg in the Northern Province of South Africa. Subjects: The sample comprised 59 men and 75 women from urban areas and 74 men and 80 women from rural areas. All were over 40 years of age, diagnosed with type 2 diabetes for at least one year, and attended primary health-care services in the study area over a 3-month period in 1998. Results: Reported dietary results indicate that mean energy intakes were low (,70% of Recommended Dietary Allowance), 8086 -8450 kJ day 21 and 6967-7382 kJ day 21 in men and women, respectively. Urban subjects had higher ðP , 0:05Þ intakes of animal protein and lower ratios of polyunsaturated fat to saturated fat than rural subjects. The energy distribution of macronutrients was in line with the recommendations for a prudent diet, with fat intake less than 30%, saturated fat less than 10% and carbohydrate intake greater than 55% of total energy intake. In most respects, nutrient intakes resembled a traditional African diet, although fibre intake was low in terms of the recommended 3-6 g/1000 kJ. More than 90% of patients ate three meals a day, yet only 32 -47% had a morning snack and 19-27% had a late evening snack. The majority of patients indicated that they followed a special diet, which had been given to them by a doctor or a nurse. Only 3.4-6.1% were treated by diet alone. Poor glycaemic control was found in both urban and rural participants, with more than half of subjects having fasting plasma glucose above 8 mmol l 21 and more than 35% having plasma glycosylated haemoglobin level above 8.6%. High triglyceride levels were found in 24 to 25% of men and in 17 to 18% of women. Obesity (body mass index $30 kg m 22) was prevalent in 15 to 16% of men compared with 35 to 47% of women; elevated blood pressure ($160/95 mmHg) was least prevalent in rural women (25.9%) and most prevalent in urban men (42.4%). Conclusions: The majority of black, type 2 diabetic patients studied showed poor glycaemic control. Additionally, many had dyslipidaemia, were obese and/or had an elevated blood pressure. Quantitative and qualitative findings indicated that these patients frequently received incorrect and inappropriate dietary advice from health educators.

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