Ways of Doing: Restorative Practices, Governmentality, and Provider Conduct in Post-Apartheid Health Care

Harris, Bronwyn; Eyles, John; Goudge, Jane

doi:10.1080/01459740.2016.1173691

Cited by 9 publications

(7 citation statements)

References 38 publications

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“…Updated findings . New studies added further examples that confirmed negative experiences at HIV clinics [ 31 , 32 , 45 , 48 , 49 , 52 , 55 , 57 , 60 , 79 ]. Physical space and layout of HIV clinics is not optimal due to poor signage and poorly laid out waiting areas (inside and outside the clinic) which do not offer PLHIV the privacy they desire.…”

Section: Resultsmentioning

confidence: 99%

Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa

et al. 2021

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Background A systematic review of randomised trials may be conclusive signalling no further research is needed; or identify gaps requiring further research that may then be included in review updates. In qualitative evidence synthesis (QES), the rationale, triggers, and methods for updating are less clear cut. We updated a QES on adherence to anti-retroviral treatment to examine if thematic saturation renders additional research redundant. Methods We adopted the original review search strategy and eligibility criteria to identify studies in the subsequent three years. We assessed studies for conceptual detail, categorised as ‘rich’ or ‘sparse’, coding the rich studies. We sought new codes, and appraised whether findings confirmed, extended, enriched, or refuted existing themes. Finally, we examined if the analysis impacted on the original conceptual model. Results After screening 3895 articles, 301 studies met the inclusion criteria. Rich findings from Africa were available in 82 studies; 146 studies were sparse, contained no additional information on specific populations, and did not contribute to the analysis. New studies enriched our understanding on the relationship between external and internal factors influencing adherence, confirming, extending and enriching the existing themes. Despite careful evaluation of the new literature, we did not identify any new themes, and found no studies that refuted our theory. Conclusions Updating an existing QES using the original question confirmed and sometimes enriched evidence within themes but made little or no substantive difference to the theory and overall findings of the original review. We propose this illustrates thematic saturation. We propose a thoughtful approach before embarking on a QES update, and our work underlines the importance of QES priority areas where further primary research may help, and areas where further studies may be redundant.

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Section: Resultsmentioning

confidence: 99%

Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa

et al. 2021

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“…On the other hand, the working conditions at the MSF run hospitals may, even when congested, be of higher quality than in governmental hospitals within fragile, resource constrained healthcare systems; regarding resources, leadership, accountability, teamwork, guidance and transparency. Furthermore, compared to busy low-resource hospitals in East Africa with workloads similar to the high-volume month, the quality of care provided at these MSF run hospitals is much higher, and the intra-hospital stillbirth rates of 2.3-9.7 much lower [20,[23][24][25][26][27]. This may in itself be a positive driver among staff to keep providing quality care even when working 50% above capacity.…”

Section: Discussionmentioning

confidence: 99%

Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

Obel

Martín

Mullahzada

et al. 2021

BMC Pregnancy Childbirth

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Background Fragile and conflict-affected states contribute with more than 60% of the global burden of maternal mortality. There is an alarming need for research exploring maternal health service access and quality and adaptive responses during armed conflict. Taiz Houbane Maternal and Child Health Hospital in Yemen was established during the war as such adaptive response. However, as number of births vastly exceeded the facility’s pre-dimensioned capacity, a policy was implemented to restrict admissions. We here assess the restriction’s effects on the quality of intrapartum care and birth outcomes. Methods A retrospective before and after study was conducted of all women giving birth in a high-volume month pre-restriction (August 2017; n = 1034) and a low-volume month post-restriction (November 2017; n = 436). Birth outcomes were assessed for all births (mode of birth, stillbirths, intra-facility neonatal deaths, and Apgar score < 7). Quality of intrapartum care was assessed by a criterion-based audit of all caesarean sections (n = 108 and n = 82) and of 250 randomly selected vaginal births in each month. Results Background characteristics of women were comparable between the months. Rates of labour inductions and caesarean sections increased significantly in the low-volume month (14% vs. 22% (relative risk (RR) 0.62, 95% confidence interval (CI) 0.45-0.87) and 11% vs. 19% (RR 0.55, 95% CI 0.42-0.71)). No other care or birth outcome indicators were significantly different. Structural and human resources remained constant throughout, despite differences in patient volume. Conclusions Assumptions regarding quality of care in periods of high demand may be misguiding - resilience to maintain quality of care was strong. We recommend health actors to closely monitor changes in quality of care when implementing resource changes; to enable safe care during birth for as many women as possible.

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“…Health care providers must take time to understand and engage with the patients during clinical consultations or treatment. Recent studies have revealed that patients are happier when involved in their own care (Harris et al, 2016). However, providers' inability to engage patients in discussing about their care may not be an individual problem; rather, it is a reflection of how the health care system is structured or functions (Valentijn et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Patients’ Experiences of Comorbid HIV/AIDS and Diabetes Care and Management in Soweto, South Africa

Bosire

2020

Qual Health Res

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More people with HIV live in South Africa than anywhere else in the world. As people with HIV increasingly confront comorbid conditions, such as Type 2 diabetes, the need for integrated chronic care continues to grow. However, chronic care for patients with multimorbidities is limited in many public hospitals in South Africa. This ethnographic study describes patients’ experiences seeking care for comorbid HIV and diabetes at a public tertiary hospital in Soweto, South Africa, and self-management at home. Findings illustrate how fragmented care, multiple clinic appointments, conflicting information, and poor patient–provider communication impeded patients’ access to care for their multimorbidities. Socio-economic factors such as poverty, costly transport to the hospital, and food insecurity impeded management of multimorbidities. Integrated care for patients with multimorbidities in Soweto is imperative and must recognize the critical role social and economic conditions play in shaping the experiences of living with HIV, diabetes, and their overlap.

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Ways of Doing: Restorative Practices, Governmentality, and Provider Conduct in Post-Apartheid Health Care

Cited by 9 publications

References 38 publications

Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa

Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa

Resilience to maintain quality of intrapartum care in war torn Yemen: a retrospective pre-post study evaluating effects of changing birth volumes in a congested frontline hospital

Patients’ Experiences of Comorbid HIV/AIDS and Diabetes Care and Management in Soweto, South Africa

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