Introduction:The neonatal intensive care unit, an environment designed to meet the needs of severely ill neonates, is an area of practice for occupational therapists. However, there is limited evidence available around the training and practice of South African occupational therapists in these units. Aim: To explore community service occupational therapists' experiences of working in neonatal intensive care units in the KwaZulu-Natal public health sector. Methodology: This study followed an explorative qualitative design. Homogenous purposive sampling was employed to recruit 12 therapists that participated in in-depth interviews. Interviews were audio-recorded and transcribed. Data were analysed thematically by inductive reasoning initially, followed by categorisation via deductive reasoning using the theory of occupational adaptation. Results: Three themes emerged; the desire for mastery (including intrinsic drivers, multiple roles and routines in the NICU and capabilities and prior experiences); demand for mastery (including barriers and enablers in the NICU environment and development of the therapist-client relationship) and press for mastery (development of occupational identity, competence and adaptation). Conclusions: The newly qualified occupational therapists who participated in this study appeared to be able to overcome the challenges of working in the highly technical environment of the NICU. There is a need for greater support and training of community service occupational therapists in this specialised field of practice.

Background Community healthcare workers (CHWs) play a vital role in linking health facilities and communities where there is a high prevalence of childhood disorders. However, there is limited literature on whether this cadre of workers is adequately prepared for this task. Aim This study explored the training needs of CHWs working in the field of childhood disorders and disabilities to improve the future training of CHWs and service delivery. Setting This study was conducted in an urban district in KwaZulu-Natal, South Africa. Methods This qualitative study used purposive sampling to recruit 28 CHWs and 4 key informants working in health facilities in one district of the KwaZulu-Natal Province in South Africa. Data were collected via semi-structured interviews and focus groups. Interviews were conducted in the first language (isiZulu) of the CHWs. Data were analysed thematically. Ethical clearance was obtained from a Biomedical Science Research Ethics Committee. Results There was an evident lack of knowledge and skill in managing childhood disorders and disabilities by CHWs. Enablers and restrictors affecting service delivery were highlighted. Moreover, the training needs of CHWs have raised critical concerns because of the variable nature of training and perceived inadequate preparation for service delivery. The challenges raised were also generic to the holistic role of CHWs and not particularly specific to the CHW role in childhood disorders and disabilities. Conclusion Training of CHWs in childhood disorders may assist in improving CHWs’ competence and confidence in the field, which may enhance service delivery and thus may assist in contributing towards improving healthcare for children at this level of care.

BackgroundThe Integrated Decentralized Training (i-DecT) project was created to address the current need for health care in South Africa among resource poor climates in rural and periurban settings. The University of KwaZulu-Natal (UKZN) in South Africa has embarked on a program within the School of Health Sciences (SHS) to decentralize the clinical learning platform in order to address this disparity. Framed in a pragmatic stance, this proposal is geared towards informing the roll out of decentralized clinical training (DCT) within the province of KwaZulu-Natal. There currently remains uncertainty as to how the implementation of this program will unfold, especially for the diverse SHS, which includes specialities like audiology, dentistry, occupational therapy, optometry, pharmacy, physiotherapy, speech-language pathology, and sport science. Consequently, there is a need to carefully monitor and manage this DCT in order to ensure that the participating students have a positive learning experience and achieve expected academic outcomes, and that the needs of the communities are addressed adequately.ObjectiveThe study aims to explore the factors that will influence the roll-out of the DCT by developing an inclusive and context-specific model that will adhere to the standards set by the SHS for the DCT program at UKZN.MethodsKey role players, including but not limited to, the South African Ministry of Health policy makers, clinicians, policy makers at UKZN, clinical educators, academicians, and students of UKZN within the SHS will participate in this project. Once the infrastructural, staffing and pedagogical enablers and challenges are identified, together with a review of existing models of decentralized training, a context-specific model for DCTl will be proposed based on initial pilot data that will be tested within iterative cycles in an Action Learning Action Research (ALAR) process.ResultsThe study was designed to fit within the existing structures, and emerging framework and memorandum of understanding between the partners of this initiative, namely, the Ministry of Health and UKZN in order to develop health care professionals that are competent and prepared for the changing dynamics of healthcare in a developing world.ConclusionsIt is envisioned that this study, the first to include a combination of health professionals in a DCT platform at UKZN, will not only contribute to effective service delivery, but may also serve to promote an interprofessional cooperation within the SHS and tertiary institutions in similar settings.

BackgroundRe-engineering of primary healthcare (PHC) was initiated nationally in 2009. There is, however, little information on the role expected of occupational therapists (OTs) in PHC.ObjectivesThis research aimed to understand how stakeholders of the Department of Health (DOH) perceived the role of OT in PHC service.MethodThis exploratory, qualitative study used purposive sampling to recruit community health-care workers (CHW; n = 23), primary healthcare nurses (PHC; n = 5), DOH management (n = 5), experienced (n = 14) and novice OTs (n = 37) who graduated from the University of KwaZulu-Natal. The PHC nurses and the CHW represented PHC clinics in one district in KwaZulu-Natal. Data were collected through semi-structured interviews and focus groups. Interviews with CHWs were conducted in isiZulu. These were transcribed and translated prior to data analysis. Audio recordings of English interviews and focus groups were transcribed. Data for each participant group were inductively and thematically analysed to identify the themes.ResultsThe findings provided an indication of the role of OTs in PHC settings. All participants perceived the role of OTs as predominantly curative/rehabilitation-based and individualised. Participants had a limited understanding of the key principles of PHC. They identified a need for adult and paediatric rehabilitation and early childhood intervention. Limited mention was made of population-based approaches, collaborative, and health promotion and prevention programmes.ConclusionThe study has highlighted that neither management nor OTs seemed to align practice and planning according to PHC principles. A review of the theory and experiential learning in the OT programme is required.

BackgroundPrimary healthcare (PHC) is central to increased access and transformation in South African healthcare. There is limited literature about services required by occupational therapists in PHC. Despite policy being in place, the implementation of services at grassroots level does not always occur adequately.ObjectivesThis study aimed at gaining an understanding of the challenges of being disabled and the services required by occupational therapists (OTs) in rural communities in order to better inform the occupational therapy (OT) training curriculum.MethodAn exploratory, descriptive qualitative design was implemented using purposive sampling to recruit 23 community healthcare workers from the uGu district. Snowball sampling was used to recruit 37 members of the uGu community, which included people with disability (PWD) and caregivers of PWDs. Audio-recorded focus groups and semi-structured interviews were used to collect data, which were thematically analysed. Ethical approval was obtained from the Biomedical and Research Ethics Committee of the University of KwaZulu-Natal (BE248/14).ResultsTwo main themes emerged namely: firstly, the challenges faced by the disabled community and secondly appropriate opportunities for intervention in PHC. A snapshot of the social and physical inaccessibility challenges experienced by the community was created. Challenges included physical and sexual abuse, discrimination and marginalisation. Community-based rehabilitation and ideas for health promotion and prevention were identified as possible strategies for OT intervention.ConclusionThe understanding of the intervention required by OT in PHC was enhanced through obtaining the views of various stakeholders’ on the role. This study highlighted the gaps in community-based services that OTs should offer in this context.