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.

Background: As the South African government re-engineers primary healthcare (PHC), the need for additional information on stakeholders involved in the process has emerged. Of these are community health workers (CHWs), who have been identified as central to PHC success.Objectives: To profile the current CHWs within KwaDabeka and Clermont in KwaZulu-Natal, to describe their roles and to explore the barriers and enablers influencing their service delivery.Method: A convergent mixed methods design was employed with a sample of CHWs with the use of a survey (n = 53) and two focus groups (n = 10) and semi-structured interviews with four ward councillors (n = 4). Data were analysed statistically and thematically.Results: The profile of CHWs reflected only women with a mixed age range and a majority of 59% who had not completed formal schooling. General work experience as a CHW varied. There were diverse opinions expressed towards the CHW role which related to their job title and identity, supervision, remuneration, growth pathways and psychological and emotional issues. Whilst the National Community Health Worker Profile Framework was established for the CHW programme, there are several factors lacking in the current CHW programme such as a formal growth pathway or formal training to align the CHWs with the National Qualifications Framework.Conclusion: The study findings are essential for the monitoring and evaluation as well as development and refinement of policies that will assist in ensuring adequate rollout of PHC with CHWs.

Background: It is well known that tertiary education is highly stressful for students, particularly in the medical

Occupational therapy relies primarily on communication between the therapist and client for effective intervention. Adequate communication may be influenced by language and cultural differences between the therapist and client. Cultural competence in relation to language and culture is thus a vital part in practice. Limited research exists on cultural competence in occupational therapy students. This study thus aimed to explore the cultural competence of final year students and their perceptions of their own cultural competence, with respect to language and culture in their practice as students. An explorative qualitative study design was utilised with a nonprobability purposeful sample of 21 final year undergraduate students at a tertiary institute in South Africa. Three focus groups were conducted, comprising between 6 and 8 students in each group. Thematic analysis using inductive reasoning was undertaken in order to analyse the students' experiences and understanding of cultural competence. Findings of the study suggest that cultural competence, in relation to language and culture, influences the occupational therapy intervention process. It was shown to both positively and negatively influence intervention through supporting or hindering rapport building, client centeredness, and effective intervention.

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.

Background: Musculoskeletal pain (MSP) conditions are common in the educational leaning environment and are often associated with poor ergonomic conditions. Objective: This study investigated the prevalence, pattern and possible risk factors of MSP among undergraduate students of occupational therapy and physiotherapy in a South African university. Methods: A cross-sectional survey using an internet-based self-designed electronic questionnaire was used to obtain information about participants’ socio-demography, ergonomic hazards, MSP, and relevant personal information. Descriptive statistics, chi-square, and logistic regression were used in analyzing the data. Results: There were 145 participants (females 115 (79.3%); physiotherapy (74) 51.03%), making 36.7% of the present undergraduate student population in the two departments. The most prevalent ergonomic work hazards were prolonged sitting (71.7%) and repetitive movements (53.8%). The 12 months prevalence of MSP among the students was 89.7%. The pattern of MSP revealed that pain on the neck region was most prevalent (66.2%) followed by pain in the low back region (64.4%). Duration of daily travels and participation in regular exercise activities were significantly associated with the prevalence of MSP. Logistic model explained 23.6% of the variance in prevalence of MSP and correctly classified 94.1% of cases ([Formula: see text], [Formula: see text]). The right-handed students were 0.13 times more likely to present with MSP than left-handed students. Also, students who exercised regularly were 9.47 times less likely to present with MSP. Conclusion: MSP is highly prevalent among health science undergraduates and is significantly associated with sedentary postures and inadequacy in structured physical activity participation.

The dynamic transitions in healthcare systems globally necessitate the training of healthcare professionals who are responsive to the needs of the community that they serve to ensure quality and relevance of care. [1] Undergraduate clinical education is therefore critical for the development of socially competent graduates who are equipped with technical skills and insight to function purposefully within these changing social and health contexts. [2] Students' clinical competence, proficiency and aptitude are core to their clinical education and training, which should be rooted in a competency-based undergraduate programme. [3-5] In South Africa (SA), the gaping disparity in health provision between the over-accessed public health facilities and well-resourced private healthcare settings prompted government to introduce the National Health Insurance (NHI), with the incorporation of the primary healthcare (PHC) approach. [6,7] NHI is a government funding model that ensures disenfranchised communities access to quality healthcare. Through NHI, PHC has proposed re-engineering focused on prevention of diseases, promotion of health and ensuring availability of rehabilitative services at community level. PHC is a strategy to ensure that healthcare services are available in resource-scarce communities, but the uptake in healthcare systems nationally remains poor. [8] Innovative approaches of actualising the implementation of the ideal PHC model are necessary to influence the disparity in public v. private healthcare in SA. [8] Perpetuating the vision for NHI, the University of KwaZulu-Natal (UKZN) College of Health Sciences (CHS), in collaboration with the KwaZulu-Natal (KZN) Department of Health (DoH), embarked on the roll-out of community-based training within a PHC (CBTPHC) approach. [9] UKZN adopted this approach to equip health science students with the necessary skills to serve communities in dire need of healthcare. For the purpose of this article, we refer to this method of training as decentralised clinical training (DCT). This study focused on the discipline of physiotherapy within the CHS at UKZN, which offers a 4-year undergraduate degree programme with a professional qualification (Bachelor degree). There is a greater theoretical bias in years 1 and 2, with a deliberate shift to clinical training and competency development in years 3 and 4 of study. Intake varies between 50 students in year 1 and up to 55 students in the final year, depending on the throughput of students during the programme. For 2017, final-year students were introduced to the DCT framework in which they were placed at urban, rural and peri-urban sites in KZN Province, where they were predominantly under the care and supervision of physiotherapy clinicians at the respective settings. The facilities provided them with clinical exposure to neurological, cardiopulmonary and neuromusculoskeletal conditions and communitybased rehabilitation. Each physiotherapy student spent 5 weeks at 4 of the clinical sites, 2 of 6 newly introduced settings t...