Knowledge and documentation of patient health information among traditional health practitioners in urban and peri-urban areas of eThekwini Municipality, KwaZulu-Natal Province, South Africa

Abstract

Background: Documentation of patient health information (PHI) is a regulatory requirement and hence a standard procedure in allopathic healthcare practice. The opposite is true for African traditional medicine (ATM) in most African countries, including South Africa, despite legal and policy frameworks that recognise and mandate the institutionalisation of ATM. Developing good practice standards for PHI documentation is an essential step in the institutionalisation of ATM. Objective: This study examined the knowledge and practices of documentation of PHI by traditional health practitioners (THPs) in Durban, eThekwini Municipality, KwaZulu-Natal Province, South Africa. Methods: In this quantitative cross-sectional study, snowball sampling was used to identify and recruit THPs. An interviewer-administered questionnaire was used to gather data. Chi-square tests and logistic regression were used to assess associations of knowledge and practice of documentation of PHI with potential predictors; age, gender, education, type of practitioner, experience, number of patients seen per day and location of the practice. Results: Of the 248 THPs who participated, 71.8% were female. Mean (SD) age was 47.4 (14.2), ranging 18–81 years. The majority (65.7%) were Izangoma (diviners). Overall, 42.9% of the THPs reported knowledge of patient medical records (PMRs). In logistic regression, only number of patients seen per day remained a significant predictor of knowledge about PMR. THPs who reported seeing 6–10 patients were five times more likely (Odds Ratio (OR): 5.164, 95% Confidence Interval (CI): 1.270–20.996; p = 0.022) to report knowledge of PMR than those seeing <6 patients per day. Overall, 25.0% of THPs reported that they were documenting some PHI. Documentation was associated with having knowledge of PMR (OR: 29.323, 95% CI: 10.455–82.241; p < 0.0001) and being an Isangoma (OR: 3.251, 95% CI: 1.092–9.679; p = 0.02). Not knowing what (56.5%) and how (50.5%) to record were the most commonly cited reasons for not documenting. Conclusion: Knowledge of PMR is low, and the practice of documenting PHI is even lower among THPs in eThekwini. That knowledge of PMR was a strong predictor of documentation practice, and the most common reason for not documenting was lack of knowledge about what and how to document suggests that training could improve PHI documentation in traditional medicine practice.

Attitudes and perceptions of traditional health practitioners towards documentation of patient health information in their practice in eThekwini Municipality, KwaZulu-Natal, Natal Province, South Africa

“…The negative factor, the fear that practising documentation of patient health information in ATM will reveal their practice, had the highest weight, scoring 54.76%. As previously reported, of the 248 participants in this study, 62 (25.0%) confirmed documenting some form of patient health information in their practice (Zhandire et al, 2019).…”

“…The major finding in this study was that THPs had positive attitudes towards documenting patient health information and that these positive attitudes influenced their perceptions towards documentation of patient health information in ATM practice. Our findings further showed that even though participants in this study had limited knowledge about documenting patient health information, as discussed in Zhandire et al (2019), they expressed positive attitudes and perceptions about introducing this practice in ATM. Misconceptions about documenting patient health information in ATM seemed common.…”

“…THPs gave reasons for either being keen or not keen to introduce documenting of patient health information in their practice. The questionnaire was piloted with five THPs in February 2018, as described in Zhandire et al (2019).…”

“…We have previously reported on the documentation patterns that currently exist in ATM in eThekwini Municipality in South Africa (Zhandire et al, 2019). Unlike the national health system, which has remained well documented and become even more effective in improving documentation systems, including electronic systems, documentation practice in ATM, a major aspect of patient care, is still not robust.…”

The role of health classifications in health information management

“…Hay et al (2020: 69) discussed the role of clinical documentation improvement (CDI) specialists in ensuring that documentation is able to be translated into the clinical codes that are “one of the building blocks of reporting for public and private hospitals.” Shepheard (2018) made the point that CDI programs must be adequately resourced and must focus on identifying the clinical truth to support quality clinical coding and that HIMs and CCs are well placed to fulfil these roles. Zhandire et al (2020) highlighted the deficiency in documentation of African traditional medicine practice, making good health information difficult, if not impossible, to obtain.…”