Exploring primary healthcare practitioners’ experiences regarding the coronavirus disease 2019 (COVID-19) pandemic in KwaZulu-Natal, South Africa

Primary Health Care Research and Development, Volume 23, No. 3, Year 2022

Interpretation

Background: The coronavirus disease 2019 (COVID-19) has spread rapidly around the world since the initial outbreak in Wuhan, China. With the emergence of the Omicron variant, South Africa is presently the epicentre of the COVID-19 pandemic in sub-Saharan Africa. Healthcare workers have been at the forefront of the pandemic in terms of screening, early detection and clinical management of suspected and confirmed COVID-19 cases. Since the beginning of the outbreak, little has been reported on how healthcare workers have experienced the COVID-19 pandemic in South Africa, particularly within a low-income, rural primary care context. Methods: The purpose of the present qualitative study design was to explore primary healthcare practitioners’ experiences regarding the COVID-19 pandemic at two selected primary healthcare facilities within a low-income rural context in KwaZulu-Natal, South Africa. Data were collected from a purposive sample of 15 participants, which consisted of nurses, physiotherapists, pharmacists, community caregivers, social workers and clinical associates. The participants were both men and women who were all above the age of 20. Data were collected through individual, in-depth face-to-face interviews using a semi-structured interview guide. Audio recordings were transcribed verbatim. Data were analysed manually by thematic analysis following Tech’s steps of data analysis. Results: Participants reported personal, occupational and community-related experiences related to the COVID-19 pandemic in South Africa. Personal experiences of COVID-19 yielded superordinate themes of psychological distress, self-stigma, disruption of the social norm, Epiphany and conflict of interest. Occupational experiences yielded superordinate themes of staff infections, COVID-19-related courtesy stigma, resource constraints and poor dissemination of information. Community-related experiences were related to struggles with societal issues, clinician-patient relations and COVID-19 mismanagement of patients. Conclusion: The findings of this study suggest that primary healthcare practitioners’ experiences around COVID-19 are attributed to the catastrophic effects of the COVID-19 pandemic with the multitude of psychosocial consequences forming the essence of these experiences. Ensuring availability of reliable sources of information regarding the pandemic as well as psychosocial support could be valuable in helping healthcare workers cope with living and working during the pandemic. We employed a qualitative approach using a descriptive cross-sectional design to explore and describe PHC practitioners’ experiences regarding the Coronavirus (COVID-19 pandemic) in KwaZulu-Natal, South Africa. The study was conducted at two different PHC facilities, namely a community health centre and satellite clinic in a purposively selected health district in the KwaZulu-Natal province of South Africa. The health facilities selected form part of the public health system, which belongs to the Department of Health. The selected health facilities are both located in an area which is rural, serving an under-resourced, underdeveloped and mostly unemployed community. The community health centre is located in the northern part of the KwaZulu-Natal province and serves a catchment population of 65 000 people in a rural community. The average headcount of the facility is 22 000 people per month who use the health facility to access an array of comprehensive PHC services which include chronic disease management (TB, HIV and non-communicable diseases), treatment of minor ailments and provision of maternal, women and child health service, the facility also provides mobile health service in hard to reach areas within the catchment community. Services in the community health centre are provided by various members of the multi-disciplinary health team which includes doctors, nurses, physiotherapist, occupational therapist, clinical associates, radiographers, social workers and community caregivers. The selected satellite clinic is also located in the northern part of the KwaZulu-Natal province and serves a catchment population of 25 000 people living in the community. The average number of people who use the facility is 7000 every month. This facility provides also provides comprehensive PHC services using a one-stop shop approach with service delivery being primarily nurse-led. The clinics selected for data collection were in the geographical location that was nearest to the senior author, thus allowing for an in-depth and immersive understanding of the participants’ experiences within the context of the dynamics of the respective communities. Purposive sampling was used to achieve the desired result. Purposive sampling is especially useful for investigating unusual situations and participants are chosen for a specific reason which is peculiar to them (Leedy and Ormrod, 2001:219; Neuman, 2006:222). Hence, 35 healthcare workers were viewed as key informants as they are frontiers in this pandemic. For the study, PHC practitioners included workers who were permanently employed in the two selected clinics for a duration of at least six months, while volunteers, students, temporarily employees and those who were working for a duration of less than six months at the PHC were excluded. The sample size constituted of nurses, clinical associates, pharmacists, social workers and community caregivers. However, medical doctors, dentists and occupational therapists elected not to participate. A clash in schedules was the main hindrance from collecting data. A reschedule was proposed but this was turned down for unknown reasons. Hence, the researcher did not pursue further because any forced interactions would taint the quality of data. As a result, sample scope became limited to nurses, clinical associates, pharmacists, social workers and community caregivers. The age of participants ranged from 20 to 55 years (See Table Table11 for demographic details of participants). Profile of participants Initial identification and recruitment of study participants was done through mediated access, which involved obtaining permission from participants’ immediate supervisors so as to obtain buy-in for carrying out the study. Supervisors were assisted by providing information on participants that would be relevant to the study based on the study’s inclusion criteria. Participants were then approached by the researcher. All participants provided informed consent to participate in this study. A total number of 35 participants were targeted to participate in the study. However, a total number of 15 interviews were conducted because of the point of content saturation. The researcher observed that there were no new themes that were emerging; hence, to avoid repetition it was decided to stop at 15 interviews. Individual, one-on-one in-depth interviews using a semi-structured interview guide were used to collect data. The data collection instrument comprised of two sections – the first was related to demographic details of the participants and the second was related to semi-structured interview guide developed by the senior author with questions related to participants’ experiences of COVID-19 in KwaZulu-Natal, South Africa. Data were collected between April 2020 and September 2020. All interviews were conducted in English, and an audiotape was used to record the interview. The duration of each interview ranged from 20 to 55 min. Thirty-five participants were targeted; however, 25 participants were willing to be part of the study. All interviews were completed at the end of the day after the participants had completed their clinical duties. To maintain privacy, the interviews were conducted in a private consulting room in both clinics, and COVID-19 protocols were followed. Due to the COVID-19 government regulations in effect at the time, all COVID-19 safety precautions were observed by use of PPE (such as surgical mask) by participants and the senior author during the interviews. Surfaces were also sanitised before and after each interview in each of the consulting rooms where interviews were conducted. Social distancing was maintained, and hand hygiene practices were followed before and after each interview. A pre-test was done with one healthcare worker prior commencement of the actual study to validate the instrument. No changes were made to the original data collection instrument based on the initial data collected. Data were analysed concurrently with data collection. Recruitment of participants ceased after data content saturation was reached. Content data saturation was reached at the 15th participant. The collected data were transcribed verbatim and then analysed thematically using content analysis. Vaismoradi et al. (2013:399) explain that thematic analysis aims to qualify and analyse narrative data on social life. Narratives describe how people live their daily lives, practices and subjective perceptions, which can be communicated orally or in written texts (Neuman, 2006:474). Thus, thematic analysis was key to data analysis. Tesch’s (2013) method of data analysis for qualitative research was followed. Data were analysed in collaboration with experts in qualitative research methodology to ensure trustworthiness. All the authors also reviewed the codebook, categories and the themes that emerged from the data. Disagreements were discussed, and consensus was reached after further deliberations. The analysis of data was an iterative process, which entailed continuous reading and re-reading of the interview transcripts. The transcripts were consistently reviewed and compared with audio-recorded data to ensure the reliability and credibility of the research findings. Ethical approval to conduct this study was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BREC/00001446/2020). Approval to conduct the study was also obtained from the KwaZulu-Natal Department of Health (NHRD Ref: KZ_202007_015). Informed consent was obtained verbally and in writing prior to data collection from all participants. Participants were also given a written information sheet to ensure they understood the nature of the study.

AI Digest

Study Justification:

– The study aims to explore primary healthcare practitioners’ experiences regarding the COVID-19 pandemic in a low-income, rural primary care context in KwaZulu-Natal, South Africa.
– Little has been reported on how healthcare workers have experienced the pandemic in South Africa, particularly in low-income, rural areas.
– Understanding the experiences of healthcare workers is crucial for improving their well-being and providing appropriate support during the pandemic.

Study Highlights:

– The study used a qualitative approach to explore and describe primary healthcare practitioners’ experiences of the COVID-19 pandemic.
– Data were collected through individual, in-depth face-to-face interviews with a purposive sample of 15 participants, including nurses, physiotherapists, pharmacists, community caregivers, social workers, and clinical associates.
– Participants reported personal, occupational, and community-related experiences related to the pandemic.
– Personal experiences included psychological distress, self-stigma, disruption of social norms, epiphany, and conflict of interest.
– Occupational experiences included staff infections, COVID-19-related courtesy stigma, resource constraints, and poor dissemination of information.
– Community-related experiences were related to struggles with societal issues, clinician-patient relations, and mismanagement of COVID-19 patients.

Study Recommendations:

– Ensure the availability of reliable sources of information regarding the pandemic for healthcare workers.
– Provide psychosocial support to help healthcare workers cope with the challenges of living and working during the pandemic.

Key Role Players:

– Primary healthcare practitioners (nurses, physiotherapists, pharmacists, community caregivers, social workers, clinical associates)
– Supervisors and managers in primary healthcare facilities
– Department of Health
– Researchers and experts in qualitative research methodology

Cost Items for Planning Recommendations:

– Training and education programs for healthcare workers on COVID-19 information and management
– Development and implementation of psychosocial support programs
– Resources for infection prevention and control measures (e.g., personal protective equipment)
– Research and evaluation activities to assess the effectiveness of interventions
– Collaboration and coordination efforts between healthcare facilities and the Department of Health

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study design and includes a description of the study methods, sample size, data collection process, and data analysis approach. However, the abstract does not provide specific details about the findings or the implications of the study. To improve the evidence, the abstract could include a summary of the main themes or findings from the qualitative analysis, as well as a discussion of the implications for primary healthcare practitioners and suggestions for future research or interventions.

Abstract

We employed a qualitative approach using a descriptive cross-sectional design to explore and describe PHC practitioners’ experiences regarding the Coronavirus (COVID-19 pandemic) in KwaZulu-Natal, South Africa. The study was conducted at two different PHC facilities, namely a community health centre and satellite clinic in a purposively selected health district in the KwaZulu-Natal province of South Africa. The health facilities selected form part of the public health system, which belongs to the Department of Health. The selected health facilities are both located in an area which is rural, serving an under-resourced, underdeveloped and mostly unemployed community. The community health centre is located in the northern part of the KwaZulu-Natal province and serves a catchment population of 65 000 people in a rural community. The average headcount of the facility is 22 000 people per month who use the health facility to access an array of comprehensive PHC services which include chronic disease management (TB, HIV and non-communicable diseases), treatment of minor ailments and provision of maternal, women and child health service, the facility also provides mobile health service in hard to reach areas within the catchment community. Services in the community health centre are provided by various members of the multi-disciplinary health team which includes doctors, nurses, physiotherapist, occupational therapist, clinical associates, radiographers, social workers and community caregivers. The selected satellite clinic is also located in the northern part of the KwaZulu-Natal province and serves a catchment population of 25 000 people living in the community. The average number of people who use the facility is 7000 every month. This facility provides also provides comprehensive PHC services using a one-stop shop approach with service delivery being primarily nurse-led. The clinics selected for data collection were in the geographical location that was nearest to the senior author, thus allowing for an in-depth and immersive understanding of the participants’ experiences within the context of the dynamics of the respective communities. Purposive sampling was used to achieve the desired result. Purposive sampling is especially useful for investigating unusual situations and participants are chosen for a specific reason which is peculiar to them (Leedy and Ormrod, 2001:219; Neuman, 2006:222). Hence, 35 healthcare workers were viewed as key informants as they are frontiers in this pandemic. For the study, PHC practitioners included workers who were permanently employed in the two selected clinics for a duration of at least six months, while volunteers, students, temporarily employees and those who were working for a duration of less than six months at the PHC were excluded. The sample size constituted of nurses, clinical associates, pharmacists, social workers and community caregivers. However, medical doctors, dentists and occupational therapists elected not to participate. A clash in schedules was the main hindrance from collecting data. A reschedule was proposed but this was turned down for unknown reasons. Hence, the researcher did not pursue further because any forced interactions would taint the quality of data. As a result, sample scope became limited to nurses, clinical associates, pharmacists, social workers and community caregivers. The age of participants ranged from 20 to 55 years (See Table Table11 for demographic details of participants). Profile of participants Initial identification and recruitment of study participants was done through mediated access, which involved obtaining permission from participants’ immediate supervisors so as to obtain buy-in for carrying out the study. Supervisors were assisted by providing information on participants that would be relevant to the study based on the study’s inclusion criteria. Participants were then approached by the researcher. All participants provided informed consent to participate in this study. A total number of 35 participants were targeted to participate in the study. However, a total number of 15 interviews were conducted because of the point of content saturation. The researcher observed that there were no new themes that were emerging; hence, to avoid repetition it was decided to stop at 15 interviews. Individual, one-on-one in-depth interviews using a semi-structured interview guide were used to collect data. The data collection instrument comprised of two sections – the first was related to demographic details of the participants and the second was related to semi-structured interview guide developed by the senior author with questions related to participants’ experiences of COVID-19 in KwaZulu-Natal, South Africa. Data were collected between April 2020 and September 2020. All interviews were conducted in English, and an audiotape was used to record the interview. The duration of each interview ranged from 20 to 55 min. Thirty-five participants were targeted; however, 25 participants were willing to be part of the study. All interviews were completed at the end of the day after the participants had completed their clinical duties. To maintain privacy, the interviews were conducted in a private consulting room in both clinics, and COVID-19 protocols were followed. Due to the COVID-19 government regulations in effect at the time, all COVID-19 safety precautions were observed by use of PPE (such as surgical mask) by participants and the senior author during the interviews. Surfaces were also sanitised before and after each interview in each of the consulting rooms where interviews were conducted. Social distancing was maintained, and hand hygiene practices were followed before and after each interview. A pre-test was done with one healthcare worker prior commencement of the actual study to validate the instrument. No changes were made to the original data collection instrument based on the initial data collected. Data were analysed concurrently with data collection. Recruitment of participants ceased after data content saturation was reached. Content data saturation was reached at the 15th participant. The collected data were transcribed verbatim and then analysed thematically using content analysis. Vaismoradi et al. (2013:399) explain that thematic analysis aims to qualify and analyse narrative data on social life. Narratives describe how people live their daily lives, practices and subjective perceptions, which can be communicated orally or in written texts (Neuman, 2006:474). Thus, thematic analysis was key to data analysis. Tesch’s (2013) method of data analysis for qualitative research was followed. Data were analysed in collaboration with experts in qualitative research methodology to ensure trustworthiness. All the authors also reviewed the codebook, categories and the themes that emerged from the data. Disagreements were discussed, and consensus was reached after further deliberations. The analysis of data was an iterative process, which entailed continuous reading and re-reading of the interview transcripts. The transcripts were consistently reviewed and compared with audio-recorded data to ensure the reliability and credibility of the research findings. Ethical approval to conduct this study was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BREC/00001446/2020). Approval to conduct the study was also obtained from the KwaZulu-Natal Department of Health (NHRD Ref: KZ_202007_015). Informed consent was obtained verbally and in writing prior to data collection from all participants. Participants were also given a written information sheet to ensure they understood the nature of the study.

Materials

N/A

Innovations

Based on the provided information, it seems that the study focused on exploring primary healthcare practitioners’ experiences regarding the COVID-19 pandemic in a low-income, rural primary care context in KwaZulu-Natal, South Africa. The study used a qualitative approach and collected data through individual, in-depth face-to-face interviews with a purposive sample of 15 participants, including nurses, physiotherapists, pharmacists, community caregivers, social workers, and clinical associates.

The study aimed to understand the personal, occupational, and community-related experiences of healthcare workers during the COVID-19 pandemic. The findings highlighted various themes, including psychological distress, self-stigma, disruption of social norms, staff infections, resource constraints, poor dissemination of information, struggles with societal issues, clinician-patient relations, and COVID-19 mismanagement of patients.

To improve access to maternal health, based on the information provided, it is important to consider the following potential recommendations:

1. Strengthening communication and information dissemination: Ensure that accurate and up-to-date information about maternal health services, COVID-19 precautions, and available resources is effectively communicated to healthcare workers and the community. This can be done through various channels, such as training sessions, informational materials, and community outreach programs.

2. Enhancing psychosocial support: Recognize and address the psychological distress experienced by healthcare workers during the pandemic. Provide access to counseling services, peer support networks, and mental health resources to help healthcare workers cope with the challenges they face in providing maternal health services.

3. Improving infection prevention and control measures: Implement strict infection prevention and control protocols to minimize the risk of staff infections and ensure the safety of healthcare workers and patients. This includes providing adequate personal protective equipment (PPE), training on proper use of PPE, and regular monitoring and enforcement of infection control practices.

4. Strengthening collaboration and coordination: Foster collaboration and coordination among healthcare workers, community caregivers, and other stakeholders involved in maternal health services. This can help ensure a comprehensive and integrated approach to maternal health, especially during the COVID-19 pandemic.

5. Addressing resource constraints: Advocate for increased resources, including staffing, equipment, and supplies, to support maternal health services in low-income, rural areas. This can help overcome the challenges posed by resource constraints and improve access to quality maternal healthcare.

It is important to note that these recommendations are based on the provided information and may need to be further tailored and contextualized to the specific needs and challenges faced in the study setting.

AI Innovations Description

Based on the provided description, the recommendation to improve access to maternal health based on the study findings could be to implement the following:

1. Strengthen the dissemination of accurate and reliable information: Ensure that primary healthcare practitioners have access to up-to-date and reliable information regarding maternal health, including guidelines for managing maternal health during the COVID-19 pandemic. This can help healthcare workers provide accurate information to pregnant women and improve their overall care.

2. Provide psychosocial support: Recognize the psychosocial consequences experienced by primary healthcare practitioners during the pandemic and establish support systems to help them cope. This can include access to counseling services, peer support groups, and mental health resources to address the psychological distress and self-stigma reported by healthcare workers.

3. Enhance infection control measures: Address the issue of staff infections by implementing strict infection control measures in healthcare facilities. This can include providing adequate personal protective equipment (PPE), training healthcare workers on proper infection prevention and control practices, and ensuring regular testing and monitoring of healthcare staff.

4. Improve resource allocation: Address resource constraints reported by healthcare workers by ensuring adequate staffing, equipment, and supplies in primary healthcare facilities. This can help healthcare workers provide quality maternal health services and improve access for pregnant women.

5. Strengthen clinician-patient relations: Address the reported mismanagement of COVID-19 patients by improving communication and collaboration between healthcare providers and patients. This can include training healthcare workers on effective communication skills, promoting patient-centered care, and involving patients in decision-making regarding their maternal health.

By implementing these recommendations, it is hoped that access to maternal health services can be improved, particularly in low-income, rural areas in South Africa, and healthcare workers can be better supported in their efforts to provide quality care during the COVID-19 pandemic.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can improve access to maternal health by allowing pregnant women to consult with healthcare providers remotely. This can be particularly beneficial for women in rural areas who may have limited access to healthcare facilities.

2. Mobile clinics: Establishing mobile clinics that provide maternal health services can reach underserved communities, especially in rural areas. These clinics can offer prenatal care, vaccinations, and health education to pregnant women who may not have easy access to healthcare facilities.

3. Community health workers: Training and deploying community health workers who are knowledgeable about maternal health can help bridge the gap between healthcare facilities and pregnant women in remote areas. These workers can provide education, support, and referrals to ensure that pregnant women receive the care they need.

4. Improved transportation: Enhancing transportation infrastructure and services can facilitate access to maternal health services. This can include providing transportation vouchers or subsidies for pregnant women to travel to healthcare facilities, especially in areas with limited public transportation options.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that would benefit from the recommendations, such as pregnant women in rural areas.

2. Collect baseline data: Gather information on the current access to maternal health services in the target population, including factors such as distance to healthcare facilities, availability of transportation, and utilization of services.

3. Develop a simulation model: Create a model that incorporates the recommendations and their potential impact on improving access to maternal health. This could involve estimating the number of pregnant women who would benefit from each recommendation and the potential increase in utilization of maternal health services.

4. Input data and run simulations: Input the baseline data into the simulation model and run simulations to estimate the impact of the recommendations. This could include estimating the increase in the number of pregnant women accessing prenatal care, the reduction in travel time to healthcare facilities, or the improvement in health outcomes.

5. Analyze results: Analyze the simulation results to assess the potential impact of the recommendations on improving access to maternal health. This could involve comparing the baseline data with the simulated outcomes to determine the effectiveness of the recommendations.

6. Refine and validate the model: Refine the simulation model based on the analysis of the results and validate it using additional data or expert input. This will help ensure the accuracy and reliability of the simulation findings.

By following these steps, the impact of the recommendations on improving access to maternal health can be simulated and evaluated, providing valuable insights for decision-making and resource allocation.

Author

Dima Health

Identifiers:

DOI: 10.1017/S1463423622000536

ISSN: 14634236

Research Areas:

Community Interventions, COVID, Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Social Determinants, Workforce

Study Countries:

South Africa

Study Design:

Cross Sectional Study, Grounded Theory, Narrative Study, Phenomenological Study

Study Approach:

Qualitative

Participants Gender:

Male & Female