Intervention strategies to strengthen eye care follow-up among glaucoma patients in selected district hospitals of Limpopo Province South Africa

Abstract

AIM AND OUTLINE OF THE THESIS There is a challenge in keeping glaucoma patients within the health care system. To engage the patient, there should be counselling to enhance their understanding of the disease and encourage the participation of the patient in their choice of therapy and compliance with treatment. The ease of financing mechanisms for their treatment is also important. Additional efforts should be geared towards providing a pleasant hospital experience so that follow-up visits would entail a one-stop-shop (Sawesi et al,2016). Therefore, eye care providers working together with the glaucoma patients may enhance better treatment outcomes in South Africa (Cook,2009; Abdull, Chandler & Gilbert, 2016). Many factors influence glaucoma loss to follow up. A better understanding of the relationships between glaucoma knowledge and patient-reported problems in using glaucoma medication revealed opportunities for intervention that may improve patients ‘clinical outcomes (Reponen, 2016.The current study seeks to develop a strategy to strengthen eye care follow-up among glaucoma patients in Limpopo province, South Africa. Chapter 1 introduces the thesis, presenting a theoretical background, theoretical health models, the problem statement, purpose and objectives of the study, definition and operational concepts of the study. It also contains the significance and conclusion of the study. Chapter 2 is a systematic literature review that analyses the intervention strategies to ensure that glaucoma patients remain in care. The study was published as an article titled “Systematic Literature Review on strengthening Eye Care Follow-Up among Glaucoma Patients in Limpopo Province” in The Open Public Health Journal (2020). The chapter established that various techniques have been employed globally to design and evaluate several interventions to improve glaucoma adherence with diverse accomplishments. The reviewed studies showed that educational interventions are a common strategy that led to significant improvement in medication adherence. The purpose of the systematic literature review was to analyse intervention strategies used to ensure that glaucoma patients remain in care within the health care facilities. In Chapter 3 A survey was conducted to increase the understanding of the reasons for loss to follow-up among 429 glaucoma patients. This study has been published as “Loss to follow-up amongst glaucoma patients in selected hospitals of the Limpopo Province, South Africa” in the journal African Vision and Eye Health (AVEH) (2020). The purpose of the study was to identify behavioural determinants contributing to loss to follow-up amongst glaucoma patients. The study was conducted in fundamentally different settings in Vhembe District: a general regional hospital, district hospitals, and a specialized ophthalmic hospital. 3 The study findings revealed that non-adherence to scheduled follow-up appointments among glaucoma patients in rural hospitals was still prevalent. However, factors varied due to every person’s unique experience. Forgetfulness and financial difficulties were indicated as some of the barriers contributing to glaucoma medication non-adherence. Most glaucoma patients did not know that glaucoma needed regular follow-ups like any other chronic disease such as diabetes and hypertension. This was attributed to the fact that glaucoma is asymptomatic. Other patients held traditional or religious beliefs which assumed that glaucoma is caused by witchcraft or evil spirits. Detailed information from patients who were identified as glaucoma loss to follow-up was gathered and it forms part of Chapter four. Chapter four: This forms part of the qualitative study. The material of this chapter was subsequently published as an article titled “Challenges Contributing to Loss to Follow-up as Experienced by Glaucoma Patients in the Vhembe District of Limpopo Province, South Africa” in The Open Public Health Journal (2020). This study sought to explore factors contributing to loss to follow-up as experienced by glaucoma patients in South Africa. The key findings from the qualitative study were mostly system-related factors such as the negative attitude of the hospital workers, shortage of glaucoma medications, long waiting time, and long queues. The problem of poor communication between patients and health care providers was also highlighted. Other findings revealed by patients that contribute to glaucoma LTFU are lack of escort and family support, difficulty in getting time off, and the issue of stigma and discrimination. Similar findings were experienced by other patients who suffered from other chronic diseases like HIV and AIDS and those attending maternal health. Chapter five introduces the proposed strategies to strengthen eye care follow-up which were developed after the analyses and interpretation of the three chapters (chapters 2-4) that revealed knowledge gaps. The development of proposed strategies was guided by various theories. The most used theories are the Health Belief Model (HBM); Social Cognitive Theory (SCT); Information Motivation Behavior Skill Model (IMB) and the Social Action Theory (SAT). The selected theories have positive health benefits and have the potential to improve medication adherence. The chapter to be submitted as a proposed strategy to strengthen eye care follow-up among glaucoma patients in a peer reviewed journals. Chapter five(a) forms part of the proposed strategies to strengthen eye care follow-up.The material of this chapter was published as an article titled”Application of an information-motivation-behavioural skills model to strengthen eye care follow-up amongst glaucoma patients” in the in the journal African Vision and Eye Health (AVEH) (2021).The study sought to investigate how the application of IMBSM can strengthen eye care follow-up 4 of glaucoma in Limpopo province South Africa.The key findings from the proposed strategy was that non-adherence limits the potential of successful treatments to improve patients’ health and quality of life. The study also revealed that strategies to improve adherence to glaucoma medication are likely to be effective when they include multiple components such as educating the patient and their family members. Therefore, these findings suggest that the application of the IMBSM might improve glaucoma patients’ adherence. Chapter six is a compilation of general discussion which includes empirical findings of the summary of the research findings, strengths and limitations and recommendation to the study. It also reveals the conclusions based on the study findings as well as recommendations for further research works. The following recommendations were made: the patients and family members and community health workers; Primary Health Care(PHC) and eye care health practitioners (ECHP); the Department of Health (DOH); and recommendations for further research and lastly the conclusion of the study. ANNEXURES: The section included all the annexures such as questionnaire for all glaucoma patients, interview guide for patients who are lost to follow-up, ethical clearance from research and innovation committee, permission letters from the Provincial and district department of health and permission letters from the hospitals. Besides, proofreading and editing letters are also included.