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Item Analysis of factors contributing to non-adherence to highly active antiretroviral therapy in selected facilities in Namibia: A development of adherence improvement Programme for health professionals(University of Namibia, 2023) Katjiuanjo, Maazuu ZauanaHealth professionals are faced with challenges of ART non-adherence in patient enrolled on HAART. This study was aimed at developing a programme to assist health professionals to improve ART adherence at the facilities in Oshikoto and Kavango West regions. The study was carried out in four phases i) phase 1: situational analysis ii) phase 2: conceptual framework development iii) adherence programme development and iv) programme evaluation. Phase 1 involved carrying out a situational analysis using a mixed-method design to understand magnitude of adherence problem in the study area. In the quantitative part of the study a descriptive and analytic cross sectional study was conducted to collect data using structured interview, with HIV infected persons (n=296) under antiretroviral treatment in Oshikoto and Kavango West regions. Medication adherence was measured with the Adult AIDS Clinical Trial Group (AACTG) method and the Morisky Medication adherence Scale (MMAS-8) In depth Interviews (IDIs) of health professionals (n=43) and four Focus Group Discussions (FGDs) with (n=32) individuals who received ART at a primary health care clinics were conducted at four facilities in the selected regions. Overall adherence levels was 76 % with AACTG and 36 % with MMAS-8. Factors contributing to non-adherence were Type of House, Region and Health Facility, the relationship was a negative one with beta < 0. Other factors were forgetfulness and regimens missed during the weekends as reported by the MMAS-8. Determinants of non-adherence using the AACTG adherence were found to be Confident of regularly taking medicine, Intention to regularly take medicine over the next year, Treatment support in taking medicine available and Cues to Action with beta >0.5). ART potency, that is Doses per day, ART Regimen and Dose each time per day ii with beta >0.5). The factors contributing to non-adherence with Morisky scale that showed strong positive relations with beta <0.5 were the medicinal barriers, perceived barriers, more likely to get ill than others, concerned about becoming seriously ill and barriers based on Infection severity. Determinants of non-adherence using the MMAS 8 were benefits of efficacy (r = 0.143, p <0.05), perceived barriers (r = -0.194, p <0.05) and social support in taking medicine (r = -0.127, p < 0.05). Four themes emerged of factors influencing non-adherence to antiretroviral therapy, these were: patient-related factors, health system, therapy-related factors, and condition related factors. In the qualitative data analysis, health professionals reported reasons for ART non-adherence. The subthemes included Unemployment and being poor; forgetfulness; lack of knowledge due to negative beliefs; side-effects, health system challenges; workload, inadequate training, lack of skills, and poor adherence reporting systems; stigma. The HAART participants reported several barriers that negatively influenced their medication experience and adherence. These barriers included the following subthemes: financial burden; side-effects, psychological factors, such alcohol use and stigma. The facilitators included social support, treatment support and positive patient-provide relationship. In Phase 2, the development of the conceptual framework was based on the theory of Dickoff et al. (1968) using the findings of the mixed method. Phase 3 addressed the development of the Adherence Improvement Programme (AIP) for the health professionals (1). The programme was developed within the concepts of Intervention mapping framework suggested by Bartholomew et al. (2006), which outlines the processes of developing a theory-based health promotion programme. Finally, the programme was evaluated in Phase 4 using the Centre for Disease Control (CDC) iii ‘Framework for programme evaluation in public health’ (2). A pool of public health experts was utilised for this purpose. The AIP has four programme components consisting of four objectives. Key performance areas based on the intervention strategies to improve adherence were elaborated under each objective. Tasks to be performed under each key performance areas were stipulated accompanied by indicators to measure programme performanceItem An educational programme to support primary health care providers regarding the management of emergency contraceptives for adolescents in Ohangwena region, Namibia(University of Namibia, 2023) Nghifikwa, Loide AmbugaFamily planning (FP) could be called one of the most crucial decisions in a woman, young adult, and lately in an adolescent’s life. Emergency contraceptive refers to the strategies of birth control (FP) to prevent unwanted pregnancies after unprotected sexual intercourse (WHO, 2021). On a daily basis, healthcare facilities offer free services for emergency contraceptives (ECs) to women of childbearing age including adolescents and young people to prevent unwanted pregnancies. However, the impact of such services is minimal, and adolescent pregnancies remain a public health concern in Namibia. The Ohangwena region in Namibia is among the regions with the highest adolescent pregnancies. Therefore, the aim of this study was to assess the knowledge, attitudes and practices of Primary Health Care (PHC) providers regarding the management of ECs among adolescents in order to develop an educational programme for PHC providers. The objectives of the study were: to assess the knowledge, attitudes and practices of PHC providers regarding the management of emergency contraceptives for adolescents; determine the factors related PHC providers’ knowledge, attitudes and practices of ECs by PHC providers for adolescents; to develop a conceptual framework as the foundation for an educational programme; to develop an educational programme to support PHC providers regarding the management of ECs for adolescents; to implement the educational programme; and to evaluate the educational programme. The study adopted a quantitative approach. In this study, a descriptive cross-sectional study design was used in this study. The study was conducted in four phases. The first step was to conduct a situational analysis that assessed the knowledge, attitudes and practices of PHC providers regarding the management of ECs among adolescents as well as determine the factors related to PHC providers’ knowledge, attitudes and practices of ECs by PHC for adolescents. To collect data, a self-administered questionnaire was used, and a multi-stage stratified sampling method was used to select PHC providers from various health care facilities. A total of ninety-three PHC providers completed the self- ii administered questionnaire with a response rate of 100%. The collected data were entered into the statistical package SPSS version 26. Descriptive and inferential data analysis methods were used to analyse the data. In total, 79% of PHC providers had heard of emergency contraceptives (ECs). However, only 66% of the PHC providers know that combined pills are types of ECs methods, while only 14% correctly identified copper IUD as a method of ECs. In identifying those that are eligible for ECs use, a majority of respondents (76%) named women who had unprotected sex and only 12% identified adolescents as appropriate candidates for using ECs. Rape situations (79%) were the most frequently cited reason for EC prescriptions, followed by condom breakage (61%) and (16%) in case of missed contraceptive pills. Almost 64% of the respondents knew about the effective time to use ECs. The majority (78.3%) of the respondents knew that ECs are used in preventing unwanted pregnancies. The analytical findings revealed that the standardised direct (unmediated) effect of Negative Attitudes on Positive Attitudes was -0.452 (p < 0.01, which implies that a nurse with a negative attitude is likely to have a high misconception attitude and a low positive attitude towards EC. The study found that only 15.2% of the participants were trained in both FP and ECs, and this lack of training in FP and ECs can have a negative impact on ECs practices. As evidenced by less than 50% of participants reportedly providing ECs to clients, the practice of ECs was found to be poor. There is a significant relationship between demographic variables such as age (p=0.00), professional qualification (p=0.00), and work experience (p=0.02) and PHC providers' knowledge, attitudes, and practices. The study revealed a deficit in the knowledge, misconceptions, negative attitude and poor practice of ECs by the PHC providers, which may be barriers to accessing ECs by adolescents. These findings have negative consequences for adolescents’ usage of ECs. As a result, educational interventions should be provided to PHC providers on ECs the knowledge, demystification of misconceptions and for correction of negative attitudes towards EC services. iii Based on Dickoff, James, and Wiedenbach's survey list, the second phase addressed the conceptual framework to guide the development of an educational programme to support PHC providers in the management of ECs for adolescents. The third phase focused on developing an educational programme to assist PHC providers, guided by the Nicholls Cyclic Curriculum Development Model. The fourth stage dealt with programme implementation and evaluation. Knowles' Andragogy model and Kolb's experiential learning theory guided this phase. The educational programme was evaluated during and after its implementation. The findings indicated that the education programme was useful and supportiveItem A model for health professionals to facilitate a wellness program in the state health facilities of Oshikoto region, Namibia(University of Namibia, 2022) Amadhila, JuliaThe purpose of this study was to develop a model for health professionals to facilitate a wellness program in the state health facilities of Oshikoto Region in Namibia. A significant number of health professionals experience psychosocial, physical and personal challenges in the workplace, which has necessitated the development of this proposed model. However, the development of the model required concepts that are derived from empirical data. To achieve that, the study design involved a convergent mixed method approach which required both quantitative and qualitative methods of data collection and analysis. The study was conducted in four phases. Phase 1 involved identification and analysis of concepts focusing on: (1) assessing the state health facilities in terms of the facilitation of wellness programs, using a checklist, (n=3) which were purposely selected; (2) describing knowledge, practices and experiences of health professionals with regard to the facilitation of a wellness programs, using self-administered questionnaires, nurses (n=147) who were randomly selected through stratified sampling; doctors (n=17) who were conveniently sampled and (3) exploring and describing perceptions of health professional managers regarding facilitation of wellness programs, using in-depth interviews, (n=6) which were purposely selected and all- inclusively sampled. The findings revealed that health professionals are faced with organizational challenges such as unavailability of wellness policies, unavailability of wellness program and lack of consultation for staff recruitment; resource challenges such as staff shortage, inadequate facilities and equipment; psychosocial challenges such as insufficient support from management, stress, scope of practice issues and workload; and personal challenges such as inadequate knowledge on wellness program, illnesses and lack of self-care in the work environment that hinder the facilitation of wellness programs. Using the WHO Framework and model (2010), psychosocial, physical and personal environment concepts were identified as the main central concepts and as a guiding tool to develop this model. These concepts form the basis of model development. The WHO framework and model (2010) guided the identification and analysis of concepts; and the Practice Oriented theory of Dickoff, James and Wiedenbach (1968) was used to describe the identified concepts. Phase 2 involved the construction of the relationships statement. To achieve this, the Practice Oriented theory of Dickoff et al. (1968), WHO framework and model (2010); and Fayol’s Management theory (1920) were adopted to guide the construction of the relationships statements v that formed the basis for the development of a model. Phase 3 involved the description and evaluation of the model. A model for health professionals to facilitate wellness programs was described according to Chinn and Kramer’s descriptive components in terms of its purpose, structure (assumptions, definitions of concepts, relation statements and nature) and process. Three phases of the model were identified, namely: needs assessment, managing and maintaining a conducive environment and outcome. The model was evaluated using Fawcett’s six criteria (significance, internal consistency, parsimony, testability, empirical adequacy, and pragmatic adequacy) of evaluating nursing theories. Phase 4 involved the development of guidelines for operationalization of the model, based on the needs identified from the study findings, to guide the Ministry of Health and Social Services (MoHSS), health professionals and all stakeholders in the facilitation of wellness programs. Guidelines were developed to direct the effective implementation of the model that would facilitate the wellness program in the state health facilities. Based on the study findings, recommendations were made to the policymakers, regulatory body, MoHSS and management respectively, to develop a comprehensive and inclusive wellness policy to institute a wellness program in the state health facilities; revise the scope of practice for nurses; establish a wellness directorate at the national level; advocate for and facilitate psychosocial, physical and personal support to enable health professionals cope with challenges in their work environment. Future research is recommended on implementation and evaluation of the effectiveness of the model and guidelines that has been developed.Item Facilitating the mental health of individuals living with chronic mental illness in the Northwest health directorate - Northern Namibia: A community involvement approach(2014) Shifiona, Ndapeua N.Living with chronic mental illness in Namibia is a challenge. It often means a permanent fight against stigma and a daily struggle to make ends meet. The impact of living with the illness produces enormous subjective sufferings for the individuals, as well as untold psychological and financial burdens for many families. Through the researcher‟s interactions with individuals living with chronic mental illness, it became clear that they are not adequately supported by relatives and other members of the communities in which they live. Sometimes they are deprived access to basic needs namely, shelter, medications, freedom of movement and of expression. There is an exaggerated fear of, as well as a negative attitude towards those living with mental illness. In the Northwest Health Directorate of Namibia, there are no community care facilities for individuals living with chronic mental illness. There are no alternative community aftercare modes for discharged individuals living with chronic mental illness. Post-discharge of the patient from the hospital, there are no follow-ups regarding the social circumstances they find themselves in. As a result, the home-care for someone living with chronic mental illness after hospitalization remains the sole responsibility of the relatives who rarely know how to look after the patient. On many occasions the public has been very ignorant about mental illness, resulting in them having a very negative attitude towards persons living with chronic mental illness. The main purpose of this research was to explore and describe the lived experiences of individuals living with chronic mental illness, and the experience of the family members, community members, and health care workers dealing with individuals living with chronic mental illness. Thereafter, the researcher developed a mental health nursing model, which provides a theoretical frame of reference for the advanced psychiatric mental health nurse practitioner to facilitate constructive interactions through communicating, relating and sharing by discharged individuals living with chronic mental illness in Namibia...