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Solina Richter

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Social Determinants of Health

Solina Richter

Faculty of Nursing

University Terrace Building, R 7-50L
8303 112 street

  • Associate professor

Subject areas and related deposits

  • Adolescent health

    • Accessibility of adolescent health services

      Adolescents represent a large proportion of the population. As they mature and become sexually active, they face more serious health risks. Most face these risks with too little factual information, too little guidance about sexual responsibility and multiple barriers to accessing health care. A typical descriptive and explanatory design was used to determine what the characteristics of an accessible adolescent health service should be. Important results and conclusions that were reached indicate that the adolescent want a medical doctor and a registered nurse to be part of the health team treating them and they want to be served in the language of their choice. Family planning, treatment of sexually transmitted diseases and psychiatric services for the prevention of suicide are services that should be included in an adolescent accessible health service. The provision of health education concerning sexual transmitted diseases and AIDS is a necessity. The service should be available thought out the week (included Saturdays) and within easy reach. It is recommended that minor changes in existing services be made, that will contribute towards making a health delivery service an adolescent accessible service. An adolescent accessible health service can in turn make a real contribution to the community’s efforts to improve the health of its adolescents and can prove to be a rewarding professional experience to the health worker.

    • The perception of South African adolescents regarding primary health care services

      Most of the South African public health facilities fail to provide adolescent-friendly health services. A quantitative, descriptive research study was conducted at Stinkwater, a rural area in Hammanskraal, South Africa. The objective of the study was to describe the adolescent’s preferences regarding primary health care services. A survey was conducted among 119 adolescents. It was found that adolescents wished to be involved in the planning of the activities of the adolescent health service, and that friendliness and respect for adolescents were seen as desirable characteristics of an adolescent-friendly health care service. Adolescents preferred services to be available throughout the week and to be located at the school, youth center, community center, hospital, or clinic. Health education was indicated as a priority and the health care team should include different members of a multidisciplinary team. Adolescents preferred that their health services be separated from adult services and that a male nurse be employed in the adolescent service in order to create a less feminine image. It was also recommended that all adolescents be educated about the types of services available. Understanding health care service preferences of adolescents is needed in order to deliver optimal health care to this group.

  • Capacity building nurses

    • Qualitative Research in an International Research Program: Maintaining Momentum while Building Capacity in Nurses.

      Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decision-makers from Canada and five low- and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled “Strengthening Nurses’ Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean.” The goal of the research program was to explore and promote nurses’ involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.

  • Caregivers

    • The educational and supportive needs of informal caregivers working at Refentse Clinic, Hammanskraal

      Informal caregivers have long been used as health care providers. It is also not uncommon in present days, to see such practice in the community. This practice of caring normally occurs within the context of the family. The purpose of the study is to explore and describe the educational and supportive needs of informal caregivers. This will assist in planning and establishing health education programmes and a supportive network, for the informal caregivers at Refentse clinic, at Hammanskraal. A qualitative, explorative and descriptive design was followed, to collect the data. Participants in this study were informal caregivers, who were involved in Refentse clinic and resided in Stinkwater village. The method of choice, to gather data, was focus groups. An unstructured interview with a schedule was followed. Tesch’s method was used, to analyse the data. The results indicated that the informal caregivers’ educational needs were mostly concentrated on health promotion and disease prevention activities. Their needs concerning support, mainly concentrated around support from government, the community, the University and the Primary Health Care clinic, in the area where they are serving. Personal needs focused on recognition and respect.

  • Child Health

    • Perception of the health of children living and working on the streets of Sunnyside - Part 1: Literature review and methodogly

      The phenomenon of street children is generating increasing concern in South Africa. The number of street children has grown because of the current economic hardship in South Africa, increasing levels of violence and widespread family and community disruption. In terms of health, it is clear that street children may be vulnerable to a range of severe risks. The street child’s view of health may differ considerably from that of the researcher. Discrepancies exist between the perceptions of the street children, and those of community health workers. This can have serious consequences when planning health promotion strategies (Jenkins & Emmet 1997:427). The purpose of the study was to describe the perceptions of street children concerning their own health. A qualitative descriptive design was followed in this study. Focus groups were used to obtain data. The findings of this research revealed five categories: • Influences the environment has on street children’s wellness • Paths of homelessness of street children of Sunnyside that play a leading role in their wellness • Wellness seeking behaviors of the street children of Sunnyside and the access to care they make use of • Sources of advice and wellness education the street children of Sunnyside make use of • Illnesses perceived by the street children of Sunnyside

  • Childbirth education

    • Standards for perinatal education - Part 1

      Quality control in perinatal education is imperative, with the purpose to deliver a high quality and appropriate healthcare service to the family in the perinatal period. The purpose of this study was to develop valid standards for perinatal education in South Africa. To reach this goal, the study proceeded as follows: Development phase - concepts were developed for perinatal education, - the concepts were logically systematised and formulated in concept standards, - the standards were presented for peer group review with the purpose of refinement and further development. Quantification phase - the statistical validity of the standards was determined/calculated. After completion of the study the researcher reached the conclusion that quality perinatal education must adhere to the following standards: • A philosophy for perinatal education must exist. • The perinatal facilitator must be a well trained professional person, and must possess certain personal traits. • The perinatal education style/method must adapt according to the client’s socio-economic status, age, marital status and needs. • The perinatal facilitator must make use of acknowledged teaching methods and techniques in order to facilitate learning. • The perinatal education must comply with certain minimum requirements in order to make it accessible and acceptable to the client. • The perinatal facilitator must complete a preparatory phase before she is allowed to give education. • A perinatal education programme must have a curriculum that can be adapted to the client’s circumstances. • Perinatal education must be presented purposefully. • The end result of perinatal education must focus on a healthy baby and a healthy, empowered mother, family and community.

  • Confidentiality

    • Confidentiality and treatment decisions of minor clients: a health professional’s dilemma & policy makerschallenge.

      Issues relating to confidentiality and consent for physical and mental health treatment with minor clients can pose challenges health care providers. Decisions need to be made regarding these issues despite the absence of clear, direct, or comprehensive policies and legislation. In order to fully understand the scope of this topic, a systemic review of several pieces of legislation and guidelines related to this topic are examined. These include the: Canadian Human Rights Act, Children’s Rights: International and National Laws and Practices, Health Information Act, Gillick Competence and Medical Emancipation, Freedom of Information and Protection of Privacy Act, Child, Youth and Family Enhancement Act, Common Law Mature Minor Doctrine, and Alberta Health Services Consent to Treatment/Practice(s) Minor/Mature Minor. In order to assist health professionals with decisions regarding confidentiality and treatment with minor clients a case study and guide for decision-making is also presented.

  • Content analysis

    • Homelessness Coverage in Major Canadian Newspapers, 1987 – 2007

      This article describes how the Canadian printed news media depicted the homeless and their situations between 1987 and 2007. Our study used a descriptive, cross-sectional design and a content analysis was conducted on selected newspaper articles on homelessness issues. The main themes were housing-related issues, profiling of homelessness, health-related issues, economic factors, illegal activities, community aid and support, and social factors as cause of homelessness. Housing related issues, community aid and support, profiling of homelessness and economic factors were addressed in 85.3% of the stories. This study provides a retrospective examination of the media’s interests in and portrayal of the homeless and homelessness issues.

  • Global homelessness

    • Research Planning for Global Poverty and Homelessness Policies and Services: A Case Study of a Joint Canadian-South Africa Initiative

      Global poverty, homelessness and health-related issues require both international and country-specific research to explore best collaborative approaches, determine relevant global health services and policy research questions, and explore how collaborative partnerships and research can be applied in practice with people who are homeless. A workshop was organized in South Africa with Canadian and South African researchers, non-researchers and community leaders, and community charitable organizations. Open discussions focused on the approaches for joint research, capacity building and knowledge transfer initiatives regarding low income and homelessness issues. One of the results is a guiding framework for these initiatives.

  • Homelessness

    • Homelessness Coverage, Social Reality, and Media ownership: Comparing a National Newspaper with two Regional Newspapers in Canada

      The media plays an important role in the discourse of homelessness. The purpose of this study was to compare how two Alberta newspapers (Calgary Herald and Edmonton Journal) and one national newspaper(the Globe and Mail) covered homeless issues in terms of population, main themes, article type, monthly differences, and critical time periods. Through purposive sampling technique, 449 articles from 1987 to 2007 were selected for analysis, including 128 news articles from the Edmonton Journal, 152 from the Calgary Herald and 169 from the Globe and Mail. A content analysis showed that these newspapers have different agenda settings for homelessness related issues. We argue that the differences among the newspapers’ coverage on homelessness are directly related to media ownership, and the unique economic and political structure and ideology at national and provincial levels.

    • A Systematic Review on the Intersection of Homelessness and Healthcare in Canada

      Background: Nurses must understand the needs and barriers of people who are homeless when they are in a health care environment in order to render effective care. Objective: The objective of this review is to synthesize research findings on studies that examine the needs and barriers of people who are homeless in Canada when they intersect with health care providers. Methods: A scope of manuscripts, published in English from 1980 to 2011 that assess the needs and barriers of people experiencing homelessness in Canada when in the health sector without limitation on study design from different electronic databases and manual searches, was conducted. Results: Six articles (N=4 qualitative, N=2 quantitative) met the inclusion and exclusion criteria. Eight themes emerged from a narrative synthesis of the findings. Conclusion: Individuals who are homeless have multiple needs when in the health care sector. Thus, collaboration among different disciplines is essential in order to provide them with holistic care.

  • Nursing

    • Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethnocultural groups: an integrative review of the literature

      Background: High income nations are currently exhibiting increasing ethno-cultural diversity which may present challenges for nursing practice. We performed an integrative review of literature published in North America and Europe between 1990 and 2007, to map the state of knowledge and to identify nursing assessment tools/models which are have an associated research or empirical perspective in relation to ethno-cultural dimensions of nursing care. Methods: Data was retrieved from a wide variety of sources, including key electronic bibliographic databases covering research in biomedical fields, nursing and allied health, and culture, e.g. CINAHL, MEDline, PUBmed, Cochrane library, PsycINFO, Web of Science, and HAPI. We used the Critical Appraisal Skills Programme tools for quality assessment. We applied Torraco’s definition and method of an integrative review that aims to create new knowledge and perspectives on a given phenomena. To add methodological rigor with respect to the search strategy and other key review components we also used the principles established by the Centre for Reviews and Dissemination. Results: Thirteen thousand and thirteen articles were retrieved, from which 53 full papers were assessed for inclusion. Eight papers met the inclusion criteria, describing research on a total of eight ethno-cultural assessment tools/models. The tools/models are described and synthesized. Conclusions: While many ethno-cultural assessment tools exist to guide nursing practice, few are informed by research perspectives. An increased focus on the efficiency and effectiveness of health services, patient safety, and risk management, means that provision of culturally responsive and competent health services will inevitably become paramount.

  • Nursing assessment

    • Evaluating the utility of the FamCHAT ethnocultural nursing assessment tool at a Canadian tertiary care hospital: a pilot study with recommendations for hospital management

      Objectives: The multicultural nature of Canadian society and the decline in health of immigrants after relocation to Canada prioritizes a commitment to ensure equity in health care access and outcomes. An important feature shaping health care access and outcomes is the reception of culturally safe and competent care. Partnering with senior management at a tertiary care hospital, this pilot study aimed to investigate whether an identified cultural assessment tool, the Family Cultural Heritage Assessment Tool (FamCHAT), validated for use in a rural primary care setting, was suitable for use in tertiary care. The objectives were to investigate: 1) whether using the FamCHAT enabled the nurses to elicit assessment information from their patients who represent diverse ethnocultural groups, and 2) the nurses’ perspectives on the practical use of this form in their clinical practice. Methods: Nurses purposively selected from the Women’s, Surgery and Medicine units were asked to complete the FamCHAT form with all patients admitted during a three-month period in 2009. Focus group interviews were then held to learn the nurses’ perspectives related to the form’s constructs and its use in their practice. The data from the completed FamCHAT forms were tabulated and analyzed using descriptive statistics to determine the extent of completion and accuracy, and the sample characteristics. The interview data was analyzed using qualitative analytical software (ATLAS.ti Scientific Software Development, GmbH, Germany) and Roper and Shapira’s framework for analysis of ethnographic data. Results: The nurses filled out forty-four FamCHAT forms with patients having a diverse ethnocultural profile. In many forms, several questions were either left blank or answered incorrectly with regard to the guidance notes containing categorical answers for the variables of family size and language. Nine nurses participated in two focus groups (n = 4 and n = 5) and one in an individual interview. Five themes emerged from the qualitative data analysis: feasibility of using the FamCHAT in acute care practice; ethnocultural awareness needs of the participating nurses; perspectives of nurses about patient concerns; potential for enhancement to nursing care assessments; and suggestions for enhancing and facilitating a new tool or approach. Nurses participating in the interviews thought that the constructs within FamCHAT could be useful for enhancing nursing assessments in their practice, but thought the tool was too long, was repetitive to some of their current assessment data, and had questions many patients were uncomfortable answering. One option suggested in both focus groups was to embed the most useful constructs into existing assessment frameworks. Some of the variables were thought to be of limited relevancy for some nursing specialties. Conclusions: The findings provided valuable information for the hospital management in their efforts to revise nursing assessment tools. Consideration is being given to integrating some of the constructs into their existing nursing assessment, with recognition that each unit might benefit from different approaches. Other, systematic, approaches to enhancing cultural competency also need to be considered. This study highlights the importance of validating practice tools for use in settings that differ from those used for their original development.

  • Public Health

  • Teenagers

    • Perception of rural teenagers on teenage pregnancy

      It is important to seek an understanding of teenagers’ perceptions regarding teenage pregnancy. The purpose of this study was to explore and describe the perceptions of teenagers in Bushbuckridge district in the Limpopo Province, South Africa, towards teenage pregnancy. An explorative qualitative research design was used with convenience sampling to select participants. Thirty-two teenagers participated; 10 boys and 22 girls. Face-to-face interviews were conducted to collect data. Tesch’s method of data analysis was used. Three main categories emerged from the analyses of the interviews: (1) teenagers’ attitudes and perceptions of teenage pregnancy, (2) teenagers’ level of knowledge of contraception, and also (3) their reasons for becoming pregnant. Teenage pregnancy poses significant social and health problems in the Bushbuckridge district and has implications for all health care professionals. Given the complexity of this problem, health care professionals working with this group should develop a wide range of practical and interpersonal skills.

  • Tuberculosis

    • Tuberculosis in the era of infection with the human immunodeficiency virus: Assessment and comparison of community knowledge of both infections in rural Uganda.

      Background In Uganda, despite a significant public health burden of tuberculosis (TB) in the context of high human immunodeficiency virus (HIV) prevalence, little is known about community knowledge of TB. The purpose of this study was to assess and compare knowledge about TB and HIV in the general population of western Uganda and to examine common knowledge gaps and misconceptions. Methods We implemented a multi-stage survey design to randomly survey 360 participants from one district in western Uganda. Weighted summary knowledge scores for TB and HIV were calculated and multiple linear regression (with knowledge score as the dependant variable) was used to determine significant predictors. Six focus group discussions were conducted to supplement survey findings. Results Mean (SD) HIV knowledge score was 58 (12) and TB knowledge score was 33 (15), both scores out of 100. The TB knowledge score was statistically significantly (p < 0.001) lower. Multivariate regression models included age, sex, marital status, education, residence, and having a friend with HIV/TB as independent variables. TB knowledge was predicted by rural residence (coefficient = −6.27, 95% CI: -11.7 to −0.8), and age ≥45 years (coefficient = 7.45, 95% CI: 0.3-14.6). HIV knowledge was only predicted by higher education (coefficient = 0.94, 95%CI: 0.3-1.6). Focus group participants mentioned various beliefs in the aetiology of TB including sharing cups, alcohol consumption, smoking, air pollution, and HIV. Some respondents believed that TB was not curable. Conclusion TB knowledge is low and many misconceptions about TB exist: these should be targeted through health education programs. Both TB and HIV-infection knowledge gaps could be better addressed through an integrated health education program on both infections, whereby TB program managers include HIV information and vice versa.

  • Women

    • A case study: Retrospective analysis of homeless women in a Canadian city.

      A retrospective study was performed using the case files of women shelter users to profile and describe the factors that are associated with homelessness in the women population in Edmonton, Alberta, Canada. Case files (660) were extracted by selecting every fifth file in each group (one group per year) beginning in 1985. Of all the files examined, the mean age was 34 years. Fifty three percent were single women and half were Aboriginal. Main reasons given for using the shelters were housing problems and involvement in abusive relationships. Thirty eight percent of women used shelters only once, while 25.6 % were considered chronic users. Establishing the profile of homeless women proved difficult because of the lack of usable data. What is urgently needed for women shelters is the creation of a standardized admission form that incorporates sensitivity and flexibility for each shelter admission.