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Jock, J., Kobayashi, L., Chakraborty, R., Chen, X., Wing, C., Berkman, L., . . . Rosenberg, M. (2023). Effects of pension eligibility expansion on men’s cognitive function: findings from rural South Africa. Journal of Aging & Social Policy
Open this publication in new window or tab >>Effects of pension eligibility expansion on men’s cognitive function: findings from rural South Africa
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2023 (English)In: Journal of Aging & Social Policy, ISSN 0895-9420, E-ISSN 1545-0821Article in journal (Refereed) Epub ahead of print
Abstract [en]

Two-thirds of people living with Alzheimer’s disease and related dementias (ADRD) live in low- and middle-income countries, and this figure is expected to rise as these populations are rapidly aging. Since evidence demonstrates links between socioeconomic status and slower rates of cognitive decline, protecting older adults’ cognitive function in resource-limited countries that lack the infrastructure to cope with ADRD is crucial to reduce the burden it places on these populations and their health systems. While cash transfers are a promising intervention to promote healthy cognitive aging, factors such as household wealth and level of education often confound the ability to make causal inferences on the impact of cash transfers and cognitive function. This study uses a quasi-experimental design, leveraging an exogenous expansion to the Old Age Pension for men in South Africa, to approximate causal associations with cognitive function. We found evidence that there is a potential benefit of cash transfers at an earlier age for older individuals. As such, transfers such as pensions or other forms of direct basic income transfers may hold promise as potential interventions to promote healthy cognitive aging.

Place, publisher, year, edition, pages
Routledge, 2023
Keywords
Cash transfers, cognitive function, natural experiment, pension, Rural South Africa
National Category
Public Health, Global Health, Social Medicine and Epidemiology Neurosciences
Identifiers
urn:nbn:se:umu:diva-206781 (URN)10.1080/08959420.2023.2195785 (DOI)000957735400001 ()36975023 (PubMedID)2-s2.0-85152007470 (Scopus ID)
Available from: 2023-04-24 Created: 2023-04-24 Last updated: 2023-04-24
Du Toit, J. D., Kapaon, D., Crowther, N. J., Abrahams-Gessel, S., Fabian, J., Kabudula, C. W., . . . Gaziano, T. A. (2023). Estimating population level 24-h sodium excretion using spot urine samples in older adults in rural South Africa. Journal of Hypertension, 41(2), 280-287
Open this publication in new window or tab >>Estimating population level 24-h sodium excretion using spot urine samples in older adults in rural South Africa
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2023 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, no 2, p. 280-287Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: South Africa has introduced regulations to reduce sodium in processed foods. Assessing salt consumption with 24-h urine collection is logistically challenging and expensive. We assess the accuracy of using spot urine samples to estimate 24-h urine sodium (24hrUNa) excretion at the population level in a cohort of older adults in rural South Africa.

METHODS: 24hrUNa excretion was measured and compared to that estimated from matched spot urine samples in 399 individuals, aged 40-75 years, from rural Mpumalanga, South Africa. We used the Tanaka, Kawasaki, International Study of Sodium, Potassium, and Blood Pressure (INTERSALT), and Population Mean Volume (PMV) method to predict 24hrUNa at the individual and population level.

RESULTS: The population median 24hrUNa excretion from our samples collected in 2017 was 2.6 g (interquartile range: 1.53-4.21) equal to an average daily salt intake of 6.6 g, whereas 65.4% of participants had a salt excretion above the WHO recommended 5 g/day. Estimated population median 24hrUNa derived from the INTERSALT, both with and without potassium, showed a nonsignificant difference of 0.25 g (P = 0.59) and 0.21 g (P = 0.67), respectively. In contrast, the Tanaka, Kawasaki, and PMV formulas were markedly higher than the measured 24hrUNa, with a median difference of 0.51 g (P = 0.004), 0.99 g (P = 0.00), and 1.05 g (P = 0.00) respectively. All formulas however performed poorly when predicting an individual's 24hrUNa.

CONCLUSION: In this population, the INTERSALT formulas are a well suited and cost-effective alternative to 24-h urine collection for the evaluation of population median 24hrUNa excretion. This could play an important role for governments and public health agencies in evaluating local salt regulations and identifying at-risk populations.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-202343 (URN)10.1097/HJH.0000000000003327 (DOI)000906026000011 ()36583353 (PubMedID)2-s2.0-85145157416 (Scopus ID)
Available from: 2023-01-12 Created: 2023-01-12 Last updated: 2023-09-05Bibliographically approved
Marcus, M. E., Mahlalela, N., Drame, N. D., Rohr, J. K., Vollmer, S., Tollman, S. M., . . . Bärnighausen, T. (2023). Home-based HIV testing strategies for middle-aged and older adults in rural South Africa. AIDS, 37(14), 2213-2221
Open this publication in new window or tab >>Home-based HIV testing strategies for middle-aged and older adults in rural South Africa
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2023 (English)In: AIDS, ISSN 0269-9370, E-ISSN 1473-5571, Vol. 37, no 14, p. 2213-2221Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: More than one in four adults over 40 years with HIV in South Africa are unaware of their status and not receiving antiretroviral therapy (ART). HIV self-testing may offer a powerful approach to closing this gap for aging adults. Here, we report the results of a randomized comparative effectiveness trial of three different home-based HIV testing strategies for middle-aged and older adults in rural South Africa.

DESIGN: Two thousand nine hundred and sixty-three individuals in the 'Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)' cohort study were randomized 1 : 1 : 1 to one of three types of home-based and home-delivered HIV testing modalities: rapid testing with counseling; self-testing, and both rapid testing with counselling and self-testing.

METHOD: In OLS regression analyses, we estimated the treatment effects on HIV testing and HIV testing frequency at about 1 year after delivery. Finally, we assessed the potential adverse effects of these strategies on the secondary outcomes of depressive symptom as assessed by the CESD-20, linkage to care, and risky sexual behavior.

RESULTS: There were no significant differences in HIV testing uptake or testing frequency across groups. However, respondents in the self-testing treatment arms were more likely to shift from testing at home and a facility [self-testing (HIVST), -8 percentage points (pp); 95% confidence interval (CI) -14 to -2 pp; self-testing plus rapid testing and counselling (ST+RT+C); -9 pp, 95% CI -15 to -3 pp] to testing only at home (HIVST 5 pp; 95% CI 2 to 9 pp; ST+RT+C: 5 pp, 95% CI 1 to 9 pp) - suggesting a revealed preference for self-testing in this population. We also found no adverse effects of this strategy on linkage to care for HIV and common comorbidities, recent sexual partners, or condom use. Finally, those in the self-testing only arm had significantly decreased depressive symptom scores by 0.58 points (95% CI -1.16 to -0.01).

CONCLUSION: We find HIV self-testing to be a well tolerated and seemingly preferred home-based testing option for middle-aged and older adults in rural South Africa. This approach should be expanded to achieve the UNAIDS 95-95-95 targets.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-216192 (URN)10.1097/QAD.0000000000003698 (DOI)37696252 (PubMedID)2-s2.0-85175269845 (Scopus ID)
Funder
NIH (National Institutes of Health), P01 AG041710
Available from: 2023-11-08 Created: 2023-11-08 Last updated: 2023-11-08Bibliographically approved
Abrahams-Gessel, S., Gómez-Olivé, F. X., Tollman, S. M., Wade, A. N., Du Toit, J. D., Ferro, E. G., . . . Gaziano, T. A. (2023). Improvements in Hypertension Control in the Rural Longitudinal HAALSI Cohort of South African Adults Aged 40 and Older, From 2014 to 2019. American Journal of Hypertension, 36(6), 324-332
Open this publication in new window or tab >>Improvements in Hypertension Control in the Rural Longitudinal HAALSI Cohort of South African Adults Aged 40 and Older, From 2014 to 2019
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2023 (English)In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 36, no 6, p. 324-332Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Over half of the South African adults aged 45 years and older have hypertension but its effective management along the treatment cascade (awareness, treatment, and control) remains poorly understood.

METHODS: We compared the prevalence of all stages of the hypertension treatment cascade in the rural HAALSI cohort of older adults at baseline and after four years of follow-up using household surveys and blood pressure data. Hypertension was a mean systolic blood pressure >140 mm Hg or diastolic pressure >90 mm Hg, or current use of anti-hypertension medication. Control was a mean blood pressure <140/90 mm Hg. The effects of sex and age on the treatment cascade at follow-up were assessed. Multivariate Poisson regression models were used to estimate prevalence ratios along the treatment cascade at follow-up.

RESULTS: Prevalence along the treatment cascade increased from baseline (B) to follow-up (F): awareness (64.4% vs. 83.6%), treatment (49.7% vs. 73.9%), and control (22.8% vs. 41.3%). At both time points, women had higher levels of awareness (B: 70.5% vs. 56.3%; F: 88.1% vs. 76.7%), treatment (B: 55.9% vs. 41.55; F: 79.9% vs. 64.7%), and control (B: 26.5% vs. 17.9%; F: 44.8% vs. 35.7%). Prevalence along the cascade increased linearly with age for everyone. Predictors of awareness included being female, elderly, or visiting a primary health clinic three times in the previous 3 months, and the latter two also predicted hypertension control.

CONCLUSIONS: There were significant improvements in awareness, treatment, and control of hypertension from baseline to follow-up and women fared better at all stages, at both time points.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
adult, aged, blood pressure, hypertension/therapy, rural population, South Africa
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-210282 (URN)10.1093/ajh/hpad018 (DOI)000950569400001 ()36857463 (PubMedID)2-s2.0-85159785421 (Scopus ID)
Available from: 2023-06-21 Created: 2023-06-21 Last updated: 2023-06-21Bibliographically approved
Thsehla, E., Balusik, A., Boachie, M. K., Tombe-Mdewa, W., Kabudula, C., Du Toit, J., . . . Hofman, K. (2023). Indirect effects of COVID-19 on maternal and child health in South Africa. Global Health Action, 16(1), Article ID 2153442.
Open this publication in new window or tab >>Indirect effects of COVID-19 on maternal and child health in South Africa
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2023 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 16, no 1, article id 2153442Article in journal (Refereed) Published
Abstract [en]

Background: The unfinished burden of poor maternal and child health contributes to the quadruple burden of disease in South Africa with the direct and indirect effects of the COVID-19 pandemic yet to be fully documented.

Objective: To investigate the indirect effects of COVID-19 on maternal and child health in different geographical regions and relative wealth quintiles.

Methods: We estimated the effects of COVID-19 on maternal and child health from April 2020 to June 2021. We estimated this by calculating mean changes across facilities, relative wealth index (RWI) quintiles, geographical areas and provinces. To account for confounding by underlying seasonal or linear trends, we subsequently fitted a segmented fixed effect panel model.

Results: A total of 4956 public sector facilities were included in the analysis. Between April and September 2020, full immunisation and first dose of measles declined by 6.99% and 2.44%, respectively. In the follow-up months, measles first dose increased by 4.88% while full immunisation remained negative (−0.65%) especially in poorer quintiles. At facility level, the mean change in incidence and mortality due to pneumonia, diarrhoea and severe acute malnutrition was negative. Change in first antenatal visits, delivery by 15–19-year olds, delivery by C-section and maternal mortality was positive but not significant.

Conclusion: COVID-19 disrupted utilisation of child health services. While reduction in child health services at the start of the pandemic was followed by an increase in subsequent months, the recovery was not uniform across different quintiles and geographical areas. This study highlights the disproportionate impact of the pandemic and the need for targeted interventions to improve utilisation of health services.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
diarrhoea, Immunization, mortality, pneumonia, pregnancy, severe acute malnutrition
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-203558 (URN)10.1080/16549716.2022.2153442 (DOI)000908094400001 ()36607314 (PubMedID)2-s2.0-85145925129 (Scopus ID)
Available from: 2023-01-19 Created: 2023-01-19 Last updated: 2023-09-05Bibliographically approved
Rowe, K., Ruiz Pozuelo, J., Nickless, A., Nkosi, A. D., dos Santos, A., Kahn, K., . . . Stein, A. (2023). The adolescent HIV executive function and drumming (AHEAD) study, a feasibility trial of a group drumming intervention amongst adolescents with HIV. AIDS Care, 35(11), 1796-1814
Open this publication in new window or tab >>The adolescent HIV executive function and drumming (AHEAD) study, a feasibility trial of a group drumming intervention amongst adolescents with HIV
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2023 (English)In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 35, no 11, p. 1796-1814Article in journal (Refereed) Published
Abstract [en]

AHEAD feasibility trial assessed the feasibility and acceptability of an 8-session group drumming programme aiming to improve executive function, depression and anxiety symptoms, and perceived social support in adolescents living with HIV in a rural low-income South African setting. Sixty-eight 12- to 19-year-old adolescents participated. They were individually randomised. The intervention arm (n = 34) received weekly hour-long group drumming sessions. Controls (n = 34) received no intervention. Feasibility and acceptability were assessed using rates of: enrolment; retention; attendance; logistical problems; adolescent-reported acceptability. Secondary measures included: five Oxford Cognitive Screen-Executive Function (OCS-EF) tasks; two Rapid Assessment of Cognitive and Emotional Regulation (RACER) tasks; the Self-Reporting Questionnaire-20 (SRQ-20) measuring depression and anxiety symptoms; the Multidimensional Scale of Perceived Social Support (MSPSS). All feasibility criteria were within green progression limits. Enrolment, retention, and acceptability were high. There was a positive effect on adolescent depressed mood with signal for a working memory effect. There were no significant effects on executive function or socio-emotional scales. Qualitative findings suggested socio-emotional benefits including: group belonging; decreased internalised stigma; improved mood; decreased anxiety. Group drumming is a feasible and acceptable intervention amongst adolescents living with HIV in rural South Africa. A full-scale trial is recommended.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
adolescents, drumming, executive function, HIV, mental health, trial
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-206946 (URN)10.1080/09540121.2023.2195607 (DOI)000969090600001 ()37039077 (PubMedID)2-s2.0-85152457883 (Scopus ID)
Available from: 2023-04-27 Created: 2023-04-27 Last updated: 2024-01-08Bibliographically approved
Lippman, S. A., Pettifor, A., Dufour, M.-S. K., Kabudula, C. W., Twine, R., Peacock, D., . . . Kahn, K. (2022). A community mobilisation intervention to improve engagement in HIV testing, linkage to care, and retention in care in South Africa: a cluster-randomised controlled trial. The Lancet HIV, 9(9), e617-e626
Open this publication in new window or tab >>A community mobilisation intervention to improve engagement in HIV testing, linkage to care, and retention in care in South Africa: a cluster-randomised controlled trial
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2022 (English)In: The Lancet HIV, ISSN 2405-4704, E-ISSN 2352-3018, Vol. 9, no 9, p. e617-e626Article in journal (Refereed) Published
Abstract [en]

Background: Community mobilisation, engaging communities in a process to collectively enact change, could improve HIV testing and care engagement. In South Africa, current rates fall below those needed for epidemic control. We assessed whether community mobilisation increased HIV testing, linkage to care, and retention in care over time in intervention relative to control communities.

Methods: We conducted a cluster-randomised controlled trial in villages in the Agincourt sub-district of the rural Mpumalanga Province in South Africa. 15 villages were randomly assigned to either a community mobilisation intervention engaging residents to address social barriers to HIV testing and treatment (intervention arm) or to a control arm using balanced randomisation. Villages were eligible if they had been fully enumerated in 2014, had not been included in previous mobilisation activities, and included over 500 permanent adult residents aged 18–49 years. Primary outcomes included quarterly rates of HIV testing, linkage to care, and retention in care documented from health facility records among residents of the intervention and control communities over the 3-year study period. Intention-to-treat analyses employed generalised estimating equations stratified by sex. This trial is registered with ClinicalTrials.gov, NCT02197793.

Findings: Between Aug 1, 2015, and July 31, 2018, residents in eight intervention communities (n=20 544 residents) and seven control communities (n=17 848) contributed data; 92 residents contributed to both arms. Among men, HIV testing increased quarterly by 12·1% (relative change [RC] 1·121, 95% CI 1·099 to 1·143, p<0·0001) in the intervention communities and 9·5% (1·095, 1·075 to 1·114, p=0·011) in the control communities; although increases in testing were greater in the intervention villages, differences did not reach significance (exponentiated interaction coefficient 1·024, 95% CI 0·997 to 1·052, p=0·078). Among women, HIV testing increased quarterly by 10·6% (RC 1·106, 95% CI 1·097 to 1·114, p<0·0001) in the intervention communities and 9·3% (1·093, 1·084 to 1·102, p=0·053) in the control communities; increases were greater in intervention communities (exponentiated interaction coefficient 1·012, 95% CI 1·001 to 1·023, p=0·043). Quarterly linkage increased significantly among women in the intervention communities (RC 1·013, 95% CI 1·002 to 1·023, p=0·018) only. Quarterly linkage fell among men in both arms, but decreased significantly among men in the control communities (0·977, 0·954 to 1·002, p=0·043). Quarterly retention fell among women in both arms; however, reductions were tempered among women in the intervention communities (exponentiated interaction coefficient 1·003, 95% CI <1·000 to 1·006, p=0·062). Retention fell significantly among men in both arms with difference in rates of decline.

Interpretation: Community mobilisation was associated with modest improvements in select trial outcomes. The sum of these incremental, quarterly improvements achieved by addressing social barriers to HIV care engagement can impact epidemic control. However, achieving optimal impacts will probably require integrated efforts addressing both social barriers through community mobilisation and provision of improved service delivery. 

Place, publisher, year, edition, pages
Elsevier, 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-199390 (URN)10.1016/S2352-3018(22)00192-8 (DOI)000876364400011 ()36055294 (PubMedID)2-s2.0-85137090517 (Scopus ID)
Available from: 2022-09-29 Created: 2022-09-29 Last updated: 2023-09-05Bibliographically approved
Moffett, B. D., Pozuelo, J. R., van Heerden, A., O'Mahen, H. A., Craske, M., Sodi, T., . . . Stein, A. (2022). Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study): protocol for a pilot randomised controlled trial. BMJ Open, 12(12), Article ID e065977.
Open this publication in new window or tab >>Digital delivery of behavioural activation therapy to overcome depression and facilitate social and economic transitions of adolescents in South Africa (the DoBAt study): protocol for a pilot randomised controlled trial
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 12, article id e065977Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Scalable psychological treatments to address depression among adolescents are urgently needed. This is particularly relevant to low-income and middle-income countries where 90% of the world's adolescents live. While digital delivery of behavioural activation (BA) presents a promising solution, its feasibility, acceptability and effectiveness among adolescents in an African context remain to be shown.

METHODS AND ANALYSIS: This study is a two-arm single-blind individual-level randomised controlled pilot trial to assess the feasibility, acceptability and initial efficacy of digitally delivered BA therapy among adolescents with depression. The intervention has been coproduced with adolescents at the study site. The study is based in the rural northeast of South Africa in the Bushbuckridge subdistrict of Mpumalanga province. A total of 200 adolescents with symptoms of mild to moderately severe depression on the Patient Health Questionnaire Adolescent Version will be recruited (1:1 allocation ratio). The treatment group will receive BA therapy via a smartphone application (the Kuamsha app) supported by trained peer mentors. The control group will receive an enhanced standard of care. The feasibility and acceptability of the intervention will be evaluated using a mixed methods design, and signals of the initial efficacy of the intervention in reducing symptoms of depression will be determined on an intention-to-treat basis. Secondary objectives are to pilot a range of cognitive, mental health, risky behaviour and socioeconomic measures; and to collect descriptive data on the feasibility of trial procedures to inform the development of a further larger trial.

ETHICS AND DISSEMINATION: This study has been approved by the University of the Witwatersrand Human Research Ethics Committee (MED20-05-011) and the Oxford Tropical Research Ethics Committee (OxTREC 34-20). Study findings will be published in scientific open access peer-reviewed journals, presented at scientific conferences and communicated to participants, their caregivers, public sector officials and other relevant stakeholders.

TRIAL REGISTRATION NUMBERS: This trial was registered on 19 November 2020 with the South African National Clinical Trials Registry (DOH-27-112020-5741) and the Pan African Clinical Trials Registry (PACTR202206574814636).

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
Child & adolescent psychiatry, Depression & mood disorders, PUBLIC HEALTH
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-203351 (URN)10.1136/bmjopen-2022-065977 (DOI)000924514400015 ()36585150 (PubMedID)2-s2.0-85145425790 (Scopus ID)
Available from: 2023-01-18 Created: 2023-01-18 Last updated: 2023-09-05Bibliographically approved
Yu, S.-T., Houle, B., Manderson, L., Jennings, E. A., Tollman, S. M., Berkman, L. F. & Harling, G. (2022). The double-edged role of accessed status on health and well-being among middle- and older-age adults in rural South Africa: The HAALSI study. SSM - Population Health, 19, Article ID 101154.
Open this publication in new window or tab >>The double-edged role of accessed status on health and well-being among middle- and older-age adults in rural South Africa: The HAALSI study
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2022 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 19, article id 101154Article in journal (Refereed) Published
Abstract [en]

Background: Social capital theory conceptualizes accessed status (the socioeconomic status of social contacts) as interpersonal resources that generate positive health returns, while social cost theory suggests that accessed status can harm health due to the sociopsychological costs of generating and maintaining these relationships. Evidence for both hypotheses has been observed in higher-income countries, but not in more resource-constrained settings.

We therefore investigated whether the dual functions of accessed status on health may be patterned by its interaction with network structure and functions among an older population in rural South Africa.

Method: We used baseline survey data from the HAALSI study (“Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa”) among 4,379 adults aged 40 and older. We examined the direct effect of accessed status (measured as network members’ literacy), as well as its interaction with network size and instrumental support, on life satisfaction and self-rated health.

Results: In models without interactions, accessed status was positively associated with life satisfaction but not self-rated health. Higher accessed status was positively associated with both outcomes for those with fewer personal contacts. Interaction effects were further patterned by gender, being most health-protective for women with a smaller network and most health-damaging for men with a larger network.

Conclusions: Supporting social capital theory, we find that having higher accessed status is associated with better health and well-being for older adults in a setting with limited formal support resources. However, the explanatory power of both theories appears to depending on other key factors, such as gender and network size, highlighting the importance of contextualizing theories in practice.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Accessed status, Health, Social capital, Social cost, Social network, South Africa
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-198217 (URN)10.1016/j.ssmph.2022.101154 (DOI)000913320200002 ()2-s2.0-85133895623 (Scopus ID)
Funder
Wellcome trust, 058893/Z/99/A; 069683/Z/02/Z; 085477/B/08/Z
Available from: 2022-07-22 Created: 2022-07-22 Last updated: 2023-09-05Bibliographically approved
van der Merwe, M., D'Ambruoso, L., Witter, S., Twine, R., Mabetha, D., Hove, J., . . . Kahn, K. (2021). Collective reflections on the first cycle of a collaborative learning platform to strengthen rural primary healthcare in Mpumalanga, South Africa. Health Research Policy and Systems, 19(1), Article ID 66.
Open this publication in new window or tab >>Collective reflections on the first cycle of a collaborative learning platform to strengthen rural primary healthcare in Mpumalanga, South Africa
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2021 (English)In: Health Research Policy and Systems, ISSN 1478-4505, E-ISSN 1478-4505, Vol. 19, no 1, article id 66Article in journal (Refereed) Published
Abstract [en]

Background: Frontline managers and health service providers are constrained in many contexts from responding to community priorities due to organizational cultures focused on centrally defined outputs and targets. This paper presents an evaluation of the Verbal Autopsy with Participatory Action Research (VAPAR) programme—a collaborative learning platform embedded in the local health system in Mpumalanga, South Africa—for strengthening of rural primary healthcare (PHC) systems. The programme aims to address exclusion from access to health services by generating and acting on research evidence of practical, local relevance. Methods: Drawing on existing links in the provincial and national health systems and applying rapid, participatory evaluation techniques, we evaluated the first action-learning cycle of the VAPAR programme (2017–19). We collected data in three phases: (1) 10 individual interviews with programme stakeholders, including from government departments and parastatals, nongovernmental organizations and local communities; (2) an evaluative/exploratory workshop with provincial and district Department of Health managers; and (3) feedback and discussion of findings during an interactive workshop with national child health experts. Results: Individual programme stakeholders described early outcomes relating to effective research and stakeholder engagement, and organization and delivery of services, with potential further contributions to the establishment of an evidence base for local policy and planning, and improved health outcomes. These outcomes were verified with provincial managers. Provincial and national stakeholders identified the potential for VAPAR to support engagement between communities and health authorities for collective planning and implementation of services. Provincial stakeholders proposed that this could be achieved through a two-way integration, with VAPAR stakeholders participating in routine health planning and review activities and frontline health officials being involved in the VAPAR process. Findings were collated into a revised theory of change. Conclusions: The VAPAR learning platform was regarded as a feasible, acceptable and relevant approach to facilitate cooperative learning and community participation in health systems. The evaluation provides support for a collaborative learning platform within routine health system processes and contributes to the limited evaluative evidence base on embedded health systems research.

Place, publisher, year, edition, pages
BioMed Central, 2021
Keywords
Collaborative learning platform, Community participation, Embedded research, Primary healthcare, South Africa
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-182913 (URN)10.1186/s12961-021-00716-y (DOI)000641251900001 ()33874951 (PubMedID)2-s2.0-85104627793 (Scopus ID)
Available from: 2021-05-28 Created: 2021-05-28 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0744-7588

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