BACKGROUND: People who identity as lesbian, gay, bisexual and transgender (LGBT) have specific health needs. Sexual orientation and gender identity are social determinants of health, as homophobia and heteronormativity persist as prejudices in society. LGBT patients often experience discrimination and prejudice in health care settings. While recent South African policies recognise the need for providing LGBT specific health care, no curricula for teaching about LGBT health related issues exist in South African health sciences faculties. This study aimed to determine the extent to which LGBT health related content is taught in the University of Cape Town's medical curriculum. METHODS: A curriculum mapping exercise was conducted through an online survey of all academic staff at the UCT health sciences faculty, determining LGBT health related content, pedagogical methodology and assessment. RESULTS: 127 academics, across 31 divisions and research units in the Faculty of Health Sciences, responded to the survey, of which 93 completed the questionnaire. Ten taught some content related to LGBT health in the MBChB curriculum. No LGBT health related content was taught in the allied health sciences curricula. The MBChB curriculum provided no opportunity for students to challenge their own attitudes towards LGBT patients, and key LGBT health topics such as safer sex, mental health, substance abuse and adolescent health were not addressed. CONCLUSION: At present, UCTs health sciences curricula do not adequately address LGBT specific health issues. Where LGBT health related content is taught in the MBChB curriculum, it is largely discretionary, unsystematic and not incorporated into the overarching structure. Coordinated initiatives to integrate LGBT health related content into all health sciences curricula should be supported, and follow an approach that challenges students to develop professional attitudes and behaviour concerning care for patients from LGBT backgrounds, as well as providing them with specific LGBT health knowledge. Educating health professions students on the health needs of LGBT people is essential to improving this population's health by providing competent and non-judgmental care.
BACKGROUND: Over the last decade, developments in e-Learning and technologies are creating the groundwork for health sciences and medical education. Literature demonstrates that we have yet to reach any form of consensus about which indicators are needed to assess and teach quality health sciences and medical education through technology or innovation. There is, therefore, a greater need for a tool or platform that is properly constructed, validated and tested within health sciences. METHODS: This paper presents a study, which is part of a larger research project assessing staff and students' perceptions of the importance and relevance of different aspects of e-Learning and mHealth in health sciences curricula at four universities in South Africa. The specific objectives of this study were to: (i) assess health sciences staffs' perceptions and understanding of these two applications; and (ii) establish challenges and opportunities of e-Learning and mHealth applications in the health sector, as well as perceptions on the importance and relevance of these applications to their curricula and future practices. A combination of Focus Group Discussions (FGDs) and a key-informant interview was used. A total of 19 staff from four universities participated. Atlast.ti was used for the data analysis and the findings were coded using a primarily deductive thematic coding framework. RESULTS: The findings revealed that not all staff members are equipped or trained with new applications or technologies, such as mHealth. Most participants believed that diverse technologies and tools could be integrated with mHealth and e-Learning. Furthermore, participants agree that a new multi-modal platform, in the form of a learning management system (LMS) with relevant applications (and possible plugins) integrated, tailored towards health sciences will benefit all stakeholders, and be valuable to higher education and health sectors. CONCLUSIONS: Digitalisation as well as digital citizenship is gradually being integrated into teaching and learning. It is imperative to adapt the health sciences curricula through constructive alignments and promote health sciences education in the current 4IR. This would allow graduates to be better prepared for digitalised practice environments.
The professional training and development of healthcare professionals in the area of telehealth is important to ensure the sustainability of this service delivery model. Tertiary institutions are among the key constituents involved in telehealth education, training and development. Academics within the healthcare sciences should therefore have the necessary experience and knowledge in this area to support the education and training of students. The objectives of this study were to determine the perspectives, experiences and attitudes of South African academics within various disciplines of health sciences regarding telehealth, as well as their views on suitable content areas for a telehealth module. A descriptive survey design was implemented. Sixty-six fulltime employed academic staff from five universities participated. The majority of participants were familiar with the terms telehealth/electronic health (eHealth), while 59% were unfamiliar with terms such as synchronous and asynchronous services. Eighty percent of respondents felt it necessary to include telehealth in the curriculum. The majority (89%) did not conduct research in telehealth. Seventy-one percent felt positive that telehealth could benefit the profession, and 30% stated that lack of standards creates a negative attitude toward the area and its sustainability. The majority of participants (77%) felt that their final-year students knew very little about telehealth upon exiting their study programme. Almost half (45%) of the participants felt that ethical issues were the most important aspect that needed to be included in a telehealth module, while data management was ranked as being least important (49%). The correlation between the perspectives on ethical issues and limitations to telehealth was statistically significant ( p =0.007), implying that participants saw lack of ethical considerations as a limitation to the uptake of telehealth practice. While attitudes regarding telehealth were positive, concerns were raised around the lack of standards and guidelines. Opportunities for professional development in telehealth need to be created through continued professional development (CPD) workshops and training. This in turn may provide more skilled faculty to teach in this area, allowing students to receive better instruction on telehealth service delivery models.
Background: Suicidal ideation is an important mental health concern amongst university students who are exposed to multiple stressors. Furthermore, those studying towards degrees in the field of Health Sciences are exposed to additional and unique stressors. This quantitative cross-sectional study aimed to define the prevalence of suicidal ideation and its determinants amongst undergraduate students within the Faculty of Health Sciences at a large, urban South African University. Materials and methods: An online questionnaire was administered to the 4089 students registered in the Faculty of Health Sciences, with 1211 students submitting responses between March and April 2020. The distribution of this survey coincided with the onset of the national lockdown due to the Covid-19 pandemic. The survey was comprised of validated tools measuring depression (with an included indicator of suicidal ideation), anxiety and resilience. Data analysis was completed using the STATA statistical software (version 14). Both a bivariate analysis and a multivariate logistic regression adjusted for gender were performed. Results: The total prevalence of suicidal ideation adjusted for gender and race in this sample was found to be 21.8% (CI: 18.6-25.3; p<0.001). Females had significantly higher suicidal ideation than males (24.1% versus 17.8%; p=0.011). In the multivariate model adjusted for gender, having depressive (aOR 10.8; CI: 7.9-14.8; p<0.001) or anxiety (aOR 5.1: CI: 3.8-6.8; P<0.001) symptoms, only sometimes (aOR 2.7: CI 1.8-4.0; p<0.001) or never (aOR 2.7; CI: 1.8-4.0; p<0.001) having anyone to talk to and being of colored race (aOR 2.0; CI: 1.1-3.4; p=0.019) were significantly associated with suicidal ideation, whilst higher resilience (aOR 0.3; CI: 0.3-0.4; p<0.001) was associated with lower levels of suicidal ideation. Conclusion: The prevalence of suicidal ideation found in this study was higher than that found in the general South African adult population and highlights the need to further investigate and address student mental health, especially students in the field of Health Sciences. Interventions aimed at mitigating the determinants, including depression and anxiety, and promoting the development of protective factors such as resilience and social support may lead to a reduction in suicidal ideation in this population group. Institutional initiatives aimed at improving access to and the quality of mental health services offered to students should be widely advocated for and implemented.
Abstract The global COVID-19 pandemic has added considerable complexity to the education and training of health care professionals as well as patient care. Literature suggests that e-Learning and mobile health (mHealth) technologies have great potential, but research studies are sparse, especially in low- to middle-income countries. The paper presents South African health science students’ perceptions of the importance, relevance, constraints and future possibilities of e-Learning and mHealth. Students from five universities participated in a modified Delphi. The first phase of student focus groups and interviews (n = 5), established baseline experiences and perceptions of e-Learning and mHealth during and post-COVID-19. These findings informed the design of an online survey (n = 155) for the second phase of the study. The majority of students were familiar with e-Learning, less so with mHealth; however most believed both to be a beneficial complement to theoretical and clinical teaching. Reasons for an integrated Learning Management System (LMS), also known as virtual learning environments, include increased flexibility, access and enhanced learning; and issues of anxiety, reduced interactivity, an absence of context and a lack of discipline- or profession-specific features as reasons against. The perceived importance of particular features of e-Learning and mHealth tools were highlighted. These findings will contribute to the redesign of online work-integrated curricula and the development of an inclusive, student-centred, health sciences-specific integrated and multi-modal LMS directed towards student-centred learning while addressing concerns around the digital divide and social justice.
BACKGROUND: The complicity of the South African health sector in apartheid and the international relevance of human rights as a professional obligation prompted moves to include human rights competencies in the curricula of health professionals in South Africa. A Train-the-Trainers course in Health and Human Rights was established in 1998 to equip faculty members from health sciences institutions nationwide with the necessary skills, attitudes and knowledge to teach human rights to their students. This study followed up participants to determine the extent of curriculum implementation, support needed as well as barriers encountered in integrating human rights into health sciences teaching and learning. METHODS: A survey including both quantitative and qualitative components was distributed in 2007 to past course participants from 1998-2006 via telephone, fax and electronic communication. RESULTS: Out of 162 past participants, 46 (28%) completed the survey, the majority of whom were still employed in academic settings (67%). Twenty-two respondents (48%) implemented a total of 33 formal human rights courses into the curricula at their institutions. Respondents were nine times more likely (relative risk 9.26; 95% CI 5.14-16.66) to implement human rights education after completing the training. Seventy-two extracurricular activities were offered by 21 respondents, many of whom had successfully implemented formal curricula. Enabling factors for implementation included: prior teaching experience in human rights, general institutional support and the presence of allies - most commonly coworkers as well as deans. Frequently cited barriers to implementation included: budget restrictions, time constraints and perceived apathy of colleagues or students. Overall, respondents noted personal enrichment and optimism in teaching human rights. CONCLUSION: This Train-the-Trainer course provides the historical context, educational tools, and collective motivation to incorporate human rights educational initiatives at health sciences institutions. Increased implementation of human rights instruction, both formally and extracurricularly, has demonstrated the training's significance not only within academic institutions but more broadly across the health sector. Coworkers are vital allies in teaching human rights to health sciences students, helping to alleviate institutional barriers. Training fellow staff members and those in key leadership roles is noted as vital to the sustainability of human rights education.
Introduction The South African health system has disturbing inequalities, namely few black doctors, a wide divide between urban and rural sectors, and also between private and public services. Most medical training programs in the country consider only applicants with higher-grade preparation in mathematics and physical science, while most secondary schools in black communities have limited capacity to teach these subjects and offer them at standard grade level. The Faculty of Health Sciences at Walter Sisulu University (WSU) was established in 1985 to help address these inequities and to produce physicians capable of providing quality health care in rural South African communities. Intervention Access to the physician training program was broadened by admitting students who obtained at least Grade C (60%) in mathematics and physical science at standard grade, and who demonstrated appropriate personal attributes. An innovative curriculum, combining problem-based learning with community-based education (PBL/CBE) in small tutorial group settings, was also adopted. This approach was aimed at educating and graduating a broader cohort of students, while training future doctors to identify, analyze, and treat health problems in the rural South African context. Outcomes To date, 745 doctors (72% black Africans) have graduated from the program, and 511 students (83% black Africans) are currently enrolled. After the PBL/CBE curriculum was adopted, the attrition rate for black students dropped from 23% to <10%. The progression rate rose from 67% to >80%, and the proportion of students graduating within the minimum period rose from 55% to >70%. Many graduates are still completing internships or post-graduate training, but preliminary research shows that 36% percent of graduates practice in small towns and rural settings. Further research is underway to evaluate the impact of their training on health services in rural Eastern Cape Province and elsewhere in South Africa. Conclusions The WSU program increased access to medical education for black students who lacked opportunities to take advanced math and science courses prior to enrolling in medical school. Innovative admission requirements and adoption of a PBL/CBE curriculum have made the WSU program one of the top training programs for black African doctors in South Africa.
Older African Americans' participation in health-related research is severely limited; they are not involved in sufficient numbers to ensure the applicability of advancements in medical and behavioral health. This research participation gap exacerbates older African Americans' vulnerability to poor health outcomes and disparities. The Michigan Center for Urban African American Aging Research employs a progressive community-based participatory model that utilizes a structured community advisory board (CAB) of African American older adults in metro Detroit, Michigan to oversee the research recruitment and retention of fellow minority older adult research participants. CAB members develop and support community health programming that provides free resources to older adults and also serves as fertile ground for recruiting participants in a volunteer research registry. CAB members are also provided ongoing training on social and behavioral health research and are supported in acting as a consultancy to outside researchers where they can be compensated for their expertise and engagement. This community-engaged model of sustaining a CAB of African American older adults offers key lessons learned on building relationships and trust, valuing and leveraging community members' expertise and time, sharing decision-making, and fostering genuine community all while promoting research recruitment and retention among underserved populations.
BACKGROUND: Rural areas in all countries suffer from a shortage of health care professionals. In South Africa, the shortage is particularly marked; some rural areas have a doctor-to-population ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages, as the students are more likely to work in rural areas after graduating. OBJECTIVE: To determine the proportion of rural-origin students at all medical schools in South Africa. DESIGN: A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine, dentistry, physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city, town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3%). RESULTS: . Of the 7 358 students, 4 341 (59%) were from cities, 1 107 (15%) from towns and 1 910 (26%) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine--27.4%, physiotherapy--22.4%, occupational therapy--26.7%, and dentistry--24.8%. CONCLUSION: The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas.
Digital health interventions, particularly electronic referrals (e-referrals) and health information systems, have revolutionised clinical workflows in public hospitals by automating processes. However, the utilization of e-referrals has yielded mixed outcomes, with varying levels of success in organisational processes.This paper explores improvisation of health information systems in Southern African public hospitals from a socio-technical perspective. In particular the paper explains the design-reality gaps giving rise to improvisations of mandated health information systems in order to understand their occurrence and impact on referral outcomes. We employed the design-reality framework and the Process framework for Healthcare Information System Workarounds and Impacts to explain the socio-technical issues related to the phenomenon of interest.We conducted semi-interviews with 31 respondents from health organisations as case studies.Respondents from two public hospitals in South Africa and two in Namibia were interviewed to examine how they devised improvisations to various health information systems in each setting.The findings showed that using WhatsApp or improvising existing
Global rates of mental health concerns are rising, and there is increasing realization that existing models of mental health care will not adequately expand to meet the demand. With the emergence of large language models (LLMs) has come great optimism regarding their promise to create novel, large-scale solutions to support mental health. Despite their nascence, LLMs have already been applied to mental health related tasks. In this paper, we summarize the extant literature on efforts to use LLMs to provide mental health education, assessment, and intervention and highlight key opportunities for positive impact in each area. We then highlight risks associated with LLMs' application to mental health and encourage the adoption of strategies to mitigate these risks. The urgent need for mental health support must be balanced with responsible development, testing, and deployment of mental health LLMs. It is especially critical to ensure that mental health LLMs are fine-tuned for mental health, enhance mental health equity, and adhere to ethical standards and that people, including those with lived experience with mental health concerns, are involved in all stages from development through
The uptake of machine learning (ML) approaches in the social and health sciences has been rather slow, and research using ML for social and health research questions remains fragmented. This may be due to the separate development of research in the computational/data versus social and health sciences as well as a lack of accessible overviews and adequate training in ML techniques for non data science researchers. This paper provides a meta-mapping of research questions in the social and health sciences to appropriate ML approaches, by incorporating the necessary requirements to statistical analysis in these disciplines. We map the established classification into description, prediction, and causal inference to common research goals, such as estimating prevalence of adverse health or social outcomes, predicting the risk of an event, and identifying risk factors or causes of adverse outcomes. This meta-mapping aims at overcoming disciplinary barriers and starting a fluid dialogue between researchers from the social and health sciences and methodologically trained researchers. Such mapping may also help to fully exploit the benefits of ML while considering domain-specific aspects rele
Mobile health has the potential to revolutionize health care delivery and patient engagement. In this work, we discuss how integrating Artificial Intelligence into digital health applications-focused on supply chain, patient management, and capacity building, among other use cases-can improve the health system and public health performance. We present an Artificial Intelligence and Reinforcement Learning platform that allows the delivery of adaptive interventions whose impact can be optimized through experimentation and real-time monitoring. The system can integrate multiple data sources and digital health applications. The flexibility of this platform to connect to various mobile health applications and digital devices and send personalized recommendations based on past data and predictions can significantly improve the impact of digital tools on health system outcomes. The potential for resource-poor settings, where the impact of this approach on health outcomes could be more decisive, is discussed specifically. This framework is, however, similarly applicable to improving efficiency in health systems where scarcity is not an issue.
The COVID-19 pandemic has profoundly impacted the world, having taken the lives of over 6 million individuals. Accordingly, this pandemic has caused a shift in conversations surrounding the burden of diseases worldwide, welcoming insights from multidisciplinary fields including digital health and artificial intelligence. Africa faces a heavy disease burden that exacerbates the current COVID-19 pandemic and limits the scope of public health preparedness, response, containment, and case management. Herein, we examined the potential impact of transformative digital health technologies in mitigating the global health crisis with reference to African countries. Furthermore, we proposed recommendations for scaling up digital health technologies and artificial intelligence-based platforms to tackle the transmission of the SARS-CoV-2 and enable equitable vaccine access. Challenges related to the pandemic are numerous. Rapid response and management strategies - that is, contract tracing, case surveillance, diagnostic testing intensity, and most recently vaccine distribution mapping - can overwhelm the health care delivery system that is fragile. Although challenges are vast, digital health
This paper discusses and explores the potential and relevance of recent developments in artificial intelligence (AI) and digital twins for health and well-being in low-resource African countries. We use the case of public health emergency response to disease outbreaks and epidemic control. There is potential to take advantage of the increasing availability of data and digitization to develop advanced AI methods for analysis and prediction. Using an AI systems perspective, we review emerging trends in AI systems and digital twins and propose an initial augmented AI system architecture to illustrate how an AI system can work with a 3D digital twin to address public health goals. We highlight scientific knowledge discovery, continual learning, pragmatic interoperability, and interactive explanation and decision-making as essential research challenges for AI systems and digital twins.
In this work, we present AfriNLLB, a series of lightweight models for efficient translation from and into African languages. AfriNLLB supports 15 language pairs (30 translation directions), including Swahili, Hausa, Yoruba, Amharic, Somali, Zulu, Lingala, Afrikaans, Wolof, and Egyptian Arabic, as well as other African Union official languages such as Arabic (MSA), French, Portuguese, and Spanish. Our training data covers bidirectional translation between English and 13 languages, and between French and two languages (Lingala and Wolof). AfriNLLB models are based on NLLB-200 600M, which we compress using iterative layer pruning and quantization. We fine-tune the pruned models on parallel corpora we curated for African languages, employing knowledge distillation from a larger teacher model. Our work aims at enabling efficient deployment of translation models for African languages in resource-constrained settings. Our evaluation results demonstrate that AfriNLLB models achieve performance comparable to the baseline while being significantly faster. We release two versions of the AfriNLLB models, a Transformers version that allows further fine-tuning and a CTranslate2 version for effic
Electronic Health Record (EHR) has become an essential tool in the healthcare ecosystem, providing authorized clinicians with patients' health-related information for better treatment. While most developed countries are taking advantage of EHRs to improve their healthcare system, it remains challenging in developing countries to support clinical decision-making and public health using a computerized patient healthcare information system. This paper proposes a novel EHR architecture suitable for developing countries--an architecture that fosters inclusion and provides solutions tailored to all social classes and socioeconomic statuses. Our architecture foresees an internet-free (offline) solution to allow medical transactions between healthcare organizations, and the storage of EHRs in geographically underserved and rural areas. Moreover, we discuss how artificial intelligence can leverage anonymous health-related information to enable better public health policy and surveillance.
Selecting the right monitoring level in Remote Patient Monitoring (RPM) systems for e-healthcare is crucial for balancing patient outcomes, various resources, and patient's quality of life. A prior work has used one-dimensional health representations, but patient health is inherently multidimensional and typically consists of many measurable physiological factors. In this paper, we introduce a multidimensional health state model within the RPM framework and use dynamic programming to study optimal monitoring strategies. Our analysis reveals that the optimal control is characterized by switching curves (for two-dimensional health states) or switching hyper-surfaces (in general): patients switch to intensive monitoring when health measurements cross a specific multidimensional surface. We further study how the optimal switching curve varies for different medical conditions and model parameters. This finding of the optimal control structure provides actionable insights for clinicians and aids in resource planning. The tunable modeling framework enhances the applicability and effectiveness of RPM services across various medical conditions.
The rapid spread of health misinformation on online social networks (OSNs) during global crises such as the COVID-19 pandemic poses challenges to public health, social stability, and institutional trust. Centrality metrics have long been pivotal in understanding the dynamics of information flow, particularly in the context of health misinformation. However, the increasing complexity and dynamism of online networks, especially during crises, highlight the limitations of these traditional approaches. This study introduces and compares three novel centrality metrics: dynamic influence centrality (DIC), health misinformation vulnerability centrality (MVC), and propagation centrality (PC). These metrics incorporate temporal dynamics, susceptibility, and multilayered network interactions. Using the FibVID dataset, we compared traditional and novel metrics to identify influential nodes, propagation pathways, and misinformation influencers. Traditional metrics identified 29 influential nodes, while the new metrics uncovered 24 unique nodes, resulting in 42 combined nodes, an increase of 44.83%. Baseline interventions reduced health misinformation by 50%, while incorporating the new metrics
This research paper presents a meta-analysis of the multifaceted role of technology in mental health. The pervasive influence of technology on daily lives necessitates a deep understanding of its impact on mental health services. This study synthesizes literature covering Behavioral Intervention Technologies (BITs), digital mental health interventions during COVID-19, young men's attitudes toward mental health technologies, technology-based interventions for university students, and the applicability of mobile health technologies for individuals with serious mental illnesses. BITs are recognized for their potential to provide evidence-based interventions for mental health conditions, especially anxiety disorders. The COVID-19 pandemic acted as a catalyst for the adoption of digital mental health services, underscoring their crucial role in providing accessible and quality care; however, their efficacy needs to be reinforced by workforce training, high-quality evidence, and digital equity. A nuanced understanding of young men's attitudes toward mental health is imperative for devising effective online services. Technology-based interventions for university students are promising, al