The importance of social media users’ responses in tackling digital COVID-19 misinformation in Africa

Objective Digital technologies present both an opportunity and a threat for advancing public health. At a time of pandemic, social media has become a tool for the rapid spread of misinformation. Mitigating the impacts of misinformation is particularly acute across Africa, where WhatsApp and other forms of social media dominate, and where the dual threats of misinformation and COVID-19 threaten lives and livelihoods. Given the scale of the problem within Africa, we set out to understand (i) the potential harm that misinformation causes, (ii) the available evidence on how to mitigate that misinformation and (iii) how user responses to misinformation shape the potential for those mitigating strategies to reduce the risk of harm. Methods We undertook a multi-method study, combining a rapid review of the research evidence with a survey of WhatsApp users across Africa. Results We identified 87 studies for inclusion in our review and had 286 survey respondents from 17 African countries. Our findings show the considerable harms caused by public health misinformation in Africa and the lack of evidence for or against strategies to mitigate against such harms. Furthermore, they highlight how social media users’ responses to public health misinformation can mitigate and exacerbate potential harms. Understanding the ways in which social media users respond to misinformation sheds light on potential mitigation strategies. Conclusions Public health practitioners who utilise digital health approaches must not underestimate the importance of considering the role of social media in the circulation of misinformation, nor of the responses of social media users in shaping attempts to mitigate against the harms of such misinformation. </jats:sec

A Comparative Study of Selected Hospital-Based Health Professionals&rsquo; Perceptions of a Learning Organisation in Five South African Districts

Background/Objectives: The concept of learning organisations, which rely on research-based evidence and emphasise employees&rsquo; continuous learning and professional development, is essential for effectively managing change and enhancing the quality of services. To better understand the effects of implementing learning organisation principles in hospital settings, this study aimed to compare the perceptions of selected health professionals regarding learning organisations across five sub-districts in South Africa&rsquo;s Eastern Cape province. Methods: This study employed a quantitative, cross-sectional survey design to collect data from selected health professionals in 9 hospitals in Eastern Cape province. Results: Overall, the study showed wide variations in how different healthcare professionals perceived the commitment and communication of department leaders regarding the importance of learning. Key findings showed that 90.9% of dentists agreed that department leaders communicate the importance of learning. In comparison, 68.8% of allied health professionals and 56.5% of pharmacists agreed that department leaders communicated the importance of learning; 21.7% of pharmacists and 25% of allied health professionals disagreed. Conclusions: The study has highlighted significant disparities in the perceptions of selected hospital-based health professionals toward introducing a learning organisation in healthcare facilities. This divergence points to the need for tailored approaches in communicating and implementing LO strategies within hospital settings to ensure that all health professionals are equally engaged and that the benefits of continuous learning are fully realised across disciplines

Factors influencing the information behaviour of doctors and nurses in South Africa’s Eastern Cape, Mpumalanga, Limpopo and Northern Cape provinces: a survey study protocol

Introduction Information is a prerequisite for quality healthcare service. Health professionals play a key role in the health system as they jointly have the responsibility of looking after patients everyday. Failure to use evidence in medicine may lead to medical errors such as incorrect diagnosis and/or mismanagement. Health professionals with access to quality health information can improve health services. This study focuses on the information behaviour of doctors and nurses whose role involves direct patient care.Methods and analysis This study will employ a quantitative approach using a cross-sectional survey design. Simple random sampling will be used to identify the provinces and hospitals. Stratified random sampling will be used to select doctors and nurses to whom a validated questionnaire will be administered. The study will use a structured self-administered questionnaire. Data collection will be carried out at Nelson Mandela Academic Hospital, Witbank Hospital, Pietersburg Hospital and Robert Mangaliso Hospital, respectively. Questionnaires are distributed to health professionals in one of two ways. First, by emailing an editable Microsoft word document (questionnaire) to the health professionals to complete and send back. Second, by sharing with the health professionals through WhatsApp or email, an online version of the questionnaire that has been created on Google Forms. Data collection process is scheduled to commence on 14 March 2022 and is expected to end on the 15 September 2022.Ethics and dissemination Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee (reference: M211013) and Walter Sisulu University Human Research Ethics and Biosafety Committee (reference: 099/2021). Permission to access the health facilities was approved by the Provincial Health Research Committees of the Eastern Cape, Limpopo, Mpumalanga and Northern Cape. Finally, results will be shared with all key stakeholders, including hospital management, clinical staff, through public presentation and direct engagements with stakeholders

Protocol for exploring the use of hospitals as a learning organisation: a cross-sectional study in South Africa’s Eastern Cape province

IntroductionIn today’s highly competitive environment, where changes happen at a rapid pace, organisations that stand a chance to survive are those that are proactive and easily adapt to changes. Hospitals are faced with various challenges including scrutiny from stakeholders. This study seeks to investigate learning strategies used by hospitals in one of South Africa’s provinces to achieve the principle of a learning organisation.Methods and analysisThis study will employ a quantitative approach using a cross-sectional survey on health professionals of a South African province. Stratified random sampling will be used to select hospitals and participants in three phases. The study will use a structured self-administered questionnaire, designed to collect data on learning strategies used by hospitals to achieve the principle of a learning organisation between June and December 2022. Descriptive statistics (mean, median, percentages, frequency, etc) will then be used to describe the raw data and allow the discovery of patterns. Inferential statistics will also be used to make inferences and predictions about the learning habits of health professionals in the selected hospitals.Ethics and disseminationThe approval to access the research sites with reference number: EC_202108_011 has been granted by the Provincial Health Research Committees of the Eastern Cape Department. Ethical clearance with Protocol Ref no: M211004 has been approved at the Human Research Ethics Committee of the Faculty of Health Sciences at the University of Witwatersrand. Finally, results will be shared with all key stakeholders, including hospital management, clinical staff, through public presentation and direct engagements with stakeholders. The findings may guide hospital leaders and other relevant stakeholders to develop guidelines and policies on creating a learning organisation that contributes to the improvement of quality patient care.</jats:sec

Protocol for exploring the use of hospitals as a learning organisation: a cross-sectional study in South Africa’s Eastern Cape province

Introduction In today’s highly competitive environment, where changes happen at a rapid pace, organisations that stand a chance to survive are those that are proactive and easily adapt to changes. Hospitals are faced with various challenges including scrutiny from stakeholders. This study seeks to investigate learning strategies used by hospitals in one of South Africa’s provinces to achieve the principle of a learning organisation.Methods and analysis This study will employ a quantitative approach using a cross-sectional survey on health professionals of a South African province. Stratified random sampling will be used to select hospitals and participants in three phases. The study will use a structured self-administered questionnaire, designed to collect data on learning strategies used by hospitals to achieve the principle of a learning organisation between June and December 2022. Descriptive statistics (mean, median, percentages, frequency, etc) will then be used to describe the raw data and allow the discovery of patterns. Inferential statistics will also be used to make inferences and predictions about the learning habits of health professionals in the selected hospitals.Ethics and dissemination The approval to access the research sites with reference number: EC_202108_011 has been granted by the Provincial Health Research Committees of the Eastern Cape Department. Ethical clearance with Protocol Ref no: M211004 has been approved at the Human Research Ethics Committee of the Faculty of Health Sciences at the University of Witwatersrand. Finally, results will be shared with all key stakeholders, including hospital management, clinical staff, through public presentation and direct engagements with stakeholders. The findings may guide hospital leaders and other relevant stakeholders to develop guidelines and policies on creating a learning organisation that contributes to the improvement of quality patient care

Exploring the Information Sources Consulted by Doctors at the Point of Care in Four Selected South African Referral Hospitals

Background: To provide an understanding of the clinical information sources consulted by teaching or referral hospital-based doctors in four South African provinces. Methods: A quantitative cross-sectional survey design was used. To identify provinces, hospitals, and participants, simple random sampling was adopted. This study targeted a total of 276 doctors from all the four hospitals working across different departments within the hospitals. This study was conducted in four selected South African public referral/teaching hospitals in four different provinces, namely Nelson Mandela Academic Hospital in the Eastern Cape province; Witbank Hospital in Mpumalanga province; Robert Mangaliso Sobukwe Hospital in Northern Cape province and lastly, Pietersburg Hospital in Limpopo province. Results: Overall, 221 doctors were surveyed. Doctors relied more on colleagues as formal and informal sources of information. They seldomly relied on newspapers, reference, and library books, or used hospital computers to access the internet. They seldomly attended training workshops organised by the district or provincial office. Protocols and clinical guidelines which are kept in the hospitals and easily accessible were often (27.9%) or always (51.1%) used. Conclusions: Teaching hospitals need to strengthen information resources to ensure that even when colleagues are used as an information source, they are an accessible means to validate the correctness of the information provided

Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial

SummaryBackgroundRobust evidence of the effectiveness of task shifting of antiretroviral therapy (ART) from doctors to other health workers is scarce. We aimed to assess the effects on mortality, viral suppression, and other health outcomes and quality indicators of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) programme, which provides educational outreach training of nurses to initiate and represcribe ART, and to decentralise care.MethodsWe undertook a pragmatic, parallel, cluster-randomised trial in South Africa between Jan 28, 2008, and June 30, 2010. We randomly assigned 31 primary-care ART clinics to implement the STRETCH programme (intervention group) or to continue with standard care (control group). The ratio of randomisation depended on how many clinics were in each of nine strata. Two cohorts were enrolled: eligible patients in cohort 1 were adults (aged ≥16 years) with CD4 counts of 350 cells per μL or less who were not receiving ART; those in cohort 2 were adults who had already received ART for at least 6 months and were being treated at enrolment. The primary outcome in cohort 1 was time to death (superiority analysis). The primary outcome in cohort 2 was the proportion with undetectable viral loads (<400 copies per mL) 12 months after enrolment (equivalence analysis, prespecified difference <6%). Patients and clinicians could not be masked to group assignment. The interim analysis was blind, but data analysts were not masked after the database was locked for final analysis. Analyses were done by intention to treat. This trial is registered, number ISRCTN46836853.Findings5390 patients in cohort 1 and 3029 in cohort 2 were in the intervention group, and 3862 in cohort 1 and 3202 in cohort 2 were in the control group. Median follow-up was 16·3 months (IQR 12·2–18·0) in cohort 1 and 18·0 months (18·0–18·0) in cohort 2. In cohort 1, 997 (20%) of 4943 patients analysed in the intervention group and 747 (19%) of 3862 in the control group with known vital status at the end of the trial had died. Time to death did not differ (hazard ratio [HR] 0·94, 95% CI 0·76–1·15). In a preplanned subgroup analysis of patients with baseline CD4 counts of 201–350 cells per μL, mortality was slightly lower in the intervention group than in the control group (0·73, 0·54–1.00; p=0·052), but it did not differ between groups in patients with baseline CD4 of 200 cells per μL or less (0·94, 0·76–1·15; p=0·577). In cohort 2, viral load suppression 12 months after enrolment was equivalent in intervention (2156 [71%] of 3029 patients) and control groups (2230 [70%] of 3202; risk difference 1·1%, 95% CI −2·4 to 4·6).InterpretationExpansion of primary-care nurses' roles to include ART initiation and represcription can be done safely, and improve health outcomes and quality of care, but might not reduce time to ART or mortality.FundingUK Medical Research Council, Development Cooperation Ireland, and Canadian International Development Agency