title: The perceptions and perspectives of patients and health care providers on chronic diseases management in rural South Africa: a qualitative study.
abstract: BACKGROUND
  Preventive health care represents the future for health care delivery in South Africa to improve management of chronic diseases as this has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. Individual person's health is unique, as they move in and out of chronic and acute health care phases, there is need to integrate chronic and acute care constructs to improve continuity of care and maximize health and improve wellbeing. The aim of this study was to determine the perceptions and perspectives of chronic patients' and nurses regarding chronic disease management in terms of barriers, facilitators and their experiences.
  
  
  METHODS
  To meet our aim we used qualitative methods involving the collection of information by means of focus group discussions in Dikgale Health and Demographic Surveillance System (HDSS). All data was recorded, transcribed verbatim and analysed using data-driven thematic analysis.
  
  
  RESULTS
  Our study showed that chronic disease patients have a first contact with health care professionals at the primary health care level in the study area. The main barriers mentioned by both the health care workers and chronic disease patients are lack of knowledge on chronic diseases, shortage of medication and shortage of nurses in the clinics which causes patients to wait for a long periods in a clinic. Health care workers are poorly trained on the management of chronic diseases. Lack of supervision by the district and provincial health managers together with poor dissemination of guidelines has been found to be a contributing factor to lack of knowledge in nurses among the clinics within the study area. Both patients and nurses mentioned the need to involve community health workers and traditional healers and integrate their services in order to early detect and manage chronic diseases in the community.
  
  
  CONCLUSIONS
  Nurses and chronic disease patients mentioned similar barriers to chronic disease management. Concerted action is needed to strengthen the delivery of medications at the clinics, improve the chronic disease knowledge for both nurses and patients by conducting in-service trainings or workshops, increase the involvement of community health workers and establish a link (through formal referral system) with traditional healers.
authors.affiliation: Department of Medical Sciences, Public Health and Health Promotion, University of Limpopo, Turfloop campus, Private Bag X1106, Sovenga, 0727, South Africa. ericmaimela@webmail.co.za.|International Health Unit, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium. ericmaimela@webmail.co.za.
authors.forename: Eric
authors.initials: E
authors.lastname: Maimela
authors.affiliation: International Health Unit, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium. jean-pierre.vangeertruyden@uantwerpen.be.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Van Geertruyden
authors.affiliation: Department of Medical Sciences, Public Health and Health Promotion, University of Limpopo, Turfloop campus, Private Bag X1106, Sovenga, 0727, South Africa. Marianne.Alberts@ul.ac.za.
authors.forename: Marianne
authors.initials: M
authors.lastname: Alberts
authors.affiliation: Department of Medical Sciences, Public Health and Health Promotion, University of Limpopo, Turfloop campus, Private Bag X1106, Sovenga, 0727, South Africa. perpetua.modjadji@ul.ac.za.
authors.forename: Sewela E P
authors.initials: SE
authors.lastname: Modjadji
authors.affiliation: Department of Sociology and Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Sint-Jacobstraat 2, BE-2000, Antwerpen, Belgium. herman.meulemans@uantwerpen.be.|Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa. herman.meulemans@uantwerpen.be.
authors.forename: Herman
authors.initials: H
authors.lastname: Meulemans
authors.affiliation: Research group Medical Sociology and Health Policy, University of Antwerp, Universiteitsplein 1, 2600, Wilrijk, Belgium. jessica.fraeyman@uantwerpen.be.
authors.forename: Jesicca
authors.initials: J
authors.lastname: Fraeyman
authors.affiliation: Department of Primary and Interdisciplinary care, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium. hilde.bastiaens@uantwerpen.be.
authors.forename: Hilde
authors.initials: H
authors.lastname: Bastiaens
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000451:nursing*; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology