Kganetso Sekome

Despite the known benefits of physical activity and diet modifications for hypertension control, adults in rural South African settings still have high levels of uncontrolled hypertension. This paper outlines an intervention that targets adjusting routine physical activity and diet practices for hypertension control in adults from rural South Africa (HYPHEN). The intervention involved a structured group education, individualised physical activity education, and individualised dietary education. We aimed to evaluate the feasibility, acceptability, and fidelity of HYPHEN for adults aged 40 years and older living with hypertension in rural South Africa. Feasibility was measured by assessing recruitment and retention rates. Acceptability was assessed through interviews after the intervention using pre-determined themes of perceived expectations, benefits, motivation, and barriers concerning the intervention. Fidelity was evaluated by intervention adherence, dosage, quality, and participant responsiveness. Participants were also asked to rate their overall satisfaction on a Likert scale out of 10. Our study demonstrated high level of feasibility, acceptability, and fidelity. Thirty participants were successfully recruited (100% of target), 28 (93%) participants were retained, and 28 (93%) provided complete data. Qualitative data demonstrated high acceptability, with participants reporting that the intervention met expectations, provided benefits, motivated continued engagement, and involved few barriers. Intervention fidelity was high with all three components carried out as planned, minor dosage adjustment, high delivery quality, and 100% participant engagement. The average rating on the Likert scale was 8.6/10 (SD = 2.55). HYPHEN is a feasible and acceptable intervention for hypertension control. Trial registration: Pan African Clinical Trial Registry (pactr.samrc.ac.za) PACTR202306662753321. Retrospectively registered on 29 June 2023.

Background: In South Africa, community health workers (CHWs) provide home-based care and health promotion for patients with chronic conditions like hypertension. However, their views on patients’ poor blood pressure control remain unclear. Understanding CHWs’ perspectives could inform future community-level strategies for improving blood pressure management. Objectives: To explore CHWs’ experiences about factors contributing to uncontrolled hypertension among adults living in a South African District. Methods: A qualitative exploratory design, based on 22 face-to-face, semi-structured interviews with CHW. Data was transcribed and analysed manually using thematic analysis. Findings: Four themes emerged: (1) adequate knowledge about blood pressure and hypertension. However, lack of comprehension about the physiological concept of blood pressure and hypertension, (2) interventions used for hypertension control were contextualized and very simple, (3) contextual barriers to hypertension control included financial, personal, systemic, medication as well as cultural and traditional factors, (4) strategies to improve hypertension control included improved team work, awareness creation, holistic healthcare, improved access to clinic facilities, system-related improvements and patient initiatives. Conclusion: Community health workers (CHWs) demonstrated sufficient knowledge of hypertension, highlighting the need to strengthen and standardize their training, supervision, and support. Their patient advice was practical and context-specific. To address barriers and stigma around hypertension, CHWs should lead awareness campaigns and engage in community-based exercise and support groups, with help from rehabilitation teams. Collaborating with local police and community leaders to address violence, alcohol, and crime, along with initiatives like community gardens, multidisciplinary teamwork, and more frequent home visits, could further improve hypertension control.

Background: Understanding the physical activity behaviours of adults at risk of poor health is important to inform targeted interventions. We profiled the frequency, intensity, duration and domain (work or non-work) of self-reported physical activities of rural South African adults living with hypertension. Objectives: The aim of this study was to provide a profile of the frequency, intensity, duration and domain of self-reported physical activities over a 7-day period in adults with hypertension from a rural sub-district in South Africa. Method: A total of 429 adults diagnosed with hypertension aged 40 years and above completed the International Physical Activity Questionnaire Long-Form via telephone interview. Data were summarised using means and standard deviations or medians and interquartile ranges. The Mann–Whitney U test and Krustal–Wallis rank test were used to assess physical activity differences by sex and work status. Statistical significance was set at p < 0.05. Results: The mean age of the participants was 65.1 (standard deviation [s.d.] ± 10.9 years), 58% were women and 52% had paid or unpaid work. Men reported greater (duration and frequency) vigorous physical activity at work compared to women (p = 0.003 and p = 0.002). Walking frequency as a mode of transport was higher for working men and women (p < 0.001). Women reported higher frequency of moderate-intensity physical activity inside the house (p < 0.001) and outside the house (p < 0.001) compared to men. Non-working men and women spent more time sitting during the week compared to their working counterparts (p = 0.009). Conclusion: The physical activity profile of hypertensive adults varied by sex and work status. Clinical implications: Contextual factors such as gender roles are also related to the physical activity profile of hypertensive adults living in rural South Africa and should be considered when designing specific interventions targeted at improving hypertension control for this population. Keywords: IPAQ; hypertension; high blood pressure; sedentary; exercise.

Introduction: Stroke is one of the global leading causes of disability, with a higher prevalence at a younger age in sub-Saharan Africa. Returning to functional status is a primary goal of rehabilitation for stroke survivors. However, the cost of intensive rehabilitation is often a barrier for the under-resourced in South Africa. Patient presentation: This article describes the individualised ‘return-to-function’ approach to rehabilitation and its outcomes for five stroke survivors delivered through a non-profit public–private partnership in a low-income community in South Africa. Management and outcome: A retrospective case series of stroke survivors who participated in the Bounce Back Journey (BBJ) programme between 2019 and 2021 was conducted. The beneficiaries’ ages ranged from 21 to 55 years; two were females and three were males. The goals and outcomes of five stroke survivors with impairments, functional limitations and participation restrictions admitted into the BBJ programme were evaluated through standardised outcome measures. All the beneficiaries required financial support and extensive rehabilitation to return to a functional life. All showed improved outcomes in functional independence and health-related quality of life at discharge. Depressive symptoms clinically deteriorated in one patient. At discharge, all participants faced challenges finding opportunities to return to work. Conclusion: The case series demonstrates how an alternative community-based rehabilitation programme has the potential to improve functionality, health-related quality of life and mental health. Contribution: A low-cost, community-based, intensive rehabilitation programme can improve functionality, but return to work and community re-integration opportunities remain limited. Keywords: stroke; goal setting; return to work; quality of life; participation; mental health.

Background: Over half of adults from rural South Africa are hypertensive. Apart from pharmaceutical treatment, lifestyle changes such as increasing physical activity and reducing dietary salt have been strongly advocated for the control of hypertension. However, the control rates of hypertension for adults in rural South Africa are low. In this paper we explore whether this is due to the recommended lifestyle intervention not aligning with the individual’s socio-cultural determinants of behaviour change. Aim: To explore the social and cultural beliefs, perceptions and practices regarding physical activity and diet as a hypertension control intervention on hypertensive adults living in a rural sub-district in South Africa. Methods: Nine focus group discussions were conducted with hypertensive adults aged 40 years and above from Bushbuckridge sub-district in Mpumalanga Province of South Africa using a semi-structured interview guide. Each session began with introductions of the discussion theme followed by a short discussion on what the participants know about hypertension and the normal blood pressure readings. Physical activity and dietary habits were then introduced as the main subject of discussion. Probing questions were used to get more insight on a specific topic. A thematic analysis approach was used to generate codes, categories, and themes. A manual approach to data analysis was chosen and data obtained through transcripts were analysed inductively. Findings: Participants had a lack of knowledge about blood pressure normal values. Perceived causes of hypertension were alluded to psychosocial factors such as family and emotional-related issues. Physical activity practices were influenced by family and community members’ attitudes and gender roles. Factors which influenced dietary practices mainly involved affordability and availability of food. To control their hypertension, participants recommend eating certain foods, emotional control, taking medication, exercising, praying, correct food preparation, and performing house chores. Conclusion: Lifestyle interventions to control hypertension for adults in a rural South African setting using physical activity promotion and dietary control must consider the beliefs related to hypertension control of this population.

Introduction: In rural and remote South Africa, most strokes and ischaemic heart diseases are as a consequence of hypertension, which is a modifiable risk factor. The widely recommended therapeutic approaches to control hypertension are through physical activity and diet modifications. However, there is a lack of culturally sensitive community-based, lifestyle interventions to control hypertension among rural African adult populations. We designed an intervention which recommends adjusting daily routine physical activity and dietary behaviour of adults with hypertension. This study aims to evaluate the feasibility and acceptability of HYPHEN in a rural community setting. Methods: We aim to recruit 30 adult participants with a self-report hypertension diagnosis. A one-arm, prospective design will be used to assess the feasibility and acceptability of recruitment, uptake, engagement, and completion of the 10-week intervention. Recruitment rates will be assessed at week 0. Intervention uptake, engagement, and adherence to the intervention will be assessed weekly via telephone. Blood pressure, body mass index, waist-hip ratio, urinary sodium, accelerometer-measured physical activity, and 24-h diet recall will be assessed at baseline and at 10 weeks. Qualitative semi-structured interviews will be conducted at 10 weeks to explore feasibility and acceptability. Discussion: This study offers a person-centred, sociocultural approach to hypertension control through adaptations to physical activity and dietary intake. This study will determine whether HYPHEN is feasible and acceptable and will inform changes to the protocol/focus that could be tested in a full trial. Trial registration number: PACTR202306662753321.

Introduction: In rural and remote South Africa, most strokes and ischaemic heart diseases are as a consequence of hypertension, which is a modifiable risk factor. The widely recommended therapeutic approaches to control hypertension are through physical activity and diet modifications. However, there is a lack of culturally sensitive community-based, lifestyle interventions to control hypertension among rural African adult populations. We designed an intervention which recommends adjusting daily routine physical activity and dietary behaviour of adults with hypertension. This study aims to evaluate the feasibility and acceptability of HYPHEN in a rural community setting. Methods: We aim to recruit 30 adult participants with a self-report hypertension diagnosis. A one-arm, prospective design will be used to assess the feasibility and acceptability of recruitment, uptake, engagement, and completion of the 10-week intervention. Recruitment rates will be assessed at week 0. Intervention uptake, engagement, and adherence to the intervention will be assessed weekly via telephone. Blood pressure, body mass index, waist-hip ratio, urinary sodium, accelerometer measured physical activity, and 24hour diet recall will be assessed at baseline and at 10-weeks. Qualitative semi-structured interviews will be conducted at 10 weeks to explore feasibility and acceptability. Discussion: This study offers a person-centred, sociocultural approach to hypertension control through adaptations to physical activity and dietary intake. This study will determine whether HYPHEN is feasible and acceptable and will inform changes to the protocol/focus that could be tested in a full trial. Trial registration number: PACTR202306662753321.

Background: Physiotherapy is a healthcare profession that enhances human functioning and prevents further disability. In addition to this physiotherapy promotes health, wellbeing and the prevention of diseases. In South Africa, physiotherapy and rehabilitation services are largely accessed by those living in urban communities and those with private medical funding. Rehabilitation is an essential component of the package of care yet these services do not reach disadvantaged communities who vitally need them. Through the equitable provision of service-learning, physiotherapy students can play a vital role in improving rehabilitation access to vulnerable communities.Aim: This paper illustrates how physiotherapy students studying at a South African university provide equitable services to disadvantaged rural and urban communities.Discussion: The first and second years of study focus on theoretical and classroom-based learning where students gain an understanding of basic principles of inclusion, equity, diversity, and self-awareness. In later years, students provide community-based services in urban and rural communities with a focus on increasing access to rehabilitation services. The clinical objectives which students are required to fulfil are guided by principles of public health and community rehabilitation. The Covid-19 pandemic highlighted the issue of poor access to rehabilitation services and the case study we provide demonstrates the roles physiotherapy students played to fill this gap. The authors offer a reflection from their involvement in physiotherapy student training and provide an example of a moment which displayed equity, diversity, and inclusion in their career.Conclusion: There is a huge gap to fill in the provision of equitable rehabilitation services for the South African population. Institutions responsible for the training of physiotherapists, or any rehabilitation profession, should realize their role in service delivery through a service-learning approach.

The journal is published for the purpose of advancing scholarship in disability studies and rehabilitation sciences in a uniquely African context. Widely read by scholars, professionals and students, it encourages scholarly exchange between all disciplines and academics from low, middle and high-income countries to work towards the improvement of human development and its practices across the continent.

Background: People living with knee osteoarthritis (OA) commonly present with difficulty in walking long distances, ascending and descending stairs or rising from sitting. These functional limitations have been shown to have a negative effect on their overall activities of daily living. Objectives: The aim of this study was to determine the effects of a 4-week hydrotherapy programme on measures of pain and self-perceived functional status in individuals living with knee OA. Method: A total of 18 participants with chronic knee OA participated in this study. Participants completed 4 weeks of hydrotherapeutic intervention provided by an independent physiotherapist. Outcome measures for the study included pain assessed using the visual analogue scale (VAS) and self-perceived functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcome measures were assessed at baseline and after the 4 weeks of intervention. Results: The 4-week hydrotherapy programme resulted in a significant decrease in pain and a significant improvement in self-perceived functional status in all participants. There was a statistically significant mean decrease in VAS scores of 3.72 (± 2.45), p ≤ 0.05, with a 95% confidence interval ranging from 2.506 to 4.938. There was also a statistically significant mean decrease in WOMAC scores of 29.5 (± 15.51), p ≤ 0.05. with a 95% confidence interval ranging from 21.788 to 37.212. Conclusion: This study demonstrated that a 4-week hydrotherapeutic exercise programme results in significantly reduced pain and improved self-perceived functional status in individuals living with knee OA. Clinical implications: Four weeks of hydrotherapy exercises twice a week in a heated pool can significantly decrease pain and improve functional status in individuals with knee OA.