Development of guidelines for the primary health care services to support widows in Tshwane Gauteng Province South Africa

Abstract

Widowhood is a stressful life event demanding practical support such as giving assistance and encouragement on physical, psychological, social and spiritual levels. The intent of this study was to explore and describe the experiences widows have of primary health care services. The usefulness of this study lies in primary health care nurses gaining understanding of the health support needs of widows. The findings of this study enabled the researcher to develop guidelines for primary health care nurses to support widows in Tshwane, Gauteng Province. The study was conducted in two phases–Phase 1 and Phase 2. In Phase 1 of the study, a qualitative, descriptive phenomenological approach grounded in Husserl’s philosophy (1859-1938) was followed to explore the experiences of widows in terms of primary health care services delivered to them. The study enabled the health support needs of widows to be identified. The study population for Phase 1 was made up of widows residing in Tshwane Metropolitan Municipality. Participants were purposively selected. They were 12 widows aged between 25-65 years. Data were collected by means of unstructured individual phenomenological interviews aimed at describing the essence of the widow’s experiences. The phenomenological reductions and reflexivity were applied during data collection and data analysis. The descriptive phenomenological method of data analysis was used, as it is in line with the reflective life-world research. The essence of the widow’s experiences, as well as the constituents related to widowhood, support needs and health support required by widows from the primary healthcare services were deduced from the transcribed interviews. The essence of the experiences identified was verified by means of a literature synthesis. The findings were presented and summarised in tables and the illustrative quotations from participant’s concrete descriptions of the research phenomenon. The essence of the experience was described under the eight constituents that emerged from the data analysis: widowhood as an embodied experience; widowhood as an intense emotional experience; cognitive impact related to the effects of widowhood; widowhood experienced on an existential level; widowhood as a socially disruptive experience; widow’s need to feel in control; widow’s need to accept what happened and the widow’s need to resume a meaningful or normal life. Going through the painful mourning period, women attempted to find help from other people including the primary health care services. Participants recommended person-centred care, appropriate referrals and establishment of peer support groups for widows. This approach had the capacity to provide the basis for the evidence of all knowledge claims in this study. The development of the guidelines was based on the empirical data obtained in Phase 1. Phase 2 of this study entailed the development and validation of guidelines for the primary health care services to support widows in Tshwane, Gauteng Province. The development and validation of the guidelines was guided by the framework developed by the researcher based on the AGREE II (2010) instrument: advancing guideline development, reporting and evaluation in healthcare and AGREE II (2003-2013) instrument: appraisal of guidelines for research and evaluation, incorporating the Delphi technique. Delphi technique is a method for consensus building by using a series of rounds to collect data from a panel of experts to ensure reliable guidelines. The findings of this study led to the primary health care nurses and the researcher gaining deeper understanding of the health support needs of widows, and to the development of guidelines for providing primary health care services that support widows. This study meets the ethical requirements namely beneficence, respect for human dignity and justice, and might benefit widows making use of primary health care services.