Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa

Abstract

Background: Age-specific health promotion messages appear in the Road-to-Health-Booklet, an assessment and monitoring tool for child health in South Africa. Healthcare workers should communicate health promotion messages to caregivers at each clinic visit.

Objective: This investigation, part of a larger Road-to-Health-Booklet survey, assessed the implementation of health promotion messages and identified barriers to its successful implementation.

Methods: A cross-sectional descriptive study with analytical components was conducted in the Western Cape Province. Knowledge and practices of caregivers and healthcare workers were assessed at 143 randomly selected primary health care facilities. Information was obtained through questionnaires; direct observation of consultations and recording of health promotion material in facilities.

Results: In total, 2442 children (0-36 months; mean age 6.26 ± 6.24 months.); 2481 caregivers and 270 healthcare workers were included. Caregivers' educational level varied, with only 24.3% completing Grade 12. Healthcare workers had a median of five years (0.5 - 37.0 years) work experience in primary health care. All healthcare workers indicated that health promotion messages are important, however, messages were only conveyed in 51% of consultations observed. If communicated, health promotion messages were age-appropriate in 97% of cases. Barriers to the implementation of health promotion messages hinged on time and staff constraints, workload and language barriers. Various forms of health promotion material were available in facilities.

Conclusions: Sub-optimal implementation of the health promotion messages in the Road-to-Health-Booklet are apparent despite healthcare workers realising the importance of health promotion. Barriers to optimal implementation must be urgently addressed by the National Department of Health and healthcare workers in partnership with caregivers and supported by society to promote child health and care.