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Endurance, resistance and resilience in the South African health care system: case studies to demonstrate mechanisms of coping within a constrained system

Overview of attention for article published in BMC Health Services Research, September 2015
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Title
Endurance, resistance and resilience in the South African health care system: case studies to demonstrate mechanisms of coping within a constrained system
Published in
BMC Health Services Research, September 2015
DOI 10.1186/s12913-015-1112-9
Pubmed ID
Authors

John Eyles, Bronwyn Harris, Jana Fried, Veloshnee Govender, Pascalia Munyewende

Abstract

South Africa is at present undertaking a series of reforms to transform public health services to make them more effective and responsive to patient and provider needs. A key focus of these reforms is primary care and its overburdened, somewhat dysfunctional and hierarchical nature. This comparative case study examines how patients and providers respond in this system and cope with its systemic demands through mechanisms of endurance, resistance and resilience, using coping and agency literatures as the theoretical lenses. As part of a larger research project carried out between 2009 and 2010, this study conducted semi-structured interviews and observations at health facilities in three South African provinces. This study explored patient experiences of access to health care, in particular, ways of coping and how health care providers cope with the health care system's realities. From this interpretive base, four cases (two patients, two providers) were selected as they best informed on endurance, resistance and resilience. Some commentary from other respondents is added to underline the more ubiquitous nature of these coping mechanisms. The cases of four individuals highlight the complexity of different forms of endurance and passivity, emotion- and problem-based coping with health care interactions in an overburdened, under-resourced and, in some instances, poorly managed system. Patients' narratives show the micro-practices they use to cope with their treatment, by not recognizing victimhood and sometimes practising unhealthy behaviours. Providers indicate how they cope in their work situations by using peer support and becoming knowledgeable in providing good service. Resistance and resilience narratives show the adaptive power of individuals in dealing with difficult illness, circumstances or treatment settings. They permit individuals to do more than endure (itself a coping mechanism) their circumstances, though resistance and resilience may be limited. These are individual responses to systemic forces. To transform health care, mutually supportive interactions are required among and between both patients and providers but their nature, as micro-practices, may show a way forward for system change.

Mendeley readers

The data shown below were compiled from readership statistics for 123 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Unknown 122 99%

Demographic breakdown

Readers by professional status Count As %
Student > Master 25 20%
Student > Ph. D. Student 23 19%
Researcher 15 12%
Student > Bachelor 13 11%
Student > Doctoral Student 7 6%
Other 21 17%
Unknown 19 15%
Readers by discipline Count As %
Nursing and Health Professions 27 22%
Social Sciences 25 20%
Medicine and Dentistry 22 18%
Psychology 13 11%
Agricultural and Biological Sciences 5 4%
Other 11 9%
Unknown 20 16%

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 06 October 2015.
All research outputs
#10,995,338
of 12,372,945 outputs
Outputs from BMC Health Services Research
#3,789
of 4,083 outputs
Outputs of similar age
#208,009
of 252,966 outputs
Outputs of similar age from BMC Health Services Research
#4
of 6 outputs
Altmetric has tracked 12,372,945 research outputs across all sources so far. This one is in the 1st percentile – i.e., 1% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,083 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.4. This one is in the 1st percentile – i.e., 1% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 252,966 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 6 others from the same source and published within six weeks on either side of this one. This one has scored higher than 2 of them.