Background: Academic failure among nursing students remains a significant challenge within nursing education institutions, often accompanied by stigma associated with academic failure (SAWAF). The SAWAF contributes to adverse psychological, social and academic consequences among repeating nursing students (RNS), potentially affecting their academic progression and professional identity formation. Despite increasing recognition of this issue, limited attention has been given to the systemic and cyclical nature of stigma-structured interventions aimed at addressing stigma within nursing education. Objectives: To develop a conceptual framework that explains and addresses the cyclical nature of SAWAF in nursing education. Methods: Qualitative descriptive design using triangulation. Data were drawn from three qualitative datasets exploring the experiences of RNSs, perceptions of nurse educators (NEs) and non-repeating nursing students. A triangulation approach was used to integrate findings and identify patterns of convergence and divergence. Thematic synthesis informed the development of a conceptual framework comprising root causes, key drivers, impacts and intervention points. Results: The findings revealed that SAWAF is sustained through interconnected institutional policies, NE behaviours and peer dynamics, which collectively contribute to psychological distress, academic underperformance, social exclusion and financial hardship among RNS. The proposed framework highlights NEs’ training, equitable teaching practices and institutional policy reforms as critical for disrupting the cycle. Conclusion: The proposed framework provides an evidence-informed model to guide interventions aimed at reducing stigma, strengthening educator practices and fostering inclusive learning environments in nursing education. Contribution: This study contributes an evidence-informed conceptual framework integrating institutional, educator and peer-level influences on SAWAF and identifying intervention points to disrupt its cyclical reproduction in nursing education.
Background: Tuberculosis (TB) remains a major burden in the province of Mpumalanga, South Africa. Treatment adherence is a key factor in the outcome of therapy. Objectives: To develop a conceptual framework based on extended self-efficacy theory to explain patients’ non-adherence to TB treatment in healthcare facilities in the province of Mpumalanga. Method: The study employed a quantitative approach with a cross-sectional survey design. Data were collected through structured questionnaires distributed to 89 patients receiving TB treatment. Descriptive statistics, the Pearson correlation coefficient and multiple regression analysis were among the many analyses carried out in this study. Results: Self-efficacy has a significant influence on medication literacy (β = 0.136, t = 2.359, p < 0.001), patient satisfaction (β = 0.105, t = 2.115, p < 0.001) and pill burden (β = 0.166, t = 2.977, p < 0.001) towards non-adherence to TB treatment and, thus supporting hypotheses H1, H2 and H3. There was a negative relationship between patient satisfaction and attitudes toward healthcare workers (β = 0.039, t = 0.684, and p > 0.72). Therefore, H4 is not supported. Attitude towards TB treatment has a significant effect on patient satisfaction towards non-adherence to TB treatment (β = 0.143, t = 2.691, p < 0.001); hence, H5 was accepted. Conclusion: Self-efficacy had a partial significant mediating effect on the relationship between medication literacy and medication adherence. This study emphasises self-efficacy and the importance of improving treatment attitudes, medication literacy and the efforts of healthcare professionals to prevent non-adherence to TB treatments. Contribution: The findings contribute to the body of knowledge and offer a platform for assessing the current strategies on fighting the disease through the developed research model aimed at determining the obstacles to non-adherence to TB treatments at healthcare facilities. The research model suggests various strategies that ultimately reduce the rate of treatment default, limits community transmission, and lower the global risk of multi-drug-resistant tuberculosis (MDR-TB).
Background: Patients with myocardial infarction require adaptive coping skills and adequate health literacy levels to improve their health and reduce morbidity, cost of care and mortality. Objectives: This study examined the association between commonly used coping strategies and health literacy levels among Jordanian patients with myocardial infarction. Method: A descriptive cross-sectional survey design was used. Systematic random sampling was used to recruit 140 patients with myocardial infarction from four hospitals in Jordan. Respondents completed two scales: the Arabic versions of the Brief COPE (AR-BC) and the 16 items European Health Literacy Survey Questionnaire (HLS-EU-Q16). The research process followed ethical principles and measures. Results: Respondents had low scores of engaging in coping activities. Emotion-focused coping and religious strategies were most used. Less than half (39.3%, n = 55) had adequate health literacy. The highest score was for the dimension Applying Information and the lowest was for Information Processing. Positive associations were found between health literacy levels and positive coping strategies (planning, acceptance, active coping, emotional support and positive reframing) and negative associations between negative coping strategies (venting) and health literacy levels. Conclusion: Patients with myocardial infarction had low health literacy and made more use of emotion-focused strategies rather than problem-focused coping strategies. Higher health literacy levels may be associated with the use of more adaptive coping strategies. Health literacy assessment and patients’ use of adaptive coping strategies should be fundamental to the nursing care of patients with myocardial infarction. Contribution: Jordanian patients post-myocardial infarction have limited health literacy and use mainly emotion-focused coping strategies. To promote patients’ adaptive, problem-focused coping, we recommend that health literacy training is included in nursing education curricula and HL screening is included in cardiac rehabilitation programmes.
Background: Single young mothers raising a child with severe intellectual disability face distinct day-to-day challenges. For many, the caregiving role is both demanding and life-changing. Beyond typical parenting duties, mothers often provide intensive care and must navigate health and support systems that can be difficult to understand and access. This can create ongoing uncertainty as they manage daily care and supervision, make sense of complex diagnoses and care needs, cope with emotional and practical demands, and seek appropriate resources and services. As they work to secure suitable care and services for their children, mothers may experience ongoing uncertainty, stress and worry. Objectives: The study aimed to explore and describe the experiences of single young mothers caring for children with severe intellectual disability. Method: A qualitative, exploratory and descriptive research design was adopted to capture the nuanced experiences of eight purposefully sampled single young mothers caring for a child with severe intellectual disability. Results: Three themes emerged: (1) Knowledge gaps among single young mothers, (2) Emotional and psychological impact of the diagnosis and (3) Strength and support systems among single young mothers. Conclusion: The findings can guide professionals in developing initiatives for single young mothers that strengthen financial stability, overall well-being, and caregiver education in caring for their children. Contribution: The study provides in-depth insight into the experiences of single young mothers caring for children with severe intellectual disability in the South African context. It highlights the knowledge gap, emotional challenges and support needs. The findings inform contextually relevant recommendations to strengthen professional support, enhance maternal well-being and improve quality of life for both the mothers and their children.
Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting children worldwide. Limited research exists on AD in rural settings. Objectives: This study aimed to investigate the clinical characteristics, environmental factors and quality of life of children with AD. Method: This is a cross-sectional research design. Children (n = 114) with AD were included in the survey, with parents serving as proxy informants. A semi-structured questionnaire and the validated Children’s Dermatology Life Quality Index (CDLQI) were used to collect data. Data were analysed using SPSS version 29. Descriptive statistics summarised demographics, clinical characteristics, environmental factors and the impact of AD on children’s quality of life. The Kruskal–Wallis test was used to analyse factors associated with the quality of life of children with AD at the 0.05 significance level. Results: The median age of the children was 6 years (interquartile range [IQR]: 4–9 years), with a high prevalence of mild AD (65%). The most affected body parts are the face (33.3%), the hands (23.7%) and the feet (20.2%). Key environmental triggers included pet ownership (81.6%), use of regular soap (98.2%) and seasonal exacerbation during winter (53.9%). Atopic dermatitis had a weak effect on the quality of life of most children (65.2%). The effect of AD on the quality of life was not influenced by gender, age group or the body part affected (p > 0.05). Conclusion: The quality of life of children in rural settings is primarily impacted by AD in areas such as schooling, sleeping and treatment domain. Contribution: Public health efforts should be scaled up to mitigate the burden of atopic dermatitis.
