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Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20. Published in final edited form as: Afr J Phys Health Educ Recreat Dance. 2014 September ; 2014(Suppl 2): 35–44.
Demographic determinants of health care practitioners’ intentions to work with traditional healers M.G. Mokgobi Department of Psychology, School of Health Sciences, Monash South Africa, P.O. Box X60, Ruimsig, 1725, Republic of South Africa; [email protected]
Abstract Author Manuscript
The aim of this study was to investigate the demographic determinants of health care practitioners’ intentions to work with traditional healers in South Africa. The study sampled 319 health care practitioners from State hospitals and clinics in Limpopo and Gauteng provinces, South Africa. Participants completed the Views on Traditional Healing Questionnaire (VTHQ) which was designed for the purposes of this study. Results of multiple regression analyses indicated that health care practitioners’ demographic variables (i.e. their designated roles, home language and hospital/clinic setting) did not yield significant variations in terms of their intentions to work with traditional healers in the future. Overall, health care practitioners’ attitudes towards traditional healing explained their intentions to work with traditional healers in the future. For xiTsonga and Sesotho speaking health care practitioners, their experiences with traditional healing explained their intentions to work with traditional healers in the future.
Author Manuscript
Keywords Intentions; health care practitioners; traditional healers
Introduction
Author Manuscript
South Africa is a country which is serviced by two parallel health care systems, namely, traditional African healing and Western biomedical healing. The World Health Organisation (2003) defines traditional healing as “health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercise, applied singular or in combination, to treat, diagnose and prevent illnesses or maintain well-being”. Traditional healing is holistic in its approach because it does not only treat illnesses with herbs but includes spiritual treatment, where necessary (Joint United Nations Programme on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) UNAIDS, 2006) . Traditional healing embodies the collective wisdom of indigenous knowledge that is mainly handed down from generation to generation (Ashforth, 2005). Consumers of traditional healing are largely black people in both rural and urban areas of South Africa. Approximately 80% of black people in South Africa use traditional healing in one way or another (Ramgoon, Dalasile, Paruk & Patel, 2011). Traditional healers are usually the first port of call when individuals present with illnesses that are perceived to be
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man-made. Man-made illnesses are illnesses that are considered to be inflicted by witchcraft and sorcery and therefore it is generally believed that such illnesses should appropriately be treated by using traditional healing and not by using the Western Biomedical model (Gumede, 1990).
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Contrary to the abovementioned principle of traditional African healing which views some illnesses as purely man-made, the Western Biomedical model is premised on the Germ Theory of illness in which the human body is likened to a machine whose parts sometimes do not function optimally as a result of the natural defenses of the body being inadequate and succumbing to the deadly germs that attack them (Craffert, 1997). In the Western Biomedical model, the treatment of disease/illness requires the repair and or replacement of parts in the form of drugs and surgery whose knowledge is the preserve of formally Western-trained health care personnel whose practice of health care is governed and regulated by the Health Professions Council of South Africa (Gumede, 1990).
Author Manuscript
South Africa is dogged by the shortage of Western-trained health care personnel in the public sector. Many health care professionals leave the public health care sector to go and seek better job prospects in the private sector or even outside the borders of South Africa (particularly in North America, Europe, middle eastern Europe and Australia). The shortage of Western-trained health care personnel coupled with the fact that the majority of black people use traditional healing necessitated the proposal to integrate the traditional healing and Western Biomedical model in State hospitals and clinics in South Africa. This proposal has been met with widespread criticisms particularly from Western-trained health care professionals (Van Eeden, 1993). Some of the criticisms revolve around the notion that traditional healing is porous and poorly regulated to an extent that anybody can claim to be a traditional healer (De Beer, 2010; Yeboah, 2000). The State is in no way able to differentiate between a bona fide traditional healer and an impostor. Other criticisms of traditional healing include, but not limited to, the issues of lack of proper hygiene practices by traditional healers. A practice that draws a lot of criticisms from Western-trained health care practitioners and the general population is the method of cupping/blood-letting (an age old procedure in which a traditional healer sucks an affliction out of the patient’s body by using a tennis ball and in some cases using their own mouth) (Gelfand, 1967). This is considered problematic and potentially dangerous because HIV and other blood-borne conditions can easily be transmitted from one person to another through this method.
Author Manuscript
With the above criticisms and differences between traditional healing and the Western biomedical model in mind, the current study aimed to determine whether Western-trained health care practitioners would be willing to work with traditional healers in the future. Particular focus of the study was on the biographical determinants of health care practitioners’ intentions to work with traditional healers. Previous studies have indicated that demographic variables such as designated role, home language and hospital/clinic setting may affect health care practitioners’ perceptions of and intentions to work with traditional healers (Edgington, Sekatane & Goldstein, 2002; Upvall, 1992).
Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
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Methodology Participants Participants in this study included 319 health care practitioners from two provinces in South Africa, namely, Gauteng province and Limpopo province. Participants were sampled on an opportunistic basis because only participants who were on duty during data collection had a chance of being part of the study. Participants’ age ranged between 21 years and 72 years. Procedure To conduct the study, permission was sought from relevant state authorities as per the requirements in each province or district. Ethical clearance for this study was obtained from the Department of Psychology’s Human Ethics Committee at the University of South Africa.
Author Manuscript
In total, five hundred questionnaires (N=500) were distributed. Out of the 500 questionnaires that were distributed, three hundred and nineteen (n=319) were correctly completed and returned. This represented a 63.8% return rate. Measuring instruments
Author Manuscript
For the purposes of this study, the Views on Traditional Healing Questionnaire (VTHQ) was designed. The VTHQ was designed to measure Western-trained health care practitioners’ opinions of, attitudes towards, knowledge of, experiences with and behavioural intentions of working with traditional healers in the future. The VTHQ consisted of 90 closed-ended questions. The VTHQ was subjected to the Exploratory Factor Analysis and it yielded five factors with eigenvalues greater than 2 (eigenvalue > 2). The Kaiser-Meyer-Olkin Measure of Sampling Adequacy for the current sample indicated a value of 0.927 which is higher than the recommended value of 0.6 (Brace, Kemp & Snelgar, 2003). In addition, Bartlett’s test of sphericity also revealed a significant value and therefore indicated that the VTHQ was factorable with p < 0.001. Final decision about the number and interpretation of the five factors was based on how strongly the variables loaded on each component (after varimax rotation was performed). The interpretation of the five factors resulted in the following sub-scales that were used in this study:
Author Manuscript
The Attitudes sub-scale was used to measure health care practitioners’ attitudes towards traditional healing. The Attitudes sub-scale was a 22-item self-report questionnaire modeled on a five-point Likert-type scale of 1 to 5. High scores indicated health care practitioners’ positive attitudes while low scores indicated negative attitudes towards traditional healing. The Chronbach’s alpha coefficient of the Attitudes scale was high at 0.95. The Opinions sub-scale was used to measure health care practitioners’ opinions of traditional healing. The Opinions sub-scale comprised 19 items modeled on the Likert-type scale of 1 to 5. High scores indicated health care practitioners’ positive opinions while low scores indicated negative opinions of traditional healing. The Cronbach’s alpha coefficient of the Opinions scale was 0.93.
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The Experiences sub-scale was used to measure health care practitioners’ experiences with traditional healing. The scale comprised of 10 items that were modeled on the Likert-type scale of 1 to 5. High scores indicated that health care practitioners had more experience while low scores indicated that they had less experience with traditional healing. The Cronbach’s alpha coefficient of the Experiences scale was moderately high at 0.76. The Behavioral Intentions sub-scale was used to measure health care practitioners’ behavioral intentions to work with traditional healers in the future. The Behavioural Intentions scale consisted of 7 items that were modeled on a Likert-type scale of 1 to 5. High scores indicated that health care practitioners were willing to work with traditional healers in the future. Low scores suggested that health care practitioners were either reluctant to work with traditional healers or were not willing to work with traditional healers in the future. The Cronbach’s alpha coefficient of the scale was 0.87.
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The Knowledge sub-scale was used to measure health care practitioners’ knowledge of traditional healing. The Knowledge sub-scale was made up of 10 items modeled on the Likert-type scale of 1 to 5. High scores indicated that health care practitioners had more knowledge of traditional healing while low scores indicated less knowledge of traditional healing. The Cronbach’s alpha indicated a high reliability of 0.81. Inter-item correlations for each sub-scale were positive suggesting that items within each sub-scale measured the same construct.
Results
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Multiple regression analyses were computed by splitting the data file into different demographic variables to determine whether there were any differences in terms of health care practitioners’ intentions of working with traditional healers in the future.
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The majority of participants were general nurses (52.7%, n = 168), followed by psychiatric nurses (27.9%, n = 89), physicians (11.6%, n = 37) and psychiatrists (7.8%, n = 25). Regarding home language distribution, the sample consisted mostly of Sepedi speaking participants in contrast to any other home language speakers, with just over forty six percent (46.7%; n = 149) of participants indicating Sepedi as their home language. The second largest group (9.7%, n = 31) reported speaking isiZulu and the smallest group (1.6%; n = 5) indicated isiSwati as their home language. Participants who were classified as ‘other’ (2.8%, n = 9) reported speaking non-South African languages. Lastly, participants were categorised according to the area or setting in which they worked. The majority (68%; n = 217) of the participants worked in State hospitals and or clinics situated in rural areas of Limpopo province. Almost a third (32%; n = 102) were employed in urban areas of Gauteng province. Health care practitioners’ designated role as a determinant of behavioural intentions to work with traditional healers When participants were divided by ‘role’, results revealed that attitudes explained 9.7% of the variance in psychiatrists’ behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 62.2%, F (4, 20) = 8.231, p < 0.001. In the model, only attitudes sub-scale was significant (beta = 0.48, p < 0.05) (Table
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1). This implies that psychiatrists who have positive attitudes towards traditional healing also showed more willingness to work with traditional healers in the future. For physicians, attitudes explained 6% of the variance in their behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 58.9%, F (4, 32) = 11.446, p < 0.05. The attitudes sub-scale was significant (beta = 0.41, p < 0.05) (Table 1). By implication, physicians with positive attitudes towards traditional healing also showed more intentions to work with traditional healers in the future.
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For general nurses, attitudes and knowledge explained 7.7% and 3.8% of the variance, respectively. The total variance explained by the model as a whole was 49.9%, F (4, 163) = 40.557, p < 0.001. In the model, both attitudes and knowledge were significant, with the attitudes sub-scale recording a higher beta value (beta = 0.536, p < 0.001) than the knowledge sub-scale (beta = 0.260, p ≤ 0.001) (Table 1). These results imply that general nurses with positive attitudes and more knowledge of traditional healing also registered more intentions of working with traditional healers in the future. For psychiatric nurses, opinions explained 5.6% of the variance with a beta value of 0.430, p < 0.005 (Table 1). The model as a whole explained a total variance of 53.5%, F (4, 84) = 24.128, p < 0.001. Language-based determinants of health care practitioners’ behavioural intentions to work with traditional healers
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For Sepedi speaking participants, attitudes and knowledge respectively explained 6.3% and 3% of the variance in their behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 50.1%, F (4, 144) = 36.181, p < 0.001. The two variables were significant, with the Attitudes sub-scale recording a higher beta value (beta = 0.443, p < 0.001) than the Knowledge sub-scale (beta = 0.219, p < 0.005). For isiZulu speaking participants, attitudes explained 15.8% of their behavioural intentions to work with traditional healers in the future. The model as a whole explained a total variance of 60.2%, F (4, 26) = 9.850, p < 0.001. The attitudes were significant, with the Attitudes sub-scale recording a beta value of 0.682, p < 0.05. Experiences for xiTsonga speaking sample explained 38.4% of the variance in their behavioural intentions to work with traditional healers in the future. The model explained a total variance of 64.7%, F (4, 9) = 4.122, p < 0.05. Experiences were significant, with the Experiences sub-scale recording a beta value of -0.692, p < 0.050 (Table 2).
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For the English speaking sample, attitudes explained 12.4% of variance in their behavioural intentions to work with traditional healers in the future and was found to be significant (beta = 0.704, p < 0.050). The total variance explained by the model as a whole was 77.7%, F (4, 21) = 18.313, p < 0.001. For Sesotho speaking sample, experiences explained 19.5% of the variance in their behavioural intentions to work with traditional healers in the future. The model as a whole explained a total variance of 59.5%, F (4, 13) = 4.766, p < 0.050. Experiences were significant, with a beta value of 0.547, p < 0.050.
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Setting/area-based determinants of health care practitioners’ behavioural intentions to work with traditional healers
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Health care practitioners were divided into those who were working in rural areas and those who were working in urban areas during data collection. The majority of health care practitioners were working in rural areas (n = 217). The results revealed that for this group, attitudes and knowledge, respectively, explained 6.4% and 4.3% of the variance in their behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 50.5%, F (4, 212) = 54.051, p < 0.001. Attitudes and knowledge were significant, with the Attitudes sub-scale recording a higher beta value (beta = 0.428, p < 0.001) than the Knowledge sub-scale (beta = 0.262, p < 0.001). For health care practitioners who were working in the urban areas, only attitudes were found to be significant and explained 7.4% of the variance in their behavioural intentions to work with traditional healers in the future. The Attitudes sub-scale recorded a beta value of 0.560, p < 0.001. The total variance explained by the model as a whole was 53.5%, F (4, 97) = 27.886, p < 0.001.
Discussion
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This study aimed to ascertain whether Western-trained health care practitioners would be willing to work with traditional healers in the future. In particular, the study investigated the biographical influences of health care practitioners’ intentions to work with traditional healers. The following biographical variables were of interest in this study namely; participants’ designated role; home language and hospital/clinic setting. The aim was to determine if these biographical variables could differentiate between different groups of health care practitioners in terms of their intentions to work with traditional healers in the future. In this study, health care practitioners’ demographic differences did not yield much variation in terms of health care practitioners’ intentions to work with traditional healers in the future. Results indicated that for physicians, psychiatrists and general nurses, attitudes explained their behavioural intentions to work with traditional healers in the future. These results are similar to those ofBurnett et al. (1999) and Hoff and Shapiro’s (1986). However, for psychiatric nurses in the present study, their opinions of traditional healing explained their intentions to work with traditional healers in the future. Hopa, Simbayi and du Toit (1998) reported similar findings in a study that investigated health care practitioners’ opinions of traditional healing.
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For Sepedi speaking, Zulu speaking and English speaking health care practitioners, attitudes towards traditional healing explained their intentions to work with traditional healers in the future. However, xiTsonga speaking and Sesotho speaking health care practitioners’ intentions to work with traditional healers were explained by their experiences with traditional healing. xiTsonga speaking health care practitioners had more negative experiences with traditional healing and therefore indicated less willingness to work with traditional healers in the future. This was contrary to Sesotho speaking health care practitioners who had more positive experiences and therefore indicated more willingness to work with traditional healers in the future. In previous studies, Risenga, Botha and Tjallinks Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
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(2007) found that Shangaan/xiTsonga patients in Limpopo province reported positive experiences with traditional healing in the management of hypertension. In both urban and rural settings, health care practitioners’ intentions to work with traditional healers were explained by their attitudes towards traditional healing. Both urban-based and rural-based health care practitioners showed more positive attitudes and more willingness to work with traditional healers in the future. These findings are inconsistent with Upvall ‘s (1992) findings in which urban-based health care practitioners expressed negative attitudes towards traditional healing and were less willing to collaborate with traditional healers.
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The current findings imply that if South Africa were to go ahead with the proposed integration of traditional healing and Western medicine in public hospitals and clinics, health care practitioners’ attitudes towards traditional healing could be used as an indication of the practicality of the mooted integration.
Conclusion Health care practitioners’ attitudes, and to some extent their experiences and opinions about traditional healing, explained their behavioural intentions to work with traditional healers in the future, despite the fact that health care practitioners in this study had different designated roles in hospitals/clinics, worked in different settings and spoke different home languages.
References
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Ashforth A. Muthi, medicine and witchcraft: Regulating ‘African science’ in post-apartheid South Africa. Social Dynamics. 2005; 31(2):211–241. Brace, N.; Kemp, R.; Snelgar, R. SPSS for Psychologists: A Guide to Data Analysis Using SPSS for Windows. 2nd ed.. Hampshire: Palgrave Macmillan; 2003. Burnett A, Baggaley R, Ndovi-MacMillan M, Sulwe J, Hang’omba B, Bennett J. Caring for people with HIV in Zambia: are traditional healers and formal health workers willing to work together? AIDS Care. 1999; 11(4):481–491. [PubMed: 10533542] Craffert PF. Opposing world-views: The border guards between traditional and biomedical health care practices. South African Journal of Ethnology. 1997; 20(1):1–8. De Beer F. Issues in community conservation: The case of the Barberton Medicinal Plants Project. Development in Practice. 2010; 20(3):435–445. Edginton ME, Sekatane CS, Goldstein SJ. Patients’ beliefs: Do they affect tuberculosis control? A study in a rural district of South Africa. International Journal of Tuberculosis and Lung Diseases. 2002; 6(12):1075–1082. Gelfand, M. The African Witch: With Particular Reference to Witchcraft Beliefs and Practice Among the Shona of Rhodesia. Edinburgh: E & S Livingstpone Ltd; 1967. Gumede, MV. Traditional Healers: A Medical Doctor’s Perspective. Cape Town: Skotaville Publishers; 1990. Hoff W, Shapiro G. Traditional healers in Swaziland. Parasitology Today. 1986; 2(12):360–361. [PubMed: 15462763] Hopa M, Simbayi LC, du Toit CD. Perceptions on integration of traditional and western healing in the new South Africa. South African Journal of Psychology. 1998; 28(1):8–14. Ramgoon S, Dalasile NQ, Paruk Z, Patel CJ. An exploratory study of trainee and registered psychologists’ perceptions about indigenous healing systems. South African Journal of Psychology. 2011; 41(1):90–100. Risenga PR, Botha A, Tjallinks JE. Shangaan patients and traditional healers’ management strategies of hypertension in Limpopo province. Curationis. 2007; 30(2):4–11. [PubMed: 17703818] Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
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UNAIDS. Collaborating with Traditional Healers for HIV Prevention and Care in Sub-Saharan Africa: Suggestions for Program Managers and Field Workers. Geneva, Switzerland: UNAIDS; 2006. Upvall MJ. Nursing perceptions of collaboration with indigenous healers in Swaziland. International Journal of Nursing Studies. 1992; 29(1):27–36. [PubMed: 1551751] Van Eeden A. The traditional healer and our future health system. South African Medical Journal. 1993; 83(47):441–442. [PubMed: 8211473] World Health Organization. Fact sheet No. Vol. 134. Geneva, Switzerland: 2003. Available at http:// www.who.int/mediacentre/factsheet/fs134/en. [Accessed 24 September 2008] Yeboah T. Improving the provision of traditional health knowledge for rural communities in Ghana. Health Libraries Review. 2000; 17:203–208. [PubMed: 11198326]
Author Manuscript Author Manuscript Author Manuscript Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
Author Manuscript 0.411 0.536 0.260 0.430
Attitudes Attitudes Knowledge Opinions
Physicians
General
Nurses
Psychiatric Nurses
Indicates significance (p ≤ 0.05).
*
0.483
Attitudes
Beta
Psychiatrists
Predictor 0.312 0.244 0.277 0.195 0.236
0.039* 0.000* 0.001* 0.002*
Part Correlations
0.035*
p-value
5.6%
3.8%
7.7%
6%
9.7%
Unique Variance
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Role
Tolerance
0.300
0.562
0.267
0.351
0.417
Author Manuscript
Predicting behavioural intentions on the basis of role
89
168
168
37
25
n
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Table 1 Mokgobi Page 9
Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
Author Manuscript
Author Manuscript 0.682 −0.692 0.704 0.574 0.547
Attitudes
Experiences
Attitudes
Knowledge
Experiences
isiZulu
xiTsonga
English
Afrikaans
Sesotho
Indicates significance (p ≤ 0.05).
*
0.443 0.219
Beta
Attitudes Knowledge
Predictor
Sepedi
Language 0.251 0.173 0.398 −0.620 0.352 0.418 0.442
0.003* 0.012* 0.003* 0.030* 0.026*
Part Correlations
0.000* 0.004*
p-value
19.5%
17.5%
12.4%
38.4%
15.8%
6.3% 3%
Unique Variance
0.653
0.529
0.250
0.802
0.340
0.322 0.625
Tolerance
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Predicting behavioural intentions on the basis of home language
18
11
26
14
31
149 149
n
Author Manuscript
Table 2 Mokgobi Page 10
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Author Manuscript
Author Manuscript 0.428 0.262 0.560
Knowledge
Attitudes
Beta
Attitudes
Predictor
Indicates significance (p ≤ 0.05).
*
Urban
Rural
Setting 0.253 0.207 0.272
0.000* 0.000*
Part Correlations
0.000*
p-value
7.4%
4.3%
6.4%
Unique Variance
0.237
0.622
0.349
Tolerance
102
217
217
n
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Predicting behavioural intentions on the basis of setting/area
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Table 3 Mokgobi Page 11
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Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20. Published in final edited form as: Afr J Phys Health Educ Recreat Dance. 2014 September ; 2014(Suppl 2): 35–44.
Demographic determinants of health care practitioners’ intentions to work with traditional healers M.G. Mokgobi Department of Psychology, School of Health Sciences, Monash South Africa, P.O. Box X60, Ruimsig, 1725, Republic of South Africa; [email protected]
Abstract Author Manuscript
The aim of this study was to investigate the demographic determinants of health care practitioners’ intentions to work with traditional healers in South Africa. The study sampled 319 health care practitioners from State hospitals and clinics in Limpopo and Gauteng provinces, South Africa. Participants completed the Views on Traditional Healing Questionnaire (VTHQ) which was designed for the purposes of this study. Results of multiple regression analyses indicated that health care practitioners’ demographic variables (i.e. their designated roles, home language and hospital/clinic setting) did not yield significant variations in terms of their intentions to work with traditional healers in the future. Overall, health care practitioners’ attitudes towards traditional healing explained their intentions to work with traditional healers in the future. For xiTsonga and Sesotho speaking health care practitioners, their experiences with traditional healing explained their intentions to work with traditional healers in the future.
Author Manuscript
Keywords Intentions; health care practitioners; traditional healers
Introduction
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South Africa is a country which is serviced by two parallel health care systems, namely, traditional African healing and Western biomedical healing. The World Health Organisation (2003) defines traditional healing as “health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercise, applied singular or in combination, to treat, diagnose and prevent illnesses or maintain well-being”. Traditional healing is holistic in its approach because it does not only treat illnesses with herbs but includes spiritual treatment, where necessary (Joint United Nations Programme on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) UNAIDS, 2006) . Traditional healing embodies the collective wisdom of indigenous knowledge that is mainly handed down from generation to generation (Ashforth, 2005). Consumers of traditional healing are largely black people in both rural and urban areas of South Africa. Approximately 80% of black people in South Africa use traditional healing in one way or another (Ramgoon, Dalasile, Paruk & Patel, 2011). Traditional healers are usually the first port of call when individuals present with illnesses that are perceived to be
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man-made. Man-made illnesses are illnesses that are considered to be inflicted by witchcraft and sorcery and therefore it is generally believed that such illnesses should appropriately be treated by using traditional healing and not by using the Western Biomedical model (Gumede, 1990).
Author Manuscript
Contrary to the abovementioned principle of traditional African healing which views some illnesses as purely man-made, the Western Biomedical model is premised on the Germ Theory of illness in which the human body is likened to a machine whose parts sometimes do not function optimally as a result of the natural defenses of the body being inadequate and succumbing to the deadly germs that attack them (Craffert, 1997). In the Western Biomedical model, the treatment of disease/illness requires the repair and or replacement of parts in the form of drugs and surgery whose knowledge is the preserve of formally Western-trained health care personnel whose practice of health care is governed and regulated by the Health Professions Council of South Africa (Gumede, 1990).
Author Manuscript
South Africa is dogged by the shortage of Western-trained health care personnel in the public sector. Many health care professionals leave the public health care sector to go and seek better job prospects in the private sector or even outside the borders of South Africa (particularly in North America, Europe, middle eastern Europe and Australia). The shortage of Western-trained health care personnel coupled with the fact that the majority of black people use traditional healing necessitated the proposal to integrate the traditional healing and Western Biomedical model in State hospitals and clinics in South Africa. This proposal has been met with widespread criticisms particularly from Western-trained health care professionals (Van Eeden, 1993). Some of the criticisms revolve around the notion that traditional healing is porous and poorly regulated to an extent that anybody can claim to be a traditional healer (De Beer, 2010; Yeboah, 2000). The State is in no way able to differentiate between a bona fide traditional healer and an impostor. Other criticisms of traditional healing include, but not limited to, the issues of lack of proper hygiene practices by traditional healers. A practice that draws a lot of criticisms from Western-trained health care practitioners and the general population is the method of cupping/blood-letting (an age old procedure in which a traditional healer sucks an affliction out of the patient’s body by using a tennis ball and in some cases using their own mouth) (Gelfand, 1967). This is considered problematic and potentially dangerous because HIV and other blood-borne conditions can easily be transmitted from one person to another through this method.
Author Manuscript
With the above criticisms and differences between traditional healing and the Western biomedical model in mind, the current study aimed to determine whether Western-trained health care practitioners would be willing to work with traditional healers in the future. Particular focus of the study was on the biographical determinants of health care practitioners’ intentions to work with traditional healers. Previous studies have indicated that demographic variables such as designated role, home language and hospital/clinic setting may affect health care practitioners’ perceptions of and intentions to work with traditional healers (Edgington, Sekatane & Goldstein, 2002; Upvall, 1992).
Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
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Methodology Participants Participants in this study included 319 health care practitioners from two provinces in South Africa, namely, Gauteng province and Limpopo province. Participants were sampled on an opportunistic basis because only participants who were on duty during data collection had a chance of being part of the study. Participants’ age ranged between 21 years and 72 years. Procedure To conduct the study, permission was sought from relevant state authorities as per the requirements in each province or district. Ethical clearance for this study was obtained from the Department of Psychology’s Human Ethics Committee at the University of South Africa.
Author Manuscript
In total, five hundred questionnaires (N=500) were distributed. Out of the 500 questionnaires that were distributed, three hundred and nineteen (n=319) were correctly completed and returned. This represented a 63.8% return rate. Measuring instruments
Author Manuscript
For the purposes of this study, the Views on Traditional Healing Questionnaire (VTHQ) was designed. The VTHQ was designed to measure Western-trained health care practitioners’ opinions of, attitudes towards, knowledge of, experiences with and behavioural intentions of working with traditional healers in the future. The VTHQ consisted of 90 closed-ended questions. The VTHQ was subjected to the Exploratory Factor Analysis and it yielded five factors with eigenvalues greater than 2 (eigenvalue > 2). The Kaiser-Meyer-Olkin Measure of Sampling Adequacy for the current sample indicated a value of 0.927 which is higher than the recommended value of 0.6 (Brace, Kemp & Snelgar, 2003). In addition, Bartlett’s test of sphericity also revealed a significant value and therefore indicated that the VTHQ was factorable with p < 0.001. Final decision about the number and interpretation of the five factors was based on how strongly the variables loaded on each component (after varimax rotation was performed). The interpretation of the five factors resulted in the following sub-scales that were used in this study:
Author Manuscript
The Attitudes sub-scale was used to measure health care practitioners’ attitudes towards traditional healing. The Attitudes sub-scale was a 22-item self-report questionnaire modeled on a five-point Likert-type scale of 1 to 5. High scores indicated health care practitioners’ positive attitudes while low scores indicated negative attitudes towards traditional healing. The Chronbach’s alpha coefficient of the Attitudes scale was high at 0.95. The Opinions sub-scale was used to measure health care practitioners’ opinions of traditional healing. The Opinions sub-scale comprised 19 items modeled on the Likert-type scale of 1 to 5. High scores indicated health care practitioners’ positive opinions while low scores indicated negative opinions of traditional healing. The Cronbach’s alpha coefficient of the Opinions scale was 0.93.
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The Experiences sub-scale was used to measure health care practitioners’ experiences with traditional healing. The scale comprised of 10 items that were modeled on the Likert-type scale of 1 to 5. High scores indicated that health care practitioners had more experience while low scores indicated that they had less experience with traditional healing. The Cronbach’s alpha coefficient of the Experiences scale was moderately high at 0.76. The Behavioral Intentions sub-scale was used to measure health care practitioners’ behavioral intentions to work with traditional healers in the future. The Behavioural Intentions scale consisted of 7 items that were modeled on a Likert-type scale of 1 to 5. High scores indicated that health care practitioners were willing to work with traditional healers in the future. Low scores suggested that health care practitioners were either reluctant to work with traditional healers or were not willing to work with traditional healers in the future. The Cronbach’s alpha coefficient of the scale was 0.87.
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The Knowledge sub-scale was used to measure health care practitioners’ knowledge of traditional healing. The Knowledge sub-scale was made up of 10 items modeled on the Likert-type scale of 1 to 5. High scores indicated that health care practitioners had more knowledge of traditional healing while low scores indicated less knowledge of traditional healing. The Cronbach’s alpha indicated a high reliability of 0.81. Inter-item correlations for each sub-scale were positive suggesting that items within each sub-scale measured the same construct.
Results
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Multiple regression analyses were computed by splitting the data file into different demographic variables to determine whether there were any differences in terms of health care practitioners’ intentions of working with traditional healers in the future.
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The majority of participants were general nurses (52.7%, n = 168), followed by psychiatric nurses (27.9%, n = 89), physicians (11.6%, n = 37) and psychiatrists (7.8%, n = 25). Regarding home language distribution, the sample consisted mostly of Sepedi speaking participants in contrast to any other home language speakers, with just over forty six percent (46.7%; n = 149) of participants indicating Sepedi as their home language. The second largest group (9.7%, n = 31) reported speaking isiZulu and the smallest group (1.6%; n = 5) indicated isiSwati as their home language. Participants who were classified as ‘other’ (2.8%, n = 9) reported speaking non-South African languages. Lastly, participants were categorised according to the area or setting in which they worked. The majority (68%; n = 217) of the participants worked in State hospitals and or clinics situated in rural areas of Limpopo province. Almost a third (32%; n = 102) were employed in urban areas of Gauteng province. Health care practitioners’ designated role as a determinant of behavioural intentions to work with traditional healers When participants were divided by ‘role’, results revealed that attitudes explained 9.7% of the variance in psychiatrists’ behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 62.2%, F (4, 20) = 8.231, p < 0.001. In the model, only attitudes sub-scale was significant (beta = 0.48, p < 0.05) (Table
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1). This implies that psychiatrists who have positive attitudes towards traditional healing also showed more willingness to work with traditional healers in the future. For physicians, attitudes explained 6% of the variance in their behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 58.9%, F (4, 32) = 11.446, p < 0.05. The attitudes sub-scale was significant (beta = 0.41, p < 0.05) (Table 1). By implication, physicians with positive attitudes towards traditional healing also showed more intentions to work with traditional healers in the future.
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For general nurses, attitudes and knowledge explained 7.7% and 3.8% of the variance, respectively. The total variance explained by the model as a whole was 49.9%, F (4, 163) = 40.557, p < 0.001. In the model, both attitudes and knowledge were significant, with the attitudes sub-scale recording a higher beta value (beta = 0.536, p < 0.001) than the knowledge sub-scale (beta = 0.260, p ≤ 0.001) (Table 1). These results imply that general nurses with positive attitudes and more knowledge of traditional healing also registered more intentions of working with traditional healers in the future. For psychiatric nurses, opinions explained 5.6% of the variance with a beta value of 0.430, p < 0.005 (Table 1). The model as a whole explained a total variance of 53.5%, F (4, 84) = 24.128, p < 0.001. Language-based determinants of health care practitioners’ behavioural intentions to work with traditional healers
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For Sepedi speaking participants, attitudes and knowledge respectively explained 6.3% and 3% of the variance in their behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 50.1%, F (4, 144) = 36.181, p < 0.001. The two variables were significant, with the Attitudes sub-scale recording a higher beta value (beta = 0.443, p < 0.001) than the Knowledge sub-scale (beta = 0.219, p < 0.005). For isiZulu speaking participants, attitudes explained 15.8% of their behavioural intentions to work with traditional healers in the future. The model as a whole explained a total variance of 60.2%, F (4, 26) = 9.850, p < 0.001. The attitudes were significant, with the Attitudes sub-scale recording a beta value of 0.682, p < 0.05. Experiences for xiTsonga speaking sample explained 38.4% of the variance in their behavioural intentions to work with traditional healers in the future. The model explained a total variance of 64.7%, F (4, 9) = 4.122, p < 0.05. Experiences were significant, with the Experiences sub-scale recording a beta value of -0.692, p < 0.050 (Table 2).
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For the English speaking sample, attitudes explained 12.4% of variance in their behavioural intentions to work with traditional healers in the future and was found to be significant (beta = 0.704, p < 0.050). The total variance explained by the model as a whole was 77.7%, F (4, 21) = 18.313, p < 0.001. For Sesotho speaking sample, experiences explained 19.5% of the variance in their behavioural intentions to work with traditional healers in the future. The model as a whole explained a total variance of 59.5%, F (4, 13) = 4.766, p < 0.050. Experiences were significant, with a beta value of 0.547, p < 0.050.
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Setting/area-based determinants of health care practitioners’ behavioural intentions to work with traditional healers
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Health care practitioners were divided into those who were working in rural areas and those who were working in urban areas during data collection. The majority of health care practitioners were working in rural areas (n = 217). The results revealed that for this group, attitudes and knowledge, respectively, explained 6.4% and 4.3% of the variance in their behavioural intentions to work with traditional healers in the future. The total variance explained by the model as a whole was 50.5%, F (4, 212) = 54.051, p < 0.001. Attitudes and knowledge were significant, with the Attitudes sub-scale recording a higher beta value (beta = 0.428, p < 0.001) than the Knowledge sub-scale (beta = 0.262, p < 0.001). For health care practitioners who were working in the urban areas, only attitudes were found to be significant and explained 7.4% of the variance in their behavioural intentions to work with traditional healers in the future. The Attitudes sub-scale recorded a beta value of 0.560, p < 0.001. The total variance explained by the model as a whole was 53.5%, F (4, 97) = 27.886, p < 0.001.
Discussion
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This study aimed to ascertain whether Western-trained health care practitioners would be willing to work with traditional healers in the future. In particular, the study investigated the biographical influences of health care practitioners’ intentions to work with traditional healers. The following biographical variables were of interest in this study namely; participants’ designated role; home language and hospital/clinic setting. The aim was to determine if these biographical variables could differentiate between different groups of health care practitioners in terms of their intentions to work with traditional healers in the future. In this study, health care practitioners’ demographic differences did not yield much variation in terms of health care practitioners’ intentions to work with traditional healers in the future. Results indicated that for physicians, psychiatrists and general nurses, attitudes explained their behavioural intentions to work with traditional healers in the future. These results are similar to those ofBurnett et al. (1999) and Hoff and Shapiro’s (1986). However, for psychiatric nurses in the present study, their opinions of traditional healing explained their intentions to work with traditional healers in the future. Hopa, Simbayi and du Toit (1998) reported similar findings in a study that investigated health care practitioners’ opinions of traditional healing.
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For Sepedi speaking, Zulu speaking and English speaking health care practitioners, attitudes towards traditional healing explained their intentions to work with traditional healers in the future. However, xiTsonga speaking and Sesotho speaking health care practitioners’ intentions to work with traditional healers were explained by their experiences with traditional healing. xiTsonga speaking health care practitioners had more negative experiences with traditional healing and therefore indicated less willingness to work with traditional healers in the future. This was contrary to Sesotho speaking health care practitioners who had more positive experiences and therefore indicated more willingness to work with traditional healers in the future. In previous studies, Risenga, Botha and Tjallinks Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
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(2007) found that Shangaan/xiTsonga patients in Limpopo province reported positive experiences with traditional healing in the management of hypertension. In both urban and rural settings, health care practitioners’ intentions to work with traditional healers were explained by their attitudes towards traditional healing. Both urban-based and rural-based health care practitioners showed more positive attitudes and more willingness to work with traditional healers in the future. These findings are inconsistent with Upvall ‘s (1992) findings in which urban-based health care practitioners expressed negative attitudes towards traditional healing and were less willing to collaborate with traditional healers.
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The current findings imply that if South Africa were to go ahead with the proposed integration of traditional healing and Western medicine in public hospitals and clinics, health care practitioners’ attitudes towards traditional healing could be used as an indication of the practicality of the mooted integration.
Conclusion Health care practitioners’ attitudes, and to some extent their experiences and opinions about traditional healing, explained their behavioural intentions to work with traditional healers in the future, despite the fact that health care practitioners in this study had different designated roles in hospitals/clinics, worked in different settings and spoke different home languages.
References
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Ashforth A. Muthi, medicine and witchcraft: Regulating ‘African science’ in post-apartheid South Africa. Social Dynamics. 2005; 31(2):211–241. Brace, N.; Kemp, R.; Snelgar, R. SPSS for Psychologists: A Guide to Data Analysis Using SPSS for Windows. 2nd ed.. Hampshire: Palgrave Macmillan; 2003. Burnett A, Baggaley R, Ndovi-MacMillan M, Sulwe J, Hang’omba B, Bennett J. Caring for people with HIV in Zambia: are traditional healers and formal health workers willing to work together? AIDS Care. 1999; 11(4):481–491. [PubMed: 10533542] Craffert PF. Opposing world-views: The border guards between traditional and biomedical health care practices. South African Journal of Ethnology. 1997; 20(1):1–8. De Beer F. Issues in community conservation: The case of the Barberton Medicinal Plants Project. Development in Practice. 2010; 20(3):435–445. Edginton ME, Sekatane CS, Goldstein SJ. Patients’ beliefs: Do they affect tuberculosis control? A study in a rural district of South Africa. International Journal of Tuberculosis and Lung Diseases. 2002; 6(12):1075–1082. Gelfand, M. The African Witch: With Particular Reference to Witchcraft Beliefs and Practice Among the Shona of Rhodesia. Edinburgh: E & S Livingstpone Ltd; 1967. Gumede, MV. Traditional Healers: A Medical Doctor’s Perspective. Cape Town: Skotaville Publishers; 1990. Hoff W, Shapiro G. Traditional healers in Swaziland. Parasitology Today. 1986; 2(12):360–361. [PubMed: 15462763] Hopa M, Simbayi LC, du Toit CD. Perceptions on integration of traditional and western healing in the new South Africa. South African Journal of Psychology. 1998; 28(1):8–14. Ramgoon S, Dalasile NQ, Paruk Z, Patel CJ. An exploratory study of trainee and registered psychologists’ perceptions about indigenous healing systems. South African Journal of Psychology. 2011; 41(1):90–100. Risenga PR, Botha A, Tjallinks JE. Shangaan patients and traditional healers’ management strategies of hypertension in Limpopo province. Curationis. 2007; 30(2):4–11. [PubMed: 17703818] Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
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UNAIDS. Collaborating with Traditional Healers for HIV Prevention and Care in Sub-Saharan Africa: Suggestions for Program Managers and Field Workers. Geneva, Switzerland: UNAIDS; 2006. Upvall MJ. Nursing perceptions of collaboration with indigenous healers in Swaziland. International Journal of Nursing Studies. 1992; 29(1):27–36. [PubMed: 1551751] Van Eeden A. The traditional healer and our future health system. South African Medical Journal. 1993; 83(47):441–442. [PubMed: 8211473] World Health Organization. Fact sheet No. Vol. 134. Geneva, Switzerland: 2003. Available at http:// www.who.int/mediacentre/factsheet/fs134/en. [Accessed 24 September 2008] Yeboah T. Improving the provision of traditional health knowledge for rural communities in Ghana. Health Libraries Review. 2000; 17:203–208. [PubMed: 11198326]
Author Manuscript Author Manuscript Author Manuscript Afr J Phys Health Educ Recreat Dance. Author manuscript; available in PMC 2015 November 20.
Author Manuscript 0.411 0.536 0.260 0.430
Attitudes Attitudes Knowledge Opinions
Physicians
General
Nurses
Psychiatric Nurses
Indicates significance (p ≤ 0.05).
*
0.483
Attitudes
Beta
Psychiatrists
Predictor 0.312 0.244 0.277 0.195 0.236
0.039* 0.000* 0.001* 0.002*
Part Correlations
0.035*
p-value
5.6%
3.8%
7.7%
6%
9.7%
Unique Variance
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Role
Tolerance
0.300
0.562
0.267
0.351
0.417
Author Manuscript
Predicting behavioural intentions on the basis of role
89
168
168
37
25
n
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Table 1 Mokgobi Page 9
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Author Manuscript 0.682 −0.692 0.704 0.574 0.547
Attitudes
Experiences
Attitudes
Knowledge
Experiences
isiZulu
xiTsonga
English
Afrikaans
Sesotho
Indicates significance (p ≤ 0.05).
*
0.443 0.219
Beta
Attitudes Knowledge
Predictor
Sepedi
Language 0.251 0.173 0.398 −0.620 0.352 0.418 0.442
0.003* 0.012* 0.003* 0.030* 0.026*
Part Correlations
0.000* 0.004*
p-value
19.5%
17.5%
12.4%
38.4%
15.8%
6.3% 3%
Unique Variance
0.653
0.529
0.250
0.802
0.340
0.322 0.625
Tolerance
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Predicting behavioural intentions on the basis of home language
18
11
26
14
31
149 149
n
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Author Manuscript 0.428 0.262 0.560
Knowledge
Attitudes
Beta
Attitudes
Predictor
Indicates significance (p ≤ 0.05).
*
Urban
Rural
Setting 0.253 0.207 0.272
0.000* 0.000*
Part Correlations
0.000*
p-value
7.4%
4.3%
6.4%
Unique Variance
0.237
0.622
0.349
Tolerance
102
217
217
n
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Predicting behavioural intentions on the basis of setting/area
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