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Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study
Background: Chronic wounds impose a significant burden on health systems, as delayed access to care contributes to poorer clinical outcomes and increased healthcare costs. These delays are particularly pronounced within resource-constrained systems such as the South African public healthcare system....
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| Format: | Thesis |
| Language: | English English |
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Department of Public Health and Family Medicine
2026
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| _version_ | 1867613194531373056 |
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| access_status_str | Open Access |
| author | Stofberg, Anronel |
| author2 | Githaiga, Jennifer |
| author_browse | Githaiga, Jennifer Stofberg, Anronel |
| author_facet | Githaiga, Jennifer Stofberg, Anronel |
| author_sort | Stofberg, Anronel |
| collection | Thesis |
| description | Background: Chronic wounds impose a significant burden on health systems, as delayed access to care contributes to poorer clinical outcomes and increased healthcare costs. These delays are particularly pronounced within resource-constrained systems such as the South African public healthcare system. Identifying barriers to accessing care can contribute to developing interventions to optimise pathways to chronic wound care. Aim: To map existing services, resources, and referral pathways for chronic wounds at each level of care and identify barriers to accessing care in the Khayelitsha health district. Methods: A mixed methods study was conducted in the Khayelitsha health district between November 2020 and May 2021. Quantitative data was obtained through surveys in all 12 healthcare facilities offering chronic wound care across three levels of care. Qualitative data was gathered through semi-structured individual interviews with 10 chronic wound care providers and 10 patients. The Four Delays framework (seeking, reaching, receiving, and remaining in care) was utilised to identify and map barriers to accessing care. Results: Nine overlapping barriers were identified, each contributing to multiple delays across all three levels of care. Seeking care was delayed by personal beliefs and the fear of amputation. Reaching care was delayed by transportation costs and safety concerns. Receiving care was delayed by chronic wound care provider and stock shortages, together with the non-utilisation of treatment and referral protocols. Remaining in care was delayed by deficient health information and lengthy waiting times at healthcare facilities. Conclusion: This study underscores the complexity of pathways to chronic wound care and emphasises the need for a holistic approach to improve access. Key recommendations include: (1) community health education campaigns, (2) subsidies for transportation to healthcare facilities, (3) increasing the nursing workforce, and (4) ensuring adherence to treatment and referral protocols. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/42737 |
| institution | University of Cape Town (South Africa) |
| language | English eng |
| last_indexed | 2026-06-10T12:32:13.078Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/42737 Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study Stofberg, Anronel Githaiga, Jennifer Chu, Kathryn chronic wound care public health healthcare access barriers to care Four Delays framework mixed methods Khayelitsha South Africa Background: Chronic wounds impose a significant burden on health systems, as delayed access to care contributes to poorer clinical outcomes and increased healthcare costs. These delays are particularly pronounced within resource-constrained systems such as the South African public healthcare system. Identifying barriers to accessing care can contribute to developing interventions to optimise pathways to chronic wound care. Aim: To map existing services, resources, and referral pathways for chronic wounds at each level of care and identify barriers to accessing care in the Khayelitsha health district. Methods: A mixed methods study was conducted in the Khayelitsha health district between November 2020 and May 2021. Quantitative data was obtained through surveys in all 12 healthcare facilities offering chronic wound care across three levels of care. Qualitative data was gathered through semi-structured individual interviews with 10 chronic wound care providers and 10 patients. The Four Delays framework (seeking, reaching, receiving, and remaining in care) was utilised to identify and map barriers to accessing care. Results: Nine overlapping barriers were identified, each contributing to multiple delays across all three levels of care. Seeking care was delayed by personal beliefs and the fear of amputation. Reaching care was delayed by transportation costs and safety concerns. Receiving care was delayed by chronic wound care provider and stock shortages, together with the non-utilisation of treatment and referral protocols. Remaining in care was delayed by deficient health information and lengthy waiting times at healthcare facilities. Conclusion: This study underscores the complexity of pathways to chronic wound care and emphasises the need for a holistic approach to improve access. Key recommendations include: (1) community health education campaigns, (2) subsidies for transportation to healthcare facilities, (3) increasing the nursing workforce, and (4) ensuring adherence to treatment and referral protocols. 2026-01-28T12:49:29Z 2026-01-28T12:49:29Z 2025 2026-01-28T12:48:04Z Thesis / Dissertation Masters MSc http://hdl.handle.net/11427/42737 en eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | chronic wound care public health healthcare access barriers to care Four Delays framework mixed methods Khayelitsha South Africa Stofberg, Anronel Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study |
| thesis_degree_str | Master's |
| title | Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study |
| title_full | Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study |
| title_fullStr | Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study |
| title_full_unstemmed | Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study |
| title_short | Identifying barriers to accessing healthcare for chronic wounds in the Khayelitsha sub-district: a mixed methods study |
| title_sort | identifying barriers to accessing healthcare for chronic wounds in the khayelitsha sub district a mixed methods study |
| topic | chronic wound care public health healthcare access barriers to care Four Delays framework mixed methods Khayelitsha South Africa |
| url | http://hdl.handle.net/11427/42737 |
| work_keys_str_mv | AT stofberganronel identifyingbarrierstoaccessinghealthcareforchronicwoundsinthekhayelitshasubdistrictamixedmethodsstudy |