Conceptual Framework for the health and well-being of caregivers of HIV/AIDS orphans in North West Province, South Africa

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Previous research has shown that providing care in an unsuitable environment has an impact on the health and well-being of caregivers of HIV/AIDS orphans. The research also showed that the North West Province lacks a conceptual framework that addresses the health and well-being of caregivers caring for HIV/AIDS orphans. As a result, this study developed a conceptual framework to improve the health and well-being of caregivers of HIV/AIDS orphans in the north-west province, South Africa. Methods A descriptive and contextual design was used. The practice-orientated theory by Dickoff, James, and Wiedenbach guided the development of the conceptual framework. These six steps include the agent, recipient, context, procedure, dynamics, and terminus. Results The study findings include home visits, health education, support during disclosure, routine monitoring of blood and growth, mobilisation of support systems and resources, and utilisation of government services. Conclusion The conceptual framework offers data that can help OTLs and registered nurses in PHC facilities improve the health and well-being of caregivers of HIV/AIDS orphans by providing high-quality care. The framework guides OTLs and registered nurses in PHC institutions on the procedure to follow to improve and preserve the optimal state of health. Conceptual framework caregivers HIV/AIDS orphans health well-being Figures Figure 1 Background The human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain a public health disease that has left caregivers of HIV/AIDS orphans with challenges [ 1 , 2 ]. Caregivers who are expected to care for HIV/AIDS orphans after the passing away of their parents are sometimes unable to carry out caring duties due to poor health and well-being [ 3 , 4 ]. Furthermore, research carried out in South Africa's North West Province (NWP) revealed that unfavourable conditions in which they must discharge caregiving duties and the burden of caring for HIV/AIDS orphans deteriorated the health and well-being of HIV/AIDS caregivers [ 6 ]. The World Health Organization defines health as a state of complete physical, mental and social well-being and not simply the absence of disease or infirmity [ 5 ]. A peaceful and satisfied life is influenced by being in excellent health. Living without stress and illness is essential for maintaining health and well-being. Well-being is defined as the union of happiness, optimal functioning, experience of positive emotions, and relationships in a conducive environment [ 6 ]. Health and well-being are two dimensions of health that are interrelated and influence each other. Activities promoting health help people in transitioning from an unhealthy lifestyle to one that improves their health and well-being [ 7 ]. The literature on the conceptual framework to improve the health and well-being of children orphaned by HIV/AIDS in the North west province remains unknown. Therefore, the findings of an intervention for the health and well-being of caregivers of HIV/AIDS orphans are critical to allow them to perform caregiving responsibilities as they should. Therefore, the researchers saw a need to develop a conceptual framework for the health and well-being of caregivers of HIV/AIDS orphans in the North West Province. A conceptual framework helps to aid in the comprehension of the connections between concepts or variables about the actual world [8,9.10]. To produce and organize information about connected concepts or issues, the conceptual framework connects concepts, empirical research, and pertinent theories [ 4 ]. Additionally, a conceptual framework is used to design a general research challenge or to strengthen an already-identified issue [ 10 ]. Conceptual frameworks developed by [ 11 , 12 ]. followed the Practice-Oriented Theory (POT) by Dickoff, James and Wiedenbach [ 13 ] to develop conceptual frameworks for psychosocial care and support for orphans and vulnerable children and for rape survivors diagnosed with post-traumatic stress disorders [ 11 , 12 ]. Given that, researchers saw it necessary to adopt POT survey list to develop a conceptual framework for health and well-being of caregivers of HIV/AIDS orphans. This article is part of the main study that aims to develop health promotion strategies to improve the health and well-being of caregivers of children orphaned by HIV/AIDS in the Ngaka Modiri Molema district, North West Province of South Africa. Therefore, the developed conceptual framework will be used to guide the development of health promotion strategies for health and well-being of the caregivers of HIV/AIDS orphans in North West Province which is the main objective of this study. Conceptual framework The POT survey list by [ 13 ] was adopted to develop a conceptual framework for the health and well-being of caregivers of HIV/AIDS orphans. The features of POT include the following: Agent (Who is the agent of the framework? The term ‘agent’ refers to individuals who ensure the implementation of conceptual frameworks [ 13 ]. In addition, the agent is an individual within the structure who carries out tasks that are integrated into it. In this study, agent refer to all professional nurses who works in the healthcare facilities and for ward-based primary healthcare outreach teams (WBPHCOTs) as outreach team leaders (OTLs). Recipient (who is the recipient of the framework) The recipient refers to the person who benefits from the health services provided by the agent [ 11 ]. In this study, all recipients were caregivers of children orphaned by HIV/AIDS. The caregivers refer to aunt, uncle, grandparents, sisters, brothers, over the age of 18, single or married, and taking care of children orphaned by HIV/AIDS in North West Province, South Africa. Context (in which context will the framework be implemented) The context in this study refers to the environment or surroundings in which the conceptual framework will be implemented [ 13 ]. In this study, context refer to the homes of the caregivers of children orphaned by HIV/AIDS and the healthcare facilities in North West Province, South Africa. The WBPHCOTs are composed of community health workers (CHWs) who get oversight, referral, and support from OTLs and are connected to nearby primary health care (PHC) institutions [ 14 ]. The community care and support system that was established in response to HIV and AIDS in South Africa is based on non-governmental organizations (NGOs), which is the foundation upon which these outreach teams build [ 14 ]. Procedure (How will the framework be implemented) The procedure refers to the process that is described in this framework that the agent to achieve the objectives of the study [ 13 ]. The process includes health promotion activities that aim to improve health and well-being of caregivers of children orphaned by HIV/AIDS in North West Province, South Africa. Dynamics (What are the dynamics of the framework) The dynamics are the actions that the agents to ensure that the conceptual framework is implemented [ 13 ]. In this study, dynamics refer to collaborative efforts by OTLs to ensure that the objective of the conceptual framework is achieved. The OTLs can partner with doctors, social workers, psychologists, dieticians, police, community-based organizations, NGOs, and other stakeholders that will be needed to advance the needs of the caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa. Terminus (What will be the endpoint of the framework) The concept “terminus" describes the conclusion or result of the conceptual framework [ 13 ]. The authors further explained the endpoint as the result of the agent's efforts leading to improved outcomes. In this study, the endpoint is the conceptual framework that informs the development of the health promotion strategies to improve health and well-being of the caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa. Method 2.1 Study Design The exploratory descriptive contextual design was used for this study. Qualitative research approach methods were used to perform three steps of the empirical phase. Phase 1 of this study had two steps namely steps one, and two. Step one of this addressed two objectives of the study. Objective one explored and described challenges faced by caregivers of children orphaned by HIV/AIDS whilst objective two explored and described the coping mechanisms used by caregivers of children orphaned by HIV/AIDS. Regarding step two, support provided by outreach team leaders (OTLs) to the caregivers of HIV/AIDS orphans was explored. Exploratory research design was used to explore research questions for this study as they were not investigated before. [ 15 ]. The descriptive research design was used to describe a phenomenon and its characteristics [ 16 ]. In terms of contextual research design, interviews were conducted at where the participants reside [ 17 ]. 2.2 Context The study context included five municipalities of the Ngaka Modiri Molema District, North West Province of South Africa. The municipalities where data was collected include Mahikeng, Ramotshere-Moiloa, Ditsobotla, Ratlou, and Tswaing. Within the province of North West, Ngaka Modiri Molema District is one of four district municipalities, encompassing an approximate area of 28 114 km² [ 18 ]. Currently, Ngaka Modiri Molema District Municipality is home to 268 099 houses and 961 960 residents. Using the upper poverty line criterion, there are 640 000 (67.66%) persons living in poverty in Ngaka Modiri Molema District Municipality. This is 3.14% more than the 621 000 in 2008 [ 18 ]. 2.3 Population and sampling The study population was caregivers of children orphaned by HIV/AIDS, professional nurses working as primary health care outreach team (WBPHCOT) leaders, commonly known as outreach team leaders (OTLs) and that is the name that has been used in this study to refer to them. Purposive sampling was used to select both caregivers of HIV/AIDS orphans and the professional nurses. Caregivers of HIV/AIDS orphans who gave consent to participate in the study were thirteen (13), their ages ranges from 28–69. Amongst the caregivers of HIV/AIDS orphans, nine were unemployed whilst four of them were pensioners. All caregivers of HIV/AIDS orphans who participated in the study were females. With regards to professional nurses, thirty-seven (37) participated in the study of which thirty-three (33) were females and four (4) were males. Four categories of age of the professional were as follows: 30–39 were 2, 40–49 were 5, 50–59 were 12, and 60–69 were 18. 2.4 Data collection Two steps in Phase 1 were followed to collect data in this study. In step one of Phase 1, individual semi-structured interviews were used to explore and describe the challenges faced by caregivers of HIV/AIDS orphans. This study developed the interview guide to achieve the objectives of the study. The research questions for individual semi-structured interviews were: What are the challenges that you face to care for HIV/AIDS orphans and what are the coping mechanisms that you use to care for HIV/AIDS orphans. Step two of Phase 1 used focus group semi-strucutred interviews to explore and describe the support provided by outreach team leaders (OTLs) to caregivers of HIV/AIDS orphans. This phase had only one central question for step which was: what support you provide to the caregivers of children orphaned by HIV/AIDS. The results gathered in Phase 1 were combined in Phase 2 to develop a conceptual framework for health and well-being of caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa. Data was collected during the day in both interviews. An audio recorder was used to record all the interviews. Setswana language was used to collect data during semi-structured individual interviews which were later translated into English language before transcribing. Focus group semi-structured interviews were conducted using English language. Data analysis Six steps of thematic data analysis were followed to analyze data collected in Phase 1 which had three steps [ 19 ]. Before beginning any analysis, the researchers and co-coder familiarized themselves with the data. Throughout the entire coding process, the research question served as a guide. The codes were grouped into themes to answer the research question and fulfil the objectives of the study [ 19 ]. Following the themes' examination, pertinent data was categorized with each theme. The establishment of the relationship between themes and sub-themes was done [ 20 ]. Data analysis took place simultaneously with data collection to establish whether data saturation has been reached [ 21 ]. Field notes and all the data collected during Phase 1 were first examined independently, and then combined. 2.5 Recruitment of participants After approval of this study by the North West University Health Research Ethics Committee (NWUHREC), including the North West Provincial Department of Health, pamphlets were emailed to the district communication officer to invite nurses to participate in the study. The subdistrict managers of the five local municipalities under Ngaka Modiri Molema district and the Primary Health Care (PHC) programme manager were also copied. The communication officers posted pamphlets on the Department notice boards. Nurses who showed interest in participating in the study called the research assistant to make an appointment with him for further details. The research assistant had a short interview with nurses who showed interest in assessing their eligibility to participate in the study. The same procedure was followed to recruit caregivers for children orphaned by HIV/AIDS. In the case of caregivers, brochures were posted in public spaces such as clinics, stores, and churches to recruit them for participation in the study. Interested caregivers also called the research assistant to make appointments to discuss how to meet up to plan for the data collection date. 2.6 Ethics approval This study was approved by NWUHREC, an institution of higher learning in the North West Province. Permission to conduct the study was obtained from North West Department of Health Ethics committee. This work is part of our overall research which aims to develop health promotion strategies to improve the health and well-being of caregivers of children orphaned by HIV/AIDS. The participants were informed about the purpose of the study and their rights prior participating in the study. The participants were informed about the principle of autonomy, which is voluntary participation [ 22 ]. Furthermore, the right to withdraw at any time from the study was also explained to the participants. Privacy and confidentiality were maintained throughout the entire process of interviews [ 23 ]. 2.7 Trustworthiness The following four trustworthiness principles were adhered to maintain the rigor of the study. Credibility Prolonged engagement was applied throughout the study. Interviews were recorded and field notes were also taken to annotate the verbal and non-verbal cues. Participants in the study were consulted after data analysis for validation purposes [ 24 ]. Dependability Qualitative exploratory, descriptive, and contextual design methods were used in this study. This principle was adhered to by ensuring detailed data transcription, data coding, data analysis, and the use of literature control [ 24 ]. Confirmability The data were independently analysed by both the researcher and the coder. After analysing data independently, the two parties compared both themes and subthemes emerging from the study. Open-ended questions were also applied, followed by probing for clarity. The existing literature was used to confirm and equally disprove the findings of the study [ 24 ] Transferability By giving readers thorough contextual information to evaluate the findings' applicability, a thick description of the data was preserved [ 24 ]. Results and Discussion This study aimed to develop a conceptual framework to improve the health and well-being of caregivers of children orphaned by HIV/AIDS. The focus of this section will be on the process followed to develop the conceptual framework see the diagram below for more information. 3.2 The relevance of the conceptual framework The conceptual framework developed was clear and concise and set out clear steps to improve the health and well-being of HIV/AIDS-infected children’s caregivers in the Ngaka Modiri Molema district, West Africa. Furthermore, since the conceptual framework has been developed for nurses, it is user-friendly and can be used in all PHC service contexts. The information provided in the conceptual framework can also be used by policymakers to improve the health and well-being of caregivers of HIV/AIDS-affected children at the national level. 3.3 The assumptions of the conceptual framework The main themes and subthemes arising from the empirical phase were combined to develop this conceptual framework. Dickoff et al. answered six crucial questions. The following description of the practical orientation theory [ 13 ] is as follows: Agent: (Who Is the Agent?) The roles and responsibilities of OTLs as agents are to provide community outreach services, preventive, promotional, therapeutic, rehabilitation, and relief medicine, as well as primary health care to families and households [ 25 ]. Furthermore, OTLs are responsible for communicating with the community to identify issues that affect their health and well-being and take the necessary measures to address identified health problems [ 26 ]. In the context of this study, agents must follow six steps of the conceptual framework developed to improve the health and well-being of care for HIV/AIDS orphan children. Recipient (Who is the recipient?) Caring for HIV/AIDS orphans in a stressful environment has negatively affected the health and well-being of caregivers. Consequently, this has decreased caregiver motivation to discharge their duties. Based on that, caregivers may benefit from the conceptual framework after full implementation as it aims to improve their health and well-being. Context (In what context is the conceptual framework performed?) The framework will be implemented in the respective homes of caregivers of children orphaned by HIV/AIDS. The second context is the existing PHC facilities whereby OTLs report to their operational activities. Each WBPHCOT in South Africa is connected to a PHC facility and is made up of five or more community health workers (CHWs) in addition to a team leader, who is typically a professional nurse commonly known as OTLs [ 27 ]. Additionally, the study conducted in South Africa reported that WBPHCOT acts as a liaison between the community and PHC facilities they are eyes and ears, and hands of profession [ 28 ]. The authors further claim that WBPHCOT serve as the PHC facilities' professional staff's hands, eyes, and ears. According to The WBPHCOT is essential in helping PHC facility professional nurses connect with patients in the community and track the course of their illness [ 28 ]. If caregivers of children orphaned by HIV/AIDS consult at the, PHC facilities professional nurses should use the developed conceptual framework developed as a vehicle to address their health needs. Procedure (How will the conceptual framework be implemented?) In this study, the procedure denotes the steps that will be followed by OTLs and the professional nurses as agents when implementing the conceptual framework for caregivers of HIV/ADS orphans. Home visits are vital as they help the OTLs in evaluating the living conditions and health practices of caregivers. According to a descriptive cross-sectional study carried out in Ghana, community health nurses use home visits as a medical platform to offer some basic curative and mostly preventative healthcare services to community members in the comfort of their own homes [ 29 ]. The authors further asserted that community health nurses provide support to families in maintaining a healthy lifestyle and provide extra care to the most vulnerable members of the community [ 29 ]. Within the context of this study, home visits should first start by the CHWs to identify the health needs of the caregivers of children orphaned by HIV/AIDS. After identifying health problems experienced by caregivers of children orphaned by HIV/AIDS, the CHWs refer the matter to the OTLs for interventions by taking the necessary actions relevant to the health needs identified and give health education. Health education is the structured approach used by healthcare professionals to provide society with the resources it needs to practice preventative care [ 30 ]. To improve community well-being, health education is essential because it addresses a variety of health issues, from social, psychological, mental health to chronic diseases, and it promotes healthy behaviours and knowledge across all age groups [ 31 ]. In other words, nurses need to be prepared to use health education as an instrument to modify their lifestyles for betterment of health [ 32 ]. Nurses must be able to teach patients how to prevent illness, enhance their health, take prescribed medications, and make sure their efforts to return to normal function are successful [ 32 ]. Consequently, OTLs should see to it that caregivers of children orphaned by HIV/AIDS receive ongoing health education. Routine blood and growth monitoring must be used as a tool to measure target achievement to keep an eye on whether caregivers are administering medication appropriately. Healthcare professionals in the South African context are empowered by policies, guidelines, and standards set by the Department of Health to monitor the growth of the children who are infected and by HIV/AIDS [ 33 ]. The World Health Organization (WHO) promoted viral load measurement because, in the wake of increased adherence support, it aids in distinguishing between treatment failure and non-adherence among people living with HIV (PLWHIV) [ 34 ]. Moreover, viral load testing provides PLWHIV with a gauge of their knowledge, control, and incentive to follow their treatment plan and comprehend the extent of their HIV infection [ 34 ]. According to descriptive research carried out in Mumbai, India, routine viral load testing prevented needless switching and allowed for the early identification of treatment failures and referrals to second- and third-line regimens [ 35 ]. According to qualitative research done in the Polokwane municipality of South Africa, the program assists in identifying developmental milestones and growth failing in children so that prompt interventions can be implemented [ 36 ]. This study suggests that OTLs must not strictly rely on guidelines, protocols, and policies of HIV/AIDS management in South Africa. Flexibility is needed in the cases of implementation of the standards curtailed by Department of Health to manage HIV/AIDS in South Africa. For instance, if children living with HIV (CLWHIV) present with failure to thrive (FTT), the OTLs must not wait for the period prescribed to monitor blood monitoring it should be attended to immediately. Growth of CLWHIV should be monitored regularly during home visits or consultation at the PHC facilities. The OTLs must provide both caregivers and HIV/AIDS orphans with emotional support during disclosure. Previous research highlighted that there are caregivers of children orphaned by HIV/AIDS who struggle to carry out disclosure process governments should set up mechanisms to capacitate with knowledge and skills that boost their confidence [ 37 ]. Consistently with existing literature, a narrative review by Molato et al. [ 38 ]. highlighted the following elements as having an impact on HIV status disclosure to affected children: the children's age; the primary caregivers' educational status; stigma and discrimination; and a lack of knowledge and skills about HIV status disclosure. A qualitative exploratory descriptive study carried out in the Limpopo Province, South African caregivers for CLWHIV were not trained in initiating HIV disclosure [ 39 ]. Given that, caregivers of orphaned children by HIV/AIDS who lack the ability to disclose believed that healthcare professionals should help them to conduct disclosure process [ 40 ]. Despite inadequate support, the findings of the study conducted by Muditambi et al. [ 39 ] revealed that caregivers reported that the healthcare practitioner had advised them on how to disclose HIV status to CLWHIV. We therefore suggest that training and unequivocal support should be provided to the caregivers to enable them conduct disclosure process independently. Alternatively, OTLs can also avail themselves during disclosure to provide both caregivers and children orphaned by HIV/AIDS with emotional support to alleviate emotional distress. Additionally, OTLs should help by being a sympathetic ear and helping to ease their discomfort. The significance of disclosure of HIV status to CLWHIV should be a key factor that drives both caregivers and OTLs. One of the importance of disclosing HIV status that include facilitation of medication adherence was reported by the scoping review conducted by [ 41 ]. OTLs must first explore the effective coping mechanisms that caregivers use to cope with burden of caring for children orphaned by HIV/AIDS. In line with existing literature, the qualitative study conducted in the North West Province highlighted that caregivers who relied on religious practices managed to cope with all the difficulties that interfered with their ability to discharge effective and efficient care for HIV HIV/AIDS orphans [ 42 ]. According to the authors, some of the caregivers used singing of gospel hymns and prayer for coping whenever they find themselves in predicament aggravated by execution of caring tasks among children orphaned by HIV/AIDS. Similar results were reported by the study conducted in Ethiopia caregivers put God first in everything that they were doing and difficulties that confronted them in caring for orphaned children [ 43 ]. They had hope that through him everything is possible he cannot leave his children to suffer without providing solutions to their problems [ 43 ]. The findings of this study, together with those from earlier research, demonstrate the necessity of having trust and hope in God and the necessity of involving him in whatever we do daily. As Christians, we affirm that God is willing to listen to our suffering and provide interventions to help us overcome the obstacles we encounter. On that note, OTLs must encourage and motivate caregivers of children orphaned by HIV/AIDS who are Christians not to lose hope in God even if their prayers take time to be answered, they must be patient. They should emulate a man who was critically ill, helpless, and stayed for a period of 38 years next to the river of Bethesda with hope, faith, and trust that one day he’ll get help [ 44 ]. It should be the prerogative of OTLs to ensure that all children who have lost parents due to HIV/AIDS receive foster care grants (FCG) from the government monthly. Social grants play an important role in their lives as they help them in accessing essentials such as food, stationery, and school uniforms. The welfare and well-being of the orphaned children depend heavily on the state providing the FCG to foster caregivers to help them alleviate the financial strain on their family [ 45 ]. The FCG program also gives foster parents the tools and assistance they need to ensure that the needs of orphaned children are appropriately met [ 45 ]. It is thus imperative that OTLs screen for caregivers of children of orphaned by HIV/AIDS who do not receive FCG during home visits routines and establish the root cause and intervene. OTLs should mobilize support networks for caregivers of children orphaned by HIV/AIDS. Research has indicated that social support from friends, family, and other social networks improves life quality and serves as a crucial defense against mental health issues [ 46 ]. This was evident in the study conducted in the NWP in which caregivers of HIV/AIDS orphans relied on the support of significant others to cope with all challenges that interfered with their ability to carry out their day-to-day activities [ 42 ]. OTLs must also motivate caregivers to join social clubs and groups. According to the literature, caregivers who joined social clubs and groups were able to learn more about HIV care, lessen discrimination and stigma, encourage disclosure, and improve their relationship with orphaned children [ 47 ]. Moreover, caregivers of children orphaned children by HIV/AIDS should be advised and encouraged to join social clubs. Social connections are usually made between people who have common social interests rather than between strangers [ 48 ]. As a result, while examining how social networks arise, it is also important to carefully examine the social environment, in particular the quantity and variety of social clubs as well as the kinds of affiliations that individuals have inside them [ 48 ]. Common examples of social clubs include support groups, stokvels, family society, and sports clubs. Considering this, OTLs must counsel caregivers of children orphaned by HIV/AIDS to become members of social clubs like stokvels, which are recognized in literature as the primary means of reducing poverty and promoting social mobility [ 49 ]. The authors also claimed that members of stokvels can meet their fundamental necessities. Members of stokvels could invest, save, and eventually amass assets [ 49 ]. Previous studies reported that stokvels helped caregivers save a lump sum of money that they divided at the end of the year to buy bulk groceries [ 42 , 50 ]. According to the authors, caregivers were relieved that they didn't have to buy groceries after receiving social grants because the groceries lasted for almost three months. Caregivers had to reallocate the social grant funds to buy other essentials they needed. As far is mobilization of the resources is concerned, OTLs must ensure that community resources such as multi-purpose skills centers are utilized effectively to empower caregivers of children orphaned by HIV/AIDS with knowledge and skills to sustain their life. In support of these findings, a cohort longitudinal study conducted in Swaziland revealed that caregivers of children orphaned by HIV/AIDS were capacitated with skills to start businesses [ 51 ]. According to the authors, among the WORTH members who were caregivers for orphaned children, one-third (33.4%) were able to start a business, and 41% of the caregivers was able to grow their business from one to two (or more) [ 51 ]. Literature about measures put in place by government or non-governmental organizations (NGOs) to develop caregivers of children orphaned by HIV/AIDS remain unknown in the South African context. Therefore, it is essential that OTLs work with various stakeholders who are interested in community development to empower caregivers of HIV/AIDS orphaned children in this study. It should be the prerogative of the OTLs to ensure that all children who have lost parents due to HIV/AIDS are receiving foster care grants from the government monthly. Social grants play a significant role in their lives as they assist them in accessing essentials such as food, stationery, and school uniforms. According to the qualitative study conducted in South Africa, social grants given by the government to caregivers and children who have become orphans due to HIV/AIDS are insufficient to meet their daily needs [ 52 ]. The author also stated that caregivers had respectfully asked for an increase in foster care grant to cover the costs of various extras, such as educational policies, which are crucial to ensuring that orphaned children have a respectable future. Dynamics (What are the dynamics of the conceptual framework) Accessibility of health in terms of information and distance is greatly facilitated by the WBPHCOT initiative, which extends PHC services to the community and household level [ 53 , 54 ]. CHWs as members of WBPCOT are expected to take healthcare services to the society at their respective households regardless of limited training, resources, and support [ 53 ]. OTLs who are professional nurses lead the team and work closely with CHWs to supervise them in ensuring that professional duties are carried out accordingly. Therefore, it is important that agents of the framework induct CHWs on the conceptual framework so that they can be aware of their roles and responsibilities and know what is expected of them. As custodians of the provision of healthcare services in South Africa, the Department of Health detailed the responsibilities of OTL to collaborate with non-healthcare professionals, private health centres, and non-governmental organizations to eradicate community health-related issues. This research confirms the findings of previous studies that emphasised the central role of MDT as a means of assembling a team of healthcare professionals from various specialities to design individualized plans for the treatment of patients [ 55 ]. The MDT stakeholders reported in this study include nurses, social workers, psychologists, dieticians, and many others who fall into the medical field. Caregivers of children orphaned by HIV/AIDS who are encountering psychosocial challenges should be referred to the social workers. This result aligns with the recommendation of a qualitative study carried out in South Africa, which suggested that foster parents of abandoned children exhibiting social and welfare issues ought to be referred to the social workers [ 56 ]. In the cases of caregivers not coping due to emotional and psychological distress due to stressful situations in which they care for orphaned children, they should be referred to the psychologists. Prior studies have emphasized that psychologists are responsible for addressing social issues and advancing the health and well-being of community members [ 57 ]. They also work to create preventative initiatives and educate the public on how to maintain that. Dietitians must be involved by the OTLs to start community nutrition, which is the act of assisting people and groups in creating wholesome eating habits to promote wellbeing and fend against disease [ 58 ]. To improve the health and nutrition status of people living with HIV, the expertise of a registered dietitian/nutritionist as part of the health care team should be considered. Past research has demonstrated that nutrition education or counselling improves dietary intake and nutritional status in adults living with HIV/AIDS significantly [ 59 , 60 , 61 , 62 ]. The authors stressed that to enhance the health and nutritional condition of those living with HIV, dietitians and nutritionists should be taken into consideration. OTLs can also facilitate collaboration with non-healthcare professionals to advance the needs of caregivers of children orphaned by HIV/AIDS who are dysfunctional socially. OTLs as the framework's agents have a responsibility to maintain communication between MDT and other stakeholders. There should be constant communication between the agent and MDT to facilitate the health and well-being of caregivers of children orphaned by HIV/AIDS. Patient safety may be at risk when members of the healthcare team are not communicating properly [ 63 ]. As per the authors' assertion, inadequate communication exacerbates the likelihood of medical errors [ 63 ]. Therefore, effective communication is the primary factor influencing the team's performance and quality [ 64 ]. The author went on to explain that effective communication forms the cornerstone of all subsequent endeavours and guarantees favourable patient outcomes [ 64 ]. Health promotion has been the cornerstone of the Healthy People project, which aims to promote "health and well-being" more broadly [ 65 ]. Currently, health promotion process contributes to both individual and societal well-being in addition to health [ 65 ]. In terms of health promotion, illness prevention, treatment, and care, nurses are the backbone of health teams they play a significant role in ensuring that the goals of the program are achieved [ 66 ]. In the framework of this study, OTLs are required to plan, coordinate, and carry out health promotion activities to improve the health and wellbeing of caregivers of children orphaned by HIV/AIDS in the North West Province. Moreover, OTLs should strengthen community action for health, build their skills, and create supportive environments for health to meet the goal of improving the health and well-being of the caregivers of children orphaned by HIV/AIDS in the North West Province [ 67 ]. Terminus (What is the end point of the conceptual framework?) The agent must ensure that all steps of the conceptual framework are carried out productively so that the last step can be achieved, which is evidenced by optimum health, functional support system, effective coping mechanisms, and active execution of caregiving responsibilities. The developed conceptual framework will also be used to develop health promotion strategies to improve health and well-being of caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa see Fig. 1 below for more information. Limitations The punctuality of the participants was a problem, the researcher had to always start late, and other appointments scheduled for that day were affected by such incidents. Conclusions This study aimed to develop a conceptual framework for health promotion strategies of caregivers of children orphaned by HIV/AIDS in the Ngaka Modiri Molema district. A qualitative and descriptive contextual research design was used to achieve the study objectives. The conceptual framework may inform the development of health promotion strategies to improve the health and well-being of caregivers of children orphaned by HIV/AIDS in the Ngaka Modiri Molema district of South Africa. Declarations Acknowledgements We gratefully acknowledge Prof N.V. Sepeng for peer reviewing the manuscript, Mr I.O. Mokgaola, and Mr K. Racoco for designing the conceptual framework. Authors Contributions: The conceptualization was carried out by BJ, SSM, MPK and M.J.M., The study design was developed B.J., S.S.M., M.P.K., and MMJ, JSM and B.J.M. was responsible for data collection, BJM, SSM, MPK and M.J.M., analyzed data, BJ.M., S.S.M., M.P.K., and M.J.M drafted the manuscript, SSM M.P.K and M.J.M C.H. critically revised and edited the article. All authors have reviewed and approved the manuscript for publication. Funding: This study received funding from Health and Welfare Sector Education and Training Authority (HWSETA). Institutional Review Board Statement: This study was approved by the North West University Health Research Ethics Committee (NWU-HREC) (Reference Number: NWU-00309-21-A1) Data Availability Statement: There will be no public sharing of any of the raw data, it will remain private and confidential. This includes audio recordings and interview transcripts. Declarations of conflict of interest Ethics approval and consent to participate Written informed consent was obtained from both caregivers of children orphaned by HIV/AIDS and nurses prior to the beginning of the interviews. They were given at least 7-14 days to consult and make an informed decision before signing the consent form. After 7-14 days, the researcher met the prospective participants face to face to explain further and for signing of the consent form. Informed consent was acquired from all study participants when conducting this study. Consent for publication Not applicable Competing Interests The authors declare that there is no conflict of interest. References Osafo J, Knizek BL, Mugisha J, Kinyanda E. The experiences of caregivers of children living with HIV and AIDS in Uganda: a qualitative study. Globalization and health. 2017 Dec;13(1):1-3. Campbell, C., Foulis, C. 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Molato BJ, Meno OF, Sepeng NV, Mokgaola IO, Gause G, Sehularo LA. Factors motivating PLWHVA to disclose status to sexual partners: A scoping review: HIV/AIDS Review, 2024 [Unpublished]. Molato BJ, Moloko-Phiri SS, Koen MP, Matsipane MJ. Coping mechanisms used by caregivers of HIV/AIDS orphans in North West province, South Africa. S Afr Fam Pract. 2024;66(1), a5857. https://doi.org/ 10.4102/safp. v66i1.5857 Tadesse A, Helton JJ, Li K. Perceived Worries and Spirituality: A Mixed Methods Study of the Primary Caregiver Well-Being of Orphan and Vulnerable Children in Ethiopia. Children. 2024 Mar 22;11(4):380. Bible Gateway. Healing at the Pool. Accessed on 22 May 2022 https://www.biblegateway.com/passage/?search=John%205&version=NIV Lebelo MS. The social impact of the foster care grant on families caring for orphaned children: a case of Senwabarwana, Limpopo. University of Johannesburg (South Africa); 2020. Wickramaratne PJ, Yangchen T, Lepow L, Patra BG, Glicksburg B, Talati A, Adekkanattu P, Ryu E, Biernacka JM, Charney A, Mann JJ. Social connectedness as a determinant of mental health: A scoping review. PloS one. 2022 Oct 13;17(10):e0275004. Molato BJ, Moloko-Phiri SS, Koen MP, Matsipane MJ. Support provided by outreach team leaders to caregivers of HIV/AIDS orphans in the North-West Province of South Africa, 2024 [Unpublished]. Fershtman C, Persitz D. Social clubs and social networks. American Economic Journal: Microeconomics. 2021 Feb 1;13(1):224-51. Matuku S, Kaseke E. The role of stokvels in improving people's lives: The case in orange farm, Johannesburg, South Africa. Social work. 2014;50(4):504-15. NASASA. About Stokvels https://nasasa.co.za/about-stokvels/ (Accessed on 22 May 2024). Makufa SC, Kisyombe D, Miller N, Barkey N. Empowering caregivers of orphans and vulnerable children in Swaziland. African Journal of AIDS Research. 2017;16(4). Hendricks EA. The view of foster parents on the adequacy of foster care grant in meeting the needs of recipients in Amathole District, South Africa. Social work and social sciences review. 2021 Apr 3;22(2):103-15. Assegaai & Schnider, 2019: National guidance and district-level practices in the supervision of community health workers in South Africa: a qualitative study Khuzwayo LS, Moshabela M. The perceived role of ward-based primary healthcare outreach teams in rural KwaZulu-Natal, South Africa. African J Prim Heal Care Fam Med. 2017;9(1):1–5. Taberna M, Gil Moncayo F, Jane-Salas E, Antonio M, Arribas L, Vilajosana E. The multidisciplinary team approach (MDT) and quality of care. Front Oncol. 2020; 10: 85. Alpaslan N, Mabutho SL. Caring for AIDS orphans: The experiences of elderly grandmother caregivers and AIDS orphans. Social Work/Maatskaplike Werk. 2005 May 3;41(3):276-95. Cherry K. Different Types of Psychologists and What They Do. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4534176","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":324757456,"identity":"3ceac923-56f5-4f49-87bd-7dfa15f4a80b","order_by":0,"name":"Boitumelo Joy Molato","email":"data:image/png;base64,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","orcid":"","institution":"North-West University","correspondingAuthor":true,"prefix":"","firstName":"Boitumelo","middleName":"Joy","lastName":"Molato","suffix":""},{"id":324757460,"identity":"5f640c68-71a0-4ec6-88b0-b494d3f26501","order_by":1,"name":"Salaminah Moloko-Phiri","email":"","orcid":"","institution":"North-West University","correspondingAuthor":false,"prefix":"","firstName":"Salaminah","middleName":"","lastName":"Moloko-Phiri","suffix":""},{"id":324757461,"identity":"ded7ce77-508e-4bca-9df7-fc959f52e672","order_by":2,"name":"Magdalena Koen","email":"","orcid":"","institution":"North-West University","correspondingAuthor":false,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Koen","suffix":""},{"id":324757462,"identity":"6bbc0e8b-67f9-4852-95fb-6de4cfeb77ec","order_by":3,"name":"Molekodi Matsipane","email":"","orcid":"","institution":"North-West University","correspondingAuthor":false,"prefix":"","firstName":"Molekodi","middleName":"","lastName":"Matsipane","suffix":""}],"badges":[],"createdAt":"2024-06-05 12:45:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4534176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4534176/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-024-02411-z","type":"published","date":"2024-10-14T15:57:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60614390,"identity":"28e59ea5-ccba-40b1-9de7-2d44c08f4031","added_by":"auto","created_at":"2024-07-18 20:03:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":237897,"visible":true,"origin":"","legend":"\u003cp\u003eA conceptual framework for health and well-being of caregivers of children orphaned by orphaned by HIV/AIDS\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4534176/v1/75bcef3260b8a5729fba7f50.png"},{"id":67149157,"identity":"9a749f2f-2972-4186-81f0-5b68ef7919a6","added_by":"auto","created_at":"2024-10-21 16:12:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":663272,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4534176/v1/dc9d1a2f-a9c9-42d8-b447-e320d5fdb6ce.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Conceptual Framework for the health and well-being of caregivers of HIV/AIDS orphans in North West Province, South Africa","fulltext":[{"header":"Background","content":"\u003cp\u003eThe human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain a public health disease that has left caregivers of HIV/AIDS orphans with challenges [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Caregivers who are expected to care for HIV/AIDS orphans after the passing away of their parents are sometimes unable to carry out caring duties due to poor health and well-being [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Furthermore, research carried out in South Africa's North West Province (NWP) revealed that unfavourable conditions in which they must discharge caregiving duties and the burden of caring for HIV/AIDS orphans deteriorated the health and well-being of HIV/AIDS caregivers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The World Health Organization defines health as a state of complete physical, mental and social well-being and not simply the absence of disease or infirmity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A peaceful and satisfied life is influenced by being in excellent health. Living without stress and illness is essential for maintaining health and well-being. Well-being is defined as the union of happiness, optimal functioning, experience of positive emotions, and relationships in a conducive environment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHealth and well-being are two dimensions of health that are interrelated and influence each other. Activities promoting health help people in transitioning from an unhealthy lifestyle to one that improves their health and well-being [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The literature on the conceptual framework to improve the health and well-being of children orphaned by HIV/AIDS in the North west province remains unknown. Therefore, the findings of an intervention for the health and well-being of caregivers of HIV/AIDS orphans are critical to allow them to perform caregiving responsibilities as they should. Therefore, the researchers saw a need to develop a conceptual framework for the health and well-being of caregivers of HIV/AIDS orphans in the North West Province. A conceptual framework helps to aid in the comprehension of the connections between concepts or variables about the actual world [8,9.10]. To produce and organize information about connected concepts or issues, the conceptual framework connects concepts, empirical research, and pertinent theories [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, a conceptual framework is used to design a general research challenge or to strengthen an already-identified issue [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Conceptual frameworks developed by [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. followed the Practice-Oriented Theory (POT) by Dickoff, James and Wiedenbach [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] to develop conceptual frameworks for psychosocial care and support for orphans and vulnerable children and for rape survivors diagnosed with post-traumatic stress disorders [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven that, researchers saw it necessary to adopt POT survey list to develop a conceptual framework for health and well-being of caregivers of HIV/AIDS orphans. This article is part of the main study that aims to develop health promotion strategies to improve the health and well-being of caregivers of children orphaned by HIV/AIDS in the Ngaka Modiri Molema district, North West Province of South Africa. Therefore, the developed conceptual framework will be used to guide the development of health promotion strategies for health and well-being of the caregivers of HIV/AIDS orphans in North West Province which is the main objective of this study.\u003c/p\u003e\n\u003ch3\u003eConceptual framework\u003c/h3\u003e\n\u003cp\u003eThe POT survey list by [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] was adopted to develop a conceptual framework for the health and well-being of caregivers of HIV/AIDS orphans. The features of POT include the following:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAgent (Who is the agent of the framework?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe term \u0026lsquo;agent\u0026rsquo; refers to individuals who ensure the implementation of conceptual frameworks [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In addition, the agent is an individual within the structure who carries out tasks that are integrated into it. In this study, agent refer to all professional nurses who works in the healthcare facilities and for ward-based primary healthcare outreach teams (WBPHCOTs) as outreach team leaders (OTLs).\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eRecipient (who is the recipient of the framework)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe recipient refers to the person who benefits from the health services provided by the agent [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In this study, all recipients were caregivers of children orphaned by HIV/AIDS. The caregivers refer to aunt, uncle, grandparents, sisters, brothers, over the age of 18, single or married, and taking care of children orphaned by HIV/AIDS in North West Province, South Africa.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eContext (in which context will the framework be implemented)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe context in this study refers to the environment or surroundings in which the conceptual framework will be implemented [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, context refer to the homes of the caregivers of children orphaned by HIV/AIDS and the healthcare facilities in North West Province, South Africa. The WBPHCOTs are composed of community health workers (CHWs) who get oversight, referral, and support from OTLs and are connected to nearby primary health care (PHC) institutions [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The community care and support system that was established in response to HIV and AIDS in South Africa is based on non-governmental organizations (NGOs), which is the foundation upon which these outreach teams build [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eProcedure (How will the framework be implemented)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe procedure refers to the process that is described in this framework that the agent to achieve the objectives of the study [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The process includes health promotion activities that aim to improve health and well-being of caregivers of children orphaned by HIV/AIDS in North West Province, South Africa.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eDynamics (What are the dynamics of the framework)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe dynamics are the actions that the agents to ensure that the conceptual framework is implemented [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, dynamics refer to collaborative efforts by OTLs to ensure that the objective of the conceptual framework is achieved. The OTLs can partner with doctors, social workers, psychologists, dieticians, police, community-based organizations, NGOs, and other stakeholders that will be needed to advance the needs of the caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTerminus (What will be the endpoint of the framework)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe concept \u0026ldquo;terminus\" describes the conclusion or result of the conceptual framework [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The authors further explained the endpoint as the result of the agent's efforts leading to improved outcomes. In this study, the endpoint is the conceptual framework that informs the development of the health promotion strategies to improve health and well-being of the caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e2.1 Study Design\u003c/p\u003e\n\u003cp\u003eThe exploratory descriptive contextual design was used for this study. Qualitative research approach methods were used to perform three steps of the empirical phase. Phase 1 of this study had two steps namely steps one, and two. Step one of this addressed two objectives of the study. Objective one explored and described challenges faced by caregivers of children orphaned by HIV/AIDS whilst objective two explored and described the coping mechanisms used by caregivers of children orphaned by HIV/AIDS. Regarding step two, support provided by outreach team leaders (OTLs) to the caregivers of HIV/AIDS orphans was explored. Exploratory research design was used to explore research questions for this study as they were not investigated before. [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. The descriptive research design was used to describe a phenomenon and its characteristics [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. In terms of contextual research design, interviews were conducted at where the participants reside [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e2.2 Context\u003c/p\u003e\n\u003cp\u003eThe study context included five municipalities of the Ngaka Modiri Molema District, North West Province of South Africa. The municipalities where data was collected include Mahikeng, Ramotshere-Moiloa, Ditsobotla, Ratlou, and Tswaing. Within the province of North West, Ngaka Modiri Molema District is one of four district municipalities, encompassing an approximate area of 28 114 km\u0026sup2; [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e]. Currently, Ngaka Modiri Molema District Municipality is home to 268 099 houses and 961 960 residents. Using the upper poverty line criterion, there are 640 000 (67.66%) persons living in poverty in Ngaka Modiri Molema District Municipality. This is 3.14% more than the 621 000 in 2008 [\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e2.3 Population and sampling\u003c/p\u003e\n\u003cp\u003eThe study population was caregivers of children orphaned by HIV/AIDS, professional nurses working as primary health care outreach team (WBPHCOT) leaders, commonly known as outreach team leaders (OTLs) and that is the name that has been used in this study to refer to them. Purposive sampling was used to select both caregivers of HIV/AIDS orphans and the professional nurses.\u003c/p\u003e\n\u003cp\u003eCaregivers of HIV/AIDS orphans who gave consent to participate in the study were thirteen (13), their ages ranges from 28\u0026ndash;69. Amongst the caregivers of HIV/AIDS orphans, nine were unemployed whilst four of them were pensioners. All caregivers of HIV/AIDS orphans who participated in the study were females. With regards to professional nurses, thirty-seven (37) participated in the study of which thirty-three (33) were females and four (4) were males. Four categories of age of the professional were as follows: 30\u0026ndash;39 were 2, 40\u0026ndash;49 were 5, 50\u0026ndash;59 were 12, and 60\u0026ndash;69 were 18.\u003c/p\u003e\n\u003cp\u003e2.4 Data collection\u003c/p\u003e\n\u003cp\u003eTwo steps in Phase 1 were followed to collect data in this study. In step one of Phase 1, individual semi-structured interviews were used to explore and describe the challenges faced by caregivers of HIV/AIDS orphans. This study developed the interview guide to achieve the objectives of the study. The research questions for individual semi-structured interviews were: What are the challenges that you face to care for HIV/AIDS orphans and what are the coping mechanisms that you use to care for HIV/AIDS orphans. Step two of Phase 1 used focus group semi-strucutred interviews to explore and describe the support provided by outreach team leaders (OTLs) to caregivers of HIV/AIDS orphans. This phase had only one central question for step which was: what support you provide to the caregivers of children orphaned by HIV/AIDS. The results gathered in Phase 1 were combined in Phase 2 to develop a conceptual framework for health and well-being of caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa. Data was collected during the day in both interviews. An audio recorder was used to record all the interviews. Setswana language was used to collect data during semi-structured individual interviews which were later translated into English language before transcribing. Focus group semi-structured interviews were conducted using English language.\u003c/p\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eSix steps of thematic data analysis were followed to analyze data collected in Phase 1 which had three steps [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Before beginning any analysis, the researchers and co-coder familiarized themselves with the data. Throughout the entire coding process, the research question served as a guide. The codes were grouped into themes to answer the research question and fulfil the objectives of the study [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e]. Following the themes\u0026apos; examination, pertinent data was categorized with each theme. The establishment of the relationship between themes and sub-themes was done [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Data analysis took place simultaneously with data collection to establish whether data saturation has been reached [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. Field notes and all the data collected during Phase 1 were first examined independently, and then combined.\u003c/p\u003e\n \u003cp\u003e2.5 Recruitment of participants\u003c/p\u003e\n \u003cp\u003eAfter approval of this study by the North West University Health Research Ethics Committee (NWUHREC), including the North West Provincial Department of Health, pamphlets were emailed to the district communication officer to invite nurses to participate in the study. The subdistrict managers of the five local municipalities under Ngaka Modiri Molema district and the Primary Health Care (PHC) programme manager were also copied. The communication officers posted pamphlets on the Department notice boards. Nurses who showed interest in participating in the study called the research assistant to make an appointment with him for further details. The research assistant had a short interview with nurses who showed interest in assessing their eligibility to participate in the study. The same procedure was followed to recruit caregivers for children orphaned by HIV/AIDS. In the case of caregivers, brochures were posted in public spaces such as clinics, stores, and churches to recruit them for participation in the study. Interested caregivers also called the research assistant to make appointments to discuss how to meet up to plan for the data collection date.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e2.6 Ethics approval\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThis study was approved by NWUHREC, an institution of higher learning in the North West Province. Permission to conduct the study was obtained from North West Department of Health Ethics committee. This work is part of our overall research which aims to develop health promotion strategies to improve the health and well-being of caregivers of children orphaned by HIV/AIDS. The participants were informed about the purpose of the study and their rights prior participating in the study. The participants were informed about the principle of autonomy, which is voluntary participation [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, the right to withdraw at any time from the study was also explained to the participants. Privacy and confidentiality were maintained throughout the entire process of interviews [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e2.7 Trustworthiness\u003c/p\u003e\n \u003cp\u003eThe following four trustworthiness principles were adhered to maintain the rigor of the study.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eCredibility\u003c/h2\u003e\n \u003cp\u003eProlonged engagement was applied throughout the study. Interviews were recorded and field notes were also taken to annotate the verbal and non-verbal cues. Participants in the study were consulted after data analysis for validation purposes [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eDependability\u003c/h2\u003e\n \u003cp\u003eQualitative exploratory, descriptive, and contextual design methods were used in this study. This principle was adhered to by ensuring detailed data transcription, data coding, data analysis, and the use of literature control [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eConfirmability\u003c/h2\u003e\n \u003cp\u003eThe data were independently analysed by both the researcher and the coder. After analysing data independently, the two parties compared both themes and subthemes emerging from the study. Open-ended questions were also applied, followed by probing for clarity. The existing literature was used to confirm and equally disprove the findings of the study [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\n \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003eTransferability\u003c/h2\u003e\n \u003cp\u003eBy giving readers thorough contextual information to evaluate the findings\u0026apos; applicability, a thick description of the data was preserved [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Results and Discussion","content":"\u003cp\u003eThis study aimed to develop a conceptual framework to improve the health and well-being of caregivers of children orphaned by HIV/AIDS. The focus of this section will be on the process followed to develop the conceptual framework see the diagram below for more information.\u003c/p\u003e \u003cp\u003e3.2 The relevance of the conceptual framework\u003c/p\u003e \u003cp\u003eThe conceptual framework developed was clear and concise and set out clear steps to improve the health and well-being of HIV/AIDS-infected children\u0026rsquo;s caregivers in the Ngaka Modiri Molema district, West Africa. Furthermore, since the conceptual framework has been developed for nurses, it is user-friendly and can be used in all PHC service contexts. The information provided in the conceptual framework can also be used by policymakers to improve the health and well-being of caregivers of HIV/AIDS-affected children at the national level.\u003c/p\u003e \u003cp\u003e3.3 The assumptions of the conceptual framework\u003c/p\u003e \u003cp\u003eThe main themes and subthemes arising from the empirical phase were combined to develop this conceptual framework. Dickoff et al. answered six crucial questions. The following description of the practical orientation theory [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] is as follows:\u003c/p\u003e \u003cp\u003eAgent: (Who Is the Agent?)\u003c/p\u003e \u003cp\u003eThe roles and responsibilities of OTLs as agents are to provide community outreach services, preventive, promotional, therapeutic, rehabilitation, and relief medicine, as well as primary health care to families and households [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Furthermore, OTLs are responsible for communicating with the community to identify issues that affect their health and well-being and take the necessary measures to address identified health problems [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In the context of this study, agents must follow six steps of the conceptual framework developed to improve the health and well-being of care for HIV/AIDS orphan children.\u003c/p\u003e \u003cp\u003eRecipient (Who is the recipient?)\u003c/p\u003e \u003cp\u003eCaring for HIV/AIDS orphans in a stressful environment has negatively affected the health and well-being of caregivers. Consequently, this has decreased caregiver motivation to discharge their duties. Based on that, caregivers may benefit from the conceptual framework after full implementation as it aims to improve their health and well-being.\u003c/p\u003e \u003cp\u003eContext (In what context is the conceptual framework performed?)\u003c/p\u003e \u003cp\u003eThe framework will be implemented in the respective homes of caregivers of children orphaned by HIV/AIDS. The second context is the existing PHC facilities whereby OTLs report to their operational activities. Each WBPHCOT in South Africa is connected to a PHC facility and is made up of five or more community health workers (CHWs) in addition to a team leader, who is typically a professional nurse commonly known as OTLs [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Additionally, the study conducted in South Africa reported that WBPHCOT acts as a liaison between the community and PHC facilities they are eyes and ears, and hands of profession [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe authors further claim that WBPHCOT serve as the PHC facilities' professional staff's hands, eyes, and ears. According to The WBPHCOT is essential in helping PHC facility professional nurses connect with patients in the community and track the course of their illness [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. If caregivers of children orphaned by HIV/AIDS consult at the, PHC facilities professional nurses should use the developed conceptual framework developed as a vehicle to address their health needs.\u003c/p\u003e \u003cp\u003eProcedure (How will the conceptual framework be implemented?)\u003c/p\u003e \u003cp\u003eIn this study, the procedure denotes the steps that will be followed by OTLs and the professional nurses as agents when implementing the conceptual framework for caregivers of HIV/ADS orphans. Home visits are vital as they help the OTLs in evaluating the living conditions and health practices of caregivers. According to a descriptive cross-sectional study carried out in Ghana, community health nurses use home visits as a medical platform to offer some basic curative and mostly preventative healthcare services to community members in the comfort of their own homes [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe authors further asserted that community health nurses provide support to families in maintaining a healthy lifestyle and provide extra care to the most vulnerable members of the community [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Within the context of this study, home visits should first start by the CHWs to identify the health needs of the caregivers of children orphaned by HIV/AIDS. After identifying health problems experienced by caregivers of children orphaned by HIV/AIDS, the CHWs refer the matter to the OTLs for interventions by taking the necessary actions relevant to the health needs identified and give health education.\u003c/p\u003e \u003cp\u003eHealth education is the structured approach used by healthcare professionals to provide society with the resources it needs to practice preventative care [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. To improve community well-being, health education is essential because it addresses a variety of health issues, from social, psychological, mental health to chronic diseases, and it promotes healthy behaviours and knowledge across all age groups [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In other words, nurses need to be prepared to use health education as an instrument to modify their lifestyles for betterment of health [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Nurses must be able to teach patients how to prevent illness, enhance their health, take prescribed medications, and make sure their efforts to return to normal function are successful [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Consequently, OTLs should see to it that caregivers of children orphaned by HIV/AIDS receive ongoing health education.\u003c/p\u003e \u003cp\u003eRoutine blood and growth monitoring must be used as a tool to measure target achievement to keep an eye on whether caregivers are administering medication appropriately. Healthcare professionals in the South African context are empowered by policies, guidelines, and standards set by the Department of Health to monitor the growth of the children who are infected and by HIV/AIDS [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The World Health Organization (WHO) promoted viral load measurement because, in the wake of increased adherence support, it aids in distinguishing between treatment failure and non-adherence among people living with HIV (PLWHIV) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, viral load testing provides PLWHIV with a gauge of their knowledge, control, and incentive to follow their treatment plan and comprehend the extent of their HIV infection [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. According to descriptive research carried out in Mumbai, India, routine viral load testing prevented needless switching and allowed for the early identification of treatment failures and referrals to second- and third-line regimens [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. According to qualitative research done in the Polokwane municipality of South Africa, the program assists in identifying developmental milestones and growth failing in children so that prompt interventions can be implemented [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This study suggests that OTLs must not strictly rely on guidelines, protocols, and policies of HIV/AIDS management in South Africa. Flexibility is needed in the cases of implementation of the standards curtailed by Department of Health to manage HIV/AIDS in South Africa. For instance, if children living with HIV (CLWHIV) present with failure to thrive (FTT), the OTLs must not wait for the period prescribed to monitor blood monitoring it should be attended to immediately. Growth of CLWHIV should be monitored regularly during home visits or consultation at the PHC facilities.\u003c/p\u003e \u003cp\u003e The OTLs must provide both caregivers and HIV/AIDS orphans with emotional support during disclosure. Previous research highlighted that there are caregivers of children orphaned by HIV/AIDS who struggle to carry out disclosure process governments should set up mechanisms to capacitate with knowledge and skills that boost their confidence [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Consistently with existing literature, a narrative review by Molato et al. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. highlighted the following elements as having an impact on HIV status disclosure to affected children: the children's age; the primary caregivers' educational status; stigma and discrimination; and a lack of knowledge and skills about HIV status disclosure.\u003c/p\u003e \u003cp\u003eA qualitative exploratory descriptive study carried out in the Limpopo Province, South African caregivers for CLWHIV were not trained in initiating HIV disclosure [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Given that, caregivers of orphaned children by HIV/AIDS who lack the ability to disclose believed that healthcare professionals should help them to conduct disclosure process [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Despite inadequate support, the findings of the study conducted by Muditambi et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] revealed that caregivers reported that the healthcare practitioner had advised them on how to disclose HIV status to CLWHIV.\u003c/p\u003e \u003cp\u003eWe therefore suggest that training and unequivocal support should be provided to the caregivers to enable them conduct disclosure process independently. Alternatively, OTLs can also avail themselves during disclosure to provide both caregivers and children orphaned by HIV/AIDS with emotional support to alleviate emotional distress. Additionally, OTLs should help by being a sympathetic ear and helping to ease their discomfort. The significance of disclosure of HIV status to CLWHIV should be a key factor that drives both caregivers and OTLs. One of the importance of disclosing HIV status that include facilitation of medication adherence was reported by the scoping review conducted by [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOTLs must first explore the effective coping mechanisms that caregivers use to cope with burden of caring for children orphaned by HIV/AIDS. In line with existing literature, the qualitative study conducted in the North West Province highlighted that caregivers who relied on religious practices managed to cope with all the difficulties that interfered with their ability to discharge effective and efficient care for HIV HIV/AIDS orphans [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. According to the authors, some of the caregivers used singing of gospel hymns and prayer for coping whenever they find themselves in predicament aggravated by execution of caring tasks among children orphaned by HIV/AIDS. Similar results were reported by the study conducted in Ethiopia caregivers put God first in everything that they were doing and difficulties that confronted them in caring for orphaned children [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThey had hope that through him everything is possible he cannot leave his children to suffer without providing solutions to their problems [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. The findings of this study, together with those from earlier research, demonstrate the necessity of having trust and hope in God and the necessity of involving him in whatever we do daily. As Christians, we affirm that God is willing to listen to our suffering and provide interventions to help us overcome the obstacles we encounter. On that note, OTLs must encourage and motivate caregivers of children orphaned by HIV/AIDS who are Christians not to lose hope in God even if their prayers take time to be answered, they must be patient. They should emulate a man who was critically ill, helpless, and stayed for a period of 38 years next to the river of Bethesda with hope, faith, and trust that one day he\u0026rsquo;ll get help [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e It should be the prerogative of OTLs to ensure that all children who have lost parents due to HIV/AIDS receive foster care grants (FCG) from the government monthly. Social grants play an important role in their lives as they help them in accessing essentials such as food, stationery, and school uniforms. The welfare and well-being of the orphaned children depend heavily on the state providing the FCG to foster caregivers to help them alleviate the financial strain on their family [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The FCG program also gives foster parents the tools and assistance they need to ensure that the needs of orphaned children are appropriately met [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. It is thus imperative that OTLs screen for caregivers of children of orphaned by HIV/AIDS who do not receive FCG during home visits routines and establish the root cause and intervene.\u003c/p\u003e \u003cp\u003eOTLs should mobilize support networks for caregivers of children orphaned by HIV/AIDS. Research has indicated that social support from friends, family, and other social networks improves life quality and serves as a crucial defense against mental health issues [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This was evident in the study conducted in the NWP in which caregivers of HIV/AIDS orphans relied on the support of significant others to cope with all challenges that interfered with their ability to carry out their day-to-day activities [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. OTLs must also motivate caregivers to join social clubs and groups. According to the literature, caregivers who joined social clubs and groups were able to learn more about HIV care, lessen discrimination and stigma, encourage disclosure, and improve their relationship with orphaned children [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Moreover, caregivers of children orphaned children by HIV/AIDS should be advised and encouraged to join social clubs.\u003c/p\u003e \u003cp\u003eSocial connections are usually made between people who have common social interests rather than between strangers [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. As a result, while examining how social networks arise, it is also important to carefully examine the social environment, in particular the quantity and variety of social clubs as well as the kinds of affiliations that individuals have inside them [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Common examples of social clubs include support groups, stokvels, family society, and sports clubs. Considering this, OTLs must counsel caregivers of children orphaned by HIV/AIDS to become members of social clubs like stokvels, which are recognized in literature as the primary means of reducing poverty and promoting social mobility [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe authors also claimed that members of stokvels can meet their fundamental necessities. Members of stokvels could invest, save, and eventually amass assets [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Previous studies reported that stokvels helped caregivers save a lump sum of money that they divided at the end of the year to buy bulk groceries [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. According to the authors, caregivers were relieved that they didn't have to buy groceries after receiving social grants because the groceries lasted for almost three months. Caregivers had to reallocate the social grant funds to buy other essentials they needed. As far is mobilization of the resources is concerned, OTLs must ensure that community resources such as multi-purpose skills centers are utilized effectively to empower caregivers of children orphaned by HIV/AIDS with knowledge and skills to sustain their life. In support of these findings, a cohort longitudinal study conducted in Swaziland revealed that caregivers of children orphaned by HIV/AIDS were capacitated with skills to start businesses [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. According to the authors, among the WORTH members who were caregivers for orphaned children, one-third (33.4%) were able to start a business, and 41% of the caregivers was able to grow their business from one to two (or more) [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Literature about measures put in place by government or non-governmental organizations (NGOs) to develop caregivers of children orphaned by HIV/AIDS remain unknown in the South African context. Therefore, it is essential that OTLs work with various stakeholders who are interested in community development to empower caregivers of HIV/AIDS orphaned children in this study.\u003c/p\u003e \u003cp\u003e It should be the prerogative of the OTLs to ensure that all children who have lost parents due to HIV/AIDS are receiving foster care grants from the government monthly. Social grants play a significant role in their lives as they assist them in accessing essentials such as food, stationery, and school uniforms. According to the qualitative study conducted in South Africa, social grants given by the government to caregivers and children who have become orphans due to HIV/AIDS are insufficient to meet their daily needs [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. The author also stated that caregivers had respectfully asked for an increase in foster care grant to cover the costs of various extras, such as educational policies, which are crucial to ensuring that orphaned children have a respectable future.\u003c/p\u003e \u003cp\u003eDynamics (What are the dynamics of the conceptual framework)\u003c/p\u003e \u003cp\u003eAccessibility of health in terms of information and distance is greatly facilitated by the WBPHCOT initiative, which extends PHC services to the community and household level [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. CHWs as members of WBPCOT are expected to take healthcare services to the society at their respective households regardless of limited training, resources, and support [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. OTLs who are professional nurses lead the team and work closely with CHWs to supervise them in ensuring that professional duties are carried out accordingly. Therefore, it is important that agents of the framework induct CHWs on the conceptual framework so that they can be aware of their roles and responsibilities and know what is expected of them.\u003c/p\u003e \u003cp\u003eAs custodians of the provision of healthcare services in South Africa, the Department of Health detailed the responsibilities of OTL to collaborate with non-healthcare professionals, private health centres, and non-governmental organizations to eradicate community health-related issues. This research confirms the findings of previous studies that emphasised the central role of MDT as a means of assembling a team of healthcare professionals from various specialities to design individualized plans for the treatment of patients [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. The MDT stakeholders reported in this study include nurses, social workers, psychologists, dieticians, and many others who fall into the medical field. Caregivers of children orphaned by HIV/AIDS who are encountering psychosocial challenges should be referred to the social workers. This result aligns with the recommendation of a qualitative study carried out in South Africa, which suggested that foster parents of abandoned children exhibiting social and welfare issues ought to be referred to the social workers [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the cases of caregivers not coping due to emotional and psychological distress due to stressful situations in which they care for orphaned children, they should be referred to the psychologists. Prior studies have emphasized that psychologists are responsible for addressing social issues and advancing the health and well-being of community members [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. They also work to create preventative initiatives and educate the public on how to maintain that.\u003c/p\u003e \u003cp\u003eDietitians must be involved by the OTLs to start community nutrition, which is the act of assisting people and groups in creating wholesome eating habits to promote wellbeing and fend against disease [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. To improve the health and nutrition status of people living with HIV, the expertise of a registered dietitian/nutritionist as part of the health care team should be considered. Past research has demonstrated that nutrition education or counselling improves dietary intake and nutritional status in adults living with HIV/AIDS significantly [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. The authors stressed that to enhance the health and nutritional condition of those living with HIV, dietitians and nutritionists should be taken into consideration. OTLs can also facilitate collaboration with non-healthcare professionals to advance the needs of caregivers of children orphaned by HIV/AIDS who are dysfunctional socially.\u003c/p\u003e \u003cp\u003eOTLs as the framework's agents have a responsibility to maintain communication between MDT and other stakeholders. There should be constant communication between the agent and MDT to facilitate the health and well-being of caregivers of children orphaned by HIV/AIDS. Patient safety may be at risk when members of the healthcare team are not communicating properly [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. As per the authors' assertion, inadequate communication exacerbates the likelihood of medical errors [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Therefore, effective communication is the primary factor influencing the team's performance and quality [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. The author went on to explain that effective communication forms the cornerstone of all subsequent endeavours and guarantees favourable patient outcomes [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHealth promotion has been the cornerstone of the Healthy People project, which aims to promote \"health and well-being\" more broadly [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Currently, health promotion process contributes to both individual and societal well-being in addition to health [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. In terms of health promotion, illness prevention, treatment, and care, nurses are the backbone of health teams they play a significant role in ensuring that the goals of the program are achieved [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. In the framework of this study, OTLs are required to plan, coordinate, and carry out health promotion activities to improve the health and wellbeing of caregivers of children orphaned by HIV/AIDS in the North West Province. Moreover, OTLs should strengthen community action for health, build their skills, and create supportive environments for health to meet the goal of improving the health and well-being of the caregivers of children orphaned by HIV/AIDS in the North West Province [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTerminus (What is the end point of the conceptual framework?)\u003c/p\u003e \u003cp\u003eThe agent must ensure that all steps of the conceptual framework are carried out productively so that the last step can be achieved, which is evidenced by optimum health, functional support system, effective coping mechanisms, and active execution of caregiving responsibilities. The developed conceptual framework will also be used to develop health promotion strategies to improve health and well-being of caregivers of children orphaned by HIV/AIDS in the North West Province, South Africa see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below for more information.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThe punctuality of the participants was a problem, the researcher had to always start late, and other appointments scheduled for that day were affected by such incidents.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study aimed to develop a conceptual framework for health promotion strategies of caregivers of children orphaned by HIV/AIDS in the Ngaka Modiri Molema district. A qualitative and descriptive contextual research design was used to achieve the study objectives. The conceptual framework may inform the development of health promotion strategies to improve the health and well-being of caregivers of children orphaned by HIV/AIDS in the Ngaka Modiri Molema district of South Africa.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge Prof N.V. Sepeng for peer reviewing the manuscript, Mr I.O. Mokgaola, and Mr K. Racoco for designing the conceptual framework.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions:\u0026nbsp;\u003c/strong\u003eThe conceptualization was carried out by BJ, SSM, MPK and M.J.M., The study design was developed B.J., S.S.M., M.P.K., and MMJ, JSM and B.J.M. was responsible for data collection, BJM, SSM, MPK and M.J.M., analyzed data, BJ.M., S.S.M., M.P.K., and M.J.M drafted the manuscript, SSM M.P.K and M.J.M C.H. critically revised and edited the article. All authors have reviewed and approved the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study received funding from Health and Welfare Sector Education and Training Authority (HWSETA).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u0026nbsp;\u003c/strong\u003eThis study was approved by the North West University Health Research Ethics Committee (NWU-HREC) (Reference Number: NWU-00309-21-A1)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThere will be no public sharing of any of the raw data, it will remain private and confidential. This includes audio recordings and interview transcripts. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations of conflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from both caregivers of children orphaned by HIV/AIDS and nurses prior to the beginning of the interviews. \u0026nbsp;They were given\u0026nbsp;at\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eleast 7-14 days to consult and make an informed decision before signing the consent form. \u0026nbsp;After 7-14 days, the researcher met the\u0026nbsp;prospective participants face to face to explain further and for signing of the consent form.\u0026nbsp;Informed consent was acquired from all study participants when conducting this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOsafo J, Knizek BL, Mugisha J, Kinyanda E. 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Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane database of systematic reviews. 2013(2).\u003c/li\u003e\n\u003cli\u003eHong H, Budhathoki C, Farley JE. Effectiveness of macronutrient supplementation on nutritional status and HIV/AIDS progression: a systematic review and meta-analysis. Clinical nutrition ESPEN. 2018 Oct 1; 27:66-74.\u003c/li\u003e\n\u003cli\u003eTang AM, Quick T, Chung M, Wanke CA. Nutrition assessment, counseling, and support interventions to improve health-related outcomes in people living with HIV/AIDS: a systematic review of the literature. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2015 Apr 15;68: S340-9.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Daniel M, Rosenstein AH. Professional communication and team collaboration. Patient safety and quality: An evidence-based handbook for nurses. 2008 Apr.\u003c/li\u003e\n\u003cli\u003eMedakovic S. Communication in Multidisciplinary Teams. Published on March 06\u003csup\u003eth\u003c/sup\u003e, 2020file:///C:/Users/MolatoB/Downloads/Communication_in_Multidisciplinary_Teams.pdf (Accessed on 14 May 2024).\u003c/li\u003e\n\u003cli\u003ePronk N, Kleinman DV, Goekler SF, Ochiai E, Blakey C, Brewer KH. Promoting health and well-being in healthy people 2030. Journal of Public Health Management and Practice. 2021 Nov 1;27(Supplement 6): S242-8.\u003c/li\u003e\n\u003cli\u003eDemocratic Nursing Organization of South Africa. Global nursing campaign to launch 27 February 2018 https://www.denosa.org.za/News_View.php?id=35892 (Accessed on 22 May 2024). \u003c/li\u003e\n\u003cli\u003eKumar S, Preetha GS. Health promotion: an effective tool for global health. Indian Journal of Community Medicine. 2012 Jan 1;37(1):5-12.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Conceptual framework, caregivers, HIV/AIDS orphans, health, well-being","lastPublishedDoi":"10.21203/rs.3.rs-4534176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4534176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are an epidemic that continues to increase the burden of care among caregivers of orphaned children. Previous research has shown that providing care in an unsuitable environment has an impact on the health and well-being of caregivers of HIV/AIDS orphans. The research also showed that the North West Province lacks a conceptual framework that addresses the health and well-being of caregivers caring for HIV/AIDS orphans. As a result, this study developed a conceptual framework to improve the health and well-being of caregivers of HIV/AIDS orphans in the north-west province, South Africa.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive and contextual design was used. The practice-orientated theory by Dickoff, James, and Wiedenbach guided the development of the conceptual framework. These six steps include the agent, recipient, context, procedure, dynamics, and terminus.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study findings include home visits, health education, support during disclosure, routine monitoring of blood and growth, mobilisation of support systems and resources, and utilisation of government services.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe conceptual framework offers data that can help OTLs and registered nurses in PHC facilities improve the health and well-being of caregivers of HIV/AIDS orphans by providing high-quality care. The framework guides OTLs and registered nurses in PHC institutions on the procedure to follow to improve and preserve the optimal state of health.\u003c/p\u003e","manuscriptTitle":"Conceptual Framework for the health and well-being of caregivers of HIV/AIDS orphans in North West Province, South Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 20:03:20","doi":"10.21203/rs.3.rs-4534176/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-15T05:23:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-12T12:54:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-12T10:06:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-09T13:55:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-09T13:44:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"338799032897250836645540196354628081406","date":"2024-07-08T17:51:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34232029432710218643948042017136302561","date":"2024-07-05T08:59:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181725491990897340494627268046005953184","date":"2024-07-03T13:57:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-01T20:59:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250006623834245633086194598142846150203","date":"2024-07-01T15:10:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203635497988516545992894156739718058363","date":"2024-07-01T13:36:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7751158049877714338104115073771253621","date":"2024-07-01T12:49:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320979520672884685060769661317664564684","date":"2024-06-22T10:01:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211728550928135283851913313035208991227","date":"2024-06-21T16:31:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162512353530238758476200305979344981712","date":"2024-06-21T16:00:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-21T14:35:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-21T06:29:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-20T13:40:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-06-05T12:43:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5db00dc1-deb9-45f4-a72b-5a9704756ee8","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T16:06:09+00:00","versionOfRecord":{"articleIdentity":"rs-4534176","link":"https://doi.org/10.1186/s12912-024-02411-z","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2024-10-14 15:57:09","publishedOnDateReadable":"October 14th, 2024"},"versionCreatedAt":"2024-07-18 20:03:20","video":"","vorDoi":"10.1186/s12912-024-02411-z","vorDoiUrl":"https://doi.org/10.1186/s12912-024-02411-z","workflowStages":[]},"version":"v1","identity":"rs-4534176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4534176","identity":"rs-4534176","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}