Phase one of Ophelia: needs assessment

Lavender Hill, Cape Town, South Africa

The primary goal of this project was to conduct the first phase of the Ophelia process to identify the health literacy needs and capacities of the residents of the Lavender Hill community, and to generate ideas for potential solutions to health literacy-related issues.


Location: Outskirts of Cape Town, South Africa    Type of organisation: non-profit organisation

Mothers Unite is a non-profit organisation that provides holistic after-school care and recreation for children, and facilitates other initiatives to engage families of the Lavender Hill community, which is situated on the outskirts of Cape Town, South Africa. Lavender Hill has widespread poverty and high rates of violence, accidents, chronic disease and unemployment, and is a resource-poor community where residents have limited access to timely health services including emergency care. Mothers Unite runs a branch of the Emergency First Aid Responder (EFAR) program. This program, an extension of Cape Town’s emergency medical services, trains local lay volunteers to be first aid responders to emergency incidents in townships – including formal and informal settlements – that surround Cape Town. The partnership between the EFAR program and Mothers Unite enables residents to engage local EFAR trainees and adapt the program to local needs, language and context.  

What was the problem?

Locally trained EFARs expressed interest in extending their services beyond emergency response. Ideas include EFARs communicating with local physicians and officials about the health needs of the community.  The primary goal of this project was to conduct the first phase of the Ophelia process to identify the health literacy needs and capacities of the residents of the Lavender Hill community. The secondary goal was to determine potential differences in health literacy between EFARs and other community members.

In early 2014, health literacy and demographic data were collected from 293 Lavender Hill residents. Participants recruited were EFARs (n=93), community members who had no EFAR training (n=100), and patients from the Retreat Community Health Clinic (n=100), a primary care clinic where residents receive most of their health care. All participants were at least 18 years old, and fluent in English, Afrikaans or both languages. Results from the survey were discussed in solutions workshops with healthcare providers, Department of Health employees, community leaders, EFARs, and EFAR leaders. Overall findings were:

·         Many Lavender Hill residents did not feel understood and supported by their healthcare providers, did not feel they had sufficient information to manage their health, and did not feel they could find good health information or navigate the healthcare system.

·         There were minimal differences in health literacy between EFARs, community members and patients, however, EFARs scored higher on navigating the healthcare system.

What solutions were found?

Discussions in the solutions workshop lead to four potential intervention ideas:

1.       Healthcare provider training to support provision of evidence-based health information to community members.

2.       Group interventions to support community members to better manage their health.

3.       Improved individual patient empowerment to encourage active self-management of health.

4.       Development of a large-scale campaign to educate community members about how to access healthcare services.

What was the impact?

This is the first systematic health literacy needs assessment study in a South African population. The intervention ideas generated by this community are directly related to the needs and capabilities of the residents of Lavender Hill.


This case study is based on original work by Jennifer Bress for her Master of Science Degree in Emergency Medicine.

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