Healthcare users’ experiences of preventing and managing non-communicable diseases in a rural health and demographic surveillance site in South Africa: A qualitative study
1
1 Department of Public Health, University of Limpopo, Polokwane, South Africa
2
2 Academic Affairs and Research, National Health Laboratory Services, Johannesburg, South Africa
3
3 Department of Public Health, Walter Sisulu University, Umtata, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in South Africa, with a growing burden in rural communities. Although prevention and management strategies are largely delivered through primary healthcare services. Little is known about how healthcare users in health and demographic surveillance system (HDSS) settings experience these services.
METHODS:
A qualitative descriptive study was conducted in the Dikgale-Mamabolo-Mothiba (DIMAMO) Health and Demographic Surveillance System (HDSS) in Limpopo Province, South Africa. In-depth semi-structured interviews were conducted with 23 adult healthcare users living with or at risk of hypertension and diabetes. Participants were purposively sampled to ensure variation in age, sex, socioeconomic status, and type of NCD. Interviews were conducted in Sepedi, audio-recorded, transcribed verbatim, and analysed thematically using Tesch’s eight-step method. Trustworthiness was ensured through credibility, dependability, confirmability, and reflexivity.
RESULTS:
Six interrelated themes emerged: (1) understanding and perceptions of NCDs; (2) experiences of NCD management within primary healthcare; (3) knowledge and practice of preventive behaviours; (4) structural and socioeconomic constraints; (5) modifiable behavioural risk factors; and (6) perceived vulnerability across the life course. While participants demonstrated basic awareness of hypertension and diabetes as chronic conditions, their ability to engage in sustained prevention and management was constrained by poverty, food insecurity, limited opportunities for physical activity, long waiting times, and medicine stock-outs. Family support emerged as a key facilitator of adherence and coping.
CONCLUSIONS:
Healthcare users in rural South Africa experience substantial structural and socioeconomic barriers to effective NCD prevention and management. Strengthening primary healthcare services alone is insufficient without addressing the broader social determinants of health. Context-specific, user-centred, and multisectoral interventions are essential to improve NCD outcomes and reduce rural health inequities.
Non-communicable diseases (NCDs) are a leading cause of morbidity and mortality in South Africa, with a growing burden in rural communities. Although prevention and management strategies are largely delivered through primary healthcare services. Little is known about how healthcare users in health and demographic surveillance system (HDSS) settings experience these services.
METHODS:
A qualitative descriptive study was conducted in the Dikgale-Mamabolo-Mothiba (DIMAMO) Health and Demographic Surveillance System (HDSS) in Limpopo Province, South Africa. In-depth semi-structured interviews were conducted with 23 adult healthcare users living with or at risk of hypertension and diabetes. Participants were purposively sampled to ensure variation in age, sex, socioeconomic status, and type of NCD. Interviews were conducted in Sepedi, audio-recorded, transcribed verbatim, and analysed thematically using Tesch’s eight-step method. Trustworthiness was ensured through credibility, dependability, confirmability, and reflexivity.
RESULTS:
Six interrelated themes emerged: (1) understanding and perceptions of NCDs; (2) experiences of NCD management within primary healthcare; (3) knowledge and practice of preventive behaviours; (4) structural and socioeconomic constraints; (5) modifiable behavioural risk factors; and (6) perceived vulnerability across the life course. While participants demonstrated basic awareness of hypertension and diabetes as chronic conditions, their ability to engage in sustained prevention and management was constrained by poverty, food insecurity, limited opportunities for physical activity, long waiting times, and medicine stock-outs. Family support emerged as a key facilitator of adherence and coping.
CONCLUSIONS:
Healthcare users in rural South Africa experience substantial structural and socioeconomic barriers to effective NCD prevention and management. Strengthening primary healthcare services alone is insufficient without addressing the broader social determinants of health. Context-specific, user-centred, and multisectoral interventions are essential to improve NCD outcomes and reduce rural health inequities.
| eISSN: | 2654-1459 |
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