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1
Duncan, E. M. "Perspectives on occupational therapy transformation in South Africa." Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/25831.
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This minor dissertation is built around the Vona du Toit Memorial lecture that was given, by the author, to the Occupational Therapy Association of South Africa (OT ASA) in July 1999. The central theme of both the lecture and the dissertation is professional transformation. the impetus for which is seen to reside in the axiology of the profession, starting with the morn! values, attitudes and beliefs of individual practitioners and moving towards a collectively revisioned professional ontology. It is proposed that the ·identification, analysis and resuscitation of the profession's ethos at an individual level will ultimately impact transformatively on the nature and characteristics of the profession collectively. Particular emphasis is placed on undergraduate ethics curriculum reform for the vision of transform3tion at an individual level to be realised. The dissertation documents the pilot phase of a dialectical research cycle (Reason 1981) during which the author developed perspectives about the ethical concerns that the occupational therapy profession in South Africa needs to consider in the light of its past during apartheid and in view of its future in a developing nation. It contains a conceptual analysis of the pivotal role that professional ethics and morality will have to play in effecting fundamental change in the philosophical, structural, political and education at dimensions of the profession in response to the unique demands of the African context and suggests practical educational strategies through which attitudinal transformation in undergraduate occupational therapy students may be achieved.
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Kubashe, Nomachina Theopatra. "Disclosure of HIV status and adherence to antiretroviral therapy." Thesis, Nelson Mandela Metropolitan University, 2009. http://hdl.handle.net/10948/1174.
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The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
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Westreich, Daniel J. Van Rie Annelies. "HIV, antiretroviral therapy, and tuberculosis outcomes in Johannesburg, South Africa /." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1953.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.Title from electronic title page (viewed Dec. 11, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology in the School of Public Health." Discipline: Epidemiology; Department/School: Public Health.
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Naidoo, Pevashnee. "Barking up the wrong tree : pet therapy in South Africa." Master's thesis, University of Cape Town, 2003. http://hdl.handle.net/11427/7989.
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Bibliography: leaves 183-238.There exists but one local detailed, documented study by Bergensen (1989) that focused on the effects of pet facilitated therapy on the self-esteem and socialisation of primary school children. In addition, a handful of articles have been published in South African journals. It is rather perturbing to note that a proven, highly effective adjunct to conventional therapeutic intervention is lacking in the South African therapeutic milieu. The marked ignorance and defence behind practitioners scorn for this form of therapy is rather perplexing, especially in light of its official existence for over thirty years. This dissertation probes the concept of pet-facilitated therapy by referring to extensive studies, focusing on various sub-populations, and concludes with a study investigating local opposition to pet therapy.
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De, Klerk Susanna Magdalena. "Occupational therapy assessment of the upper limb : trends in South Africa." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86347.
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Thesis (MOccTher)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Introduction: This research was conducted to establish the assessment practices of occupational therapists working with clients with upper limb injuries and/or conditions. This was done to get an updated account of frequency and variation in the use of various assessment tools as well as reasons offered for infrequent use. Methodology: A quantitative cross-sectional survey design was used. A convenience sample of therapists attending courses was recruited for the study. A questionnaire was developed for the study and face and content validity established through pilot testing. The questionnaire consisted of three sections containing demographic information and questions about upper limb assessment practices. Descriptive statistics were calculated for numerical and categorical data to describe the demographic characteristics and to identify the measurement tools that were used most frequently. The Chi-Square test of associations was used to determine whether there were any associations between frequency of use and demographic factors. Results: Questionnaires were completed by 81 (71%) respondents. Twenty-two (27.2%) of the respondents had more than five years’ experience in the field of hand therapy while the remainder (n=52, 64.2%) had less than five years. The more experienced therapists worked in the private sector (n=49, 60.5%) with two (0.03%) experienced therapists being employed in the public sector. The diagnoses that were seen most commonly were nerve injuries (90.1%), fractures (88.8%) and tendon injuries (85.1%). Of the 81 respondents 15 (18.5%) held post graduate qualifications in the field of hand therapy. Goniometry (68 of 81, 84.0%), manual muscle testing (62 of 81, 76.5%) and testing for flexor digitorum profundus and superficialis function (61 of 81, 76.3%) were used most frequently. Performance tests were used infrequently or not at all. The most common reasons for non-use of performance tests were that they were not available in the practice setting or respondents were not familiar with them. Significant associations were found between frequency of using measurement tools and practice setting, years of experience and holding a post graduate qualification in the field of hand therapy. There was a significant association between working in the private sector and using a dynamometer (p < 0.001), and working in government settings and frequent use of the test for localisation (p = 0.021). Therapists with more than five years’ experience in the field of hand therapy were significantly more likely to use Semmes Weinstein monofilaments (p = 0.034) as were those holding a post graduate qualification in hand therapy (p <0.001). Conclusion: The results of this study have serious implications in terms of the upper limb assessment practices of occupational therapists, especially in the context of evidence-based practice which has become crucial not only for the credibility of the profession, but also for its survival. Information obtained through this research could aid to guide education and training at an undergraduate and post graduate level and assist to direct a research focus for hand therapy in the South African context.
AFRIKAANSE OPSOMMING: Inleiding: Hierdie navorsing is uitgevoer om die bepalingspraktyke van arbeidsterapeute wat werk met kliënte met boonste ledemaat beserings en/of toestande vas te stel om sodoende ‘n beeld te verkry van die frekwensie en variasie van die gebruik van bepalingsinstrumente. Redes aangebied vir ongereelde gebruik hiervan is ook ondersoek. Metode: 'n Kwantitatiewe deursnee-opname-ontwerp is gebruik. ’n Gerieflikheidssteekproef van terapeute wat kursusse bygewoon het, is gewerf vir die studie. ‘n Vraelys is ontwikkel vir die studie, en voorkoms- en inhoudsgeldigheid is bepaal deur ‘n loodstudie. Die vraelys het bestaan uit drie afdelings met demografiese inligting en vrae oor boonste ledemaat bepalingspraktyke. Beskrywende statistiek is bereken vir numeriese en kategoriese data ten einde die demografiese eienskappe te beskryf en die bepalingsmetodes wat die meeste gebruik is, te identifiseer. Die Chi-kwadraat toets is gebruik om te bepaal of daar enige assosiasies tussen die frekwensie van gebruik en demografiese faktore bestaan. Resultate: Vraelyste is deur 81 (71%) respondente voltooi. Twee-en-twintig (27,2%) van die respondente het meer as vyf jaar ondervinding in die veld van handterapie gehad, terwyl die res (n = 52, 64.2%) minder as vyf jaar gehad het. Die meer ervare terapeute het gewerk in die privaatsektor (n = 49, 60.5%) met twee (0,03%) ervare terapeute in diens van die staat. Senuweebeserings (90.1%), frakture (88,8%) en tendonbeserings (85.1%) was die meeste gesien. Van die 81 respondente het 15 (18,5%) ‘n nagraadse kwalifikasie in die veld van handterapie gehad. Goniometer (68 van 81, 84.0%), spiertoetsing (62 van 81, 76,5%) en die toetse vir fleksor digitorum profundus en superficialis funksie (61 van 81, 76,3%) is die meeste gebruik. Vaardigheidstoetse is selde of glad nie gebruik nie. Die mees algemene redes aangevoer vir die feit dat vaardigheidstoetse nie gebruik is nie, was dat dit óf nie beskikbaar is in die respondent se werksarea nie, óf dat respondente nie vertroud is met die toetse nie. Beduidende assosiasies is gevind tussen die frekwensie van die gebruik van bepalingsmetodes en werksarea, jare ervaring in handterapie en 'n nagraadse kwalifikasie in die veld van die handterapie. Daar was 'n beduidende assosiasie tussen terapeute werksaam in privaatpraktyk en die gebruik van 'n dinamometer (p < 0,001) en terapeute werksaam in die staat en gereelde gebruik van die lokalisasie toets (p = 0.021). Terapeute met meer as vyf jaar ondervinding, sowel as diegene met ’n nagraadse kwalifikasie in handterapie was beduidend meer geneig om Semmes Weinstein monofilaments te gebruik (p = 0,034 en p < 0,001 respektiewelik). Gevolgtrekking : Die bevindinge van hierdie studie het ernstige implikasies in terme van die arbeidsterapie bepalingspraktyke van die boonste ledemaat, veral in die konteks van bewys-gebaseerde praktykvoering (evidence based practice) wat noodsaaklik geword het nie net vir die geloofwaardigheid van die beroep nie, maar ook vir die oorlewing daarvan. Inligting wat verkry is deur middel van hierdie navorsing kan help met onderrig en opleiding op 'n voor-en nagraadse vlak. Dit kan ook help om navorsing in handterapie te rig binne die Suid- Afrikaanse konteks.
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Toi, Claire. "Culture, race and therapy : with special reference to South African Chinese therapists." Thesis, Stellenbosch : Stellenbosch University, 2004. http://hdl.handle.net/10019.1/49900.
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Thesis (MSc)--University of Stellenbosch, 2004.ENGLISH ABSTRACT: Differences between the therapist and the client such as differing genders, social classes, races, cultures and languages, inevitably influence the therapeutic situation. This research assignment reviews the literature available concerning multicultural counselling. the variables which therapists contend with in a multicultural therapeutic situation and the state of multicultural therapy in South Africa. The main body of this assignment focuses on the training experiences. as well as the countertransfcrential experiences. of therapists from a minority group with specific attention given to South African Chinese therapists. Also included are helpful ways of addressing the potential difficulties that arise in a therapeutic relationship where the culture or race of the therapist and client differ. In closing, this assignment asks what gaps exist in the literature with regard to South African Chinese therapists and what further research would be required to fill these gaps.
AFRIKAANSE OPSOMMING: Verskille tussen die terapeut en die kliënt. soos verskillende geslagte. sosiale klasse. rasse. kulture en tale. beïnvloed die terapeutiese situasie onvermydelik. Hierdie navorsingsopdrag hersien die literatuur wat beskikbaar is ten opsigte van multikulturele voorligting. die veranderlikes waarmee terapeute te doen kry in 'n multikulturele terapeutiese situasie en die toestand van multikulturele terapie in Suid- Afrika. Die vernaamste deel van hierdie opdrag fokus op die opleidingservarings. asook die teenoordragervarings. van terapeute wat van 'n minderheidsgroep afkomstig is, met spesiale aandag aan Suid-Afrikaanse Chinese terapeute geskenk. Ook ingesluit is nuttige maniere om die potensiele struikelblokke wat in 'n terapeutiese verhouding ontstaan. waar die kultuur of ras van die terapeut en kliënt verskil. aan te spreek. Om afte sluit. hierdie opdrag bevraagteken die leemtes wat voorkom in cl ie Iiteratuur met betrekk ing tot Su id-A Crikaanse Ch inesc terapeute en watter verdere navorsi ng sal benodig word om hierdie leemtes te vul.
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Ver, Loren Van Themaat Dorita Cornelia. "The practice profile of occupational therapists delivering work practice services in South Africa." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15764.
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Over the last decade, industrialised countries have experienced a significant increase in the cost of sickness, disability and employment injury benefits. Concurrently, an increase has been noticed in the need for work rehabilitation due to reasons such as disability as a result of an aging work-force, and work-related stress. Occupational therapists play a crucial role in providing work practice services, but little is known about the type of services they provide or the settings in which they are offered. The aim of this study was to describe the practice profile of occupational therapists delivering services within the field of work practice in South Africa to determine whether the work-related needs of the South African population are being met and to inform future planning of services. Methods: A descriptive cross-sectional study was undertaken. A self-administered survey was distributed to occupational therapists in the field of work practice within South Africa. Convenience and snowball sampling were used to target as many participants as possible. A survey based on the literature was developed and underwent pilot testing. Content and face validity was determined by a panel of experts who participated in a focus group. Instrument utility was established with occupational therapists who did not work in this field. Frequencies and proportions were determined for categorical data. Chi-square tests of association were undertaken to determine whether there were any significant associations between identified variables. A p-value of < 0.05 was considered significant. Open-ended questions were post coded.
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Currin, Lisa Natalie. "A journey with an abused child : a non-directive play therapy perspective." Thesis, Nelson Mandela Metropolitan University, 2006. http://hdl.handle.net/10948/434.
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The extensive amount of research conducted in the field of family violence internationally indicates that child abuse has a detrimental effect on both the physical and emotional development of children as well as having a profound effect on an individual’s psychological development and functioning in adult life. The aim of this research study was to describe the therapeutic process that unfolded with a seven year old allegedly abused female client within the framework of non-directive play therapy. The case was further contextualised utilising Erik Erikson’s theory of psychosocial development. This study served to broaden the body of psychotherapeutic knowledge by means of meaningful qualitative enquiry. The client was referred for therapy because of severe emotional and behavioural problems following the alleged sexual abuse. The client was seen over a period of eight months and this included 11 sessions of non-directive play therapy, three parent interviews and psychometric assessments conducted by a colleague. The case study method was utilised in this study. To achieve the aim of the research, the methodology of choice was the descriptive dialogic case study. A purposive sampling technique was used in the selection of the research subject for this study. The data collection and analysis were conducted according to Yin’s (1994) analytical generalisation, which consists of two main strategies: (a) using a theoretical framework as a guide to determine what data is relevant; and (b) developing a matrix as a descriptive framework for organising and integrating the data. Furthermore, the process of data analysis was aided by the use of guidelines proposed by Irving Alexander (1988) with Axline’s non-directive play therapy and Erikson’s theory of psychosocial development as the theoretical frameworks. The findings of this study suggest that plotting the play therapy sessions according to the framework of the four stages of play therapy was a particularly useful tool to monitor Michelle’s progression through the therapeutic process. This can be seen as a valuable application of a tool which can be used within the non-directive play therapy approach. Contextualising Michelle’s development according to the stages of Erikson’s theory of psychosocial development was also found to be a valuable endeavour. According to her chronological age, Michelle should have been in the fourth stage of industry versus inferiority, but in reality Michelle was still struggling to strike a healthy balance between the terms of conflict of trust versus mistrust issues of the first stage. From a therapeutic point, this was an important exercise as it helped to inform the therapist and consequently, the therapeutic process. This research undertaking can be recognised as a positive demonstration of the value of non-directive play therapy (Virginia Axline) and Erik Erikson’s theory of psychosocial development in the therapeutic process. In addition, this study has served to facilitate a more holistic understanding of the case study approach to research. Recommendations regarding future research undertakings that utilise the case study approach and methodology have been made. Key concepts: child abuse; family violence; non-directive play therapy; Erik Erikson’s theory of psychosocial development; analytical generalisation; case study research.
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Ramela, Thato. "An illustrated information leaflet for low-literate HIV/AIDS patients on antiretroviral therapy : design, development and evaluation." Thesis, Rhodes University, 2009. http://hdl.handle.net/10962/d1007563.
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South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.
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Williams, Margaret. "A chronic care coordination model for HIV-positive children requiring antiretroviral therapy." Thesis, Nelson Mandela Metropolitan University, 2013. http://hdl.handle.net/10948/d1020346.
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The human immunodeficiency virus / acquired immune deficiency syndrome pandemic (HIV/AIDS) continues to increase in prevalence worldwide, particularly in South Africa. There is a concurrent and distinct increase in the prevalence of HIV/AIDS and HIV-related diseases in the paediatric population in South Africa, particularly those using public sector health services, with a corresponding increase in morbidity and mortality rates (Abdool Karim & Abdool Karim, 2010:363), which impacts greatly on paediatric healthcare services. Adding to this, the provision of paediatric antiretroviral care has numerous stumbling blocks, not least of which is lack of decentralisation of facilities to provide treatment. There is the additional shortage of staff, which includes staff that are comfortable dealing with children, lack of training programmes on the provision of antiretroviral therapy to children, and minimal on-site mentorship of staff regarding HIV/AIDS disease in children. This lack of capacity in the healthcare system means that not all of those who require treatment will be able to access it, and this is particularly pertinent to paediatric patients (Meyers et al., 2007:198). Therefore the purpose of this research was to develop a nursing model that would assist healthcare professionals, in particular professional nurses, to optimise the comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy at PHC clinics. To achieve the purpose of this study, a theory-generating design based on a qualitative, explorative, descriptive and contextual approach was implemented by the researcher to gain an understanding of how the healthcare professionals and parents/caregivers of HIV-positive children experienced the comprehensive treatment, care and support provided at primary healthcare clinics. The information obtained was used to develop a chronic care coordination model for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy. The study design comprised the following four steps: Step One of the research design focused on the identification, classification and definition of the major concepts of the study. This involved describing and selecting the research population and the sampling process prior to conducting the field work which comprised in-depth interviews with two groups of participants, namely healthcare professionals and parents/caregivers who accompany their HIV-positive children to PHC clinics in order to receive antiretroviral therapy. Step Two of the research design focused on the development of relationship statements in order to bring clarity and direction to the understanding of the phenomenon of interest. Step Three of the design concentrated on the development and description of the chronic care coordination model for optimising comprehensive treatment, care and support for HIV-positive children who require antiretroviral therapy in order to ensure a well-managed child on ART. A visual representation of the structure of the model for chronic care coordination was given and described as well as a detailed description of the process of the model. Step Four was the last step of the research design and its focus was the development of guidelines for the operationalisation of the model for chronic care coordination for the optimisation of comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at PHC clinics. Guidelines and operational implications for each of the five sequential steps of the model were developed. The evaluation criteria of Chinn & Kramer (2008:237‒248) were used to evaluate the model. It is therefore concluded that the researcher succeeded in achieving the purpose for this study because a chronic care coordination model that is understandable, clear, simple, applicable and significant to nursing practice has been developed for use by healthcare professionals, particularly professional nurses, in order to optimise the comprehensive treatment, care and support for HIV-positive children requiring antiretroviral therapy at primary healthcare clinics.
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Struthers, Patricia. "The role of occupational therapy, physiotherapy and speech and language therapy in education support services in South Africa." Thesis, University of the Western Cape, 2005. http://hdl.handle.net/11394/8475.
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Philosophiae Doctor - PhDThis thesis investigated the education support services provided by occupational therapists, physiotherapists and speech and language therapists in the Western Cape Province of South Africa. Changes in the education policy in South Africa to an inclusive education system have major implications for the way therapists provide support. Therapists have been challenged to move from a medical model of support with a focus on highly specialised treatment for a small number of individual learners with disabilities, to a systemic and health promoting model which focuses on support for the education system, including all learners, teachers and parents. The aim of this research was to develop an appropriate and integrated approach for therapists to support schools within an inclusive and health promoting schools framework in South Africa. Participatory action research using quantitative and qualitative methodology was used. Two surveys were conducted in the Western Cape Province. The first was a survey of all therapists to determine who was working with pre-school and school-aged learners and where. The second survey was of all therapists working in special schools and a small number of private practitioners to identify the roles of the therapists in providing direct and indirect support. In two of the seven education districts in the province, focus group discussions were held with 45 teachers from special and ordinary schools, and 21 parents of school-aged learners - to identify the support they needed. Workshops, incorporating focus groups, were also held with the therapists to, firstly, identify the support they needed to give to learners, teachers, parents and the education system and, secondly, to identify the competencies they needed to give this support. The data from the surveys were subjected to simple descriptive statistical analysis. These analyses reveal that therapists have a very wide range of roles relating to direct support, including: assessment, intervention with individual learners and learners in groups, and evaluation. Interventions include the development of hearing, speech and communication skills; skills for activities of daily living; life skills; home management skills; work related skills; motor function skills; and play and leisure skills. Therapists from different disciplines frequently provide the same type of support. Indirect support provided includes support for the schools system, teachers and parents. Thirty six percent of the therapists in this study want to increase the proportion of time they spent on indirect support. The study also revealed that multidisciplinary collaboration and teamwork were Teachers involved in the study identified that they need an enormous amount of support in fulfilling their crucial roles in identifying barriers to learning; identifying the support learners need; and addressing the barriers. This includes the need for support to teach a diverse group of learners; adapting content, presentation and evaluation of the curriculum; adapting the physical environment; accepting new roles of teachers and therapists; making changes to the school system; developing relationships with the parents; addressing challenges related to socio-economic problems; networking with the community; facilitating positive attitudes to diversity; developing supportive relationships with therapists; and further training poorly developed. Teachers involved in the study identified that they need an enormous amount of support in fulfilling their crucial roles in identifying barriers to learning; identifying the support learners need; and addressing the barriers. This includes the need for support to teach a diverse group of learners; adapting content, presentation and evaluation of the curriculum; adapting the physical environment; accepting new roles of teachers and therapists; making changes to the school system; developing relationships with the parents; addressing challenges related to socio-economic problems; networking with the community; facilitating positive attitudes to diversity; developing supportive relationships with therapists; and further training. Parents in this study indicated that they need access to education and support for their children, including direct support for their children; effective means of communicating with their children; specific competencies to facilitate caring for their children; emotional support; advocates to work with them in support of their children addressing environmental physical and attitudinal barriers, and developing a supportive community; and supportive relationships with therapists.
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Buchanan, Helen. "Evidence-based practice in the occupational therapy profession in South Africa and the Western Cape." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10185.
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Includes bibliographical references (leaves 257-276).Research from upper-income countries has revealed the difficulties occupational therapists experience in implementing evidence-based practice (EBP). This thesis investigated the state of EBP in occupational therapy in South Africa and evaluated the effectiveness of two EBP educational interventions. The research consisted of three linked studies: a national cross-sectional survey of 436 registered occupational therapists; the development of a questionnaire and audit checklist to evaluate EBP knowledge, attitudes and behaviour; and a randomised controlled trial that tested whether an interactive educational intervention (IE) was more effective than a didactic one (DE) for improving EBP knowledge, attitudes and behaviour in occupational therapists.
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Dirks, Bryan Larry. "A follow up study of alcohol dependent patients following in patient treatment at the Avalon Treatment Centre." Master's thesis, University of Cape Town, 1989. http://hdl.handle.net/11427/25880.
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This is a report of an investigation assessing outcome in a consecutive series of alcohol dependent patients admitted to the Avalon Treatment Centre from 21 October 1985 to 14 April 1986. Although extensive work has been done on the epidemiology of alcoholism among "coloured" people * [classified in terms of the population registration Act]. A direct result of the original field survey by Gillis, Keet and Slabbert was the establishment of this centre. A follow up study of people identified as having drinking problems in the original field survey showed that few people stopped drinking on their own account. Little is known about treatment outcome of patients hospitalized at this centre. Treatment at The Avalon Treatment Centre is based on therapeutic community principles, group therapy, family and social case work as well as the use of antabuse. Contact with Alcoholics Anonymous is encouraged during and after hospitalisation. In addition patients are also followed up by a community sister.
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Fourie, Lise. "Music Therapy in Tshwane, South Africa : music therapists’ experiences and other professionals’ perceptions." Diss., University of Pretoria, 2009. http://hdl.handle.net/2263/36759.
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In South Africa music therapy as a profession is still in its infancy and not yet firmly
established, hence music therapists have struggled in the past to secure full-time
employment. It is important to ascertain the current state of music therapy in Tshwane as this
will offer suggestions about what needs to be addressed in the future. In this project two research questions were explored:
1. What are the experiences of music therapists, as well as the perceptions of other
professionals working in the health and education sectors in Tshwane, regarding
music therapy as a profession?
2. What do these experiences and perceptions suggest about the current state of the
music therapy profession in Tshwane?
This research project used questionnaires to generate data pertaining to the experiences of
music therapists and perceptions of allied professionals about the music therapy profession
in Tshwane. The experiences of music therapists currently practising in Tshwane shed light
on the present situation of music therapy in Tshwane. The allied professionals’ perceptions
of music therapy had implications regarding the recognition of the profession which impacts
directly on the availability of jobs, funding and resources available to music therapists.
Questionnaires generated both quantitative and qualitative data through the use of closed
questions that were analysed using descriptive statistics that were generalised and openended
questions analysed through the process of coding and categorising for emerging
themes that were discussed. Results obtained from the questionnaires indicated that not
enough is being done to promote the field as music therapist respondents (n=4) do not
create or set up new music therapy employment. This accounts for the fact that at present
other professionals working in the health and education sectors (n=27) have a varied
understanding of what music therapy comprises. Because of this varied understanding music
therapy is not always valued by these professionals. Collaboration with allied professionals
was an important theme which recurred throughout the data and seems to have been the
most successful way of furthering the profession so far in Tshwane. By promoting music
therapy, especially through collaboration with others, awareness of music therapy should be
enhanced, others’ knowledge and understanding of music therapy may be expanded and
music therapy may ultimately find its valued place among other therapeutic interventions.Mini Dissertation (MMus)--University of Pretoria, 2009.
gm2014
Music
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Dahab, M. "Factors affecting adherence and retention to antiretroviral therapy among adults in South Africa." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.536840.
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Kahts, Samantha Andrea. "Fundamental movement skill proficiency status of girls aged 9-to-12 years from previously disadvantaged communities in Nelson Mandela Bay." Thesis, Nelson Mandela Metropolitan University, 2014. http://hdl.handle.net/10948/d1021035.
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Problem Statement A lack of fundamental movement skill (FMS) proficiency in children can contribute to decreased physical activity (PA) levels, increased adiposity and poor acquisition of specialised sport specific movement skills. To prevent the latter, the identification of FMS status in early and middle childhood years is needed for targeted and specific interventions. Against the backdrop of physical education being omitted from the South African school curriculum, the presence of a patriarchal society, gender sporting stereotyping, high levels of unemployment and low education levels; the assessment of FMS status is particularly warranted. Aim of Study The primary aim of this study was to assess the FMS proficiency of girls aged 9-to-12 years from previously disadvantaged communities within Nelson Mandela Bay. Methodology A descriptive-exploratory-contextual study design, employing quantitative assessment techniques, was utilized. The sample comprised of 227 girls. Convenience sampling was employed. Testing consisted of FMS proficiency tests in the 20m and 40m sprint, standing long jump, throwing for distance, catching, static balance and throwing for accuracy. FMS process scores were assessed with the body component (BC) and Test of Gross Motor Development II (TGMD II) approaches. Anthropometric measurements of the standing and seated height, mass, arm span and leg length were additionally measured. Microsoft Excel® and Statistica® were used for descriptive and inferential statistical analysis. In the case of significant ANOVA results, the Scheffe post hoc test was used for pairwise comparisons. Statistical significance was set at p<.05 and practical significance (Cohen’s d) was set at d>.2. Pearson Correlation Coefficient identified statistical and practical correlations between two variables and chi square was applied to indicate differences in frequency distribution tables. Cramer’s V values were applied to determine practical significance in the case where statistical significant differences were identified between sets of frequency distributions The BC approach indicated that most participants could not proficiently perform the run for speed (94.71 percent), standing long jump (96.9 percent) or throw for distance (83.56 percent). Only the catch was performed proficiently (91.19 percent). TGMD II results for the present study indicated that participants’ run for speed (100 percent) and catch (96.92 percent) were performed proficiently and their standing long jump (93.78 percent) and throw for distance (83.56 percent) process scores were performed least proficiently. Only the catch composite BC scores had a statistically (df=1.31; f=3.24; p=.024) and practically significant (d=0.82) improvement in the BC scores between the age groups 9 and 12 years. Only the standing long jump, throw for distance and throw for accuracy product scores improved statically and practically significantly with aging (p<.05; d>.2). Hence the further participants jumped, the faster they ran. Standing and seated height, weight and arm span improved statistically and practically significantly with age (p<.05; d>.2). All anthropometric variables, except for leg length, had a positive medium correlation (r=.335 to r=.439) with balance errors and this was only in 12 year olds. The throw for distance product scores had a medium correlation to seated height (r=.32) and arm span (r=.33). The run for speed had a medium correlation (r=.313) with mass. According to the IOTF classifications 24.67 percent of children were overweight and 7.49 percent of children were obese. Statistically significant differences were found for the run for speed (df=224; f=27.07; p=2.9E-11) and standing long jump (df=224; f=15.68; p=4.2E-07) when comparing product scores to normal weight, overweight and obese participants. These differences were furthermore found to be of medium to large practical significance between the normal and obese participants for the run for speed (d=0.61 to d=1.77) and Standing Long Jump (d=0.40 to d=1.33). On average 50 percent and 55 percent of participants partook 60 minutes or more of PA after school on week days and on weekend’s respectively. This PA consisted mostly of running and ball games. Only 10 percent of participants had commenced with menarche Conclusion Findings have highlighted the need for specifically targeted FMS interventions at an early age in female learners from previously disadvantaged communities. Both a product and process FMS assessment is warranted as this facilitates deductions about movement proficiency levels. A FMS proficiency assessment protocol is needed for South African children which is internationally comparable. Childhood overweight and obesity impacts FMS proficiency and should be addressed in future research. Cultural norms, gender stereotypes and sport management structures at primary school level seem to be affecting FMS proficiency and should be addressed in future research
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Roux, Susanna Magrieta. "Diary cards: Preliminary evaluation of an intervention tool for improving adherence to antiretroviral therapy and TB preventive therapy in people living with HIV/AIDS." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&action=viewtitle&id=init_9725_1177916709.
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Adherence to prescribed medications is a central feature of good clinical HIV care and a key factor in determining the effectiveness of treatment. This is especially true for HIV-infected patients, on antiretroviral treatment, where adherence is strongly associated with survival. HIV-associated tuberculosis is a major and increasing health problem, especially in sub-Saharan Africa. Clinical trials have demonstrated a benefit of isoniazid preventive therapy in preventing TB among HIV-infected persons, and its use among these patients is recommended. Nearly perfect compliance seems to be indispensable to obtain the maximum benefit from highly active antiretroviral treatment and prophylactic medications. Accurately assessing non-adherence is a necessary first step towards improving adherence to active antiretroviral treatment and isoniazid preventive therapy. The introduction of diary cards is being considered as a measure of adherence and as a tool to improve adherence among HIV-infected individuals receiving antiretroviral treatment or isoniazid preventive therapy. This was a preliminary study to evaluate the effectiveness of diary cards as intervention tool for promoting adherence to antiretroviral and prophylactic TB therapy in people living with HIV/AIDS, to evaluate the diary card as a tool to measure adherence and to evaluate the feasibility and acceptability of diary cards.
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Sutton, Sandra Cecile. "The development of a method to evaluate the use and medical and socioeconomic implications of antihypertensive drug treatment in the Mamre community." Thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/25756.
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Okreglicki, Andrzej Michael. "Non-Q wave myocardial infarction : Groote Schuur Hospital Coronary Care Unit 1990-1993." Master's thesis, University of Cape Town, 1996. http://hdl.handle.net/11427/26980.
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Non-Q Myocardial Infarction (NQMI) is considered to be an unstable condition with increased risk of recurrent infarction. Thus aggressive approaches in management have been recommended. However, there is no firm evidence that this strategy influences the course of NQMI patients favourably. To determine the experience at Groote Schuur Hospital all patients admitted to CCU from 1990 to 1993 with NQMI were analysed retrospectively especially with regard to management and outcome. One-hundred and eighty-one patients were admitted with NQMI. Seventy-eight percent (141) remained cardiovascularly stable in the early period after the index event; 51% (93) underwent cardiac catheterisation during that hospital admission and revascularization was performed in 29% (52). There were 2 deaths during the initial hospital admission, both after surgical revascularisation. At one year the cardiac mortality was 7%. There were 23 cardiac deaths in all. Early readmission for symptomatic recurrence of ischaemia was identified as a risk factor (p=0.004). By one year 51% of patients had developed recurrence of symptomatic ischaemia, the majority (62%) in the first 3 months after the primary admission. There was a significantly reduced recurrence in those patients managed actively (i.e. cardiac catheterisation with/without revascularization) as compared to those treated conservatively (p=0.001).
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Hanly, Teia. "The women's health initiative study: impact on the prescribing of hormone replacement therapy in a defined South African population." Thesis, Nelson Mandela Metropolitan University, 2006. http://hdl.handle.net/10948/519.
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Context: The Women’s Health Initiative (WHI) study, published in July 2002, had a significant impact on the prescribing of hormone replacement therapy (HRT). The controversy surrounding the findings, however, has led to much uncertainty regarding the prescription of HRT. Aims and Objectives: The aim of this study is to determine both the initial and the continued impact of the WHI study on the prescribing of HRT in a defined South African population and to determine whether HRT was appropriately individualised based on recommendations published subsequent to the WHI study. Setting: Claims data from a Managed Healthcare Organisation (MHO) that administers for a number of medical aid schemes in South Africa. Method: A retrospective drug utilisation review (DUR) was conducted to identify HRT-related prescribing patterns in the defined populations. The time-frame of the dataset included January 2002, to assess prescribing patterns prior to the publication of the WHI study, January 2003 to determine the initial impact of the WHI study, and January 2005 to assess the continued impact. An extensive, additional dataset of all the HRT users in the defined populations was utilised to conduct a sub-group analysis and determine whether HRT had been appropriately individualised. Key Findings: The percentage of patients in the dataset using HRT decreased from 30.05 percent in January 2002 to 28.30 percent in January 2003 and to 23.24 percent in January 2005, with the latter decrease reaching statistical significance. Although sex hormones and modulators (G03) of the genital system were the most frequently prescribed drug class in all three years of the study period, the prescribing frequency decreased significantly from 10.40 percent in January 2002 to 9.32 percent in January 2003 and 7.44 percent in January 2005. The most noteworthy change in the prescribing of HRT was a 3.95 percent decrease in the prescribing of conjugated equine estrogen (CEE), with a corresponding 2.53 percent increase in the prescribing of estradiol between January 2002 and January 2003. However, less pronounced changes were observed in the prescribing frequencies of other types of HRT, including medroxyprogesterone and estrogen (the HRT type investigated in the estrogen plus progestin phase of the WHI study). Patients initiating HRT post-WHI publication were generally found to be in the younger menopausal age categories (40 to 49 years). These patients were more likely to have been initiated on HRT types other than those investigated in the WHI study and were at a higher risk for disease states for which HRT use is beneficial, such as osteoporosis. Patients discontinuing HRT post-WHI publication were generally found to be in the older menopausal age categories (60 to 69 years), were more likely to have been combined HRT users (although not necessarily the type investigated in the WHI study) and were at a higher risk for disease states for which HRT use is considered harmful or has an uncertain effect, such as diseases affecting the cardiovascular system. Conclusion: It can be concluded that the WHI study did have an impact on the prescribing of HRT in the defined South African population of this study, but that the impact was considerably less than the impact reported in global studies. It was also determined that HRT was appropriately individualised according to recommendations made subsequent to publication of the WHI study.
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Singh, Vikesh. "Implementation of the dual therapy prevention of mother-to-child transmission protocol." Thesis, Nelson Mandela Metropolitan University, 2010. http://hdl.handle.net/10948/1374.
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Antiretroviral drugs taken during pregnancy, reduce the rates of mother-to-child transmission from 35 percent to as low as 1 to 2 percent (UNAIDS, 2009). In 2002, the Prevention of Mother-to-Child Transmission (PMTCT) programme was implemented in South Africa. Studies on the implementation of the PMTCT programme have shown that understaffed and under-developed health care facilities were key barriers to the provision of PMTCT services (Health Systems Trust, 2002: 6; Skinner et al., 2003). The aim of this study was to assess the challenges experienced by health care workers working in public sector facilities in the Nelson Mandela Metropole after implementation of the dual therapy PMTCT programme. Four areas were investigated: Infrastructure; Drug Supply Management; Clinic Procedures and Staffing. A quantitative descriptive study was conducted in August 2009 at nine public health care facilities in the Nelson Mandela Metropole, South Africa. Questionnaires were issued to 81 nurses and 41 pharmacy personnel (pharmacists and pharmacist assistants). Checklist audit forms were issued to the Facility Manager of each facility and completed with the researcher. The key findings for Infrastructure were lack of space at patient waiting rooms (9; 100 percent n=9), counselling area (5; 55.5 percent; n=9), nurse consultation rooms (6; 66.6 percent; n=9), storage areas (5; 55.5 percent; n=9) and filing areas (7; 77.7 percent; n=9). The key findings for Drug Supply Management were none of the dispensaries (0 percent; n=10) were fully compliant with Good Pharmacy Practice, pharmacy personnel indicated that there were no stock cards for medication (13; 31.7 percent; n=41); there was less than two weeks supply of buffer stock kept for zidovudine and nevirapine (13; 35.1percent; n=37) and medication orders were placed without any reference to minimum and maximum levels of medication (15; 36.5 percent; n=41) . The key findings for Clinic Procedures were only two facilities followed up on patients that had missed appointments (22.2 percent; n=9) and four facilities (44.4 percent; n=9) had a tracking system for patients that had defaulted. Of the nine facilities only three (33.3 percent; n=9) updated patient demographic details regularly. The key findings for Staffing were a shortage of doctors, nurses, counsellors and pharmacists at the facilities. One of the major challenges identified was the lack of training offered on new PMTCT protocols with 56.2 percent (45; n=80) of the nurses stating that no training was provided on the dual PMTCT protocol. Only 54.3 percent (44; n=81) of nurses stated that they knew the criteria to start the mother on dual PMTCT therapy. In conclusion there is an urgent need for barriers such as lack of staff, lack of space, lack of training on PMTCT and standard procedures for follow up of patients to be addressed in order to ensure the successful scaling up of PMTCT.
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Cloete, Lizahn. "Developing appropriate Fetal Alchohol Spectrum Disorder (FASD) prevention initiatives within a rural community in South Africa." Doctoral thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10278.
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Includes bibliographical references.This study focused on women who consumed alcohol during pregnancy. The study population was situated in the West Coast/Winelands, a rural area in the Western Cape Province of South Africa. The study was done in a community which is classified as one of the many previously disadvantaged groups in South Africa. This study was done as part of a larger three-year project on Fetal Alcohol Syndrome Prevention in the Western Cape and Gauteng Provinces of South Africa. The phenomenon of drinking during pregnancy was used as a case example of health compromising occupations in the South African context. Prenatal alcohol exposure may result in brain damage that affects behaviors of those affected. The beliefs, norms, values and perceptions of mothers regarding alcohol consumption are also an important aspect in maintaining healthy pregnancies.
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Galvaan, Roshan. "A critical ethnography of young adolescents' occupational choices in a community in post-apartheid South Africa." Doctoral thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10504.
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This thesis explored the occupational choices of young adolescents in a southern peninsula Cape Town community of Lavender Hill in South Africa. Informed by current research and prior professional and personal experiences with young adolescents in Lavender Hill, the research question asked: 'What informs occupational choice among young adolescents in Lavender Hill?' This complemented the research aim, which was to generate insight into the nature of the occupational choices of a group of young adolescents in Lavender Hill, and the factors that influenced their occupational choices.
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Parathyras, John Burns. "Molecular genetic analysis of human immunodeficiency virus antiretroviral therapy response in South Africa : a pharmacogenetics study." Thesis, Link to the online version, 2007. http://hdl.handle.net/10019/453.
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Maseko, Batlile Paulos. "Antiretroviral treatment programme outcomes scenarios in South Africa in the next two decades." Thesis, University of Limpopo (Medunsa Campus), 2012. http://hdl.handle.net/10386/1094.
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Engström, Niklas, and Hanna Näsholm. "The meaning of activity amongst women participating in a craft group in South Africa." Thesis, Örebro universitet, Hälsoakademin, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-8962.
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The aim of this study was to describe the meaning of activity amongst women participating in a craft group in South Africa. A qualitative method was used to answer the aim of the study. Ten African women who live in townships outside Pretoria have been interviewed. The interviews were conducted with support by an interview guide containing semi-structured questions. All collected data were transcribed verbatim and analyzed with a qualitative content analysis, which resulted in two main categories each containing two sub-categories; 1) “Internal Values” containing “Taking part in a social activity” and “Gaining self – esteem through activity”, and 2) “External Values” containing “productivity” and “leisure”. The categories within the Internal values contain descriptions from the participants that concern the meaning inside the person when participating in craft activities. The categories within External values contain descriptions that concern factors outside the person that have a meaning to the participants. This study showed that craft was of great importance for the participants in different areas, such as social network and personal development. The meaning of craft in Occupational Therapy needs to be further investigated and it would be interesting to conduct a similar study in Sweden.Syftet med denna uppsats var att beskriva betydelsen av aktivitet hos en grupp kvinnor som deltar i en hantverksgrupp i Sydafrika. En kvalitativ metod användes för att besvara syftet med studien. Tio afrikanska kvinnor som bor i kåkstäder utanför Pretoria intervjuades. Intervjuerna genomfördes utifrån en utarbetad intervjuguide innehållande semistrukturerade frågor. Det insamlade datamaterialet analyserades utifrån en kvalitativ innehållsanalys, som utmynnade i två huvudkategorier med två underkategorier vardera; 1) ”Inre värden” som innehåller ”deltagande i en social aktivitet” och ”ökat självförtroende genom deltagande i aktivitet”, och 2). ”Yttre värden” som innehåller” ”produktivitet” och ”fritidsaktiviteter”. I kategorin Inre värden beskriver deltagarna meningen av att delta i hantverksaktiviteter med ett inifrånperspektiv. Kategorin Yttre värden innehåller beskrivningar som är meningsfulla utanför individen. Den här studien visar att hantverk hade stor betydelse för deltagarna inom flera olika områden som socialt nätverk och personlig utveckling. Betydelsen av hantverk inom arbetsterapi behöver studeras ytterligare och det vore intressant att genomföra en liknande studie i Sverige.
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Holtzhausen, Herman. "Land and Ubuntu as competing narratives in rural South Africa : a practical theological perspective." Thesis, University of Pretoria, 2018. http://hdl.handle.net/2263/64316.
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Agricultural land ownership, tenure and access in South Africa are historically determined along racial lines. Reactions to this untenable problem are becoming increasingly volatile. More than two decades into South Africa’s constitutional democracy, little has changed to empower the previously disadvantaged majority of South Africans in this regard. The resentment about this institutionalised discrimination and poverty is growing in the wake of government’s failures to meaningfully address the situation. For many Black South Africans, this remains a symbol of their dehumanisation by the previous racist government and its supporting voters.
I am a sixth generation land owner of a small-scale farming operation in the arid North West Province of South Africa. This research represents my efforts in searching for ways of creating a more equal and just relationship with my Tswana co-worker in terms of his access and tenure of land. In the final instance, this work would hopefully be of value to farmers and their labourers in similar contexts.
I engaged a narrative enquiry based on social constructionism, employing postfoundational practical theology as interpreted and developed by Műller in his 7-steps to participate in this action research.
Auto-ethnography and fictional research writing enabled me to problematise a dominant narrative that has become increasingly one-dimensional. According to this narrative, Whites stole the land at gunpoint or through trickery. Political leaders with varying agendas are prone to abusing this version of our past to the advancement of their self-enrichment and patronage networks. My methodology of choice offered the opportunity to establish a non-dominant narrative, using the particulars of this context to create a preferred outcome.
I created a revisionist understanding of ubuntu as ‘right action’, which is helpful in securing Joba’s access and tenure to the land. Current affairs in terms of State Capture and other narratives that are dynamically related to this course of events, thicken the plot to such an extent that it causes strain between ubuntu and land
reform. I engaged mindfulness as my chosen spirituality to create harmony rather than competition between land and ubuntu.
Subsequently, it seems that Joba and my working partnership can be beneficial for both of us and also for other land owners and their co-labourers, particularly, when operated as a share scheme.Thesis (PhD)-University of Pretoria, 2018.
Practical Theology
PhD
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Theron, Talita. "Music therapy in South Africa music therapists' perceptions of training needs for current practice /." Diss., Pretoria : [s.n.], 2006. http://upetd.up.ac.za/thesis/available/etd-09182008-114636/.
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Bernstein, Molly. "Intimate partner violence among HIV-infected pregnant women initiating antiretroviral therapy in South Africa." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/15601.
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Background: Intimate Partner Violence (IPV) is recognized globally as a major public health concern linked to numerous adverse physical, mental, sexual and reproductive health outcomes. IPV is associated with both pregnancy and HIV-infection independently, but there are few data on IPV in populations of HIV-infected pregnant women. We examined the prevalence and predicators of IPV among pregnant women initiating lifelong antiretroviral therapy (ART) in a large primary care clinic in Cape Town, South Africa. Methods: Consecutive pregnant women seeking antenatal care in Gugulethu, Cape Town were recruited into the MCH-ART study examining service models for postpartum ART care. IPV, depression, alcohol and drug use, and emotional distress were assessed using the 13-item WHO Violence Against Women questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), alcohol and drug use disorders identification test (AUDIT/DUDIT) and the Kessler-10 (K-10) scale, respectively. Questionnaires were administered privately by trained interviewers. Women identified with specific IPV or mental health concerns were referred to appropriate services. Logistic regression was used to examine factors independently associated with experiences of IPV after adjusting for age and socioeconomic status. Results: From April 2013-May 2014, 623 women were enrolled (median age, 28 years):97% reported being in a relationship, 38% were married and/or cohabiting and 70% reported not having discussed or agreed on pregnancy intentions prior to conception . Overall, 21%(n=132) reported experiencing ≥ 1 act of IPV in the past 12 months, including emotional violence(15%), physical violence(15%) and sexual violence(2%). Of those reporting any IPV, 48% reported experiencing multiple types. Emotional and physical violence were most prevalent among women 18-24 years old, while sexual violence was most commonly reported among women 25-29 years old. Women who reported not discussing or disagreeing on pregnancy intentions with their partners prior to conception were significantly more likely to experience violence(p=0.030), and women who experienced IPV reported higher levels of substance abuse, depression and emotional distress(p<0.001 for all associations). Discussion: These data demonstrate high levels of IPV in this population. While the potential impact of HIV-infection, pregnancy and pregnancy intention on the risk of IPV and related factors require further research, IPV-related screening and support services should be considered as part of the package of care for ART in pregnancy.
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Greene, Mark A. "Rethinking biokinetics: a philosophical critique concerning the roles and responsibilities of practitioners and patients." Thesis, Nelson Mandela Metropolitan University, 2016. http://hdl.handle.net/10948/10381.
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The specialist responsible for providing prescribed exercise as a form of medicine to the South African population is the biokineticist. Biokinetics is a relatively new profession developed in response to empirical research supporting exercise as medicine. Although the role of the biokineticist is clearly defined by the Health Professions Council of South Africa (HPCSA), there is still confusion concerning this profession and its services. At present, the dominant medicalscientific and capitalist-economic discourses offer a narrowly mechanistic and instrumental understanding of the human body and its treatment, which contributes to this confusion. This dissertation proposes a new point of departure, enriched by historical and philosophical understandings of the human body, from which the biokineticist can begin to redefine him/herself. The study aims to shift biokinetics as a practice away from the reductionist and dehumanising influences of instrumentalist, scientific and neoliberal capitalist-economic discourses, and to restore to biokineticists, and their clients, the ability they need to interact as relatively autonomous individuals. The study draws on the ideas of Michel Foucault, specifically on his notions for ‘discipline’, ‘docility’, and ‘the care of the self’ (1991; 2005), as well as Gilles Deleuze and Felix Guattari and their ideas of ‘becoming’ and ‘rhizomatic thinking’ (1983; 1987); ultimately presenting a philosophically enriched, holistic representation of the human body. From here recommendations for best practice in contemporary biokinetics are suggested that encourage interactions and connections between the professional and his/her patients, which move beyond the mere physiological interpretations currently dominating health discourse.
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Phillips, Tamsin Kate. "Understanding women's engagement in HIV care after initiating antiretroviral therapy during pregnancy in South Africa." Doctoral thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/30428.
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Background: Sustained engagement in HIV care, including adherence to antiretroviral therapy (ART) and retention in HIV services, is essential to optimize maternal health and prevent perinatal, postnatal and sexual HIV transmission. However, engagement in care remains a substantial challenge for pregnant and postpartum women. Women’s experience of and response to barriers to engagement in care, including ART side effects, transfer of care and mobility, may be altered by the transitions experienced in pregnancy and motherhood, and there have been few quantitative analyses of these risk factors in maternal ART cohorts. The way engagement in HIV care is measured also varies widely and no gold standard measures of ART adherence or retention exist. Composite assessments of adherence and retention, including drug concentrations, longitudinal self-reported adherence, and interlinked routine electronic health data, have not been thoroughly evaluated among African women living with HIV. To address these gaps in knowledge, this thesis investigates novel measures of ART adherence, and evaluates interlinked routine electronic health data to measure retention in a South African maternal ART cohort. It describes maternal engagement in HIV care, and examines barriers to engagement that require consideration specific to maternal ART. Methods: This research included women who initiated ART during pregnancy in a large integrated antenatal care and ART clinic in Gugulethu, South Africa (2013-2014). Until July 2013, only women who met certain clinical criteria (CD4 cell count <350 cells/µL or disease stage III or IV) were eligible for lifelong ART, thereafter guidelines changed to recommend lifelong ART for all pregnant women living with HIV. In this setting, all women receive ART and antenatal care in an integrated clinic during pregnancy and are required to transfer to a general ART clinic postpartum. Data were obtained from questionnaires (including demographics, self-reported ART adherence and self-reported side effects) and blood specimens (for HIV viral load) collected at study visits approximately every three months from pregnancy through 18 months postpartum. One additional visit took place 3-4 years postpartum where blood specimens for drug concentrations were also collected. In parallel, routine electronic data, linked across clinics and data sources including HIV clinical visits, laboratory testing and pharmacy dispensing data, were obtained through 30 months on ART. Findings: Substantial disengagement from care, both non-adherence and non-retention, was observed in all analyses. At least one ART side effect was reported by 97% of women during pregnancy and high overall side effect burden was associated with reported missed ART doses. Retention worsened over the first two years on ART and 21% of women were lost immediately after transfer from the integrated clinic. Women who linked to care spread to multiple different ART clinics after transfer; 21% moved clinics two or more times. Using combined routine medical records, only 59% of women had evidence of accessing routine HIV care in consecutive 12-month windows through 24 months on ART. Among women with viral loads available, attending ≥2 clinics was associated with viraemia. In analyses of ART adherence, TFV-DP in DBS provided a more nuanced adherence measure but plasma efavirenz and tenofovir assays had similar ability to predict viral suppression. Areas under the Receiver Operating Curve were higher for all drug concentrations (all >0.850) compared to self-reported adherence using a cross-sectional three-item scale (0.756). Longitudinal measurement of the same self-reported adherence scale showed that reporting worse adherence on any of three items over consecutive visits could predict viremia (>50 and >1000 copies/mL), particularly among women who were suppressed at the initial visit. Measuring retention using routine interlinked electronic data facilitated tracing of women beyond transfer from the integrated clinic to any clinic where they accessed HIV care postpartum. Estimates of retention varied widely using different retention definitions and data sources. Overall, electronic primary health care data, linked across clinics, performed better than laboratory data alone and was a robust measure for monitoring retention in HIV care. Conclusions: Taken together, these findings underscore a concerning level of disengagement from HIV care during and after pregnancy. Potential ART side effects, required transfer of care, the potential challenges of mobility and the importance of sustained engagement in care beyond pregnancy and breastfeeding, should be emphasised in ART counselling. Drug concentrations in DBS and plasma strongly predict viral suppression, but these data on longitudinal self-reported adherence provide a proof of concept for a low resource interim adherence measure that warrants further investigation in routine care settings with limited resources for viral load or drug concentration testing. Transfer of care and postpartum mobility mean that interlinked data sources are essential to obtain accurate estimates of retention postpartum. Further evaluation of the optimal approaches to transferring maternal ART care and the development of interventions to support engagement both in and beyond the clinic of ART initiation will be critical to sustain maternal engagement in HIV care in the long term.
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Githinji, Leah Nyawira. "Lung function in perinatally HIV-infected adolescents on antiretroviral therapy in Cape Town, South Africa." Doctoral thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31387.
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Background: Lung disease is a common complication of human immunodeficiency virus (HIV) infection in children and adolescents. As antiretroviral programmes have strengthened and HIV diagnosed earlier, survival of perinatally HIV-infected children has improved. Therefore, an increasing number of perinatally HIV-infected children are surviving into adolescence, with development of chronic multisystem disease including chronic lung disease (CLD). However, there is limited information on the determinants, spectrum and progression of lung disease. Lung function testing, an objective, non-invasive, reproducible tool, is useful in characterising CLD and in monitoring disease progression. Aim: To investigate the spectrum, determinants and progression of lung function in perinatally HIV-infected adolescents on antiretroviral therapy (ART) in Cape Town, South Africa. Specific objectives included describing the spectrum and determinants of lung function; investigating cardiopulmonary dysfunction and investigating progression of lung function over two years. Methods: The study population was from a prospective cohort, the Cape Town Adolescent Anti-retroviral cohort (CTAAC), that enrolled 515 perinatally HIV-infected adolescents on ART and 110 age-matched HIV-uninfected adolescents followed six-monthly for two years in Cape Town, South Africa. Eligibility criteria were adolescents, aged 9-14 years, with perinatally acquired HIV, who had been on ART for at least six months. Comprehensive lung function testing was done, and clinical and lung function data collected at baseline, 12 and 24 months. Results: At baseline, HIV-infected adolescents had lower forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, diffusing capacity for carbon monoxide, respiratory system compliance and functional residual capacity; and higher airway resistance and lung clearance index compared to HIV-uninfected adolescents, p< 0.05 for all. At 24 months, FEV1 and FVC remained lower in the HIV-infected compared to the uninfected, p< 0.05 for both. Impaired cardiopulmonary function was detected in 13% of HIV-infected adolescents and 8% of HIV-uninfected adolescents, p=0.136. Past PTB was significantly associated with a low cardiopulmonary function, OR 2.3, 95%CI 1.2-4.4. Conclusion: Perinatally HIV-infected adolescents had lower lung function and higher resistance and ventilation inhomogeneity compared to age-matched HIV-uninfected adolescents at baseline. Lung function tracked, remaining lower at two years. Previous PTB or severe LRTI were predictors of lower lung function. Co-existent cardiopulmonary dysfunction occurred in a minority. These data highlight respiratory disease risk in this vulnerable group and may inform policy to strengthen strategies to prevent and manage HIV-associated lung or cardiopulmonary disease. Four of the chapters (2-5) of this thesis are presented as published manuscripts. Chapter 1 encompasses an overview of the burden of HIV disease and the spectrum of HIV associated chronic lung disease in adolescents and the utility of lung function in the diagnosis of chronic lung disease. Study methodology is also detailed in this chapter. Chapter 2 (published manuscript) comprises a comprehensive review of published data on lung function (over and above the literature included in the individual papers) in HIV infected children and adolescents and summarises studies that have been done in Africa, USA, Europe and Asia. Chapter 3 (published manuscript) describes the spectrum and determinants of comprehensive lung function parameters (flow, volume, compliance, resistance, ventilation inhomogeneity) in perinatally HIV-infected adolescents with a comparator group of age-matched HIV-uninfected adolescents. Chapter 4 (published manuscript) further explores the prevalence and determinants of coexistent cardiopulmonary dysfunction in perinatally HIV-infected adolescents on ART. Chapter 5 (published manuscript) describes the progressive changes in spirometry over two years in perinatally HIV-infected adolescents compared to HIV-uninfected age matched controls. It also addresses the associations of low lung function, factors amenable to public health interventions. Chapter 6 is a summary of the study findings and recommendations.
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Kampiire, Leatitia. "Substitutions to initial anteretroviral therapy due to toxicity or contraindication among children in South Africa." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/11003.
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Includes bibliographical references.According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) South Africa 2010 Country Progress report, 81% of South African children in need of antiretroviral therapy (ART) were receiving treatment which is a 20% increment in treatment access from 2008 to 2009. With increase in access to treatment, understanding drug tolerability, safety and durability is important especially among children whose drug options are limited due to few drugs being available in suitable formulations and the need for refrigeration of some drugs. While there are many paediatric studies on ART durability in the developed world, data from the developing world are limited. There is therefore a need to understand the drug-specific probability of and reasons for drug stops or changes among children initiated on ART in South Africa. This knowledge could help in optimisation of use of firstline ART in order to maximise time on first-line therapy and thereby maintain simplicity of programs (program-level benefit) and save alternative drugs for situations of toxicity and virological failure (individual benefit).
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Smart, Rosalind Vida May. "A study of the use of prescription and non-prescription drugs by an elderly population of the Southern Peninsular area of Cape Town." Master's thesis, University of Cape Town, 1991. http://hdl.handle.net/11427/26567.
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The aims of this research were to establish the drug use patterns of an elderly population in the southern suburbs of the Cape peninsula and to determine the extent of knowledge with respect to their medicines. In addition, the relationship between drug use patterns and medication knowledge and the socioeconomic status of the elderly, the health care services utilised by them and the amount of information conveyed on medicine container labels was assessed. Two hundred and sixty non-institutionalised Caucasian elderly over the age of 65 years and living in old age residences were interviewed. The interviews were structured with 4 major components: 1. a questionnaire designed to collect participant particulars; 2. an interview schedule to collect information on drug use patterns and to assess participant knowledge of medicines used (Knowledge score). 3. a container label assessment schedule (Label score); 4. a cognitive function test to identify and exclude severely cognitively impaired elderly from the study population. Analysis of the data showed the majority of the participants were English-speaking women of social class 1 or 2. Approximately one fifth of all participants were male. The State-run health care services were utilised by 38% of the participants whilst 73% retained their own general practitioner. A total of 843 medicines were used with an average of 3.2 medicines per capita. Ninety-five percent of all participants took prescribed medicines, with diuretics, non-narcotic analgesics/antipyretics, and tranquillisers the 3 most frequently prescribed classes. A smaller percentage - 41.5% - of participants used self-prescribed medicines, of which non-narcotic analgesics, homeopathic and herbal medicines, and vitamins were taken most frequently. When assessed against container label directions approximitely one third of participants were non-compliant with their dosage regimens. The majority of all medicines had been used on a continuous basis for 1 to 10 years. Average knowledge score was 58%. The majority of participants had very little knowledge about interactions, side effects, and maximum permissible dose for their medicines. Just over one fifth of all participants could correctly state both the name and the strength of their medicine. Average knowledge score was found to decline with increasing age, but no relationships were found to exist with the other patient characteristics. Similarly, no relationship was found to exist between knowledge score and label score. Participants utilising the public health care services tended to have a lower knowledge score than those receiving treatment from the private sector. Twenty-six percent of all labels did not have specific usage directions. The private sector suppliers were most frequently culpable of omitting instructions. Label legibility also proved to be a problem for the elderly participants. The drug use patterns identified in this study are similar to those of the American and British elderly and should be of value in compiling a health care plan for the South African elderly, although further research involving other race and cultural groups is needed.
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Okoli, Emmanuel Ikechukwu. "Psychosocial characteristics of AIDS patients with unsuppressed viral load after six months of antiretroviral therapy." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/79983.
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Thesis (MPhil)--Stellenbosch University, 2013.ENGLISH ABSTRACT: STUDY AIM The aim of the study is to explore the psychosocial characteristics of HIV positive clients who are yet to achieve viral load suppression after six months of commencing ARV at Sundumbili CHC in order to plan positive intervention strategies. RESEARCH DESIGN Non-experimental quantitative design was used in carrying out the study. The data was collected through retrieval of information from clinic records and completion of questionnaires to clients on ARV who met the inclusion criteria and consented to participating in the study. A total of 51 adults aged more than 18 years that were initiated in 2010/2011 and still access their treatment at Sundumbili CHC were enrolled into the study. They were selected through convenience sampling. FINDINGS Psychosocial challenges still exist among research participants whose viral load results were not suppressed after six months on ARV. This affected the adherence of some of them to their antiretroviral treatment. CONCLUSION Given the rural nature of Sundumbili and surroundings where the bulk of the patients reside, there are several psychosocial challenges affecting the patients. No known previous study has been undertaken to ascertain the psychosocial characteristics of this group of patients and the impact they may have on viral load suppression after six months of treatment. The study is therefore significant as the findings have provided more insight into the plight of the patients. It is envisaged that the recommendations from the study will assist the relevant management staff in the department in planning and subsequently implementing more positive intervention strategies. The strategies should be targeted at improving the quality of care of the HIV positive clients and attending to their psychosocial needs.
AFRIKAANSE OPSOMMING: STUDIEDOELWIT Die doel van die studie was om ondersoek in te stel na die psigososiale kenmerke van MIV-positiewe kliënte wie se virustellings ná ses maande van antiretrovirale (ARV) behandeling by die gemeenskapsgesondheidsentrum op Sundumbili steeds nie onder beheer was nie, ten einde positiewe intervensiestrategieë te beplan. NAVORSINGSONTWERP ’n Nie-eksperimentele kwantitatiewe ontwerp is gebruik om die studie te onderneem. Die data is ingesamel deur die herwinning van inligting uit klinieklêers sowel as die afneem van vraelyste onder kliënte op ARV’s wat aan die insluitingsmaatstawwe voldoen en tot deelname aan die studie toegestem het. Altesaam 51 volwassenes bo die ouderdom van 18 wat in 2010/2011 met ARV behandeling begin het en dit steeds by Sundumbili-gemeenskapsgesondheidsentrum ontvang, is in die studie opgeneem. Dié groep is deur middel van geriefsteekproefneming gekies. BEVINDINGE Psigososiale uitdagings was steeds te bespeur by navorsingsdeelnemers wie se virustellings nog nie ná ses maande op ARV’s onder beheer was nie. Dit het sommige se behandelingsgetrouheid beïnvloed. GEVOLGTREKKING In die lig van die landelike aard van Sundumbili en omgewing, waar die meeste van die pasiënte woon, kom pasiënte voor verskeie psigososiale uitdagings te staan. Daar is klaarblyklik nog nooit vantevore ’n studie onderneem om die psigososiale kenmerke van hierdie groep pasiënte, en die moontlike impak daarvan op die onderdrukking van virustellings ná ses maande van behandeling, te bepaal nie. Hierdie studie is dus waardevol, aangesien die bevindinge groter insig in die lot van die pasiënte bied. Daar word beoog dat die aanbevelings uit die studie tersaaklike bestuurspersoneel in die Departement van Gesondheid sal help om meer positiewe intervensiestrategieë te beplan en gevolglik in werking te stel. Die strategieë behoort daarop afgestem te wees om die gehalte van sorglewering aan MIV-positiewe kliënte te verbeter en in hul psigososiale behoeftes te voorsien.
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Jackson, Dawne Shirley. "The experiences of people living with HIV-AIDS with regard to the comprehensive antiretroviral therapy management received from registered nurses at selected public primary heathcare clinics in Nelson Mandela Bay." Thesis, Nelson Mandela Metropolitan University, 2009. http://hdl.handle.net/10948/1253.
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Currently South Africa has the highest number of persons living with HIV-AIDS (PLWAs) in the world. Focus-group discussions conducted by Moon (2005:3) in the Eastern Cape indicated that people may not want to get tested for HIV or to access antiretroviral therapy (ART) for fear of disclosure of their HIV-positive status and of stigmatization. These findings prompted the researcher to conduct a study in this field. The objectives of this study are to explore and describe the experiences of PLWAs with regard to the comprehensive ART management received from registered nurses at selected public primary healthcare clinics in Nelson Mandela Bay; and to develop guidelines for registered nurses that could facilitate them in rendering appropriate comprehensive ART management. The research study is based on a qualitative, explorative, descriptive, phenomenological and contextual research design. The research population comprised of HIV-positive patients who received treatment at the selected public primary healthcare clinics. Criterion-based, purposive sampling was used to select participants for the interviews. Ten in-depth unstructured interviews were conducted. Data was then transcribed and coded. One central theme identified the fact that PLWAs experienced both positive and negative experiences at the clinics. The main findings of this research included evidence of various forms of stigma experienced by the PLWAs; distrust of the lay health counselors; but also that PLWAs were generally well-treated and satisfied with the service they had received. Broad guidelines for registered nurses was formulated that could facilitate them in rendering appropriate comprehensive ART management. The study concludes with recommendations made with regards to the areas of nursing practice, education and research. Throughout the study the researcher abided by the ethical considerations. The aspects of trustworthiness implemented in this study, included dependability, credibility, transferability and confirmability (Holloway & Wheeler, 2002:354).
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Monanabela, Khathatso. "Rational drug therapy monitoring in type 2 diabetes mellitus : using glycated haemoglobin as a guide for change in therapy." University of the Western Cape, 2015. http://hdl.handle.net/11394/5305.
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>Magister Scientiae - MScType 2 diabetes mellitus is a progressive disease characterised by defects in insulin secretion, insulin action or both. Proper management of diabetes with appropriate drug and lifestyle interventions, guided by proper glycaemic monitoring has shown improved glycaemic control and a substantial decrease in morbidity associated with complications and mortality. Evidence-based guidelines for the appropriate management of diabetes, suggests the use of glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) as monitoring indicators and have set targets levels that indicate appropriate glucose control. In the event of suboptimal control, actions steps to adjust pharmacotherapeutic treatment has been set out. Of the two aforementioned glycaemic monitoring indicators, HbA1c is termed the 'gold standard' as it provides the most comprehensive data i.e. it reflects both fasting and postprandial glucose concentrations over a 3 months period as compared to FPG which only show glucose levels for a few hours. The aim of this study was to describe the use of glycaemic monitoring indicators in patients with type 2 diabetes mellitus, classified as stable, treated at primary health care facilities in the Cape Town Metropolitan Region in South Africa. The study was a descriptive, retrospective and quantitative in design. Data were collected from patient medical records and included glycaemic monitoring tests and results as well as prescribing records for a maximum period of 18 months. The study comprised of 575 participants from five primary health care facilities in the Western Cape Metropole region. All participants had FPG results, while HbA1c results were recorded for 86% of participants at least once. More than 70% of participants with either a FPG or HbA1c result showed suboptimal glucose control i.e. were outside of the target range. In 181 opportunities for intervention in participants with HbA1c results outside target, 113 (62.4%) did not have any therapy adjustments, 19 (10.5%) had the total daily dose increased, 6 (3.3%) had total daily dose decreased, 9 (5.0%) had a step-up in regimen, 5 (2.8%) had a step down in regimen and 29 (16.0%) had a lateral regimen change. In 852 opportunities for intervention in participants with FPG results outside target, 609 (71.5%) did not have any therapy adjustments, 47 (5.5%) had the total daily dose increased, 18 (2.1%) had the total daily dose decreased, 16 (1.9%) had a step-up in regimen, 15 (1.8%) had a step down in regimen and 147 (17.3%) had a lateral change in regimen. This study has demonstrated that in the primary healthcare facilities investigated, FPG was the most often used gycaemic monitoring indicator, glycaemic monitoring of patients mostly show suboptimal glucose control and that opportunities to optimise pharmacotherapy in diabetes management are mostly missed.
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Grimsrud, Anna Thora. "Loss to follow-up from South Africa's antiretroviral treatment programme: Trends, risk factors, and models of care to improve retention." Doctoral thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/14578.
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Includes bibliographical referencesOver the past decade, antiretroviral therapy (ART) programmes have rapidly expanded in resource-limited settings. Access to ART has been accelerated through a public health approach to reduce morbidity and mortality, thereby transforming HIV from a humanitarian crisis to a chronic disease. However, the benefits of ART to patients and communities are dependent on patients being retained in care. This thesis investigates loss to follow-up (LTFU) after ART initiation, in the context of scale-up and limited resources and evaluates models of ART delivery to improve retention. After a brief introduction that offers orientation to the key issues and concepts in the field, Chapter 2 provides a comprehensive literature review discussing the public health concerns related to LTFU in ART programmes, as well as the methodological concerns encountered in studying LTFU. Six results chapters (Chapters 3-8) are presented using complementary cohort data from two collaborative datasets (one from programmes in resource-limited settings and one including only South African cohorts) and from a single ART programme at a community health centre. How to define LTFU is the focus of Chapter 3, demonstrating that definitions can have an appreciable impact on estimates of LTFU. In Chapter 4, temporal factors related to the expansion of ART programmes are investigated, with evidence that the risk of patient LTFU increases with each successive calendar year of ART initiation, and that the rate of programme expansion has a stronger association with the risk of LTFU than absolute programme size. Analyses in Chapter 5 suggest that patients initiating ART at higher CD4 cell counts, above 300 cells/μl, may have an increased risk of LTFU compared to patients initiating ART with lower CD4 cell counts. Taken together, these findings underscore the notion that LTFU is a burgeoning threat to the long-term successes of ART programmes in South Africa and other resource-limited settings. Chapters 6-8 report on the implementation and outcomes from innovative models of ART delivery for stable ART patients. Patient outcomes from (i) a nurse-managed ART service and then (ii) community-based 'Adherence Clubs' highlight that comparable and, in some cases, favourable patient outcomes may be achieved when ART delivery is decentralised. This thesis concludes that LTFU is a significant challenge faced by ART programmes. In the context of ambitious targets and evidence of the potential benefits of ART for individuals and communities, concurrent changes to the health system are necessary to support retention in care. The successes of ART programmes in treating a chronic condition in resource-limited settings can be built upon by expanding community-based ART provision and potentially integrating management of other adulthood illnesses.
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Bowman, Winifred Edna. "The evaluation of an accreditation programme for quality improvement in private physiotherapy practice in South Africa." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52525.
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Thesis (PhD)--University of Stellenbosch, 2001.ENGLISH ABSTRACT: "Quality" has different meanings to different people. Even quality experts do not agree on a single definition: Juran's definition of quality revolves around his concept of "fitness for use", Crosby defines quality in terms of performance that produces "zero defects" and Deming defines quality as a "never ending cycle of continuous improvement". One element, however, that is common to all three approaches is that management must accept and demonstrate leadership if quality is to be achieved. Quality is rarely thought of as others perceive it. What is apparent is that if providers of care wish to maintain leadership in defining quality, they need to - Actively participate in the public debate about quality. Review the way in which they have been defining quality. Question whether their definitions are aligned with what the purchasers of health care define as being important. Develop meaningful measures of quality and data collection systems that will allow them to demonstrate quality and value. - Willingly share data not only on outcomes, and also measures that are specific to individual procedures and service providers. The PhysioFocus practice accreditation programme attempted to achieve the above factors. By realising the goal of the research this was determined. The goal of the research was to evaluate the PhysioFocus practice accreditation programme and to make recommendations on the educational programme for accreditation in private physiotherapy practices. This goal was realised by means of an exploratory and descriptive research design with a qualitative orientation. The evaluation of the PhysioFocus practice accreditation programme was performed by means of a validated evaluation instrument. The group interview revealed components of the PhysioFocus practice accreditation programme that require remediation. Recommendations included professional-ethical issues, business management and legislative issues. The recommendations will be implemented by the PhysioFocus practice accreditation committee. The PhysioFocus practice accreditation learning programme was evaluated by means of a semi-structured questionnaire, containing eleven questions and a section for comments. The general consensus was that the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. The implementation of the PhysioFocus practice accreditation programme resulted in the facilitation of quality physiotherapy; professional and personal development; monitoring of quality improvement processes; and the evaluation and remediation of these processes. This supported the central theoretical assumption of the research. Concerns were voiced about the lack of standards, lack of quality improvement skills, the public image of the physiotherapy profession and the lack of basic business management training. The researcher concluded that the implementation of the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. At present the current PhysioFocus practice accreditation programme does not address all the needs of private physiotherapy practices. Recommendations based on the research included remediation of the current PhysioFocus practice accreditation programme, formal education included business management, professional-ethical-Iegal issues, standards and scientific methods to analyse process variation and the development of improvement strategies in quality improvement. Other recommendations include informal education, physiotherapy management and structured quality improvement activities. The issue of the image of the professional physiotherapist was also addressed. Topics for future research were identified. The uniqueness of the research lies in the fact that this is the only physiotherapy practice accreditation programme implemented in South Africa. It is also the only physiotherapy practice accreditation programme in South Africa that has been evaluated.
AFRIKAANSE OPSOMMING: "Gehalte" het verskillende betekenisse vir verskillende mense. Selfs kenners op die gebied van gehalte stem nie saam met 'n enkele definisie nie. Juran se omvattende definisie is "gebruikswaarde", terwyl Crosby gehalte in terme van produksie, naamlik "zero defek", definieer. Deming definieer gehalte as "'n nimmereindigende siklus van voortdurende verbetering". Die een aspek wat al drie die kenners egter gemeen het, is dat bestuur leierskap moet aanvaar en demonstreer indien gehalte bereik wil word. Geen twee persone ervaar gehalte eenders nie. Indien diensverskaffers leiding wil behou ten opsigte van gehalte-definiëring, sal hulle verplig wees om: aktief deel te neem aan openbare debat oor gehalte; die aanvaarde definisie van gehalte te herevalueer; die aanvaarde definisie van gehalte op te weeg teenoor dié van die mediese hulpfonds-administrasie; gehalte- en data insamelingsisteme te ontwikkel om gehalte en waarde te bewys; en gewillig alle data te deel - nie net uitkomsdata nie, maar ook data wat spesifiek op individuele prosedures en diensverskaffers van toepassing is. Die PhysioFocus praktyk-akkreditasieprogram het gepoog om bogenoemde te bereik. Die navorsing het gerealiseer deurdat die doelstelling bereik is. Die doelstelling van die navorsing was om die PhysioFocus praktykakkreditasieprogram te evalueer en aanbevelings te maak vir 'n leerprogram vir die akkreditasieprogram. Die doelstelling het gerealiseer deur "n verkennende en beskrywende navorsingsontwerp vanuit 'n kwalitatiewe oriëntasie. Die evaluering van die PhysioFocus praktyk-akkreditasieprogram het deur middel van 'n gevalideerde evalueringsinstrument geskied. Die groepsonderhoud het areas van die PhysioFocus praktyk- akkreditasieprogram wat remediëring benodig, geïdentifiseer. Aanbevelings het professionele-etiese aspekte, besigheidsbestuur en wetlike aspekte ingesluit. Die aanbevelings sal deur die PhysioFocus praktykakkreditasiekommitee geïmplementeer word. Die evaluering van die PhysioFocus praktyk-akkreditasieleerprogram het deur middel van 'n semi-gestruktureerde vraelys met 11 oop vrae, tesame met 'n afdeling vir opmerkings, geskied. Die algemene aanname was dat die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die implementering van die PhysioFocus praktyk-akkreditasieprogram het gehalte fisioterapie, professionele en persoonlike ontwikkeling, die monitering van gehalteverbeteringsprosesse, asook evaluering en remediëring van hierdie prosesse, tot gevolg gehad. Dit het die sentraalteoretiese aanname van die navorsing ondersteun. Daar was egter kommer oor die gebrek aan standaarde, die beeld van die fisioterapieprofessie, asook die gebrek aan besigheidsbestuuropleiding. Die navorser het tot die gevolgtrekking gekom dat die implementering van die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die huidige PhysioFocus praktykakkreditasieprogram voldoen nie aan al die vereistes van privaat fisioterapiepraktyk in Suid Afrika nie. Aanbevelings vanuit die navorsing sluit die volgende in: remediëring van die huidige PhysioFocus praktyk-akkreditasieprogram; formele opleiding, insluitende profesionele-etiese-wetlike aspekte; standaarde; wetenskaplike metodes om die praktykprosesveranderinge te analiseer; en die ontwikkeling van 'n gestruktureerde gehalteverbeteringstrategie. Die beeld van die fisioterapieprofessie is ook aangespreek. Onderwerpe vir toekomstige navorsing is geïdentifiseer. Die navorsing is uniek omdat die PhysioFocus praktyk-akkreditasieprogram die enigste akkreditasieprogram vir fisioterapie in Suid Afrika is. Dit is ook die enigste fisioterapie-akkreditasieprogram wat in Suid Afrika geëvalueer is.
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Mangi, Nozuko Glenrose. "Evaluation of self-efficacy in clinical performance of nurses initiate and management of anti-retroviral therapy by South African professional nurses." Thesis, University of Fort Hare, 2017. http://hdl.handle.net/10353/4492.
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Self-efficacy in clinical performance is a very important aspect in quality of health care, because it is the ability of the person to produce the desired outcomes. The aim of the study was to evaluate self-efficacy in clinical performance of NIMART programme by professional nurses in Buffalo City Metropolitan in Eastern Cape Province South Africa. A quantitative, descriptive survey design was used to examine self-efficacy in clinical performance during implementation of NIMART programme. A purposive sample of 358 NIMART programme trained professional nurses was included in the study. Analysis of the finding was done using SPSS version 21.0. Descriptive statistics (frequencies, percentage, mean and standard deviations) were used to analyse categorical variables. To reduce data volume, factor analysis was used to identify six variable clusters: Evaluation; planning, assessment, implementation, and patient care mentoring. Factor 1 (evaluation) was highly loaded on patient driven results (0.63); nursing interventions (0.70); breakdown point location (0.80); prognosis based care decisions (0.79); prognosis based outcome monitoring (0.70); and prognosis based settings adjustment (0.70). These items collectively define evaluation of self-efficacy clinical performance of the participants. Factor 2 (planning) was termed planning of patient care in a clinical setting was significantly loaded on these items: data driven nursing diagnosis (0.51); patient driven nursing diagnosis (0.52); settings based nursing diagnosis (0.49); overall care plan formulation (0.52); short-term patients care formulation (0.58); long-term patient care formulation (0.66); goal based measurable outcomes (0.80); goal based daily patient care plan (0.79); settings based daily patient care plan (0.73). Factor 3 (assessment) which was termed assessment in clinical performance was not significantly loaded in some of the items: physical assessment (0.64); patient history (0.65); energy restoration (0.56); time management (0.71); objective patient health data (0.61); subjective patient health data (0.49); data collection documentation (0.44). Factor 4 (implementation) data source correlation; patient health data analysis (0.45); patient strength (0.46); nurse-patient/family communication (0.55); nurse patient collaboration (0.64); Experience driven decision making (0.58). Factor 5 (patient care) patient care plan adherence (0.65); setting based overall patient care (0.74); resource based overall patient care (0.59). Factor 6 (mentoring) patient’s concerns identification (0.48); patient problems prioritisation (0.46); mentor/colleague advice (0.43); mentor/colleague feedback use (0.61); patient discharge strategies (0.71); continuous reporting/documenting (0.63). The mean scores produced by the Kruskal-Wallis test showed the lowest scoring pattern as follows: 20122013201120142010. This order was the same for all the variables, confirming that the 2010 group scored significantly higher than any other group on all the variables. The overall results of the study revealed that professional nurses have high self-efficacy in clinical performance in implementation of NIMART programme, except in evaluation aspect of self-efficacy where they scored lessor. Professional nurses trained by FPD scored higher in the aspects of self-efficacy in clinical performance compared to RTC trained; but scored lower in evaluative ability of self-efficacy in both institutions (FPD and RTC). The findings of this study showed that the overall self-efficacy of the professional nurses trained on NIMART programme performed clinically satisfactorily. It is recommended that in-service education or continuous professional development for professional nurses working in PHC’s should not only concentrate on updating clinical skills, but also create opportunity for reflection and strengthening of professional nurses’ self-efficacy in clinical performance. Also, further study on other processes of goal realisation will aid our understanding of self-efficacy in achieving the desirable goals of the professional nurses for patient quality care. Further research is also needed to evaluate clients’ satisfaction during care based on the NIMART intervention programme.
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Makoba, Lerato Theodora. "The experiences of infertile married African women in South Africa a feminist narrative inquiry /." Pretoria : [s.n.], 2005. http://upetd.up.ac.za/thesis/available/etd-05282008-123151.
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Kruger, Erika. "Learners' and educators' perceptions of the Massage Therapy Institute's combined practicum and community service programme." Thesis, 2012. http://hdl.handle.net/10210/6960.
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M.Phil.Therapeutic massage therapy (TMT) as a profession has undergone major transformations on two levels simultaneously in the past five years. The first is the statutory recognition of TMT as a health profession regulated by the Department of Health and the Allied Health Professions Council of South Africa (AHPCSA) that has propelled the therapy from the services sector into the country's primary health care system. The second is the transformation of the South African education structures requiring TMT to be formalised and accredited by the South African Qualifications Authority's (SAQA) and the accommodation of the qualification on the National Qualifications Framework (NQF) in accordance with the Higher Education Act of 1997. These impetuses have led to a shift in the profession's approach to how it defines itself and how it trains future therapists. The focus of this study is the Massage Therapy Institute's Community Service Programme (MTI CSP), the focal point of the institution's second year programme. The CSP entails the combining of practical sessions and community service in order to expose learners to a wide variety of conditions to encourage theory-practice integration. It also fosters a social awareness through exposure to patients from varied cultural and socio-economic backgrounds in a clinical setting. The purpose of this study was to investigate the perceptions of learners and educators regarding the efficacy of the programme to integrate theory and practice and to prepare TMT therapists for a health profession in the primary health care domain. From the analysis it was apparent that despite a number of shortcomings, learners and educators agreed that the CSP encouraged theory practice integration and personal development. They were also able to hone their professional skills. All participants indicated however, that learners failed to effectively transfer the knowledge and skills gained during the combined practical and community service sessions to written learning tasks that formed part of and tasks outside the programme. This was confirmed by text analysis of treatment and case study reports. The implications for teaching and learning are discussed in the context of language learning and learning through language in order to move beyond the what and the how to the why. It was also clear from the research that participation in the programme led to perspective transformation in the majority of learners' perception of TMT as a health profession located in the PHCS. The analysis showed that the reasons for the exception to this trend, is related more to macro policies rather than the efficacy of the CSP. Finally, a number of recommendations are made to improve the transferability of the knowledge, skills and attitudes gained in the CSP to other learning tasks and beyond that to learners' personal and public lives. The recommendations emphasise metacognitive skills and critical reflection to equip learner-therapists to become fully participating members of a responsible and relevant health profession.
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Baron, Debra Joy. "A content-based curriculum framework for somatology specialisation in stress relief and relaxation therapy in South Africa." Thesis, 2013. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000601.
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Thesis (M. Tech. Somatology) -- Tshwane University of Technology 2013.Discusses the development a training framework for a somatology-based specialisation in stress relief and relaxation therapy in South Africa. Such a specialist qualification will fulfil a niche area in the CAM discipline that can be advantageous to both health care professionals who provide cognitive-behavioural therapy and professional somatologists who focus on stress relief and relaxation therapies.
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Roopchand, Adelle Kemlall. "A systematic review of the non-invasive therapeutic modalities in the treatment of myofascial pain and dysfunction." Thesis, 2015. http://hdl.handle.net/10321/1264.
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Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014.Background: Myofascial Pain and Dysfunction (MPD) is a diagnosis commonly encountered by practitioners, hence, there are several treatment approaches employed by various practicing physicians. Practitioners are required to perform evidence-based protocols on patients; however, such intervention becomes increasingly difficult with the increasing volume of evidence available with regards to treatment of MPD. A systematic review provides a well-structured, critical analysis of the available protocols, and as such, provides practitioners with an evidence-based summary of the available modalities and the effectiveness of these modalities. Thus, the aim of the study was to systematically review and evaluate the literature to determine the effects of various non-invasive modalities on MPD. Objectives: Studies investigating various non-invasive modalities were identified, evaluated against the inclusion criteria and then reviewed against PEDro criteria to present current available evidence regarding their effectiveness as a source of treatment for MPD. Methods: A literature search was conducted, based on key terms including: active and latent myofascial trigger points, manual therapy, manipulation, acupressure, massage, muscle stretching, ultrasound, transcutaneous electric nerve stimulation, electric stimulation therapy, magnetic field therapy, and exercise therapy. Databases searched were: PubMed, EBSCOhost, Medline, CINAL, Proquest, Health Source, Sport Discus, Science Direct, Springer Link, Google Scholar and Summons. The articles were screened according to inclusion and exclusion criteria, after which a secondary hand and reference searches were performed. Thereafter, the articles were reviewed by four independent reviewers and the researcher. The PEDro Scale was used to determine methodological rigor of the included studies. The results were then analysed and ranked. Results: Following the screening process during data collection for this study, a total of 25 studies were identified and included. The review and ranking of these studies revealed a moderate level of evidence present for the effectiveness of Topical Agents. A limited level of evidence was noted for TENS, Ischemic Compression, Ultrasound, Laser and Other Modalities. Approximately 25% of the reviewed studies involved combination therapies; hence their outcomes cannot be applied to the effectiveness of individual modalities. Conclusion: Upon comparison of the quality of evidence available for the various types of modalities present for the treatment of MPD, it was noted that Topical Agents were supported by a stronger level of evidence than TENS, Ischeamic Compression, Ultrasound, Laser and Other Modalities. However, due to a lack of strong overall evidence for any of these modalities it has been concluded that more research is required to establish which modality is in fact the most effective.
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Rammanhor, Kiveshni. "An analysis of the Somatology programme offered at South African Universities of Technology to determine whether it meets the needs of industry." Thesis, 2015. http://hdl.handle.net/10321/1266.
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Submitted in fulfilment of the requirements for the Master’s Degree in Technology: Somatology, Durban University of Technology, 2014The beginning of the 20th century presented the Somatology profession with unprecedented challenges of acquiring a scientific base and achieving professionalisation. It is in this milieu that a few research studies were previously undertaken with regard to Somatology education however, none particularly focused in relation to areas that are preparing graduates for industry. The current study was a national study that explored the existing National Diploma offering through the lens of students, educators and members of the Durban University of Technology’s Advisory Board. In particular, it focused on developing broad guidelines to guide academics on what further content was required to be integrated into the current Somatology education. A triangulated approach using both quantitative and qualitative methods was used to guide the operationalisation of the research process. Five Universities of Technology participated in the study, viz. Cape Peninsula University of Technology, Central University of Technology, Durban University of Technology, Tshwane University of Technology and the University of Johannesburg. Third year and B.Tech students were surveyed with regard to the current Somatology Programme and what further aspects needed to be integrated into it to better prepare graduates for industry. In addition, in-depth interviews were also held with ten academics, two from each University of Technology, to examine what they thought needed to be included in education to strengthen the current programme. The same was done through a focus group discussion with members of the Durban University of Technology Advisory Board. A programme analysis of current content being taught at the five Universities was also undertaken. The results reflected that although most of the samples were satisfied with the current educational programme, they still believed that gaps existed and that graduates were still not adequately prepared for industry. It was found that both students and educators saw the need for more therapies to be included in the training. Both educators and the Advisory Board sample also saw the need for a stronger emphasis to be placed on practical skill development. The Advisory Board sample also strongly articulated for training to occur in an industry context as opposed to the University based experiential setting. Using data from these multiple samples, a set of guidelines was developed and presented. These guidelines were based on what further therapies needed to be integrated into education. The Duke Integrative Medicines Wheel of Health was adopted as the theoretical framework of the study. It was also utilised to identify specific areas that needed to be interwoven into education to further strengthen graduates’ preparedness for industry.
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Müller, Alexandra Denise. "Adherence to paediatric antiretroviral therapy in South Africa." Doctoral thesis, 2009. http://hdl.handle.net/11858/00-1735-0000-0006-AF61-4.
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Mlangeni, Patience. "A feminist paradigm for drama therapy in South Africa." Thesis, 2020. https://hdl.handle.net/10539/30594.
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A thesis submitted for the degree of Masters in Drama Therapy to the Faculty of Humanities, Wits School of Arts, University of the Witwatersrand, 2020This research looks at the possibility of a feminist paradigm that can frame the practice of drama therapy in South Africa. The paper explores the challenges that black South African women are still battling with twenty-five years post-Apartheid. While investigating the notions of gender and the significance of the different waves of feminism, and how feminist pedagogy has come to help us understand gender as a social construct. Through five interviews with practising Drama Therapists in South Africa, the paper distils the themes that these practitioners face in their daily encounters. The research stresses the importance of feminism as a way of working towards deconstructing the taboos that inform gendered roles. It further explores the historical legacy of Apartheid in present-day South Africa. It also looks at the issues of body politics and how capitalism continues to exploit black bodies especially those of women for profit. Also, it explores silence and its uses
CK2021
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Yatt, Siobhan. "Divorce therapy for preschool children." Thesis, 2014. http://hdl.handle.net/10210/10408.
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Ngcobo, Kulunga. "Hillbrow wellness: Occupational Therapy & Rehabilitation Center." Thesis, 2014. http://hdl.handle.net/10539/15632.
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Located in the Hillbrow health precinct, the Occupational Therapy and Rehabilitation Centre serves the Hillbrow community which is currently subject to various social ills – such as crime, violence, substance abuse, and poverty – which often times are the root cause of unhealthy lifestyles, sickness, and disease amongst the citizens of Hillbrow. The proposed site for the building is an existing parking lot, adjacent to the Hillbrow Community Health Centre/Clinic. There is an existing rehabilitation department in the clinic, consisting of occupational therapists, physiotherapists, paediatrics department, speech and hearing specialists, social workers, and psychologists. The new proposal seeks to incorporate this rehabilitation department within the new development, while expanding its program to incorporate greater social upliftment programs and employment options through vocational rehabilitation.
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Gower, James A. "Art therapy: Perspectives of South African psychologists." Thesis, 2008. http://hdl.handle.net/10539/4913.
Full textAbstract:
Art therapy is a method that has a long global history as a treatment alternative when
conventional verbal psychotherapy and even pharmacotherapy have failed to facilitate
improvement. It helps access, give form to, and integrate experiences, memories, and
emotions that cannot be directly verbalised. Art therapy is the creative expression of
the client through the use of art making and the subsequent artefacts within therapy.
Art therapy is an opportunity for the therapist to access recesses of the client’s mind
that may otherwise be hidden. This enables the therapist to utilise these revelations
and the artefacts produced strategically within therapy.
In South Africa art therapy as a profession does not have a distinct category of its own
under the Health Professions Counsel of South Africa (HPCSA), and is not included
in psychology training courses at tertiary level. In spite of this, some South African
psychologists do use it as a modality in therapy. These psychologists are the subjects
of this study. They provided important information regarding the possible uses of art
in therapy from a unique South African perspective.
The participants in this study have responded each in uniquely favourable terms to
questions surrounding the value and benefit of art as a tool of psychological therapy.
This unequivocal professional concurrence, while derived from a limited research
sample, suggests that art therapy, though severely neglected, holds enormous potential
for positive application within the South African context. The interpretations,
definitions and applications of art therapy by each of these therapists are admittedly in
no way as profound as those evidenced in the international literature examined in the
course of this study, yet a vast resource of innovative perspectives, informative
considerations along with fresh indicators towards areas for potential future research
have come to the fore.
According to the participants in this study, art therapy does not receive enough
attention in the South African psychological arena. Areas specifically identified by
the interviewees in which art therapy can play a role include: group work;
preventative work; the crossing of language barriers; providing therapy to the greater
population and previously disadvantaged groups; shortening therapy; and trauma
work.
Art therapy is not limited to age, nor by the presenting problem. It is engaging, and
facilitates effective communication. The artefacts produced can serve as historic
records of therapy, allowing the therapist and client to recollect the process. Colour
can play an important part in therapy, yet the client’s unequivocal personal
interpretation of colour should be the focus. Art therapy is not static and facilitates
therapeutic movement, client involvement and responsibility.
The art activity and artefact provides a concrete rather than verbal medium through
which a person can achieve both conscious and unconscious expression and, as such,
can be used as a valuable agent for therapeutic change. The image is tangible and
serves as constant reminder and anchor to the clients conflict or problem, yet moves it
to a safe distance outside the client.
Art therapy is implemented in many different ways within South Africa, as is the case
internationally.
Although a multicultural South African society seems to be different in many
contexts, the implementation and occurrence of art therapy appears to be fairly
unchanged, and art may be the universal therapeutic language.