OpenUCT :: Browsing by Author "Amosun, Seyi Ladele"

Browsing by Author "Amosun, Seyi Ladele"

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Open Access
A case study exploring disability inclusion within the Muslim Ummah in South Africa
(2023) Mayat, Nafisa Essop; Amosun, Seyi Ladele; Galvaan Roshan
Religion and spirituality are central to the way many people, including persons with disabilities, make sense of both the world itself, and their place in that world. However, in most scholarship focusing on disability, religion, as a way of understanding and dealing with disability, is side-lined or absent (Imhoff, 2017). Islam has a long rich history in South Africa and is currently one of the major religions here (Mahida, 2012). Followers of Islam are commonly referred to as members of the Muslim Ummah as a collective, an Ummah that includes persons with disabilities and non-disabled persons. Given the paucity of research focusing on disability in the Muslim Ummah in South Africa, this study sets out to gain insight into the way disability inclusion is enacted within the Muslim Ummah in South Africa. The research question asks: How is disability inclusion interpreted, experienced and enacted by people within the Muslim Ummah in South Africa? Adopting an interpretative qualitative research approach and applying an intrinsic case study method, the research was conducted with members of the Ummah in three major cities in South Africa, viz. Durban, Johannesburg and Cape Town. Data was generated from persons with disabilities, family members of persons with disabilities, the Ulema and a non-disabled person from the Ummah from each city. In-depth face-to-face interviews and a review of three Muslim publications were used as data gathering mechanisms. Interviews were held with seven persons with disabilities, either a physical or sensory disability, five family members of participants with disabilities, six Ulema and three non-disabled persons. All participants were aged 18 and older. Data was analysed by looking for themes that emerged from the data. Three themes, “Seen as Inferior'', “Carrying the Weight for Inclusion” and “We Are Not Doing Enough”, each with two sub-themes, emerged from the analysis. “Seen as Inferior'' and its two sub- themes, ‘' Gaze of Othering and ‘'The Deep Impact of Disability'', highlight the way in which persons with disabilities are viewed as inferior within the Ummah and how this is reflected in the gaze of non-disabled persons on persons with disabilities and their families, and the impact of this gaze. ‘'Carrying the Weight For Inclusion” emphasises the responsibility that persons with disabilities have assumed in order to be accepted into and included in the Ummah and this is demonstrated through the two sub-themes, “The Unspoken Responsibility of Negotiating Persons with Disabilities” and ‘'Negotiating the Effort to be at the Masjid”. “We Are Not Doing Enough” explains that although some aspects of inclusion are evident within the Muslim Ummah, the pace of change is very slow and inclusion remains inadequate. Sub-themes ‘'Inclusion could Create Ease and Belonging” and “Still a Journey to Travel to be Included” capture the way disability inclusion is interpreted and experienced by the participants of the study, highlighting that much work is still needed to attain full inclusion and to create ease and belonging for persons with disabilities within the Ummah. The discussion explains how the dominant discourse around disability is one that reflects an ableist, normative, colonial narrative. This narrative influences how disability inclusion is enacted within the Ummah, belabouring a move to full inclusion. The phenomenon of an unconscious exclusion of persons with disabilities within the Ummah is discussed as it emerges from this dominant discourse, together with the silence that sustains the continuation of the exclusion. The ways in which this unconscious exclusion plays out in many spaces and places significant to the lives of persons with disabilities are identified. It is proposed that, in order to achieve full inclusion and belonging for persons with disabilities within the Ummah, there needs to be a re-shaping in the thinking around disability through generating new knowledge and by challenging the dominance of the normative, ableist narrative. Informed by a decolonial turn, pathways towards full inclusion and belonging of persons with disabilities within the Ummah are proposed. It is suggested that collective action by both persons with disabilities and non-disabled persons within the Ummah is needed for full inclusion and belonging to transpire. The pathway to full inclusion and belonging would enable systemic change around disability within the Ummah to ensue and it would help move the de-colonisation project forward.
Open Access
A prospective study exploring the experience of rehabilitation health professionals in implementing the 5 A`s strategy in addressing risk factors for non-communicable diseases
(2025) Vearey, Gillion; Maart, Soraya; Amosun, Seyi Ladele
Background: The growing epidemic of non-communicable diseases (NCDs) has a significant impact globally and locally in South Africa, not only on mortality rates, but also morbidity; increasing the risk of disability and decreasing the quality of life of people affected by these diseases. Behaviour Change interventions such as Motivational Interviewing (MI) and Five A's (5A's), have been developed and implemented to address the four behavioural risk factors causing NCDs. Method: A mixed method was used to 1) assess the use of MI in a South African context to address health risks for NCD`s through a scoping review, 2) assess the Scale of Staff Valence(SSV) in using MI in routine patient consultations by making us of a cross-sectional survey and an adapted Staff Valence questionnaire, and 3) the experience of Rehabilitation Health Professionals (RHPs) in implementing MI in a focus group discussion. Results: The original search identified 22 articles for the scoping review, 11 articles were excluded by title, 2 were excluded by abstract and 1 excluded by full text, 8 articles were included in the review. All the studies were based in the Western Cape Province. Diabetes and CVD were the most common conditions discussed. Most studies delivered training over 3-4days with 2 or more days of follow-up. Outcomes showed benefits of being more equipped to deliver MI to patients with NCDs, however barriers such as appropriate venues, buy in from other staff, and difficulties building rapport with some patients were also reported. Fifteen RHPs participated in this study, with 11 RHPs having more than 5 years' experience in their professional field. For the SSV scores, where a higher score reflects a positive result, for capability the average score was 28 (80%) with a standard deviation (SD) 2.4 under opportunity the average score was 66 (86%) with SD 6.6; and under motivation average score was 31 (90%) with SD 2.2. There was a statistical difference in opportunity across the level of experience (p< 0.05). These high scores confirm RHPs staff readiness in implementing behaviour change. Two themes emerged following the qualitative analysis of the RHPs' experiences in implementing the 5A's approach, namely 1) quality of the 5A's which developed from challenges and benefits of this framework as well as the impact of improved knowledge around behaviour change, and 2) impact of the clinical setting which compared the range of clinical settings RHPs practice in and the contact time available to implement the 5A's. Discussion and Conclusion MI and the 5A's can be considered a feasible approach to addressing health risk behaviours related to NCDs in South Africa. RHPs discussed the value and benefits of training and equipping in behaviour change strategies. However, barriers and challenges do exist, such as the limited patient contact time and the stage of behaviour change of each patient, influencing the effectiveness of this approach; especially in an acute setting. RHPs practicing in a subacute or outpatient setting are better suited to implement such an approach considering their contact time to build rapport with patients. These RHPs may be a more appropriate study population for future research. The 5A's framework and motivational interviewing can have a significant impact on NCDs in SA, further research is required to determine the long-term effects of such interventions.
Open Access
An exploration of services and member profiles at Senior Service Centres in the Western Cape, South Africa
(2018) Harris, Fahmida; Amosun, Seyi Ladele; Kalula, Sebastiana
Introduction The number of South Africans aged 60 years and older is increasing. The National Development Plan (NDP) aims to raise average life expectancy to 70 years by 2030. In response to similar global trends, the World Health Organization (WHO) developed the global Active Ageing Policy Framework (AAPF) to inform the actions taken by countries to address the needs of older persons, acknowledging the different contexts and cultures. The WHO recommended that the framework should have been evaluated to test its applicability and use in member countries by the first half of the twenty-first century. In South Africa, Senior Service Centres for Older persons were set up in communities to provide services to enhance the achievement of the goals of the AAPF. Unfortunately, little information is available on how the framework has been applied to inform services offered in African countries, including South Africa. This study explored services provided by Service Centres for Older Persons in the Western Cape using the WHO framework on Active Ageing as a guide to the services. The study was conducted in two phases. Aims In the first phase, the study explored the characteristics of Service Centres – the organisational structures, the types of services offered, the profile of the managers, and their perception of the needs of the members of the centres. In the second phase, the study explored the profile of the members of these centres by determining their socio-demographic profile, health and psychosocial characteristics. Methodology In phase 1, forty-one service centres were selected by stratified random sampling to proportionally represent the five districts and the Cape Metropole in the province. Only 35 service centres consented to take part in the study. In phase 2, a sample of convenience was recruited from 3 051 registered members at the 35 service centres. Only 625 members consented to participate. A cross sectional, descriptive research design was utilised to collect data on the characteristics of the service centres from the managers, using a modified self-developed questionnaire. To explore the profile of members of the service centres, a self-developed questionnaire and two standardised questionnaires namely, World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule II (WHODAS II), were administered. Data analysis Descriptive statistics were used to analyse the responses to the closed-ended questions in phases 1 and 2 of the study, and data presented as frequencies. Similarly, responses to the open-ended questions were summarised and themes were identified. In phase 1, quantitative and qualitative responses were analysed according to the WHO Active Ageing Framework. In phase 2, the data generated were analysed according to the WHO International Classification of Functioning, Disability and Health Framework (ICF) model. Results Services offered to members at the centres in the six categories of determinants of the AAPF included the following: • Health and social care systems – Limited screening programs were provided as part of health promotion and disease prevention services. • Behavioural – Physical activity/exercise programmes were most common, but no programs addressed healthy eating habits, tobacco and alcohol abuse, or adherence to medication use. • Personal factors – Services were provided to enhance members’ cognitive skills. • Physical environment – No services were offered on falls prevention. • Social environment – Different types of social support programmes were offered, including meeting education and literacy needs of members through the provision of Adult Basic Education Training (ABET). • Economic – Some centres offered members opportunities for formal work and volunteering, while some provided income generation activities. Most of the managers had high school education but expressed the need for training to manage these centres. The managers perceived the needs of the members would relate to health care, social support, inactivity, isolation and safety among others. The summary of the profile of the 625 members of the centres are presented in the domains of the ICF model: • Personal factors – The members were predominantly widowed women with a mean age of 74.1 ±7.51 years (range 60–100 years). Most members displayed good lifestyle habits and engaged in various leisure and physical activities. Members were also satisfied with themselves, their health, bodily appearance and quality of life and reported a variety of aspirations for their future with and without possible future-orientated behaviours. • Health conditions – Hypertension, arthritis and diabetes were the most common health problems reported by members for which they took medication. Falls were not common among members although the majority feared falling. • Body structure and function – Most members expressed good cognitive function, could concentrate and follow conversations, and reported no hearing, visual or bladder problems. Members also reported good postural balance. • Activities and participation – Members were satisfied with their abilities to do daily activities, participate in the community, and learn new tasks. • Environmental factors – Most members resided with their children or family for various reasons, including needing care for themselves or to provide care to their children and/or extended families. Discussion and conclusion Using the WHO AAPF as a guide, it was found that services provided by Service Centres for Older Persons in the Western Cape, although varied, were deficient at most service centres. The managers responsible for providing these programmes were women with limited skills who needed more education and training to be able to manage the centres appropriately. The members of service centres, despite presenting with health challenges and multi-morbidities, indicated aspirations for the future. In view of the goals of the National Development Plan (NDP) to increase life expectancy of older persons to 70 years by 2030, a more comprehensive exploration of the profile of older persons will assist the managers of the Service Centres to respond more appropriately to the diversity of needs and interests of members.
Open Access
Assessment of lung function abnormalities in adult patients with tuberculosis in a high HIV-prevalent setting and the impact of a pulmonary rehabilitation intervention to improve lung function, functional capacity, and quality of life
(2022) Manie, Shamila; Amosun, Seyi Ladele; Meintjes, Graeme; Allwood, Brian; Zinyakatira, Nesbert
Background: Globally, tuberculosis (TB) continues to be a major health problem. In the most recent World Health Organisation (WHO) Global Tuberculosis Report of 2019, TB was ranked as the leading cause of death from an infectious disease ahead of the human immunodeficiency virus (HIV) and acquired immune-deficiency syndrome (AIDS). In the 2019 WHO Global Report on TB, there is little information relating to TB post-cure effects and management. Although there is evidence that successful completion of TB treatment does not equate to normal lung function, there is growing need for research, both during and after TB treatment, on the extent of lung function abnormalities and how these impact on the individual's quality of life (QoL). Pulmonary rehabilitation programmes may provide a continuum of care for individuals with TB to address both lung function abnormalities as well as positively impacting on QoL. Objectives: The present PhD thesis aimed to provide insight into the extent of pulmonary disease in individuals with pulmonary TB during and near completion of TB treatment as well as to establish whether provision of a pulmonary rehabilitation programme (PRP) could address the research gap. To achieve this, three linked studies were undertaken in the form of observational (prevalence) study (Study 1), a systematic review (Study 2), and a randomised control trial (Study 3). Study One: Observational Study Objectives: The overall aim of the present observational study was to ascertain the prevalence of lung function abnormalities in first time, drug sensitive individuals living with TB, with or without HIV coinfection, at near completion (at least four months) of TB treatment. The specific objectives were to determine: i) baseline clinical and socio-economic profile, ii) baseline information pertaining to the QoL outcome measures of EQ-5D-3L and the St George's Respiratory Questionnaire (SGRQ), iii) measure lung function parameters, iv) establish the proportion of participants with normal or abnormal (obstructive, restrictive, or mixed) lung function and the severity of these, v) whether a correlation of lung function abnormalities with chest x-ray (CXR) abnormalities exist, vi) establish whether a relationship exists between lung function and QoL measures, and vii) identify the predictors of lung function abnormality in individuals being treated for active TB. Methods: A cross-sectional observational study using a sample of convenience was conducted. Inclusion criteria included all adult male and females between the age of 18-80 years with confirmed (smear positive or by CXR) drug-susceptible TB who were receiving treatment, with or without HIV coinfection, for at least four months (16 weeks). ii Participants were excluded from Study 1 if they were adult patients who had had previous TB episodes, recent severe chest trauma (within the previous three months), a recent history of pneumonia, known atopic asthma, chronic bronchitis, emphysema, bronchiectasis prior to TB diagnosis, cardiac failure, or any other unrelated respiratory disease as reported in their medical folder. Participants completed two QoL questionnaires (EQ-5D-3L and SGRQ), a self-designed clinical research form to collect descriptive data, a six-minute walk test (6MWT), CXR, and spirometry once off. Results: The sample of 305 participants were predominantly male (n=168:55; 1%), had a median age of 36 years (IQR:28-43), and had median time of 19 weeks (IQR:18-22) on TB treatment. Overall, 32% of the sample presented with abnormal lung function (obstructive=11%, restrictive=15%, and mixed=6%). Only 2.2% of the total sample had two or more co-morbidities. There was no statistically significant difference (p=0.29) in distance covered by participants who had obstructive compared to restrictive lung function abnormality. After logistic regression analysis of clinical and sociodemographic variables (multi-variate), only being older (56–65 years old) and being obese were statistically significant (p=0.02 and p=0.04 respectively). When considering QoL, only the domain of mobility for the EQ-5D-3L questionnaire was statistically associated with abnormal lung function (p=0.02). Linear regression modelling for continuous variables of lung function (FEV1, FVC, FEV1/FVC and percentage predicted of FEV1, FVC, and FEV1/FVC) with SGRQ, 6MWD, and CXR scores yielded no predictor. Conclusion: Overall, 32% of participants presented with abnormal lung function, which is lower than comparator studies investigating lung function in TB populations. Quality of life measures for most participants was considered good at the time of assessment. Limitations to Study 1 related to the absence of normative data for a healthy population relating to lung function and 6MWD to compare the findings in this TB population. Recommendations for future research would be to establish normative data for these outcome measures. Regarding lung function testing, it is recommended that training of correct execution of the spirometry techniques is performed prior to assessment as the technique may be unfamiliar compared to the routine tests done at clinic visits for individuals receiving TB treatment. iii Study Two: Systematic Narrative Review A systematic review was conducted to establish the evidence of the impact of non-pharmacological intervention programmes (pulmonary rehabilitation) in the rehabilitation of individuals living with TB on lung function outcomes. Methods: MEDLINE via Pubmed, CENTRAL, CINAHL, PEDro, Web of Science, Scopus, Science Direct, and African Index Medicus, including Google Scholar were searched (from January 1995 to December 2016 with an updated search in November 2018) for randomised control trials, quasi-experimental and pre-post-test studies on PRPsfor adult individuals with TB specifically with lung function measures as primary outcome. Results: In total, 1 705 studies were obtained from the search. Once duplicate studies were removed, 1 220 studies remained. The titles and abstracts of these studies were screened resulting in 1 210 studies being excluded. Therefore, 10 studies were potentially eligible. Once the full-text articles were assessed, four studies met the inclusion criteria. Of the included studies, only one was a randomised control trial, two studies were single arm before and after studies, and one study was a prospective non-randomised open trial (two arms). In total, there were 178 participants in these studies, with sample sizes ranging from 10 to 67 participants. All four selected studies had both male and female participants; however, overall, male participants were the majority with 69% versus 21% females. The mean age across the studies was 70 years. No statistically significant difference (p>0.05) was found regarding lung function parameters and the PRPs. No meta-analysis could be performed as data could not be pooled due to the differences in study characteristics and outcome measures. Conclusion: This review was unable to support or negate the use of pulmonary rehabilitation for individuals with TB primarily due to the lack of well-designed and executed randomised control trials. The studies showed that no effect on FEV1 was demonstrated. The researchers recommended that future research investigates the extent of pulmonary sequelae in patients after completion of TB chemotherapy in large-scale studies. Long-term follow-up in those who have had TB without surgical intervention should be prioritised to see the extent of lung function disorders in this population, particularly in countries on the high-burden list for the disease. A further recommendation is that well executed randomised control trials that control for biases to investigate pulmonary rehabilitation in populations of individuals with TB should be prioritised as there is a need to develop an evidencebased continuum of care. iv Study Three: Randomised Controlled Trial Objectives: The overall objective of study three was to determine what the impact of a contextually relevant PRP would have on individuals living with TB, with or without HIV co-infection, on outcomes related to lung function, functional capacity, and QoL. Methods: A pilot randomised, single blinded, pre-test-post-test design was used. Inclusion criteria were all adult males and females between 18-65 years with TB confirmed by Gene Xpert, irrespective of number of TB episodes, HIV status, or having chronic obstructive pulmonary disease. Participants had to be within their first week of TB treatment. Participants with only extra-pulmonary TB, recent severe chest trauma (within the last three months), a recent history of pneumonia (within one month), known atopic asthma, cardiac failure, or any other unrelated respiratory disease as reported in their medical folders or who had defaulted on their treatment were excluded. In addition to this, if participants failed the pre-participation health screening and were non-ambulate due to paralysis or amputation, they were also excluded. Fifty-eight participants were randomised into a control group (CG) receiving only pharmacological therapy and the intervention group (IG) who received pulmonary rehabilitation in addition to pharmacological therapy. The PRP was held for 12 weeks and consisted of two weekly sessions with a duration of 45 minutes each, which was delivered at a community centre. Participants completed two QoL questionnaires (EQ-5D-3L and SGRQ), a self-designed clinical research form to collect descriptive data, a three-minute step test, and spirometry at three time points (enrolment, at six weeks, and at 12 weeks). T-tests were conducted to determine the difference between means of the CG and IG for lung function parameters, functional capacity, and QoL outcomes. Results: There were 29 participants in each group. Regarding sex, age, and number of co-morbidities the two groups were well matched. Regarding HIV status, the CG had more participants that were HIV positive (n=22) and on anti-retroviral therapy (n=11) than their IG counterparts (n=13 and n=5 respectively). Nearly half of the participants had a first time TB diagnosis, with the participants in the IG having reported more recurring TB incidences overall (n=16 vs. n=13). A t-test for difference between means showed no statistical significance for the CG and IG regarding FEV1, FVC, and FEV1/FVC ratio for absolute or percentage predicted values. Forty-three percent of participants in the total sample had normal lung function at baseline, with the remaining participants being classified as having either obstructive (26%), restrictive (21%), or mixed (10%) lung function. At baseline, 48% of participants in the CG had abnormal lung function compared to 67% in the IG. At six weeks there was no change in the CG regarding lung abnormalities. However, the IG only had 33% abnormal lung function at the same time point. v Although there was no statistical significance for any of the lung function categories, there was a 42% improvement in normal lung function at six weeks in the IG compared to the CG at baseline. The median baseline number of steps taken by the CG was 79 steps (IQR:42-134) compared to 117 steps by the IG (IQR:84-154). A t-test conducted to test the difference between means for the CG and IG was statistically significant for the step test (p=0.002) at six weeks for the IG, but not at 12 weeks (p=0.13). No correlation was found between the SGRQ (QoL parameter) and any lung function parameter (p>0.05) at 12 weeks. Conclusion: Although the changes in lung function, functional capacity, and QoL did not reach statistical significance at completion of the PRP for the IG, the continued improvement in all the outcomes for the IG from 0 weeks to 12 weeks holds potential clinical significance.
Open Access
The feasibility and potential effectiveness of a conventional and exergame intervention to alter balance-related outcomes including fall risk: a mixed methods study
(2020) Rogers, Christine; Amosun, Seyi Ladele; Shamley, Delva
Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages.

Browsing by Author "Amosun, Seyi Ladele"

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