Browsing by Author "Draper, Catherine"
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- ItemOpen AccessAlignment between chronic disease policy and practice : case study at a primary care facility(2013) Draper, Claire Anne; Draper, Catherine; Bresick, GrahamCurrent literature supports the need to make the prevention and management of chronic diseases an international health priority. In South Africa, our Health Minister has committed the government to tackling the burden of chronic diseases alongside communicable diseases. The Western Cape has developed an excellent policy and framework to guide and improve the prevention and management of chronic diseases at a primary care level, however limited literature exists around the alignment of the policy with current practice and around any challenges to its implementation. Should the policy be well implemented, it has the potential to make a significant difference to the health of the population served. For this reason, the overall purpose of this study is to improve the care and management of patients with chronic diseases within primary health care facilities. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy (which includes an audit tool), using one primary health care facility in the Cape Town metropolis as a case study.
- ItemOpen AccessThe Border and Beyond : an analysis of the post-Border War discourses of families of ex-SADF soldiers(2001) Draper, Catherine; Foster, DonThe aim of this study was to investigate the impact of military experiences in the Border War on families of soldiers who fought in some capacity for the South African Defence Force (SADF) in Namibia and/or Angloa during the 1970s and 1980s. The sample for this study comprised one male and 14 female participants, all white South Africans between the ages of approximately 30 to 70 years. All participants were related to, or had a close relationship with a male individual who served in Namibia and/or Angola, or in the Caprivi Strip some time during the period under review. Thirteen participants responded to written appeals whilst and the other participants were referrals.
- ItemOpen AccessEvaluating exposure to and perceptions of the Woolworths Healthy Tuck Shop Guide in Cape Town, South Africa(2011) Marraccini, Toni; Draper, Catherine; Meltzer, Shelly; Bourne, LesleyBoth under-nutrition and over-nutrition pose a public health concern, especially for children in South Africa. Several initiatives exist in South Africa in order to promote healthy eating and nutrition at schools. One of them is the Woolworths Making the Difference (MTD) Programme aimed at eliminating barriers to promoting healthy lifestyles that exist at schools, such as the availability of low cost, unhealthy foods either from tuck shops or street vendors. The Healthy Tuck Shop Guide is a recent addition to the MTD programme. The aim of this evaluation is to assess schools’ perceptions of the Woolworths Healthy Tuck Shop Guide as it is being utilized in Woolworths Making the Difference schools.
- ItemOpen AccessExecutive function and physical activity in preschool children from low-income settings in South Africa(2019) Cook, Caylee Jayde; Draper, Catherine; Scerif, Gaia; Howard, StevenExecutive function (EF), that shows rapid development in the preschool years, is foundational for cognitive development. Previous research has found aspects of physical development including gross motor skills and physical activity to be related to EF. However, evidence for these relationships in the preschool years, as well as in low- and middle-income countries is lacking. Therefore, this study aimed to investigate the relationships between EF (and related components of cognitive development) with physical activity and gross motor skills (GMS) in a sample of preschool children from urban and rural low-income settings in South Africa. Cognitive and physical outcomes were measured in a sample of preschool children (N=129; Mage = 50.7±8.3 months; 52.7% girls) from urban (Soweto) and rural (Bushbuckridge) low-income settings in South Africa. Cognitive components included EF, self-regulation (Early Years Toolbox, EYT), attention (adapted visual search task) and school readiness (Early Childhood Development Criteria Test). Physical outcomes included objectively measured physical activity (accelerometry), gross motor skills (Test for Gross Motor Development 2) and anthropometric measurements (height and weight). On average, children from both settings showed higher than expected scores for EF and self-regulation (based on Australian norms for the EYT), adequate gross motor proficiency and high volumes of physical activity (M total physical = 476 minutes per day). In contrast, a high proportion of children, particularly in the rural setting, demonstrated below average scores for school readiness. Investigations into the relationships revealed that EF was positively associated with self-regulation, attention and school readiness. Positive associations were also found between GMS and physical activity and, and physical activity and body mass index (BMI). And finally, that GMS, but not physical activity, was positively associated with all components of cognitive development. This study is the first to provide evidence for the importance of EF and the link between motor and cognitive development in preschool children from South African, low-income settings. Another key finding was that there may be factors promoting early EF skills in these settings but that these skills, although associated, are not transferring to school readiness. The lack of (or negative) associations between physical activity and cognition presents another key finding, further research is needed to identify whether there are specific amounts and types of physical activity that specifically benefit cognitive development.
- ItemOpen Access"HealthKick": Formative assessment of the health environment in low-resource primary schools in the Western Cape Province of South Africa(BioMed Central Ltd, 2012) de Villiers, Anniza; Steyn, Nelia; Draper, Catherine; Fourie, Jean; Barkhuizen, Gerhard; Lombard, Carl; Dalais, Lucinda; Abrahams, Zulfa; Lambert, EstelleBACKGROUND: This study evaluated the primary school environment in terms of being conducive to good nutrition practices, sufficient physical activity and prevention of nicotine use, with the view of planning a school-based health intervention. METHODS: A sample of 100 urban and rural disadvantaged schools was randomly selected from two education districts of the Western Cape Education Department, South Africa. A situation analysis, which comprised an interview with the school principal and completion of an observation schedule of the school environment, was done at all schools. RESULTS: Schools, on average, had 560 learners and 16 educators. Principals perceived the top health priorities for learners to be an unhealthy diet (50%) and to far lesser degree, lack of physical activity (24%) and underweight (16%). They cited lack of physical activity (33%) and non-communicable diseases (NCDs; 24%) as the main health priorities for educators, while substance abuse (66%) and tobacco use (31%) were prioritised for parents. Main barriers to health promotion programmes included lack of financial resources and too little time in the time table. The most common items sold at the school tuck shops were crisps (100%), and then sweets (96%), while vendors mainly sold sweets (92%), crisps (89%), and ice lollies (38%). Very few schools (8%) had policies governing the type of food items sold at school. Twenty-six of the 100 schools that were visited had vegetable gardens. All schools reported having physical activity and physical education in their time tables, however, not all of them offered this activity outside the class room. Extramural sport offered at schools mainly included athletics, netball, and rugby, with cricket and soccer being offered less frequently. CONCLUSION: The formative findings of this study contribute to the knowledge of key environmental and policy determinants that may play a role in the health behaviour of learners, their parents and their educators. Evidently, these show that school environments are not always conducive to healthy lifestyles. To address the identified determinants relating to learners it is necessary to intervene on the various levels of influence, i.e. parents, educators, and the support systems for the school environment including the curriculum, food available at school, resources for physical activity as well as appropriate policies in this regard.
- ItemOpen AccessHealthKick: a nutrition and physical activity intervention for primary schools in low-income settings(BioMed Central Ltd, 2010) Draper, Catherine; de Villiers, Anniza; Lambert, Estelle; Fourie, Jean; Hill, Jillian; Dalais, Lucinda; Abrahams, Zulfa; Steyn, NeliaBACKGROUND: The burden of non-communicable diseases, including type 2 diabetes, is growing in South Africa. This country has a complex mix of over- and under-nutrition, especially in low-income communities, and concerning levels of physical inactivity in children and youth. This paper describes HealthKick, a school-based nutrition and physical activity intervention in primary schools in these settings aimed at reducing diabetes risk factors.METHODS/DESIGN:This study includes schools within historically disadvantaged, low-income communities from an urban area close to the city of Cape Town and from two rural areas outside of Cape Town, South Africa. The three Educational Districts involved are Metropole North, Cape Winelands and the Overberg. The study has three phases: intervention mapping and formative assessment, intervention development, and outcome and process evaluation. Sixteen schools were purposively selected to participate in the study and randomly allocated as intervention (eight schools) and control (eight schools).The primary aims of HealthKick are to promote healthful eating habits and increase regular participation in health-enhancing physical activity in children, parents and teachers, to prevent overweight, and reduce risk of chronic diseases (particularly type 2 diabetes); as well as to promote the development of an environment within the school and community that facilitates the adoption of healthy lifestyles.The components of HealthKick are: action planning, toolkit (resource guide, a resource box and physical activity resource bin), and an Educators' Manual, which includes a curriculum component.DISCUSSION:This study continues to highlight the key role that educators play in implementing a school-based intervention, but that developing capacity within school staff and stakeholders is not a simple or easy task. In spite of the challenges experienced thus far, valuable findings are being produced from this study, especially from Phase 1. Materials developed could be disseminated to other schools in low-income settings both within and outside of South Africa. Owing to the novelty of the HealthKick intervention in low-income South African primary schools, the findings of the evaluation phase have the potential to impact on policy and practice within these settings.
- ItemOpen AccessImpact of a primary school-based nutrition and physical activity intervention on learners in Kwazulu-Natal, South Africa: A pilot study(2009) Naidoo, Rowena; Coopoo, Yoga; Lambert, Estelle V; Draper, CatherineBackground. The opportunity for children to be physically active during school hours is rapidly decreasing in selected schools. This study evaluated the effects of a nutrition and physical activity (NAP) intervention incorporated within the school curriculum. Study design and methods. A prospective empirical pilot study with an intervention and an assessment of pre- and post-intervention fitness. Learners completed a NAP questionnaire and participated in a battery of fitness tests before and after intervention. Setting. A purposive sample of four primary schools in KwaZulu-Natal was selected by the provincial Department of Health. Interventions. The NAP intervention was designed to introduce various methods of physical activity and healthy nutritional habits within the school's existing curriculum. Classroom-based intervention materials were developed to provide cost-effective and, more importantly, a sustainable intervention. Results. Post-intervention results showed a significant increase (p<0.05) in the average number of sports participated in by each learner during physical education / life orientation periods. Learners were motivated to participate in physical activity including games and sports during break times. A general increase in after-school activities from pre- to post-intervention per learner was noted. Conclusion. A school-based physical activity and nutrition intervention programme has the potential to increase the physical activity of learners and to a lesser degree their nutritional behaviour.
- ItemOpen AccessAn inventory of rugby-related spinal cord injuries in South Africa(2008) Hermanus, Fiona; Noakes, Tim; Draper, CatherineThe aim of this research was to establish an inventory of rugby-related spinal cord injuries that occurred in South Africa between 1980 and July 2007, and to expand the knowledge of the risk factors. Analysis of this information may lead to improved prevention, treatment and rehabilitation of spinal cord injuries among rugby players at all levels.
- ItemOpen AccessMedical students' attitudes towards and perceptions of the Primary Health Care approach(2005) Draper, Catherine; Louw, Graham; Taylor, David; Gibbs, TrevorThe aim of this research was to provide an understanding of medical students' attitudes towards and perceptions of the PHC approach, and this was done using mainly qualitative methods, namely focus groups, interviews, and one questionnaire. This research also investigated students' views of the way in which the PHC approach was taught, their understanding of the PHC approach, what could influence students' views of the PHC approach, the appropriateness of the PHC approach in South Africa, their opinions of the fact that UCT has a PHC-driven MBChB curriculum, their views of the role of doctors in the PHC approach, and a number of other related issues. The main findings were that students enter their medical degree with an expectation of a biomedical emphasis and a lecture-based curriculum.
- ItemOpen AccessPhysical activity and gross motor skills in rural South African preschool children(2018) Tomaz, Simone Annabella; Draper, Catherine; Hinkley, Trina; Jones, RachelBackground: Global levels of overweight and obesity in preschool-aged children have increased dramatically in the last two decades, with most overweight and obese children younger than five years living in low- and middle-income countries (LMICs). Statistics from the 2013 South African National Health and Nutrition Examination Survey (SANHANES-1) confirm that levels of overweight and obesity are high in South African preschool-aged children, with prevalence rates of overweight and obesity up to 18.2% and 4.7%, respectively. This increasing problem of overweight and obesity in South African preschoolaged children highlights the need for intervening in this age group. Overweight and obesity interventions in preschool children typically include one or more of the following behaviours: physical activity, sedentary behaviour and screen time. Aim and objectives: The aim of this study was to characterise the preschool environment in rural South Africa, and to explore physical activity, gross motor skill proficiency, sedentary behaviour and screen time in rural South African preschool-aged children. Additionally, aims of this study were to explore the associations between gross motor skills, body composition and physical activity; and to assess compliance with current physical activity and sedentary behaviour guidelines. Methods: Preschool-aged children (3-5 years old, n=131) were recruited from three Preschools and two Grade R (reception year) settings in Agincourt, a rural village in north eastern South Africa. In order to gain an understanding of the Preschool and Grade R settings, an observation of the preschool environments was conducted using a tool adapted from the Outdoor Play Environmental Categories scoring tool, Environmental and Policy Assessment and Observation instrument, and the Early Learning Environments for Physical Activity and Nutrition Environments Telephone Survey. Each child’s height and weight was measured. Physical activity and sedentary behaviour were measured objectively using a hip-worn ActiGraph GT3X+ accelerometer for 7 days (24 hours, only removed for water-based activities). Gross motor skills were assessed using the Test for Gross Motor Development–Version 2 (TGMD-2). Physical activity and sedentary behaviour, including the contextual information for these behaviours, during the preschool day (08h00 until ±12h00) were measured using the Observational System for Recording Physical Activity in Children (Preschool Version). A separate sample of parents/caregivers were recruited (n=143) to complete a questionnaire that was adapted from the Healthy Active Preschool Years questionnaire and Preschool Physical Activity Questionnaire. Parents reported on their child’s screen time, and on factors within the home and community contexts in which physical activity and sedentary behaviours occur. Results: In terms of the environment, the Preschools and Grade R settings differed in that fixed play equipment only featured in the Preschool settings. Grade R settings had more open space in which to play. All Preschool and Grade R settings provided children with limited portable play equipment, and none of the schools had access to screens. Although all children recruited for the study were preschool-aged, the Grade R children were significantly older than the Preschool children (5.6±0.3years vs. 4.4±0.4 years, p <0.05). According to IOTF cut-offs, the prevalence of overweight/obesity was low (5.0%) in the sample, and 68.1% of children were classified as normal weight. On average, children spent 477.2±77.3 minutes in light- to vigorous-intensity physical activity (LMVPA) per day, and 93.7±52.3 minutes in moderate- to vigorous-intensity physical activity (MVPA). In terms of the new current guidelines (180min/day LMVPA, including 60min of MVPA, described as ‘energetic play’), and using average daily average of LMVPA and MVPA, 78.2% met current guidelines. Observed and objectively measured sedentary behaviour results revealed that children were more sedentary during preschool time (between 08:00 to 12:00) compared to the afternoons. Overall, boys were significantly more physically active than girls; and Preschool children did more physical activity during preschool time than Grade R children (all p< 0.05). Over 90% of the sample achieved an ‘average’ or better ranking for gross motor skill proficiency. The Grade R children were significantly more proficient than the Preschool children for all gross motor skill components (raw scores and standardised scores). Overall, boys achieved significantly better object control raw scores than the girls, and displayed greater proficiency than the girls in the strike (p=0.003), stationary dribble (p< 0.001) and kick (p< 0.001). None of the preschool or Grade R settings had access to screens such as televisions or iPads, and parent-reported screen time was low for the total sample (0.5±0.3hr/day). The majority of the sample (97.9%) met current screen time guidelines (<1 hour per day). Parents (82.5%) reported that they believed that their child did sufficient PA for their health, but 81.8% also reported believing that television time would not affect their child’s health. Parent responses revealed neighbourhood safety as a potential barrier to being physically active in the community. Conclusions: Rural preschool-aged children in South Africa appear to be engaged in adequate amounts of physical activity, particularly LMVPA, and are adequately proficient in gross motor skills. The children did not engage in excessive amounts of screen time. Overweight and obesity were not prevalent in this sample of rural preschool-aged children, and therefore it would appear that an intervention to reduce or prevent obesity by increasing physical activity, improving gross motor skills and reducing screen time is unnecessary. Rather, interventions that facilitate the increase in levels of MVPA in order to meet current physical activity guidelines are warranted. Additionally, it is essential that the high levels of physical activity (LMVPA) and good foundation of gross motor skills observed in this sample are promoted in an effort to maintain them throughout childhood. Future research may want to determine whether these activities (high levels of LMVPA, low levels of screen time) track throughout childhood and into adolescence.
- ItemOpen AccessProfessionalism in medicine in South Africa - a focus on medical students and their educators(2019) Olckers, Lorna; Draper, Catherine; Reid, SteveThe notion of ‘professionalism in medicine’ has become increasingly topical globally. It is a complex and ‘slippery’ concept that is variously understood – from ideas of values or virtues that reflect aspects of ‘being’, to those that are more closely associated with behaviour and aspects of ‘doing’. More recently, issues of ‘identity formation’ have added a third dimension to these two broad areas of understanding. The lack of a shared and coherent understanding of what actually constitutes professionalism has resulted in challenges with the teaching, learning and assessment of professionalism in medicine. This has been widely reflected, including within the medical curriculum at the University of Cape Town (UCT) in Cape Town, South Africa, which provides the context for this research. The aim of this study was to explore how medical students and their educators understand and experience professionalism in medicine in the South African (SA) context. The specific objectives in relation to professionalism in medicine were to explore how aspects of being or character are understood and experienced; how aspects of doing or practice are understood and experienced; how global and profession-specific changes have influenced its understandings and experiences; how the SA context is understood and experienced in relation to professionalism in medicine; and how it is understood and experienced within the Health Sciences Faculty at UCT. The research was framed within an interpretive theoretical paradigm in order to illuminate issues of context, difference and power. Qualitative methods, specifically focus groups and individual interviews, were used with participants including medical students studying at UCT, interns who had graduated from UCT, and educators from within the university. Results from the study revealed themes that were considered against physician and philosopher Dr Edmund Pellegrino’s virtue-based understanding of professionalism in medicine that shaped the conceptual framework for the study. Four key issues formed the focus of discussion – the understanding of professionalism; its development alongside emerging identity; its relationship to power and hierarchy; and the implications of context. Unlike the discrete vision of professionalism as embedded within virtues or values as expressed by Pellegrino, the understandings and experiences of study participants reflected a multi-faceted view of professionalism in medicine as a combination of values, knowledge and skills, behaviour, and responsibilities, linked to a core relationship founded on trust between doctors and patients. This understanding was informed by issues of emerging identity, influenced particularly by the ‘hidden curriculum’ and role models, as well as experiences of power and hierarchy within the university and practice settings. Contextual realities included the commercialisation of medicine, and the increasing impact of the internet and social media. The South African context, reflected by the healthcare system and patient population, further informed this multi-faceted understanding of professionalism in medicine. What became clear was that professionalism in medicine was understood and experienced by participants as complex in both theory and practice, and that curriculum design processes and medical practice must therefore be cognisant of the interdependence of the key issues.
- ItemOpen AccessSafer rugby through BokSmart? Evaluation of a nationwide injury prevention programme for rugby union in South Africa(2014) Brown, James Craig; van Mechelen, Willem; Lambert, Mike; Verhagen, Evert; Draper, CatherineIntroduction and objectives: Rugby union ('rugby') is a popular sport that has a high risk of injury. The sport has particular popularity in South Africa with about 500,000 players. Based on concerns about the number of rugby-related catastrophic injuries, the BokSmart nationwide injury prevention programme was launched in July 2009 by South African Rugby Union (SARU). This programme educates coaches and referees on safe techniques during a Rugby Safety Workshop (RSW). To assess real-world injury prevention efforts, researchers have suggested using the six Translating Research into Injury Prevention Practice (TRIPP) stages. Stage 1 and 2 investigate the incidence, severity and aetiology of injuries. Stage 2 investigates the aetiology of injuries. Stage 3 is the introduction of an intervention. Stage 4 is an investigation of the effectiveness of the intervention under ideal conditions. Stages 5 and 6 investigate the real-world implementation of the intervention. Thus, the objective of this thesis is to comprehensively evaluate the BokSmart programme using the TRIPP framework. Methods: TRIPP stages 1 and 2 are investigated in Chapters 2, 3, 4 and 5. Chapter 2 investigates the incidence, severity and aetiology of injuries at four competitive youth tournaments. Chapter 3 used Chapter 2's data to investigate the economic burden of these injuries. Chapter 4 investigates the incidence and severity of catastrophic injuries. Chapter 5 investigates the risk of both general and catastrophic injury specific to the scrum phase of play using the data from Chapters 2 and 4. TRIPP stages 3 and 4 were conducted by SARU and are thus outside the scope of this thesis. TRIPP stages 5 and 6 are investigated in Chapters 6, 7 and 8. Chapter 6 evaluates the effect of BokSmart in on catastrophic injury rates. Chapter 7 evaluates the effect of BokSmart on targeted player behaviours. Chapter 8 uses qualitative methods to investigate coaches and referees' perceptions of BokSmart. Results: Through TRIPP Stages 1 and 2 it was established that South Africa has comparable general and catastrophic injury rates to other countries. Senior players were at significantly (p<0.05) greater risk of suffering a catastrophic injury than younger players. The economic investigation indicated that injury rehabilitation was affected by whether the player had medical insurance or not – this may be unique to South Africa. Through TRIPP stages 5 and 6 BokSmart was associated with a reduction in catastrophic injuries in junior, but not senior players. BokSmart was also associated with a significant improvement in targeted player behaviours. Coaches' perceptions of the programme varied by socioeconomic status (SES). All coaches and referees agreed that the programme was capable of reducing catastrophic injuries in players. However, high SES coaches described difficulties in changing coach and player behaviour, while low SES coaches mentioned their lack of necessary infrastructure as barriers to adoption. There was also negativity about the delivery of BokSmart: coaches and referees felt the course was not practical enough, was too long and should not be compulsory. Conclusions: From BokSmart's perspective, the lack of effectiveness of the programme in senior players should be of concern, considering this age group's greater risk of catastrophic injury. This greater effect in juniors could be explained either by the higher number of players, or greater adoption in this age group. Future research should attempt to elucidate this reason. The barriers and suggestions described by low and high SES coaches and referees should be addressed to optimise the programme's impact. The programme should continue to be evaluated to assess the impact of these suggestions.
- ItemOpen AccessSpinal cord injuries in South African Rugby Union (1980-2007)(2010) Hermanus, Fiona; Draper, Catherine; Noakes, TimothyObjectives and design. To address an apparent increase in the number of rugby-related spinal cord injuries (SCIs) in South Africa, a retrospective case-series study was conducted on injuries that occurred between 1980 and 2007. We aimed to identify preventable causes to reduce the overall rate of SCIs in South African rugby. Methods. We identified 264 rugby-related SCIs. A structured questionnaire was used, and it was possible to obtain information on a total of 183 players, including 30 who had died. Results. SCIs increased in number in the 1980s and in 2006. Forwards sustained 76% of all SCIs, and club players 60%. Players aged 17 had the highest number of SCIs. In only 50% of cases were medical personnel present at the time of injury, and 49% of injured players waited longer than 6 hours for acute management. Of players with an SCI, 61% had a catastrophic outcome after 12 months, including 8% who died during that time; 65% received no financial compensation; and only 29% of players had medical aid or health insurance. Conclusion. A register of all rugby-related SCIs in South Africa is essential to monitor the magnitude of the problem, identify potential risk factors, and formulate appropriate preventive interventions. The lack of reliable denominator data limits calculation of incident rates. Players from previously disadvantaged communities in particular suffered the consequences of limited public health care resources and no financial compensation.