Browsing by Author "Duncan, Madeleine"

Now showing 1 - 14 of 14
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    A qualitative study into the advocacy and activism of carers of adolescents with Down Syndrome in Oshana, Namibia
    (2019) Kambowe, Hannah; Duncan, Madeleine; Mckenzie, Judith
    Background: Down Syndrome (DS) is a chromosomal defect known to cause intellectual disability. Adolescents with DS may need to live with their families beyond the transition period into adulthood because they require lifelong care due to the disabling consequences of the genetic condition. Evidence is lacking about the actions that carers in remote rural communities are taking to enhance the rights of their adolescents with DS as enshrined in the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Aim: To describe the advocacy and activism actions of carers that promote the disability rights of adolescents with DS. Objectives: To describe carers’ understanding of 'activism’ in relation to the needs of adolescents with DS; to explore what actions carers are engaging with in order to promote participation and equal opportunities for social inclusion of adolescents with DS; to describe barriers encountered and strategies used and to describe carers’ advocacy priority list for social inclusion of adolescents with DS. Methodology: A descriptive qualitative approach was used where three carers told their stories of activism and advocacy actions through a semi-structured in-depth interview method. Their stories were audio-recorded, transcribed into textual form and an inductive data analysis followed a framework approach guided by the research aims. Findings: One overriding theme Puuyelele (bringing adolescents with DS into the open) emerged with four categories: namely, “Speaking for and acting on behalf of adolescents with DS”, “Enabling a continuous enlightening process”, “Ensuring ongoing care and services” and “Raising public awareness on human rights of adolescents with DS”. Discussion: Three concepts about DS advocacy and activism for adolescents with DS formed the discussion; first, it is a strategic process requiring togetherness, courage and perseverance; second, it proceeds from vigilant care-giving and service provision and, lastly, it requires rising of human rights awareness. Conclusion: A strategic and contextualised DS advocacy and activism process such as Puuyelele requires human rights awareness and emerges from vigilant care that enhances community participation and social inclusion of adolescents with DS. The process creates a possible and realistic conceptual framework for further strengthening of disability-inclusive development initiatives in Namibia.
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    Caregiving of adults with acquired brain injury (ABI) a case study of mothers' perspectives
    (2013) Steinhoff Inge; Sonday, Amshuda; Duncan, Madeleine
    Includes abstract. Includes bibliographical references.
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    A comparison of the quality of life between survivors of leprosy living in a leprosarium and those re-integrated in their communities in the southern region of Malawi
    (2011) Chinguo, Dorothy; Duncan, Madeleine
    The aim of this research was to compare the quality of life being experienced by survivors of leprosy living in the remaining leprosarium and those reintegrated into their communities in the southern region of Malawi.
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    Developing health science students into integrated health professionals: a practical tool for learning
    (BioMed Central Ltd, 2007) Olckers, Lorna; Gibbs, Trevor; Duncan, Madeleine
    BACKGROUND:An integrated sense of professionalism enables health professionals to draw on relevant knowledge in context and to apply a set of professional responsibilities and ethical principles in the midst of changing work environments 12. Inculcating professionalism is therefore a critical goal of health professional education. Two multi-professional courses for first year Health Science students at the University of Cape Town, South Africa aim to lay the foundation for becoming an integrated health professional 3. In these courses a diagram depicting the domains of the integrated health professional is used to focus the content of small group experiential exercises towards an appreciation of professionalism. The diagram serves as an organising framework for conceptualising an emerging professional identity and for directing learning towards the domains of 'self as professional' 45.OBJECTIVE:This paper describes how a diagrammatic representation of the core elements of an integrated health professional is used as a template for framing course content and for organising student learning. Based on the assumption that all health care professionals should be knowledgeable, empathic and reflective, the diagram provides students and educators with a visual tool for investigating the subjective and objective dimensions of professionalism. The use of the diagram as an integrating point of reference for individual and small group learning is described and substantiated with relevant literature. CONCLUSION: The authors have applied the diagram with positive impact for the past six years with students and educators reporting that "it just makes sense". The article includes plans for formal evaluation. Evaluation to date is based on preliminary, informal feedback on the value of the diagram as a tool for capturing the domains of professionalism at an early stage in the undergraduate education of health professional students.
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    Disability and service delivery perspectives of service users in a rural community in the Eastern Cape
    (2012) Booi, Mpilo Henry; Ramma, Lebogang; Duncan, Madeleine
    Since the advent of democracy in South Africa rural and disabled people have lagged behind in terms of access to services, and that has implications on their enjoyment of socio-economic rights. Although exclusion from access to services is documented in literature, little research has been done to explore rural and disabled people's perspectives on inclusive service delivery. The purpose of this study was to contribute to the literature regarding inclusive service delivery in health, education and social development and citizen participation in rural areas. Insights into perspectives of rural citizens are pertinent for improved and inclusive service delivery. The aim of this study was to describe the perspectives of rural people regarding disability inclusive public sector service delivery in social development, health and education in a remote village in the Eastern Cape, South Africa.
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    The effect of sensory processing on the work performance of call centre agents in a South African context
    (2012) Lombard, Annemarie; Watson, Ruth; Duncan, Madeleine
    Background: Call centres are thriving and expanding commercial enterprises providing cost-effective ways for organisations to connect with new and existing clients through telecommunication channels. Call centre agents perform this function telephonically for 75% of the day in large open-plan office environments characterised by workloads that are demanding, repetitive and highly scripted. Verbal abuse by clients is prevalent adding to a work experience that is potentially emotionally draining and stressful. Agents are under constant surveillance and monitoring to abide with commercial regulations but also to ensure high call volume and quality engagement with clients, these being the most important performance indicators. High staff absenteeism and attrition levels account for large financial losses in the industry. To date no studies have been found considering the impact of sensory processing of call centre agents on their performance, absenteeism and attrition. Sensory processing considers the neuro-physiological and behavioural components of individuals in the interactions with their daily work occupations and life environments. Although predominantly applied in paediatric clinical populations in occupational therapy, sensory processing provides universal truths about human behaviour which can add value to promoting wellness amongst healthy adults in work environments. Design: A quantitative, non-experimental and correlational study design was used to measure and compare demographic, sensory processing and performance data from 459 call centre staff within four fully operational call centres, which varied in type of operation, employer and geographical area in South Africa. The standardised and validated 60-item Adolescent/Adult Sensory Profile (Brown, Tollefson, Dunn, Cromwell & Fillion, 2001) was used to measure sensory processing as neurological thresholds and potential propensity for individuals to cope with high sensory stimulating work environments. Agent performance data in each of the four centres were recorded daily, in real time, using sophisticated information technology systems, and included details about absenteeism. Attrition data were collected after the initial data intake to reflect true attrition. Results: Data were analysed using statistical methods to obtain locality (e.g. means, medians), dispersion (e.g. standard deviations and interquartile ranges) and associations (e.g. Spearman Rank correlations). Results showed strong, consistent and significant correlations between agents who displayed sensation avoiding processing and poor performance. Agents who exhibited sensation seeking processing had higher performance ratings. To a lesser, yet still significant, degree agents with low registration and sensory sensitivity also had lower performance ratings. Sensory sensitive agents were absent less often than other workers and sensation seeking agents showed a tendency for higher attrition. Results differed between service inbound call centres to sales and collections outbound ones. Team leaders, who are high performing agents promoted into these positions, had less sensory sensitive and sensation avoiding processing styles. A novel subset structure was designed to account for the multidimensional capacity of the AASP, and this was correlated with all the performance data. It provided a preliminary method for use in further research studies. The study strengths were the innovative sample in measuring sensory processing of healthy populations at work and the compilation of performance data through sophisticated computerised systems, which minimised the margin of error. Study limitations were the use of a self-questionnaire format for profile data collection and small sample sizes in subsequent data collection stages. Recommendations: The AASP has the potential to be used by call centre human resource practitioners for recruitment and performance management. Improved sensory environmental considerations and adaptations supportive of a more successful and healthier agent-job-environment fit are provided. The study findings support knowledge transfer into other general human resource management, education and training, occupational health management and occupational therapy practises. It expands the application of sensory processing theories and informs future research.
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    Health sciences undergraduate education at University of Cape Town: a story of transformation
    (Health & Medical Publishing Group, 2012) Hartman, Nadia; Kathard, Harsha; Perez, Gonda; Reid, Steve; Irlam, James; Gunston, Geney D; Janse van Rensburg, Vicki; Burch, Vanessa; Duncan, Madeleine; Hellenberg, Derek; Van Rooyen, Ian; Smouse, Mantoa; Sikakane, Cynthia N; Badenhorst, Elmi; Ige, B
    Undergraduate education and training in the Faculty of Health Sciences at the University of Cape Town has become socially responsive. A story of transformation that is consonant with wider societal developments since the 1994 democratic elections, outlining the changes in undergraduate curricula across the faculty, is presented.
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    How learning facilitators teach adults with mild and moderate intellectual disability in learnership programmes at post-school institutions in Cape Town: A descriptive qualitative study
    (2018) Feinberg, Taryn; Duncan, Madeleine
    Introduction: Adults with intellectual disability (ID) have a right to be included in post-school education (PSE) opportunities such as learnership programmes. They face many barriers, however, including the fact that learning facilitators do not know how to include and teach these learners with ID in a PSE context. Problem: No literature or documented evidence has been captured about inclusive educational approaches describing how learning facilitators taught adults with ID in three learnership programmes that can be used to develop training programmes that will equip learning facilitators with the necessary skills for teaching this group of learners. Rationale: Learning facilitators need to be adequately trained, equipped and supported to meet specific learning needs of adults with ID in learnerships. This study will provide a resource of practice-based educational strategies that could serve as the basis for this training. Aim: To describe how learning facilitators in learnership programmes at Organisation X provided teaching to adults with ID. Method: An indepth, moderately structured, open-ended interview method was used to collect data from six participants. Three Universal Design for Learning (UDL) principles and related guidelines were used to inform how the interview questions were structured. Findings: The main theme was “a learnership takes time, patience and many adjustments but it has to be done” that comprised three categories: namely “dealing with intellectual disability”, “streamlining learnership strategies” and “perceiving the 'just right’ learnership”. The sub-categories identified were populated into the UDL Framework. Discussion: Learnership programmes with adults with ID are time consuming and personally demanding for learning facilitators, but adults with ID have a right to access these programmes. Training programmes for learning facilitators need to include aspects of how to deal with learners with ID, what curriculum differentiation strategies need to be streamlined, and how to create the 'just right’ learnership. Conclusions: Learning facilitators believe that learners with ID have the right to access PSE and participate in learnerships. The success of post-school learnerships lies in providing the “just right” curriculum that offers support for both educator and learner.
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    Occupations of citizenship : the missing layer in empowered engagement between rural people with disabilities and primary healthcare workers in South Africa
    (2016) Sherry, Kate; Reid , Steve; Duncan, Madeleine
    Background: People with disabilities in impoverished rural areas of South Africa struggle to access healthcare, despite the right to health established by the Constitution and the United Nations Convention on the Rights of Persons with Disabilities. Health system challenges and structural conditions of poverty impact this group in specific ways, with implications for households and communities that are not well understood. To date, health systems research and design have largely omitted disability considerations. Primary health care (PHC) calls for community engagement with health systems, to voice local needs, influence service provision, and hold providers to account. However, current models of community engagement rely on certain political, social and economic conditions, which are not present for rural people with disabilities in South Africa. Purpose: This study sought to understand the existing engagement between rural people with disabilities and healthcare workers in the PHC interface, and thus to theorise how this could be strengthened for more responsive and equitable services.
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    Perceptions of mental health care users on the contribution of the interactive groupwork model in occupational therapy groups to their recovery
    (2018) Davidson, Shanay; Duncan, Madeleine; Ramafikeng, Matumo
    Background Mental health disorders account for a significant portion of the burden of disease in South Africa and places a substantial strain on the national mental health care system. Mental health care policy and service trends advocate for client-centred practices, whereby the needs and perspectives of the population being served are taken into account in the design and delivery of interventions. Mental health disorders affect people’s performance of and participation in the occupations of daily life. The profession of occupational therapy (OT) values clientcentred practice and seeks to offer interventions that are closely aligned with the occupational and related recovery concerns of mental health care users (MHCUs). The Interactive Groupwork Model (IGM) is an unpublished, South African OT model that is used to guide groupwork interventions in mental health care settings. It serves as the basis for a position statement on the role and scope of the profession in groupwork issued by the Occupational Therapy Association of South Africa (OTASA, 2014). Research Problem To date there is little literature documenting service users’ perspectives on groupwork in occupational therapy within the South African context. In particular, there is no published South African research in occupational therapy regarding mental health service users’ (MHCU) perspectives on the contribution of groups run according to the IGM to their recovery. Research Purpose This study contributes to the refinement of the Interactive Groupwork Model as one of a number of approaches to groupwork used by occupational therapists in South Africa. The information gained from the research will assist in creating relevant group based programmes for mental health care users who get admitted to mental health services where occupational therapy groups based on the IGM are offered. Research Question How do mental health care users perceive the contribution of the IGM to their recovery? Research Aim To describe the perspectives of users of mental health services about the contribution of IGM used in occupational therapy, to their recovery within a specialised psychiatric unit. Research Objectives Describe the perspectives of MHCU’s on the benefits of IGM for their recovery Describe the perspectives of MHCU’s on the limitations of IGM for their recovery Describe the recommendations of MHCU’s on the refinement of the IGM iv Research Design & Methodology A descriptive qualitative design positioned in a social constructivist paradigm guided the study methodology. Purposive maximum variation sampling was used. Data was collected using semi structured interviews with seven mental health care users during an eight or twelve-week admission period, at different stages of their recovery and community re-entry. Data was audio recorded and transcribed. Thematic analysis enabled the opinions of informants to be subcategorised and categorised. Ethical principles of beneficence, non-maleficence, autonomy and justice were upheld throughout the research process. Findings Participants’ perspectives on the contribution of occupational therapy groups using the IGM to their recovery was reflected in a single theme: “helping me to navigate life while living with my illness”. The theme was supported by two categories: “learning though the group space” and “learning that the journey is never over”. The learning that occurred in each category was supported by five sub-categories, each reflecting a dimension of how IGM based occupational therapy groups helped participants towards recovery: “engaging in the activity”, “participating in the group process”, “experiencing the group structure”, “recognising personal shifts” and “acknowledging stuckness”. Conclusion The research provided practice based evidence of service user perspectives on occupational therapy groupwork using the IGM. The IGM is beneficial as a change modality as it assists MHCUs with self-learning and addresses the interpersonal aspect of recovery during the acute intervention phase. With refinements considering the occupational human, and embracing the recovery philosophy, the IGM may offer greater value to MHCUs by addressing broader occupational engagement concerns that extend post discharge. The relevance of the IGM to the post discharge recovery of MHCU warrants attention if occupational therapy is to play a role in supporting MHCUs to live meaningful and productive lives through occupation. Recovery from serious mental illness is a complex lifelong process that is facilitated when health care professionals collaborate with MHCUs. Revisions to the OTASA position statement are suggested in an attempt to ensure that the OTASA position statement on groupwork represents a broader understanding of groupwork in the profession and specifically in mental health.
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    Perspectives of male mental health service users on their community integration following participation in a residential-based rehabilitation programme
    (2015) Gamieldien, Fadia; Duncan, Madeleine; Galvaan, Roshan
    Current re-engineering of primary mental health care in South Africa is directed towards providing a continuum of care for people with serious mental disorders in order to relieve the cost and resource burden of longterm hospitalisation. In the Western Cape, Healthcare 2030 has been adopted as the guiding vision for health system reform. Residential-based rehabilitation programmes have been introduced to assist mental health service users to improve their functioning in occupations of daily life so that they are better equipped to cope with community living. Problem: There is limited South African occupational therapy research into male mental health service users' perspectives on the contribution that residential-based rehabilitation programmes makes to their community integration, despite the high numbers of males using the service. Purpose: To inform public mental health services on the contribution of a residential-based rehabilitation programme to the community integration of men with serious mental disorders. Research question: How does participation in a residential-based rehabilitation programme contribute to the community integration of men with serious mental disorders? Objectives of the study: To identify what men with serious mental disorders consider community integration to be, and to describe the key elements within the residential-based rehabilitation programme that influenced their community integration. Research design and methodology: An instrumental case study design was used to guide the research methodology and five male participants were identified through purposive sampling. Observations, semi-structured interviews, community maps and document analysis w ere used as data collection tools. Data was audio-recorded and transcribed f or inductive and thematic cross-case analysis. Ethical principles of beneficence, autonomy and non-maleficence were upheld throughout the research process. Findings: One theme and three categories emerged in the findings. The theme, 'It's a catch-22 situation', comprises three categories, namely: 'It's not just what you call it'; 'There's no one size for all'; and 'It's tricky choosing between places to go and things to do'. Conclusion: Male mental health service users who participate in a residential-based rehabilitation programme will be better prepared for community integration if they are involved in co-constructing their recovery plan so that it is more personalised.
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    Perspectives of occupational therapists on the implementation of client-centred practice in Tanzania
    (2015) Mshanga, Dominick Michael; Duncan, Madeleine; Buchanan, Helen
    Background: The concept of client-centred practice (CCP) was first developed and implemented by occupational therapists in Canada during the early 1980s and subsequently transferred into the Tanzanian occupational therapy curriculum by international volunteer educators. Currently, the occupational therapy curriculum at the Kilimanjaro Christian Medical University College (KCMUCo) in Moshi, Tanzania covers CCP using assessment tools and models developed by the Canadian Association of Occupational Therapy. To date, no occupational therapy research has been conducted to investigate the relevance of CCP for Tanzania, or to document the perspectives of therapists in applying the principles of CCP. This study was indicated to inform the occupational therapy curriculum at the KCMUCo and the Tanzania Occupational Therapy Association (TOTA) about occupational therapy practice realities related to the implementation of CCP in Tanzania and to guide the alignment of the occupational therapy curriculum towards a local understanding of CCP or an alternative (non-Western) perspective. This study, therefore, aimed to determine the understanding and use of CCP by occupational therapists in Tanzania. Methodology: The study used a descriptive cross-sectional design. All qualified occupational therapists working in different regions in Tanzania were approached to participate in the study (N=80). A questionnaire, the Professional Questionnaire for Assessing CCP (PQACCP) was adapted for the study. The questionnaire consisted of five sections: 1) demographic and practice information; 2) an adaptation of an existing checklist on understanding CCP (Parker, 2006); 3) potential barriers to CCP; 4) enablers of CCP; and, 5) therapist opinions on the relevance of CCP for the Tanzanian context. The checklist of potential barriers and enablers was adapted from Sumsion & Smyth, (2000). Data were analysed using the SSPS software program (version 20.0). Numerical variables were checked for normality and the appropriate measures of central tendency and dispersion calculated. Frequencies and proportions were determined for categorical items. The Chi-square test of association was done to determine whether there were any observed associations between demographic variables and barriers/enablers.
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    Rehabilitation care workers perceptions of the outcomes of a pilot training programme
    (2015) Clark, Graham; Duncan, Madeleine; Cloete, Lizahn
    The South African National Development Plan (NDP) (National Planning Commission, 2011, p. 1) provides the road map for a reformed public health system by 2030. The proposed health system will be facilitated by, amongst others, training an appropriate balance of healthcare professional s including a cadre of community health workers (CHWs) that have a broad skills mix suited to reaching a larger number of people with first level intervention. With this in mind, a pilot group of CHWs were up-skilled as Rehabilitation Care Worker s (RCWs). The training program was a joint project between the Division of Disability Studies and the Departments of Occupational Therapy, Physiotherapy and Speech and Language Therapy at UCT. Problem: Little is known about the perspectives of RCWs on the benefits and challenges of additional training in rehabilitation and disability related skills. Rationale: To inform the curriculum for a rehabilitation care worker (RCW) training program and the Western Cape Department of Health (WCDoH) of ways in which this cadre of worker could contribute to the realization of the 2030 Healthcare Plan. Aim: To describe the outcomes of a pilot RCW training program from the perspective of the pilot group of graduates. The objectives were to identify the areas of practice where RCWs feel competent/incompetent, to identify aspects of the health services where RCWs believe they can contribute the most/the least and to identify the facilitators/barriers they experienced when deployed in the health field. Methodology: A qualitative descriptive study was conducted. Method: Focus groups were carried out with three groups of six participants. Findings: The plot that permeated the participants’ perspectives revolved around how the RCWs were pioneers in breaking new ground for the Western Cape Department of Health (WCDoH). Two themes informed the plot: "we move health services to a new level" and "we manage change in new ways". Discussion: It is argued that the pilot RCW curriculum achieved its’ objective of equipping a cadre of worker with basic rehabilitation, care and disability inclusion skills. While the envisaged role of RCWs in the health service and in making the NDP a reality is supported, it is argued that attention needs to be given to supervision structures and to training of all other health workers in order to promote inter professional practice. Conclusions: The pilot group of RCWs believe that they have acquired a new and large variety of skills that have enabled them to make a broad and positive impact in their places of work, at home and in the broader community.
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    Women's experiences of street trading in Cape Town and its impact on their well-being
    (2013) Sassen, Sharyn Ruth; Galvaan, Roshan; Duncan, Madeleine
    Street trading forms a large subsection of South Africa's informal economic activity, creating opportunity for self-employment and sustaining livelihoods (Mitullah, 2003; Skinner, 2008). Yet, street traders face various barriers including societal marginalization and pervasive poverty, threatening their well-being. The scarcity of occupational therapy literature around informal economy occupations limits the profession's understanding about what engagement in such occupations entails. While available literature around work in the informal economy emphasises economic contributions to development, there is limited evidence that informal business owners effectively escape vulnerability. From an occupational perspective, little is known about how these occupations are experienced and their implications for well-being. This study will inform contextually relevant conceptions of participation in the informal economy occupation of street trade, providing necessary knowledge for social and political practices of occupational therapy. The study aimed to describe women street traders' experiences of street trading and, how they perceived these related to their well-being. The objectives were to identify personal and external factors that promoted or hindered their well-being whilst engaged in street trading. An ethnographic inquiry was carried out with four women street traders identified through purposive recruitment. It involved semi-structured and photo elicitation interviews, and participant observation. Interviews were audio recorded and transcribed for inductive and thematic cross case analysis and field notes were made following interviews and participant observation. One theme and three categories emerged in the findings. The theme, 'Togetherness: steering against the current towards a better life", revealed the impact of interpersonal connectedness as participants attempted to steer towards valued lives against various barriers. The first category, 'Taking the helm', described the women's actions to determine valued livelihoods. 'Facing tough conditions' detailed the personal and external barriers they encountered while attempting to direct their lives towards positive outcomes through street trading. The third category, 'We're in the same boat' demonstrated the significance and the positive and negative impact of interpersonal connectedness for street traders. Conclusively, the study revealed how the contextually situated nature of this occupation translated to nuanced and fluid experiences of wellbeing in street trading, where well-being was deeply tied to valued social connectedness and significance of collective well-being.