Browsing by Author "Gretschel, Pam"

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    Factors affecting the establishment and provision of an outpatient pulmonary rehabilitation programme, as viewed by physiotherapists in the Cape Metropole
    (2024) Labuschagne, Lisa; Du Plessis, Ilse; Lupton-Smith, Alison; Gretschel, Pam
    Background: Chronic respiratory diseases are a significant global health problem, and although pulmonary rehabilitation is shown by extensive evidence to be an important tool in their management, access to it is lacking world-wide. This study aimed to explore the factors affecting the establishment and provision of outpatient pulmonary rehabilitation programmes, as viewed by Physiotherapists in the Cape Metropole- our local context. Methodology: An exploratory qualitative descriptive design was used, whereby data was collected through three tools: semi-structured interviews with six physiotherapists in the Cape Metropole, a screening questionnaire and a reflective journal. Credibility was ensured through active engagement, member checking and peer debriefing; transferability through rich, thick description; and dependability and confirmability through keeping a meticulous audit trail. Theoretical, thematic analysis was then done. The principles of Helsinki were adhered to at all times. Findings: Three themes were found in the data, relating to the three objectives of the study: 1: One size does not fit all; 2: Sustained and driven by internal factors and external sources of support; 3: Common barriers with differing impacts. Discussion: These findings were compared to findings from previous studies and discussed through the lens of social cognitive theory. The need to promote self-efficacy and behavioural capability amongst physiotherapists, in overcoming the barriers to provision of pulmonary rehabilitation programmes was emphasised.
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    The impact of play-informed caregiver-implemented home-based intervention on the academic learning outcomes for HIV positive children (aged 5 years to 8 years) on Antiretroviral Therapy (ART) living in low income conditions: a randomized control trial
    (2016) Otto, Caraleigh; Gretschel, Pam; Ramugondo, Elelwani
    BACKGROUND: The academic learning of HIV positive children is often negatively impacted by cognitive and learning deficits associated with HIV, and usually leads to poor performance at school. Occupational therapy, a profession that promotes and enhances participation in meaningful occupations, has yet to demonstrate its impact in promoting the occupation of academic learning in HIV positive children on ART. OBJECTIVES: This study investigates and compares the impact of two occupational therapy interventions; conventional one-on-one occupational therapy (control group) and play-informed caregiver-implemented home-based intervention (PICHIBI) (experimental group), in promoting academic learning for HIV positive children aged 5 to 8 year olds on ART. METHODS: The research project followed a pragmatic, single-blinded, randomised baseline, mid and post-test control-group design. From a possible population of 60 dyads who attend the Groote Schuur Hospital (Cape Town, South Africa) ARV clinic, 27 child-caregiver dyads (n=27) were recruited. One dyad was excluded from the study, due to home circumstances, leaving 26 dyads that went through the randomisation and allocation process into the two intervention groups. Randomisation was carried out by a central computer system, before the start of the intervention period. The final total sample (n=23) completed the intervention, a slight decrease from the recruited sample size. Four dyads were lost to follow up after the baseline test. This resulted in 12 dyads in the control group and 11 dyads in the experimental group. Baseline, mid (after 5 months of the intervention) and post (after 10 months of intervention) test data was collected using the Griffiths Mental Developmental Scales-Extended Revised (GMDS-ER) and the short form Beery-Buktenica Visual Motor Integration test , 5th edition (Beery-VMI) as outcome measures. RESULTS: Following randomisation there were minimal variations in the baseline demographics and measurements for the two groups, with the exception of a significant difference in time on ART (p=.021). The majority of each group had suppressed viral loads. The total sample showed delays in all the performance components linked to academic learning at baseline, that is, low for visual motor integration and visual perception, below average for motor coordination, borderline delay in language, and practical reasoning, and low average in eye hand co-ordination, performance and the overall level of functioning (general quotient). Severe delays (<70) were detected in the control group at baseline for visual perception, and at post test for language. Average scores (90-109) at post test for visual perception and motor co-ordination were only seen in the experimental group. No statistical significance was noted for between-group differences at baseline, mid and post test. For within-group changes, statistically significant improvements were observed in the following performance components linked to academic learning: in the experimental group, visual motor integration from baseline to mid test (p=.019); in the control group, visual perception from baseline to post test (p=.009) and visual perception baseline to mid test (p=.001), and in performance from baseline to mid test (p=.027). Following interventions the overall GMDS-ER quotient scores for both groups improved with 70% of the experimental group and 58.3% of the control group scoring more than -2 z-score. In the total sample, the level of severe delay at baseline (68.2%) improved to only 8 out of the 23 (36.4%) of the total sample showing a severe overall delay post intervention. These scores still classified the groups as below average (90-109) under the GMDS-ER UK classifications. Despite these scores, 95.7% of the total sample progressed to the next grade during intervention, with only one child repeating a grade. CONCLUSION: Improvements were seen in both groups from baseline to post test. The advantage of PICHIBI however is that it is better suited for expanding access to occupational therapy services in a context where the occupational therapist/patient ratio in the public health sector is low. The continued underperformance of both groups in academic learning outcomes post intervention, displays the need for ongoing intervention for HIV-infected school going children. This information will inform occupational therapy practice, guide policies and legislations relating to academic learning for children with HIV on ART, in South Africa. It is recommended that future research look into using a larger sample size for generalisability of findings, consider conducting a longitudinal study linking results with school report outcomes and comparing the effects of the intervention at various levels of health care.
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    Mothers' lived experiences of caring for their child with HIV-related neurodevelopmental disorder/s
    (2014) Dangarembizi, Nyaradzai Esther; Gretschel, Pam; Sonday, Amshuda
    Although various measures, such as the Prevention of Mother to Child Transmission (PMTCT) programme, have been put in place to combat the spread of HIV/AIDS, there are still many cases of children, in Zimbabwe, being born infected with HIV. Children born to HIV parents are reported to be at risk of having neurodevelopmental disorders (NDDs), which can reduce independence in activities of daily living by imposing varying limitations on these children. Technological advances in the field of HIV/AIDS have resulted in prolonged life for people infected with HIV/AIDS and therefore there is a growing population of mothers caring for their biologic al children who are infected with HIV. The aim of this study is focused on exploring the experiences of being a mother and caring for a child with HIV-related NDDs in Zimbabwe. Specific objectives were to describe the mothers’ experiences of engaging in the daily occupations of caring for a child with NDDs; to explore and describe factors that the mothers’ perceived to impact on their experiences while caring for their children and how these experiences of caring shape the mothers ’ own occupational identities and engagement. A descriptive phenomenological approach was designed to uncover their lived experience s of caring for a child with HIV - related NDDs. In-depth data was generated from phenomenological interviews conducted with five biological mothers who have been caring for their own children who have been diagnosed with HIV - related NDDs. A thematic analysis, guided by a simplified version of the Stevick - Colaizz - Keen method, was employed. The findings revealed the transactional nature of the mothers ’ experiences of the occupation of caring for a child with HIV - related NDD. Personal factors interacted with contextual factors such as stigma, culture and socioeconomics to shape their caring experiences, making caring for their child, a difficult and demanding role that they could not easily entrust to another. Although the mothers voiced that this caring was comprised of many burdensome tasks, the mothers reframe d the concept of the caregiver burden because they placed high value on and drew meaning from being a good mother to their child, thus making it an occupation that they would not readily entrust to another. The findings of this study encourage occupational therapists to consider carefully the resilience of these mothers and how their role as carers positively shape s their identities in the design of interventions for the mothers.
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    A randomised control trial comparing occupational therapy interventions that aim to improve developmental outcomes for HIV9positive children (aged 6 months - 5 years) on ART
    (2016) Meissner, Robyn Jess; Gretschel, Pam; Ramugondo, Elelwani
    Background: Antiretroviral treatment (ART) has reduced the mortality rate of HIV-positive children significantly, and is known to prevent the development and progression of HIV encephalopathy. However, even with ART, perinatal HIV infection places HIV-infected children at increased risk for encephalopathy and associated developmental delays. Research is lacking in the extent of developmental delay on children established on ART, along with evidence-based occupational therapy interventions to treat these developmental delays. A play-informed, caregiver-implemented, home-based group occupational therapy intervention (PICIHBI) presents one possible service delivery option to be explored. Aim: To determine whether children attending an experimental group (PICIHBI) versus children attending a control group (conventional, individual occupational therapy intervention) would present similar results in their total developmental quotient – on the Griffiths Mental Developmental Scales (GMDS) and Paediatric Functional Independence Measure (WeeFIM). Methods: A randomised control trial, which was pragmatic in nature and single-blinded, was used. The research population was all HIV-positive children, pre-formal school-going aged (6 months – 5 years), on ART attending the Groote Schuur Hospital paediatric HIV clinic at the time of the study. Caregiver and child dyads were randomly assigned to either the experimental or control group, and attended a monthly occupational therapy session. Differences in the GMDS and WeeFIM scores of each child after 5 and 10 months' intervention were compared. Results: Inter-rater reliability was established among the five researchers performing the GMDS before baseline assessments. Forty-two participants were recruited from a possible population of 72 participants and 39 participated in the baseline assessment. Twenty-eight participants completed mid and post assessments, 15 in the experimental PICIHBI group and 13 in the control group (90% power). Baseline averages on the GMDS showed the participants scoring at a borderline mental retardation level, with better performance in the locomotor and personal-social subscales, before interventions. Both groups had an average attendance of 5 sessions. Post-interventions, average total GMDS and WeeFIM scores between the two groups revealed similar scores within the predetermined non-inferiority margin and no significant differences at any time point. Conclusion: In conclusion, the low baseline scores confirm the need for occupational therapy intervention in pre-formal school-going HIV-positive children on ART. The PICIHBI intervention demonstrates a non-inferior impact in child development in this group compared to conventional, individual occupational therapy intervention. PICIHBI thus has potential for impacting occupational therapy practice in this field by providing an alternative equivalent treatment with increased reach.
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    The effectiveness of a caregiver-directed intervention promoting development in HIV-positive children on caregivers' self-efficacy: A randomised controlled trial
    (2018) Ferguson, Jessica; Gretschel, Pam; Harty, Michal
    Background: Caregiver self-efficacy (CSE) supports the capabilities of caregivers to engage in parenting activities including stimulating development in their children. Human immunodeficiency virus (HIV) remains a prevalent concern in South Africa, even with the use of antiretroviral treatment. Children with HIV are compromised in their health and development which adds to the general stress of families rearing HIV-positive children. Stress has a negative effect on CSE. However, studies indicate that CSE can be improved through parent-mediated intervention. Caregivers’ engagement in the intervention may grow their skills to promote development in their HIV-positive children. This may have a positive influence on CSE. Occupational therapists working in governmental paediatric HIV clinics developed a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for HIV affected families to be implemented. This study evaluates the effectiveness of PICIHBI on CSE. Aim: The aim of the study is to determine if the CSE levels in a group of caregivers of HIV-positive children aged 6 months to 8 years 0 months on ART, after receiving play-informed caregiver-implemented home-based intervention (PICIHBI) are not inferior to CSE levels in an equivalent group of caregivers with children receiving conventional one-on-one occupational therapy. Method: The study applied a pragmatic, randomised control trial with caregiver-child dyads attending the antiretroviral clinic at Groote Schuur Hospital, Cape Town. The control group received conventional child-directed occupational therapy on an individual basis and the experimental group received caregiver-directed, PICIHBI in a group format. The Parenting Self-Efficacy Measure (P-SEMI), Parenting Sense of Competency (PSOC) scale, and the General Self-Efficacy Scale (GSE) measured self-efficacy at baseline, half way and at the end of the yearlong, monthly interventions. Results: Sixty-four caregiver-child dyads were recruited and assessed at baseline. Thirty-nine dyads were retained in the study, completing the measures at all three test points. Results revealed that baseline CSE was high for both groups. There was a significant change (p < .001) in the P-SEMI total scale in both groups from baseline to mid-test and mid-test to post-test. In both groups the CSE scores decreased from baseline to mid-test and then increased from mid-test to post-test. There was not a significant difference in CSE results between baseline and post-test on the P-SEMI total scale for either groups. There were no significant differences between test points for the other scales and subscales for both groups. Conclusion: The results suggest that PICIHBI has a non-inferior effect on CSE to that of conventional occupational therapy. This suggests that PICIHBI is comparable to conventional occupational therapy and could be implemented as an alternative intervention without comprising the effects on CSE. Employing PICIHBI as an alternative intervention could provide a number of benefits including the development of caregiver skills, a larger reach within the population, and contextually driven intervention that is embedded in children’s home environments. Various influencing factors are proposed to explain the patterns of CSE demonstrated in the groups. Neither group showed a significant increase in CSE from baseline to post-test and thus further investigation and intervention development is required to specifically demonstrate enhanced CSE in this context. Intervention attendance for both groups was poor. This is the first investigation on the effects of PICIHBI on CSE which can inform further research to develop best occupational therapy practice in the vast population of HIV affected families.