Browsing by Author "Knight, Lucia"

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    A cross-cultural adaptation and validation of a scale to assess illness identity in adults living with a chronic illness in South Africa: a case of HIV
    (BioMed Central, 2022-08-21) Sematlane, Neo Phyllis; Knight, Lucia; Masquillier, Caroline; Wouters, Edwin
    Abstract The chronic illness trajectory and its outcomes are well explained by the concept of illness identity; the extent to which ill individuals have integrated their diagnosed chronic illness into their identity or sense of self. The capacity to measure illness identity in people living with HIV (PLHIV) is still relatively unexplored. However, this is potentially useful to help us understand how outcomes for PLHIV could be improved and sustained. This paper aims to explore the cross-cultural adaptation of a Belgian developed Illness Identity Questionnaire (IIQ) and validate the instrument using a sample of South African adults living with HIV. We followed a phased scale adaptation and validation process which included an investigation of conceptual, item, semantic and operational equivalence and also examined the psychometric properties of the IIQ. The concept of illness identity with its four factors; engulfment, rejection, acceptance and enrichment in PLHIV, was found to be relevant within this context. Five items from the original IIQ were excluded from the adapted IIQ due to either semantic insufficiency and/or inadequate measurement equivalence. The mode of administration of the IIQ was changed to accommodate current study participants. The original four factor 25-item model did not fit current data, however, a better contextualized, four-factor, 20-item model was identified and found valid in the current setting. The results showed adequate statistical fit; χ2/d.f. = 1.516, RMSEA = 0.076, SRMR = 0.0893, and CFI = 0.909. Convergent and discriminant validity were also tenable. The cross-cultural adaptation and validation of the IIQ was successful, resulting in the availability of an instrument capable of measuring illness identity in PLHIV in a high HIV prevalence and resource-constrained setting. This therefore addresses the paucity of information and expands on knowledge about illness identity.
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    A qualitative exploration of the perceived factors that influence alcohol consumption among South African girls and young women (AFYW) and the relationship with sexual risk behaviour
    (2023) Grant, Jamie; Knight, Lucia
    South Africa (SA) has one of the highest rates of problematic alcohol consumption, with rates particularly concerning among young people. SA adolescent girls and young women (AGYW), from low-resourced settings, exhibit increasingly problematic alcohol consumption behaviours. As alcohol is a key determinant of sexual risk behaviours, it increases AGYW's already disproportionate burden of potentially negative sexual and reproductive health outcomes. This paper reports on analysis of qualitative data from interviews with AGYW and stakeholders, conducted in six SA provinces. Data were thematically analysed to explore respondent's perceptions of factors influencing AGYW's alcohol consumption and experiences of alcohol-induced sexual risk behaviour. Reasons for alcohol consumption included AGYW's desires for pleasure and enhanced sociability, but also to suppress negative emotions. Access to alcohol and social modelling were also perceived as influential factors. Alcohol consumption increased sexual risk through condomless sex and risk of sexual and physical violence against AGYW. Findings indicate that AGYW face negative social reactions to their consumption habits because they contradict social norms of youth and femininity. An understanding of motivations for alcohol use among AGYW, and the influence of the social environments, are useful for formulating alcohol risk-reduction strategies for AGYW and the communities in which they live.
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    An exploration of the determinants of sexual risk behaviour among adolescent girls and young women aged 15-24 years in South Africa: a sub-study of the 2019-2022 HERStory2 study
    (2024) Chamuka, Paidashe; Knight, Lucia; Duby, Zoe
    Objective: The study aims to understand why South African adolescent girls and young women (AGYW) engage in sexual risk behaviours, such as unsafe sex and transactional and inter-generational sexual relationships. These behaviours lead to adverse sexual and reproductive health (SRH) outcomes, including HIV, STIs, unplanned pregnancies, and forced sex. By exploring the perspectives of AGYW and community stakeholders, the study seeks to enhance future interventions aimed at reducing the risk of STIs, including HIV, and unintended pregnancies among AGYW. Methods The study is based on the qualitative component of the HERStory2 study, a mixed-methods evaluation of an SRH intervention for AGYW in six South African districts. Data from in-depth interviews with twenty-seven participants were thematically analysed using the social-ecological model as a theoretical framework. Results The findings showed that the reasons for AGYW's engagement in sexual risk behaviour are nested within individual, interpersonal, community, and structural levels. At the individual level, participants reported that AGYW may engage in sexual risk behaviours due to their age, low perception of risk, problematic alcohol consumption, and the need for high grades at school. At the interpersonal level, social media-induced peer pressure was cited as a reason for AGYW's engagement in sexual risk behaviours. Community-level factors included lack of safety and economic activities such as mining. At the structural level, poverty, negative attitudes from public healthcare providers at clinics, and social and gender norms were perceived to influence AGYW's sexual risk behavior. Conclusion The results suggest that AGYW's sexual risk behaviour is influenced by many complex factors beyond the individual. The results call for targeted holistic interventions to reduce sexual risk behaviour and improve the SRH outcomes for AGYW in this high HIV burden context.
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    An exploratory qualitative study of menstrual hygiene management among adult women of reproductive ages from an under-resourced community in Cape Town, South Africa
    (2023) Ncube, Semkelisiwe; Knight, Lucia
    Background: Poor menstrual hygiene management can result in health concerns for women, particularly in low-and-middle-income countries. The evidence for the lived menstruation experiences of adult women of reproductive ages is limited. This study sought to understand the menstrual hygiene management experiences of adult women from an under-resourced community in Cape Town in South Africa. Methods: In this exploratory qualitative research design, qualitative in-depth interviews were conducted using a semi-structured interview guide with 10 women aged 25 and 49 and three key informants namely a maternal health nurse and two community health care workers. The study occurred over a period of three months and all participants were purposively selected using a homogenous sampling strategy and key informants were purposively sampled using an intensive sampling strategy. Data was manually analysed using Braune & Clarke (2016) thematic data analysis and coding was done deductively and inductively to look for emergent codes. Findings were organized around a conceptual framework developed to map the distal and proximal factors affecting girls and women menstrual hygiene management in LMICs. Results: Women menstrual experiences were shaped by their socio-cultural context and resource limitations. The main findings include psychological impacts of poor menstrual hygiene management namely shame, discomfort, culminating in feelings of powerlessness, loss of confidence, increased anxiety, and negative perceptions of menstruation. Physical health challenges related to compromised menstrual hygiene including skin irritation and rashes, increased risk of reproductive tract infections. Financial challenges culminating in poor access to and use of pain relief medication and use of substandard sanitary materials. Poor menstrual hygiene management also led to environmental pollution caused by disposal of sanitary materials and in day-to-day activities, poor menstrual hygiene led to avoidance of sexual activities and public places, reduced performance, and participation at work. Conclusion: Adult women from an under-resourced community in Cape Town experience poor menstrual hygiene management affecting their physical and psychological health. Recommendations: There is need for health education about menstruation, improved access to resources and health services required for proper MHM and further research and programming among adult populations.
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    Barriers to gender-based violence care: a qualitative study of migrant and refugee women
    (2024) Bradley, Kathleen; Knight, Lucia; Dutton, Jessica
    South Africa has long served as a destination for migrants from sub-Saharan African nations, with a growing proportion of this population being women in recent years. Female migrants experience an increased risk for gender-based violence (GBV) during the migratory journey and upon resettlement. Accessible and culturally sensitive health, psychosocial, and justice services are necessary to promote holistic recovery for survivors. However, numerous barriers, influenced by widespread xenophobia and increasingly restrictive immigration legislation, have limited this population's access to care. The study aims to explore the barriers encountered by female migrants when accessing care services following experiences of GBV. This qualitative, exploratory study was conducted in Cape Town, South Africa between June and December 2023. Participants were purposively sampled and recruited in partnership with a local migrant organization. Their countries of origin included Burundi, the Democratic Republic of Congo, and Zimbabwe. Data was collected through face-to-face, semi-structured in-depth interviews with 12 female migrants and four key informant (KI) service providers. Interviews explored women's experiences of accessing and utilizing post-violence care services. Inductive thematic analysis guided the study. Data analysis revealed that within a context of xenophobic discrimination and economic instability, female migrants face multiple obstacles in the accessibility and acceptability of post-violence care services. Notable themes in accessibility include a lack of access to information deriving from participants' severe levels of isolation and language barriers. This is compounded by social inaccessibility due to cultural norms against reporting GBV and bureaucratic inaccessibility from prolonged documentation processes. Acceptability of services found multiple reports of xenophobic treatment and victim-blaming behaviour from service providers which impacted women's willingness to seek care. However, many still expressed generally positive sentiments about the progressive nature of social services in South Africa in contrast to their home countries. A lack of information about available postviolence resources, language and cultural barriers, as well as bureaucratic challenges, are limiting the migrant woman's ability to seek help following instances of GBV in Cape Town. Findings demonstrate how non-governmental organizations and individual citizens are currently filling a gap in referrals and service provision raising concerns about sustainability. Advocacy and government intervention are necessary to ensure post-violence care services can adequately meet the needs of migrant women. This mini-dissertation is comprised of two components; Part A is the research protocol for how the study was conducted and Part B in a journal manuscript detailing the process and findings of the study.
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    It always has to come down to individual choice . Vaccination decision-making among privileged parents in South Africa
    (2024) Blumberg, Chevon; Knight, Lucia
    With most vaccine hesitancy research being performed in high income countries, little is understood about the phenomenon in low- and middle-income regions, including South Africa. Seeking to understand a gap in vaccine hesitancy research, this qualitative study examined the lived experiences and perspectives on vaccination, of parents from privileged communities, in the Western Cape, South Africa. Privilege was defined as individuals who have an educational level above high school, and through self-report had experienced no major financial difficulties, due to the COVID-19 pandemic or other reasons, that would have resulted in impact on standard of living, children's educational institution, or healthcare access. Conducted during the South African COVID-19 vaccine roll-out, from March to June 2022, the study explored how these parents make decisions about vaccination, including routine childhood vaccination, influenza and human papillomavirus vaccines, focusing on the COVID-19 vaccine. Analysis of transcripts from 14 semi-structured individual interviews was performed. Data were analysed using thematic analysis and framed within the structure of the socioecological model. Results of the study demonstrate that although privilege does not dictate whether or not an individual chooses to vaccinate, privilege impacts vaccination decision making and outcomes in both explicit and implicit ways, including lifestyle, accessibility, insight into the experience of less privileged individuals, and the entitlement of choice. Analysis of the data resulted in the classification of participants into three broad categories of vaccination decision-making processes: (1) the dutiful parent, (2) the sceptical parent, and (3) the uncertain parent. Within these categories, privilege occupies a particular place in the variable and nuanced differences in parents' vaccination decisionmaking processes. It is crucial to understand how privileged individuals determine health care choices, as these decisions can have far-reaching impacts on less privileged communities with more limited access to resources and health care
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    Social Support for Improved ART Adherence and Retention in Care among Older People Living with HIV in Urban South Africa: A Complex Balance between Disclosure and Stigma
    (Multidisciplinary Digital Publishing Institute, 2022-09-12) Knight, Lucia; Schatz, Enid
    The number of older people living with HIV (OPLWH) (aged 50-plus) in South Africa is increasing as people age with HIV or are newly infected. OPLWH are potentially vulnerable because of the intersection of age-related and HIV stigmas, co-morbidities, and lack of social support. Evidence from younger populations suggests that social support can improve ART adherence and retention in care. Further, HIV status disclosure plays a role in mediating social support and may reduce stigma by facilitating access to social support. This paper draws on qualitative research with OPLWH to explore the complex associations between disclosure, social support, and HIV stigma among OPLWH in urban Western Cape. The findings demonstrate that OPLWH receive most of their support from their family and this support can facilitate adherence to ART and retention in care. However, social support is facilitated by participants’ disclosure, thus, when perceived stigma limits disclosure, social support is less accessible. Gender, age, and pre-existing vulnerability also affect disclosure to and support from kin and community. Given that social support, particularly from family members, amplifies HIV care access and ART adherence, encouraging disclosure stimulating household HIV competency is likely to both address anticipated stigma and support improved OPLWH’s health outcomes.
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    Youth perceptions (18-24) on the role of youth clubs in delivering family planning information and services in Blantyre district, Malawi
    (2024) Makamo, Nancy; Knight, Lucia; Swartz Alison
    Background: Unmet need for family planning is a significant health problem for youth in Malawi. In order to promote family planning uptake, youth clubs were established to provide a safe and friendly environment for the youth to access sexual and reproductive health information and services. Although these tailored youth clubs exist, evidence on family planning utilisation in this population has been collected in clinics and hospitals rather than youth clubs. This study explored the perspectives of the youth on the role of youth clubs in delivering family planning information and services including condom distribution. Methods: An exploratory qualitative study design was used for this study. Four focus group discussions and ten semi-structured interviews were used to collect information from young boys and girls aged between 18 – 24. Participants were purposively sampled and were asked to give a written consent before the commencement of the interviews. The discussions and semi-structured interviews were tape-recorded and transcribed verbatim. Transcripts were coded manually and analysed using thematic analysis. Results: Youth clubs played a role in creating awareness about family planning methods and promoting positive sexual and reproductive health wellbeing of young people. The youth identified effective facilitation skills, trained peer educators and dynamic collaborations with health service providers as the facilitators of smooth delivery of family planning information. The perceived barriers to the smooth delivery of family planning information in the clubs included limited availability of resources and religious/cultural biases. Conclusions: Youth clubs are crucial in empowering the youth with knowledge and understanding about family planning hence enabling them to make informed decisions about their sexual and reproductive health and wellbeing. Effective delivery of family planning information and services in youth clubs requires strong partnerships with relevant stakeholders such as local health service providers and non-governmental organisations through leveraging their expertise, resources and networks hence strengthening the impact of family planning initiatives.