Browsing by Author "Van Der Westhuizen, Claire"

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    Family experiences and the role of the family in the development of substance use in adolescents and young adults in Zimbabwe: a qualitative study
    (2022) Chido, Ratidzai Madzvamutse; Sorsdahl, Katherine; Van Der Westhuizen, Claire
    Background Mental disorders including substance use disorders are a leading cause of disease burden, contributing 16% of the global burden of disease in young people aged 10 to 19 years. Substance use in adolescents and young people cannot be viewed outside of the family system. The family may influence the development of substance use problems in young people and the family system is an important part of recovery. The burden of substance use on family members is, however, often overlooked with emphasis being placed on the need to involve families in treatment of individuals using substances but little said about care for the family members themselves. There is need for a better understanding of the experiences of family members affected by substance use in young people and their own perceptions of the family's role in influencing adolescents' substance use. This study aimed to explore the experiences of families who have dealt with adolescent psychoactive substance use and their perceptions on how families can influence the development or avoidance of substance use in young people. Methods This was an exploratory qualitative study eliciting the experiences of nineteen family members dealing with substance use in young people aged less than 24 years purposively sampled from families of young people being managed for substance-related conditions at a tertiary mental health unit in Harare, Zimbabwe. Potential participants were identified using admission and outpatient registers and invited to take part in the study. In-depth interviews were conducted in Shona or English using a semi-structured interview guide exploring the experiences of family members dealing with substance use in a young person as well as their perceptions on the role of the family in development of substance use. The interviews were voice recorded, transcribed verbatim and the data were analysed in NVivo 12 using the framework approach. Ethical approval was granted from the University of Cape Town, Faculty of Health Sciences Human Research Ethics Committee and the Medical Research Council of Zimbabwe and the Institutional Ethics Review Boards for Harare Central Hospital. Results Five themes emerged from the data namely: Perceived causes of substance use in young people; Discovery of the substance use; Impact of the substance use; Family coping strategies and Family suggested interventions. Substance use by a young person affected family life, affecting family members and siblings emotionally, causing conflict in the family and burdening the family finances. Family members struggled with physical health problems; emotional distress, fear; helplessness; hopelessness; guilty, stigma and isolation, social and occupational consequences as a result of substance use by a young person in the family. Families also described various ways in which they attempted to cope with the challenges with spirituality highlighted as a key coping strategy. Participants suggested the family can be a mitigating factor against substance use in young people through having a better understanding about substance use, improved communication; providing an emotionally supportive home environment; creating healthier value systems in the family; actively supervising and monitoring of young people; encouraging young people to engage in meaningful work; facilitating admission for medical rehabilitation when needed as well as providing spiritual support. Conclusion There is a substantial but hidden burden of substance use on families and caregivers. This study illustrates the need for health services to provide better support for affected families, improving access to care and support for family members of young people using substances at risky levels. Further research is needed to explore how existing frameworks for structured support may be adapted for and implemented in the local setting. Substance use, particularly in young people, remains a family condition and the family needs to be not only included in treatment of young people but to be cared for themselves as well.
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    Indoda iyanyamezela (a man perseveres): Exploring the perceptions, experiences and the psycho-social challenges of Xhosa young men in the Western Cape who have transitioned from adolescence to manhood without present or involved fathers
    (2022) Moshani, Nomakhawuta Lettitia; Van Der Westhuizen, Claire; Brooke-Sumner, Carrie
    BACKGROUND: Father absence or uninvolvement is a growing problem worldwide, which not only negatively influences child development, but also the masculine identity formation of boy children. South Africa is one of the countries that has high levels of father absence, yet there has been scant research which particularly focuses on the perceptions, experiences and psycho-social challenges experienced by young men with absent fathers. Thus, the aim of this study was to explore the perceived influence of father absence or uninvolvement on Xhosa young men who have transitioned from adolescence to manhood. The first objective was to explore the perceptions, experiences and the psycho-social challenges of Xhosa young men in Khayelitsha, Western Cape who have transitioned from adolescence to manhood without present or involved fathers. The second objective was to explore Xhosa male elders' perceptions of the experiences and challenges of Xhosa young men who culturally transition from adolescence to manhood without present or involved fathers. The third objective was to identify the support needs of Xhosa young men before, during and after transitioning from adolescence to manhood in the absence of a present or involved biological father. METHODOLOGY: Using Bronfenbrenner's ecological systems theory as a conceptual framework, the study employed a qualitative approach to investigate factors that shape and influence experiences of Xhosa young men with absent or uninvolved fathers at individual, family, community and societal levels. Semi-structured in-depth individual interviews were conducted using interview guides covering various topics: family life; conceptualisation of manhood and fatherhood; father absence in Xhosa communities and its causes and impacts; the value of social fathers as well as the possible preventative interventions at different levels of the society to promote father presence or involvement and mitigate the impact of father absence. All interviews took place at different venues offered by community organisations in Khayelitsha (Ilitha Park, Site B and Nkanini) in the Western Cape province. They were conducted in isiXhosa, audio-recorded, transcribed and translated into English for analysis. Data analysis was conducted using thematic analysis utilising the NVivo 12 software package. During transcription, three researchers read the transcripts and developed an initial coding framework which was then used to code the rest of the data, making adjustments as necessary. The data were categorised thematically paying attention to dominant themes that addressed the research questions, while being open to additional themes arising in the data, and this process occurred until no new themes emerged. ETHICAL APPROVAL: The ethical approval of this study was provided by the UCT Human Research Ethics Committee (HREC 654/2018). RESULTS: The interviews were conducted with 22 Xhosa young men with absent or uninvolved fathers (ages 18-22) and five Xhosa male elders (ages 55-73). Due to the sensitivity of the topic initiation, a vignette was used to avoid directness. The main perceptions, experiences and psychosocial challenges of Xhosa young men who have transitioned from adolescence to manhood without present or involved fathers, were synthesised as follows: (i) The meaning given to cultural male circumcision by young men and elders were its individual family benefits. (ii) The challenges of Xhosa patriarchy, a father's role, and his absence, and paternal connection needs during initiation: planning, masculine guidance and protection, emotional and cultural support. (iii) The significance of the fatherly role and implications of father absence before and beyond initiation: the traditional and modern role. (iv) Barriers to father presence or uninvolvement: financial constraints, maternal gate-keeping and mother's negative attitudes. Using Bronfenbrenner's ecological systems theory, the support needs of Xhosa young men without present or involved fathers before, during and after transitioning from adolescence to manhood were identified as follows: (i) At the microsystem level, single mothers and maternal families of Xhosa young men need to be open regarding father absence, acknowledge the pain it causes and avoid maternal gatekeeping and paternal identity concealment. However, they also need to receive psycho-social support in order to be able to link the young men with social fathers, especially around initiation. (ii) At the mesosystem level, the social institutions such as churches, schools and sports clubs should have awareness regarding father absence or uninvolvement as a social problem in order to be sensitive towards the emotional needs of children with absent or uninvolved fathers. (iii) At the exosystem level, there is a need for fathers' environments (such as family, friends and the workplace) to encourage and foster lifestyles that promote father presence or involvement. (iv)At the macrosystem level, the media should raise awareness of father absence, and there must be policies and programmes that promote egalitarian parenting. (v) At the chronosystem level, there is a need to embrace and practice the modern fatherhood role which requires the father to be warm, spend quality time and have strong communication with his children. CONCLUSION: Cultural initiation is a crucial time for emotional and cultural growth which largely contributes to the development of manhood identity; it benefits the person on an individual and family level. However, this study notes that initiation comes with advantages and disadvantages for the Xhosa young men. It is a vehicle for growth, but also serves as a reminder of the vacant paternal role during this culturally significant process, especially in the midst of maternal gate-keeping and paternal identity concealment issues. Furthermore, in the course of their lives, the young men also experience loss related to not being exposed to the various positive roles a father would play, including the roles of disciplinarian, provider and the nurturer. Even though social fathers and strong maternal kin support could help Xhosa young men to cope better, the void of the biological father remains unfilled, especially around the period of initiation due to the emotional, cultural and financial implications of the ritual. This study shows that the young men could experience depression, be suicidal, have anger and resort to substance use when not supported. There is thus a need for multi-dimensional interventions to address these issues. These should start with psycho-educational support for maternal families to empower them to be supportive towards the emotional and cultural needs of the young men as the families do not always possess the necessary skills to support a child in this predicament. Absent fathers also need to be engaged in order to understand the reasons leading to their disengagement, and to sensitise them regarding the consequences of their absence for them to better understand the permanence of fatherhood. Advocacy is needed to make the wider society aware of the support needs of Xhosa young men who go through initiation in the absence of a father. Finally, the strategies that seem to yield positive results in managing father absence need to be strengthened, namely: strong maternal family support, social fathering, counselling and mentorship.
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    Intimate Partner Violence among Adolescent Girls and Young Women in Bulawayo, Zimbabwe and perceived barriers and facilitators to the provision of psychosocial interventions in salons
    (2023) Ndondo, Nonhlanhla Lindelwe; Carney, Tara; Richter, Marlise; Van Der Westhuizen, Claire
    Background. Women are disproportionately affected by intimate partner violence (IPV), particularly those in low-to-middle-income countries (LMIC). Recent research data suggests that IPV prevalence among adolescent girls and young women (AGYW) in Zimbabwe is estimated to be 36.5%. Innovative intervention models that leverage gendered spaces to provide IPV support have shown great potential in high income countries, but little is known about these in LMIC settings, including in Zimbabwe. The current qualitative study explored the experiences of IPV among AGYW as well as the feasibility of the use of pre-existing female spaces such as salons to provide psychosocial interventions in Bulawayo, Zimbabwe. Methods. Nine AGYW who had experienced IPV participated in virtual and in-person key-informant interviews. Two focus groups were conducted with salon and spa workers to explore the potential use of salon-based interventions (n=10). Purposive sampling was used as a recruitment strategy. Thematic analysis was used to analyse the data. Results. The findings indicated that in this study, AGYW participants' experiences of IPV consisted mainly of physical IPV such as being beaten with an object, being slapped, or punched with a fist, followed by psychological and lastly, sexual IPV. The results of the study highlighted the factors that seemed to predispose AGYW participants to IPV such as sociocultural influences, economic disempowerment and partner characteristics and behaviours. AGYW participants also discussed the negative physical and mental health impact of the psychological and sexual abuses they had encountered. Both salon workers and the AGYW interviewed identified peer support facilitated by the positive social capital created in salons, as well as the female-centeredness of salons as conducive elements for an acceptable intervention. However, some speculations around confidentiality and accessibility to salons were some of the potential barriers identified for implementing salon based IPV interventions. Conclusion. The findings of this study indicated that there is a need to identify and address IPV, as well as the mental health consequences that AGYW experience due to IPV. While the use of predominantly female spaces, in this case salons, were discussed as feasible spaces to incorporate into IPV support models for AGYW, there were certain barriers which will need to be addressed for this to be considered. In addition, it was clear that the content of such interventions needed to include not only IPV and associated mental health issues, but also include other components such as economic empowerment of AGYW, while also challenging traditional gender norms through salon-based interventions. Furthermore, AGYW alluded to their preference for IPV psychosocial support interventions to be peer-based and female-driven. Salons typically provide these aspects, hence increasing their viability as a choice for community based IPV support
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    Prevalence and predictors of alcohol use among HIVpositive Malawian adolescents attending selected AntiRetroviral Treatment clinics in Blantyre, Malawi
    (2024) Kuyokwa, John; Van Der Westhuizen, Claire; Sorsdahl Katherine
    Background: Alcohol use among adolescents living with HIV attending Anti-Retroviral Treatment clinics is a common occurrence in many low- and middle-income countries, yet data is scarce from Malawi. Adolescents living with HIV(ALHIV) are more likely to use alcohol because of psycho-social challenges associated with HIV status. The purpose of this study was to determine the prevalence and predictors of alcohol use among Malawian ALHIV attending selected Anti-Retroviral Treatment clinics in Blantyre, Malawi. Methods: A cross-sectional research study design was used and three hundred and seventy-six adolescents living with HIV (attending Anti-Retroviral Treatment clinics were recruited. The study participants were aged between 10-19 years. ALHIV participants were asked about their lifetime alcohol use and other psychosocial issues such as depression and anxiety symptoms, stigma, social support, peer pressure, post-traumatic stress disorder (PTSD), community factors, and family factors. For categorical and continuous variables, frequency distributions and descriptive statistics were computed. A multivariate logistic model was developed to determine factors associated with any life-time alcohol use. Results: The study found that the overall prevalence of lifetime alcohol use was 17.8% (n=67) and that other psycho-social problems were prevalent among ALHIV. Of the entire sample, 27.7% (n=104) reported depressive symptoms and 23.7% (n=89) reported symptoms of anxiety. Also, 70.5% (n=265) reported experiencing a traumatic event with 31.7%(n=119) reporting symptoms of PTSD. In the unadjusted model, seven variables were significantly associated with life-time alcohol use. Being female decreased the odds of reporting any lifetime alcohol use compared to being male (OR=0.51, 95% CI 0.29, 0.88). As age increased the odds of lifetime alcohol use also increased by 18% (OR=1.18, 95% CI 1.02, 1.31). Participants who completed secondary school had increased odds of any lifetime alcohol use by 100% compared to those who had completed primary school only (OR=2.00, 95% CI 1.16, 3.47). ALHIV with symptoms of PTSD had increased odds of any life time alcohol use by 85% (OR=1.85, 95% CI 1.08-3.18), while participants who reported having more social support from a significant other (OR=0.87, 95% CI 0.77, 0.98), family (OR=0.83, 95% CI 0.72, 0.97) or friends (OR=0.83, 95% CI 0.72, 0.96) were less likely to report any lifetime alcohol use. In the adjusted model, gender remained significantly associated with any lifetime alcohol use, where females were less likely to have used alcohol than male participants (OR=0.53, 95% CI 0.30, 0.94). Conclusion: This is the first study to show prevalence of any alcohol use among Malawian ALHIV attending selected Anti-Retroviral Treatment clinics in Blantyre, Malawi. The prevalence of any life-time alcohol use among this adolescent group was 18%. This study suggests that males were more likely to report lifetime alcohol use compared to females.. Arguably, male ALHIV in this study might have experienced psycho-social challenges which made them more at risk of alcohol use than females; this may be required to be explored further in the study context. The results of this study may inform future studies and policy in the formation of effective prevention and management of symptoms of common mental health conditions among ALHIV to improve wellbeing in this group of adolescents living with a chronic condition.