Browsing by Department "Department of Health and Rehabilitation Sciences"

Now showing 1 - 20 of 337
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    A case study exploring an occupational perspective of social inclusion among young adults dually afflicted with substance use disorder and HIV/AIDS in Zimbabwe
    (2021) Nhunzvi, Clement; Galvaan, Roshan; Langhaug, Lisa; Harding, Richard
    Background: Curtailing adverse social determinants of health is pivotal to achieving the 2030 Agenda for Sustainable Development`s vision for a healthy and inclusive society. In Zimbabwe, fulfilling Vision 2030 may involve adopting socially inclusive approaches, particularly for young people dually afflicted with HIV and substance use disorders. However, social inclusion remains conceptually unclear and underutilized in relation to marginalized groups in low resource settings. This study sought to explore and understand how dually afflicted young adults with substance use disorders and HIV in Zimbabwe experienced and negotiated their social inclusion. Methods: This study utilised a qualitative instrumental case study design. Primary qualitative and quantitative data were collected to develop a thorough understanding of the case of an occupational perspective of social inclusion among dually afflicted young adults in Zimbabwe. The multiple methods used in this study included: i) narrative inquiry with five dually afflicted young adults; ii) in-depth interviews with five key informants; iii) document analysis of seven policies; and, iv) exploratory cross-sectional survey of social inclusion and associated factors (n=105). These multiple methods and sources contributed to the study`s trustworthiness. Multi-level case study analysis was applied as follows; 1st level: narrative analysis of each of the five young adults` stories, descriptive analysis of key informant interviews, document analysis and descriptive statistical analysis of the cross-sectional survey data. 2nd level: thematic case analysis drawing from all four data sources. 3rd level: theorised conceptual occupational constructs. Findings: Five narratives illustrated how using agency and having occupational choices were central to the young adults` experience and negotiation of social inclusion. The overarching Case theme was “Navigating an already troubled life: Striving for belonging and well-being”. This consists of three categories: 1) Dealing with a context of mixed realities, 2) Trying to adjust to new challenges and, 3) Life on the margins. These findings show how dually afflicted young adults in Zimbabwe respond and resist the influences of dominant discourses through dynamic and interconnected actions that shape their realities. Conclusion: The study describes and explains how dually afflicted young adults experienced and negotiated their social inclusion. The data affirms the role of agency and proposes a more critical view of occupational choice, activist occupational choice, in understanding social inclusion. As an emergent concept it is categorized by occupational choices, largely defying standard norms of engagement, and aims to break away from oppressive systems and problematic situations. Recognising the diverse manifestation of agency yields an appreciation for how occupations that are indigenous, collective, and resist oppression contributes to experiences of social inclusion.
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    A case study exploring the application of the Occupation-based Community Development Framework: co-constructing humanising praxis
    (2019) Krenzer, Meghan Lee Mackenzie; Galvaan, Roshan
    The Occupation-based Community Development (ObCD) framework draws on critical occupational science concepts in working with marginalized communities to bring about transformative change (Galvaan & Peters, 2017a). However, little research has been conducted on this to date, specifically within community development practice (CDP) and in the Global South. This study asked the question: “How does the application of an occupational perspective and participatory action methods influence the processes within ObCD?” A qualitative research design employing an instrumental single case study was conducted. The case was bounded within the University of Cape Town’s final year Occupational Therapy student service-learning placements during the period of 2014 to 2016, in South Africa. Participants were purposively selected and included occupational therapy clinical educators and recent occupational therapy graduates who had applied the ObCD framework during their CDP placements. Data was generated through a focus group; individual semi-structured interviews and analysis of graduates’ written reports. A thematic analysis revealed the case to be that of co-constructing humanising praxis, describing the evolving thinking and doing of practice. Three themes, namely: 1) Processes of dialogue and doing; 2) Situating occupational perspectives in socio-political and historicised contexts; and 3) Negotiating positionalities, offer detailed descriptions of the elements to consider in engaging and developing this form of praxis. The discussion illustrates how praxis resonates with the values of critical and social occupational therapy in working towards promoting occupational justice. Thereby, proposing that occupational justice implies engaging in humanising praxis, through a co-constructed journey with stakeholders. The suggestion made is that praxis guided by the ObCD Framework promotes occupational justice. Shifts in terminology and concepts, that could depict the values in ObCD more explicitly are suggested. Finally, praxis as a potential avenue for decolonising domains of occupational therapy practice is identified. Recommendations relating to occupational therapy curricula, services and research are offered.
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    A case study of emerging practice in speech-language therapy in a community practice context
    (2019) Abrahams, Kristen; Kathard, Harsha; Pillay, Mershen; Harty, Michal
    Background: The profession of speech-language therapy (SLT) continues to struggle with challenges around equity and service delivery. The dominant medical model, characterised by one-on-one, individualised health care, is struggling to serve the large population in need of services. As such, there is a need to reconceptualise SLT practices toward a social justice focus. The study used clinical education as the entry point of exploration into how emerging professional practices (EPPs) may be developed. Aims/Objectives: The study aimed to describe and analyse a case study of an emerging professional practice in SLT as part of a university-school partnership in a peri-urban settlement in South Africa. The objectives were: 1. To describe and analyse the practice methods of the EPP, 2. To describe and analyse the educational and knowledge bases which support the EPP, and 3. To describe and analyse the underlying epistemology, ontology and methodology underpinnings shaping the EPP. Method: A qualitative case study methodology, guided by critical theory and decoloniality, was used. Final year SLT students were the primary participants for the study. Data were collected in the form of document analyses, participant observations, interviews, photovoice, and experiential drawings from a number of stakeholders (including SLT students, a school principal, a project coordinator, a library assistant and a clinical educator) from January to December 2017. The data were analysed using reflexive interpretation (Alvesson & Sköldberg, 2009) as a guiding frame. Findings: The three-level analysis process was used to generate the thesis offering. The first level of analysis was the construction of the overall case narrative - documenting the practice methods of the EPP through the experiences of the SLT students. The second level of analysis used thematic analysis approach to identify key themes emerging from the case narrative. Four key themes were explored in the form of narratives, collages and paintings. The third level of analysis used decoloniality (i.e. coloniality of power, knowledge and being) and the Relationship of Labouring Affinities (RoLA) as critical lenses to deepen my understanding of the case. Through using both RoLA and decoloniality, dialogue emerged as a critical form of engagement toward developing EPPs. The study specifically puts forward the concept of critical dialoguing as a necessary process for conscientisation and change. Conclusion: The findings of the study illuminated how SLT students navigated through their experiences of disruption of their traditional practice. The findings weave together participant narratives, drawings and collages to engage the reader in the EPP. The findings showed how critical engagement with political, historical, social and linguistic influences underlying their work in communication, facilitated new learning and insight into SLT practice. The thesis offering discusses the role of critical dialoguing in opening up space for critical discussions about the profession. In conclusion, supported disruption provided students with a platform to interrogate current SLT practices, re-examine the viability of practices to serve populations, and reflect on how the SLT profession can adapt and change with the changing needs of the population.
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    A case study of factors influencing primary healthcare Continuity of Care for persons with disabilities
    (2024) Padayachee, Thesandree; Kathard, H
    Background: “Continuity of Care” refers to how a patient experiences care over time and is considered to be a central pillar in the delivery of high-quality person-centred healthcare. In South Africa (SA), persons with disabilities experience a range of structural barriers to health services and even when access to health services is realised, poorly integrated health systems and services, limited human resources and poor awareness of the needs of persons with disabilities result in unmet healthcare needs. Given the rapidly transforming healthcare context of SA and the adoption of policies towards the realisation of universal health coverage, an understanding of how the health system is responding to the “Continuity of Care” needs of persons with disabilities through policy and practice is valuable step towards realising the goal of integrated people-centred health systems; particularly in the delivery of primary healthcare (PHC). Objectives: The study aimed to explore factors influencing “Continuity of Care” for persons with disabilities within the PHC context. Experiences and expectations of persons with disabilities were explored, relevant policies governing PHC and “Continuity of Care” were analysed and health systems responsiveness was explored to understand what influences “Continuity of Care” for persons with disabilities. Method: This exploratory case study used a critical social theory and a health policy and systems approach to better understand how primary healthcare “Continuity of Care” for persons with disabilities can be strengthened. The Conceptual Framework for Health Systems Responsiveness (Mirzoev & Kane, 2017) informed the case study design by exploring how persons with disabilities experienced “Continuity of Care” and supported a deeper understanding of health systems gaps through perspectives of service providers in responding to the “Continuity of Care” needs of persons with disabilities. The study was conducted within the context of the SA primary healthcare policy and implementation in an urban suburb in the city of Durban, KwaZulu Natal in South Africa. The study included multiple data collection methods including interviews, focus group discussions, document reviews and analysis of relevant policies using an adapted EquiFrame (Amin, 2011). Qualitative data was analysed thematically using inductive and deductive analysis. Results: Participants with disabilities were found to experience primary healthcare discontinuity resulting from known factors such as lack of reliable and accessible transport, negative attitudes of health facility staff and sub-optimal management of clinic and outreach services. New insights that were found to negatively affect “Continuity of Care” for persons with disabilities included the combined influences of institutional distrust; the medical model as a legacy of apartheid; incoherence in policies supporting “Continuity of care” and poor user-centred design practices in the delivery of new innovations that were unresponsive to the needs of persons with disabilities. Positive influences on “Continuity of Care” included emergent community leadership, family resilience to navigate through treatment uncertainty and supportive servant leadership styles of healthcare providers. Conclusion: The study points to the need for an expanded understanding of “Continuity of Care” for persons with disabilities within an African paradigm where care continuity extends beyond the health facility and with a stronger emphasis on community driven models of care that respect the role and influence of traditional health practitioners and cultural practices. More research is needed to better understand institutional distrust and how traditional western models of healthcare can be reshaped to deliver services.
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    A case study of how a centre-based preschool programme for children who are blind/visually impaired supports early multilingual communication development
    (2023) Kamedien, Layla; Kathard, H
    Communication development is an essential part of a child's development – socially, academically, and vocationally. For children with visual impairment/blindness (VI/B), the literature indicates that opportunities supporting early communication development can benefit a child with VI/B. Speech-language therapists' (SLTs) core focus on communication is instrumental in supporting children to develop their communication. However, little is known about the practices which support the communication development of children with VI/B. The study therefore aimed to explore and describe how the centre-based preschool programme at the League of the Friends of the Blind (LOFOB) in Cape Town supported early multilingual communication development. A qualitative case study design was used to explore and describe the programme's knowledge, values, principles, skills, and practices. Semi-structured interviews were conducted with key stakeholders, along with classroom observations and document reviews of key government policies, principles and standards. Thematic analysis was used to analyse and interpret findings. During this process a key informant with VI was used to assist with the interpretation of the data. The findings are presented as a narrative and accompanying individual vignettes. The narrative explores the activities and opportunities available for multilingual communication support. While the individual vignettes describe the knowledge, values, principles and skills that inform the practices of the programme. Key themes that emerged from thematic analysis of the data include an inclusive approach to encourage multilingual engagements and support, a structured programme that focussed on capabilities, and a committed team offering support. The study argued that there is an opportunity for the SLT profession to rethink how communication is typically supported and shifting from a focus on pathology to communication supports that explore capabilities and inclusion.
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    A case study on the experiences of persons with disabilities of the disability grant processes occurring at SASSA Springbok in the Northern Cape
    (2021) Bock, Stacey Louisa; Sonday, Amshuda; Buchanan, Helen
    Introduction: Persons with disabilities (PWDs) living in rural areas are known to have a higher risk of living in poverty as they have the lowest levels of employment. To assist persons with disabilities to overcome these challenges, the South African government has developed interventions such as social assistance programmes which aim to prevent poverty and assure the basic minimum standard of living. Over the past five years minimal research has been published which focused on the disability grant in the South African context. More specifically, no research has been conducted in the Northern Cape, home to a high proportion of persons with disabilities. Of the research conducted in other parts of South Africa, no studies have sought to understand the experiences of persons with disabilities while engaging in the disability grant process. The research question for this study was, “How are PWDs experiencing the disability grant processes occurring at the SASSA Springbok branch in the NC?” This study therefore aimed to describe the experiences of disabled persons with the disability grant processes as they occurred at the South African Social Security Agency (SASSA) in Springbok, Northern Cape. Method: A single instrumental case study research design was utilised. Five participants were purposively sampled. Data were collected through document review of pertinent SASSA documents, non-participant observation, and semi-structured interviews. Data were analysed inductively, taking a thematic approach. Findings: The theme that emerged was Respecting differences is part of humanity. The main findings reveal that engaging with persons with disabilities as humans and not disregarding their humanity because of their disability are imperative to how they experience the disability grant process. Two categories, For us, human dignity matters, and the Impact of context on occupational rights, encapsulate two specific areas that relate to the theme. Conclusion: The experience of the disability grant process in this case study was influenced by stakeholder engagement with participants, mandatory protocols implemented due to the novel coronavirus, and the administrative aspects of the process. Recommendations for an improved overall experience of the disability grant process include streamlining the disability grant application process, the implementation of consistent Batho Pele principles by all stakeholders, suitably accommodating the disability grant application process for all types of disabilities, as well as maintaining the logistical structures put in place (albeit unintentionally) from the year 2020.
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    A critical evaluation of the effectiveness of interventions for improving the well-being of caregivers of children with cerebral palsy: a systematic review protocol
    (BioMed Central, 2016-07-13) Dambi, Jermaine M; Jelsma, Jennifer; Mlambo, Tecla; Chiwaridzo, Matthew; Tadyanemhandu, Cathrine; Chikwanha, Mildred T; Corten, Lieselotte
    Background: Over the years, family-centered care has evolved as the “gold standard” model for the provision of healthcare services. With the advent of family-centered approach to care comes the inherent need to provide support services to caregivers in addition to meeting the functional needs of children with physical disabilities such as cerebral palsy (CP). Provision of care for a child with CP is invariably associated with poor health outcomes in caregivers. As such, there has been a surge in the development and implementation of interventions for improving the health and well-being of these caregivers. However, there is a paucity of the collective, empirical evidence of the efficacy of these interventions. Therefore, the broad objective of this review is to systematically review the literature on the effectiveness of interventions designed to improve caregivers’ well-being. Methods/design: This is a systematic review for the evaluation of the effectiveness of interventions designed to improve caregivers’ well-being. Two independent, blinded, reviewers will search articles on PubMed, Scopus, Web of Science, CINAHL, Psych Info, and Africa-Wide Information using a predefined criterion. Thereafter, three independent reviewers will screen the retrieved articles. The methodological quality of studies meeting the selection criterion will be evaluated using the Briggs Institute checklists. Afterwards, two independent researchers will then apply a preset data-extraction form to collect data. We will perform a narrative data analysis of the final sample of studies included for the review. Discussion: The proposed systematic review will provide the empirical evidence of the efficacy of interventions for improving the well-being of caregivers of children with physical disabilities. This is important given the great need for evidenced-based care and the greater need to improve the health and well-being of caregivers. Systematic review registration: PROSPERO CRD42016033975.
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    A descriptive study investigating functional balance in deaf school-aged children: towards the adaptation and validation of subjective questionnaires
    (2025) Mbhele, Sphilile; Rogers, Christine; Saman, Yougan
    BACKGROUND: Balance deficits are common in children with deafness. They have an impact on the child's general well-being and holistic development. However, the extent to which children with deafness experience this condition is relatively unknown given the inability of children to communicate their symptoms to healthcare professionals and the lack of self-assessment tools for this population. Although balance function has been studied in literature, the functional impact of balance deficits in children with deafness remains undervalued and under-researched. OBJECTIVE: To evaluate functional balance by quantifying symptoms of imbalance, balance-related handicap and measuring balance performance in school-aged children with deafness and children with normal hearing between the ages of 9 to 17 years. METHODS: A descriptive, case-controlled research study was conducted with 155 children; 97 with deafness and 58 with normal hearing of both sexes, between the ages of 9–17 years (mean age 14 years). The PVSQ was used to quantify balance symptoms, DHI-CA to quantify dizziness-related handicap, and the EQ-5D-Y proxy version questionnaire to determine health- related quality of life. Physical outcome measures included visual acuity, the Mini-Balance Evaluation Systems Test (Mini-BESTest) and the Modified Clinical Test of Sensory Interaction in Balance (m-CTSIB). RESULTS: The PVSQ showed a high internal consistency (Cronbach's α=0.904) and construct validity demonstrated good sensitivity (80%) and specificity (90%). The DHI-CA showed similar results with internal consistency of Cronbach's α=0.949, and sensitivity and specificity of 80%. Significant differences (p=<. 001) were noted between the two groups. Children with deafness showed reduced balance scores on the Mini-BESTest and m-CTSIB (p=<0.001), and had reduced dynamic and static visual acuity when compared with children with normal hearing. A significant relationship was noted between the balance tests and the PVSQ and DHI-CA. The EQ-5D-Y proxy version questionnaire indicated that children with deafness experienced difficulties in all five domains, while children with normal hearing showed difficulties in only two domains (Having pain or discomfort and Feeling worried, sad or unhappy). A correlation was found between the PVSQ, DHI-CA and domain 4 (Doing usual activities) and domain 5 (Having pain and discomfort) of the EQ-5D-Y proxy version questionnaire. CONCLUSION: Children with deafness presented with greater balance difficulties than normal hearing children of the same age group. The adapted PVSQ is able to detect symptoms of imbalance, while the adapted DHI-CA can describe the severity of the handicap imposed by balance symptoms in children with deafness. These tools were able to discriminate between children with impairment versus those from the control sample. Thus, the tools adapted in this study are suitable for identifying balance symptoms and the related impact thereof. These tools will provide invaluable information to healthcare professionals about a child's self-reported balance outcomes, and assist in the subsequent individualisation of therapeutic interventions, ultimately playing a significant role in enhancing the quality of life of children with deafness.
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    A functional balance profile of school aged children and adolescents diagnosed with Down Syndrome, schooled in the Eastern Cape province of South Africa: a pilot study.
    (2025) Nolte, Cilje; Rogers, Christine
    Children and adolescents with Down Syndrome (DS) are at a higher risk of falls due to impaired balance and gait patterns, which complicates their ability to safely engage in daily activities (Jung, Chung & Lee, 2017). Assessing balance function in children is not only important for identifying balance deficits, but also to inform and highlight integral areas of balance function that should be addressed during rehabilitation. Although various outcome measures have demonstrated acceptable reliability and validity in typically developing children, the applicability of outcome measures in children with DS has not been fully established. This pilot study aimed to evaluate the clinimetric properties, including reliability, validity, and practicality, of four functional balance outcome measures: the Paediatric Balance Scale (PBS), the second edition of the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2, Subtest 5), the full Children's Balance Evaluation Systems Test (Kids- BESTest), and its shortened version (Kids Mini-BESTest). To contextualise the results, a control group of age- and sex-matched typically developing peers was included for comparison. The primary objectives were to assess reliability (inter-rater and test-retest), known-groups validity, criterion validity (via correlations with Timed Up & Go (TUG) scores), and internal consistency (using Cronbach's alpha) of each measure. Outcome measures used in real-world settings like schools and clinics require qualities beyond being clinimetrially sound. Aspects regarding the practical applicability of these outcome measures should also be considered. Thus, this study evaluated the accessibility, safety, and practicality of administering these tests in a DS population, including time requirements, cost-effectiveness, and participant acceptability. The secondary objectives were to describe the balance profile of the DS group and explore the effects of potential confounders, including middle ear function, cochlear outer hair cell function, and Body Mass Index (BMI), on balance performance and test outcomes. Children from the Merryvale School for Special Education in Gqeberha, Eastern Cape (EC), South Africa (SA), participated in this study, while typically developing controls were sourced from local schools in the same area. Safety measures, such as gait belts and close guarding, were implemented to ensure participant safety and minimise fall risk during assessments. Data confidentiality and participant welfare were prioritised throughout the study. The results demonstrated significant differences in balance performance between children with DS and typically developing peers across all four assessment tools. The DS group exhibited lower mean scores and shorter durations for balance tasks, with notable floor effects in specific items, particularly within the Kids-BESTest and PBS. Independent t-tests revealed statistically significant group differences (p < 0.001), with large effect sizes (e.g., Cohen's d = 3.94 for BOT-2 Subtest 5). Reliability analysis showed good inter-rater and test-retest reliability for all tools, with Cronbach's alpha values ranging from 0.867 to 0.971, indicating strong internal consistency. Validity testing confirmed known-groups validity, with balance assessments effectively differentiating between DS and typically developing groups, while criterion validity demonstrated a significant association between balance test scores and TUG performance (e.g., Kids-BESTest R² = 0.536, p < 0.001). Health-related variables, such as BMI and middle ear status, significantly correlated with poorer balance outcomes. This correlation further emphasises the multifactorial nature of balance impairments in children with DS. This study offers initial insights into effective, safe balance assessment methods which audiologists can use for DS populations. These insights ultimately pave the way for future research to support balance related interventions.
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    A pilot study to investigate the use of the ICF in documenting levels of function and disability in people living with HIV
    (2006) Jelsma, J; Brauer, N; Hahn, C; Snoek, A; Sykes, I
    Objective: The study was a pilot study aimed at investigating the use of the International Classification of Functioning, Disability and Health (ICF) checklist developed by the World Health Organisation in determining the function of individuals living with HIV in a township near Cape Town. Methods: Twelve participants attending the HIV clinic were examined using the ICF checklist. Findings: Areas of the ICF in which problems were noted included emotional functioning and energy and drive. Four participants complained of increased sensitivity to sound. Several respondents (three) reported difficulties in relationships with community members, with less having problems in family and intimate relationships. Conclusion: The ICF was found to be time consuming and many codes were not relevant. Some of the concepts were not well understood by the participants. However, despite limitations, the use of the ICF in a resource poor setting formed a useful framework within which to examine the functional problems of HIV infected individuals. In the absence of any equivalent unifying framework within which to classify health and health related states, the use of the ICF merits further investigation.
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    A prospective study exploring the experience of rehabilitation health professionals in implementing the 5 A`s strategy in addressing risk factors for non-communicable diseases
    (2025) Vearey, Gillion; Maart, Soraya; Amosun, Seyi Ladele
    Background: The growing epidemic of non-communicable diseases (NCDs) has a significant impact globally and locally in South Africa, not only on mortality rates, but also morbidity; increasing the risk of disability and decreasing the quality of life of people affected by these diseases. Behaviour Change interventions such as Motivational Interviewing (MI) and Five A's (5A's), have been developed and implemented to address the four behavioural risk factors causing NCDs. Method: A mixed method was used to 1) assess the use of MI in a South African context to address health risks for NCD`s through a scoping review, 2) assess the Scale of Staff Valence(SSV) in using MI in routine patient consultations by making us of a cross-sectional survey and an adapted Staff Valence questionnaire, and 3) the experience of Rehabilitation Health Professionals (RHPs) in implementing MI in a focus group discussion. Results: The original search identified 22 articles for the scoping review, 11 articles were excluded by title, 2 were excluded by abstract and 1 excluded by full text, 8 articles were included in the review. All the studies were based in the Western Cape Province. Diabetes and CVD were the most common conditions discussed. Most studies delivered training over 3-4days with 2 or more days of follow-up. Outcomes showed benefits of being more equipped to deliver MI to patients with NCDs, however barriers such as appropriate venues, buy in from other staff, and difficulties building rapport with some patients were also reported. Fifteen RHPs participated in this study, with 11 RHPs having more than 5 years' experience in their professional field. For the SSV scores, where a higher score reflects a positive result, for capability the average score was 28 (80%) with a standard deviation (SD) 2.4 under opportunity the average score was 66 (86%) with SD 6.6; and under motivation average score was 31 (90%) with SD 2.2. There was a statistical difference in opportunity across the level of experience (p< 0.05). These high scores confirm RHPs staff readiness in implementing behaviour change. Two themes emerged following the qualitative analysis of the RHPs' experiences in implementing the 5A's approach, namely 1) quality of the 5A's which developed from challenges and benefits of this framework as well as the impact of improved knowledge around behaviour change, and 2) impact of the clinical setting which compared the range of clinical settings RHPs practice in and the contact time available to implement the 5A's. Discussion and Conclusion MI and the 5A's can be considered a feasible approach to addressing health risk behaviours related to NCDs in South Africa. RHPs discussed the value and benefits of training and equipping in behaviour change strategies. However, barriers and challenges do exist, such as the limited patient contact time and the stage of behaviour change of each patient, influencing the effectiveness of this approach; especially in an acute setting. RHPs practicing in a subacute or outpatient setting are better suited to implement such an approach considering their contact time to build rapport with patients. These RHPs may be a more appropriate study population for future research. The 5A's framework and motivational interviewing can have a significant impact on NCDs in SA, further research is required to determine the long-term effects of such interventions.
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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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    A questionnaire for assessing breastfeeding intentions and practices in Nigeria: validity, reliability and translation
    (BioMed Central, 2017-06-07) Emmanuel, Andy; Clow, Sheila E
    Background: Validating a questionnaire/instrument (whether developed or adapted) before proceeding to the field for data collection is important. This article presents the modification of an Irish questionnaire for a Nigerian setting. The validation process and reliability testing of this questionnaire (which was used in assessing previous breastfeeding practices and breastfeeding intentions of pregnant women in English and Hausa languages) were also presented. Method: Five experts in the field of breastfeeding and infant feeding voluntarily and independently evaluated the instrument. The experts evaluated the various items of the questionnaire based on relevance, clarity, simplicity and ambiguity on a Likert scale of 4. The analysis was performed to determine the content validity index (CVI).Two language experts performed the translation and back-translation. Ten pregnant women completed questionnaires which were evaluated for internal consistency. Two other pregnant women completed the questionnaire twice at an interval of two weeks to test the reliability. SPSS version 21 was used to calculate the coefficient of reliability. Results: The content validity index was high (0.94 for relevance, clarity and ambiguity and 0.96 for simplicity). The analysis suggested that four of the seventy one items should be removed. Cronbach’s Alpha was 0.81, while the reliability coefficient was 0.76. The emerged validated questionnaire was translated from English to Hausa, then, back-translated into English and compared for accuracy. Conclusion: The final instrument is reliable and valid for data collection on breastfeeding in Nigeria among English and Hausa speakers. Therefore, the instrument is recommended for use in assessing breastfeeding intention and practices in Nigeria.
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    A randomised control trial for the restoration of functional ability in patients post total knee arthroplasty: Eccentric versus concentric cycling ergometry
    (2018) Silal, Sandhya Prakash; Albertus, Yumna; Tam, Nicholas; Posthumus, Michael
    Introduction: While the total knee arthroplasty procedure improves joint-specific outcomes, including pain and range of movement, functional deficits post-surgery has been noted. Movement abnormalities and quadriceps weakness of the operated limb, as well as a decrease in strength on the non-operated have been widely reported. Recovery of strength and function to normal levels is also rare, thereby predisposing patients to future disability with increasing age. The purpose of this study was to determine the effects of an eight-week eccentric cycling ergometry exercise intervention versus a concentric cycling ergometry exercise intervention in total knee arthroplasty recipients three to nine months post-surgery. This study aimed to a) investigate the change in joint kinetics, kinematics and muscle activity during the phases of gait, between the eccentric and concentric groups over time and b) To determine if an eccentric cycling exercise intervention produces greater improvements in knee function when compared to concentric cycling exercise. Methods: Eighteen participants, three to nine months post total knee arthroplasty were recruited and randomly assigned to either an eccentric or concentric cycling exercise intervention group. Participants performed three exercise sessions weekly over a progressive eight-week period on the Grucox Isokinetic Ergometer. Walking gait analyses and functional outcomes, as measured by the six-minute walk test and validated knee scores (Knee Injury and Osteoarthritis Outcome Score, SF-36 Health Survey and Tegner Activity Scale) were recorded pre- and post-intervention. Results: The concentric group knee flexion range of movement increased significantly during the swing phase of gait (p=0.021) post-intervention together with a significant increase in the peak knee flexion angle during swing (p=0.038). The concentric group showed significant differences between pre and post-rehabilitation in knee flexion range of movement during the swing phase of gait (p=0.030). Significant correlations between knee joint stiffness and the quadriceps:hamstring co-activation ratio were observed in the concentric intervention group pre-intervention: during the pre-activation phase of gait between knee joint stiffness and vastus medialis / biceps femoris (r=-0.68; p=0.042) and during load acceptance phase of gait between knee joint stiffness and vastus lateralis / biceps femoris (r=0.07; p=0.036). The eccentric group recorded neuromuscular changes post-intervention with a significant decrease in the muscle activity of the biceps femoris during load acceptance phase of gait (p=0.021). The eccentric group had significantly better functional outcomes in the overall score of Knee injury and Osteoarthritis Outcome post-intervention (p=0.008) with a significant increase in function seen in the Sports and Recreation subgroup (p=0.008) and a significant increase in the level of activity as measure by the Tegner Activity Scale post-intervention (p=0.028), despite not showing any significant changes in the knee joint kinetics and kinematics. The concentric group only reported a significant increase in the overall score of the of the SF-36 Health Survey (p=0.011) with significant increases in three of the subgroups post-intervention: Bodily pains had improved (p=0.042), the role limitations due to physical heath had improved (p=0.028) and the role limitations due to emotional health had also improved (p=0.009). The concentric group also showed significant improvement in the emotional health over the intervention in comparison to the eccentric intervention group (p=0.020). Both intervention groups reported a similar significant increase in the distance covered during the six-minute walk test post-intervention (p=0.038). Conclusion: The results of this exploratory study did not find the eccentric cycling rehabilitation intervention exclusively more effective than the concentric cycling intervention in the restoration of functional ability in patients post-TKA. The eccentric intervention did however result in neuromuscular adaptations consistent with a move towards a more typical asymptomatic gait pattern and participants reported greater functional improvements on validated knee functional assessments and levels of activity scores. The concentric intervention yielded kinematic changes and participants reported improvements in their emotional and physical health post-intervention. Eccentric training and its role in early stage post-operative rehabilitation is limited. Based on the findings from this exploratory study, the benefit of eccentric training as an adjunct to rehabilitation and its role in contributing to greater improvements in the restoration of functional ability post-TKA needs to be further explored.
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    A review of childhood vestibular disorders
    (2010) Rogers, Christine
    Diagnosis of disorders of balance is challenging, as there are broad differentials and patients may present to a variety of healthcare practitioners, ranging from an audiologist to a psychiatrist. In addition, investigations, both at the bedside and laboratory, are often non-contributory, expensive and unpleasant. The adult dizzy patient is regarded with dread by many in the healthcare community: the patient is difficult to diagnose and challenging to treat, and the situation is frequently complicated by the presence of anxiety, panic and depression. When symptoms arise in childhood they cause alarm in the parents and the treating healthcare professional. Diagnosis and management of balance disorders in childhood, is even more demanding when patients are frequently unable to communicate the nature of the complaint. Furthermore, the aetiology and presentation of vestibular disturbance is markedly different between adults and children. Symptoms of vestibular disorders in children may easily be mistaken for behavioural or other medical problems, leading to under-diagnosis and inappropriate investigations and treatment. Detrimental effects of childhood vestibular disorders may include delayed gross motor development, learning and spatial problems, and time off school. This review summarises the most common causes of childhood vestibular disorders and suggests the need for a multidisciplinary approach to assessment.
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    A study of the collaborative process of volunteers in a literacy intervention programme in support of vulnerable children in South Africa
    (2019) Zoetmulder, Amy; Kathard, Harsha; Pillay, Mershen
    The development of early literacy skills is critical for all children in South Africa. Children receive language and literacy development support in the home, school, and community environments. Vulnerable children, such as orphans, may receive this support from volunteers in their home environments. Additional language development support systems in the form of programmes run by volunteers are important. This study describes and analyses the process of collaboration between six volunteers who are involved in languageliteracy programmes by examining how volunteers negotiate collaboration in promoting literacy development. This qualitative research study used a participatory action cycle design to investigate collaboration. A range of research methods such as focus groups, interviews, reflections and observations were used. Findings from this study provided insight into the identity of volunteers. They were people who had strong values in respect of literacy, a positive experience of volunteering, a sense of civic responsibility and an empathetic personality. The collaborative process was established through the presence of a strong common cause, vulnerability and trust among volunteers, a structured and well-led action cycle process, the development of self-reflection, and a passion to be change agents. Volunteers were able to problem solve and act to make changes to the intervention programme which included actions at a programme and volunteer level. The speechlanguage therapist (SLT’s) role was critical in a literacy-related intervention as a support for volunteers. The expertise of SLTs, namely knowledge in language and literacy development, was valued in streamlining the process of taking appropriate actions to enrich the literacy programme.
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    A systematic review protocol on the effectiveness of therapeutic exercises utilised by physiotherapists to improve function in patients with burns
    (BioMed Central, 2017-10-23) Mudawarima, Tapfuma; Chiwaridzo, Matthew; Jelsma, Jennifer; Grimmer, Karen; Muchemwa, Faith C
    Background: Therapeutic exercises play a crucial role in the management of burn injuries. The broad objective of this review is to systematically evaluate the effectiveness, safety and applicability to low-income countries of therapeutic exercises utilised by physiotherapists to improve function in patients with burns. Population = adults and children/adolescents with burns of any aspect of their bodies. Interventions = any aerobic and/or strength exercises delivered as part of a rehabilitation programme by anyone (e.g. physiotherapists, occupational therapists, nurses, doctors, community workers and patients themselves). Comparators = any comparator. Outcomes = any measure of outcome (e.g. quality of life, pain, muscle strength, range of movement, fear or quality of movement). Settings = any setting in any country. Methods/design: A systematic review will be conducted by two blinded independent reviewers who will search articles on PubMed, CiNAHL, Cochrane library, Medline, Pedro, OTseeker, EMBASE, PsychINFO and EBSCOhost using predefined criteria. Studies of human participants of any age suffering from burns will be eligible, and there will be no restrictions on total body surface area. Only randomised controlled trials will be considered for this review, and the methodological quality of studies meeting the selection criteria will be evaluated using the Cochrane Collaboration tool for assessing risk of bias. The PRISMA reporting standards will be used to write the review. A narrative analysis of the findings will be done, but if pooling is possible, meta-analysis will be considered. Discussion: Burns may have a long-lasting impact on both psychological and physical functioning and thus it is important to identify and evaluate the effects of current and past aerobic and strength exercises on patients with burns. By identifying the characteristics of effective exercise programmes, guidelines can be suggested for developing intervention programmes aimed at improving the function of patients with burns. The safety and precautions of exercise regimes and the optimal frequency, duration, time and intensity will also be examined to inform further intervention. Systematic review registration. PROSPERO CDR42016048370.
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    Accuracy of prediction of edurance running performance : relationship to training history, muscle pain and relative perception of effort
    (2014) Nunes, Dawn; Burgess, Theresa; Lambert, Mike
    Background: Endurance running performance is a complex interaction between training factors, exercise-induced muscle damage, and fatigue. The accuracy of prediction of running performance allows for the consideration of the effects of teleoanticipatory factors such as pacing and prior experience on performance. However, previous studies have not adequately considered the role of predicting performance outcomes before competition, and the potential influence of self-regulated pacing and prior experience on running performance. Aim: The aim of this descriptive analytical correlational study was to determine potential factors associated with the accuracy of prediction of running performance during a marathon race. Specific objectives: (a) To determine whether there were differences in training history, pacing, muscle pain and the relative perception of effort (RPE) in three identified groups that accurately predicted race time, performed faster than the predicted time, or performed slower than the predicted time; and (b) to determine if demographic characteristics, training and competition history, self-identified pacing strategy, muscle pain and the relative perception of effort (RPE) were associated with the accuracy of predicting performance during the marathon. Methods: Sixty-three healthy male and female runners were recruited through a short message service (SMS), word of mouth and at the 2013 Mandela Day marathon registration. Participants were included if they were over the age of 20 years, and were taking part in the marathon race. Participants were required to complete the marathon within the seven-hour cut-off time. Participants who had any lower limb musculoskeletal injury, medical condition or surgical intervention that prevented training for seven consecutive days in the three-month period prior to the race were excluded from the study. Participants who reported any flu-like symptoms during the two weeks preceding the race were also excluded from the study. In addition, participants with any missing race RPE or pain scores were excluded. Participants were allocated to one of three groups depending on their accuracy in predicting their final race time. A margin of two percentage points was considered as a meaningful difference in time. If the participants’ actual race time was accurate within two percentage points of their predicted race time, it was considered accurate, and those participants formed the accurate group (n = 16). Participants on either side of the two percentage points formed the fast (n = 21) and slow (n = 26) groups respectively. All participants completed an informed consent form and a medical and training questionnaire at a familiarisation session before to the race. Participants were also familiarised with the tests and procedures for collecting data during the race. During the marathon, muscle pain and relative perception of effort (RPE) were recorded at 0 km, 10 km, 21.1 km, 30 km, and 42.2 km. A short compliance questionnaire was completed when participants finished the marathon. Official race times were obtained from the Championchip® website. Muscle pain was recorded for seven days after the marathon. Participants were also asked to report when they resumed running training after the race. Results Participants in the slow group were significantly younger (p < 0.05), had faster 10 km PB times (p < 0.01), and trained at a faster pace (p < 0.01) compared to participants in the accurate and fast groups. Participants in the slow group had faster actual (p < 0.05) and predicted (p < 0.01) marathon times (p < 0.01) compared to participants in the accurate and fast groups. There was a significant positive relationship between actual and predicted marathon times (r = 0.71, p < 0.01). There were no significant differences between groups in muscle pain and RPE during the race; however there were significant main effects of time for pain (p < 0.01) and RPE (p < 0.01) during the race. Muscle pain and RPE were significantly increased at 21 km, 30 km, and 42.2 km, compared to pre-race values. There were no significant differences in post-race pain between groups, but there was a significant main effect of time (p < 0.01) as muscle pain was significantly elevated for three days after the race. This study was also unable to identify any significant demographic, training and competition history, or race factors associated with the accuracy of prediction of marathon performance. Conclusion: Linear increases in muscle pain and RPE were observed during the race in all groups. This study was unable to identify specific factors associated with the accuracy of prediction of running performance during a marathon race. However, it is possible that the slow marathon times and the low relative exercise intensity in all groups may have limited the effects of muscle pain and RPE on self-regulated pacing and performance. Future studies should have more stringent inclusion criteria to ensure runners are competing at moderate to high relative exercise intensities. In addition, future studies should carefully consider route profiles to ensure that the race profile does not potentially confound the accuracy of prediction of performance by limiting actual marathon times.
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    Adaptation of the abuse assessment screening tool for midwives in northern Nigeria
    (2019) Musa-Maliki, Ayishetu Uduoye; Duma, Sinegugu
    The term „intimate partner violence‟ (IPV) is employed in this study to denote the physical, sexual, economic, and psychological or other harm directed against a pregnant woman by her partner or spouse. It affects both pregnant women and their unborn children, as both may suffer serious health consequences. The purpose of this study is to investigate midwives‟ current screening practice for IPV among pregnant women in a northern Nigerian hospital and to adapt the Abuse Assessment Screen (AAS) tool to aid midwives‟ screening practice. Qualitative data were collected from midwives in the antenatal clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, in four phases using a panel longitudinal design as a guide. In the first phase non-participant observation and individual face-to-face semistructured interviews were conducted with ten participants using an interview guide. In phase two non-participant observation of the same participants took place as pregnant women were screened with the original AAS tool for two months, then a focus group discussion was conducted in phase three. Thematic data analysis was carried out in all phases using Yin‟s five stages of analytical cycle and also guided by the conceptual framework of Wile‟s human technology model. In phase four the original AAS tool was modified based on the findings of phases two and three. Five themes emerged in phase one and four in phase three after triangulation of data from phase two. It was found that routine screening for IPV is not practiced by midwives in the research setting as a result of various factors, some internal and others external to them. The midwives also faced several challenges that discourage screening of pregnant women for IPV. Their suggested solutions to these challenges were also incorporated into a modified version of the original AAS tool after analysing the data. Thereafter the modified tool was given to the same participants to use and to confirm its suitability for IPV screening in phase four, and a theme emerged. With adequate education and training the internal factors hindering midwives‟ screening practice can be eliminated, while the external factors will need the intervention of hospital authorities to eliminate or mitigate their effects on screening.
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    Adolescents' experiences of care during childbirth in health facilities in rural Northern Uganda: a mixed-methods study
    (2025) Udho, Samson; Clow, Sheila
    Background: Despite the importance of care experience during childbirth, there is a dearth of literature on adolescents' experiences of care during childbirth and how their experiences influence their satisfaction with care and future utilization of healthcare facilities. This study examined adolescents' perceptions of PCMC during childbirth in health facilities in rural northern Uganda and how their perceptions influenced their satisfaction with care and future childbearing intentions (intentions to give birth, give birth in the same facility, and recommend the same facility to a sister or friend), and explored the drivers of adolescents' experiences of care during childbirth. Methods: A mixed-methods study was conducted among 570 adolescents aged 14 to 19 years who gave birth in public health facilities in northern Uganda. Adolescents' perceptions of PCMC were measured using the PCMC tool, satisfaction with care was measured using the Six Simple Questions tool, and future childbearing intention was measured using questions from the Community Survey tool. Qualitative data was collected from 14 purposively sampled participants using in-depth interviews. Quantitative data were analysed using descriptive and regression analyses, while qualitative data were analysed thematically and integrated with quantitative data. Results: The PCMC percentage mean score out of 100% was 62% (SD ± 10.12), and percentage mean scores for sub-scales of dignity and respect was 60% (SD ± 12.05), 59% (SD ± 17.12) for communication and autonomy, and 63% (SD ± 9.92) for supportive care. Adolescents' perceptions of moderate/high PCMC during childbirth were positively associated with being married (AOR = 2.61, 95% CI: [1.01, 6.76]), doing casual labour (AOR = 3.18, 95% CI: [1.52, 6.68]), and having an episiotomy (AOR = 1.88, 95% CI: [1.05, 3.36]). Conversely, five to seven antenatal visits (AOR = 0.52, 95% CI: [0.33, 0.83]), birth companionship (AOR = 0.34, 95% CI: [0.19, 0.60]) and having a newborn with complications (AOR = 0.25, 95% CI: [0.09,0.68]) were negatively associated. The mean satisfaction with the care score was 30.12/42 (SD ± 4.10). Adolescents perceived moderate and high levels of PCMC during childbirth were positively associated with satisfaction with care (β = 4.01, 95% CI [3.14, 4.88], p < 0.001and β = 4.38, 95% CI [2.91, 5.86], p < 0.001 respectively). Most adolescents expressed intentions to have another child (82%), return to the same facility for future childbirth (83%), and recommend the same facility to a sister or friend (85%). Adolescents perceived moderate and high levels of PCMC during childbirth were positively associated with intentions to choose the same facility for the next childbirth (AOR=2.84, 95% CI [1.61, 5.00] and AOR=5.60, 95% CI [1.19, 26.43] respectively) and recommend the facility to a sister or friend (AOR=4.31, 95% CI [2.46, 7.54]). Adolescents had mixed experiences during childbirth, ranging from positive experiences of effective communication, dignity and respect, supportive care, and health facility hygiene to negative experiences of disrespect and abuse, and health facility constraints. Negative experiences were associated with lack of birthing necessities, younger age, and perceived low social status while positive experiences were driven by passive compliance, calm demeanor, relational skills, possession of birthing necessities, cleanliness, and smartness. Conclusion: Adolescents' varied experiences of care during childbirth, influenced by various individual-level factors, resulted in perceptions of moderate PCMC during childbirth. PCMC has the potential to enhance childbirth experience for adolescent mothers, as well as influence their satisfaction with care and future childbearing intentions.