Browsing by Subject "Community"

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    Exploring the role of context in emerging adults' experiences of occupational possibilities and occupational choice in a community in the Western Cape: a narrative inquiry
    (2025) Wicht, Minkateko; Sonday, Amshuda; Crawford-Browne, Sarah
    Introduction: Occupational therapists recognise that health and wellbeing are inextricably linked to people's occupations. Many emerging adults within the Western Cape, South Africa, are experiencing numerous social, economic, and educational challenges which may constrain their occupational engagement and negatively influence their transition into adulthood. Understanding how contexts shape the occupational possibilities and occupational choice of emerging adults will allow occupational therapists, who work with emerging adults in constraining contexts, to better support their transition into adulthood, promote meaningful and purposeful occupational engagement and ultimately enable health and wellbeing. Research Aim: The aim of this study was to explore how living in a community within Bredasdorp, Western Cape, shapes the experience of occupational possibilities and occupational choice of emerging adults aged between 18 and 25 years. Research Design: This qualitative study was informed by the social constructivist/interpretivist paradigm and used a narrative inquiry design. It utilized a transactional perspective of occupation and Laliberte-Rudman's theory of occupational possibilities and Galvaan's theory of occupational choice as the guiding theoretical frameworks. Five participants were recruited, through purposive sampling methods, with the assistance of a community-based organisation. Photovoice methods were used to generate visual data for interviews. Narrative data was then generated through two in-depth unstructured narrative interviews per participant. Data Analysis: Data was analysed using both analyses of narratives and narrative analyses methods and included three levels of analysis, namely, narrative story writing; coding, editing and member-checking of narrative stories; and individual case analysis and cross-case analysis. Findings: One overarching theme emerged from the analysis which showed that occupational possibilities and occupational choice were not dependent on either individual agency or contexts but rather resulted from an interplay between the two. Conclusion: The participants' contexts played an integral role in shaping their occupational possibilities and occupational choices and influenced their health and wellbeing by supporting or constraining a range of available choices, resources, opportunities and possibilities. This study also found that there was a transactional relationship between occupational possibilities and occupational choice. Lastly, there was some fit between the theory of emerging adulthood and the participants' experiences within their contexts.
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    Open Access
    Fidelity of HIV programme implementation by community health workers in rural Mopani district, South Africa: a community survey
    (BioMed Central, 2018-09-06) Naidoo, Nireshni; Railton, Jean P; Khosa, Sellina N; Matlakala, Nthabiseng; Marincowitz, Gert; McIntyre, James A; Struthers, Helen E; Igumbor, Jude; Peters, Remco P H
    Background South Africa has implemented a community health programme delivered by community health workers (CHWs) to strengthen primary healthcare services. Provision of community Human Immunodeficiency Virus (HIV) services constitutes an important component of this programme. To support effectiveness, we assessed fidelity of HIV programme implementation by CHWs from the community’s perspective in a rural South African setting. Methods A cross-sectional study was conducted targeting 900 randomly selected households in twelve wards of two sub-districts (Greater Giyani and Greater Letaba) of Mopani District (Limpopo Province, South Africa). Questionnaires were administered to the traditionally most appropriate adult member of the household. Included were questions related to the four standard components to measure implementation fidelity against local guidelines: coverage, frequency, duration and content of HIV programme implementation. Results Participants were enrolled at 534 households; in most other cases there was nobody or no adult member at home (n = 291). Reported coverage of 55% (141/253) and a frequency of 47% (66/140) were higher in Greater Giyani as compared to Greater Letaba (44%; 122/278 and 29%; 33/112, respectively, p = 0.007 for both comparisons). Coverage was not associated with the distance from the participant’s household to the facility (p = 0.93). Duration of programme delivery was reported to be high, where all CHW visits (253/253; 100%) were conducted within the last 6 months and the content delivered was adequate (242/253; 96%). Individuals reporting a CHW visit were more likely to know their HIV status than those not visited (OR = 2.0; 95% CI 1.06–3.8; p = 0.032). Among those visited by the CHW discussion of HIV was associated with knowing the HIV status (OR = 2.2; 95% CI 1.02–4.6; p = 0.044); in particular for women (OR = 2.9; 95% CI 1.5–5.4; p = 0.001). Conclusions This study demonstrates promising HIV programme implementation fidelity by CHWs in rural South Africa. Programme coverage and frequency should be improved whilst maintaining the good levels of duration and content. Resource investment, strengthening of operational structure, and research to identify other facilitators of programme implementation are warranted to improve programme effectiveness and impact.
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    Living heritage in the historic urban landscape: a case study of the Grand Parade Market
    (2020) Wilson, Wendy M; Roux, Naomi
    This study examines the long-established bi-weekly market held on Cape Town's Grand Parade to see if it constitutes living heritage. If it does, how is it connected with the urban landscape it inhabits, and how might it be acknowledged or safeguarded? Heritage practice in South Africa has long focused on the fabric of the historic built environment (not on the people using it or the uses to which it is put) with conservation methods tailored to that end. The importance of living heritage—or intangible cultural heritage—is increasingly accepted, particularly as a form of redress for the imbalance caused by the prioritisation of coloniser history. There is a growing sense of urgency, driven by those whose living heritage has been overlooked or ignored, to address this. In this study, I combine on-the-ground analysis of today's Wednesday/Saturday market drawn from interviews with traders, with a deep reading of various official and academic archives. This is interpreted through the most recent theoretical thinking regarding living heritage, together with the international charters, national laws and local policies that apply to the real world of Cape Town today. I determine that the market is, indeed, living heritage, and that it is important to recognise it is such. I argue that the heritage binary of intangible and tangible represents a false dichotomy, and that it is essential to consider heritage as a whole, with living heritage being indivisible from the urban landscape in which it exists. However, I identify the potential pitfalls that formal protection might bring to a living, dynamic system, and find that the significance values of tangible and living heritage require different actions to conserve and safeguard them. I show how, while the will to identify and acknowledge South Africa's living heritage has been expressed at the highest policy levels, the ensuing legislation, implementation policies and working practices of heritage practitioners are insufficient to deliver on this. I suggest that, to reflect this better in our management of heritage resources, a more trans-disciplinary approach is needed, one with processes and methodologies that accommodate diversity in the interpretation of cultural value and emphasise stakeholder involvement.
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    Prolonged health worker strikes in Kenya- perspectives and experiences of frontline health managers and local communities in Kilifi County
    (2020-02-10) Waithaka, Dennis; Kagwanja, Nancy; Nzinga, Jacinta; Tsofa, Benjamin; Leli, Hassan; Mataza, Christine; Nyaguara, Amek; Bejon, Philip; Gilson, Lucy; Barasa, Edwine; Molyneux, Sassy
    Abstract Background While health worker strikes are experienced globally, the effects can be worst in countries with infrastructural and resource challenges, weak institutional arrangements, underdeveloped organizational ethics codes, and unaffordable alternative options for the poor. In Kenya, there have been a series of public health worker strikes in the post devolution period. We explored the perceptions and experiences of frontline health managers and community members of the 2017 prolonged health workers’ strikes. Methods We employed an embedded research approach in one county in the Kenyan Coast. We collected in-depth qualitative data through informal observations, reflective meetings, individual and group interviews and document reviews (n = 5), and analysed the data using a thematic approach. Individual interviews were held with frontline health managers (n = 26), and group interviews with community representatives (4 health facility committee member groups, and 4 broader community representative groups). Interviews were held during and immediately after the nurses’ strike. Findings In the face of major health facility and service closures and disruptions, frontline health managers enacted a range of strategies to keep key services open, but many strategies were piecemeal, inconsistent and difficult to sustain. Interviewees reported huge negative health and financial strike impacts on local communities, and especially the poor. There is limited evidence of improved health system preparedness to cope with any future strikes. Conclusion Strikes cannot be seen in isolation of the prevailing policy and health systems context. The 2017 prolonged strikes highlight the underlying and longer-term frustration amongst public sector health workers in Kenya. The health system exhibited properties of complex adaptive systems that are interdependent and interactive. Reactive responses within the public system and the use of private healthcare led to limited continued activity through the strike, but were not sufficient to confer resilience to the shock of the prolonged strikes. To minimise the negative effects of strikes when they occur, careful monitoring and advanced planning is needed. Planning should aim to ensure that emergency and other essential services are maintained, threats between staff are minimized, health worker demands are reasonable, and that governments respect and honor agreements.