The meanings of sustainable community wellness in Grabouw : exploring intersections of sustainability and wellness from a complexity thinking perspective

Van Den Berg, Wessel Jan (2012-03)

Thesis (MPhil)--Stellenbosch University, 2012.

Thesis

ENGLISH ABSTRACT: An exploration of the integrated nature of sustainable development planning and health care was done in the context of people living and working in the town of Grabouw in the Western Cape. The problem that was investigated was that people working within local government and community health networks treated sustainable development planning and health care as separate issues. The notion of wellness, as different from health, was used as a central theme in the study. It allowed for an acknowledgement of the multidimensionality and contextual nature of human well-being. The notion of sustainable community wellness was used to guide the research, and was viewed as a complex phenomenon. The meanings of sustainable community wellness to people who work and live within local government and community health networks in Grabouw were observed and documented. Complexity theory was then used to discuss the observed perspectives on sustainable community wellness. Two factors informed the selection of Grabouw as a research site: Firstly, a comprehensive sustainable development programme was being carried out in the town of Grabouw during the research. Secondly, a few community health care initiatives were also being implemented at the time. Community care workers who worked in one of the community health organisations participated as primary research participants. The research combined conceptual and empirical research. The conceptual research consisted of a literature review of perspectives on wellness in Grabouw. The empirical research methods that were used combined ethnography in the form of participant observation, and participatory action research in the form of participatory photography. The researcher accompanied community care workers on their daily visits to patients. The care workers took photographs of aspects of their surroundings that represented sustainable community wellness, or the lack thereof, to them. Photographs were analysed through focus group discussions and pertinent themes were subsequently identified. Three meanings of sustainable community wellness were discovered. The first was the structural, governmental meaning that gave importance to health and socio-economic statistics, based on the mortality profile of the area. Wellness was seen from this perspective as a challenge that could be met with strategic planning. The second meaning was the community-based experience of environmental factors in Grabouw that had an impact on wellness, such as water, community forums and living spaces. In this case, wellness was experienced as a rich and diverse set of factors, both social and environmental. The third meaning was observed as instances where the apparent separate entities of local government, the community, and the physical environment were seen as one socio-ecological system, of which sustainable community wellness was an emergent property. These instances demonstrated the importance of managing the quality of relationships within the system, the need to enhance the autonomy of people working in the system and the potential of community care workers to be agents of sustainable community wellness.

AFRIKAANSE OPSOMMING: Ondersoek is gedoen na die geïntegreerde aard van volhoubare ontwikkelingsbeplanning en gesondheidsorg in die konteks van mense wat in die dorp Grabouw in die Wes-Kaap woon en werk. Die probleem wat ondersoek is, is dat mense wat in plaaslike regerings- en gemeenskapsgesondsheidnetwerke werk, volhoubare ontwikkelingsbeplanning en gesondheidsorg as afsonderlike sake beskou. Die begrip ‘welstand’, wat in betekenis van ‘gesondheid’ verskil, is as 'n sentrale tema in die studie gebruik, en is soortgelyk aan die begrip ‘welwees’. Dit het erkenning verleen aan die meerdimensionele en kontekstuele aard van menslike welwees. Die begrip volhoubare gemeenskapswelstand wat as 'n komplekse verskynsel beskou is, het die ondersoek gerig. Die betekenis van volhoubare gemeenskaps-welstand vir mense wat in plaaslike regerings- en gemeenskapsgesondheidnetwerke in Grabouw woon en werk, is waargeneem en gedokumenteer. Kompleksiteitsteorie is voorts gebruik om die waargenome perspektiewe op die volhoubare gemeenskaps-welstand te bespreek. Twee faktore het die besluit om Grabouw as 'n navorsingsgebied te gebruik, beïnvloed: Eerstens was daar tydens die navorsingstydperk reeds 'n omvattende volhoubare ontwikkeling program in Grabouw aan die gang. Tweedens was 'n paar gemeenskapsgesondheidsorg-inisiatiewe ook in dié tydperk aktief. Gemeenskapgesondheidswerkers wat in een van die gemeenskapsgesondheidsorganisasies gewerk het, was primêre deelnemers aan die navorsing. In hierdie ondersoek is konseptuele en empiriese navorsing gekombineer. Die konseptuele navorsing het uit 'n literatuuroorsig van perspektiewe op welwees in Grabouw bestaan. Die empiriese navorsingsmetodes wat gebruik is, het etnografie in die vorm van deelnemende waarneming, asook deelnemende-aksie-navorsing in die vorm van deelnemende fotografie, behels. Die navorser het gemeenskapsgesondheidswerkers op hul daaglikse besoeke aan pasiënte vergesel. Hierdie werkers het foto's geneem van die aspekte van hul omgewing wat na hulle mening die volhoubare gemeenskaps-welstand, of die gebrek daaraan, verteenwoordig. Foto's is tydens fokusgroepbesprekings ontleed en relevante temas is daardeur geïdentifiseer. Drie betekenisse van die volhoubare gemeenskaps-welstand het tydens die ondersoek na vore gekom. Die eerste is die strukturele, regeringsverwante betekenis wat bestaan het uit gesondheidsen sosio-ekonomiese statistiek, gebaseer op die sterftesyferprofiel van die gebied. Welstand is vanuit hierdie perspektief gesien as 'n uitdaging wat deur middel van strategiese beplanning aangepak kon word. Die tweede betekenis is die gemeenskapsgebaseerde ervaring van omgewingsfaktore wat 'n uitwerking op welstand het, soos water, gemeenskapsforums en leefareas in Grabouw. Welstand is in hierdie geval ervaar as bestaande uit 'n reeks ryke en diverse faktore wat beide sosiaal en omgewingsverwant is. Die derde betekenis is waargeneem deur die identifisering van die gevalle wat die kompleksiteit van die stelsel wat bestudeer is, verteenwoordig het. In hierdie gevalle is die oënskynlike aparte entiteite van plaaslike regering, die gemeenskap, en die fisiese omgewing gesien as 'n sosio-ekologiese sisteem waarvan volhoubare gemeenskaps-welstand 'n ontluikende element is. Deur hierdie gevalle is daar aangetoon dat dit belangrik is om die gehalte van die verhoudings binne die stelsel te bestuur en om die outonomie van die mense wat binne die stelsel werk te ondersteun. Ten slotte is die potensiaal van gemeenskapsgesondheidswerkers om as agente van die volhoubare gemeenskaps-welstand op te tree, uitgelig.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/19927
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