Doctoral Degrees (Psychology)

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https://scholar.sun.ac.za/handle/10019.1/664

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Browsing Doctoral Degrees (Psychology) by browse.metadata.advisor "Coetzee, Bronwyne"

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    Breast cancer stories : exploring the multimodal narratives of twelve South African women with recurrent disease
    (Stellenbosch : Stellenbosch University., 2020-03) Smit, Anri; Coetzee, Bronwyne; Roomaney, Rizwana; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: Breast cancer is a major global health burden. While advances in the detection and treatment of breast cancer have improved survival rates, a considerable proportion of women with breast cancer will experience disease recurrence. With more research emphasis directed at understanding the experiences of breast cancer survivors, less is known about women’s experiences of recurrent disease. In this dissertation, I explore the breast cancer stories of 12 South African women with recurrent disease. I present and discuss the participants’ stories, as gathered across multimodal narrative data (i.e., narrative interviews, diaries and body maps), including meanings they attached to their experiences. I conducted a thematic analysis across all narrative data to understand the content of participants’ stories. Thereafter, by using the interpretive framework of Frank’s (1995) narrative types (restitution, chaos, and quest), I undertook a narrative analysis in order to examine the structure of the stories. I then synthesized the thematic and narrative analyses to identify patterns of responses across the narrative types. Three narrative types emerged: four participants described their experience of recurrence as a temporary situation, which would soon end if the necessary treatments were adhered to. These stories followed the restitution plot and maintained a linear order characteristic of this narrative type. For another participant, her cancer recurrence seemed to have caused a great deal of anxiety, which manifested in a fragmented account; lacking narrative order. I interpreted her story as a chaos narrative. The seven remaining participants described their recurrent disease as an opportunity for self-discovery, personal growth, and for helping other women with breast cancer. These stories followed the quest narrative, though, at times, contained elements of the other narrative types. Although the findings corroborate Frank’s (1995) narrative types, the stories of recurrence seemed to be more complex than conventional, episodic, illness stories. Overall, I understood participants’ meanings of recurrence to be shaped by their responses to illness (illness appraisal and coping) and tied to their identities in relation to the illness. In some stories, participants’ illness appraisals and coping strategies moved beyond Frank’s (1995) original formulation, and in a few, changes in identity seemed to transpire into changes in narrative type. I reflect on the value of a multimodal narrative methodology and the triangulation of multiple data sets in order to arrive at a complex and nuanced understanding of breast cancer stories. I discuss the findings of my study in relation to both the broader literature and Frank’s (1995) narrative types, after which I offer directions for future research investigating breast cancer stories.
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    Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2020-12) Laurenzi, Christina; Tomlinson, Mark; Coetzee, Bronwyne; Skeen, Sarah; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT:Community health worker (CHW) programmes are regarded as important solutions for improving health care services and outcomes for mothers and children globally. In low- and middle-income countries (LMICs), CHWs may be able to bridge widening gaps between limited human resource capacity and population health needs. However, despite the expansion of CHW programmes, we lack evidence for their effectiveness at scale. Even well-researched evidence-based programmes, when broughtto scale, tend to lose some of their effectiveness. Implementation science methods have emerged as one way to investigate why programmes succeed or fail, by providing researchers with frameworks to examine processes related to delivery, quality, and context. In this dissertation, I explore the processes underpinning the delivery of a CHWprogramme in rural South Africa. This study addressed four related research questions, focused on CHW fidelity to training, client responses to and engagement with the programme, and contextual aspects that affect the programme’s delivery. I utilised a combination of data sources, including transcripts from audio recordings of CHW home visits (n=84), interviews with clients of the programme (n=26), and interviews with CHWs themselves (n=10). The findings of this study identify programmatic strengths, with high levels of fidelity to training in communication skills; instructive and mutually supportive relationships between CHWs and their clients; and dedicated CHWs who regularly prioritise their clients’ needs. These findings also echo persistent challenges in programme implementation, including occupational burdens and pressures for CHWs, and barriers for clients in linking to health care within an under-functioning health system. This dissertation points to the importance of continued training, client and community consultation, and identification of contextual challenges to make programme implementation more effective before they are able to be scaled. It also emphasises the need to adopt a human-centred approach to designing and implementing CHW programmes, shifting away from a technical, vertical mode of providing much-needed services.
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    Social representations of the burning of Boys Secondary Schools in Kenya in 2016
    (Stellenbosch : Stellenbosch University., 2020-03) Oburu, Hildah Bochere; Swartz, Leslie; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: School arson, predominantly the burning of dormitories in boarding secondary schools in Kenya, is a recurrent problem. In 2016, the school fires crisis seemed to reach a new height. A total of 239 schools experienced arson. Most of these schools were boys’ secondary schools. Discussions on school fires are often carried out in the print media, and the fires have been a subject of four government taskforce investigations, with little or no effect on the recurrence. Most of what is written about school fires in Kenya, through government reports, print media, and (for the 2016 school fires) social media, is based on the views of people outside the school system and whose views are not based on lived experiences. Using social representations theory, the aim of this exploratory, inductive study was to explore understandings of school arson in government reports, print and social media, and also by investigating the views of insiders to the school system (students, parents and teachers). A library search was used to source documents (government reports and newspaper articles) and simple search and real-time tracking for social media posts. Extreme case sampling was used to select four boys’ schools and purposive sampling to select focus group participants (32 teachers, 32 students and 32 parents) from the four schools. A thematic analysis of secondary data and focus group discussions revealed that school arson is a complex phenomenon with multiple understandings and that, so far, the discourse had been dominated by the ‘outsider’ views. However, the discourse across data sets extended beyond the specifics of school arson and revealed an overarching underlying concern: the loss of African culture due to Western influences and international conventions that clash with the reality of the cultural context, and a quest for a constructed authentic Kenyan identity in the postcolonial context. I discuss the implications of these understandings both for further work on school fires and for broader considerations regarding the future of education in Kenya.