Browsing by Author "Stewart, Jackie"

Now showing 1 - 8 of 8
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    Caregiver experiences of public services following child trauma exposure : a qualitative study
    (BioMed Central, 2018-04-10) Williamson, Victoria; Halligan, Sarah L.; Coetzee, Bronwyne; Butler, Ian; Tomlinson, Mark; Skeen, Sarah; Stewart, Jackie
    Background: Many children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential influence on parent–child reactions and coping post-trauma. Little is known about how caregivers perceive these interactions. Methods: The aim of this study was to explore caregivers’ experiences of accessing and interacting with public services post-trauma and perceptions of needed improvements to public services in a LMIC context. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in South Africa after child trauma exposure. Results: Three themes and seven sub-themes were identified regarding caregivers’ perceptions of interactions with public services post-trauma. The key themes identified related to (1) communication and exchanges with law enforcement, (2) consequences of an under-resourced justice system and (3) importance of communication and empathy in the healthcare system. Interactions with police were often positive. However, caregivers explained that police-family communication post-trauma could be improved and may help to lessen caregiver anxiety and concerns for the child’s safety post-trauma. Caregivers perceived the judicial system to be under-resourced as contact with the judicial system was often protracted and caused child anxiety and distress. Medical treatment was reportedly rushed, with extensive waiting times and little information provided to caregivers regarding the child’s injuries or treatment. Some medical staff were perceived as unsympathetic during the child’s treatment which was found to exacerbate caregiver and child distress post-trauma. Conclusions: This study provides insight into caregiver experiences of accessing public services following child trauma exposure in a high-risk LMIC context. Public services were perceived as oversubscribed and under-resourced and negative interactions often influenced caregiver responses and appraisals of child safety. Given the impact of poor interactions with public services on families post-trauma, additional research is needed to investigate feasible improvements to public services in LMIC.
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    Community context and individual factors associated with arrests among young men in a South African township
    (Public Library of Science, 2019) Christodoulou, Joan; Stokes, Lynissa R.; Bantjes, Jason; Tomlinson, Mark; Stewart, Jackie; Rabie, Stephan; Gordon, Sarah; Mayekiso, Andile; Rotheram-Borus, Mary Jane
    Background: In high-income countries, individual- and community-level factors are associated with increased contact with the criminal justice system. However, little is known about how these factors contribute to the risk of arrest in South Africa, which has one of the highest rates of arrests globally. We examine both individual- and community-level factors associated with arrests among young men living in the townships of Cape Town. Methods: Data were collected from a stratified community sample of 906 young men aged 18–29 years old living in 18 township neighborhoods. Communities with high and low rates of arrest were identified. Logistic regression models were used to assess which individual-level (such as substance use and mental health status) and community-level (such as infrastructure and presence of bars and gangs) factors predict arrests. Results: Significant predictors of arrests were substance use, gang activity, being older, more stressed, and less educated. Living in communities with better infrastructure and in more recently established communities populated by recent immigrants was associated with having a history of arrests. Conclusions: When considering both individual- and community-level factors, substance use and gang violence are the strongest predictors of arrests among young men in South Africa. Unexpectedly, communities with better infrastructure have higher arrest rates. Community programs are needed to combat substance use and gang activity as a pathway out of risk among South African young men.
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    Post-trauma coping in the context of significant adversity : a qualitative study of young people living in an urban township in South Africa
    (BMJ Publishing Group, 2017-10) Hiller, Rachel M.; Halligan, Sarah L.; Tomlinson, Mark; Stewart, Jackie; Skeen, Sarah; Christie, Hope
    Objective Compared with knowledge of the post-trauma needs of young people living in developed countries, little is known about the needs of those in low-middle-income countries. Such information is crucial, particularly as young people in these environments can be at increased risk of experiencing trauma, coupled with less available resources for formal support. The aim of this study was to explore post-trauma coping and support-seeking of young people living in a high-adversity settlement in South Africa. Design Semistructured qualitative interviews analysed using thematic analysis. Setting An urban settlement (‘township’) in Cape Town, South Africa. Participants 25 young people, aged 13–17 years, who had experienced trauma. Events included serious car accidents, hearing of a friend’s violent death, and rape, and all reported having experienced multiple traumatic events. All participants identified as black South African and spoke Xhosa as their first language. Results Social support was considered key to coping after trauma, although the focus of the support differed depending on the source. Parents would most commonly provide practical support, particularly around safety. Peers often provided an avenue to discuss the event and young person’s emotional well-being more openly. Outside of social support another key theme was that there were numerous community-level barriers to participants receiving support following trauma. Many young people continued to be exposed to the perpetrator of the event, while there was also the realistic concern around future traumas and safety, community stigma and a perceived lack of justice. Conclusion This study provides insight into how young people cope and seek support following trauma when they are living in a context of significant adversity and risk. Overall, most young people identified helpful sources of support and thought talking about the event was a useful strategy, but concerns around safety and trust could impede this process.
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    Posttraumatic stress symptoms in emergency service ambulance personnel
    (Dept. of Social Work, Stellenbosch University, 2005) Stewart, Jackie; Swartz, Leslie
    A diversity of research has demonstrated that, although all people will present with a reaction after a traumatic incident, only a minority will develop posttraumatic stress disorder PTSD (Allan, La Grange, Niehaus, Scheurkogel & Stein, 1998). A complex interaction of multiple pre- and post-trauma factors determines the response. Numerous studies have attempted to assess variables that make an individual more susceptible to developing PTSD. A number of factors were investigated including genetic (Eisen, Goldberg, Heath, Lyons, Nowak & Rise, 1993), family history (Breslau, Davis, Andreski & Peterson, 1991), individual personality (Schurr, Friedman & Rosenberg, 1993), past history of trauma (Zaidi & Foy, 1994) and life events (McFarlane, 1989). A number of studies have identified posttraumatic stress disorder (PTSD) as an important issue in various South African groups (Kaminer, Seedat, Lockhat & Stein 2000; Marais, De Villiers, Möller & Stein, 1999).
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    Space and survival : the aftermath of a fire disaster in a Cape Town informal settlement
    (Stellenbosch : University of Stellenbosch, 2008-03) Stewart, Jackie; Swartz, Leslie; Ward, Catherine; University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Psychology.
    This study is located in the Joe Slovo informal settlement, Langa, Cape Town. This is a settlement much like many other townships in South Africa in that it is a disaster-prone, marginalised community. On the 15 January 2005 a fire ravaged the area, destroying 2 590 dwellings and leaving 12 950 people homeless. This qualitative study attempted to explore the personal perspectives of the survivors of this shack fire within the wider context of communal and socio-political variables. A number of interviews were conducted, some with the fire survivors, and others with service providers in the field of disaster management. Conservation of Resources (COR) theory was found to be a useful lens through which to analyse the data. The fire event itself is shown to have been a precipitant of a far longer and more complex chain of events and ongoing struggles for survival. Reactions to the fire and subsequent events, furthermore, must be understood at a number of levels – including at inter-personal and inter-group levels. The principles and corollaries of COR theory enable a deeper exploration of the disaster especially in terms of resource loss and the implications of survivors having been disadvantaged prior to the fire taking place. A number of pre-event issues are presented in order for this context to be fully understood. Two obstacles to community intervention are emphasised as key. First, the reality of what COR theory terms ‘communities within communities’ has implications for survivor behaviour. Second, the focus on the acute aftermath of the fire, and what COR theory terms the ‘avoidance of long-term needs’ is also crucial. COR theory facilitated the visibility of a link between the data and the use of space at an intergroup level. Despite the abolition of apartheid, segregation between groups in South Africa remains high. The current study made use of the social psychology of segregation to explore the inter-group conflict that emerged as the most salient and ongoing feature of this disaster. Although the current study is exploratory, it is hoped that it will encourage future research into the interface between space, inter-group relations and disaster.
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    Value of a mobile information system to improve quality of care by community health workers
    (AOSIS Publishing, 2013) Tomlinson, Mark; Rotheram-Borus, Mary Jane; Doherty, Tanya; Swendeman, Dallas; Tsai, Alexander C.; Ijumba, Petrida; Le Roux, Ingrid; Jackson, Debra; Stewart, Jackie; Friedman, Andi; Colvin, Mark; Chopra, Mickey
    Background: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC), where the penetration rate approaches 100%. Objectives: In this article, we describe how mobile phones and may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa. Methods: This article is a descriptive study, drawing lessons from two randomised controlled trials outlining how a mobile phone information system can be utilised to enhance the quality of health interventions. We organised our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilised by CHWs and a web-based interface utilised by CHW supervisors. Computerised algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs. Results: Community health workers used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field. Conclusion: Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realised health gains for communities is yet to be tested.
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    'When you are a data collector you must expect anything'. Barriers, boundaries and breakthroughs : insights from the South African data-collection experience
    (SAGE Publications, 2019-04) Roberts, Kathryn; Gordon, Sarah; Sherr, Lorraine; Stewart, Jackie; Skeen, Sarah; Macedo, Ana; Tomlinson, Mark
    The impact of the research process on the researcher is an emerging topic of interest. Data collection in most low- and middle-income countries (LMICs) is often the responsibility of community members who are identified and trained specifically for data collection. When research involves data on mental health and social well-being, data collectors may have specific competency needs and the task of data gathering may impact data collectors. This study aims to explore the experiences and needs of data collectors within South Africa using qualitative methods to examine the impact of data collection on data collectors. Nineteen data collectors, involved in face-to-face data collection, completed semi-structured interviews exploring their insights, attitudes and experiences. Thematic analysis revealed barriers and challenges associated with research, complexities regarding boundaries within the participant-data collector relationship and the benefits of being involved with research for the individual and the community. Numerous challenges and opportunities are outlined. Findings expose the beneficial and often overlooked contribution of data collectors and warrants key considerations in the planning and implementation of future research to ensure adequate support and standardization of practice.
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    Who can we reach and who can we keep? predictors of intervention engagement and adherence in a cluster randomized controlled trial in South Africa
    (BMC (part of Springer Nature), 2020-02-27) Rabie, Stephan; Bantjes, Jason; Gordon, Sarah; Almirol, Ellen; Stewart, Jackie; Tomlinson, Mark; Rotheram-Borus, Mary J.
    Background: Engaging and retaining young men in community-based interventions is highly challenging. The purpose of this study was to investigate the individual factors that predict intervention engagement and adherence in a sample of at-risk South African men. Methods: Baseline data were collected as a part of a cluster randomised control trial (RCT) situated in Khayelitsha and Mfuleni, two peri-urban settlements situated on the outskirts of Cape Town, South Africa. Neighbourhoods were randomised to one of three intervention conditions. We performed univariate descriptive statistics to report neighbourhood and individual socio-demographic factors, and ran multivariate models, adjusting for entry of study, to determine if high adherence and consistency of engagement with the intervention were associated with sociobehavioural demographics and risk behaviours, such as hazardous substance use, gangsterism, and criminal activity. Results: Total of 729 men were on average 22.5 years old (SD 2.8), with a mean of 10 years of education. More than half of the sample were single (94%), lived with their parents (66%) and had an income below ~$30 (52%). The overall mean of adherence is 0.41 (SD 0.24) and mean of consistency of engagement is 0.61 (SD 0.30). Our data indicated that completing more years of education, living with parents, and having higher socioeconomic status were significantly associated with higher rates of engagement and adherence. Men with a history of gang membership demonstrated higher levels of adherence and consistent engagement with the intervention, compared with other men who were recruited to the intervention. Crucially, our data show that young men with a history of substance use, and young men who report symptoms of depression and high levels of perceived stress are equally likely as other young men to adhere to the intervention and attend intervention sessions consistently. Conclusion: Our results may contribute to a better understanding of young men’s patterns of engagement and adherence to public health interventions. The results may have important implications for policy and practice, as they may be useful in planning more effective interventions and could potentially be used to predict which young men can be reached through community-based interventions.