Centre for Disability and Rehabilitation Studies

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Access to primary care for persons with spinal cord injuries in the greater Gaborone, Botswana
(Stellenbosch : Stellenbosch University, 2018-03) Paulus-Mokgachane, Thato Michael Moutie; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: People with SCI often have great need for health care services, but they report access challenges. Primary care access to people with SCI has not been explored in Botswana. Aim: This study aimed to identify barriers and facilitators that users with spinal cord injuries experience in accessing primary care services in the greater Gaborone. Methods: A quantitative, cross sectional, observational study was done. Data was collected with a structured questionnaire from 57 participants with traumatic and non-traumatic SCI. Descriptive analysis was done. Results: The male to female ratio was 2.8:1. The mean age of participants was 40 (SD 9.59). Road traffic accidents caused 85% of the injuries. Most participants visited primary care facilities between 2 to 10 times in the six months before the study. Participants were satisfied with the services (63%) and felt that facilities were clean (95%) and well maintained (73.5%). Preferential treatment, respect, short waiting times and convenient hours facilitated an acceptable and adequate service. Availability was hampered by insufficient provider knowledge on SCI as indicated by 71.9% of participants, and shortage of consumables (80.7%). Structural challenges (42.1% could not enter the facility by themselves and 56.5% could not use the bathroom) and lack of height adjustable examining couches (66.7%) impeded accessibility. Cost was incurred when participants (64.9%) utilised private health services where public services failed to address their needs. Conclusion: Primary care services were mostly affordable, acceptable and adequate. Availability and accessibility aspects created barriers.
Accessibility of advanced seating services in a Western Cape setting : a qualitative exploration of the experiences of carers of children with cerebral palsy
(Stellenbosch : Stellenbosch University, 2019-12) North, Gwen-Lynn; Visagie, Surona; Geiger, Martha; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Background: It is important for health professionals to understand the experiences of carers of children with cerebral palsy (CP) when accessing health care. Understanding their experiences might help providers to make services more accessible. Aim of the study: To explore the experiences of carers of children with CP (GMFCS IV/V), around the accessibility of advanced seating services at a tertiary healthcare facility in the Western Cape. Methods: This study implemented an exploratory, qualitative research design. Of the study population consisting of 62 carers of children with severe CP, seven carers were purposively sampled and interviewed. Thematic analysis with an inductive reasoning process was used to analyse and generate themes from the semi-structured interviews that were conducted. Findings: Carers experienced a great deal of stress around accessing the tertiary healthcare facility for the seating appointment. Four themes were generated: (1) A strenuous experience, (2) Transport, (3) The child and the buggy, and (4) Facilitators to access. Conclusion: Carers encountered barriers, such as transport, that limited access to the tertiary healthcare facility to attend the advanced seating clinic. Service providers need to take cognisance of the challenges that posture support devices pose to using public transport when prescribing a posture support wheelchair. Service providers should consider decentralizing seating services. There is room for improvement of the current public transport systems to be more inclusive for carers, their children with CP and their posture support wheelchairs by enacting legislation in the Western Cape.
Accommodating children with mobility impairments in ordinary primary schools : perceptions of school principals in Johannesburg East on barriers and possible solutions
(Stellenbosch : Stellenbosch University, 2021-02) Hunt, Paulani; Luger, Rosemary; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Twenty years ago, the Department of Basic Education in South Africa introduced the Education White Paper 6: Building an inclusive education and training system, to ensure that all children between seven and 15 could access quality basic education. The purpose of this qualitative exploratory study in the Johannesburg East District of Gauteng was to establish the barriers that ordinary primary schools experience to accommodate children with mobility impairments, and what structures and procedures they put in place to bridge those barriers. Data was collected through semi-structured interviews with eight principals and a thematic analysis revealed that barriers included structural challenges like stairs and uneven school grounds, insufficient support from the District, and attitudinal barriers. Some schools devised cost-effective ways to overcome these barriers through collaboration with the community, educators, parents and children, but others were still waiting for external guidance and assistance. To ensure that all children with mobility impairments are reasonably accommodated, schools will need further assistance from the Gauteng Department of Education.
Availability, importance, and accessibility of postgraduate education for Orthotists and Prosthetists in South Africa: A mixed method study
(Stellenbosch : Stellenbosch University, 2021-03) Boshof, Pearl Ignacia; Visagie, Surona; Ohajunwa, Chioma; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Agtergrond: Ortotiste en Prostetiste speel `n belangrike rol in die rehabilitasieproses van persone met gestremdhede deur die verskaffing van orthoses en/of prostheses. Die hulpmiddels kan help om sekondêre komplikasies te voorkom, funksie te verbeter, gemeenskapsintegrasie te bewerkstellig en lewenskwaliteit te bevorder. Ortotiste en Prostetiste speel soms `n lewenslange rol in die lewe van `n persoon met `n gestremdheid. Tans in Suid-Afrika is daar drie opvoedkundige instansies wat voorgraadse studies aanbied ten opsigte van die Ortotika en Prostetika professie. Die doel van hierdie studie was om die beskikbaarheid, belangrikheid en toeganklikheid van nagraadse opleiding in die Ortotika en Prostetika professie in Suid-Afrika te ondersoek. Die doelstellings was om: • Die nagraadse opleiding tans beskikbaar in die Suid-Afrikaanse Ortotika en Prostetika professie te bepaal • Die deelnemers se mening oor die noodsaaklikheid van nagraadse opleiding vir Ortotiste en Prostetikuste in Suid Afrika te bepaal • Die behoeftes te bepaal ten opsigte van nagraadse Ortotika en Prostetika opleidingsprogramme • Te bepaal wat die hindernisse ten opsigte van die deelname aan nagraadse Ortotika en Prostetika opleiding in Suid -Afrika sal wees • Die voorkeure van die Ortotiste en Prostetiste te bepaal ten opsigte van die tipe en formaat van nagraadse opleiding Metode: `n Gemengde navorsingsmetode was gebruik. Fase 1 was kwantitatief. Data was ingesamel deur middel van epos vraelyste wat deur 47 lukraak ge-identifiseerede deelnemers voltooi is. `n Beskrywende analise was in hierdie verband gedoen. In fase 2 was kwalitatiewe data deur middel van oop vrae ingesamel van agt doelgerig geselekteerde deelnemers en die data is tematies geanaliseer. Die bevindinge van die twee fases was teenoor mekaar gestel en geintegreer in ‘n bespreking. Bevindinge: Die bevindinge het getoon dat die deelnemers nagraadse opleiding in ortotika en prostetika belangrik ag. Die deelnemers het verder ook verkies dat die nagraadse opleiding wat in ortotika en prostetika aangebied word, in verskillende formate aangebied moet word om die toeganklikheid van sulke programme te bevorder. Die deelnemers het geen toegang tot nagraadse ortotika en prostetika spesifieke opleiding nie en het beperkte toegang tot generiese opleidingsprogramme in Suid-Afrika. Dit veroorsaak `n afname in die deelname aan nagraadse opleiding in ortotika en prostetika. Daar was voorgestel dat een van die drie tersiêre opleidingsinstansies wat voorgraadse opleiding in ortotika en prostetika aanbied, `n nagraadse opleidingsprogram vir Ortotika en Prostetika in Suid-Afrika moet ontwikkel wat internasionaal erken sal word. Die huidige generiese opleidingsprogramme wat geskik sal wees vir ortotika en prostetika in Suid-Afrika, moet geidentifiseer word, en bygestaan word om meer inklusief teenoor ortotiste en prostetiste te wees. Verdere studies is nodig om die kwaliteit en effektiwiteit van voorgraadse opleiding in ortotika en prostetika in Suid-Afrika te bepaal.
Bridging the gap for transtibial prosthetic rehabilitation : analysis for the development of a pro bono application
(Stellenbosch : Stellenbosch University, 2023-03) Van Vuuren, Susanna Catharina; Visagie, Surona; Pienaar, Elzbeth; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Background: In South Africa, people with lower-limb amputations face challenges accessing rehabilitation services. The reasons for poor access to rehabilitation are multifaceted. In rural settings of South Africa, referral pathways and coordinated rehabilitation by a multidisciplinary team are rarely available. It is well known that prosthetic rehabilitation leads to improved outcomes. Currently, there are few evidence-based best practice protocols applied in transtibial prosthetic rehabilitation internationally. Mobile health technologies can reach underserved populations, improve clinical outcomes, promote attendance and adherence, and improve health-related quality of life. However, currently, only 1% of mobile health applications are grounded in scientific evidence and is evidence-based-driven. Aim: This study aimed to identify rehabilitation interventions that can inform a rehabilitation application for transtibial prosthetic users in South Africa. Study design: The study was executed in two distinct phases, namely a systematic literature review and a qualitative descriptive study. Methods: The objective of the systematic literature review was to evaluate current literature on transtibial prosthetic rehabilitation interventions globally. The literature review was executed according to the PRISMA 2020 statement. The literature search was conducted between May 2021 and February 2022 and explored rehabilitation interventions as part of transtibial prosthetic rehabilitation. Nine articles adhered to the inclusion criteria and were reviewed. The analytical studies were assessed using the Cochrane Collaboration Risk of Bias tool. The overall quality of evidence was assigned using the Cochrane Grading of Recommendations, Assessment, Development and Evaluations system. The literature probe conceptualised five themes for exercise interventions to be included in transtibial prosthetic rehabilitation. The objective of the descriptive qualitative design was to explore transtibial prosthetic users’ rehabilitation needs and experiences. In addition, it determined prosthetists’ and physiotherapists’ opinions on interventions that should be included in transtibial prosthetic rehabilitation in South Africa. Non-probability sampling techniques were used to select participants among each population group consisting of prosthetic users (n=8), prosthetists (n=8) and physiotherapists (n=10). Qualitative data were collected through telephonic interviews and were analysed using a content analysis approach. The findings from the two phases and four sources were triangulated to identify rehabilitation interventions to be included in a pro bono rehabilitation application. Findings: Through data triangulation, two main concepts were identified to be incorporated into an application. The first concept was exercise interventions that focus on balance and weight bearing, joint mobility, muscle strength and gait. The findings also suggest that a rehabilitation roadmap, patient education and peer support should be included in the application. Conclusion: It was recommended that exercise interventions should focus on balance, weight bearing, muscle strength, joint mobility and gait. Prosthetic users should be able to practise at home and must not require additional equipment to execute the exercises. It was concluded that additional factors should be included in the application. These factors include a rehabilitation roadmap, functional prosthetic rehabilitation, patient education and support as well as to incorporate a social platform into the application.
Cardiovascular Disease : Exploring the barriers to lifestyle modification in a Cape Town setting
(Stellenbosch : Stellenbosch University, 2021-12) Sawyer, Stephanie; Visagie, Surona; Geiger, Martha; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: Cardiovascular disease (CVD) is a growing problem worldwide and is the second highest cause of death in South Africa. It can be avoided by controlling modifiable risk factors such as blood pressure, food consumption and exercise. However, many people seem to struggle with modifying and maintaining a healthy lifestyle. Methods: The aim of this study was to explore the barriers to lifestyle modifications experienced by persons identified at moderate risk for CVD in the Blaauwberg suburb of Cape Town. One-on-one semi-structured telephonic interviews, guided by an interview schedule, were conducted with eleven participants. Thematic data analysis was performed. Findings: Individuals conveyed a vague understanding of heart disease. However, it was enough to encourage lifestyle modification. Modifiable risk factors revealed in this study included eating habits, physical activities, and smoking. Three themes emerged from the findings: CVD “You can prevent it”, Lifestyle modification “It just feels like an insurmountable task”, A better lifestyle “It’s all about self-awareness, self-love.” Information gathered on the barriers/facilitators for the risk factors (above) was further categorized into sub-headings including Health and quality of life, Physical environment, Sociocultural factors, Access to information and resources, and Psychological factors. Conclusion: Barriers that occur repeatedly include time, financial constraints, and support. Safety concerns when exercising, the availability of free exercise equipment in parks and free organised group physical activities are elements specific to SA.
Caregivers’ perceptions of the sexuality of adolescents with severe intellectual disability in special care centres in the North West Province of South Africa
(Stellenbosch : Stellenbosch University, 2023-03) Motshwane, Judith Ntsiki; Kahonde, Callista; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Background: Caregivers in special care centres play many roles in the lives of children and young adults with severe intellectual disabilities which include being a carer, an educator and a companion. In South Africa, there is lack of research to guide the understanding of how caregivers perceive sexuality issues of these young people with severe intellectual disabilities under their care. It has also been noted from the literature that many studies have focused on service providers’ perceptions of sexuality of people with mild to moderate intellectual disabilities and there is paucity of literature on caregivers’ perceptions of the sexuality of people with severe intellectual disabilities in South Africa. This study therefore took an initial step in addressing the gap by exploring caregivers’ perceptions of the sexuality of adolescents with severe intellectual disabilities in five special care centres in the North West Province of South Africa. Aim: To explore and describe caregivers’ perceptions of the sexuality of adolescents with severe intellectual disabilities in five special care centres in the North West Province of South Africa. Method: The study used an exploratory descriptive qualitative design. Semi-structured in-depth telephonic interviews were conducted with nine caregivers working in the special care centres. The data was analysed using thematic analysis. Findings: The findings show a range of participants’ perceptions. The participants thought the adolescents were not coping with their body changes and they lacked understanding of both the emotional and physical changes experienced at puberty. They also believed that adolescents must be discouraged from sexual expression or activity. The findings also revealed that the participants find responding to the adolescents’ sexuality challenging as they lacked skills and knowledge to guide their approaches. They expressed a need for training. The findings further revealed participants’ perceptions of the role of parents, pointing towards the impact of parents’ restrictive attitudes, disinterest and misunderstanding of their children with intellectual disability’s sexuality. Conclusion: The study gave an insight into the perceptions of caregivers of the sexuality of adolescents with severe intellectual disabilities in the study setting. The findings identify an urgent need for caregivers to receive training so that they gain skills and confidence to respond to the sexuality of their care recipients in a positive and supportive way. There is also need for strategies to educate parents and involve them in the sexuality education of the adolescents. Sexuality policies, guidelines and structured programmes are essential for caregivers to have tools to guide them.
A case study exploring community inclusion of adults with intellectual disabilities who participate in/attend protective workshops in Cape Town
(Stellenbosch : Stellenbosch University, 2024-03) Pitt, Catherine; Geiger, Martha; Kahonde, Callista; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Research shows that persons with intellectual disabilities (ID) are the most marginalized group among persons with disabilities in South Africa. Despite the progress in this country towards an inclusive and free country, persons with ID are not experiencing their full citizenship. Although South Africa signed and ratified the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) almost two decades ago, persons with ID still have limited access to services that can facilitate their inclusion into communities. Some progress has been made in education with children with ID, but little progress has been made towards the inclusion of adults with ID into employment and community activities. Furthermore, they are seldom included in research even when the research seeks to understand their day-to-day experiences. This study therefore set out to explore the community inclusion opportunities and aspirations of persons with ID attending a protective workshop in Cape Town. This study used a case study methodology within a constructivist paradigm to explore the participants’ aspirations and opportunities for community inclusion. Methods of data collection were carefully selected and planned to ensure meaningful inclusion of the participants in the data collection process. The methods included interviews, focus groups, community mapping and field notes, which were supported by tools like pictures, icons, games, community maps and repetition of the questions and discussions. An analysis of secondary data was also conducted to seek further understanding of the study context and confirm the findings from other sources of data. Twenty-eight adults with ID within the age range of 21 and 54 years, recruited from two protective workshops, participated in the study. The data was analysed using thematic analysis and four themes were generated, namely; what I do in my community, what I want from independence, the significance of relationships, and the importance of work. Their inclusion opportunities in their community ranged from assisting in their homes, and participating in community activities and hobbies and the importance of work in achieving their experience of independence and relationships was described. The participants aspired to be included in more activities independently, understanding the barriers that their impairment and the context presented. Possible supports were identified to overcome their barriers. The findings demonstrate that with appropriate support available, persons with ID are capable of contributing meaningfully to their communities. This disrupts the status quo of myths and stereotypes about persons with ID that marginalize them. The participants grappled with the conflict of their desire for independence versus their identified vulnerability. Further, they described the variety of relationships that they find to mitigate loneliness. Finally, work was described as a facilitator of inclusion. These findings can inform policy developers to effect changes to service provision to establish supports for persons with ID to be included in their communities. Emerging from these findings was a possible tool of community inclusion which aligns the environment with the supports of persons with ID to facilitate inclusion in the activities of their own choice.
Challenges faced by occupational therapists and teachers in the implementation of vocational programmes in selected special needs schools for learners with severe intellectual disability in the metro district within the City of Cape Town
(Stellenbosch : Stellenbosch University, 2023-03) Solomon, Elana Tina; Ned, Lieketseng; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Introduction: Vocational programmes run by Occupational therapists (OTs) and/or vocational teachers in the special needs school context can play a significant role in the vocational development of learners with severe intellectual disability. They can also lead to positive postschool employment outcomes or opportunities in the open labour market. However, challenges such as limited resources in the implementation can have a direct impact on the post-school employment outcome of these learners. Aim: This study explored the challenges that Occupational Therapists and teachers faced in the implementation of vocational programmes in selected special needs schools for learners with Severe Intellectual Disability in the metro district within the City of Cape Town, South Africa. Methods:A qualitative descriptive design was used to allow the opportunity to gather in-depth information and to bring consciousness of the lived challenges. Eighteen Severe Intellectual Disability schools in the metro were contacted, 12 participants (six OTs and six teachers) from six special needs schools, volunteered and partook in the study. One-on-one semi-structured interviews with teachers and occupational therapists were done. An interview schedule was used as a tool and all interviews were transcribed and translated into English verbatim. Thematic analysis was applied to analyse data. Findings: The data showed that OTs and teachers encounter many challenges in the implementation of vocational programmes in special needs schools for learners with SID. Seven themes derived from the data included: (1) Poor to lack of proper facilities/resources, (2) Inadequate support systems, (3) Challenges with the DCAPS curriculum, differentiation and integrated learning areas, (4) Learner skills and limitations, behaviour and emotional challenges, (5) Lack of training, guidelines and support, (6) Accessing work-based learning (Job shadowing) and (7) Advising and facilitating opportunities for learners with SID. The overall ability of participants to successfully implement the vocational programmes at their respective special needs schools was hindered by inadequate support, resources and lack of relevant training. This study also highlights the issues of existing policy and the lack of a mandatory policy on vocational programmes for special need schools. Conclusion: The participants’ experiences provided knowledge on the challenges in the implementation and added value to the existing literature. To address the challenge, a multi-faceted policy framework is much needed in the South African context that includes a set of principles for effective implementation, procedures, responsibilities, and comprehensive support plans for vocational programmes for special needs schools for SID. The recommendations propose ideas that can be used by policy makers and educational institutions to better support OTs and teachers and improve post-school employment outcomes for learners with SID.
A description of recorded HIV status in persons with disabilities at Western Cape Rehabilitation Centre
(Stellenbosch : Stellenbosch University, 2014-12) Nash, Megan Renee; Geiger, Martha; Bardien, Faeza; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences: Centre for Rehabilitation Studies.
ENGLISH ABSTRACT: It is only recently that research on HIV and persons with disabilities has started to emerge. There still remains, however, a lack of research on the prevalence of HIV infection in persons with disabilities. The challenges facing HIV prevalence studies include that persons need to be tested for HIV to be able to be certain of HIV status. Issues related to disclosure and accessibility to health care further limit HIV prevalence studies, especially in the disabled population where stigmatisation and marginalisation, due to the disability, already exist. This research assignment aimed to yield some preliminary quantitative information on HIV disease in the population of persons with disabilities admitted to WCRC. It aimed to describe the HIV status information as recorded in the medical files of in-patients admitted to WCRC in a 6-month period. A cross-sectional design was applied in this exploratory study. Data was collected through an audit of 331 clients‟ clinical records. Variable information collected was type of disability, gender, population group, age, the source documents used to gather data, and recorded information regarding HIV status (i.e. positive, negative or unknown). The source documents used to gather information were medical records, laboratory results, pharmacy scripts and therapy notes. The recorded information in the medical records and therapy notes was, however, subject to client disclosure. The unknown subset in the sample included folders with HIV status recorded as unknown as well as folders lacking any HIV information, which constituted a major limitation of the study. 16.4% of females were recorded with an HIV positive status, compared to only 6.51% of males. Per population group, Black African clients had the highest number of recorded HIV positive status whereas Coloured clients had the highest recorded unknown HIV status. The recorded HIV positive status information of the study sample was 9.97%, which is comparable to the national estimate of 9.9%. The results indicate that a better understanding of the undercurrents driving HIV information recording and disclosure in the disabled population of WCRC is needed. According to the literature, various factors could contribute to disclosure or non-disclosure of HIV status, such as fear of stigmatisation, lack of access to testing and social marginalisation. This study aims to provide a first step in research, and specifically in hypothesis generating research, of HIV information recording and supports the need for HIV prevalence studies in the disabled population.
Disability and health care access in an isolated quarter of the Karoo
(Stellenbosch : Stellenbosch University, 2015-04) Visagie, Surona; Swartz, Leslie; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Centre for Rehabilitation Studies.
ENGLISH ABSTRACT: Introduction: High quality comprehensive health care services contribute to community integration and participation of persons with disability. However, persons with disabilities often experience barriers with regard to health care access. Neither these barriers nor the concept of disability have been sufficiently explored in rural Global South settings. This study describes the experience of living with a disability in a remote, rural setting with a specific focus on barriers and facilitators to health care access. Method: A qualitative design utilising case study methodology and interpretative phenomenological analysis was used. The study population consisted of 283 persons with moderate or severe activity limitations, who lived in a rural town in the Northern Cape Province of South Africa. Eight of them were purposively sampled as anchor participants in eight case studies. Their significant others completed each case study. In addition data were collected from six service providers to the study community. Data were collected through 19 in-depth interviews and one focus group discussion, between March and October 2012. The principles of interpretative phenomenological analysis were used to analyse data and identify themes. Similar themes were clustered under superordinate themes. Cases were analysed separately after which patterns across cases were identified. Results: Participants conceptualised disability as an individual problem according to the moral or medical approaches and often interpreted disability as physical in nature. Participants’ level of participation and community integration varied from very little to being employed and well integrated. Self-belief and the attitude and support of significant others, community members and employers played an important role in the level of participation persons with disability achieved. Participants’ primarily utilised public, formal, health care services. These services were found to be mainly curative and preventative in nature. The provision of health promotion and rehabilitation were lacking. Users were not empowered to take control of their own health management and were not included in the health care team. Health system barriers identified included insufficient human and material resources, communication challenges, Stellenbosch University https://scholar.sun.ac.za iv and rigid protocols. The remoteness of the setting hampered health care service delivery. Free health care provision, high quality services at tertiary level, and outreach services to the community were identified as facilitators. A lack of products and technology, poverty, and low levels of education created further barriers to community integration and health care access. Implications: Suboptimal health care together with personal and environmental barriers might have resulted in poor health, functional, community integration, and participation outcomes for participants. Health care was provided reactively to individual users and not according to the principles of primary health care. The little rehabilitation that was provided was not enough to ensure improved functioning or community integration and participation. Recommendations: Since this was an inductive study with few participants recommendations centre on hypotheses for further study. The focus of these theories is on ways to provide health care according to the philosophy of primary health care and on introducing specific rehabilitation programmes in the community.
Do clients with spinal cord injuries know what they need to know about pressure ulcers? A descriptive study on the knowledge, beliefs and practices about pressure ulcers
(Stellenbosch : Stellenbosch University, 2016-12) Visser, Adri Marica; Visagie, Surona; Hendry, Jenny; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Background: Pressure ulcers are a serious, but preventable, secondary complication of spinal cord injury (SCI). Pressure ulcers limit community integration, and are potentially life-threatening. They also put an increased financial and care burden on health systems. Pressure ulcers can be prevented by following the guidelines for good skin care and pressure-ulcer prevention programmes. Adherence to pressure-ulcer prevention practices is influenced by a person`s knowledge and beliefs. Aim: To describe the knowledge, beliefs and practices about pressure ulcers of clients with SCI who received rehabilitation at a Cape Town rehabilitation center. Methods: A quantitative, descriptive study, that employed consecutive sampling, was done. Participants included in-patients (n=30), out-patients (n =33) and peer supporters (n = 8). Data was collected during April and March 2015 with a questionnaire developed through collating existing questionnaires and adapting them for the study context. Descriptive and inferential analyses of data was done. To determine if any relationship existed between the variables, the Fisher’s exact test and Kruskal-Wallis test were applied. A P-value of <0.05 was considered statistically significant. Results: The mean age of participants was 36.3 years with 86% being male. Only 31% of participants finished school and 77% were unemployed. Of all the participants, 43% had developed a pressure ulcer at some stage. The mean combined knowledge score was 23.9 out of a possible 56 (42.7%). The in-patients and out-patients had similar scores (40.4% and 39.4% respectively). Areas of knowledge that were particularly challenged, included nutrition to prevent pressure ulcers, the staging of pressure ulcers, the time it takes for a pressure ulcer to develop and the risk factors for pressure ulcer development. While having a similar knowledge score as in-patients, personal experience of life with SCI and contact with others might have influenced the beliefs of out-patients over time as more of them saw themselves as likely to develop pressure ulcers, and a higher percentage believed PU would seriously impact their activities. Peer supporters had a higher mean knowledge score than the other two groups. Despite their higher mean knowledge score, their scores might be too low to effectively teach others PU prevention practices. The majority of participants (88.7%) believed pressure ulcers to be serious and 45% thought they were likely to develop a PU. They believed daily skin checks (80.3%), weight shifting (86%) and limiting sitting time (80.3%) could prevent PU development. Pressure relief was not practiced correctly by 51% of participants, while 39% did not perform skin inspection correctly and 38% of participants smoked. Inferential statistics showed that most of the variables did not have a statistically significant relationship. An increase in time since injury had a significant impact on the belief that pressure ulcers would interfere with ADL (p=0.024), and increased knowledge scores impacted significantly on correct pressure relief practices (p=0.001). Conclusion: Participants showed a lack of knowledge which might have impacted their beliefs and pressure-ulcer prevention practices negatively. It seems as if participants were not equipped with sufficient knowledge to assist them in adhering to pressure-ulcer prevention practices, even though they realized pressure ulcers were serious and would impact their lives negatively. The study findings can be used to assist with the development of a contextually relevant training programme on pressure care.
The effect of compression garments on participation in life roles ; experiences of women with breast cancer related lymphoedema
(Stellenbosch : Stellenbosch University, 2023-03) Altin, Marzanne; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Introduction: Breast cancer is one of the most common cancers amongst women. Lymphoedema, a complication of breast cancer treatment, is often managed with a compression garment during maintenance phase that controls swelling which then improves function. Aim: To explore the experiences of women with breast cancer-related lymphoedema about the effect of compression garments on their participation in life roles. Owing to the explorative nature of the study, no specific objectives were set. Method: The study followed an interpretative phenomenological approach. Five participants were purposefully sampled from a population of 23. Virtual semi-structured interviews were used to gather data. Employing an interpretative phenomenological analysis framework, data for each participant was analysed separately, followed by cross case analysis and development of emerging themes. Results: Four themes emerged: “Controlling the narrative”, “Braving the public”, “A double edged sword” and “Influence on mental health”. Controlling the narrative showed the need for choice of garment type, design and colour, wearing schedule, and around conversations about it. Braving the public focused on the attention the garment draws. A double edged sword showed that, while decreasing impairments and improving function, the garments were also a source of irritation. Mental health symptoms such as frustration on the one side and security on the other emerged. Conclusion: The garments gave relief on an impairment level and supported activities and participation. However, accepting the compression garment as part of their lives for the rest of their lives was emotionally difficult. Participants were often not comfortable to appear in public with their compression garments because of the negative attention and emotions they created. They counteracted negative emotions by taking control.
The effect of neurofeedback in post-concussion syndrome
(Stellenbosch : Stellenbosch University, 2019-04) Lamprecht, Catherina Elizabeth; Unger, M.; Derman, E. W.; Stellenbosch University.Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: Concussion in sport as well as the risk of repeated concussion if athletes return too soon, is well documented. Current intervention guidelines recommend rest followed by graded return to physical activity. There are however increasing interventions aimed at speeding up the recovery process. Similarly, there is a drive to include assessment of postural control, especially dynamic balance (with and without cognitive loading) after a person has sustained a concussion and to monitor recovery to ensure persons who have sustained a concussion injury do not return to play too soon. Aim: This study aimed to investigate the effects of a novel intervention, namely neurofeedback, on postural control recovery in sport related concussion. This study also aimed to explore the use of selected postural control measures, namely the Functional Gait Assessment (FGA) and Tandem Gait time (TG), without and with cognitive loading in assessment and determine whether there is any correlation between these and the Sport Concussion Assessment Tool (SCAT 5). Methodology: A randomised controlled, double blind study design was used to determine the effect of neurofeedback on postural control as measured by the SCAT 5, FGA and TG, with and without loading in young collegiate adults who reported to Stellenbosch University Campus Health with a concussion sustained during participation in sport. Participants were randomly assigned to either an intervention group (neurofeedback) or a control group (sham feedback). Neither participants nor the researcher knew to which group participants were assigned. Baseline measurements (SCAT 5, FGA and TG, with and without loading) were recorded at baseline. Participants in both groups were given 4 treatment session. The FGA and TG measures were also repeated before each treatment session. The SCAT 5 was repeated at the time to return to play or after the 4th treatment session (due to time constraints). Data was processed and analysed using Stata version 14 with the help of a statistician. Results: Sixteen participants were finally recruited into the study, 7 in the intervention group and 9 in the control group. Data was not normally distributed and as such results are reported as medians (ranges) and were analysed using non-parametric analyses. A significant change in the treatment group compared to the placebo group was found on the TG without loading measurement. The FGA and TG with loading showed a positive trend. All participants scored below the norms for the postural control assessments (FGA and TG, with and without loading), suggesting dynamic balance is affected in persons with concussion. Significant correlations between the TG without loading and the SCAT 5 number of symptoms (ICC=0.512 )(p<0.05) and severity of symptoms (ICC=0.419 )(p<0.05) was found. Similarly significant correlations were also found for TG with loading and the SCAT 5 number of symptoms (ICC=-0.271 )(p<0.05) and severity of symptoms (ICC=-0.153 )(p<0.05). Gender differences were found in that males participants significantly under-reported both the number of symptoms and severity of symptoms when comparing these with their dynamic balance scores on the FGA and TG (p=0.01). Conclusion: Neurofeedback may be an effective intervention to impact recovery after concussion injury. The current study showed that neurofeedback had a significant effect on gait speed as measured by the TG with both loading and had a positive effect on postural control compared to a placebo group. Sport related concussion does affect postural control as measured by FGA, TG time, with and without loading. The FGA showed a moderate negative correlation to the SCAT 5 number of symptom and severity of symptoms reported indicating that as the number of and severity symptoms increases, the FGA scores decreased. Similar findings were found for TG time without loading. There were a difference in gender in their TG time with and without loading as well as their reporting of symptoms on the SCAT. It is clear that male students under report their symptoms as well as their severity in order to return to sport sooner. Our recommendation is that further studies be done on the effect of neurofeedback as a treatment in the recovery of postural control after sport related concussion. Furthermore that FGA, TG time with and without loading be taken into consideration when the return-to-play decision is made especially if a pre-seasons time can be established.
Evaluation of the functional rehabilitation outcomes of clients after receiving physical rehabilitation at TC Newman community day centre
(Stellenbosch : Stellenbosch University, 2014-04) Felix, Rochelle Karen; Statham, S. B.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Centre for Rehabilitation Studies.
ENGLISH ABSTRACT: Introduction: Rehabilitation is an important tool in helping persons with disabilities to recover and attain functional independence as far as possible in achieving a good quality of life. However, scarce rehabilitation services and barriers may prevent full attainment of functional outcomes and impact on quality of life. Even though guidelines exist for rehabilitation services there remains a need to standardise documentation of outcomes, implementing appropriate outcomes tools and defining expectations for rehabilitation. Headcounts alone cannot fully account for rehabilitation services. The NRP echoes monitoring and evaluation of rehabilitation services, so as to measure its effectiveness and relevance. A lack of clear understanding of rehabilitation outcomes may result in it being overlooked during planning for resources. While on the other hand outcomes can be used to motivate for more rehabilitation services. Aim of the Study: The aim of the study was to evaluate the functional rehabilitation outcomes of clients after receiving physical rehabilitation at TC Newman Community Day Centre. Method: Study Design: A pre-test, post-test descriptive longitudinal study using mainly quantitative methods of data collection was applied. Study setting: The research was conducted at TC Newman CDC. Study Population and Sampling method: Study participants were those presenting with one of the five most prevalent conditions at TC Newman CDC, indicated from therapist’s data working there, during 2008/2009. Pre-tests were administered to 114 participants adhering to the inclusion criteria. Only 12 participants of the 114, returned for follow up assessments. The low return rate of participants was a critical concern for the researcher, which led to the inclusion of home visits (8) and telephonic follow up (16), to increase the number of responses from the outcome measures and to determine why participants did not return for follow up appointments. Only 20 participants completed the preand post-tests. Data collection instruments: Data collection instruments used in the study, on demographics, were designed by the SANPAD research group and validated by rehabilitation experts. The study further used validated functional diagnostic specific outcome measures to answer the research question. Data collection process: Pre-tests and post-tests were administered at TC Newman CDC by a trained research assistant. The telephonic follow up and data extraction from the patient folders were done by the researcher. Home visits were administered by the research assistant, with support from the researcher. Data analysis: Quantitative data was analysed by a statistician from the University of Stellenbosch. Qualitative data obtained from the telephonic follow up was thematically analysed, to identify why clients did not return for their follow up appointments. Results: Despite the low return rate, results indicated an overall improvement in functioning, with mobility, as the one area of functioning demonstrating significant improvement after rehabilitation. Participants that returned for follow up sessions also indicated feeling better after receiving therapy. In addition to transport and income, environmental factors having the most influence on participants attendance to follow up therapy, were health systems challenges such as appointment systems, poor follow-up and inadequate documentation. Overall participants indicated they experienced their rehabilitation positively. Conclusion: Contextual factors should be taken into account when planning rehabilitation services, to ensure optimal access and the best possible outcomes for clients needing rehabilitation. Even though rehabilitation services at TC Newman CDC are available, the extent of accessibility is questionable, thus it is important to look at how rehabilitation services are delivered.
Experiences of persons with disabilities of Xhosa rituals and traditions, which contribute to health and wellbeing
(Stellenbosch : Stellenbosch University, 2023-03) Dwadwa-Henda, Nomvo; Mji, Gubela; Ohajunwa, Chioma; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: The disability scholarship has always been dominated by Western literature (1)(2)(3)(4) which locates disability on the person and presents it as a tragedy without considering contextual factors which contribute to the various understandings of disability by people of the South. With a paucity of literature on disability by African scholars, some literature on disability in Africa is most of the time presented by people from the North who leave out the situations and things that existed in the past and are part of the people’s history – this is a missed opportunity on important aspects of disability of Indigenous peoples. The study explored the Xhosa rituals and traditions of Bomvana people (an Indigenous community in the Eastern Cape Province of South Africa) from birth to adulthood, and how persons with disabilities experienced these rituals. The study also explored the contribution of these rituals to the health and wellbeing of the person. Factors that contributed towards building a collective disability framework that is centred around the worldview of AmaBomvana for the health and wellbeing of the community were also explored. Data gathering methods included an exploratory case study with persons with disabilities, focus group discussions with knowledge holders, observations, one-on-one in-depth interviews, journaling, and informal conversations. Sampling of participants from the three Gusi village clusters comprised of 50 participants. Content analysis was used with the text divided into meaningful units – guided by the study aim and the research questions. The PhD study findings presented conceptualisation of disability by AmaBomvana, which demonstrated that their Indigenous worldview plays a role in how they interpret the world. Their understanding of disability is in contrast with Western approaches, and carries respect and dignity, which attests to their ancestral reverence – whereby spirituality takes precedence to the physical. Hence their disability ontology is quite unique and comforting. Ubuntu as the Bomvana guiding principle serves to examine and guide justification for their moral judgements in their community. The study concluded by proposing a disability framework that is modelled on collectivism which continues to express Ubuntu philosophy as principle.
Experiences of persons with mobility impairment in using public transport in Knysna townships in the Western Cape Province
(Stellenbosch : Stellenbosch University, 2020-03) Gudwana, Khangelani; Geiger, Martha; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: For persons with mobility impairments, accessible public transport remains a major challenge in many areas such as Knysna townships in the Western Cape;, South Africa, with implications for their access to services such as health and their participation in economic and social activities. The aim of this study was to explore the experiences of persons with mobility impairment in accessing public transport in Knysna townships in the Western Cape Province. Method: An exploratory qualitative design was implemented. The townships in Knysna in the Western Cape Province, were chosen as the study setting because of its steep and rough terrain and its restricted public transport options. The study population consisted of all persons with mobility impairment, aged 18-35 using public transport in Knysna townships. Purposive and snowball sampling was used to select the participants. A final sample of six was determined by data saturation. Data were collected using in-depth interviews. With the permission of participants, interviews were audio-recorded, and field notes were used to supplement and verify the voice recording after interviews. Photos of the home environment were taken with consent of each participant. Manual data analysis was implemented using a six-step thematic data analysis guide. Ethical considerations: informed consent was obtained, and confidentiality was safeguarded. Rigour: All aspects of the study were carefully monitored against the criteria of trustworthiness such as credibility, transferability, dependability and confirmability. Findings: Six themes emerged, namely: Challenges related to lack of safety; challenges related to cost of transport for persons with mobility impairment; challenges related to accessibility to the taxi, the road and to the houses; attitudes contributing to exclusion, and finally; participant’s perceptions on ways to address the challenges. Conclusion: Participants concurred that challenges in accessing public transport cause them to suffer social / economic exclusion. The recommendations to diverse stakeholder audiences should be implemented sooner rather than later due to the ongoing negative impact on basic human rights and human dignity for persons with mobility impairment in Knysna townships.
An exploration and description of rural rehabilitation service model in the Mbhashe Municipality, Amathole district in the Eastern Cape Province of South Africa : a pilot study
(Stellenbosch : Stellenbosch University, 2020-03) Gysman, Nozipiwo Joyce; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Background: People with disabilities are still disadvantaged in accessing health and rehabilitation services, especially those who reside in rural areas, despite the available policies. Rehabilitation is one of the components of Primary Health Care (PHC) but it remains excluded and poorly understood in PHC programmes. Despite available policies to address rehabilitation for people with disabilities (PWDs), PWDs still have difficulty accessing the rehabilitation services. Rehabilitation remains: •excluded and poorly understood in PHC programmes, •fragmented and uncoordinated with services inaccessible to some parts ofsociety especially in the rural context compared to urban counterparts, •dominated by the medical model and institutionalization of services, and •questionable in terms of relevance of services as there is less involvement,guidance and support from communities where these rehabilitation servicesare being provided. Aim of the study: To explore and describe rehabilitation services rendered in a rural setting of Mbashe municipality in the Eastern Cape Province in South Africa. Study objectives: To describe the rehabilitation and health services in the selected area; to identify the key role players for rehabilitation services in this area (both community-based and institution-based); to describe the rehabilitation pathways available within the health facilities and the community; to explore the challenges experienced by all role players delivering rehabilitation services in the study area; to determine the perceptions of people with disabilities with regards to the current model of rehabilitation in the study area; and, to make recommendations for addressing the challenges with regard to rehabilitation services in the study area and the existing rehabilitation model. Method: A qualitative exploratory and descriptive study design was implemented to describe the rural rehabilitation service model in the Mbashe Municipality in the Amathole District in the Eastern Cape Province of South Africa. Four areas out of nine (Gusi, Hobeni, Nkanya and Xhora) were conveniently selected in the study setting. In-depth interviews were conducted with Health Professionals from the District hospital (Madwaleni). Semi-structured interviews were conducted with the community representatives inclusive of, the Clinic Nurse Practitioner (one from each of the clinics in four selected areas); The Chief/Chieftain (one from each area in four selected areas); and a person with a disability, a representative of persons with disabilities. Focus group discussions (a group from each area) were conducted with persons with disabilities their families and their communities. Instruments used for developing interviewing schedules for data collection were based on Kaplan’s Framework of Organisational Capacity, (1999) and the Wheel of Opportunities (Lorenzo & Sait, 2000). These instruments were used interchangeable to address the objectives of the study. Qualitative methods of data analyses were applied whereby segments of data were broken down into manageable categories which were later grouped and subjected to content analysis to identify emerging themes. Findings: Themes that emerged from interviews conducted with health professionals, communities and focus group discussions with persons with disabilities revealed that the current model of rehabilitation was institution-based. Participants in rehabilitation services, though aware of available health and rehabilitation services, experienced their main challenge in gaining access to these services. One of the main challenges was related to transport to gain access to health and rehabilitation services. Home visits were not part of the rehabilitation services and this limited rehabilitation professionals in understanding about home and cultural situations of their patients. Rehabilitation goals were not fully met with one of the highest goals of rehabilitation – which is community participation – was not met by persons with disabilities in their rehabilitation process. Conclusion: The study findings indicated a need for the development of a rehabilitation model that will be accessible and will provide an opportunity for participation as well as integration of persons with disabilities with their families as well as their communities. Community-based rehabilitation was seen as a suitable rehabilitation service model for this rural community.
An exploration of lower limb prosthetics service delivery in Namibia in comparison to global standards
(Stellenbosch : Stellenbosch University, 2023-03) Likando, Christopher Mubita; Visagie, Surona; Mji, Gubela; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Background: In 2017, the World Health Organisation published prosthetics and orthotics standards that are aimed at improving prosthetics and orthotics services internationally. The standards are meant to assist member states to improve prosthetics service delivery. The prosthetics standards document calls for the comparison of “the national prosthetics systems and services with the complete set of standards to derive a baseline against which to monitor further development” (WHO, 2017: xxi). Aim: The aim of this study was to explore the status of lower limb prosthetics service delivery in the public healthcare system of Namibia and compare it against the World Health Organisation`s global standards for prosthetics and orthotics. Methods: A sequential mixed methods design was adopted for this study where qualitative (descriptive) and quantitative (cross-sectional survey) data were collected and analysed sequentially. The study was carried out in Namibia's Khomas (urban) and Oshana (rural) regions. Insufficient records necessitated non-probability sampling in both settings and phases. Qualitative data were collected through semi-structured interviews with two service managers, nine service providers, and 16 prosthetics service users guided by interview schedules. Quantitative data were collected from two service managers, ten service providers, and 120 lower limb prosthetics service users. A survey was developed for managers and providers while users completed the TAPES-R. Content analysis was used for the qualitative data. The 60 standards provided deductive themes. Quantitative data was mainly analysed descriptively. Data from the two phases was triangulated and presented together. Findings: Findings showed that 12 of the 60 standards were implemented in Namibia. A further 28 were partially adhered to, while 20 were not implemented at all. Namibia had national policies that guide prosthetic service delivery, but the policies were outdated and not well adhered to. The study established that funding was available but insufficient. There was a wide range of prosthetics products available at no cost to users. Users’ needs were mostly met by available prosthetic products except for the ability to perform vigorous activities and participate in sports, which were limited for 90.8% (n=109) and 87.5% (n=105) of users respectively. Service users 82.6% (n=99) were satisfied with their prosthetic devices and the prostheses allowed them to be economically active 75.0% (n=90). Service providers were well-trained but did not regularly participate in continuous professional development. Training to qualify as a prosthetics service provider was not available in Namibia and in-service training opportunities were scarce. The number of service providers was insufficient. Lower limb prosthetics services were provided to all in need but often this involved long travel distances (mean 258.38 km; sd 265.611) as services at the primary level were not readily available. Users were not involved in policy development and implementation. Experienced users had the choice of products and providers, but first-time users did not. Users were provided with training, follow-up, and repairs. There was little collaboration with other team members during prosthetic rehabilitation. Conclusion: The study showed that more efforts are needed toward improving the delivery of lower limb prosthetics services in Namibia and upgrading them to levels that are in accordance with the World Health Organisation standards. It was concluded that a systems approach, based on the ten ‘Ps’ of systems thinking in assistive technology, could be adopted as a conceptual framework to identify interventions that can be most effective and efficient in efforts to meet the required standards.
An exploration of the development of community health forums as a strategy to improve communication between biomedical health professionals and an indigenous community : a rural participatory action research study
(Stellenbosch : Stellenbosch University, 2021-12) Gxamza, Faniswa Desiree; Mji, Gubela; Reid, Steve; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Rationale: Firstly, the existence of nine (9) clinics and a district hospital in Bomvaneland has been seen by people of this area as both a blessing and a problem as there is poor communication between allopathic health workers and the indigenous community. Allopathic health practitioners (AHP) chastise and marginalize patients who have used indigenous health (IH) prior to visiting allopathic healthcare services. Secondly, the complexity of understanding IH and that indigenous people have a concept of health that is eco-social and often communal, rather than individual. Thirdly, there is lack of institutional spaces where both indigenous knowledge system (IKS) and allopathic healthcare could be discussed for promoting wellness and quality of life of Bomvane people. Aim and Objectives: The study explored and described the development of a Community Health Forum as a strategy to improve communication between allopathic health practitioners and an indigenous community. The main study objectives were to explore and describe: • The process of establishing relationships and development of community partnerships. • Development of community health forums as a strategy to improve communication between allopathic health professionals and an indigenous community. Method: The main methods for data collection were ethnographic and participatory action research (PAR). Using participatory action research in cycles of reflection, the study covered four phases (1-4) to gain consensus on the main aim of the study, study objectives and data collection methods. During community entry and the three conferences (2016, 2018 and 2019), key community stakeholders from the nine (9) sub-municipalities of the research area participated. Mji’s critical research findings were used as a tool to initiate communication. Phase 5 focused on the development of a community health forum and data was collected from four sub-municipalities (Xhora, Gusi, Hobeni and Nkanya). Purposive and snowball sampling was used to select n=37 study participants (12 being allopathic health practitioners, eight indigenous healers and 15 community members). Data-gathering methods for phase 5, included focus group discussions, in-depth interviews, (Chilisa, 2012), journaling and photography. Phase 6 was the last method of data collection which was a conference in 2019 to pilot a community health forum. Findings: The study findings further affirmed the earlier propositions of challenges of communication and poor relationships between allopathic and indigenous health practitioners. When sick, the indigenous community uses both the indigenous and allopathic health practitioners. Some attempts had been made to improve these poor relationships by introducing a referral system, unfortunately this attempt was still not sufficient as it appears only the indigenous health practitioners refer their patients to allopathic health practitioners. This caused indigenous health practitioners to feel they are still not trusted by allopathic health practitioners. An outline was given by participants on the nature of future communication, including a framework that will drive the communication process between allopathic and indigenous health practitioners. At the core of this outline is a need for the communication process to be underpinned by respect for each other’s human dignity. One of the major findings of the study is the development of an Interim community health forum which was achieved in Phase 6 of this study. Mji’s critical research findings further affirmed negative social determinants of health (NSDH) that were blighting AmaBomvane. Unfortunately, it appears that with passage of time these had become worse with fighting of children and sickly older males suffering from ailments due to working in the mines. What gave hope out of this concerning situation is the draft MOU that was developed by the indigenous health practitioners. Within this MOU are guiding principles which are positive social determinants of health (PSDH) to support AmaBomvane to turn around the NSDH to PSDH. Conclusion: The dual health-seeking behaviour of AmaBomvana should not be seen in a negative light by allopathic health practitioners, instead they should try to understand more about indigenous health and its practises. The chastising of indigenous patients when they have consulted indigenous healers results in the silencing of indigenous patients. Communication is at the core of proper diagnosis and subsequent care for the sick patient. The paradigmatic differences that exist between allopathic and indigenous health practitioners might need time to be resolved. The community health forum seems to offer a bridge for these two constituencies to work together in a respectful manner despite their differences. These two healthcare systems need to acknowledge their different practices and come to a realisation that working together may not be possible but working in parallel and focusing on certain areas, such as social determinants of health, would improve the health of Bomvane people. In the wake of Covid-19 Pandemic, the suggested model (CHF) is a way forward for the area.

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