Doctoral Degrees (Psychology)

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    Understanding the needs and experiences of family caregivers of individuals with dementia in Soweto, a South African township
    (Stellenbosch : Stellenbosch University, 2023-12) Mahomed, Aqeela Noor.; Pretorius, Chrisma; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
    ENGLISH ABSTRACT: In an endeavour to comprehensively elucidate the intricate experiences and attendant needs of family caregivers tending to individuals with dementia, an in-depth exploration was undertaken within the unique socio-cultural confines of Soweto, a predominantly Black African township in South Africa. Utilising purposive sampling procedures, an ensemble of thirty family caregivers was interviewed utilizing an open-ended, semi-structured approach. The research drew on Reflective Thematic Analysis (RTA) and the Classifcaton System for Personal Constructs (CSPC) to enhance its analytical rigour. Thus, ensuring a nuanced distillation of essential themes that traversed caregivers' perceptions, challenges, resilience, environmental contingencies, and explicitly stated needs. At the forefront, a paradigmatic shift in the epistemological understanding of dementia emerged. Displacing the historically entrenched cultural or spiritual narratives, there emerged an evolving, sophisticated comprehension of dementia, albeit interspersed with significant caregiving challenges. Importantly, the psychological toll of dementia caregiving precipitated a range of adverse mental health outcomes, most saliently stress, anxiety, and pronounced grief responses. Exacerbating this dynamic was the omnipresent socio-economic milieu emblematic of townships. Issues ranging from entrenched poverty, structural unemployment, endemic crime, and myriad practical challenges served not only as backdrop but as amplifiers to the caregiving burden. Notwithstanding these adversities, caregivers manifested a profound resilience. Their discursive constructs, imbued with themes of mastery, self-efficacy, resilience, and altruistic commitment, underscored their intrinsic adaptive capacities. Yet, it is pivotal to recognize that such resilience, whilst meritorious, necessitates an encompassing support framework to stave of potential deleterious outcomes, including burnout. Caregivers emphasised the need for tailored measures that focus specifically on dementia, both in terms of legislation and interventions. The scope of their advocacy efforts spanned a wide range, including direct service provision, comprehensive psychoeducational initiatives, and capacity-building endeavours. Simultaneously, there was a clear focus on raising awareness at the grassroots level, allocating resources strategically, and implementing comprehensive policy initiatives. The grassroots-level expressions were found to align strongly with the recommended guidelines set forth by Alzheimer's Disease International (ADI) for an effective National Dementia Plan. This underscores the existing lack of policy in South Africa's dementia care system. In conclusion, this doctoral study presents a scholarly and comprehensive analysis of the complex and interconnected relationships between individual psychosocial factors, sociocultural complexity, and broader contextual influences that shape the experience of caring for individuals with dementia in the intricate social environments of South African townships. The findings emphasise the need for a comprehensive intervention strategy that involves many levels, policy adjustments, and a complete restructuring of the system. The act of mobilising and providing assistance to pre-existing community resources, such as the implementation of memory clinics in socioeconomically disadvantaged regions, can play a role in enhancing the quality of care, support, and resources available to families impacted by dementia.
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    Gender identity and gender fluidity amongst low-income transgender and gender diverse people in the Western Cape, South Africa: Implications for HIV service access
    (Stellenbosch : Stellenbosch University, 2023-12) de Villiers, Laing; Swartz, Leslie; Hoddinott, Graeme; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
    ENGLISH ABSTRACT: Transgender women are at high risk for HIV globally. HIV amongst transgender women has been largely under-researched in the South African context. Even less is understood about the experiences and risk levels of a particular group of people who fall under the trans umbrella but do not identify as transgender. These are feminine identifying trans women who have been assigned male sex at birth, termed in this study as transfeminine women. I aimed to understand the lived experiences of transfeminine women in lowincome and high HIV prevalent communities of the Western Cape of South Africa. I conducted a secondary analysis of data from a qualitative cohort nested in an HIV prevention trial. Eight transfeminine participants were repeatedly interviewed over one and a half years using themed discussion guides and participatory methods. The study was a dissertation by publication with the first publication a scoping review, to form part of the literature background of the study. The other three manuscripts were grouped into three themes to contextualise the experiences of transfeminine participants: gender expression, stigma and social support structures. Results from the scoping review showed research that used limited gender identification terms for transfeminine women, and that biologically assigned male sex persons who have a feminine gender identity were either conflated into key population groups of transgender women or men who have sex with men (MSM). We concluded in the gender identity manuscript that gender expression amongst the participants was very fluid and context bound – relating to the people they were relating to, the time and place. We found in the stigma manuscript transfeminine women anticipated, experienced and internalised both gender-related stigma and HIV-related stigma. There were added layers of stigmatisation related to other parts of participants’ social identities, such as being sex workers and their sexual orientation. These factors contributed to difficulty in accessing HIV services. In the social support manuscript we found that in and amongst largely discriminated lived realities, participants could rely on familial and household structures for social support. When the initial family or household unit neglected to support the participant, some participants were able to recreate and re-structure their support systems from peers, friends and extended family members, reorganising their social support structure to be better supported. These are some of the first results from a core sample of transfeminine women in the local South African context, in particular to lived experience around HIV service access, stigma, gender expression and social support. My recommendations are not to identify another sub-group of key-populations, but clearly point to disparities and variation within the key population groups of MSM and transgender. In this case I recommend gender sensitive services, training and intake forms to allow for people to be able to openly express their gender, sexual and other selfidentities. Clearly more work needs to be done with this group, and with sub-groups of key population groups, to allow for inclusion of services for everyone, especially groups such as transfeminine women with a very high HIV risk and low service uptake.
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    Invisibility, informality and impropriety: multi-stakeholder perspectives on the implementation and administration of south africa’s care dependency grant for children with disabilities
    (Stellenbosch : Stellenbosch University, 2023-08) Trafford, Zara Katya; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
    ENGLISH ABSTRACT: The key state-subsidised intervention for the social protection of disabled children in South Africa is the care dependency grant (CDG). Despite its importance to these children and their families, however, the CDG is profoundly under-researched. The CDG is an unconditional cash transfer, available to the primary caregiver of a child who requires full-time care due to their disability. To be eligible, caregivers must have an income below a certain threshold, and their child must undergo assessment by a doctor to gauge the child’s need for care. The CDG is legislated by the national Department of Social Development (DSD) and all grants are managed and distributed by officials at the DSD’s implementation agency, the South African Social Security Agency (SASSA). Additional role-players include social workers, civil society organisations, activists and academics who support and advocate for disabled children and their families. This study aimed to expand the extremely limited evidence base on the CDG by interviewing the abovementioned stakeholders. This dissertation is presented in three parts. Part One includes the study background, a critical literature review and the methods used. Other chapters in Part One assess the translation of international guidelines into local policy and implementation, the importance of context in the design of interventions for disability-related support, and the history of legislation on the CDG. Part Two presents three published articles, which focused on the CDG’s central stakeholders: SASSA officials, assessing doctors and caregivers. These chapters compare how different stakeholders understood CDG eligibility guidelines, application processes, inclusion and exclusion criteria, and related issues, revealing both overlapping and diverging perspectives. Key areas of discussion in these chapters include the measurement of disability and the role of ‘severity’, the role of subjectivity and objectivity in the administration of public benefits, and the (in)sufficiency of income support as a standalone social protection intervention. Part Three contains two chapters that synthesise findings from the desk-based and empirical research conducted for this study and ask more philosophical questions of the data. The first of these final two chapters explores the idea of ‘constructive informality’ in the local implementation of national policy on the CDG. It argues that while the negative dimensions of informality have historically been considered a threat to efficient bureaucracies, ‘constructive informality’ may actually contribute to the achievement of important policy goals. The second of these final two chapters contends that disabled children and their families experience a particularly intense and multi-layered ‘invisibility’ in South Africa, and that the systemic neglect of disabled children is rooted in the discomfort non-disabled adults feel when they ‘gaze upon’ these children. The chapter ends with caregiver’s narratives about their children’s personalities and their own hopes for the future, giving these parents the last word in a study primarily concerned with these families’ wellbeing. Those of us working in this area should commit to observing, documenting and communicating more nuanced stories about disabled children, while continuing to advocate for more material support for these children and their families.
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    Exploring conceptualisations and praxis of community engagement with Stellenbosch University student leaders
    (Stellenbosch : Stellenbosch University, 2023-03) Demas, Grant Henry; Naidoo, Anthony V.; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
    ENGLISH ABSTRACT: Community engagement (CE) is a mandatory enterprise at South African higher education institutions (SAHEIs). One of the main reasons for this is to redress the damaging legacy of apartheid. Historically, these institutions were designed to be complicit in perpetuating the objectives of apartheid, and it is therefore important that due great care be exercised in how these institutions conceptualise and enact CE. This study explored SU students’ conceptualisation and praxis of CE. Twenty-one SU student volunteers in various CE leadership roles, within the ambit of their student club, society, residence, and faculty structures, were individually interviewed with the view to develop a theoretical explanation to explore the question: What is the theoretical explanation for Stellenbosch University students’ conceptualisation and praxis of voluntary community engagement? This was accomplished this by applying a grounded theory approach to analyse each interview transcript until a narrative emerged from the themes that were generated, from which a theoretical explanation was developed. I found that family, faith (religion), school, neighbourhood as formative microsystem contexts, and the broader socio-political and historical macrosystemic context in South Africa shaped this study’s participants’ conceptualisation and praxis of CE. Initially their CE praxis was predominantly motivated by altruistic intentions and then morphed into transactional and, in some cases, transformative ideals, as a consequence of participation in their CE initiatives. This study contributes to understanding the conceptualisation and implementation of CE as it provides a rich description of CE from different perspectives of students volunteering within their club and societies’ structures. It also provides insight into how university structuring of CE can enable and support Stellenbosch University https://scholar.sun.ac.za iii student based voluntary initiatives. The findings suggest that in order to achieve transformative ideals of CE, it is imperative to imbed an awareness of contextual influences and to adequately prepare and consistently support the students who stand in this critical position between the university and its engagement with external organizations and communities.
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    Family relationships and non-resident black South African fathers’ contact with their adolescent children: a study of families with infrequent non-resident father-child contact
    (Stellenbosch : Stellenbosch University, 2023-03) Nell, Erika; Elmien, Lesch; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: Constructive paternal involvement has the potential to greatly contribute to family and child mental health. Many South African fathers, however, do not live with or close to their children and are not benefiting from regular father-child contact. The relationships between non-resident fathers and other members in the larger family system play a significant role in father child contact in general, but especially in Black South African communities where fatherhood is understood to happen to families rather than individuals. Moreover, the quality of the parental relationship is often significantly influenced by the inputs of maternal grandparents or other extended kin. However, the non-resident father as a member of the larger family system, in which his relationships with key family members play an important role in father-child contact, has been neglected in South African family research. This study aimed to address this gap by investigating if and how the quality of relationships with biological children of Black South African non-resident fathers is influenced by the quality of his relationships with key family members. This study was informed by family systems theory and utilised a qualitative research design in which data from multiple family members were obtained. Purposive sampling resulted in the recruitment of ten family systems with four family members participating in the study (N = 40). This included the non-residential father, his adolescent biological child, mother of the child, and extended family member. Individual semi-structured interviews were conducted with each of these members to explore the nature and quality of the father’s contact with the child, mother, and extended family; and how the quality of these relationships impacted father child contact. These interviews were transcribed and Braun and Clarke’s six-phase thematic analysis method was used to identify the following five themes that shed light on infrequent non-resident father-child contact: (i) Fathers as mainly material providers: The dominance of the father as provider discourse negatively affected family relationships and limited father child contact as mothers saw the father’s provision as proof of his affection for his child. (ii) Expectations of fathers beyond provision: Family members acknowledged that fathers have roles beyond provision. They thought that fathers could contribute to children’s well-being by showing interest in their children’s lives and having contact with them, as well as contribute children’s academic functioning. (iii) Responsibility for father-child contact: Mothers, children and extended kin put the onus of father-child contact on the father. Fathers in return awaited the mothers’ contact as indication that their presence was welcome and convenient, but mothers viewed this as ‘forcing’ father-child contact. (iv) Extended kin as father-child contact resource: Stellenbosch University https://scholar.sun.ac.za iii Extended kin supported father-child contact and could be seen as a potential resource. They often acted as intermediaries, provided a physical space for father-child contact and/or waived the payment of damages as a precondition for father-child contact. (v) Changes in families after the interviews: This theme highlights the unexpected and encouraging changes that occurred after the first interviews in terms of increased quality and frequency of father-child contact, as well as increased provision from the father. These shifts suggest that non-resident father families may be open to feedback and able to implement changes toward frequent father-child contact. Some recommendations based on these findings are that more should be done on the macrosystem level to emphasise, promote and support a range of non-resident father contributions to child well-being, providing non-resident fathers with knowledge and skills (that do not involve money) to build father-child connections, and the encouragement and provision of mediation services for non-resident families to assist family members to work together to support constructive non-resident father-child contact