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- ItemLived experiences of caregivers of children with autism spectrum disorder in Kenya(AOSIS, 2019) Cloete, Lizahn; Obaigwa, Evans O.Background: Autism spectrum disorder (ASD) is a global public health concern. In African countries such as Kenya, there is a greater need for establishing support services for developmental disorders such as ASD. The emotional, social and economic burden of ASD on caregivers is unknown because of a number of challenges. Citizens of Kenya have a unique view of disability and inclusion. Objectives: To explore the perspectives of caregivers who are responsible for caring for both family and children living with ASD and to highlight the needs of children with ASD as well as the needs of their caregivers. Method: A qualitative, descriptive phenomenological study utilising focus group discussions (FGDs) was conducted. Verbatim transcription was used. QSR N ’Vivo 10 was used to organise and analyse the data. Content analysis was used to identify important ideas and concepts. Results: One theme, namely ‘the burden of caring for children with ASD’, was identified. Children with ASD and their caregivers experience isolation and stigmatisation. Conclusion: Occupational therapists in Kenya should collaborate with the relevant national and global stakeholders for the promotion of the inclusion of children with ASD and their families. Responsive and context-appropriate occupational therapy interventions may begin to address service barriers.
- ItemExploring the value of mentorship programmes as a preventative strategy for prenatal alcohol use for at risk women in the South Africa(Stellenbosch : Stellenbosch University, 2021-03) Zietsman, Linda; Cloete, Lizahn; Fredericks, Jerome Peter; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.ENGLISH SUMMARY : Introduction: The high prevalence rate of FASD is well-known in South Africa, especially in certain areas in the rural Western Cape with an estimation of about 180-260 children in 1000 being affected. Literature confirms that there is poor recognition and response to the epidemic of FASD, and that a response from public health, which could include occupational therapy, could benefit many. Occupational therapy could be a valuable contributor to maternal health during the prenatal stages considering their holistic, client-centered approach. There have been many preventative strategies implemented to lower the prevalence of FASD, and one of them is by the means of mentorship programmes for at-risk mothers in high-risk communities. At-risk women face many barriers in accessing adequate healthcare services and mentorship programmes could potentially provide the necessary care and support at-risk mothers need to improve their maternal health. There is a need for exploring the value of these mentorship programmes to further assist with the development of successful prevention strategies for FASD. Methodology: A qualitative, explorative case study has been done on community-based mentorship programmes for at-risk mothers in South Africa, with a focus on the Western Cape. The study population has been field experts within the mentorship programmes, as well as mentors and mentees. Data has been collected by the means of an online focus group discussion of field experts (n=4), and SMS-journaling of mentors and mentees over a period of three weeks (n=6). An inductive analysis approach was used. The data was analysed according to themes, sub-themes and codes using content analysis. Ethical clearance has been obtained. Credibility has been ensured by member checking and peer examination. Data triangulation was ensured by using multiple data collection methods. Transferability has been ensured by thick description. Findings: There were four main themes that emerged from the collected data. These themes were (1) “It’s not just a generic programme”, (2) “Our pregnant women are struggling out there”, (3) “It has been a wonderful challenge to be a mentor” and (4) “What I will say that does not work”. Discussion: The most valuable components of a mentorship programme as studied is the client-centered, holistic approach while building empathetic, trustworthy relationships and supporting and empowering the at-risk mothers. This relationship between the above-mentioned components is transactional in nature, and one cannot function without the other. It is also important to consider the contextual challenges that at-risk mothers face in their daily lives, including unemployment, poverty, crime, violence, gangsterism and household abuse which often leads to poor coping mechanisms such alcohol and substance abuse. It is also important for the mentors themselves to feel supported and empowered throughout the mentorship programme to add to the success of a mentorship programme. It also became evident that prevention of FASD should not only start with at-risk mothers, but preventative strategies, such as education for primary school learners, should be implemented. The accessibility of mentorship programmes should also improve to reach more at-risk mothers. Conclusion: In conclusion, mentorship programmes should include a client-centered, holistic approach while building strong relationships between the mentor and the at-risk mother. It is also important to support and empower the at-risk mother as she experiences a range of adversities and challenges and focus should be given to her mental well-being. This requires a shift from the problems within the person, but rather to that of the environment. Occupational therapy can play a vital role in the fields of maternal health and can assist at-risk mothers to achieve client-centered goals and create supportive environments. This could assist in the success of these programmes, and success of these programme could benefit the public health system in decreasing the prevalence of FASD in those communities.
- ItemFemale mental health care users perspectives of their occupational engagement at a tertiary psychiatric facility(Stellenbosch : Stellenbosch University, 2021-03) Sonday, Haseena; Cloete, Lizahn; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.ENGLISH SUMMARY : Introduction: The prevalence of mental illness, burden of disease in South Africa is increasingly high, a global trend amongst other low-and middle-income countries, affecting more females than males. Poverty, crime, intimate partner violence and the existence and co-morbidities, such as HIV, make people in previously disadvantage areas, particularly females, more vulnerable to mental illness. South Africa’s legislation, and vision for mental health, outlined in Healthcare 2030 exemplified the improvement of tertiary psychiatric services and patient experience, in the face of decentralisation. Despite this, readmission rates remain high, a complex phenomenon, for which the reasons are multifaceted. One of the reasons cited is that the lack of meaningful occupational engagement for patients in mental health care leads to a deterioration of mental health and subsequent relapse and readmission. The aim of the study is to explore female mental health care users’ perspectives of their occupational engagement in the pre-discharge ward at a tertiary psychiatric facility. Methodology: The study is grounded in a constructivist paradigm. A qualitative method of inquiry investigates the subjective underpinnings of meaningful occupational engagement of mental health care users. The collective case study used data from interviews, the Activities Clock, participant observations and the programme in the pre-discharge ward. Five (n=5) participants were included in the collective case study. Inductive analysis was used to analyse data. A four phased analytical strategy, thematic, content, within-case and across-case analyses was performed. Credibility was ensured through member checking. Data triangulation was ensured by using multiple data sources. An audit trail and thick descriptions were used to ensure transferability. The findings of the study were verified amongst other researchers in the field, ensuring confirmability. Reflexive journaling was used to bracket the researcher’s thoughts and feelings. The study received ethical approval and adhered to sound ethical practices. Findings: Two themes emerged. The first theme, “this is not a prison, it’s a hospital”, demonstrated mental health care users’ experience of dehumanisation in the pre-discharge environment. Mental health care users experienced gross human rights violations in the number of restrictions they were subject to, the lack of privacy and freedom enforced by staff in the pre-discharge ward. The second theme, “we need to do more” highlights that mental health care users were unstimulated, bored, and frustrated in the pre-discharge ward. There were not enough opportunities for meaningful occupational engagement in the pre-discharge ward. Discussion: Tertiary psychiatric facilities situated in the medical model violated the occupational and human rights of mental health care users and creates an environment ill conductive for occupation-based practice. Navigating mental health care users’ rights to freedom and privacy, with the responsibility of healthcare providers to offer a safe and caring environment, that is supportive of the recovery of mental health care users in the pre-discharge ward, remains a challenge. Conclusion: Tertiary psychiatric services should embrace a shift in paradigm from a dominantly medical model towards an occupation-based practice and recovery approach, in an environment that is less restrictive, that creates opportunities for meaningful occupational engagement, within a human and occupational rights framework.
- ItemThe strategies and barriers addressed by occupational therapists in the process of successful work-related transitions for clients who have sustained serious hand injuries(Stellenbosch : Stellenbosch University, 2020-03) Uys, Michelle Elizabeth; Van Niekerk, Lana; Buchanan, Helen; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.ENGLISH ABSTRACT : Introduction. The socio-economic burden of a hand injury in South Africa is substantial. Occupational therapists who facilitate work-related transitions after a hand injury require contextually relevant and robust evidence to inform their clinical practice. Aim. The thesis aimed to understand the strategies employed by occupational therapists to facilitate successful work-related transitions for people with serious hand injuries in both the government and private sectors of South Africa. Methods. A concurrent mixed-methods approach was used. The thesis comprised three phases’ a scoping review, a survey and a collective case design informed by phenomenological principles. The scoping review captured sources published between 2008 and 2018 across fourteen databases. The data was analysed descriptively and was used to inform a survey used in the second phase. The survey made use of a descriptive cross-sectional research design. The questionnaire was piloted. The data were exported from SUsurveys into Microsoft Excel for analysis. Phase three was a collective case design informed by phenomenological principles. Each of the four cases identified through purposive sampling comprised of an occupational therapist and client, amounting to eight participants. Sixteen interviews took place. Data was thematically analysed. Findings. Fifteen studies from 16 countries (14 high- and two upper-middle income) were identified in the scoping review. These revealed four strategies to facilitate work-related transitions and four factors that contributed to their success. No sources were found that detailed the different types of work-related transitions. Three themes emerged in the qualitative study: the acute rehabilitation phase, the pre-occupational phase and the occupational phase. A process model was developed to illustrate the phases through which participants transitioned. The least used strategies were issuing assistive devices for work, a worksite visit, observing a client completing work tasks and implementing a work trial. Financial support and compensation were seen as both an asset and a barrier. Conclusion. The absence of literature from low- and middle-income countries is likely to restrict the evidence-based practice in these countries, as interventions used in high-income countries may not be feasible in these contexts. In clinical practice, an occupation-based approach for work-related transitions is optimal. Collaboration with employers and co-workers enhances service delivery. Clients were positively impacted by the occupational therapists to successfully transition to work. In a country with high levels of unemployment, occupational therapists can contribute to facilitating work-related transitions despite the barriers identified.
- ItemExploring the transition from student to clinician by the first cohort of locally trained occupational therapists in Ghana(Stellenbosch : Stellenbosch University, 2020-03) Nkansah, Opoku Eric; Van Niekerk, Lana; Jacobs-Nzuzi Khuabi, Lee-Ann; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.ENGLISH ABSTRACT: Background : The nature of a new clinician’s transition from student to clinician is a significant determinant of the ease or difficulty of the journey to professional competence. Transition into practice for the new graduate has been described as a complex experience characterised by periods of stress and anxiety. In Ghana, after several failed attempts to establish occupational therapy services, the Ministry of Health in collaboration with the University of Ghana started an undergraduate programme in Occupational Therapy in 2012 (the first of its kind in the West African sub-region) to educate occupational therapists locally. This exploration of the experiences of transition into practice for the first cohort of locally trained occupational therapists was important because they worked autonomously and in a self-directed manner in their first year of practice after graduation, in a country where occupational therapy had not been established. Aims and objectives: The aim was to explore the experiences of the first cohorts of locally trained occupational therapists during transition from being students to clinicians within the first year of their practice in Ghana. The objectives were to explore the challenges and facilitators of their transition, the coping strategies employed to effectively manage the challenges they encountered and their experiences of continued professional competence. Methodology: The research comprised of three stages; stage one was to develop a systematic scoping review protocol to explore the factors that affect new clinicians’ transitions into practice. In stage two, the scoping review was conducted to synthesize literature published in the last two decades on the transitions of new clinicians into practice. The focus was to determine the challenges and facilitators of new clinicians’ transitions from student to clinician and the evidence-based coping strategies that can be employed to ease the transition. Stage three was a phenomenological study aimed at exploring the transition from students to clinicians by the first cohort of occupational therapists in Ghana. Two in-depth interviews were done with each participant. Inductive content analysis was used to analyse the data into four overarching themes. Ethical approval was obtained from the Health Research Ethics Committee of Stellenbosch University prior to conducting this study. Results: In the scoping review, 562 studies were initially identified, relevant data was extracted from 24 studies that met the inclusion criteria and were analysed to form this review. Four overarching themes emerged namely: systems and structures, personal capacities, professional competence and mediating processes. Each theme revealed the barriers, facilitators and coping strategies of transition into practice among new health graduates. In the phenomenological study, four themes emerged: ‘Being “new” in a new profession’, ‘Introducing occupational therapy into a medical model health system’, ‘Personal and professional competence,’ and “The future is bright”. New graduates found continued professional competence activities essential for successful transition into practice. Conclusions and recommendations: New graduates needed assistance to translate knowledge into practice. New graduates lacked adequate supervision given the lack of practicing occupational therapists to fulfill supervisory roles. What was evident from the findings is that, well-organized collaboration between undergraduate university educators, leadership and management of health facilities, other health professionals and the new graduates can facilitate a successful transition into practice. Future research is needed to explore the transition of other cohorts of occupational therapy graduates to explore if they had similar experiences. This will allow for a more holistic understanding of students transition into practice to generate further suggestions to enrich occupational therapy education and practice in Ghana.