<p>Namibia is severely affected by the HIV/AIDS epidemic, with an estimated HIV prevalence of 17.8%. A comprehensive, public HIV/AIDS treatment and care programme was established in 2003 by the government of Namibia in association with its development partners. The introduction of antiretroviral therapy [ART] has dramatically decreased HIVrelated mortality and morbidity, improved quality of life, revitalized communities and transformed perceptions of HIV/AIDS from a plaque and death sentence to a manageable chronic condition. Intermediate Hospital Oshakati (IHO) in the Oshana region, is one of the six pilot hospitals where highly antiretroviral therapy (HAART) was initiated. Adherence to antiretroviral therapy (ART) is a key factor in ensuring optimal clinical outcomes and is associated with improved survival among HIV and AIDS patients. Sustained high levels of adherence (taking 95% or more of medication as prescribed) are essential for treatment success. Suboptimal adherence to treatment has been associated with virologic, immunologic and clinical failure, and may increase the risk of resistance to first-line ART drugs. Studies conducted in various parts of the country including the Oshakati district, report small proportions of patients defaulting on ART. Defaulting from treatment raises questions about adherence to ART as it can be assumed that poor adherence would precede defaulting from treatment. This study explored factors that influence poor adherence to ART among patients at Intermediate Hospital Oshakati.</p>

Results from assessment on the SIPT and sensory profile were discussed with reference to earlier studies and available literature on long term effects of childhood cancer treatment and literature on sensory processing disorders. SIPT SD scores in domains of function, as determined by the grouping of SIPT tests were discussed. The scores obtained by members of the study population receiving chemotherapy documented in previous studies and the literature review was discussed in each domain of function. The prevalence of members of the study population in each SIPT diagnostic group was discussed, with the most prevalent disorders being visuo- and somatodyspraxia and generalised sensory integrative disorder. No conclusive results were obtained in analysis of scores in partial patterns of sensory processing disorders. Behavioural observations made in testing were indicative of difficulties with modulation of sensory information, specifically in the tactile sense, and inability to cope with demands of testing. Clinical observations made indicate inadequate vestibular and proprioceptive processing, and the possible functional implication of this is discussed. The hand function, bilateral hand skill test performance and observations made in the behaviour and test scores of members of the study population receiving chemotherapy through peripheral lines is discussed.

The aim of this study was to investigate the job satisfaction status of occupational therapists in the Public Health Sector (PHS) of the Free State (FS). For the purpose of this study, job satisfaction referred to the occupational therapistâs perception of the fulfillment and gratification experienced while doing their work within the context of the PHS. A scientific inquiry was instigated to assess and address the job satisfaction of occupational therapists in the PHS of which the researcher, at the time of the study, was part. Employees of the PHS at that time seemed to suffer from low morale and the frequency with which occupational therapists became disillusioned with either the profession or the PHS was worrisome. The investigation was conducted by making use of multiple research methods namely questionnaires for the quantitative typical descriptive study design and semi-structured interviews for the qualitative phenomenological study design. Electronic self-administrative questionnaires were distributed to all the occupational therapists in the service of the Free State Department of Health in November 2008. Thirty-five (n=35) questionnaires were used for the analysis of quantitative data. In augmentation to this base-line data gathered, semistructured interviews with an opening question and an interview schedule were conducted among fifteen occupational therapists practicing in the PHS of the FS between November and December 2008. The thirty-five respondents in the quantitative investigation, as well as the sixteen participants in the semi-structured interviews, represented a largely homogenous group of white, Afrikaans-speaking females on senior, chief and assistant manager level. Community service occupational therapists who had already completed at least six monthsâ tenure were also included. Only occupational therapists directly involved in clinical services were eligible to participate in the study. The results of the study showed that the occupational therapists in the PHS of the FS experienced low levels of job satisfaction. This was found to be in contrast with most other studies conducted on the job satisfaction of occupational therapists in other parts of the world. This disparity was clarified when the contextual factors of the PHS such as; inadequate resources, excessive red-tape, poor management and an undesirable working environment were configured. The results and findings showed that the afore-mentioned facets were sources of dissatisfaction for the participants and consequently increased their job dissatisfaction. More so however, the main causes of the occupational therapists dissatisfaction were; the low status of occupational therapy as a profession and poor salary. Inadequate career-paths and disillusionment with the current performance appraisal system of the PHS added to further dissatisfaction for the participants in this study. The main source of the occupational therapistsâ satisfaction with the job was that of âworking with people, making a difference and experiencing success with clientsâ. Secondary facets of satisfaction were the relationships colleagues had with each other, inherent characteristics of the profession such as autonomy, creativity, diversity and to a lesser degree some advantages to working in the PHS such as fringe benefits and job/income security. In conclusion it was found that the job satisfaction status of the occupational therapists in the PHS of the FS was low. This was mainly due to the influence of contextual factors and not with regards to profession itself. As was the last objective of the study, extensive recommendations were made to redress the balance between job satisfaction and dissatisfaction for this population.

The mental health care user (MHCU) with psychosis presents with various restrictions in his/her occupational performance components (OPCâs) and occupational performance areas (OPAâs). Restricted motivation, inappropriate affect and sensory-motor problems, together with poor cognition, cause inability in directedness towards activity that leads to poor execution of tasks (Reed, 2001:821-823). These restrictions in OPCâs lead to restrictions in OPAâs, and therefore negatively affect the MHCUâs occupation. This negative effect compromises the promotion of Occupational Therapy goals with this population, as well as integration in the community and prognosis (Sue, Sue & Sue, 2006:421). In the field of psychiatry, music is used by music therapists to treat psychiatric illnesses. The effect of slow versus fast tempo music, together with activity, during Occupational Therapy treatment of the MHCU with psychosis was investigated by using a quantitative, experimental study design. The focus was specifically on MHCUâs with agitated symptoms versus MHCUâs with inhibited symptoms during the psychotic phase. The Ethics Committee of the Faculty of Health Sciences, University of the Free State, approved the study (ETOVS 23/9). Data was collected between October 2009 and September 2010 at the Free State Psychiatric Hospital (FSPC). Hundred and sixty (160) MHCUâs with psychosis, admitted in block A and C of FSPC, participated in the study. The median ages of the study population varied between 27.5 and 30.5 years in the four groups and 72.0% of the participants were male. The participants were included in the study after being evaluated by the inclusion criteria checklist. The MHCUâs were divided into two experimental groups by a process of randomisation. The groups did not contain more that four members and agitated, as well as inhibited MHCUâs could be included in one group. The activity participation of the MHCUâs, in terms of attention, following of instructions, directedness towards activity and willingness to participate, as well as behavior was evaluated by three evaluators by means of a pretest, composed by the researcher. Thereafter the two groups were exposed to either fast or slow tempo music, during Occupational Therapy intervention (creative leatherwork activity). The post test, evaluating the same components and behavior, followed and was administered by the same evaluators. The blood pressure and pulse rate of each participant were also measured and noted during the execution of the group. Results were analysed and presented in four groups. Department of Biostatistics, University of the Free State, analysed the data of the study.

South African childrenâs performance in reading, numeracy and writing performance is well below expected levels. In the Quality Improvement, Development, Support and Upliftment Programme Baseline Study (QIDS-UP) conducted in the Free State in March 2008, the results for the Grade 3s in respect of literacy and numeracy were 43,32% and 38,24% respectively. There are a myriad of reasons why learners are unable to read and write, among which educatorsâ knowledge and attitudes could be contributing factors. A significant conceptual change to the Inclusive Education System is the early identification of learners with barriers, such as developmental delays, and the subsequent support of such learners. Developmental delays can become evident in writing, numeracy and reading deficits in scholastic tasks. Occupational therapists do not remediate the reading or writing delays, but assess a child to determine the underlying performance skills delays that cause the scholastic problem. Currently, there is only one occupational therapist working for the Free State Department of Education at the district level. An effective means of delivering occupational therapy services within this particular context would be to empower educators to identify, manage and support learners who demonstrate poor performance skills. This research attempted to determine educatorsâ knowledge and attitudes regarding the age-appropriate performance skills of a typical Grade 1 learner. This was a cross-sectional study involving a stratified, randomly selected sample of 48 of the 257 schools in the Motheo District. All the Grade 1 educators at the selected schools were requested to complete a questionnaire designed by the researcher. The questionnaire was developed by considering the age-appropriate performance skills that underlie the scholastic skills of a Grade 1 learner and further by extracting the associated Grade 1 outcomes from the National Curriculum Statement with which educators are familiar. This research focused on the following components: gross-motor, fine-motor and cognitive skills. Educatorsâ attitudes regarding behavioural, cognitive and affective aspects were determined. The sample comprised 117 educators of whom 47,3% had completed their training more than 20 years before. Only 18,8% had a four-year qualification, the minimum requirement for educators. The mean age of the participants was 46,6 years. The mean for Grade 1 teaching experience was 88 months, while the median for Foundation Phase teaching experience was 16,6 years. The mean number of learners per class was 42 (ranging between 21 and 67). The medians of the total correct scores for knowledge regarding gross-motor skills, fine-motor skills and cognitive skills were 25,0%, 25% and 28,6% respectively. There were 2,6% who could not answer any questions correctly and 91,5 % of the educators scored below 46,7% on the composite knowledge score. The highest score (66,7%) was obtained by 2,6% of the educators. Educators were found to have a generally positive attitude in respect of support to learners experiencing performance-skills delays (mean = 80,0%). Relationships were determined between training, experience, knowledge and attitude. It was evident that as the number of years of training increased, so attitude improved (p=0.0321). No relationship was apparent between training and knowledge, nor between experience and knowledge or attitude. The poor scores for the identification of motor and cognitive skills could indicate that educators will not be able to identify learners with barriers in their classes. The exceptionally positive attitudes found among educators could have resulted from this lack of knowledge, which, in turn, led to skewed perceptions regarding the demands of teaching learners with barriers and developmental delays. These findings will guide the researcher to develop educator-friendly and purposeful training that will empower educators to identify and support learners who present with delays in development. The important role that the occupational therapist at the district level should play in supporting educators and learners to embrace inclusive practices was also emphasised.

Various patients with mental health disorders display problematic anger experiences and anger behaviour (DiGuiseppe & Tafrate, 2007:9). Many people with high anger tendencies appear to abuse substances on regular basis (Tafrate et al., 2002:1585). It seems as if the sensory processing patterns of substance abusers are clinically significant (Quadling et al., 1999:12). Sensory processing is reflected in peopleâs moods, temperament and ways in which they organise their lives (Dunn, 2001:609). Relationships between sensory processing, anger experiences and anger behaviour were investigated in substance abusers, using a quantitative cross-sectional research design. The Ethics Committee of the Faculty of Health Sciences, University of the Free State, approved the study. (ETOVS nr. 133/08). Data was collected between 1 October 2008 en 29 May 2009 at Stabilis Treatment Centre and Denmar Specialist Psychiatric Hospital. The study was piloted at both institutions and these results were included into the studyâs results. Eighty four in-patients, with a history of substance abuse, voluntarily participated in the study. Convenience sampling was used and the majority of participants spoke Afrikaans (64%), were male (68%) and had abused alcohol (66%). Participantsâ average age was 36 years and 6 months. The participants completed three questionnaires. Questionnaire one collected demographic information. Participantsâ sensory processing was assessed through completing the Adolescent/Adult Sensory Profile. The anger questionnaire was compiled, based on indicators from literature and assessed the intensity of anger experiences in situations related to sensory processing behaviours and the frequency of anger behaviour. Anger behaviour was investigated with regards to: expressing anger verbally, expressing anger physically, withdrawing from the angering situation, using substances when experiencing anger, suppressing anger, expressing anger non-verbally and applying calming strategies. Department Biostatistics, University of the Free State, analysed the data of the study. According to the results it appeared as if participantsâ could experience high intensity levels of anger in situations related to their: ⢠low registration behaviour more than the typical norm, in vestibular, visual and auditory processing, ⢠sensory sensitive behaviour more than the typical norm, in vestibular, touch and auditory processing and ⢠sensory avoiding behaviour more than the typical norm in touch and auditory processing, as well as activities that did not provide for sensory avoiding behaviours. The results further indicated that participants with low registration patterns more than the typical norm of this quadrant, regularly used substances when they were angry and regularly expressed their anger verbally and physically. With regards to participants with sensory avoiding patterns more than the typical norm of this quadrant, results indicated that they regularly withdrew from angering situations, suppressed their anger, expressed their anger non-verbally, applied calming strategies and used substances when experiencing anger. A need for further research was indicated with regards to the relationships between sensory seeking patterns and anger behaviour. Ongoing research with regards to adult clinical populationsâ sensory processing appears to be worthwhile. Occupational therapists should consider assessing their adult patients, with problematic anger (like substance abusers), sensory processing and if necessary integrate it into treatment.

This study aimed to investigate the effect of ASI intervention on the development of premature infants with ELBW to VLBW, within the first 12 months. ASI intervention approach is from the sensory integration theoretical and practice frame of reference used in occupational therapy. ASI provides playful meaningful activities aimed at enhancing sensory processing abilities of the brain and ultimately lead to appropriate adaptive functioning in daily life. From the literature review it was evident that newborn premature infants are at risk for possible SI difficulties and developmental delays due to their immature CNS and possible times of medical instability, discomfort, pain and stress during the first weeks or months after birth. Research on effective developmental intervention strategies for premature infants is however limited and previous research related to ASI intervention on the development of the premature infant post discharge from the NICU could not be found by the researcher. Since SI forms the underlying foundation for learning and social behavior (Ayers, 2008:7), research in this field is essential for prevention of developmental delays and learning difficulties of premature infants. The research proposal for this study was approved by the Ethics Committee, Faculty of Health Sciences of the University of the Free State (ECUFS no. 117/2011). Permission was obtained from appropriate authorities to conduct the study at the Occupational Therapy Department of Universitas Academic Hospital. A pilot study was done to determine the feasibility of the study. A quantitative research approach was used to determine the effect of ASI intervention on the development of the ELBW to VLBW premature infant. Through a pre-test/post-test experimental design, the population of 24 premature infants was randomly divided into an experimental and control group with 12 infants in each group respectively. Infants were matched according to their corrected ages and gender. Participants had corrected ages between four and 10 months, VLBW to ELBW, adhered to the inclusion criteria for the study and were referred from the High-Risk Infant Clinic at Universitas Academic Hospital. The developmental status of participants was determined with the Bayley III Scales of Infant and Toddler Development (Bayley, 2006a), Test of Sensory Function in Infants (TSFI) (DeGangi & Greenspan, 1989) and Infant /Toddler Sensory Profile (Dunn, 2002) before and after a 10 week ASI intervention period with infants in the experimental group. The results of the Fidelity Measure indicated that the interventions sessions complied with the requirements for ASI intervention. The pre- and post-test results were analyzed, interpreted and compared. The anthropometric and demographic profiles of the infants in both groups indicated that there was no statistical difference between the two groups except for the time hospitalized which was in favour of the control group and therefore the researcher was able to make reliable conclusions in terms of the study results. This study has found that ASI intervention had a positive effect on the sensory processing and developmental progress of ELBW to VLBW premature infants especially in terms of cognitive-, language-, motor- and adaptive behaviour development within a short period of 10 weeks. Parents showed more interest and a better understanding of the developmental progress and sensory processing of their infants. This study has therefore provided sufficient evidence that early intervention in terms of ASI plays a critical role in the intervention approach of the sensory integration trained occupational therapists, working with premature infants and their parents. The study results did not only indicate the importance of ASI intervention for better developmental outcomes for ELBW to VLBW premature infants, but also revealed that a lack of ASI intervention leads to a deterioration of developmental and behavioural outcomes.

The aim of this study was to explore the occupations and socio-cultural context of the Sesotho speaking adult with mental health problems, attending either of the group therapy programs at The Clinic or The Second Clinic (both psychiatric hospitals in the Free State, South Africa). This exploration was undertaken due to a lack of literature and formal guidance on providing culturally relevant and meaningful therapy to the Sesotho speaking adult with mental health problems. Most sources of literature on occupational therapy in the field of mental health, originates in Western societies, specifically the United States of America and the United Kingdom; and are therefore not directly applicable to practice settings in South Africa. Since the researcher wanted to âunderstandâ more about the daily experiences of the Sesotho speaking adult with mental health problems, a qualitative study of interpretive nature was conducted, with a collective case study as the strategy of inquiry. The first set of data was captured by conducting individual interviews with volunteering Sesotho adults as the sample. These interviews were based on the Kawa Model, a conceptual model of occupational therapy which uses the metaphor of âlife as riverâ. The sample of patients that participated in the individual interviews, consisted of Sesotho speaking adults with mental health problems, admitted to The Clinic by psychiatrists. All participants were permanently employed, in jobs ranging from teaching and policing, to traffic officers and performance managers. Data collected during the interviews based on the Kawa Model, needed to be supplemented specifically regarded the socio-cultural context of the Sesotho-speaking patient at The Clinic. A focus group interview was then conducted at The Second Clinic, to further explore the themes identified in the interviews. The sample of patients for the focus group at The Second Clinic, was included according to the same selection criteria than with the individual interviews, and the sample was very similar to that of the individual interviews at The Clinic. Data was analyzed by the researcher and two co-coders. The interpretive thematic analysis approach was used to first analyze the transcriptions of individual interviews, and thereafter the focus group interview. Findings elaborated on the occupations and socio-cultural context of participants, as per the aim of the study. Participants were found to experience much stress at work, relating to strained interpersonal relationships. At the same time, their personal finances, family responsibilities and lack of sleep were found to be stressors. Participation in leisure, as well as experiencing work and family as sources of support (in spite of also regarding those as stressors), were regarded as positives in their daily occupational participation. Values that may influence occupational participation, were described as involvement in community and family; having a positive mindset and an active spiritual life. The participantsâ socio-cultural context was described as a context containing habits and âways of doingâ with a strong influence on their occupations and relationships. In conclusion, recommendations towards culturally relevant therapy, were made. These recommendations included suggestions for the content of an occupational therapy program, as well as suggestions for presenting such a program appropriately for the Sesotho speaking person with mental health problems. The limitations of the study were acknowledged and discussed, and recommendations for future research were set out.

<p>Many individuals with nonfluent aphasia experience social isolation and depression as a result of their communication impairments. For these individuals, the use of communicative drawing and other communication modalities may potentially overcome barriers to social isolation. This thesis describes a single case, time series design used to evaluate the effectiveness of a drawing treatment program that simultaneously targets drawing recognizability and the use of drawing outside of the structured therapy tasks for an individual with nonfluent aphasia. Results indicated a general improvement in drawing recognizability and an increase in the use of drawing within conversation. Additionally, these results were maintained 8 weeks following the end of therapy. The author discusses these results in relation to the current body of research in the area of aphasia rehabilitation, as well as possible avenues for future research. </p>

There is no abstract available for this thesis.