Background: Caregiver self-efficacy (CSE) supports the capabilities of caregivers to engage in parenting activities including stimulating development in their children. Human immunodeficiency virus (HIV) remains a prevalent concern in South Africa, even with the use of antiretroviral treatment. Children with HIV are compromised in their health and development which adds to the general stress of families rearing HIV-positive children. Stress has a negative effect on CSE. However, studies indicate that CSE can be improved through parent-mediated intervention. Caregivers’ engagement in the intervention may grow their skills to promote development in their HIV-positive children. This may have a positive influence on CSE. Occupational therapists working in governmental paediatric HIV clinics developed a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for HIV affected families to be implemented. This study evaluates the effectiveness of PICIHBI on CSE. Aim: The aim of the study is to determine if the CSE levels in a group of caregivers of HIV-positive children aged 6 months to 8 years 0 months on ART, after receiving play-informed caregiver-implemented home-based intervention (PICIHBI) are not inferior to CSE levels in an equivalent group of caregivers with children receiving conventional one-on-one occupational therapy. Method: The study applied a pragmatic, randomised control trial with caregiver-child dyads attending the antiretroviral clinic at Groote Schuur Hospital, Cape Town. The control group received conventional child-directed occupational therapy on an individual basis and the experimental group received caregiver-directed, PICIHBI in a group format. The Parenting Self-Efficacy Measure (P-SEMI), Parenting Sense of Competency (PSOC) scale, and the General Self-Efficacy Scale (GSE) measured self-efficacy at baseline, half way and at the end of the yearlong, monthly interventions. Results: Sixty-four caregiver-child dyads were recruited and assessed at baseline. Thirty-nine dyads were retained in the study, completing the measures at all three test points. Results revealed that baseline CSE was high for both groups. There was a significant change (p < .001) in the P-SEMI total scale in both groups from baseline to mid-test and mid-test to post-test. In both groups the CSE scores decreased from baseline to mid-test and then increased from mid-test to post-test. There was not a significant difference in CSE results between baseline and post-test on the P-SEMI total scale for either groups. There were no significant differences between test points for the other scales and subscales for both groups. Conclusion: The results suggest that PICIHBI has a non-inferior effect on CSE to that of conventional occupational therapy. This suggests that PICIHBI is comparable to conventional occupational therapy and could be implemented as an alternative intervention without comprising the effects on CSE. Employing PICIHBI as an alternative intervention could provide a number of benefits including the development of caregiver skills, a larger reach within the population, and contextually driven intervention that is embedded in children’s home environments. Various influencing factors are proposed to explain the patterns of CSE demonstrated in the groups. Neither group showed a significant increase in CSE from baseline to post-test and thus further investigation and intervention development is required to specifically demonstrate enhanced CSE in this context. Intervention attendance for both groups was poor. This is the first investigation on the effects of PICIHBI on CSE which can inform further research to develop best occupational therapy practice in the vast population of HIV affected families.

Includes bibliographical references. / Although various measures, such as the Prevention of Mother to Child Transmission (PMTCT) programme, have been put in place to combat the spread of HIV/AIDS, there are still many cases of children, in Zimbabwe, being born infected with HIV. Children born to HIV parents are reported to be at risk of having neurodevelopmental disorders (NDDs), which can reduce independence in activities of daily living by imposing varying limitations on these children. Technological advances in the field of HIV/AIDS have resulted in prolonged life for people infected with HIV/AIDS and therefore there is a growing population of mothers caring for their biologic al children who are infected with HIV. The aim of this study is focused on exploring the experiences of being a mother and caring for a child with HIV-related NDDs in Zimbabwe. Specific objectives were to describe the mothers’ experiences of engaging in the daily occupations of caring for a child with NDDs; to explore and describe factors that the mothers’ perceived to impact on their experiences while caring for their children and how these experiences of caring shape the mothers ’ own occupational identities and engagement. A descriptive phenomenological approach was designed to uncover their lived experience s of caring for a child with HIV - related NDDs. In-depth data was generated from phenomenological interviews conducted with five biological mothers who have been caring for their own children who have been diagnosed with HIV - related NDDs. A thematic analysis, guided by a simplified version of the Stevick - Colaizz - Keen method, was employed. The findings revealed the transactional nature of the mothers ’ experiences of the occupation of caring for a child with HIV - related NDD. Personal factors interacted with contextual factors such as stigma, culture and socioeconomics to shape their caring experiences, making caring for their child, a difficult and demanding role that they could not easily entrust to another. Although the mothers voiced that this caring was comprised of many burdensome tasks, the mothers reframe d the concept of the caregiver burden because they placed high value on and drew meaning from being a good mother to their child, thus making it an occupation that they would not readily entrust to another. The findings of this study encourage occupational therapists to consider carefully the resilience of these mothers and how their role as carers positively shape s their identities in the design of interventions for the mothers.

The purpose of the study was to determine the relationship between leisure boredom and substance use in adolescents attending high school in Cape Town. The degree of leisure boredom experienced by adolescents was investigated, as well as the extent to which boredom is associated with alcohol use, cigarette smoking and cannabis use, gender, grade and race. A stratified sample of 39 high schools in and around Cape Town was selected, using the postal distribution areas as stratification criteria. Students were then randomly selected from two Grade 8 and two Grade 11 classes at these schools, producing a sample of 621 adolescents. Data were gathered using two instruments: the Leisure Boredom Scale which is a self-report scale consisting of 16 items, with demonstrated reliability and validity (Iso-Ahola and Weissinger, 1990); and a questionnaire which was used to obtain demographic data and substance use data (Flisher et al. 1993). These were self-report questionnaires, available in English, Xhosa and Afrikaans, and were completed by students during two consecutive school periods. Administrations took place during the second and third school quarters of 1997. The results of the study showed that leisure boredom was significantly associated with gender (p = 0.003), race (p = 0.000) and alcohol use (p = 0.031). Further analysis showed no significant association between leisure boredom and substance use when controlling for demographic variables. Female adolescents, younger adolescents and black adolescents experienced the highest degree of leisure boredom and may be at risk of using substances as an exciting way of alleviating boredom. Recommendations are that leisure education programmes should be incorporated into lifeskills programmes at high schools, as part of a "lifestyles approach" (Flisher et al. 1996) to dealing with substance use in adolescents. Leisure education programmes should enable adolescents to explore different leisure activities, structure their leisure time constructively, and to become aware of the value of leisure in personal development. Occupational therapists, as part of their role in health promotion, should form partnerships with teachers and parents in order to implement these programmes effectively. Finally, adequate leisure resources for adolescents should be developed, particularly within the more disadvantaged communities in Cape Town.

Includes abstract. / Includes bibliographical references (leaves 95-100). / As an occupational therapist enjoying recreational cycling, I became aware of the potential positive value of participation in cycling. Cycling, however, is considered an elite sport, with participation reserved for those who can afford it. The Cycling Club is a Subsection 21 company (Not for Profit Organisation) attempting to bridge this problem through the promotion of cycling in South Africa’s poorest communities. They provide opportunities for young people from disadvantaged communities to participate in cycling. Their aim is twofold: to help youth develop their skills as cyclists; and to enable them to develop their potential as human resources through their participation in the programme. Taking an occupational perspective, it has been proposed that occupational engagement in meaningful occupations can contribute to the development of people as individuals and members of society. Yet, one should be cautious not to assume that participation in cycling will necessarily result in change for cyclists and that all contributions are necessarily experienced as positive. Every cyclist is a unique individual coming from a particular context which, through participation in cycling, results in certain experiences. Consequently, this study intended to uncover the experiences of young cyclists from disadvantaged communities participating in professional cycling.

BACKGROUND: Cycling has become increasingly popular as a recreational and competitive sport, and the positive health benefits of cycling are well known. However, there are negative health effects associated with cycling. Exercise induced muscle damage (EIMD) and fatigue are common in cycling populations, and require a period of recovery so as not to progress into more serious chronic injury and overtraining, and allow for improved performance through adaptation. There are many recovery methods currently available to facilitate this recovery process. However, there is little information regarding the use of these modalities, and further, the understanding of these modalities. An understanding of the specific use of recovery modalities in cycling is necessary to guide further research, and to promote safe and efficient use of recovery strategies. AIM AND OBJECTIVES: The aim of this study was to describe the use of recovery interventions in road and mountain bike (MTB) cyclists in South Africa. The specific objectives of this study were: (a) to determine the pattern of use of recovery modalities by endurance cyclists, specifically which modalities are being used, the frequency of use of each modality, and the use of each modality during training and races; (b) to determine the factors that influence road and MTB endurance cyclists' choices of recovery modalities and the rationale for use of specific recovery modalities; (c) to explore associations between the use of recovery modalities by road and MTB endurance cyclists and socio-demographic factors such as gender, age, body mass index (BMI), monthly income, level of education; and training and competition history. METHODS: This study had a descriptive, cross-sectional correlational design. Healthy adult cyclists who had been cycling for at least six months of the previous two years were included in the study. Participants who failed to provide informed consent or did not complete mandatory sections of the questionnaire were excluded. Participants were recruited by social media and word of mouth. Participants were required to complete a purpose-developed online questionnaire that included demographic and medical, training and race history, and use of recovery sections. The questionnaire was validated by a panel of topic experts. RESULTS: The study sample included 95 participants. Participants were predominantly middle- to higher-income, tertiary educated males. Participants reported using an average of 9 ± 2 recovery modalities, with protein (86%), carbohydrate (82%), sleep (75%) and passive recovery (74%) being the most commonly used. Recovery modality use was prevalent after all kinds of races (road and MTB), whether single or multiple stage. Personal experience, followed by coaches and trainers, fellow cyclists, and healthcare providers were the strongest influencers of which recovery modalities cyclists used. Participants aged 40 years or older were more likely to use ice/cold therapy, compression garments, active recovery, and carbohydrates. A BMI of 18.5-24.9 was predictive of the use of compression garments, passive recovery, and protein. Monthly income of more than R50 000 was a predictor for the use of stretching. Pre-race cycling volume of four or more training sessions per week was predictive of the use of active recovery, protein and carbohydrate. There were no predictive demographic characteristics explaining the use of anti-inflammatory medication, contrast therapy, massage, sleep, hyperbaric oxygen therapy and vitamins and minerals. Cycling history, pre-race cycling frequency and race experience were not predictive for the use of any of the listed recovery modalities. CONCLUSION: In conclusion, this study demonstrates that while there is widespread use of recovery modalities, the practice of use is inconsistent. In the case of modalities that are shown to be beneficial, correct protocols for use need to be disseminated to ensure safe and efficient practice going forward.

Bibliography: leaves 115-120.

Transitions from one life stage to the next are considered to be a normal part of every person's life. Transitions have been described as important landmarks in the educational career of youth, as successful transitions prepare them for adult life. When youth with disabilities leave school, the transition to post school does not occur naturally. Research has found that youth with intellectual disabilities and their families find the transition from school to post school to be challenging. In South Africa, Education White Paper 6 on special needs represents the country's plan for addressing shortcomings in the education system. There is still very little information available on the preparation of intellectually disabled youth for their post school future in the South African context. Consequently, parents of intellectually disabled youth face tremendous challenges when their child reaches this transition age. This study aimed to describe parents' experience of the transition of their intellectually disabled youth from special school to post school in the West Coast. A qualitative descriptive study using in-depth interviews was conducted with five parents of youth with intellectual disability. Inductive analysis of the transcripts yielded two themes and six categories. Theme one, "It really hit us hard" had three categories: "feeling uncertain and confused", "managing without peer support" and "mixed feelings". Theme two, "Parental adjustment to post transition life" had three categories: "setting up a routine", "negotiating everyday occupations" and "accessing resources and a support system". The research found that the meanings parents attribute to their experience of transition are significantly influenced by their personal responses and coping strategies in the context they find themselves in during the transition period.

Risk Factors for Low Back Pain in Recreational Distance Runners By Jonathan E. Gallas Purpose. The purpose of this study was to examine differences between runners with and without low back pain and a control group of non-runners in demographic, physical/running, and LBP variables. Subjects. This study included 102 subjects in three groups. Subjects, 18 to 55 years old, were from a running store, sports club, and physical therapy clinics in Rockford, IL. Methods. A pilot study of ten runners with LBP was conducted prior to data collection to assess testers’ reliability. One hundred and twelve runners, with or without LBP, who run 20-30km/wk for at least one year were recruited. Runners with LBP are defined as one with a current episode of LBP for 2 weeks but less than 6 months. Subjects completed the informed consent form and demographic and training variable questionnaire prior to data collection. This study utilized demographic and physical/running variable data. Additional data was obtained on lumbar flexion/extension AROM, Biering-Sorensen test, passive lumbar extension test, right and left side bridge, and the Beighton Scale. An ANOVA test was performed to assess for group differences. T-tests, Mann Whitney U, and Chi square tests were conducted to determine differences among running groups. Results. Significant differences were found in the side bridge test between the control group and both running groups, Biering-Sorensen test between the control and runners without LBP, and BMI between the control and runners with LBP. Group differences were found between runners with and without LBP in days/wk, rest days/wk, years run, and marathons run. Group difference were also found in km/wk of running and age among running groups. Discussion. Further research is needed in runners with LBP to determine why they were able to run more miles, take less rest days, run more marathons, and more years. Future studies should address the characteristics of runners that allowed them to demonstrate greater trunk muscle endurance and core muscle stability and be prospective and longitudinal in nature. Key Words. low back pain, recreational distance runner.

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].

A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy [Physical Therapy].