Thesis (MPhil (Industrial Psychology))--University of Stellenbosch, 2009. / The fact that patients on Highly Active Antiretroviral Therapy (HAART) default scheduled drug pick-ups and clinic visits requires attention, because the long-term effect is non-adherence to prescribed regimens and the development of drug resistance, as indicated in the report of the Fourteenth Conference on Retroviruses and Opportunistic Infections held in November 2007 in Los Angeles. A cross-sectional survey and observational qualitative study was done to identify key factors associated with the fact that patients on antiretroviral therapy fail to pick up drugs and keep scheduled clinic appointments, with a view to suggesting intervention measures. The study focused on Murchison Hospital in Ugu District, Kwa Zulu Natal Province. Data were collected from patient records, telephonic interviews with patients, or patients’ caregivers, treatment supporters and family members of a patient who did not return for follow-up at the clinic, as well as from face-to-face interviews with healthcare workers to understand the reason for default. Observation checklists were used to collect data from systems, structures and processes used in services provision. Thereafter data were analyzed through the various stages of coding and writing up of notes and reported. Of 638 defaulters identified, 205 were contactable, and only 95 patients were reached. The key factors associated with default identified were death (49.5%) and logistics and cost (15%). Other additional factors were travel and migration, religious beliefs, hospitalization, side effects, work schedules and commitments, imprisonment and visiting private practices. Poor relationships with healthcare workers, patients’ financial difficulties and termination of disability grants added to the problem.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The aim of this research study was to look at the challenges which student peer educators face at Stellenbosch University. Semi-structured interviews were done with male and female peer educators who are involved at the Office for Institutional HIV Co-ordination (OIHC), where the peer educators have been recruited and trained. Interviews were done to determine what the peer educators’ experiences are when they work on campus, go out into the community and even when they socialise with their friends. From listening to the peer educators’ experiences it was found that with safe sex messaging there are mixed responses from males and females. According to the peer educators, students would rather purchase another brand of condoms than the Choice condoms distributed on campus. It was also found that males did not have a problem with condoms being placed in their residences, while females had a problem with that. Regarding HIV testing, females are much more open and enthusiastic to go for an HIV test than males. Challenging someone’s risky sexual behaviour is a huge challenge for all peer educators, since behaviour change does not happen easily. Many students also used withdrawal as a form of contraception. In the community peer educators were faced with language barriers and married people were not very enthusiastic to go for an HIV test. Behaviour change is possible, but difficult to bring about. / AFRIKAANSE OPSOMMING: Die doel van die navorsingstudie was om te kyk na die uitdagings wat studente portuurgroep-opleiers ervaar by Stellenbosch Universiteit. Semi-gestruktureerde onderhoude is gedoen met manlike en vroulike portuurgroep-opleiers wie betrokke is by die Kantoor vir Institusionele MIV Ko-ordinering, waar die portuurgroep-opleiers opleiding ontvang het. Onderhoude is gedoen om te bepaal wat die portuurgroep-opleiers se ervarings was wanneer hulle gewerk het op kampus, in die gemeenskap, of met hulle vriende gekuier het. Deur na die portuurgroep-opleiers se ervarings te luister is daar gevind dat deur die oordra van veilige seks boodskappe daar gemengde reaksies was by mans en vroue. Volgens die portuurgroep-opleiers sal studente liewer ander kondome koop en gebruik as die Choice kondome wat op kampus versprei word. Daar is ook gevind dat mans in die koshuise nie ’n probleem gehad het as daar kondome in hulle koshuis geplaas word nie, terwyl vroue wel ’n probleem daarmee het. Wat MIV toetse betref was vroue meer entoesiasties om vir ‘n MIV toets te gaan as mans. Om iemand se seksuele gedrag uit te daag is baie moeilik aangesien gedragsverandering nie so maklik gebeur nie. Baie studente gebruik ook “withdrawal” as ‘n tipe voorbehoedmiddel. In die gemeenskap was daar taal probleme wat portuurgroep-opleiers ondervind het sowel as getroude mense wat nie optimisties was om vir ‘n MIV toets te gaan nie. Gedragsverandering is moontlik, maar baie moeilik.

Thesis (MPhil (Industrial Psychology. School of HIV/AIDS Management))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: This study examines the level of HIV/AIDS Knowledge, attitudes towards HIV/AIDS as well as practices amongst the employees of Telkom SA Ltd. Furthermore it also aims to determine the effectiveness of the Peer Education programme within the company as well as the role that promoters are playing in encouraging Peer Educators to do awareness in the workplace on the one hand and encouraging their subordinates to attend such programmes on the other hand. A total of 80 employees were invited to participate in the survey. At the end of the survey period, which ran from 2 to 21 February 2009, it was found that a total of 66 employees responded by completing the on-line survey. This represents a return of 82,5%. While the survey results shows a remarkably high level of HIV/AIDS knowledge amongst the responds, it could not be conclusively proven that it was as a result of attending HIV/AIDS workplace awareness programmes. However, it can be said that this knowledge was sufficient to: Enable employees to make informed decisions about their own sexual behaviour Peer Educators were confident that their knowledge levels were sufficient to educate their peers. The results also show quite a high level of disinvolvement on the part of promoters with regard to HIV/AIDS workplace issues. Finally this study also contains a range of recommendations and suggestions which were derived from the findings. / AFRIKAANSE OPSOMMING: Hierdie studie ondersoek the vlak van MIV/VIGS Kennis, houdings teenoor MIIV/VIGS sowel as die gebruike van die werknemers van Telkom SA Bpk. Dit poog ook om die effektiwiteit van die Portuur Voorligtingsprogram binne die maatskappy te ondersoek sowel as om te bepaal watter rol toesighouers speel om enersyds Portuur Voorligters aan te moedig in bewusmakings sessies in die werkplek te reel en om andersyds die rol wat toesighouers speel om hulle ondersgeskiktes aan te moedig om sodanige sessies by te woon. ‟n Totaal van 80 werknemers was genooi om die navorsing mee te maak. Aan die einde van die navorsingstydperk, wat vanaf 2 tot 21 Februarie 2009 geloop het, was daar bevind dat ‟n totaal van 66 werknemers die aan-lyn vraelys voltooi het. Hierdie syfer verteenwoordig ‟n opbrengs van 82,5%. Onderwyl die resultate ‟n merkwaardige hoë vlak van MIV/VIGS kennis onder die respondente getoon het, kon dit nie onteenseglik bewys word dat dit as gevolg van die bywoning van MIV/VIGS werkplek bewusmakings sessies was nie. Ten spyte van die voorgenoemde, kan daar egter met sekerheid gesê word dat hierdie kennis genoegsaam is om: Werknemers in staat te stel om ingeligte besluite te neem oor hulle eie seksuele gedrag Portuur Voorligters in staat te stel om hulle gelykes voldoende op te voed by wyse van bewusmakings sessies. Die resultate het ook ‟n hoë mate van onbetrokkenheid van toesighouers getoon ten opsigte van MIV/VIGS werkplek angeleenthede. Hierdie studie bevat ook „n reeks van aanbevelings en voorstelle wat voortspruit uit die bevindinge.

Thesis (MPhil (Industrial Psychology))--Stellenbosch University, 2008. / The purpose of this research was to determine the efficacy of an innovation in HIV prevention programming in Ukraine, which leverages the culture of Ukrainian society by appreciating its values and incorporating them into the strategy. Analysis of the results indicates that positive changes in two of the questions of the Behavioural Models were significant among the participants of the Experimental Group. This was not seen in the Control Group. The number of respondents from the Experimental Group who spoke to their partner about HIV/AIDS in the past month increased during the month after the training. The number of people who were tested for HIV during the month after training also increased. Based on the results of this research, it can be concluded that participation of employees’ sexual partners in HIV prevention programs can influence Behaviour Models and lead to desired changes in this area changes in Behaviour Models, which are very important and as we can see depends much on participation of both sexual partners in training.

Thesis (MPhil (Industrial Psychology))--University of Stellenbosch, 2006. / The impact of HIV/AIDS on small and medium enterprises (SMEs) is little known in South Africa. SMEs are arguably the largest employer, nationally, particularly in the Western Cape. Unfortunately, SMEs fall within the profile of businesses that have neither measured the prevalence and impact of HIV/AIDS on their businesses, nor devised a response to it. Realizing the risks and costs posed by HIV/AIDS in their business partners, chief executive officers of Western Cape corporate employers, signed a pledge to mentor SMEs. This paper focuses specifically on the mentorship programme of South African Breweries (SAB), which uses taverns and shebeens as a platform for education and awareness programmes in the fight against HIV/AIDS. This was a comparison study, which measured the Knowledge, Attitude and Practice (KAP) of trained and untrained tavern owners in four geographical areas to determine how business has responded to the epidemic. A quantitative research approach was used. The study revealed that the experimental group (trained tavern owners) displayed greater basic knowledge and understanding of HIV and AIDS, than the control group (untrained tavern owners). Some of the challenges facing workplace programmes were the involvement in programmes without enough information. The study concluded that without capacity building through methods such as instruction, coaching, providing experience, modeling, advising, training, information sharing and resources by corporates, the negative impact of HIV/AIDS in SMEs will not be mitigated. While the survey results suggest the need for greater involvement by corporates in mentoring programmes, further research on the role of the private sector in HIV/AIDS management is necessary.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The advent of anti-retroviral therapy (ART) has bought hope and reprieve in a previously hopeless situation where there was no available drug to combat the virus with the result that AIDS deaths from chronic, untreated HIV infection became the major cause of morbidity and mortality especially in sub-Saharan Africa where the disease burden is highest. Since March 19, 1987, when the FDA approved Zidovudine for the treatment of AIDS, there has been great improvement in the prognosis and quality of life of HIV infected persons especially in sub- Saharan countries like Nigeria where the burden of HIV disease is high. Even though the treatment of HIV looked promising to all HIV sufferers, there were strict requirements for taking the ARVs, that meant patients had to be able to take the medication more than 95% of the prescribed time. The requirements also involved strict dietary restrictions that further made adherence to these medications very difficult indeed. In addition, the potential for side effects of the medications and its requirement for life-style modifications like abstinence from excess alcohol made sticking to the required regimen very cumbersome and rather patient unfriendly. Therefore, as the use of ARVs became more popular and effective, so did the problem of nonadherence continue to fester and deteriorate even further. Therefore, the problem of lack of optimum adherence to ARVs is one that potentially threatens all the gains of the discovery and use of potent, life-saving ARVs. Hence, there is now a need to look at how best to improve adherence to ARVs in the most innovative, cost-effective and patient-friendly manner. This study argues for the use of simple, locally-driven adherence strategies that overcome the low literacy and excessive alcoholism that are major factors preventing optimal adherence to ARVs amongst patients. / AFRIKAANSE OPSOMMING: Die intrede van anti-retrovirale behandeling het hoop en genade gebring aan ‘n voorheen hopelose situasie waar daar geen behandeling beskikbaar was om die virus te beveg nie, wat daartoe gelei het dat VIGS, as gevolg van MIV-infeksie wat nie behandel is nie, die grootste oorsaak van sterftes in veral Sub-Sahara Afrika is. Sedert 19 Maart 1987, wanneer Zidovudine goedgekeur is vir die behandeling van VIGS, is daar ‘n groot verbetering in die prognose en kwaliteit van lewe van MIV-geinfekteerde mense, veral in Sub-Sahara lande soos Nigerië waar die voorkoms van MIV hoog is. Hoewel de behandeling van MIV vir alle MIV-lyers belowend gelyk het, was daar streng vereistes vir die neem van anti-retrovirale behandeling. Daar was ook streng dieetkundige beperkinge wat die getrouheid tot die behandeling bemoeilik het. Die moontlike newe-effekte van die behandeling en nodige leefstyl veranderinge, soos byvoorbeeld weerhouding van oormatige alkohol gebruik, maak die behandeling redelik pasiënt onvriendelik. Soos die anti-retrovirale behandeling meer gewild en effektief geraak het, het die probleem van ongetrouheid ook toegeneem. Die probleem rondom ongetrouheid tot behandeling bedreig alles wat deur die behandeling gebied kan word. Daar is nou ‘n behoefte daaraan om getrouheid tot anti-retrovirale behandeling te bevorder in die mees innoverende, koste-effektiewe en pasiënt vriendelike manier. Die studie beveel eenvoudige, plaaslik gedrewe getrouheid-strategieë aan wat optimale getrouheid aan behandeling sal verseker.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The vulnerability of female adolescents to HIV/AIDS has been widely documented with little effort being made to investigate the obstacles that these female adolescents actually face in translating HIV knowledge and attitudes into HIV preventive behaviours. The researcher randomly selected 120 school going female adolescents aged between 14-19, from six secondary schools in the Gweru District in an effort to assess their levels of knowledge on HIV/AIDS and their attitudes towards HIV prevention. The study aimed to uncover the obstacles the female adolescents face in practicing HIV preventive sexual behaviours. Inferences drawn from the study point to the fact that although female adolescents may have high levels of knowledge on HIV/AIDS and positive attitudes towards HIV prevention, there are cultural and religious values that promote male dominance in patriarchal societies and female docility thereby leaving little or no room for females to negotiate HIV prevention in sexual relationships. Poverty- driven economic dependency on men, orphan hood, peer pressure, lack of support from parents and guardians on issues to do with their sex and sexuality, lack of skills to be assertive and negative attitudes of health service providers were some of the barriers the female adolescents face as they try to pave their way in to safe motherhood. / AFRIKAANSE OPSOMMING: Die kwesbaarheid van vroulike adolessente aan MIV/vigs is wyd gedokumenteer met min moeite wat gemaak word die struikelblokke te ondersoek dat hierdie vroulike adolessente werklik gesig in die vertaling van MIV kennis en gesindhede in MIV voorkomende gedrag. Die navorser lukraak gekies 120 skoolgaande vroulike adolessente tussen die ouderdomme van 14-19, van ses sekondêre skole in die Gweru-distrik in 'n poging om hulle vlakke van kennis oor MIV / vigs en hul houding teenoor MIV-voorkoming te evalueer. Die studie is daarop gerig om die struikelblokke ontbloot die vroulike adolessente gesig in die beoefening van MIV voorkomende seksuele gedrag. Gevolgtrekkings waartoe die studie verwys na die feit dat alhoewel vroulike adolessente kan 'n hoë vlakke van kennis oor MIV / vigs en 'n positiewe houding teenoor MIV-voorkoming, is daar kulturele en godsdienstige waardes wat die bevordering van manlike oorheersing in patriargale samelewings en vroulike handelbaarheid daardeur sodat daar min of geen ruimte vir vrouens MIV-voorkoming in seksuele verhoudings te onderhandel. Armoede-gedrewe ekonomiese afhanklikheid van mans, wees kap, groepsdruk, gebrek aan ondersteuning van ouers en voogde op die kwessies te doen het met hul seks en seksualiteit, gebrek aan vaardighede om selfgeldend en negatiewe houdings van gesondheid diensverskaffers is 'n paar van die hindernisse die vroulike adolessente gesig soos hulle probeer om hul weg te baan in 'n veilige moederskap.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The researcher conducted an explorative, qualitative study to identify the perceptions and experiences of stigma and discrimination among people living with HIV and AIDS in order to establish strategies within ARV Clinic to deal with the situation and eliminate this as a barrier to access the services. The study population included 5 men and 5 women who access health services at Oshakati ARV Clinic and have been on ARVs for more than one year, aged 20-60 years old. The study participants were selected using a purposive sampling approach and interviewed in the ARV clinic. The study found that participants have experienced enacted and internal stigma and discrimination related to their HIV status within their community and families. They however did not perceive or report any experiences of stigma and discrimination in the ARV clinic. Possibility exists that the participants might not be well empowered to detect acts of stigma and discrimination in the health care environment. / AFRIKAANSE OPSOMMING: Die navorser het 'n verkennende, kwalitatiewe studie uitgevoer om die waarnemings en ervarings van stigma en diskriminasie tussen mense wat met MIV en VIGS leef, vas te stel met die doel om strategieë te bepaal binne die ARV kliniek om die situasie te hanteer en die hindernes om dienste te bekom te verwyder. Die studiepopulasie het bestaan uit 5 mans en 5 vroue wat die gesondheidsdienste van die Oshakati ARV kliniek gebruik en wat ARV’S vir meer as een jaar gebruik en tussen die ouderdomme van 20-60 jaar is. Die deelnemers is gekies met 'n doelgerigte steekproeftrekking-benadering en onderhoude is gevoer in die ARV-kliniek. Die studie het bevind dat die deelnemers interne stigma en diskriminasie wat verband hou met hul MIV-status binne hul gemeenskap en families ondervind het. Hulle het egter nie aangedui dat hulle stigma en diskriminasie ervaar het by die ARV-kliniek nie. Die moontlikheid bestaan dat die deelnemers nie goed bemagtig is om dade van stigma en diskriminasie in gesondheidsdienste te kan identifiseer nie.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The study sought to answer the question, what are the reasons for low utilization of long acting contraceptives among HIV positive women attending the Harare Post-test support services clinic. The study was conducted at Harare Post-test support services clinic from September to December 2012. Data was collected using respondent administered questionnaires. A sample of 30 respondents was used for the study. After data collection, data was grouped, analysed and presented in the form of tables, figures, charts and descriptive statistics. The major findings from the study were that the majority of the women who attend the Harare Post-test support services clinic are within the age groups 35-49yaers. Most of the women are not using and modern contraceptive method. Condoms are used by 17% of the respondents and the long acting contraceptives, Jadelle and IUCD and used by a very low number of women attending the clinic. Fear of side effects is one of the reasons why the women are not suing long acting contraception. Most of the women know that the Jadelle and IUCD are long acting methods of contraception which prevents unintended pregnancy for up to five years for Jadelle and up to ten years for the IUCD. The long acting contraceptives are not available at the post test-support services clinic since the set-up of the clinic is not ideal for the provision of these services, women who need the methods are refereed outside the clinic were the cost to access the services is not affordable for most of the respondents. The conclusion drawn from the study is that women living with HIV have limited knowledge and access the long acting contraceptives at Harare Post-test support services clinic hence are not utilizing the methods. The researcher recommends that all women attending the clinic should be educated on the benefits of using dual protection to protect against unintended pregnancy as well as HIV transmission. A proper referral system should be established so that women referred to other service providers do not pay extra fees to access family planning services at the referral centres. Any IEC material should address the myths and fears related to use of long acting contraception by HIV positive women. The young age group below 35years should also be encouraged to access family planning services through the Post-test support services clinic. / AFRIKAANSE OPSOMMING: Die doel van die studie was om te bepaal wat die redes is vir die lae gebruik van langwerkende voorbehoeding onder MIV positiewe vroue wat die Harare Post-test ondersteuningsdienste kliniek besoek. Data is deur middel van vraelyste onder 30 deelnemers ingesamel. Die resultate het getoon dat die meerderheid van vroue wat die kliniek besoek het tussen die ouderdomme van 35 en 49 was. Meeste van hulle gebruik nie moderne voorbehoeding nie, slegs 17% het aangedui dat hul kondome gebruik. Die langwerkende voorbehoeding Jadelle en IUCD word deur min die van vroue gebruik. ‘n Vrees vir die nadelige uitwerking daarvan is een van die redes waarom hul nie die voorbehoeding gebruik nie. Meeste van die vroue is bewus dat Jadelle en IUCd langwerkede metodes is wat swangerskap voorkom en dat Jadell tot 5 jaar werk en IUCD tot 10 jaar effektief kan wees. Die langwerkende metodes is egter nie by die kliniek beskikbaar nie en vroue wat die metodes verkies word na ander diensverskaffers verwys waar wat vir meeste van die vroue nie bekostigbaar is nie. Daar kan dus van die studie afgelei word dat MIV positiewe vroue beperkte kennis en toegang rakende die langwerkende voorbehoeding het en daarom nie die metodes ten volle benut nie. Die navorser beveel aan dat alle vroue wie die klinkiek besoek ingelig moet word oor die voordele van die tweeledige vorm van beskerming, nie net teen swangerskap nie maar ook teen MIV-infeksie. ‘n Verwysingstelsel moet in plek gestel word sodat die vroue wat na ander diensverskaffers verwys word nie nodig het om ekstra daarvoor te betaal nie. Daar word verder ook voorgestel dat die klinkiek meer inligtig rakende die langwerkende voorbehoeding beskikbaar stel en ook gesinsbeplanningsdienste aanbied.

Thesis (MPhil (Industrial Psychology. Africa Centre for HIV/AIDS Management))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: This study sought to establish the level of knowledge of people on the medical benefits of male circumcision, especially the protective effect against HIV, with the aim of gathering baseline information on the subject for future health promotion programmes. A cross-section survey was conducted at Border Timbers Limited forest management units with 220 respondents that were conveniently selected into the study, and of these 49% were males and the reminder females. The data were collected using two questionnaires; one for females and the other for males. The data was analyzed using an Epi Info programme. The findings showed that, there was little knowledge on the benefits of male circumcision as they scored an average score of three out of eight, and 66% scored less than 50%. Striking was that that females were more knowledgeable than their male counterparts. Less than 20% knew of the protective effect of male circumcision against HIV. Fifty eight percent of the respondents had negative perceptions of the procedure, and 55% of the respondents were of the opinion that, male circumcision should be stopped with as little as twenty percent of the uncircumcised men willing to be circumcised. Under a third of the total respondents (26.7%) expressed their willingness to circumcise their male children. Medically conducted circumcision was preferred by 95% of the respondents over traditionally conducted circumcision. Based on the above; the study concluded that, raising people's knowledge on benefits of male circumcision would help in changing people's perceptions and increase the acceptability of the procedure. It is recommended that the government together with the private sector urgently need to carry awareness campaigns to raise workplace on how male circumcision can reduce chances of getting HIV. Furthermore, traditional circumcision practice should be encouraged and the practitioners trained to carry the procedure in a safe way. Further studies are recommended to assess the impact of stigma on the already circumcised in order to effectively plan and overcome societal barriers for the recommended strategies to make an impact. / AFRIKAANSE OPSOMMING: Hierdie studie poog om die vlak van kennis van mense rakende die mediese voordele van manlike besnyding te vestig, veral die voorkomende effek teen MIV met die doel om basislyn inligting oor die onderwerp van toekomstige gesondheidsbevoordelings programme te bevorder. 'n Proefopname is uitgevoer by die Border Timbers Beperk bosbestuur eenhede met 220 respondente wat gerieflik gekies is, waarvan 49% mans en die res vroue is. Data is ingesamel met behulp van twee vraelyste vir vrouens en mans onderskeidelik. Die data was ontleed deur gebruik te maak van die Epi Info program. Die bevindinge het getoon dat daar min kennis oor die voordele van manlike besnyding is, aangesien 'n gemiddelde telling van drie uit agt behaal is en 66% respondente het minder as 50% behaal. Wat opvallend was, is dat vroue meer kennis as hul manlike eweknieë oor die onderwerp gehad het. Minder as 20% het geweet van die beskermende effek van manlike besnyding teen MIV. Agt en vyftig persent van die respondente het negatiewe persepsies oor die proses en 55% van die respondente was van mening dat manlike besnyding gestop moet word en so min as twintig persent van die onbesnyde mans is bereid om besny te word. Minder as 'n derde van die totale respondente (26,7%) was bereid om hul manlike kinders te besny. Medies uitgevoerde besnyding was verkies deur 95% van die respondente teenoor tradisionele besnyding. Gegrond op bogenoemde, het hierdie studie bevind dat die verhoging van mense se kennis oor die voordele van manlike besnyding sal help om mense se persepsies asook die verhoging van aanvaarbaarheid van die proses te verander. Daar word aanbeveel dat die regering, tesame met die privaatsektor dringend bewusmakingsveldtogte moet uitvoer om die werksplek op te voed oor hoe manlike besnyding die kanse om MIV te verminder. Verder moet tradisionele besnydingspraktyke aangemoedig word en praktisyne moet opgelei word om die prosedure op „n veilige manier uit te voer. Verdere studies word aanbeveel om die impak van stigma op die reeds besnydes te assesseer om doeltreffend te beplan en om maatskaplike hindernisse te oorkom vir die aanbevole strategieë om 'n impak te maak.