A research report presented to the school of Human and Community Development Faculty of Humanities University of Witwatersrand in partial fulfilment of the requirements for the degree Masters of Arts in Social Work November 2016. / Globally, the HIV/AIDS epidemic is number six in the top ten disease burdens. This epidemic was viewed as an obstacle to the achievement of Millennium Development Goal (MDG) Number 1 which deals with poverty eradication. The HIV/AIDS epidemic undermines economic development and exacerbates poverty (World Health Organisation [WHO], 2012). The Republic of South Africa has adopted the implementation of the Home and Community Based Care (HCBC) and Support Programme, as a strategy to address this epidemic. This qualitative research study sought to explore the psychosocial circumstances of community caregivers working in Tshwane Region. Individual interviews were conducted with 14 community care workers using a semi-structured interview schedule. The participants were sampled by using purposive sampling and they represented three different communities, namely urban, rural and from informal settlements. Thematic content analysis was used to analyse data collected. Six themes summarised the findings of the research. Both negative and positive effects of the psychosocial circumstances that affect work performance, home and personal lives of community caregivers working in Tshwane Region were discovered through the research. For most caregivers the circumstances are so dire that they have compromised their marriages, family relationships as well as their health conditions. However, a few caregivers are benefiting much better from the services. These are those that were trained and accredited as Child and Youth Care Workers. They earn a living wage and have learned better skills to deal with work situations. However, poor communication and withholding information from staff have led to other caregivers being disillusioned and jealous of those that have progressed, as they feel unfairly treated and discriminated against either due to their age or level of education. Low stipends contribute to more dissatisfaction, as the caregivers cannot afford their living expenses while they are also vulnerable to the same conditions as their beneficiaries. This goes together with lack of support and supervision and being left to fend for themselves in service rendering and acquiring resources. The available care for the carer’s programme seems ineffective and least appreciated. It is hoped that this study will contribute to the knowledge base on the psychosocial circumstances of community caregivers in Tshwane and provide useful information to influence and improve the existing Framework for Home and Community Based Care and Support Programmes in Tshwane. / GR2017

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This study examines the experience of individuals who participated or did not participate in the caregiving process for a family member who died within approximately the past three years of an AIDS-related illness. The focus of this study is on the adjustment of the caregivers and non-caregivers after the death of the PWA. It was hypothesized that due to their direct involvement in the caregiving process, caregivers would differ significantly from non-caregivers on a number of measures designed to evaluate adjustment. It was hypothesized that caregivers would report better overall adjustment than non-caregivers.Participants completed the Symptom Checklist 90 (SCL-90; Derogatis, Lipman, & Covi, 1973), as well as a semi-structured interview about their experiences. A two-tailed t-test revealed no significant differences between groups. However, effect sizes computed for these variables revealed moderate to large diff ererences between caregivers and non-caregivers on the somatization and interpersonal subscales of the SCL-90. Comparisons to a standardization sample showed that caregivers differed significantly on all subscales from that standardization sample: Non-caregivers differed only on the depression and interpersonal sensitivity subscales. Analysis of the interview data revealed a significant difference in reported stress, with caregivers reporting significantly more stress during the illness of the PWA than non-caregivers. Effect sizes were computed for nine other interview categories; these suggested that caregiversreported substantially less social withdrawal, fewer feelings of guilt, fewer problems resolving issues with the PWA, substantially more physical illness, and more life affirming statements than their non-caregiver counterparts. Several other noteworthy trends that emerged in the interview portion of the study are discussed.Small sample size and pre-existing characteristics of the participants are explored as possible factors affecting the outcome of the study. More controlled studies exploring the adjustment of caregivers and non-caregivers are needed in order to better understand the possible differences that may exist between caregivers and non-caregivers in terms of adjustment after the death of their loved one from an AIDS-related illness. / Department of Psychological Science

There is presently an increasing trend towards deinstitutionalization of several different populations, including physically disabled adults. Although a variety of staffed resources provide for alternative care, 'home' and 'family' remain the primary resource in the community based care system. Given that the family of the 1980's has a decreased capacity to care due to such factors as increased mobility and loss of extended family networks we must be concerned with the continued viability of this resource. And, given that 'family’ is often a euphemism for 'nearest female relative' and that women's role in society has changed markedly in recent years the issue of women as caregivers is one of particularly urgent concern. This study is based on extensive interviews with eight women caring for disabled husbands. The interview schedule and methodology facilitated descriptive data regarding caregiving tasks as well as a comprehensive exploration of what was problematic about the day to day reality of caregiving for these women. The data analysis identified struggling with the 'role' of wife-caregiver, isolation and a changed marital dynamic as primary themes in the process of caregiving. This study provides some insight into what is problematic about caregiving for these wives and some suggestions for improving social work practice and providing more effective services in relation to this population. / Arts, Faculty of / Social Work, School of / Graduate

This study is a Time 4 (T4) follow-up interview of ninety-three caregivers of persons who experienced a first stroke between 2 to 4 years (mean = 36 months) prior to the T4 interview. The first wave of data collection occurred within two months after the stroke. The second and third waves occurred six and twelve months, respectively, after the first interview. The caregivers were identified by the person with stroke as being the person closest to him/her who would be responsible for care after the stroke. Data were gathered at all four interviews using reliable and valid measures for depressive symptomatology (CES-D; Radloff, 1977), psychological well-being (IPWB; Berkman, 1971), and caregiver burden (Zarit, 1980). The contribution of social support to caregiver well-being was also investigated. Additional areas of investigation at T4 included coping strategies (F-Copes; McCubbin, Larsen, and Olson, 1981), caregiver adjustment, and the respondents' perception of themselves as "caregivers". The mean scores of depressive symptomatology, perceived burden, negative well-being, and positive well-being did not change significantly over the four points in time. However, the percentage of the sample having CES-D levels of 16 and above (indicating potential diagnosis of clinical depression) decreased by ten percent between T1 and T4. About ten percent of the respondents who were at risk for clinical depression at T4 reported high levels of depressive symptoms at all four interviews. Respondents who specifically thought of themselves as "caregivers" (sixty-two percent) were significantly more likely to report high levels of depressive symptoms, to experience high levels of strain and caregiver burden, and to be caring for persons who were more severely impaired by the stroke than those who did not. Caregiver characteristics contributed more to the variance in depressive symptoms and psychological well-being than did characteristics of the stroke. However, depressive symptomatology and perceived burden were significantly associated with both the functional capacity of the person with stroke and with an index of stroke severity comprised of communication impairments and negative personality/behavior changes since the stroke. The findings from this study have implications for stroke management programs, caregiver intervention planning, and health care policy.