A dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Arts (Clinical Psychology) in the Department of Psychology University of Zululand, South Africa, 2011. / While care-giving is a common topic, very few studies have been done on the experiences of caregivers in caring for the elderly in South Africa. This study focused on the subjective experiences of the caregivers caring for the elderly in one of the old age homes called La Gratitude in KwaZulu-Natal in a town called Newcastle, just under Km 400 north of the University of Zululand. This research study adopted qualitative research methods, although it also integrated elements of a quantitative approach. The study used non-random sampling techniques, in particular purposive sampling. The purposive sample of eight caregivers was selected from the old age home caregiver population. These caregivers’ ages ranged from age 28 to 39 years. The General Health Questionnaire and structured interviews were the tools used for the purpose of collecting the data. Content analysis was used for analyzing data in the present study. The research finding of this study indicated that even though there are challenges in the caregiving job; however the majority of the caregivers experienced the job of caring for the elderly as rewarding and enjoyable. / National Research Foundation (NRF)

The deadly HIV/AIDS pandemic is one of the major developmental challenges facing our nation. Community caregivers (CCGs) play a significant role in addressing the psychosocial needs of orphan and vulnerable children (OVC); however, little attention has been paid to the work and experiences of CCGs. In an endeavour to increase our understanding of their lived experiences, this research qualitatively explored the concerns and motivations experienced by CCGs who work on a daily basis with children in circumstances of extreme adversity, specifically those affected by HIV/AIDS in South Africa. This study draws on the ecological theory of Bronfrenbrenner (1979) to provide a conceptual framework in which to consider the working circumstances of CCGs. Methodologically, focus group discussions were used as the primary source of data collection. Focus groups were conducted with CCGs from three different non-governmental organisations (NGOs) who provide psychosocial support to children affected by HIV/AIDS. The research found that CCGs are passionate about providing holistic care to the children, families and communities in which they work and they experience a variety of concerns about the way in which services are provided and how funding agendas drive the nature of the work and the manner of monitoring and evaluation. They also experience joy and satisfaction in what they do. Limitations and suggestions for future studies are noted, with the aim being for NGOs to acknowledge the concerns and motives and to develop and implement programmes to support staff, and maintain the resilience needed for CCGs to be even more effective in contributing towards providing meaningful services in the difficult circumstance in which they work. / Thesis (M.Soc.Sci.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

Submitted in fulfillment of the requirements for the degree Masters in Counselling Psychology in the Department of Psychology, Faculty of Arts at the University of Zululand, South Africa, 2012. / The focus of this research is in the area of the role of traditional Zulu medicine on psychosis. Such a study is important in order to have an in-depth-understanding of how people of the African ancestry conceptualise and treat a mental disorder such as psychosis. The research approach adopted in in this dissertation includes qualitative content analysis. The findings of this research provide evidence that Traditional Zulu healers and a few community members view psychosis as a curable illness that is usually caused by bewitchment. This dissertation recommends that further in-depth investigation into how Africans tend to conceptualise the concept of a “mental disorder” be undertaken in in order for this group of people to be better understood by mental health care practitioners whose approach is predominantly western. This might benefit both parties.

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

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Introduction Tuberculosis is still a leading cause of deaths in low and middle income countries especially those of Sub-Saharan Africa. The successful implementation of strategies to improve TB outcomes remains critical for South Africa as the country is faced with the burden of many TB related deaths. South Africa has included TB management as a priority programme for the country in its strategies to the achieve millennium development goals. The National Department of Health introduced the CCG programme to assist professional health workers in the control and management of various health conditions including TB. The competent management of the CCGs is central to meeting service delivery objectives. Aim of the study The aim of the study was to explore and describe the experiences of community care givers caring for TB clients. Methodology A qualitative, exploratory, descriptive design was used to conduct the study. Purposive sampling was used to recruit 24 community care givers that were employed by Department of Health receiving a stipend and had been working as community care givers for at least two years. Data was collected using semi structured interviews and was subsequently analysed using Tesch’s method of data analysis Results The themes that emerged from the interviews included: accessibility of kits and protective clothing to the CCGs, their safety and security, training and development, ii including financing of the CCG programme. The following sub-themes emerged as part of the themes: Insufficient supply of kits, alternative means of making kits available to the CCG’s, promotion and supply of uniforms for the CCGs, procurement and supply of protective clothing, alternative ways of getting protective clothes, vaccination against communicable diseases, safety allowance, transparency on criteria for further training and development, age limits regarding the selection of the CCGs, lack of career pathing, stipend received by the CCGs and employment benefits for the CCGs. Recommendations Recommendations were made with regards to institutional management and practice, policy development and implementation, and further research. These included establishing processes for: supply of kits, protective clothes and vaccines, pre and periodical medicals, criteria for further training and development, and issuing of stipend. A broader study involving all the CCGs affiliated to all PHC clinics in eThekwini district on the required support and supervision was also recommended. / M

A research report in partial fulfilment of Masters of Arts in Social and Psychological Research, School of Human and Community Development, University of Witwatersrand, 2018 / Caregiving is reported in numerous studies to have adverse effects on caregivers, including caregiver stress; mental and emotional strain; feelings of burden; and even the risk of mortality. Specifically for caregivers of adults with physical disabilities (AWPD), it is appreciated that caregiving is a life-changing experience as major modifications have to be made. These numerous changes have been reported to expedite the manifestation of stress that is differently perceived by the caregivers. Caregivers of AWPD are therefore anticipated to be at high risk of stress as this type of caregiving has been reported to be burdensome. In South Africa, researchers seem to have overlooked caregivers of adults with physical disabilities as a group that potentially have specific and unique perceptions in the role of caregiving. Most importantly the literature seemed limited in presenting how caregivers of AWPD qualify stress levels. Another paucity observed in the existing literature is that there are no accounts by caregivers on how the qualified stress levels impact on the relationship between the caregiver and care recipient. The aim of the current research was to explore perceived stress levels of caregivers of AWPDs. A second aim was to establish how caregivers of AWPD perceive stress levels to impact on the caregiver-care recipient relationship. The results highlighted that caregivers perceived stress levels to be fluctuating with time and affecting their health. According to the perspectives of the caregivers of AWPD, stress has either positive or negative impacts on the caregiver-care recipient communication, cooperation and closeness, differing amongst caregivers. / XL2018

Using a qualitative and interpretive approach, this research focuses on the training and support needs of crisis interventionists volunteering at an organisation for the abused. This research developed out of a need identified by the board for recommendations to be made in order to compile a new training manual as well as to explore and improve the support services offered to volunteers at the organisation. The research used a thorough examination of the current literature available dealing with crisis intervention and intimate partner violence both nationally and internationally to provide a framework and standard for all recommendations. This was then supplemented with a participatory and interpretive approach to understand the experiences of the crisis interventionists themselves currently volunteering at the organisation. The major themes that emerged from the data included an understanding of the current training process, the impact of volunteering for the desk, the impact and importance of organisational culture and the organisation and self care techniques used by the volunteers. These were then interpreted in terms of their relevance to the training and support needs of the volunteers looking specifically at the training process to ensure an ideological shift and information retention as well as explore supportive services that would be the most beneficial and accessible to the volunteer. The research was then able to provide the most appropriate recommendations for the organisation going forward. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

The objective of this research is to reveal the implications of the choice of home- and community-based care as opposed to other policy choices and, using a gendered lens, to find a plausible way of assessing the social and economic effects of this care policy for households, families, and centrally for women. Women’s paid and unpaid work, the continuum of paid and unpaid health/care work, care work, the care economy and community care are reviewed, as well as household structure, unemployment and the provision of health and welfare services in South Africa. The costs of unpaid care provision, methods for and issues to do with measuring time-use, and approaches to valuing unpaid care work are also considered. Time-use and financial cost information obtained as part of the 2004 KwaZulu-Natal Income Dynamics Study qualitative study from 19 family caregivers of 17 terminally ill people in 16 households, is the central source of data. The qualitative study employed a modified extended case study method. The psychological, emotional, social and physical costs of unpaid care work are not counted. Instead, caregivers’ labour time spent in unpaid care work is counted and valued using four methods (average earnings, opportunity cost, generalist, specialist), and financial costs to households of unpaid care provision are also counted. In this way unpaid care work is assigned various costs, a necessary step if this work is to be included in policy making processes. The findings are not representative but make possible some speculation about home-based care in KwaZulu-Natal. Findings on financial costs suggest that the welfare grant to the poorest elderly is subsidising the health services. On average 10 hours are spent by household caregivers in unpaid care work per ill person per day, and women are accounting for the bulk of this time. Moreover, in terms of valuing, most appropriate to the poor in KwaZulu-Natal is the generalist method using the proportionate approach and median earnings rates. If family caregivers were paid for the time spent in unpaid care work and households were reimbursed for their financial costs, for 2004/5 using the low estimate it would cost approximately R585 per month per ill person for unpaid care provision that takes place seven days a week and 10 hours per day (R7,619 per month using the high estimate). When multiplied by the number of AIDS-sick people in KwaZulu-Natal, this spending on costed unpaid care provision exceeds the monthly health and welfare spending on home-based care in KwaZulu-Natal for 2004/5 of approximately R2 million by R104,025,512 million if the low estimate is used. These costs are compared to the costs of a selection of similar public and private interventions in South Africa. Without fail the costs of unpaid care provision do not exceed 26 percent of the costs of alternatives. The findings show that the home- and community-based care guidelines have inequality-creating effects: wealthier families may be able to buy in care if necessary, while poorer families have to provide this care themselves. Moreover, government is saving substantially on the health budget by limiting the provision of public inpatient care. Because of the high costs of operation of both high- and low-cost inpatient centres, as well as home-based care as delivered by NGOs/FBOs/CBOs, the potential for these interventions to deliver to all of those in need of such care, when compared with unpaid care provision, is not great from the perspective of a government seeking to cut costs. The findings show that home-based care is cost-effective for government but not for family caregivers who carry the bulk of care costs. Policy options such as payment for caregiving, the basic income grant and expansion of the expanded public works programme are presented. Since family caregivers are meeting a minimum standard of productive participation, it is argued that a citizen based model of social protection be adopted. Finally, what worked and did not work with regard to the study is used to inform recommendations for improved future research on unpaid care work in South Africa. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.

M.Ed. (Educational Psychology) / Adolescent-headed households are a rapidly growing form of family both nationally and internationally, due to increased death rates caused by HIV/AIDS, migration of labourers from rural to urban areas, and the weakened state of traditional family safety nets in taking up care. This raises responsibilities of orphaned children, with extended families no longer able to cope due to strained socio-economic circumstances. As a result, older siblings become caregivers to the younger siblings, and have to assume the role of parenting their siblings, ensuring that they are well taken care of financially, emotionally and otherwise. Resilience is needed to rise above adversity and to stand firm despite all the obstacles. This study was conducted to explore how creative expressive arts can explore the resilience of adolescents in adolescent-headed households. Creative expressive arts are a source of healing for people who may experience amongst other things emotional barriers as well as an inability to express feelings. Arts in therapy are also of exceptional value when used with people with learning difficulties. This study was based on a socio-cultural framework by Lev Vygotsky as a framework for the research with critical discussion of relevant literature on resilience, adolescent-headed households and their development, mild to moderate intellectual impairment as well as creative expressive arts. A qualitative research approach was chosen to understand the research topic from the perspective of the participants. For the purpose of the study, the interpretivist paradigm was chosen, which focused on how people create meaning out of their lives and experiences. A phenomenological design was employed and research participants included five adolescents from a school that catered for learners with mild intellectual impairments. The participants were purposefully selected. Data collection methods included semi-structured focus group interviews, artefacts and participant observation. As a method of data analysis, the Interpretative phenomenological analysis was used to identify themes that emerged, namely: “externalising their contextual stories”, “voicing” and “connecting with belief systems”. The study concludes with possible contributions, limitations and recommendations for future research.

M.Ed. (Educational Psychology) / The influence of the HIV and AIDS pandemic has had a detrimental effect on the lives of children and adolescents affected by it in that the disease has caused the loss of their parents or parental support. The result of the HIV and AIDS pandemic has seen an increase in the number of children and adolescents living in child-headed households. Research shows that children living in child-headed households may be at risk both in a socio-economical and educational manner. There is a concern that children living in child-headed households may also be affected developmentally, especially with regard to development into adulthood. Psychosocial developmental theory of an individual posits that there is an interaction between social and psychological factors which is to say that an individual’s culture, values, beliefs, attitudes and feelings are all involved in how an individual develops into an adult. This research study aims at exploring the psychosocial developmental experiences of Grade 10 learners from child-headed households. A phenomenological multiple case study design was used to gain an in-depth understanding of four cases. This design was descriptive and exploratory in nature. The data collection methods used included semi-structured individual interviews and collages with four purposefully selected participants, and a focus group interview with a separate group of participants from similar circumstances. The data was subjected to content analysis so as to explore emerging themes as related to the psychosocial developmental experiences of the participants. The findings revealed that the psychosocial developmental experiences of the participants can be described by three themes, namely psychological experiences, social experiences and educational experiences. The sub-themes that emerged demonstrate that these participants have a generally positive outlook on life and the future. The participants demonstrated a desire for a better life and felt that getting a good education would stand them in good stead to reach their dreams and goals. Despite this positive outlook, findings also indicated that there is a need for psychological and social support for learners in child-headed households. As such it is recommended that support systems such as mentors and educational psychologists are implemented in school and community environments.