Magister Scientiae (Occupational Therapy) - MSc(OT) / Tuberculosis (TB) and multi-drug resistant (MDR) TB have been identified as one of the largest health problems in the world, and notably recognized as a big issue in democratic South Africa. Socio-demographic factors such as poverty and unemployment were identified to be major contributing factors to the epidemic. Individuals with TB reportedly have poor levels of occupational self-efficacy and found it challenging to return to work after prolonged hospitalization. The Model of Occupational Self-Efficacy (MOOSE) has been used effectively to assist individuals with traumatic Brain Injury (TBI) to return to work. Adaptation of the MOOSE was recommended for application with other syndromes associated with long hospitalization and absence from work. The aim of the study was to adapt the MOOSE for clients living with tuberculosis and to aid them in returning to work. The study was conducted through exploratory research. Semi-structured interviews were conducted with ten purposively selected key informants from private and public health facilities in the Western Cape. The data was analysed through thematic analysis from which six themes emerged. Themes One, Two and Six describe the barriers experienced by the participants when returning to work following their diagnosis of PTB or MDR-TB. Theme Three, Four and Five discussed the factors that facilitate the resumption of the worker role for the PTB and MDR-TB survivors. The findings of this study were used to inform the adaptation of the MOOSE for use with patients living with TB. Ethics clearance was obtained from the Biomedical Research Ethics Committee (BMREC) of UWC. Permission was given by the Department of Health to conduct the study on the clinical platform. All ethics principles were upheld.

Magister Scientiae (Occupational Therapy) - MSc(OT) / Stroke has been identified as a global cause of neurological disability with a resultant burden shared not only by the survivor but also by the society. The resumption of one’s role as a worker after having a stroke is an important rehabilitation goal. South-West, Nigeria has experienced high incidence and prevalence of stroke leaving a quarter of survivors with severe disability and difficulty in community integration after rehabilitation. As a disability resulting from a stroke could be viewed as being a dynamic interaction between the health condition and contextual factors, a client-centred approach should be focal to stroke management to facilitate return to work. Therefore, it became necessary to explore the return to work process from stroke survivors and stakeholder’s perspective in order to understand the challenges stroke survivors face while adapting to their worker roles, to improve service design and delivery as well as to facilitate the return to work after having a stroke. The study was aimed at exploring and describing the experiences of rehabilitated stroke survivors and perceptions of stakeholders about stroke survivors returning to work in South-West Nigeria. A qualitative research design was used to explore these experiences and perceptions from nineteen participants that comprised of nine stroke survivors, two key informants (rehabilitation specialists) and eight caregivers of the respective stroke survivor. Two methods of data collection were used by the researcher to access the perceptions and experiences of the participants. The researcher made use of focus groups with the caregivers while in-depth interviews were conducted with the stroke survivors and rehabilitation specialists. One pilot testing in-depth interview and eleven in-depth interviews were conducted with the stroke survivors and rehabilitation specialists while two focus group discussions were held with the eight caregivers consisting of four participants per group. The data from the study was analysed using thematic analysis. All data were managed manually. The study was further aimed at obtaining participants` perceptions and experiences of barriers and facilitators as well as adaptation processes that influenced the stroke survivors’ ability to resume their worker role. The findings were revealed in five themes. Theme one and two describes the barriers experienced by the stroke survivors while returning to work in the form of loss of former self and returning to work is a struggle. The resumption of the previous worker role by the stroke survivors was construed to be a contest which entails a struggle between the survivor, survivor’s job characteristics, rehabilitation intervention and stigma from the society. Poor access to rehabilitation interventions, inadequacy of treatment and poor insight of the stroke survivor regarding condition, job characteristics as well as social stigma related to the condition were observed as factors that posed great challenges to the participants. Theme three describes the factors that facilitated the resumption of the worker role for the stroke survivors. Engagement in rehabilitation as well as social support enabled the stroke survivors to overcome the barriers and returning to work. Theme four describes the adaptation strategies that enable the return to work for the stroke survivors. Theme four was described by an intrinsic adaptation process that involves the acceptance of the illness and being motivated to return to work and an extrinsic adaptation process that involves gradual work exposure, workplace and home adaptation. Theme five describes the participants’ perception of changes needed in the rehabilitation services and policies that would facilitate the quick return to work of the stroke survivor. Promoting participation of stroke survivors in work through government policies was observed to be a necessary recommendation for the study. These were seen to be achievable through the improvement of rehabilitation resources, enabling access to rehabilitation through financial assistance, change of the regulatory environment to accommodate for the disabled and the initiation of health promotion through public awareness campaigns in the community regarding stroke. The Person Environment Occupation model of occupational performance was used as a framework to interpret the findings of the study; the barriers, facilitators and adaptation process was placed into perspectives as they impacted on the experience of the stroke survivors ‘resumption of their worker role. The resumption of the worker role of the stroke survivors was observed not only to be influenced by the individual characteristics of the survivors but also by the environmental context within which the return to work process took place.

Bakgrund/syfte: Det finns en alltmer ökad fokusering på hemrehabilitering för personer diagnostiserade med stroke. Dock kan utförandet på hemrehabiliteringen variera och det är ännu inte klarlagt hur ett fungerande åtgärdsprogram ska utformas. Syftet var att identifiera vad en hemrehabilitering för personer med stroke bör innehålla utifrån personalens perspektiv i multidisciplinära hemrehabiliteringsteam. Metod: Studien är en deskriptiv studie i enlighet med Delphi-tekniken. Frågeformulär skickades ut via e-mail i 3 rundor till 12 experter bestående av arbetsterapeuter, sjuksköterskor och sjukgymnaster. I Runda 1 fick experterna svara på öppna frågor för att få deras personliga åsikter i ämnet. Frågeformulären i Runda 2 och 3 utformades utifrån svaren från föregående runda där experterna fick markera grad av instämmande på en Likert skala efter varje påstående. Resultat: Sextifyra av 74 påståenden uppnådde en nivå av konsensus på 75 % eller mer. Hemrehabilitering bör innehålla patientens självbestämmande och delaktighet i utformandet. Detta säkerställs av ett klientcentrerat arbetssätt genom samarbete, samverkan och samordning på olika sätt med den sociala omgivningen under rehabiliteringsprocessen. Slutsats: Övergripande komponenter i en hemrehabilitering för personer med stroke är egenmakt, delaktighet och självständighet som uppnås genom det ”det goda teamet” och strategier för samordning. Studiens betydelse: Resultatet i studien kan bidra med värdefull information vid utformandet av hemrehabiliteringsprogram i klinisk verksamhet inom strokerehabilitering. / Background/aim: There is an increasingly focus on home-based rehabilitation for persons diagnosed with stroke. However, rehabilitation in the home environment can be delivered in many different ways and the best way to deliver home-based rehabilitation and its content is not yet clarified in the literature. The aim was to identify what home-based rehabilitation should contain from the perspective of members working in multidisciplinary teams in homes of persons diagnosed with stroke. Methods: The study design was a consensus-building, three-round Delphi survey. Questionnaires were sent by e-mail to a panel of 12 experts including occupational therapists, nurses and physiotherapists. In round 1 the experts were asked to answer open-ended questions to obtain their personal views on the subject. The questionnaire in Round 2 and 3 were built on the results of the previous ones and the experts were asked to mark on a Likert scale the importance of each statement. Results: Sixty-four of 74 statements reached a consensus level of 75% or more.  Home-based rehabilitation should contain patient’s autonomy and participation in the rehabilitation program. This is ensured by a client-centred approach characterized by cooperation and interaction with the social environment throughout the rehabilitation process. Conclusions: Overall components in home-based rehabilitation for persons diagnosed with stroke is empowerment, participation and autonomy achieved by ”The good team” and coordination strategies. Significance of the study: The result of the study could be an important source of information when designing home rehabilitation programs for persons with stroke.

>Magister Scientiae - MSc / Globally, high unemployment rates exist amongst individuals with schizophrenia. Evidence suggests that these individuals have a desire to return to work (RTW), however, they experience difficulty in finding as well as sustaining employment. Work plays a pivotal role in the functioning of individuals with schizophrenia and has a substantial positive influence on their quality of life (QOL). Several studies recommend supported employment as a practice aimed at improving rates of competitive employment for individuals with schizophrenia. The current study aimed to explore the experiences and perceptions of individuals, with a primary diagnosis of schizophrenia, about the use of the Model of Occupational Self-Efficacy (MOOSE) as a supported employment strategy in enhancing the work skills and facilitating RTW in the open labour market. A qualitative research design was utilised to explore these experiences and perceptions from nine participants. Additionally, one occupational therapist and one occupational therapy technician were selected and participated as key informants of the study. Participants were selected through the use of purposive sampling. Written informed consent was received from the participants, and their confidentiality was upheld throughout the study. Semi-structured interviews were used to collect data, and were audiotaped and transcribed verbatim. Transcriptions were anal

Introduction: Early supported discharge intervention offers strokerehabilitation in the home environment. Digitalisation in society may make it demanding to perform everyday activities in traditional ways. Considering that the use of technology now is part of our daily activities, occupational therapists need to maintain a client-centred practice and make sure that their own competencies in using the technology is adequate. Aim: The aim with this study is to explore occupational therapists' perceptions and experiences of interventions involving digital technology with post-stroke patients in early supported discharge settings. Method: A qualitative study with aphenomenological approach was carried out. Four interviews of occupational therapists were conducted. A qualitative content analysis approach was done for the analysis. Findings: Two main categories emerged which were interpreted into the theme Digitalization requires clinical reasoning. Many factors that involved the digitalization of today's society affected both the patients' occupations pre- and post-stroke and therefore also affected the OTs roles and work process. Conclusions: This study highlights that more knowledge is required regarding digital technology and enhancing competence and clinical reasoning within the occupational therapy practice process. Significance: This3study may provide a better understanding for the potential effects that digitalization has within occupational therapy practise.

This qualitative study explored and described the lived experience of people with brain injuries with regard to resuming their worker roles. Based on the results, an occupational therapy practice model to facilitate return to work was developed. The theoretical framework of occupational science with emphasis on occupational risk factors informed the study. The research design was a theory generative design based on a qualitative, phenomenological, explorative and descriptive research approach utilizing the methods of theory generation as advocated by Chinn and Kramer (1999), Walker and Avant (2005) and Dickoff, James and Wiedenbach (1968).

This qualitative study explored and described the lived experience of people with brain injuries with regard to resuming their worker roles. Based on the results, an occupational therapy practice model to facilitate return to work was developed. The theoretical framework of occupational science with emphasis on occupational risk factors informed the study. The research design was a theory generative design based on a qualitative, phenomenological, explorative and descriptive research approach utilizing the methods of theory generation as advocated by Chinn and Kramer (1999), Walker and Avant (2005) and Dickoff, James and Wiedenbach (1968).

Philosophiae Doctor - PhD / This qualitative study explored and described the lived experience of people with brain injuries with regard to resuming their worker roles. Based on the results, an occupational therapy practice model to facilitate return to work was developed. The theoretical framework of occupational science with emphasis on occupational risk factors informed the study. The research design was a theory generative design based on a qualitative, phenomenological, explorative and descriptive research approach utilizing the methods of theory generation as advocated by Chinn and Kramer (1999), Walker and Avant (2005) and Dickoff, James and Wiedenbach (1968). / South Africa

This study is concerned with the pre-test counselling conversation (as regulated by policy-governing and training documents) that occurs between HIV counsellors and their clients. It attempts to explore and describe some of the assumptions underlying HIV/AIDS pre-test counselling in South Africa, and reflects on how these assumptions determine the content and process of HIV pre-test counselling. This exploration has been done by means of an analysis of a selection of official and non-official documentation on pre-test counselling. The aim of HIV/AIDS counselling in general is to support and educate infected/affected clients about the HI-virus. Pre-test counselling (the conversation that takes place before an HIV-test is administered) forms the entry level to HIV counselling service delivery in South Africa, and it is often the only opportunity a counsellor has to support and educate a client about HIV/AIDS. Policy-governing pre-test counselling and training documents on such counselling confirm the role played by counsellors. The pre-test counselling conversation is based on the assumption that education about the HI-virus will enable clients to make informed decisions about their health which will help them to live long and healthy lives once they are aware of their HIV-status. However, this educational approach does not seem to be successful, as a change in risk behaviour is often not achieved. My recognition of this situation motivated this study and its focus on the conversation that takes place between counsellors and their clients in pre-test counselling. I was curious about what is discussed during pre-test counselling and why, if we acknowledge that counselling plays a major role in infection rate prevention, risk-reducing behaviour is not being achieved. This qualitative study was based on a social constructionist paradigm and document analysis was used as a research method. This study offers an alternative approach to health education – a drive towards client-centred pre-test counselling where the client’s needs become the focus of the pre-test counselling conversation. / Dissertation (MA (Counselling Psychology))--University of Pretoria, 2007. / Psychology / unrestricted