This study aimed to investigate the role of the interpreter in medical communication in the Eastern Cape. This role was found to be a complex and varied one. Interpreters do not only change the words of one language into equivalent words in the other language, but act as advisers, explainers, cultural mediators, supervisors and advocates of the patient. In order to fulfil these functions, they communicate independently within the medical consultation and do not merely interpret what has been said by each participant. Rather, they tailor the message to the participants and the situation by adding to the message, omitting parts of it and changing it where necessary. This does not happen in an arbitrary fashion, but is subject to influence from a number of non-linguistic and linguistic contextual factors. These factors are discussed in this study and included in a suggested model of the interpreted medical consultation, which differs from other models of interpreting which were found to be more adequate for the-situation of conference interpreting than for community interpreting, of which medical interpreting is an example. Data was collected from interviews with interpreters and patients apd from interviews and questionnaires given to medical professionals. The results suggest that using trained medical interpreters in the interpreted medical consultation may solve some of the problems that arise and medical professienals should be encouraged to, learn the languages of their patients to alleviate some of the misunderstanding which occurs. The study also raises questions about the way in which we view interpreting and shows that community interpreting does not always observe the ideals envisaged by theories of interpreting.

Thesis (Ph. D. (Translation Studies)) -- University of Limpopo, 2014 / The study focuses on communication during consultations between English-speaking foreign medical doctors, patients and nurses as interpreters in the Limpopo province. It aims to identify and describe the communication strategies, politeness strategies, influence of gender on the communication process as well as a review of the policy on language practice in the hospitals with a view to suggesting amendments. Through a field work carried out in 10 public health facilities in Limpopo province, the study adopts an eclectic research method of semi-structured interviews, audio recording, and observation in the collection of data. Thirty-five patients, thirteen nurses and nineteen medical doctors are involved in the study. All the interviews and audio recordings were transcribed and translated wherever needed. Collected data was analysed using the Statistical Package for Social Sciences (SPSS) and Nvivo softwares. Results showed that many foreign doctors were frustrated that they could not communicate directly with patients because they could not speak the indigenous language and the assumption that most patients could communicate in English often turned out to be erroneous. The hospitals are ill equipped to deal with the language problems. The linguistic barrier made it difficult to give equal medical care to all patients and doctors resorted to avoidance strategies in selecting patients. Five consultations types based on the turn-taking were identified. These are clarification, continuation, convergence, knowledge and avoidance strategies. The study also reveals that the doctors use more positive politeness strategies when communicating with the patients and nurses. Gender was found to influence the choice of communication strategies by the foreign doctors. The inadequacies of the National Department of Health Language Practice Policy are highlighted and suggestions are made towards its amendment. KEY CONCEPTS English-speaking foreign medical doctors, communication strategies, politeness strategies, gender, language policy, interpreters.

This study sought to establish some ofthe problems that occur during a consultation process between a healthcare worker and a patient, such as intangible and tangible verbal/nonverbal communication problems. Tangible nonverbal problems refer to eye contact, gestures, body posture and facial expression. Tangible verbal problems refer to voice tone/attitude and language and intangible to race, age, gender, education and culture. It was made clear that the problems involved in the consultation process were, in the main, common to other fonns of communication such as that between a reference librarian and a client, customer, visitor or user. The factors that hindered communication were investigated by means of semi-structured interviews and questionnaires. The sample population was made up of 100 black isiZulu speaking females and seven healthcare workers of a heterogeneous background. The perception ofthe respondents in relation to the above-named factors (language, age, gender, attitude, culture, education, gestures and postures) was sought. The analysis of the results obtained showed that some of the significant factors that are a problem in communication include voice tone/attitude, eye contact, sitting position, gestures, facial expression and language. Patients, for the sake ofeffective concentration and free flow ofinfonnation, preferred healthcare workers who were polite, had a cheerful demeanour and who sat still and straight up (not looking around or standing). This is noted because the majority of the patients acknowledged such healthcare workers and were not satisfied with those who behaved otherwise. For example, in relation to previous consultations (irrespective of the Clinics), out of the 70 respondents who encountered problems, 61 (87%) in despair cited cases of rudeness, of which the majority of such cases related to African healthcare workers. Culture also mattered, when seen in terms of people being able to speak the same language and understand one another, with respect to the contextual meaning of words. As far as eye contact was concerned, it was apparent that adjustments had been made. For example, it was discovered that although it is the Zulu culture to avoid eye contact, especially between the young and the old, Zulu people have come to accept eye contact in a crosscultural South Africa. Their acceptance was also seen as due to the advantages ofeye contact. This was made clear by the fact that ofthe 90 (91%) respondents who acknowledged the fact that the healthcare workers maintained eye contact during the consultation process, 87 (97%) said it was polite as it gave them the assurance that the healthcare workers were paying attention to what they were saying. Among the socio-demographic variables investigated, the gender of the healthcare worker emerged as one ofthe important predictors of effective communication. This is because the majority of the respondents indicated feeling freer with someone of the same gender groupmg. Certain recommendations were made which were considered vital in improving not only the consultation process but any other form of communication, including that between a reference librarian and a client. The main recommendations were that the healthcare workers be polite and endeavour to speak the main language as the patients. Due to the fact that some healthcare workers hurry during consultation, it was recommended that more staff be employed. / Thesis (M.I.S.)-University of Natal, Pietermaritzburg, 2000.

M.Cur.(Medical & Surgical Nursing: Critical Care General) / The majority of Africans use traditional medicine, but do not divulge this information to the nurses and doctors when admitted to critical care units. For this reason, patients develop complications, and these makes it difficult for nurses and medical doctors in critical care units to assess and to provide comprehensive quality care, as they treat only the visible clinical manifestations. The purpose of this study was to explore and describe the factors leading to non- divulgence by patients who used traditional medicines in critical care units of a Westrand mine hospital, in order to describe strategies to facilitate divulgence. The researcher used a qualitative, exploratory, descriptive and contextual research design. The population was composed of the patients who were envisaged to have used traditional medicines in the critical care unit of a Westrand mine hospital. Twelve participants were purposively selected from the critical care unit register because these patients displayed the symptoms of having used traditional medicine. Semi-structured individual interviews were conducted. Ethical principles were adhered to. Trustworthiness was ensured by using namely; credibility, transferability, dependability and confirmability. A qualitative open coding method of data analysis was used according to Tesch’s protocol. The following theme and subthemes emerged from the data analysis: Fear and anxiety as the main theme. Subthemes were 1. Fear to divulge secrets. 2. Fear of negative attitudes from nurses and 3. Fear to lose rights, norms and values. It is recommended that the strategies described be used in clinical practice, nursing education and for further research regarding divulgence of the use of traditional medicine to the nurses and doctors, in order to provide a comprehensive assessment and treatment of the patients in critical care units.

The aim of this study is to discover the relationship between health, media and gender, more specifically HIV and AIDS prevention, women’s magazines and women as readers. This research has been conducted within a Master’s dissertation at the Centre for Communication, Culture, Media & Society (CCMS) at the University of KwaZulu-Natal in 2012 and the primary emphasis is on media reception and the way in which women make sense of women’s magazines messages, particularly of HIV and AIDS messages. Therefore, the study’s focus is on media consumption, influences of women’s magazines and personal interpretation of embedded messages. The aim is to identify the role of women’s magazines as part of mass media within a particular field of communication rather than to identify the magazines’ impact on gender roles. My study will discover the reception of health messages on HIV and AIDS surrounded by controversial messages on femininity and gender stereotypes. The main research questions are: i) How, why and when are recipients using women’s magazines? ii) How are recipients perceiving and interpreting HIV and AIDS messages in women’s magazines, and specifically within the context of contradictory messages on sex, femininity and gender roles? iii) And, if and how are health messages in women’s magazines influencing recipients and their interaction with others? The interpretive qualitative research paradigm is applied and the method of qualitative interviews is used for collecting the data. The uses and gratification theory, social learning/social cognitive theory, the concept of entertainment education (EE), and the women-centred sense-making approach are consulted. As an overall result, the analysis reflects a positive picture and interpretation of women’s magazines by the participants, but it also shows the dual character of women’s magazines. Contradictions and critique on content were expressed, positive and negative features were identified, female stereotypes and at the same time the enjoyment of reading was noted, and with regards to health messages, the overall reception was predominantly positive and various content elements seemed to be relevant for the participants. In conclusion, the decisive factors for health messages on HIV and AIDS in women’s magazines, identified in my study are: motivation as an important stage, according to social learning/social cognitive theory in order 7 to enable behaviour modelling; relatedness, originally identified as a third human need within the self-determination theory, which helps to strengthen intrinsic motivation; the dual character of women’s magazines as an on-going conflict between the pleasure of reading a magazine and the consciousness of reprehensible stereotypes and female roles; the sense of female community and finally the role of readers as female opinion leaders. These results present women’s magazines as a multifaceted medium and might influence future research and programmes for health communication on HIV and AIDS prevention. Key words: Women, health, HIV and AIDS, women’s magazines, print media, reception analysis, HIV and AIDS communication, development communication, media usage, media consumption, health messages, relatedness, duality. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2013.

The pandemic of HIV/AIDS has been felt by nations throughout the world. It is a well-known fact that the AIDS epidemic is catastrophic in sub Saharan Africa, which heads the list of the most affected regions. As the epidemic imposes a strain on the already limited resources, a better understanding of the disease is continuously being sought out. This understanding is enhanced with better information dissemination. The present research aims to assist the information requirements of HIV/AIDS researchers in the country through a bibliometric study. The present study comprised an investigation of the patterns of authorship and publications of academic institutions in the sciences, medical institutions and affiliated organizations in South Africa, focusing on HIV/AIDS literature for the two decade period, 1982-2002. Published literature in the sciences and medicine from three internationally recognised databases were used for the assessment. They were: AIDSearch, lSI Science Citation Index Expanded and MEDLINE (OVID). A total of 2 281 documents formed the basis for the assessment. The results of the study are presented, as are their consequences for researchers and policy makers. Some recommendations are provided for the developers and designers of databases. The results of the study demonstrate exponential growth in the literature as might be expected. Because of the multidisciplinary nature of the disease, research is scattered in a variety of discipline-based journals. Researchers publish mainly in journals and the South African Medical Journal is the most productive in the field of HIV/AIDS. Collaboration in research on the subject is evident. The results also demonstrate that South African researchers are fast becoming internationally recognized in the field of HIV/AIDS research. The Medical Research Council emerged as the leader in South Africa's research efforts on HIV/AIDS. Of the academic institutions, the University of the Witwatersrand is the most productive institution, followed by the University of Natal. / Thesis (M.I.S.)-University of KwaZulu-Natal, Pietermaritzburg, 2003.

Thesis (MPhil)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: This work provides a comprehensive overview of the South African HIV/AIDS epidemic. It examines the historical and social background of the HIV/AIDS situation and looks at the importance of the media and science communication in combating the effects of the epidemic on society. This research explores the different forms of health communication and the varied benefits of each. Overall, it highlights positive media efforts that have helped redirect the HIV/AIDS epidemic within the social and political context of the HIV epidemic in South Africa. The second half of this work covers the challenges experienced in gaining publicsector antiretroviral treatment and the roles the media have played in informing and mobilizing society for these efforts. Through a community clinic ethnographic case study this work explores the current state of treatment clinics, social challenges experienced in the Usapho Lwethu Clinic of Gugulethu and the future of the HIV/AIDS epidemic in South Africa. / AFRIKAANSE OPSOMMING: Hierdie werk verskaf ‘n omvattende oorsig van die Suid-Afrikaanse HIV/VIGS epidemie. Dit ondersoek die historiese en sosiale agtergrond van die HIV/VIGS toestand en belig die belangrikheid van media en wetenskaplike kommunikasie in die bestryding van die effek van hierdie epidemie op die samelewing. Hierdie navorsing verken die verskillende vorms van gesondheidskommunikasie en die onderskeie voordele van elk. In sy geheel beklemtoon dit die positiewe pogings van die media wat gehelp het met die herkanalisering van die HIV/VIGS epidemie binne die sosiale en politieke konteks in Suid-Afrika. Die tweede helfte van die werk gee 'n oorsig van die rol wat die media speel in die beskikbaarstelling van inligting en die mobilisasie van die publiek en die stryd rondom die verkryging van antiretrovirale behandeling vir die algemene publiek. ‘n Etnies-grafiese gevallestudie van ‘n plaaslike gemeenskapskliniek word gebruik om die huidige toestand in behandelingsklinieke toe te lig asook die sosiale uitdagings in die Usapho Lwethu Kliniek in Gugulethu en die toekoms rondom die HIV/VIGS epidemie in Suid-Afrika.

South Africa has an estimated 920 000 patients on antiretrovirals (ARVs), the largest number of patients in any country. ARV therapy demands adherence levels in excess of 95% to avoid development of drug resistance, but adherence to ARV therapy is estimated to be only between 50% and 70%. Poor medication adherence is acknowledged as a major public health problem, reducing the effectiveness of therapy and promoting resistance to ARVs. More than two thirds of the South African population have marginal reading skills and this significantly influences a patient’s ability to read and understand health-related information. Patient education materials tailored for the South African population could be a useful aid in facilitating communication with patients and perhaps impact positively on their medicine-taking behaviour. This behaviour is influenced by patient knowledge, beliefs, attitudes and expectations and includes self-management, self-efficacy and adherence. Self-efficacy, which refers to patient confidence in the ability to self-manage medicine taking, is a key factor influencing adherence. This study aimed to develop illustrated patient information leaflets (PILs) and medicine labels for all first-line ARV regimens used in the public health sector in South Africa and, using a randomised control study design, to investigate the impact of these illustrated information materials on knowledge, medication-taking behaviours and health outcomes in HIV/AIDS patients taking ARVs. To achieve this aim, the objectives were to assess HIV/AIDS and ARV-related knowledge, as well as self-efficacy and adherence to ARV therapy; to assess the influence of demographic variables on knowledge, adherence and self-efficacy; to assess the influence of the information materials on knowledge, self-efficacy and adherence and to assess the association of knowledge with health outcomes. Medicine labels and PILs, both English and isiXhosa, were developed for ARV regimens 1a, 1b, 1c and 1d. The 8-item Morisky Medication Adherence Scale (MMAS-8) and HIV Treatment Adherence Self Efficacy Scale (HIV-ASES) instruments for measuring respectively adherence and self-efficacy, were modified to optimize clarity, simplicity and cultural acceptability and were translated into isiXhosa using a multi-stage translation-back translation. The questions and the rating scales, for both the MMAS and HIV-ASES, underwent preliminary qualitative evaluation in focus group discussions. Patients were recruited from local Grahamstown clinics. A pilot study to evaluate applicability of the instruments was conducted in 16 isiXhosa AIDS patients on ARVs and the results from this study informed further modifications to the instruments. One hundred and seventeen patients were recruited for the randomised control trial and were randomly allocated to either control group (who received standard care) or experimental group (who received standard care as well as pictogram medicine labels and the illustrated PIL). Interviews were conducted at baseline and at one, three and six months. Data were analysed statistically using the t-test, chi-squared test and ANOVA (Analysis of Variance) at a 5% level of significance. Correlations were determined using Pearson and Spearman rho correlations. Approval was obtained from Rhodes University Ethical Standards Committee, Settlers Hospital Ethics Committee and the Eastern Cape Department of Health. The results of this research showed that illustrated PILs and medicine labels enhanced understanding of HIV/AIDS and ARV information, resulting in a mean overall knowledge score in the experimental group of 96%, which was significantly higher than the 75% measured in the control group. Variable knowledge scores were measured in three areas: baseline knowledge of general HIV/AIDS-related information was good at 87%, whereas knowledge scores relating to ARV-related information (60%) and side-effects (52%) were lower. These scores improved significantly in the experimental group over the 4 interviews during the 6 month trial duration, whereas in the control group, they fluctuated only slightly around the original baseline score. There was no significant influence of gender on knowledge score, whereas health literacy, education level and age tested (at one and three months) had a significant influence on knowledge. Self-efficacy and adherence results were high, indicating that the patients have confidence in their ability to adhere to the ARV therapy and to practice optimal self-care. Age, gender and education, in most cases, significantly influenced self-efficacy, but were found to have no effect on adherence. The CD4 count improved over the trial duration which may have been influenced by a number of factors, including better knowledge of ARVs and improved adherence. No significant parametric correlation was found between knowledge score and change in CD4 count, however, Spearman's rho showed significance (rs=0.498; p=0.022). Both patients and healthcare providers were highly enthusiastic about the illustrated labels and PILs, and indicated their desire for such materials to be routinely available to public sector HIV/AIDS patients. The isiXhosa version of the PIL was preferred by all the patients. These simple, easy-to-read leaflets and illustrated medication labels were shown to increase understanding and knowledge of ARVs and HIV/AIDS in low-literate patients, and their availability in the first-language of the patients was central to making them a highly useful information source.

This research study was initiated by the desire to identify the constraining and enabling factors experienced by environmental health officers (EH Os) and their management in the implementation of environmental health education and promotion programmes in the environmental health sector. The research contextualises the issues of health promotion, the role of education in health promotion, and community-based environmental health service provision with specific reference to the role of the EHO in relation to these issues. The foremost value ofthis study lies in the fact that it profiles the need for change in the delivery of community-based environmental health education and promotion programmes and identifies distinctive policy changes and skills development needs in the field of environmental health promotion which are central to improved and sustainable community-based environmental health education and promotion. / Educational Studies / M. Ed. (Environmental Education)

Mental health care in South Africa has long been governed by inequalities (Foster & Swartz, 1997). During apartheid, those who did not speak English and Afrikaans could not access mental health services in the same way as those who did (Foster & Swartz, 1997). One main reason for this is the majority of mental health practitioners could not, and were not required to speak languages other than English and Afrikaans (Swartz, 1991). The South African mental health literature suggests that language and communication must be prioritised if there is to be an improvement in mental health care services for those individuals who do not speak English and Afrikaans (Bantjes, 1999; Drennan & Swartz, 1999; Swartz & Drennan, 2000; Swartz & MacGregor, 2002). Drawing on Prasad's (2002) interpretation of Gadamer's critical hermeneutic theory and utilising thematic networks analysis (Attride-Stirling, 2001), this study investigated the process of translated clinical assessment interviews within a psychiatric hospital in the Eastern Cape Province within South Africa. Results of the study revealed that contextual factors, issues concerning linguistic and cultural heritage, clinicians' role expectations regarding translators' role performance, as well as relational dynamics regarding individual levels of control and influence within the translation triad, all impacted on the effectiveness of communication, translation and service provision. These fmdings are supported by literature on the theory and practice of translation that identifies these issues as prominent (Robinson, 2003). Specific recommendations regarding the formalisation of translation practices within the hospital setting, as well as the familiari~ation of clinical practitioners and psychiatric nurses with the intricacies of translation processes are offered.