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)

Text in English / Health Communication Campaigns are one of the strategies used in facing the challenges of the spread and effects of the HIV/AIDS epidemic, which is not only a health issue but also has sociocultural implications and consequences. Although there are some models and research tools available to guide the planning, designing, implementing, monitoring and evaluation of health communication campaigns, the premise of the study was on two assumptions. First, most available models that guide the planning and execution of HIV/AIDS communication campaigns do not sufficiently highlight sociocultural variables; and second, since most available models do not sufficiently emphasise sociocultural variables, the design of the instruments for the assessment of the campaigns are not sufficiently geared towards identifying and assessing sociocultural variables of the campaigns. In light of these assumptions, the study was undertaken for three reasons. Firstly, to construct a sociocultural health communication campaign conceptual model that incorporates and highlights sociocultural variables to guide the planning and implementation of health communication campaigns; particularly HIV/AIDS communication campaigns. Secondly to develop an assessment instrument for assessing the presence or absence of sociocultural variables in the planning and implementation of health communication campaigns. Thirdly to test the theoretical sociocultural assessment instrument developed in the study in an HIV/AIDS communication campaign of the Ekurhuleni Metropolitan Municipality’s HIV/AIDS Unit. The results indicated that the instrument is a functional sociocultural assessment tool that can be used to determine three main aspects. Firstly, whether or not and at what level there is/or was active involvement and participation of the target audience in the communication campaigns process. Secondly, whether or not and at what level in the planning and execution of a campaign, the sociocultural context was taken into consideration and the relevant elements of such context incorporated in the campaign process. Thirdly, whether or not and at what level relevant theories/models underpinned the whole process of the health communication campaigns in the planning, designing, implementation, monitoring and evaluation stages. The sociocultural assessment instrument, therefore, is not meant for assessing the effectiveness of health communication campaigns per se. It is rather meant for use to ascertain the presence or absence of those three aspects on the assumption that if they are taking care of in the planning and implementation of such campaigns, the probability is that the campaigns would be more socioculturally appropriate. The implications of this study are that for health communication campaigns to be socioculturally appropriate, they display continuous community interactivity and participative (ensuring mutual relationship between campaign planners and target audience) in their planning, implementation and evaluation/assessment; making the whole campaign process strategic and integrative – their management should be strategic, implementation creative and monitoring and evaluation continuous. / Communication Science / D. Litt. et Phil. (Communication)

There are many inequities that exist in health-care that stem from culture related communication misunderstandings. In most cases where doctors and patients from different cultural and linguistic background interact, doctors use medical language which is different from everyday language used by patients. Patients enter this communication context with anxiety because they depend on the physicians to give them accurate information concerning their health, but they do not always understand all the terms used by physicians to inform them about their conditions. In some cases interpreters are used but their expertise is often inadequate and the interpreting of the patient’s statements to the health staff is also prone to distortion by interpreter / doctor because of the lack of proper understanding of the messages / languages. This may result in a deterioration of the patient’s health condition and unavoidable complications.

South Africa's HIV prevalence rate is estimated to be 5.7 million and at the end of2007 a total of 45845 HIV/AIDS adult patients were taking antiretroviral therapy (ART). The global incidence of HIV/AIDS has been slowly decreasing over the years but is still widespread. This disease is still more prevalent in sub-Saharan Africa than in other parts of the world, with more than 60% people living with HIV/AIDS. Highly active antiretroviral therapy (HAART), the treatment of choice, slows the progression of the human immunovirus but demands a high adherence rate in excess of 95%. Patients who are poorly informed about antiretrovirals (ARVs) and misunderstand medicine-taking instructions or experience unexpected side effects may interrupt therapy, predisposing them to the development of resistance. Such patients need information but, given the poor literacy skills prevalent in South Africa, written information is often not fully comprehended and is often written at too high a reading level. The objectives of this research project were to design, modify and evaluate HIV / AIDS patient education materials for low-literate isiXhosa speaking adults residing in Grahamstown and to examine their impact on the understanding of various aspects of the disease and its treatment. Pictograms illustrating common side effects of ARVs (e.g. stavudine, efavirenz, lamivudine), as well as various sources 'for purchasing nonprescription medicines, storage and medicine-taking instructions were designed and evaluated both qualitatively, using group discussions, and quantitatively through individual interviews where interpretation of the pictograms was assessed. These pictograms were incorporated in a patient information leaflet (PIL) which had been specifically designed for people with limited reading skills and was a simple document containing the minimum of essential text. A previously developed PIL was modified in collaboration with the target population and two versions were produced, one incorporating pictograms illustrating side effects, the other with none. Pictograms were used in both to illustrate other medicine-taking instructions. The PILs were tested objectively to assess the readability, format, content, and general design. They were translated into isiXhosa prior to being qualitatively and quantitatively evaluated in a low-literate isiXhosa speaking population. Understanding of the PILs was assessed by asking a series of questions about the PIL content. Participant opinion of the readability and appearance of the PIL was recorded. The relationship between PIL understanding and selected demographic variables was investigated. Findings from this study illustrated that well designed pictograms assist in the location of information in written leaflets and they may enhance understanding of the information. It was further demonstrated that education influences total understanding of PIL content thus emphasizing the need for tailor-written information in accordance with the education level of the target population. A desire to receive PILs incorporating pictograms was expressed by the majority of participants. Collaboration with the intended target population is essential to design culturally acceptable, easily interpreted pictograms and to produce user-friendly, easy-to-read, comprehensible patient education materials. The rigorous, iterative design, modification and testing process described in this study is one that should be adopted in producing all health-related education materials.