D.Cur. / Not only do communities and individuals have the right to participate in their own health care, but a key means to reducing the risk of potential social and psychological harm of people participating in clinical health research, especially efficacy trials, is to ensure that the community in which the research is being carried out, as well as health service providers, are meaningfully involved in the research process. One of the requirements of the South African White Paper for the Transformation of the Health System (South Africa, 1997: 74-78) which refers to Essential National Health Research (ENHR), is that the research agenda should initiate a process whereby stakeholders are equal inclusive partners in the research. Therefore researchers are no longer perceived as having the right to exercise a monopoly on conducting and explaining their research but now have a duty to empower their research participants and the research community to understand their own situation and become a collaborative partner in the research process. In this participatory approach to research, a collegiate partnership needs to be facilitated, but the power differentials that exist between stakeholders in community research make this a difficult partnership. The researcher, having had prolonged interaction with a community which has been targeted for large efficacy trials, initiated this research to gain insight into some of these difficulties and to describe the understanding and expectations of key stakeholders into community participation in clinical health research and develop a model to manage this participation. The critical elements in the study took cognisance of the research context, the dynamics within that context, the relevant stakeholders in a participatory approach to clinical health research and the processes within which they engage. Literature was reviewed throughout the study that was conducted in two phases. Phase one of the research design is ideographic, contextual and descriptive in nature. A perception survey, within a targeted community, was conducted to describe the understanding and expectations of community representatives, health service providers and researchers of community participation in clinical health research. The analysis of the perception survey endorsed the notion that community participation needs to be an v integral part of all clinical health research. The findings from the perception survey and a further literature search enabled the researcher to develop a theoretical framework for the construction of a model to manage community participation in clinical health research. The model is overarching with multiple processes namely: the participatory management process central to the model; the preparatory process; research process and quality improvement process. The model facilitates a collegiate partnership between stakeholders where there is mutual influence and collaborative interaction. Its implementation requires a radical paradigm shift in research and a commitment on the part of those "in power" to share power. It is recommended that standards that monitor, measure and evaluate community participation in clinical health research be developed to operationalise the model. Funders increasingly mandate community participation in clinical health research and the challenge is to ensure that this process goes beyond tokenism. A model to manage community participation in clinical health research will facilitate the conscious integration of key stakeholders into the research process to provide a platform for the voiceless and powerless within the research community, so that they become active participants and partners, not merely 'objects' in the process of research and knowledge creation. This will not only meet the requirements of funders and the ENHR, but this collaboration and partnership will foster trust between researcher, health service providers, community representatives and trial participants. There will be mutual understanding of the research issues and this will ensure that the study or clinical trial respects cultural and ethnic differences among participants. The primary outcome of the operationalisation of the model will be to facilitate quality management of community participation in clinical health research.

The historical record of humankind has been punctuated by epochs of great calamity and catastrophes. These have been through natural disasters or man-made causes, and these occurrences have in most cases led to innovations and discoveries to thwart the impending consequences. The most devastating has been the prevalence of diseases, which have decimated communities. In Europe, such scourges like bubonic plague, tuberculosis and many others led to communities adopting myriad survival strategies in response to these threats. This cyclical trend is currently being experienced around the globe and more especially in the developing countries, vis-à-vis the HIV/AIDS epidemic. The impact of HIV/AIDS on communities is leading to fundamental changes in the socio-economic fabric, and consequently to diverse livelihood strategies being adopted by both the victims and their dependants. The social effects of the loss of a breadwinner or head of the household result in an increase of orphans, child-headed households and dependants. The resultant livelihood strategies adopted from this scenario stretch from legal to illegal activities, and the latter being more pronounced in an urban context. The epidemic has also had other social implications in terms of the service delivery capacity of governments and other developmental role-players in alleviating the poverty exacerbated by this disease. The non-availability of a vaccine, skewed national health policies and the high price levels of existing short-term medications further worsen the problem of at least making the affected population become economically active and expand their livelihoods. HIV/AIDS cuts across the socio-economic status divide of any community and thus cannot only be associated or ascribed to the poor segment of a given population. The livelihood strategies of the affluent differ widely from the low-income group –more especially given the fact that the former have fiscal livelihood portfolios in place for risk aversion. For the poor segment of the community, the livelihood strategies continuum would entail basic activities to entitlements provided by the state in its social policy framework. This study will explore the livelihood strategy dynamics of an urban context; with a special emphasis on the HIV/AIDS support groups and community-based organizations in Mamelodi Township. / Mr. H. Mushonga

Magister Scientiae (Physiotherapy) - MSc(Physio) / The purpose of this study was to identify the physical needs of the elderly with regard to physiotherapy services in the Livingstone district in Zambia. The objectives were to determine the knowledge of the elderly on the role of physiotherapy in the care of the elderly; the barriers to utilization of the services; the prevalence of physical problems and it also examined associations between education, knowledge and utilization of physiotherapy services in the district. / South Africa

Magister Educationis - MEd / Decentralization of health services in Uganda, driven by the structural adjustment programme of the World Bank, was embraced by government as a means to change the health institutional structure and process delivery of health services in the country. Arising from the decentralization process, the transfer of power concerning functions from the top administrative hierachy in health service provision to lower levels, constitutes a major shift in management, philosophy, infrastructure development, communication as well as other functional roles by actors at various levels of health care. This study focused its investigation on ways and levels to which the process of decentralization of health service delivery has attained efficient and effective provision of health services. The study also examined the extent to which the shift of health service provision has influenced the role of local jurisdictions and communities. Challenges faced by local government leaders in planning and raising funds in response to decentralized health serdelivery were examined. / South Africa

D.Litt. et Phil. / Health and social issues have a reciprocal relation and this is evident in the South African context. Poverty that includes poor living conditions, unemployment and the consequent low income results in disease and malnutrition. A vicious circle exists between poverty and disease. The HIV/Aids pandemic results in people being in need of care, not being able to work nor provide for their next of kin, children being orphaned and taking over the parental role, without emotional and material means. Chronic diseases, for example tuberculosis, hypertension, diabetes and chronic psychiatric disease assume enormous proportions and influence the person-and-environment interaction, which is the social work focus. Health and social issues can therefore not be seen as separate entities. Social workers should then form an integral part of health care services. The social work service rendering in the Health Sector should be effective, efficient and appropriate. Effective, efficient and appropriate health care social work services will encompass people-centred, developmental, preventative, promotative primary health care approaches with emphasis on participation, partnership and self-determination. An effective and appropriate service will rely on home-based and community-based strategies. Health care social work is however fragmented and social workers in the Health Sector practice within different governmental and non-governmental organizations. Health care social work in the Gauteng Health Department where the researcher did the research, is largely curative, rehabilitative, hospital-based, individual-based and relies on institutional care. It is therefore ineffective, inefficient and inappropriate. A shift towards an effective, efficient and appropriate health care social work service is essential especially when the reciprocal relationship between health and social issues in South Africa are taken into account. The researcher decided therefore to develop a community-based model for health care social work with emphasis on a people-centred and developmental approach emphasizing participation, partnership and self- determination of the people. This model will be utilized on a primary health care level within a community health centre and community context where the health care social worker will form part of a multi-disciplinary health care team. The main goal of this study is the development of a community-based model for health care social work. The objectives to attain the main goal of describing a community-based model for health care social workers were: ♦ To explore and describe the thoughts and experiences regarding the perceived needs with reference to the general health of the following patients: Patients who attend provincial community health centres to address their health needs; Patients who are representative of the diversity of all South African citizens and therefore include White, Black, Coloured and Indian population groups; Patients who qualify in terms of their income to utilize Governmental health services and who do not belong to medical schemes; Patients from formal, well organized and structured communities with different community resources, as well as patients from informal settlements without structured community services; Patients of different age and gender groups; and Patients with acute and chronic, including life threatening medical conditions. ♦ To describe the needs of patients after interviews were conducted and data had been analyzed; ♦ To explore and describe the needs that health care social workers can address and the intervention strategies that they can utilize in doing so; ♦ To explore and describe the priority needs that a health care social worker could address and the intervention strategies they could utilize in doing it, in the opinion of the following multi-disciplinary health care team members: Medical doctors; Nursing staff; Allied health professionals (physiotherapists or their assistants, occupational therapists or their assistants, speech therapists, dieticians, pharmacists and community based rehabilitation workers); ♦ To describe specific needs and services which health care social work exclusively or most effectively can address according to ranking on a scale; ♦ To develop a community-based model for health care social work according to the needs that a health care social worker can address and which will result in an effective and appropriate health care social work service; ♦ To evaluate the tentative model; and ♦ To revise the intervention and describe guidelines to operationalize the model. The research design utilized to attain these objectives was based on a research model that the researcher developed. The researcher developed the research model by utilizing The Intervention Design and Development model (Rothman & Thomas, 1994) qualitative research for interviews with patients, observations and field notes, data analysis and literature control. Quantitative research designs were included in the model and consisted of the Delphi technique and Lickert scale. Levels of theory generation were also included in the model and the researcher developed level of theory generation for the research based on the levels of theory generation of Dickoff et al. (1968) and Chinn and Kramer (1995). The research model that the researcher developed for developing a community-based model for health care social work encompasses certain phases and research activities, as well as theory generation and reasoning strategies. The reasoning strategies included analysis induction, synthesis, derivation and deduction. The first phase of the research was the problem analysis and project-planning phase of the research. The researcher carried into effect the following research activities. The researcher determined the feasibility of the research project; gained entry to and cooperation from setting and identified and involved role-players in the research. The identification and involvement of the role-players encompassed the sampling and the pilot study. The second phase of the research was the information gathering, analysis and synthesis phase of the research. This phase included research activities, as well as levels of theory generation. The research activities that were followed during this phase started with the conducting of semi-structured interviews with twenty-two patients and observations and the keeping of field notes. Ethical issues were addressed during this phase and formed part of the interviewing and observation process. Data analysis of interviews, with an independent coder, and literature control to affirm the findings of data analysis followed as part of the research activities. The researcher then utilized the Delphi technique with nine experts in health care social work. The aim of this was to establish the patient’s needs, established during data analysis, that a health care social worker could address and the intervention strategies that they could utilize. These needs and intervention strategies were established by questionnaires and a group session was held to reach consensus of data. The above-mentioned data established from health care social work experts were then compiled into a Lickert scale for twenty-five multi-disciplinary health care team members. The aim of the scale was to establish the needs that health care social work could address exclusively of most effectively, as well as the intervention strategies that they could utilize in the opinion of the multi-disciplinary health care team members. A final literature control completes the research activities of the information gathering, analysis and synthesis phase in order to establish if literature exist that verifying the results of the data obtained and if these could assist in the development of a communitybased model for health care social work. The levels of theory generation followed in the information gathering, analysis and synthesis phase of the research consist of the following: The first level of theory generation consisted of factor isolating theory. The researcher utilized concept analysis. Concepts were firstly identified and the researcher identified the concept health. The concept health is a central concept in all the policy documents and theory that were utilized in the problem analysis of the research. The concept health was also central in the data analysis and literature control of the interviews with patients. The concept health was then defined and refined by utilizing dictionaries and thesauruses, as well as utilizing sources of evidence namely, a model and contrary case, evidence of people and professional literature. The researcher then classified the concept health and the related concepts. The second level of theory generation, factor relating and structuring followed during the information gathering, analysis and synthesis phase of the research. The researcher related factors and associated them through statements that indicate interrelationships. The third level of theory generation consisted of the situation relating level followed by predicting relationships between concepts utilizing if-then statements. The third phase of the research was the design and early development phase. The researcher utilized the fourth level of theory generation that consisted of the situation producing level of theory generation to conduct the research activity of the creating and describing of the theoretical model for community-based health care social work. The last phase of the research consisted of the theory testing and evaluation phase of the research. The research activities that were followed encompass the planning of evaluation, selection of evaluation methods and then the evaluation process. The evaluation process was done with a panel of nine experts utilizing a specific questionnaire in the form of a Lickert scale. The panel consisted of academic staff from the Universities of the Witwatersrand, Pretoria and Randse Afrikaanse University from social work and nursing as well as multi-disciplinary health care team members from community health centres and social workers from different practice settings. The second part of the evaluation process was done during doctoral seminars where peer evaluation was done by health care social workers, medical doctors, nursing staff and allied health workers from different levels of service rendering including the Gauteng Health Department’ Head Office, community-based centres and different levels of hospitals. Participants from private hospitals also attended the doctoral seminars. The researcher then utilized the evaluation results to identify design problems and to revise the community-based model for health care social work. The final level of theory generation was then done in the theory testing and evaluation phase of the research to operationalize the model by describing guidelines for operationalization. The methods of trustworthiness that were followed during the research included the four criteria of Lincoln and Guba (1985) of credibility, transferability, dependability and conformability. The researcher finalized the research by indicating the conclusions from the research, specifying the limitations of the research and providing recommendations for social work practice, education and research. The research document might be marked by repetition of content, but this was necessary because chapter six, the model, as well as chapter eight, the guidelines for operationalizing the model, form the basis for health care social work practice at community health centres. These chapters could then be extracted from the research document as a tool for implementation. / Prof. J.B.S. Nel Prof. A. Nolte

The period 1980-2000 was important for infant health in Florida and the United States more generally. This period of dramatic social change and substantial improvements in therapeutic technology has produced striking improvements in infant health and survival. Despite overall declines in all-cause infant mortality, some evidence has suggested that racial disparities have persisted and even widened during this period. While the maternal socio- demographic factors associated with these racial disparities are well-established areas of research, several points remain unclear. First, it is not well-known which causes of death have contributed to the widening racial disparities in infant mortality. Second, it is uncertain how the changing social context may have affected these patterns. Finally, it is unknown which has been more influential, changes in the social context or changes in individual maternal socio- demographic characteristics. This study addresses these questions, using linked birth and infant death files on the 1980 and 2000 Florida birth cohorts. This investigation has three main findings. First, the racial disparity in infant mortality in Florida increased during the period 1980-2000. Black infants born in the earlier cohort had about 60% greater odds of infant death than white infants. Even though absolute rates of infant death declined for both groups between 1980 and 2000, the racial disparity increased over this period such that in the year 2000 black infants had 80% higher mortality risk than white infants. Second, maternal and socio-demographic variables are able to explain less of the black-white mortality differences in 2000 than in 1980. Third, changes in cause specific infant deaths have contributed to the increased racial disparity in infant mortality over the period 1980-2000. Deaths due to prematurity causes and maternal and obstetric conditions were the most important for changes in the racial disparity that occurred over the period 1980-2000. The findings of this research highlight the need to consider cause-specific infant mortality in understanding the racial disparity in infant death. Changes in individual causes of death due to advancing therapeutic technologies and improved distributions of maternal risk factors can influence the overall distribution of infant deaths by race. Additionally, social context should continue to be included in future studies, although new measures may need to be considered. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Fall Semester, 2010. / October 1, 2010. / Infant Health, Racial Disparities, Multi-level Modeling, Cause-Specific Infant Death / Includes bibliographical references. / Isaac W. Eberstein, Professor Directing Dissertation; Lisa Jordan, University Representative; Elwood Carlson, Committee Member; Verna Keith, Committee Member; Miles Taylor, Committee Member.

Stroke is the fifth leading cause of death in the United States. Minority groups are disproportionately affected, particularly African Americans, who are three times more likely to be affected than their White counterparts. An effective strategy for addressing these disparities is to improve knowledge of stroke risk factors through innovative and culturally tailored education programs delivered by community health workers (CHW), such as the Columbia Institute for Training Outreach and Community Health (InTOuCH) program. The purpose of this study was to develop and validate outcome measures generated by the Stroke Literacy Assessment Test (SLAT) designed for use with community health workers (CHW) in a stroke prevention training program. The specific aims were to: 1) identify gaps in the literature related to assessment measures in stroke literacy for CHWs, 2) assess and evaluate the need for a stroke literacy assessment test for CHWs, 3) demonstrate evidence of the validity and reliability for the stroke literacy assessment test, and 4) assess stroke literacy in a sample of CHWs participating in the Columbia InTOuCH stroke prevention training program. The scoping review of literature demonstrated that CHW–specific competency assessment methods were limited, with few or no domain-referenced tools on stroke risk factors that complied with measurement standards. Guided by the CHW assessment context, the study applied a unified instrument design and validation approach using an iterative Process Model to develop the SLAT. The SLAT content domain was first specified to produce an initial item pool. Both were content validated by external expert review and refined. Next, empirical validation continued with evidence on examinee response processes, diagnostic item statistics and quality, total score reliability and verification of theoretically expected subgroup differences in SLAT scores. The iterative design process yielded a subset of well-functioning items of the initial 46. These were assembled to construct a final assessment test for empirical evaluation. The final SLAT was administered to 68 CHW alumni of the InTOuCH training program. Results showed that a 34-item SLAT that assesses the factual knowledge and application levels of cognition demonstrates sufficient validity and reliability for use with CHWs specializing in stroke prevention efforts.

Includes bibliographical references. / This thesis examines the social determinants of women's health status, health knowledge and knowledge and use of health services in a peri-urban area, using Kbayelitsha in Cape Town, South Africa as a case study. It argues for the importance of women's health as a specific focus, looks at some trends in women's health internationally over the past two decades and reviews the main factors affecting women's health. Some key issues in women's health of special relevance to developing countries such as South Africa are discussed. There is a special focus on newly urbanised women in peri-urban areas. Against this background the results of a community-based survey, preceded by indepth interviews, and conducted amongst 659 women in Kbayelitsha in 1989 and 1990 are presented. Data collected were statistically analysed using unIvariate,, bivariate and multivariate analysis. A number of priority social and health problems are identified: poverty; poor environmental conditions; lack of education, partlcularly skills training appropriate for finding work and the subordinate social status of women. Major health concerns included reproductive tract infections, especially sexually transmitted diseases, infertility, contraceptive use and ante-natal care during pregnancy. There were inadequacies in cervical screening conducted by health services and deficiencies in respondents' knowledge of AIDS. cervical smears and where to obtain various health services . Young, newly urbanised women, living in the poorly serviced and unserviced informal housing areas were partlcularly vulnerable in their socio-economic and health status within a peri-urban African community such as Khayelitsha. They also had poorest health knowledge and least knowledge of where to acquire health services. Some recommended interventions focussing on certain of these areas are suggested. It is argued that changes in the provision of women's health services within a primary health care setting can only be part of the process of improving women's health. Improvements in women's economic status and their social status are fundamental to any initiatives to improve their health status.

A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Psychology, University of Zululand, South Africa, 2006. / The University of Zululand Community Psychology Centre (CPC) is a joint project of the Department of Psychology, Educational Psychology and Industrial Psychology. It was established in response firstly to the University's need to provide relevant training for its post-graduate psychology students and secondly to meet the need within the Zululand community for affordable psychosocial and psycho-educational services. The Centre works in partnership with other local Zululand Mental Health centres. The Centre is accredited with the Professional Board for Psychologists of the Health Professions Council of South Africa (HPCSA). This board ensures that institutions providing psychological services observe ethical codes of conduct and good practice (HPCSA, 2002). The present research was motivated by the fact that the CPC functioning has never been evaluated in terms of service delivery and relevance. The desire to know whether the CPC serves the purposes for which it was established, and to identify areas that need improvement, is a strong motivation. This helps to identify its viability, effectiveness, and value for the University of Zululand and the community served by the University. The aims of the study were to evaluate the CPC in terms of clients' perceptions with regard to effectiveness of the centre in meeting their needs and improving their psychological well-being. An accidental or convenient sample was used. An invitation to volunteer was extended to clients who happened to come for the CPC services. Volunteers completed a questionnaire^ which included a biographical inventory needs analysis questionnaire and RyfTs Scale (1995) of psychological well-being. Participants were pre and post-tested on the variable of psychological well being. The study concluded that the CPC still serves the purpose for which it was established. It is still relevant to the demand of the community. The results revealed that pre and post testing was associated with a significant improvement in total psychological well-being as with special reference to personal growth and positive relations with others. / NRF

No description available.