This study investigated the social factors influencing the poor uptake of HIV Testing and Counselling (HCT) services by middle-aged black men in Pimville, Soweto. A qualitative research approach was used for this study in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics, knowledge of HIV and AIDS, health-seeking behaviours, understanding of multiple sexual partnerships, male circumcision, and challenges in using HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors are major reasons for the poor HCT uptake. Despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Pimville are recommended. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)

The purpose of this current study was to determine the role of acculturation, ethnic identity, and religious fatalism regarding attitudes towards seeking psychological help among Coptic (Egyptian Christian) Americans. In addition, differences between groups of gender and generational status, first-generation adult immigrants versus U.S.-born second-generation Copts, were analyzed. The study had a total sample of 91 individuals that self-identified as Coptic by race and/or Coptic Orthodox by religion, who voluntarily completed an anonymous online questionnaire. Results indicate that ethnic identity and acculturation are strong predictors of religious fatalistic beliefs, and those who identified as having more Arab ethnic identity and less assimilation to dominate culture have stronger religious fatalistic beliefs than those who identified with more western culture and an American ethnic identity. However, religious fatalism and ethnic identity were not significant predictors of attitudes towards seeking psychological help, and other variables such as stigma, language barriers, and skepticism of western psychology may be better predictors of attitudes towards seeking psychological help. Between groups comparisons identified subtle differences between males and females, and between first and second-generation Coptic Americans on acculturation, ethnic identity, and religious fatalism, but the groups were not statistically significant from one another. Clinical implications and directions for future research will also be discussed.

This research was stimulated by an indication that members of the Africa Gospel Church do not utilise professional health care services optimally, probably due to religious reasons. This may also be the result of registered nurses’ inability to render culture congruent care. To render culture congruent care, nurses require knowledge of the belief system and the health seeking behaviours of the church members. The qualitative research investigated the religious beliefs and health seeking behaviours of members of the Africa Gospel Church in Francistown, Botswana. An exploratory ethnonursing research method was applied. Semi-structured interviews were held with two purposively selected samples. Qualitative data analysis was done using computer software to reduce data and interpret the research results. The study indicated that members utilise the Church structure for health care purposes and seek health care mainly from priests and prophets. / Advanced Nursing Sciences / M.A. (Nursing Science)

This study investigated the social factors influencing the poor uptake of HIV Testing and Counselling (HCT) services by middle-aged black men in Pimville, Soweto. A qualitative research approach was used for this study in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics, knowledge of HIV and AIDS, health-seeking behaviours, understanding of multiple sexual partnerships, male circumcision, and challenges in using HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors are major reasons for the poor HCT uptake. Despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Pimville are recommended. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

This study investigated caregivers' perceptions with regard to vaccine-preventable diseases in terms of six constructs of the Health Belief Model. A qualitative research design that is explorative, descriptive and contextual in nature was employed in order to understand and describe the perceptions influencing access and utilisation of services that lead to missed immunisation opportunities and consequently outbreaks of vaccine-preventable diseases. The data-collection techniques were individual unstructured in-depth interviews, field notes and clinical records. The sample consisted of twenty two (N=22) caregivers who volunteered to be interviewed. The study has highlighted that caregivers' perceptions or cognitive factors play an important role for having children in completing immunisation schedule to protect the public from vaccine-preventable diseases. It is recommended that mass media programmes are needed to address the role of vaccines in reducing high morbidity and mortality rates caused by vaccine preventable diseases and improvement in access to immunisation services. / Health Studies / MPH (Health Studies)

The overall aim of this thesis was to examine the distribution of health literacy (HL) levels in newly arrived Arabic-, Dari-, or Somali-speaking refugees in Sweden. Further aims were to investigate sociodemographic characteristics associated with inadequate HL in this group, and to investigate whether HL levels are associated with experiences of the health examination for asylum seekers (HEA), health seeking behaviour and health. Three quantitative cross-sectional studies, using data from two different surveys, were conducted among Arabic-, Dari-, and Somali-speaking, newly arrived refugees taking part in courses in Swedish for immigrants or civic orientation. In addition, an explorative qualitative study, based on focus group discussions, was performed on Arabic- and Somali-speaking newly arrived refugees who had taken part in an HEA. All data were collected 2013-2016. The quantitative data were analysed using different statistical methods, foremost descriptive statistics and univariate and multivariate binary logistic regression analyses. The qualitative data were analysed using Graneheim and Lundman’s method for latent content analysis. The main findings were that the majority of Arabic-, Dari-, or Somali-speaking refugees in Sweden have limited functional health literacy (FHL) and/or limited comprehensive health literacy (CHL). Having a low education level and/or being born in Somalia were associated with having inadequate FHL, but not with having inadequate CHL. Limited FHL was associated with inadequate CHL. Experiences of poor quality of communication and having benefited little from the HEA were more common among those with limited CHL, as compared to those with higher CHL. Experiences of communication problems and a lack of information related to the HEA were found in the qualitative studies as well. In addition, it was more common that those with limited CHL reported poor general health and impaired psychological well-being, and that they had refrained from seeking healthcare. In conclusion: limited HL is common among newly arrived refugees in Sweden and seems to be of importance for the experience of the HEA, health-seeking behaviour and health. HL needs to be taken into consideration in the work with refugees in order to increase equity in healthcare and health.

Abstracts in English and Zulu / Immunisation is a cost-effective public health intervention that contributes to the attainment of the Sustainable Development Goals (SDGs). About 40% of children under the age of five years die from vaccine-preventable diseases in Nigeria. Routine immunisation has been quite low in Nigeria, where national coverage is estimated to be 33%, according to a 2016–2017 survey. This empirical research was aimed at determining the key socio-economic and gender determinants of immunisation in the Federal Capital Territory (FCT), identifying gaps and proffering solutions. Mixed methods of data collection and analysis were used. Data were gathered from several secondary sources and from 11 key informants using semi-structured interviews and 501 household and 26 health-facility surveys using questionnaires mounted on Open Data Kit. Lot quality assurance sampling and probability to population size methodology were used to size the samples and identify survey locations. Odds ratio analysis and logistic regression analysis were conducted to gauge the statistical association between the determinants and the coverage of immunisation. The main finding that was reached on the basis of the documents reviewed and the feedback received from the key informants was that they were gender blind at worst and gender neural at best. Most of the current strategies give little attention to socio-economic and gender barriers. Over 40 immunisation variables were identified. The analysis, particularly using the 2x2 odds ratio, yielded mixed results. The majority of the variables exhibited a close statistical association as far as immunisation indices were concerned. These variables included urban residency, married couples, literacy, birth at a health facility, antenatal care experience, vaccination card possession, immunisation knowledge, child health information, non-farming earnings, socio-economic status and tolerance of spouse beating. On the other hand, variables that were found to have no statistical significance included sex, marital status, marriage type, age, religion, tetanus toxoid (TT) vaccination and adequacy of income. Immunisation and gender are intertwined, particularly because of mothers’ biological and social attachment to their children. At the same time, conducting vaccination avails the opportunity to access almost all households. Moreover, it is important to recognise that socio-economic and gender determinants are not totally in control of one ministry. Single agenda interventions will not produce the desired result. A paradigm shift and the concerted effort of various sectors and partners are required. Therefore, the Nigerian government should galvanise the relevant stakeholders to bring gender and socio-economic variables into the mainstream throughout the immunisation ecosystem and to implement integrated development initiatives by prioritising vulnerable communities. / Ugonyo yindlela engcono yokungenela kwezempilo yabantu engathela esivivaneni ekufinyeleleni izinhloso zentuthuko eqhubekela phambili ezaziwa ngelokuthi yi- Sustainable Development Goals (SDGs). Cishe izingane ezifinyelela ku 40% ezingaphansi kweminyaka emihlanu zibulawa yizifo ezivimbelekayo ngomgcabo emitholampilo eNigeria. Ukugonya njalo kusezingeni eliphansi eNigeria, laphokhona ukwengamela kuzwelonke kulinganiselwa ku 33%, ngokuya kocwaningo olwenziwe phakathi kuka 2016-2017. Ucwaningo lokuthola ubufakazi lwalunenhloso yokubona imithelela yezesimo sabantu nomnotho (socio-economic) kanye nobulili ngokugonya kwi-Federal Capital Territory (FCT) ukubona amagebe kanye nokutholakala kwezixazululo. Amamethodi axubene okuqokelela ulwazi kanye nohlaziyo kwasetshenziswa. Ulwazi lwaqokelelwa ngokufunda imithombo yemibhalo (secondary sources) kanye nakubantu ababalulekile abanolwazi (key informants) abangu 11 ngokusebenzisa ama-semi-structured interview kanye nemizi engu 501 kanye namasurvey amafasilithi ezempilo angu 26 ngokusebenzisa uhla lwemibuzo yamaquestionnaire ebifakelwe kwi-Open Data Kit. Kwasetshenziswa nemethodi ye-Lot quality assurance sampling ne-probability, ngemethodoloji yobuningi babantu, ukwenza usayizi wamasampuli kanye nokubona izindawo okumele kwenziwe kuzo ama-survey. Kwenziwa nohlaziyo lwe-Odds ratio analysis kanye ne-logisic regression analysis ukubona ukuhambelana kwamastatistiki phakathi kwezinto eziwumthelela kanye nokunaba kongamelo lokwenziwa kogonyo. Okukhulu okutholakele ngokulandela amadokhumende okufundwe kuwo, kanye nezimpendulo ezivela kulabo abanolwazi ababalulekile (key informants) kube wukuthi bekungaboneleli ubulili (gender blind) kanti futhi bekungachemile ngokulandela ubulili (gender neutral) ngezinga elibi nangokungcono kakhulu. Amasu amaningi amanje awanakekeli kakhulu izihibe ezimayelana nabantu nezomnotho kanye nezobulili. Kwaphawulwa cishe izinto ezehlukene zama-variable ezingu 40 mayelana nogonyo. Uhlaziyo, ikakhulukazi ngokusebenzisa i 2x2 odds ratio, lwaveza imiphumela exubene. Ezinto zama-variable ehlukene eziningi zikhombise ukuhlobana phakathi kwamastatistiki mayelana namaindices ogonyo. Lama variable, abandakanye ukuhlala emadolobheni, abantu abashadile, ikhono lokubhala nokufunda, ukuzalwa kwezingane kumafasilithi ezempilo, izipiliyoni zonakekelo lwengane ngaphambi kokuzalwa, ukuba nekhadi lomgcabo ix wasemitholampilo, ulwazi ngogonyo, ulwazi ngempilo yengane, ukuthola imali ngemisebenzi engeyona eyokulima, isimo sabantu mayelana nezomnotho, kanye nokuqinisela ukuhlukunyezwa ngokushaywa kwabesimame. Kanti ngakolunye uhlangothi, ama-variable atholakale engenakho ukubaluleka ngokwamastatistiki, abandakanya ubulili, isimo ngokomendo, inhlobo yomendo, iminyaka yobudala, inkolo, umgcabo we-tetanus toxoid (TT), kanye nokwenela kwengeniso lemali. Ugonyo kanye nobulili kuyangenelana nokuhambelana, ikakhulukazi ngenxa yokusondelana komama kanye nezingane zabo. Ngaso leso sikhathi, ukwenziwa kogonyo kuhlinzeka ngethuba lokufinyelela cishe kuwo yonke imizi eminingi. Nangaphezu kwalokho, kubalulekile ukwamukela ukuthi isimo sabantu mayelana nezomnotho kanye nobulili kuyizinto ezinomthelela, azinalo ulawulo oluphelele kumnyango kangqongqoshe owodwa. Ungenelo ngento eyodwa ngeke kwaveza imiphumela efiswayo. Ukugudluka ngokomqondo (paradigm shift), kanye nemizamo eqhubekela phambili yemikhakha ehlukene kanye nabasebenzisani kuyadingeka. Ngakho-ke uhulumeni waseNigeria, kumele agqugquzele ababambiqhaza abafanele ukuhlanganisa nokufaka emkhakheni ofanele izinto ezimayelana nabantu nomnotho kanye nobulili, kuyo yonke inqubo yokusebenzisana kwemikhakha okumele isebenzisane nehlangene ukusebenza ngokulandela inqubo yentuthuko ehlangane ngokubonelela imiphakathi ekwizimo ezibucayi / Development Studies / D. Phil. (Development Studies)

A qualitative research design and an ethno-nursing research method were used to identify cultural factors influencing Xhosa women's health seeking behaviours associated with breast lumps. Focus group interviews were conducted to obtain data. The research results revealed that these Xhosa women with breast lumps did not disclose some cultural factors which influenced their health seeking behaviours associated breast lumps. Registered nurses, sharing the same culture and language as the Xhosa women, revealed that Xhosa women with breast lumps sought treatment from traditional healers, prior to seeking medical care from the hospital and/or clinics. When they arrive at the hospital/clinics the breast lumps have often progressed to advanced ulcerated breast cancer, with poor prognoses and poor treatment outcomes. Xhosa women lacked knowledge about the management of breast lumps. Health promotion efforts should address this issue at Primary Health Care services in the Eastern Cape. / Health Studies / M.A. (Health Studies)

This study investigated social contextual factors influencing poor uptake of HIV counselling and testing (HCT) services by middle-aged black men in Ratanda, Heidelberg. A qualitative research approach was used in which ten men and two key informants were interviewed. Themes explored were the participants’ biographical characteristics; knowledge of HIV and AIDS; health-seeking behaviours; understanding of multiple sexual partnerships and male circumcision and challenges in utilising HCT services. Various social behaviour change theories formed the theoretical framework guiding this study. It was found that fear, stigma and cultural factors largely contributed to poor HCT uptake. Moreover despite the men’s high HIV risk perceptions, behaviour change lags behind. Greater efforts to establish a men’s forum to discuss sexual health matters in Ratanda is recommended. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)