A dissertation submitted to the Faculty of Arts in fulfilment of the requirements for the Degree of Doctor of Philosophy (Community Psychology) in the Department of Psychology at the University Of Zululand, 2017 / Health is a human need and considered to be a human right across all societies. Access to health care services is not a problem for those who can afford it, but, for those who cannot provide for themselves, legislation needs to protect their rights. Although there is legislation in place to protect these vulnerable populations, it is ultimately the health care practitioners’ job to protect and improve the health of their communities. It is these health care practitioners who were the inspiration for and focus of the present study. The present study emerged as a separate, but expanded version of the researcher’s limited 2011 study, which specifically focused on medical practitioners’ experiences of the current health care delivery system. Results from this 2011 study suggested that a broader spectrum of health care practitioners may be similarly affected by the current health care system and that their experiences may ultimately contribute towards a better understanding of the dynamics within which health care practitioners work and function. Therefore, the present phenomenologically-oriented study aimed to describe, explicate, interpret and analyse the experiences of a broad sample of health care practitioners through their lived, day-to-day realities in both the public and private health care sectors. Data were collected from a non-probability, purposive, convenience sample of 30 adult registered health care practitioners in public and private hospitals, clinics and private practices in the uThungulu District of Kwa-Zulu Natal, South Africa. There were 15 participants from the public and 15 from the private sector. An open-ended questionnaire was used to ascertain and understand their experiences, knowledge and exposure to the relatively new national health insurance (NHI) system, what they perceived as key objectives for effective transformation of the South African health care system, possible reasons for considering emigration in light of the current staff shortages and their views on the new NHI policy, in order to find solutions to problems. The overall data analysis consisted of three levels of subsidiary data analysis, descriptive, social constructionist and interpretive paradigms, each contributing to the whole, both “vertically and horizontally”, where participants’ experiences were described, explicated and interpreted. Research findings indicated persisting large divisions and fragmentation in and between the public and private health care sectors. Yet there was unity in responses concerning the poor and disadvantaged members of society and the challenges of their access to health care services. Sensitivity to human rights standards, past socio-political influences and awareness of health as a human right and need were evident in all participant responses. Valuable solutions to improve the health care delivery system were offered by health care practitioners as key stakeholders in the future of health care delivery in South Africa. Public health care practitioners’ experiences were dominated by overall expressions of unhappiness, anger and frustration related to poor service delivery, lack of resources, inadequate management structures, wages, inadequate consultation, fear for personal (and family) safety and the future of health care. Concern for the poor, vulnerable and the majority of citizens who use health care services, coupled with the burgeoning burden of disease, were perceived as a major stressor and source of anger towards the government and bureaucracy in general. Chronic stress and anxiety, suggestive of burnout and other negative psychological states, were also apparent. The inability to service long patient queues, inadequate communication structures/channels and lack of cohesive team practices, ethics and standards created a sense of emotional overburden and other negative affective states. These, and the uncertain future of health care under the new NHI, exerted extra stress on already overworked health care personnel. Education and effective consultation about the NHI were expressed as being inadequate and incomplete. Despite these factors, health care practitioners offered various valuable solutions and suggestions for the improvement of health care service delivery. Despite also being stressed, participants who work in the private sector were generally happier and they evinced less negative psychological states. Although a stressful environment with its own problems, within the private sector the NHI was considered to be a good concept in principle, although many participants doubted its feasibility and felt that regulatory changes often took place without adequate consultation. Given the nature and transparency of the present study, across multidisciplinary teams of health care practitioners, the researcher is of the opinion that the present study created a platform for discussion and debate around the context of a changing health care system within South Africa’s culturally diverse society. In conclusion, a critical review of the present study and recommendations for management structures, health care practitioners themselves and future research is provided.

There are two independent streams of health care in South Africa: traditional healing and Western medicine. Proposals to formally integrate the two streams have been made by the World Health Organization and by the South African Department of Health. In this study, the philosophical background behind each of the two health care models is discussed, as well as literature on the possible integration of the two systems. It has not been clear if Western-trained health-care practitioners would be prepared to work with traditional healers. The purpose of this study was therefore to examine health care practitioners’ opinions, attitudes, knowledge and experiences with traditional healers, and to determine to what extent these variables would predict their intentions to work with these healers. A Within-Stage Mixed Model design was used, and data were collected using a selfdeveloped questionnaire. A total of 319 health care practitioners from State hospitals and clinics in Gauteng and Limpopo provinces participated in the study. The results of the study revealed significant differences between groups of health care practitioners in terms of their opinions, attitudes, experiences and intentions to work with traditional healers. Psychiatric nurses and psychiatrists showed more positive opinions, more positive attitudes, more knowledge and more willingness to work with traditional healers than do general nurses and physicians. Psychiatric and general nurses also had more experiences with traditional healing than did psychiatrists and physicians. The results also revealed that attitudes, knowledge, opinions and experiences predict Western health care practitioners’ intentions to work with traditional healers, with attitudes being the strongest and experiences the weakest predictors. Health care practitioners’ views of traditional healing were contradictory and ambivalent in many instances. This implies that integration of the two health care systems will be complex, that the current potential to integrate the systems is weak and that such integration can only be realised with considerable effort from all stakeholders. / Psychology / D. Litt. et Phil. (Psychology)

There are two independent streams of health care in South Africa: traditional healing and Western medicine. Proposals to formally integrate the two streams have been made by the World Health Organization and by the South African Department of Health. In this study, the philosophical background behind each of the two health care models is discussed, as well as literature on the possible integration of the two systems. It has not been clear if Western-trained health-care practitioners would be prepared to work with traditional healers. The purpose of this study was therefore to examine health care practitioners’ opinions, attitudes, knowledge and experiences with traditional healers, and to determine to what extent these variables would predict their intentions to work with these healers. A Within-Stage Mixed Model design was used, and data were collected using a selfdeveloped questionnaire. A total of 319 health care practitioners from State hospitals and clinics in Gauteng and Limpopo provinces participated in the study. The results of the study revealed significant differences between groups of health care practitioners in terms of their opinions, attitudes, experiences and intentions to work with traditional healers. Psychiatric nurses and psychiatrists showed more positive opinions, more positive attitudes, more knowledge and more willingness to work with traditional healers than do general nurses and physicians. Psychiatric and general nurses also had more experiences with traditional healing than did psychiatrists and physicians. The results also revealed that attitudes, knowledge, opinions and experiences predict Western health care practitioners’ intentions to work with traditional healers, with attitudes being the strongest and experiences the weakest predictors. Health care practitioners’ views of traditional healing were contradictory and ambivalent in many instances. This implies that integration of the two health care systems will be complex, that the current potential to integrate the systems is weak and that such integration can only be realised with considerable effort from all stakeholders. / Psychology / D. Litt. et Phil. (Psychology)

This study used a qualitative, explorative, and descriptive design to understand the experiences of adolescents after HIV status disclosure in Hhohho region Swaziland. The data were collected through in-depth individual semi structured face-to-face interviews from 10 adolescents living with HIV between the ages 15-19 years. To analyse interviews, Tesch’s qualitative data analysis approach was used. Findings from the study revealed that participants experienced sadness, despair and anger after disclosure and also had fear of death because some had lost one or both parents. The participants reported recurrent episodes of poor health, which resulted in failure at school. In addition, they stressed that they could not disclose their HIV status because they feared discrimination and stigma. Recommendations were made to improve coping strategies of adolescents and revising the nursing curriculum to equip nursing students with appropriate skills that would enable them to care for adolescents living with HIV (ALHIV). / Health Studies / MA (Health Studies)

Mental illness remains one of the most devastating condition affecting the social functioning of individuals and families. The affected individuals and their caregivers expressed dissatisfaction in mental health service delivery. The mental health system is medically oriented and does not involve caregivers as partners in the provision of mental health services. Although the developmental approach has been adopted to guide the provision of services recognising human rights and social justice, the medical model remains a challenge in the provision of comprehensive mental health services. This is compounded by the Mental Health Care Act (Act No. 17 of 2002) that is silent on the role of families in the mental health system. Additionally, social workers are unable to provide adequate services due to lack of resources. A qualitative study using the exploratory, descriptive and contextual designs was undertaken. Purposive sampling was used to select 28 participants from three groups, namely ten MHCUs, nine caregivers and nine social workers. The goals of the study were to understand the experiences of MHCUs, caregivers and social workers in mental health service delivery; and to proffer guidelines for social work practice to enhance partnership between the family and mental health care providers. Data was gathered through semi-structured interviews and analysed according to Tesch’s (in Creswell, 2009:186; 2014) framework. Data verification was guided by Lincoln and Guba’s (in Krefting, 1991:214-222) model to enhance trustworthiness. The findings suggest that MHCUs and caregivers received inadequate psychosocial support which is attributed to lack of involvement in service delivery. Furthermore, social workers lack adequate training to provide effective mental health care. As a result, guidelines were developed for the establishment and enhancement of partnership between families and mental health service providers to offer comprehensive and sustainable mental health services. Future exploration of the role of the family in mental health services is required. / Social Work / D. Phil. (Social Work)