HIV/AIDS is a global challenge and its impact is evident. This places a burden on hospitals and health professionals. To ease this burden there are home-based care programmes which, through home-based caregivers, provide patients living with HIV/AIDS with physical and palliative care. However, these HBCGs face various challenges such as poverty, discrimination and stigma when caring for PALHIV, and their own emotional strain, which becomes burdensome without sufficient support from the home-based care centre. The qualitative study undertaken investigates the challenges and coping mechanisms of the HBCGs. Thirteen research participants were drawn from a centre in Mamelodi. Data was gathered through interviews and observations, categorised into themes and analysed. Major findings revealed that social challenges faced by HBCGs include poverty, stigmatisation and discrimination. Emotions experienced by HBCGs include guilt, anger, hopelessness, but they have spiritual reliance through prayer as one of their coping mechanisms. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Made available in DSpace on 2016-06-02T19:44:11Z (GMT). No. of bitstreams: 1 4459.pdf: 6181899 bytes, checksum: 9e1db597a6ecb8a8e0694c39910b8026 (MD5) Previous issue date: 2011-02-21 / Financiadora de Estudos e Projetos / The family is of fundamental importance in child development. Although neglected in many studies, the father is a unique contributor to his child s development, but remains absent from early intervention programs. This study aimed to determine the effect of a home-based intervention for fathers on their child s development, the interaction of both parents with their child, and the effects on home envorinment and on stress, depression, level of coping, parental and marital satisfaction, perceptions of family functioning and social support and empowerment of both parents. Six families of children with Down s syndrome, between 1 and 2 years of age had their children s development evaluated using the Operationalized Portage Inventory, in two São Paulo in country cities. The Questionnaire for the Characterization of the Family System was used to capture demographic information about the families; parts C and D of the General Guide of Transcription of Interview Data to evaluate the participation of fathers and grandparents; the Interview for the Characterization of Brazilian Fathers Role in the Education of a Child with an Intellectual Disability to evaluate fathers involvement; HOME Inventory to assess stimulation ofered to the child in the home environment; QRS-F and Lipp s Inventory of Stress Symptoms to measure parents stress; Beck s Depression Inventory to assess the existence and the level of depression; FACES III to evaluate the perception of family functioning; Coping Strategies Inventory to assess the level of coping; Social Suport Questionnaire to evaluate the perception of social suport; PSOC to assess parental satisfaction; Scale of Marital Satisfaction to assess marital satisfaction and FES to evaluate parents empowerment. In order to observe fatherchild, mother-child and father-mother-child interactions, it was used the Protocol for Categorizing the Analysis of Filmed Interactions, the Definitive System of Observational Categories and a Protocol for the Evaluation of Dyadic/Triadic Interaction. It was observed that all children had developmental delays. Parents asessment indicated: low levels of stress related to the child s presence, absence of stress among fathers, stress among all the mothers, high levels of self-esteem and empowerment, one father with depression, high levels of cohesion and adaptability, the use of various coping strategies, wide social networks and satisfaction with social support and good marital satisfaction among couples. In addition, all offered home environments that stimulated and supported their children, and family interactions were satisfatory, although they differed in some respects between fathers and mothers and in dyads and triads. The training activities conducted by the fathers, based on the Portage Inventory contributed to the development of new repertories in their children, positive behaviour in interactions were more frequent over time and a decrease in indices of stress among the mothers. The other parents charateristics assessed didn t alter generally during the families participation in the study. The stimulation and support in the home environment became better or worse depending on the family. The relation between some results and research in this field is discussed. It was concluded that early intervention programs should abandon the child-centered model to adopt a familycentered model, in which fathers are an important parent for family functioning and for child development. / A família tem importância fundamental no desenvolvimento infantil. Negligenciado em muitos estudos, o pai constitui contribuinte singular no desenvolvimento de seu filho, mas continua ausente nos programas de intervenção precoce. Este estudo teve o objetivo de conhecer o efeito de uma intervenção domiciliar com este genitor como treinador no desenvolvimento da criança e na interação de ambos os genitores com a criança, além dos efeitos no ambiente domiciliar e no estresse, depressão, no nível de enfrentamento, na satisfação parental e marital, na percepção do funcionamento familiar e do suporte social e no empoderamento de ambos os genitores. Seis famílias de crianças com Síndrome de Down com idade entre 1 e 2 anos tiveram o desenvolvimento de suas crianças avaliado por meio do Inventário Portage Operacionalizado, em duas cidades do interior paulista. Foram utilizados o Questionário de Caracterização do Sistema Familiar para caracterizar demograficamente as famílias; as partes C e D do Guia Geral de Transcrição dos Dados de Entrevista para avaliar a participação do pai e dos avós; o roteiro de Entrevista de Caracterização do Papel do Pai Brasileiro na Educação da Criança com Deficiência Mental para avaliar o envolvimento paterno; o Inventário HOME para avaliar a estimulação oferecida à criança no ambiente domiciliar; o QRS-F e o ISSL para medir o estresse dos pais; o Inventário de Depressão de Beck para avaliar a existência e o grau de depressão; o FACES III para avaliar a percepção do funcionamento familiar; o Inventário de Estratégias de Coping para avaliar o nível de enfrentamento; o Questionário de Suporte Social para avaliar a percepção do suporte social; o PSOC para avaliar a satisfação parental; a Escala de Satisfação Conjugal para avaliar a satisfação marital e a FES para avaliar o empoderamento dos pais. A fim de observar as interações pai-filho, mãe-filho e pai-mãe-filho utilizou-se o Protocolo de Categorias de Análise das Filmagens de Interação, o Sistema Definitivo de Categorias Observacionais e o Protocolo de Avaliação da Interação Diádica/Triádica. Observou-se que todas as crianças apresentavam atrasos de desenvolvimento. A avaliação dos genitores indicou: baixos níveis de estresse em relação à presença da criança, ausência de estresse entre os genitores masculinos, estresse para todas as mães, altos índices de autoestima e empoderamento, depressão em um pai, altos índices de coesão e adaptabilidade familiar, diversas estratégias de enfrentamento, ampla rede e satisfação com o suporte social e boa satisfação conjugal entre os casais. Além disso, todos ofereciam ambiente domiciliar que estimulava e apoiava as crianças e as interações familiares foram satisfatórias, porém, diferentes em alguns aspectos entre pais e mães e nas díades e tríades. As atividades de treino realizado pelo pai, baseadas no Portage, desenvolveram novos repertórios na criança, comportamentos positivos nas interações foram mais frequentes com o passar do tempo e houve diminuição dos índices indicativos de estresse nas mães. As demais características parentais avaliadas não sofreram alterações generalizadas durante a participação das famílias no estudo. A estimulação e o apoio no ambiente domiciliar sofreram melhoras e pioras dependendo da família. Discute-se a relação entre alguns resultados e pesquisas na área. Conclui-se que programas de intervenção precoce deveriam abandonar o modelo centrado na criança para adotar um modelo centrado na família, na qual o pai constitui genitor relevante para o funcionamento da mesma e para o desenvolvimento dos filhos.

In-home family therapy has become one of the most common options of treatment for providing services to families who do not typically utilize a private clinic (Lawson, 2005; Reiter, 2000; Yorgason, McWey, & Felts, 2005). Researchers have given some attention to the topic of home-based therapy and to general supervision, but little attention has focused on the actual supervision experiences of home-based therapy providers. This phenomenological study explored the supervision experiences of seven past and current in-home therapists: marriage and family therapists (MFTs) and social workers (MSWs). Semi-structured interviews were conducted with the participants, and data was analyzed to develop structured descriptions and meanings via highlighted “significant statements” that described the participants’ experiences (Kvale, 2007). The participants’ descriptive accounts were categorized as 1) in-home therapy descriptions, 2) factors affecting in-home therapy supervision, and 3) effective and ineffective supervisory practices. Implications of the research findings suggested that clinicians’ needs and expectations related to safety, burn out, and supervisory knowledge were often unmet. Supervisory practices that appeared significantly effective were 1) developing trusting supervisor-supervisee relationships, 2) reviewing models and clinical application collaboratively, and 3) actively prioritizing clinician safety and burn out prevention.

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed. / <p>Härtill 4 uppsatser</p>

HIV/AIDS is a pandemic infecting and affecting millions of people worldwide. South Africa is also severely affected by this disease. Because hospitals cannot cope with patients admitted daily especially with the influx caused by HIV/AIDS patients, the government has introduced home-based care of people living with HIV/AIDS. Amongst those who practice home-based care are the volunteers. This study is aimed at exploring and describing the experiences of volunteers involved in home-based care of people living with HIV/AIDS in the Lusikisiki Magisterial district in the former Transkei area of the Province of the Eastern Cape. The researcher used a qualitative methodology with the aim of finding out what it is like to be a volunteer involved in home-based care in a rural area. The data was collected by means of semi-structured one-to-one interviews or guided interviews. A total sample of thirteen research participants was acquired through purposive as well as snowball sampling. The interviews were guided by a number of broad question themes. Data was analyzed using Tesch’s framework of data analysis as described in Creswell (1994). The researcher used Guba’s model as outlined in Krefting (1991) to ensure trustworthiness of the research findings. A literature control was undertaken to find out what other researchers and authors say about the issues raised by the study. There were five themes that came out of the data analysis process and these themes are: o The experiences of volunteers with home-based care. o Factors facilitating the work of volunteers. o Problems encountered by volunteers. o Possible solutions to problems encountered. o Views of volunteers regarding home-based care. These broad themes were further reduced into sub-themes and categories. Based on the discussion of themes, sub-themes, and categories, some research findings were presented. The discussion of the themes, sub-themes and categories was supported by verbatim quotations from the participants. On the basis of research findings, conclusions and recommendations were made.

社區安寧療護的推展以「居家存有」為中心，以身心整體照顧為導向的醫療，與全然「醫療權力」視角不同。本研究嘗試探討家屬照顧者於居家安寧照顧處境下的經驗，嘗試以「倫理關係」思考居家型的照顧內涵。 本研究透過田野參與觀察及深度訪談法，以北部某醫療院所提供之社區安寧療護服務區域為田野，訪談接受社區安寧照護之五位家屬主要照顧者。資料分析依現象學心理學分析方法（李維倫、賴憶嫺，2009）。而後，邀請兩名受訪者，對資料的組織脈絡描述及其所驅動的主題置身結構，予以交叉討論與分享，提昇質性研究可靠度的品質。 研究結果發現，鄉村型態安寧照顧者的置身經驗中，呈現出一種「鄉村型態的寓居」混合狀態，既安居又陌生的處境。一方面，參與者經驗到的棲居地域，並不侷限於家屋建築或特定地域，更是對地方的認同與情感的依附，從而開展自我「寓居於世」的「照顧者棲居」樣態；另一方面，照顧事件的衝擊，為照顧者帶來一種既熟悉又陌生的詭譎「無居家感」（uncanny）狀態。然而，如此看似矛盾處境，反使其於居家照顧處境之倫理凝視中，啟動反身窺探自我生命，以及於居家照顧處境中與他者間關係的梳理，進一步帶出「居家照顧作為一倫理行動」，進而深刻化「照顧自己/關切他人」的倫理意涵。 由此發現，鄉村型態居家照顧經驗之置身結構，可為與其相似處境之居家照顧者提供置身經驗之參考，並據以推動社區安寧方案的規劃。 / The goal of the home-based palliative care model is to facilitate the patients and their family to feel “being at home.” Differ from the perspective of the “power domination in medical regime,” the home-based palliative care model focuses on the ethical relationship besides the bio-psycho-social care aspects. This study aims to understand the caring situatedness of family members as caregivers in home-based palliative care model, and try to disclose the sense of homelikeness through the caring relationship. We applied the participatory observation and depth interview to collect data. Five family caregivers who agreed the informed consent were recruited from home-based palliative care service in northern Taiwan and were interviewed twice. Interviews were recorded, transcribed, and analyzed by a phenomenological psychology method. The results revealed that there is ambivalent caring experience towards “dwelling in the community-home”. The experiences they felt seemed both strange and familiar. On the one hand, the caregivers’ dwelling pattern of being-in-the-world was constructed from the perspective of human-environment comfortable relationship (sense of feeling at home); on the other hand, they are bothered and struck by the caring problem, they faced the new challenges and thrown into the situation of “uncanny.” It is an unhomelike being-in-the-world in which Da-sein takes on alien and uncanny qualities. However, the two caring modes manifested the meaning of existentiality. Immersed in this situation, caring is not only the labor work, it is also the ethical act to respond the worrisome emotion and regain the relationships with others during the caring experiences. Ethical caring is the cornerstone of relational understanding towards the human subjectivity rather than the medical positivism. By elaborating the situatedness of home-based palliative care model, further planning of the community-based palliative care model in similar situation may base on this study outcome implication.

This study examines the role of Community Based-Organisations (CBOs) in the response to HIV/AIDS as a development challenge drawing examples from the Gabane Community Home-Based Care CBO in Botswana. The study adopted qualitative methods of research and used group discussions, relative unstructured interviews, direct observation and literature review as methods of data collection. The study found out that HIV/AIDS is indeed a development problem and that it can be dealt with using some existing development approaches such as the sustainable livelihoods approaches. The study further identified specific roles that CBOs play in the response to HIV/AIDS. It also revealed the potential that CBOs have in achieving development. In addition, the study identified and outlined challenges that CBOs face in responding to HIV/AIDS. Key recommendations are that CBOs must integrate poverty reduction interventions in their activities. They must also form coalitions and strengthen their capacity to sustain their activities and manage partnerships. / Development Studies

MPH / Department of Public Health / See the attached abstract below

MPH / Department of Public Health / Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) place a significant burden on the caregivers for people living with HIV/AIDS (PLWHA). Caring for PLWHA is usually carried out by community members who are recruited from the same community as the PLWHA. These community members are trained to provide services as volunteer caregivers. The caregivers face various challenges in the process of giving care to PLWHA, often inadequately assisted by relatives, friends, neighbours, private individuals, grassroots traditional and political leaders. This results in caregivers being overwhelmed by their responsibilities, making their coping process even more difficult. The aim of this study was to explore the challenges experienced by community home-based caregivers (CHBCGs) caring for people living with HIV/AIDS at Tsianda Village, in Makhado Municipality, South Africa. This study adopted a qualitative explorative design. The population for this study were all CHBCGs caring for PLWHA. Non probability purposive sampling was used to select the community home-based caregivers working at Tsianda Community Home-based care organisation. In-depth interviews, using a semi-structured interview guide, was conducted by the researcher and a voice recorder were used to record data from participants. Data saturation was reached at the 11th participant. This is when the participants were no longer giving new information. The data collected from the study were analysed thematically. The following themes emerged from data analysis: Challenges for community home-based caregivers, perceived support for community home-based caregivers, coping strategies for community home-based caregivers. Measures to ensure trustworthiness and the code of ethics to protect the rights of the participants was applied and observed. The findings of the study revealed that community home-based caregivers experience various challenges which have a negative impact on their personal life, as well as their physical and psychological wellbeing. Community home-based care also uses different strategies to cope with these challenges. It was concluded that the community home-based caregivers are experiencing serious shortages of personal protective equipment, which makes them work with the fear of being infected with the diseases. It is recommended that the DOH should take it into consideration to provide the CHBCG’s organization with enough personal protective equipment for their safety and working without fear of being infected with deadly viruses. / NRF

Goal The goal of our pilot study was to evaluate the effect of short-term home based sensomotoric Training program (six weeks) in healthy adults on dynamic postural stability. We used the SOT at baseline and post the training program to evaluate the effect. Methodology The number of participants in this experiment was 10 healthy students, the number of males was 8 and 2 females, they were all between the age of 23 and 40 (mean 29.5 and ± S.D = 5.1 years). The sensory organization test was conducted at baseline and post the home based sensomotoric training program by using the dynamic posturography SMART Balance Master System (NeuroCom). The somatosensory (SOM), visual (VIS), vestibular (VEST), preference (PREF) and composite equilibrium outcome measures of the sensory organization test were evaluated. Results The VIS sensory system has significantly improved also the VEST sensory system with p-value < 0.05. The SOM sensory system had no significant improvement also the PREF sensory system with p-value > 0.05, while the overall composite equilibrium had a significant improvement with p-value > 0.05. Conclusion According to our findings the short-term home based sensomotoric training program has a positive effect in terms of improving the overall dynamic balance in healthy adults. Keywords Dynamic...