The goal of this project was to test intervention program of locomotion for mentally affected children. Testing took place in a Special Care Institute in Blatná. Children were taught easy locomocy games and practiced psychomotor and yoga exercises. The control group consisted of 10 children and the experimental group consisted of 13 children. The experimental group actively participated in the experiment. Standardized locomocy tests were used to evaluate the effect of the program on the children. Both groups were measured at the beginning and at the end of the task. Gained numerical values were statistically evaluated. The evaluation showed improvement for the experimental group.

AFRIKAANS: Die navorsing handel oor die effek van SHIP® (Spontaneheling Intrasistemiese Proses) by adolessente tennisspelers en die waarde daarvan ten opsigte van die ontwikkeling van sielkundige potensiaal van spelers. Tradisioneel word Sportsielkunde vanaf ‘n kliniese konteks gevoed. Dit is ‘n dinamiese veld wat voordurend op soek is na nog verdere tegnologiese ontwikkeling. Die waarde van die studie is dat dit die eerste keer is dat ‘n hele kliniese intervensieprogram suiwer in ‘n sportkonteks toegepas word. Die doel van die studie is om te bepaal wat die moontlike sielkundige bydrae van SHIP® op die sielkunde van die tennisspeler is. Die intervensie SHIP® het tussen vier tot ses maande geduur met ‘n gemiddeld van tien sessies per speler waar ‘n sessie een uur lank duur. ‘n Totaal van tien adolessente tennisspelers wat verbonde is aan ‘n tennisskool is vir die studie gebruik. Die spelers wat aan die studie deelgeneem het bestaan uit vier manlike en ses vroulike tennisspelers. Die eksperimentele groep bestaan uit ses tennisspelers (twee manlik en vier vroulik) wat ‘n reeks psigometriese toetse afgelê het en deur SHIP® behandel is. Die kontrole groep bestaan uit vier tennisspelers (twee manlik en twee vroulik) wat nie deur SHIP® behandel is nie, maar wel die psigometriese toetse afgelê het. Die studie maak gebruik van ‘n tradisionele eksperimentele ontwerp wat van ‘n eksperimentele en kontrole groep gebruik maak. Verder leen die studie aspekte van Pieterse (2004) se enkelproefpersoonnavorsingsontwerp. Die ontwerp behels onderhoude wat met al die spelers gevoer is, voor die intervensie. Die onderhoude handel oor die spelers se sterkpunte, swakpunte en belewenis van angs en stres tydens tenniswedstryde. Na die intervensie is daar onderhoude met die afrigters en drie spelers gevoer om te bepaal of daar enige verandering by die spelers plaasgevind het. Die resultate van die studie toon ‘n afname in kognitiewe en liggaamlike angs van die eksperimentele groep met geen beduidende veranderinge by die kontrole groep nie. Al hierdie veranderinge is beduidend op die 5% peil van betekenis. Ten opsigte van selfvertroue het beide groepe ‘n statisties beduidende verandering getoon op die 10% peil van betekenis. Die eksperimentele groep het egter ‘n beduidende toename getoon terwyl die kontrole groep se tellings op die subskaal beduidend afgeneem het. Die spanning-angs toetstellings van die kontrole groepe was beduidend hoër as die eksperimentele groep. Hierdie verskil was beduidend op die 10% peil van betekenis. Die depressie en woede-vyandigheid toetstellings van die kontrole groep was ook statisties hoër as die eksperimentele groep na die intervensie. Hierdie verskille was beduidend op die 5% peil van betekenis. Die resultate van die analise binne groepe, toon dat die vigortellings van die eksperimentele groep beduidend toegeneem het, terwyl die afname in die kontrole groep se tellings nie beduidend was nie. Hierdie statisties beduidende veranderinge in die eksperimentele groep was beduidend op die 5% peil van betekenis. Die afgematheid telling van die eksperimentele groep het beduidend afgeneem oor die tyd met geen beduidende verandering in die kontrole groep nie. Hierdie verandering was beduidend op die 10% peil van betekenis. Die verwarringtellings van die eksperimentele groep het beduidend afgeneem, met geen beduidende veranderings in die kontrole groep nie. Die verandering was beduidend op die 5% peil van betekenis. Die outonomiteitssubskaaltelling van die eksperimentele groep het statisties beduidend toegeneem. Die verandering was beduidend op die 10% peil van betekenis. Geen beduidende verandering het ten opsigte van hierdie subskaal by die kontrole groep plaasgevind nie. Die kontrole groepe het ‘n statisties beduidende afname in die positiewe verhoudingssubskaal getoon. Ten opsigte van entiteitsingesteldheid het die kontrole groep ‘n beduidende toename in die tellings getoon. Hierdie toename was beduidend op die 10% peil van betekenis alhoewel die eksperimentele groep se tellings ook toegeneem het, was dit nie statisties beduidend nie. Uit die onderhoude met die spelers en afrigters na die intervensie is dit duidelik dat die eksperimentele groep gegroei het ten opsigte van aandag en konsentrasiebeheer, die hantering van stres en angs en genot tydens tenniswedstryde. ENGLISH: This study examines the effect of SHIP® (Spontaneous Healing Intrasystemic Process) on adolescent tennis players and its advantages in accordance with the development of the players’ potential. Traditionally Sport Psychology has evolved from a clinical context. It is a dynamic field that is always open to further technological development. The value of the study lies in the fact that it is the first time that an entire clinical intervention programme is applied in a purely sports context. The goal of the study is to determine the possible psychological effects that SHIP® might have on the psychology of tennis players. The SHIP® intervention lasted between four to six months, with an average of ten sessions per player, and each session lasting one hour. A total of ten adolescent tennis players who attend a tennis school participated in the study. Of these players, four were male and six female. The experimental group consisted of six tennis players (two male and four female) who completed a battery of psychometric tests and went through SHIP®. The control group consisted of four tennis players (two male and two female) who completed the psychometric tests, but were not put through SHIP® . The study made use of a traditional experimental design, consisting of an experimental and a control group. In addition, the study also employed aspects of Pieterse’s (2004) single subject design. Specific aspects of this design that were applied, include interviews conducted with all the players prior to the intervention. The interviews focused on the players’ strong points, weak points and their experience of anxiety and stress during tennis matches. Follow-up interviews were conducted with three players and their coaches after the intervention, to determine if the players had experienced any change. The results of the study point toward a decrease in the cognitive and physical anxiety of the experimental group, with no significant changes manifesting in the control group. All these changes are significant on the 5%-level of significance. With regard to self-confidence, both groups showed a statistically meaningful change on the 10%-level of significance. The experimental group scores showed a significant increase, while the control group scores on this subscale decreased significantly. The stress-anxiety test scores of the control group were significantly higher than those of the experimental group. This difference was meaningful on the 10%-level of significance. The depression and anger test scores of the control group were statistically higher than those of the experimental group after the intervention. These changes were meaningful on the 5%-level of significance. The results of the analysis within groups, showed that the vigor scores of the experimental group had increased significantly, while the decrease in the control group scores was of no significance. These statistical changes in the experimental group were meaningful on the 5%-level of significance. The fatigue scores of the experimental group decreased significantly over time, with no significant changes in the control group. These changes were meaningful on the 10%-level of significance. The confusion scores of the experimental group decreased significantly, with no significant changes in the control group. This change was meaningful on the 5%-level of significance. The autonomy subscale scores of the experimental group increased statistically significantly. This change was meaningful on the 10%-level of significance. No significant change occurred in the control group with regard to this subscale. The control group showed a statistically significant decrease in the positive relationship subscale. This change was meaningful on the 10%-level of significance. The experimental group showed no significant change with regard to this scale. With regard to the entity mindset, the control group showed a significant increase in scores. This increase was meaningful on the 10%-level of significance. Although the experimental group scores also increased, the scores were not statistically significant. From the interviews with the players and coaches after the intervention, it became clear that the experimental group had grown in terms of attention and concentration control, coping with stress and anxiety, and pleasure experienced during tennis matches. / Thesis (DPhil)--University of Pretoria, 2009. / Biokinetics, Sport and Leisure Sciences / unrestricted

PhD (Advanced Nursing Science) / Department of Advanced Nursing Science / See the attached abstract below

The purpose of this study was to explore and describe the experiences of three volunteer care workers in their role as facilitators of an intervention programme aimed at strengthening the resilience of pre-school children. The study forms part of a broad research project, the Kgolo-Mmogo project, involving a multidisciplinary team of researchers from the University of Pretoria and Yale University in the United States of America. One of the objectives of the project is to investigate the possibility of strengthening the resilience, as well as the adaptive functioning of children affected by HIV and AIDS. These children are living in poor urban communities in South Africa and their vulnerability is related to their mothers being infected with HIV. The conceptual framework for my study was based on existing theory relating to care workers, focussing on their responsibilities and experiences, and the process of facilitation. In addition I explored the concepts ‘resilience’ and ‘vulnerable children’. I followed a qualitative research approach, guided by an interpretivist epistemology. I employed an instrumental case study design and conveniently selected three volunteer care workers fulfilling the role of facilitators in the Kgolo-Mmogo project, as participants. These volunteer care workers were responsible for facilitating an intervention programme with a small group of 3 to 5-year old children. I observed five of the intervention sessions, which were presented by the participating volunteer care workers. I conducted a focus group discussion with the participants in order to explore their experiences as facilitators of the intervention programme. I furthermore conducted a follow-up focus group discussion with the purpose of member checking. In addition, I relied on a reflective journal, field notes and audio-visual methods, for data collection and documentation purposes. Four main themes emerged as a result of the thematic data analysis and interpretation that I completed. Firstly, I found that the foreseen scenario of the facilitation of an intervention programme differed from the real scenario of what such a role would entail. The role of facilitators of an intervention programme implied more than what the volunteer care workers had anticipated and implied diverse responsibilities. Secondly, from my results I concluded that the participants encountered a variety of positive experiences, including experiences of being meaningful and self-development, as well as feelings of pride, excitement and joy. Thirdly, the participants encountered some challenges in their role as facilitators of an intervention programme. They were required to deal with negative emotions, handle conflict more effectively, become more flexible, and deal with stress appropriately. The last theme that emerged relates to the participants experience of the importance of continuous support. This was offered by means of training and a structured manual, regular debriefing sessions by the volunteer care workers’ supervisor and the research coordinator, as well as support by colleagues. Based on the findings of my study, I concluded that the experiences of the volunteer care workers facilitating the intervention programme with young vulnerable children were diverse and multifaceted. As such, the role of facilitator implied multiple responsibilities, and led to the experience of a variety of benefits and challenges. In addition, my study highlights the value of continuous support in order to assist volunteer care workers to successfully facilitate intervention programmes they present. Furthermore, in dealing with the challenges they faced, the volunteer care workers in my study developed valuable skills that could be applied during future facilitation tasks, as well as in their personal lives. As such, their involvement as facilitators in the Kgolo-Mmogo project seemed to have contributed to their professional and personal development. Copyright / Dissertation (MEd)--University of Pretoria, 2009. / Educational Psychology / unrestricted

The goal of the study was to determine whether there would be a significant improvement in preschool children’s emotional intelligence when a Gestalt intervention programme was implemented. The research was conducted according to the quantitative approach with a pre-test/post-test design. The Vineland Adaptive Behaviour Scales (2nd edition) was completed and returned by a sample of 30 parents (N=30) from a crèche in the Gauteng area. The Joseph Picture Self-Concept Scale was used to test a sample of 30 preschool children (N=30) from the same crèche. The representative sample of preschoolers aged 3 to 5 years was divided into an experimental (n=15) and control (n=15) group. A Gestalt play therapy intervention programme, the Wise child programme, was conducted with the experimental group. The results indicated that there was a significant improvement of the preschool children’s emotional intelligence in terms of intra- and interpersonal skills after the implementation of a Gestalt intervention programme. / Social Work / M. Diac. (Play Therapy)

Thesis (MEd)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: It is clear from a recent study done by the Western Cape Education Department that the quality of literacy instruction in primary schools is not up to standard (WCED, 2006; Kruizinga, 2010). Therefore, countless learners struggle with the acquisition of literacy skills, such as reading and writing (WCED, 2006). One of the numerous reasons for South Africa's poor literacy levels is stated in the National Reading Strategy (Department of Education, 2008:10): “Learners who experience barriers to learning often do not receive the support needed to become fluent readers.” Despite the policies of inclusive education that recognise the special needs of learners in all sectors of education (Department of Education, 2008:10), countless children find it impossible to decipher and make sense of the unfamiliar texts they encounter in school. For this reason, many learners struggle with feelings of frustration, inadequacy and a sense of failure. As a result of the poor literacy levels, a literacy intervention programme was developed that was used to improve the literacy levels of learners who needed individualised instruction in the specific areas of reading and writing. This intervention programme was based on the principles of Reading Recovery®, a New Zealand literacy intervention programme developed by Clay (1993). Her Observation Survey assessment tasks (Clay, 2002) were used as the main research instrument within a pre-test, mid-test and post-test design. In addition to quantitative data, the Observation Survey yielded qualitative, descriptive data on children's literacy-processing behaviours, which were used to monitor learner progress and provide a source of feedback to guide teachers' instructional decision-making. Three struggling grade three learners were chosen for the intervention, together with a control group consisting of four average-performing learners to which the intervention group was compared. The comparison was done in order to gain knowledge of the intervention group‟s improvement and to see whether they progressed to the level of the control group as a result of the intervention. This programme was designed to accelerate the learning process of struggling learners, firstly by using levelled texts, and secondly by teaching the learners to apply the comprehension strategies needed for successful reading and writing. The results indicate that the intervention group reached the average performance level of the control group and therefore the intervention proved to be successful. Towards the end of the intervention it became clear that the project merited further research and support. / AFRIKAANSE OPSOMMING: 'n Onlangse studie wat deur die Wes-Kaapse Onderwysdepartement voltooi is, het aangetoon dat die kwaliteit van geletterdheidsonderrig nie op standaard is nie. Gevolglik is daar baie leerders wat geletterdheidsprobleme ervaar (WCED, 2006). Een van die vele redes vir Suid-Afrika se lae geletterdheidsvlakke word in die Nasionale Leesstrategie (Department of Education, 2008:10) weergegee: “Leerders wat struikelblokke tot leer ervaar, ontvang gewoonlik nie die ondersteuning wat hul benodig om suksesvolle lesers te word nie.” Ten spyte van die Inklusiewe Onderwysriglyne wat die spesiale behoeftes van alle leerders in alle sektore van onderwys erken (Department of Education, 2008:100), is daar steeds vele kinders wat dit feitlik onmoontlik vind om sin te maak van onbekende tekste waarmee hul in die skool te doen kry. Vir hierdie redes sukkel baie leerders met gevoelens van frustrasie, ontoereikendheid en mislukking. As gevolg van die geletterdheidsprobleme onder jong leerders, het ek 'n intervensieprogram ontwikkel wat gebruik is om die geletterdheidsvlakke van leerders wat spesifiek geletterdheidsprobleme ervaar op te stoot. Die intervensie is gebaseer op beginsels van Reading Recovery®, 'n Nieu-Seelandse Geletterdheidsprogram wat deur Clay (2002) ontwikkel is. Die bykomende “Observation Survey” assesseringstake is gebruik as die hoof navorsingsinstrument binne die raamwerk van 'n voortoets, middel-toets, natoets-navorsingsontwerp. Bo en behalwe die kwantitatiewe data wat die “Observation Survey” take opgelewer het, het die assesseringsinstrument ook kwalitatiewe data verskaf ten opsigte van die leerders se geletterdheids-prosesseringsgedrag. Hierdie data het my gehelp om die leerders se vordering te monitor, asook om my onderrigsbesluite te rig. Drie graad drie leerders wat geletterdheidsprobleme ervaar het, is gekies om deel te neem aan die intervensie. Vier graad drie leerders wat gemiddeld presteer, is vir die kontrolegroep gekies waarteen die intervensiegroep gemeet is. Een van die doele van die intervensie was om te sien of die intervensiegroep binne die gegewe tydperk die gemiddelde vlak van die kontrolegroep kon bereik. Die program is ontwerp om op die een-tot-een vlak sukkelende leerders se leerproses te versnel deur eerstens gebruik te maak van tekste wat in vlakke van „n progressiewe moeilikheidsgraad opgedeel is. Tweedens is die intervensieleerders geleer om 'n verskeidenheid begripstrategieё toe te pas wat enige leser nodig het om met sukses te kan lees en skryf. Die assesseringsresultate het getoon dat die intervensieleerders na verloop van die intervensie die gemiddelde lees- en skryfvlakke van die kontrole groep bereik het. Dus was die studie 'n sukses. Aan die einde van die intervensie het dit duidelik geword dat die projek verdere navorsing in hierdie veld vereis.

Background: South Africa is a multicultural, multi-ethnic developing country currently experiencing a unique quadruple burden of disease, of which malnutrition (both over- and under nutrition) is one of them. The increase in childhood obesity within the current South-African health setting is of serious concern, approximately 14% boys and 18% girls currently are overweight and it is estimated that this number will increase to 25% within the next decade. Healthy eating habits and increased physical activity are important components of a healthy lifestyle, and decrease the risk of overweight and obesity. It is also often the corner stone of many lifestyle modification intervention programmes aimed at preventing or decreasing overweight/obesity. Aim: This sub-study was part of a larger intervention study where a nutrition education intervention programme (NEIP) for children in the form of a musical play (based on the South African Food Based Dietary Guidelines [SAFBDG]) was developed to increase nutrition knowledge and thereby also contribute towards healthy lifestyle behaviour. The aim of this sub-study was therefore to explore and describe the attitude of a specific group of primary school children (aged 6-12 years) towards healthy eating, unhealthy eating, and physical activity before and after a NEIP as well as the standard school curriculum. Secondly, it was aimed to identify possible barriers to and motivators for healthy eating, unhealthy eating and physical activity. Methods: Children were randomly selected from the experimental group (n=143) of the main study. Children were selected into one of four focus groups per school (6 children per focus group) from which qualitative data were gathered on children’s attitude and perception towards healthy eating, unhealthy eating, and physical activity. Focus groups were defined by age and gender (boys and girls seperately, grades I-III and grades IVVI seperately), totalling a number of 96 children. A total of 75 children completed this sub-study, 21 children dropped out due to school-related problems or after school activities that clashed with the time slots during which the NEIP was implimented. Quantitative data was gathered with a socio-demographic and physical activity questionnaire, as well as a 3-point hedonic facial expression scale which was used to quantify attitude towards healthy eating, unhealhty eating and physical activity. All data (quantitative and qualitative) were collected at both baseline and end measurements. Results: The main findings of this sub-study were that the attitude of most primary school children towards healthy eating, unhealthy eating or physical activity remained unchanged after a unique NEIP. Five major themes were identified out of focus group discussions namely health awareness, healthy eating, unhealthy eating, physical activity, and consequences of unhealthy eating and sedentary behaviour. Mothers were identified as the main motivator for eating healthy and avoiding unhealthy eating. The taste and smell of food were both either identified as motivators or barriers for healthy eating and unhealthy eating. Older girls associate unhealthy eating with becoming fat while many children associate the combination of unhealthy eating and being sedentary with becoming fat. Most children have a positive attitude towards physical activity and enjoy doing it although the biggest motivator for partaking in physical activity is their parents and not themselves. Conclusion: Even though some children’s attitude did change in the desired direction after the implementation of a unique and fun NEIP, most children’s attitude towards healthy eating, unhealthy eating and physical activity remained unchanged. This might have been due to the measurement tool that was not sensitive enough to detect subtle changes. Various factors that can influence children’s attitude and perceptions towards healthy eating, unhealthy eating and physical activity both positively or negatively were identified. This study is one of only a few that explored and described the ‘true’ motivators of and barriers for children’s attitude towards healthy eating, unhealthy eating and physical activity. Results generated from this sub-study can thus make a valuable contribution to the existing literature available in this specific study field. / Thesis (MSc (Dietetics))--North-West University, Potchefstroom Campus, 2012

Background and objective: Researchers have been looking for a way to predict future emission rates, and come up with explanations on how to tackle the issue of global warming through changes in individual behavior for decades. The focus of these studies have, on the other hand, focused more on nutritional bases rather than cultural. This study’s objective is to provide a method, as a useful tool in further analysis on GHG-emission based on cultural behavioral factors such as socio-economic status as well as age, sex, etc. with diet as emission prediction factor. This could be a stepping stone toward future research on Co2e related to e.g. physiological factors such as BMI, blood pressure and diseases. Method: With the use of data obtained from the FFQ questionnaire within the VIP-program, combined with estimates of greenhouse gas-emission (Co2e) attributed to specific diets obtained from Röös, estimations of individual Co2e emission-levels were calculated using the software “R”. The dataset contained 159 687 observations and 152 different variables. The data was obtained from the Department of Public Health and Clinical Medicine at Umeå University. Portions sizes were mainly collected from the Swedish Food Composition Database. Box-plots and regression analysis were made to illustrate the main findings. Result: The result was a new dataset that could be applied to any population to estimate Co2e-emission on individual level based on an FFQ, given that the FFQ have the same structure as the one in the VIP. The variables that contributed to the highest amount of Co2e were animal products i.e. butter, milk and meat. Chicken, pork and fish were not nearly as Co2e heavy as the meat products containing beef such as “steak”, “minced meat” and “hamburgers”. The regression analysis showed that higher age had a positive effect on reducing emission, as well as being a woman. Education showed an increase in Co2e for higher education. There were some small differences among municipalities. Marital status gave a slight decrease in the regression, meaning married couples emits more than singles. Exercise showed an increase in Co2e for active individuals in the regression analysis. However, the most noticeable result were sex, yielding a relatively big decrease in Co2e-emission for women compared to men. Conclusion: People at younger ages, within the observed age groups 40-60, seemed to reduce their carbon footprint more in relation to the higher age groups over the last 20 years. Overall, the general diet-based carbon footprint in Västerbotten seems to have increased slightly during the last 17 years. A remarkable dip were noticed in 2003, however this might not have been due to any behavioral changes, since the trend broke in 2006 and instantly receded back to the normal levels. This study confirms the fact that meat and dairy products are responsible for a significant amount of the diet-based emission. This topic needs to be studied more, and with this method of applying GHG-emission measures to individual diet-based data, a gate has been opened for a new field of research.

Background: Diabetes is a common and costly disease that is expected to continue even to grow in prevalence and health expenditures over the coming decades. Type 2 diabetes is the most common diabetes type and is characterized by insulin resistance and relative insulin deficiency. Type 2 diabetes develops over a long period and is often undetected over years. During this time, people almost always first develop any of the pre-diabetic states, i.e. impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or a combination of both (IFG&IGT). This thesis focuses on type 2 diabetes only. In the following, the term diabetes is used to refer to type 2 diabetes only. Diabetes is associated with a sedentary lifestyle and obesity. While those are not the only factors contributing to the development and maintenance of diabetes, several studies have shown that prevention of diabetes among individuals at high risk through lifestyle change is possible, effective and cost-effective, especially targeting diet and exercise to reduce weight. No previous study had, however, estimated the cost-effectiveness of diabetes prevention strategies from a population-based perspective including healthy individuals and also considered IFG and IGT as two distinct pre-diabetic states. Objective: The overall objective of this thesis was to establish, describe and evaluate a model that can assess the cost-effectiveness of lifestyle intervention programs to prevent diabetes. Methods: First, a Markov Model was established using data from the literature. The cost of a German diabetes prevention program was estimated. Second, risk equations for change to worsened glucose states were estimated using factor analysis and logistic regression based on consecutive data from the Västerbotten Intervention Program (VIP). The risk equations described transition probabilities in the final model and were based on several risk factors such as age, sex, physical activity and smoking status. Third, information on the Short-Form 36 questionnaire from the VIP population was transformed into Short-Form 6D. Health utility weights (HUW) by glucose group and four risk factors were estimated using beta regression. Fourth, an updated Markov model was established using an updated model structure compared to the one in Paper I, program costs of Paper I, risk equations of Paper II, health utility weights of Paper III and updated cost and mortality estimates. Results: The first model in Paper I showed that lifestyle intervention programs have the potential to be cost-effective with a high degree of uncertainty. The risk equations in Paper II indicated that the impact of each risk factor depended on the starting and ending pre-diabetes state, where high levels of triglyceride, hypertension, and high body mass index were the strongest risk factors to transit to a worsened glucose state. The overall mean HUW in Paper III was 0.764 with healthy individuals having the highest HUW, those with diabetes the lowest and those in pre-diabetic states ranging in between. The intervention described in Paper IV was cost-effective for all sex and age scenarios ranging from 3,833 EUR/QALY gained (women, 30 years) to 9,215 EUR/QALY gained (men, 70 years). The probability that the intervention is cost-effective was high (85.0-91.1%). Conclusion: We established a model that can estimate the cost-effectiveness of different scenarios of initiatives to prevent diabetes. The prevention or the delay of the onset of diabetes is feasible and cost-effective. A small investment in a healthy lifestyle with the change in physical activity and diet together with weight loss can have a decent, cost-effective result. The full range of possibilities this model offers has not been evaluated so far. We have, however, shown that implementing a lifestyle intervention program like the Västerbotten Intervention Programme would be cost-effective.

Thesis (Ph.D. (Physiotherapy))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Stroke impacts on a survivor’s ability to participate in community activities such as return to work (RTW) and affects people who are still within the working age. Return to work contributes to life satisfaction and social identity at least partly through independence gained from income-generation. The impact of RTW programmes for stroke survivors is limited and not generalisable to South Africa. This study aimed to bridge this gap in South Africa, and was conducted within the Gauteng province as it comprises the largest share of the South African population. Objectives and Methodology: The aim of the study was to determine the current practice in RTW intervention programmes for stroke survivors in the Gauteng Province of South Africa and to establish the effect of a workplace intervention programme on the rate of RTW of previously employed stroke survivors. This study had two stages: Stage one: A cross sectional survey was performed using a self administered questionnaire to establish current practice in RTW intervention programmes and the therapists’ perceived barriers and enablers of RTW after stroke. Stage two study included: a) a randomised controlled trial (RCT) to evaluate a six week RTW intervention, with follow-up at three and six months. The workplace intervention programme was tailored according to the functional ability and workplace challenges of each stroke survivor and was as follows: Week one: Assessment for work skill. The assessment included work modules which identified potential problems such as: visual discrimination; eye hand coordination; form and spatial perception; manual dexterity; colour discrimination; cognitive problems, and job specific physical demand factors. Week two: The therapist interviewed the stroke survivor and employer separately to establish perceived barriers and enablers of RTW. This was followed by a meeting between the therapist, stroke survivor and employer/supervisor to discuss and develop a plan to overcome identified barriers and to strengthen identified enablers based on consensus between stroke survivor and employer. Week three: A work visit for the stroke survivor to demonstrate what they did at work and identify what they could still do safely and what they could not do. This included vocational counselling and coaching; emotional support; adaptation of the working environment; advice on coping strategies to compensate for mobility and upper limb functional limitations; and fatigue management. Weeks four, five and six: continuation of the work visits, while monitoring progress, and making necessary adjustments as per stroke survivor and employer’s needs. This was done at the workplace while the participants continued with their usual therapy at the hospital. The control group received usual care. The primary outcome was RTW rate. The secondary outcomes included activities of daily living (measured with the Barthel Index); mobility (measured with the Modified Rivermead Mobility Index); basic cognitive function (measured with the Montreal Cognitive Assessment) and perceived quality of life (measured with the Stroke Specific Quality of life Scale). Another aim of stage two study was to: b) establish the stroke survivors’ and employers’ perceived barriers and enablers of RTW (this was done with the experimental group only); and to: c) identify predictors of RTW. Stage one study results: Thirty six (68%) of the 53 questionnaires sent to stroke rehabilitation facilities were returned. Seventeen (47%) of the 36 clinical settings referred stroke survivors to facilities offering RTW services; 12 (33%) facilities did not refer stroke survivors for RTW and did not offer RTW services; and seven (20%) facilities offered RTW services. Of the seven facilities that rendered RTW services for stroke survivors, five (71%) communicated with the employer to discuss reasonable accommodation and four (57%) did assessments for potential to RTW. The most common reason given by the 29 facilities for not offering RTW services was that they referred stroke survivors to other therapists who offered these services. The second most common reason was the unemployment status of the stroke survivor at the time of having stroke. The therapists’ most commonly perceived barriers of RTW were the severity of the stroke survivors’ physical impairments (n = 3) (36%) and their employment status (n = 11) (31%) at the time of having stroke. The most commonly perceived enablers were willingness of the employer to reasonably accommodate the stroke survivor at work (n = 12) (33%), family support (n = 8) (22%) and increased length of hospital stay to allow for intensive rehabilitation (n = 7) (19%). Stigma in the workplace was the only variable which had a statistically significant relationship with the type of clinical facility therapists worked at (p = 0.02). Stage two study results: The average age for the study group was 45 (SD: 8.7) years and the average stroke duration was 4.6 (SD: 1.8) weeks. There were 41 (51%) male stroke survivors and 39 (49%) female stroke survivors. Majority (55%) of the stroke survivors were breadwinners (63%), had a grade 11 to 12 educational level (64%), an income above R5000 (46%) and had a helper (74%) whom they did not have to pay (81%). Stroke survivors who returned to work had better quality of life at six months after stroke than those who did not RTW (p = 0.05). Results from the qualitative study indicated that the perceived enablers of RTW included: ability of the employer to provide reasonable accommodation and good interpersonal working relationships between stroke survivor, employer and co-workers. The perceived barriers of RTW included: unaffordable reasonable accommodation costs; inaccessible transport; having cognitive (memory and attention) and speech impairments and high unemployment rates. The overall RTW rate was 20% at three months follow-up and 40% at six months follow-up. Twenty seven percent of the stroke survivors in the intervention group returned to work at three months compared to 12% in the control group (p = 0.13). At six months, the majority of stroke survivors (60%) in the intervention group returned to work compared to 20% in the control group (p <0.001). The following factors were predictive of RTW: male gender (p = 0.03); fewer speech problems (p = 0.02); increased time off work post stroke (p = 0.001); ability to perform activities of daily living (p = 0.02); good mobility (p = 0.01) and good cognitive ability (p = 0.02). The stroke survivors in the intervention group were 5.2 times more likely to RTW than those in the control group at six months following stroke, and for every unit increase in the activities of the Barthel Index and Montreal Cognitive assessment score, the likelihood of RTW increased by 1.7 and 1.3 respectively. Conclusion: A RTW intervention consisting of workability assessments and workplace visits was effective in facilitating RTW for stroke survivors in Gauteng province, South Africa. Key predictors of RTW included male gender; increased time off work post stroke; ability to perform activities of daily living; good mobility and good cognitive ability and were identified as facilitating RTW; speech problems were identified as barriers to RTW. Overall, these results suggest the need to direct resources towards increasing work place intervention strategies after stroke.