Thesis (M Speech Path)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: This study was done in collaboration with the Foundation for Alcohol Related Research (FARR), a non-governmental organization whose primary objective is to develop and maintain Fetal Alcohol Spectrum Disorder (FASD) prevention programmes across South Africa. Research has shown the occurrence of FASD in South Africa to be much higher than in other parts of the world. As part of their prevention programmes, FARR uses a three part diagnostic process, including a maternal interview, a dysmorphological examination, as well as a general developmental assessment. The maternal interview questionnaire that FARR currently uses takes an average of two hours per interviewee to complete. Even though a recent study indicates that FASD prevention programmes administered by FARR can potentially reduce FASD prevalence, shorter maternal interviews could improve the use of FARR resources and the ability of FASD research studies to gather meaningful information and inform future prevention efforts. The main purpose of this study was to adjust the maternal interview questionnaire used by FARR in order to make interviews with mothers shorter while delivering the information needed for successful FASD prevention programmes. Data related to the adequacy of the adjusted maternal interview questionnaire was collected and analysed according to an action research approach in four consecutive phases. The research procedures consisted of two separate focus group interviews with five key role players from FARR. During the first focus group interview the main problems with the questionnaire was identified as being (i) the length of the questionnaire, (ii) the unsuitability of the questionnaire to interview someone other than the biological mother, and (iii) inconsistency between interviewers when using the questionnaire. During the second phase of the study the questionnaire was adjusted and revised as part of a second focus group interview. The interviewers, data capturer and data analyst who used the adjusted questionnaire as part of a larger FASD prevention programme made several suggestions on how the questionnaire could be further adjusted to suit the needs of FARR. These suggestions were addressed during the final phase of the study, after which the adjusted questionnaire was finalized. Findings from the study suggest that identified problems with FARR’s original maternal interview questionnaire were successfully addressed by the adjusted questionnaire, while simultaneously satisfying the objectives of a maternal interview as identified by participants during the first focus group interview. Results confirmed that more maternal interviews could be conducted in the same time period using the adjusted interview questionnaire compared to when the original questionnaire was used, due to the fact that the questionnaire was shorter and took less time to administer. As part of this study an additional questionnaire was developed specifically for caregiver interviews. According to FARR role players, inconsistency between interviewers was for the most past successfully addressed by the development of this additional questionnaire and the development of an interviewer guideline. Recommendations for future research include the further development and evaluation of the caregiver questionnaire and interviewer guideline. / AFRIKAANSE OPSOMMING: Hierdie studie is uitgevoer in samewerking met die “Foundation for Alcohol Related Research” (FARR), ‘n nie-regeringsorganisasie met die primêre objektief om Fetale Alkohol Spektrum Afwyking (FASA) voorkomingsprogramme in Suid-Afrika te ontwikkel en te handhaaf. Volgens navorsing is die voorkoms van FASA in Suid-Afrika beduidend hoër as in ander dele van die wêreld. ‘n Drie-delige diagnostiese proses word as deel van FARR se voorkomingsprogramme gebruik, insluitend ‘n onderhoud gefokus op moeders, ‘n dismorfologiese ondersoek, asook ‘n evaluasie van die kind se algehele ontwikkeling. Die moeder-onderhoudsvraelys wat tans deur FARR gebruik word neem gemiddeld twee ure om te voltooi. Alhoewel ‘n onlangse studie aandui dat die voorkomingsprogramme deur FARR oor die potensiaal beskik om die prevalensie van FASA te verlaag, kan korter moeder-onderhoude potensieël daartoe lei dat bronne beter benut word, asook dat FASA voorkomingstudies betekenisvolle inligting versamel vir die ontwikkeling van toekomstige voorkomingsprogramme. Die hoofdoel van die huidge studie was om die moeder-onderhoudsvraelys wat tans deur FARR gebruik word aan te pas, om sodoende die onderhoude met moeders korter te maak terwyl die nodige inligting vir suksesvolle FASA voorkomingsprogramme steeds verkry word. Gedurende hierdie studie is data rakende die toereikendheid van die aangepaste moederonderhousdvraelys versamel en geanaliseer volgens ‘n aksie-navorsingsbenadering in vier opeenvolgende fases. Die navorsingsprosedures het bestaan uit twee afsonderlike fokusgroeponderhoude met vyf van die sleutelrolspelers van FARR. Gedurende die eerste fokusgroeponderhoud is die hoofprobleme met die vraelys geïdentifiseer as (i) die lengte van die vraelys, (ii) die ongeskiktheid van die vraelys om ‘n onderhoud met iemand anders as die biologiese moeder te voer, en (iii) die inkonsekwentheid tussen onderhoudvoerders met die gebruik van die vraelys. Gedurende die tweede fase van die studie is die vraelys aangepas en hersien as deel van ‘n tweede fokusgroeponderhoud. Die onderhoudvoerders, data verwerker en data analis wat die aangepaste vraelys gebruik het as deel van ‘n groter FASA voorkomingsprogram het verskeie aanbevelings gemaak rakende hoe die vraelys verder aangepas kan word om te voldoen aan FARR se behoeftes. Laasgenoemde aanbevelings is aangespreek gedurende die laaste fase van die studie, waarna die aangepaste vraelys gefinaliseer is. Die bevindinge van die studie dui aan dat die geïdentifiseerde probleme met FARR se oorspronklike moeder-onderhoudsvraelys suksesvol deur die aangepaste vraelys aangespreek is, terwyl die objektiewe van ‘n moeder-onderhoud (soos geïdentifiseer deur die deelnemers aan die eerste fokusgroeponderhoud) steeds vervul is. Resultate het bevestig dat meer moeder-onderhoude in dieselfde tydsperiode met behulp van die aangepaste vraelys gevoer kon word as met die oorspronklike vraelys, as gevolg van die feit dat dit korter was en minder tyd geneem het om te voltooi. As deel van die studie is ‘n bykomstige vraelys spesifiek vir sorggewer-onderhoude ontwikkel. Volgens die FARR rolspelers is inkonsekwentheid tussen die onderhoudvoerders grootliks suksesvol aangespreek deur middel van die ontwikkeling van hierdie bykomstige vraelys asook die ontwikkeling van ‘n riglyn vir onderhoudvoerders. Aanbevelings vir verdere navorsing sluit die verdere ontwikkeling en evaluasie van die sorggewer-vraelys en onderhoudvoerder riglyn in.

Made available in DSpace on 2016-04-27T18:12:10Z (GMT). No. of bitstreams: 1 Aline Oliveira Ferraz.pdf: 538559 bytes, checksum: c766a2f35218b55c481475202c072160 (MD5) Previous issue date: 2006-03-21 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This research had as principal objective, study the alimentation in the light of the winnicottian theory, to understand the alimentary complaints of children with appetite´s disturbances, in the context of the language and hearing science clinic. The gap between the maternal complain and the demand of the child based the interest on understand the meanings of feeding desorders, from a relationary perspective. In these children s histories, the difficulties around the alimentation had indicated a necessity to exceed the clinical look directly to the functionality of the alimentary process, in sight of the hypothesis that the imperfections of the environment propitiate conditions to the establishment of alimentary difficulty. To reach the proposed objective, two case-studies in the perspective of clinical-qualitative method had been consummated, contemplating the interviews with the mothers and the consultations with the children, accomplished in a health setting. On both presented cases, some aspects of the constituent experiences of the children were revealed; the appearing of alimentary problems in the first years of life and the relations established with people and foods. Was concluded that the occurrence of ambiental faults, relative to the handling of alimentation in initial periods of the patients lifes, had subsidized the way which the food, in the winnicottian perspective of objetal relation, was absorved by the two children. In reason of the work consummated in a team of infantile nutrition, was possible constitute a space to reflect about the possibles contributions of the Language and Hearing Therapy to the treatment of patients who presents alimentary difficulties, assuming also a new perspective on oral functions involved in alimentation. The intervention of speech therapy in the clinic of feeding desordes consists in benefit the relationship between patient and food, in sight of a therapeutical approach that includes the winnicottian thought on the object´s presentation. With the knowledge that the Language and Hearing Therapy possesss about dynamics of deglutition, its performance will consist in handle with alimentary oral functions, since the anticipate and preparatory phases are voluntaries and can be modified / Esta pesquisa objetivou estudar a alimentação à luz da teoria winnicottiana, para compreender as queixas alimentares de crianças com distúrbios do apetite no contexto da clínica fonoaudiológica. O hiato entre a queixa materna e a demanda do próprio paciente fundamentou o interesse em entender os significados do distúrbio alimentar, a partir de uma perspectiva relacional. As dificuldades em torno da alimentação indicaram a necessidade de ultrapassar um olhar clínico voltado exclusivamente à funcionalidade do processo alimentar, tendo em vista a hipótese de que as falhas do ambiente propiciam condições para que os sintomas alimentares se estabeleçam. Para alcançar o objetivo proposto, foram realizados dois estudos de casos na perspectiva do método clínico-qualitativo, contemplando as entrevistas com as cuidadoras e as consultas com as crianças, realizadas em um setting de saúde. Nos dois casos apresentados, revelaram-se alguns aspectos das experiências constitutivas dos pacientes, o surgimento dos problemas alimentares no decorrer dos primeiros anos de vida, assim como as relações estabelecidas com as pessoas e com os alimentos. Concluiu-se que a ocorrência de falhas ambientais, relativas ao manejo da alimentação em períodos iniciais da vida, subsidiou o modo pelo qual o alimento, na perspectiva winnicottiana de relação objetal, foi internalizado por ambos. Em razão do trabalho realizado em uma equipe de nutrição infantil, foi possível constituir um espaço para refletir sobre as contribuições da área fonoaudiológica ao tratamento de pacientes que apresentam dificuldades alimentares, na perspectiva de uma nova atuação diante das funções orais envolvidas na alimentação. Nesse contexto, propõe-se que a intervenção fonoaudiológica na clínica dos distúrbios alimentares consista em beneficiar a relação que o paciente estabelece com o alimento em si, tendo em vista uma abordagem terapêutica que inclua a noção winnicottiana sobre a apresentação de objetos. A partir do entendimento que o fonoaudiólogo possui sobre a dinâmica da deglutição, sua atuação consistirá em manejar as funções orais alimentares, já que as fases antecipatória e preparatória são voluntárias e passíveis de serem modificadas