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The purpose of this study was to explore and understand the resilience processes employed by families from a low socio-economic background living in a predominantly black township (Mamelodi). The study further aimed to assess how the participants’ experiences have shaped their perceptions of their society. Walsh’s family resilience framework (2003) served as a conceptual framework for the study. Two grandparent-headed households were selected from an ongoing study at a nongovernmental organisation and drop-in centre in Mamelodi. A qualitative methodology was suitable for this study, because it aims to understand how the participants derive meaning from the social and cultural contexts within which they live. The two focus group discussions were conducted in isiZulu, with a translator present during the grandmothers’ focus group discussion, because one of the grandmothers spoke Xitsonga. The sessions were audio-recorded and later transcribed. The transcripts were analysed using thematic analysis in order to deduce themes that emerged from the participants’ experiences. Based on the results, a better understanding of how families from low socio-economic backbackgrounds develop their resilience was established through the themes that emerged, which were as follows: belief system, flexibility of roles and connectedness, unsupportive environment, and self-empowerment. The results were related to existing literature and Walsh’s family resilience framework. / Dissertation (MEd)--University of Pretoria, 2015. / Educational Psychology / MEd

Raising children is a highly demanding job for any family; the demands are even higher when the child has a disability. The cost of raising a child with a disability is said to be three times higher than that of raising a non-disabled child. Unfortunately, children with disabilities could be born into any family, including the poorest of the poor, who, due to their low socio-economic status, already have less than what is necessary to meet the needs of the non-disabled members. There is limited research into the coping strategies of families raising the children with disabilities in Lesotho, for this reason, the researcher decided to undertake this particular study to feed the curiosity on how families with low socio-economic status managed to raise the children with physical disabilities in this poverty stricken country. Following the Qualitative methodology, the researcher utilised both the purposive and the simple random sampling techniques to select participants from a list provided by the Department of Social Development. A total of ten (10) interviews were conducted with representatives of low socio-economic status families raising children with physical disabilities in the Makaota E12 community council of the Mafeteng district. The study revealed that the majority of families were coping well and that they were generally happy despite the presence of a child with a disability in their homes. The study further revealed a number of factors that played a role in determining the coping ability of each family; these include availability of the support structures and the severity of the child's disability. Finally, the study raised a need for post diagnosis counselling and educational campaigns intended to equip the families of children with physical disabilities with relevant skills and information they require to assist the children to develop to their full potential. The study further raised a need for broader research into the lives of children living with disabilities and their families, for better understanding of the area and for improved service delivery. / Mini Dissertation (MSW)--University of Pretoria, 2016. / Social Work and Criminology / MSW / Unrestricted

The purpose of the study was to explore and understand how orphaned adolescents in grandparent-headed households achieve healthy functioning and how they rise above unfavourable circumstances. In exploring and gaining understanding, the research was approached from an interpertivist stance as it entails an inductive qualitative enquiry suitable to gaining a better understanding of the experiences and perceptions of orphaned adolescents. A qualitative methodological design was followed to ensure that the research questions could be answered. Purposive sample selection was used to select participants for this research study. The sample included nine adolescent orphans who reside in grandparent-headed households and are affiliated with Stanza Bopape Community Centre. Data collection included biographical questions, focus group interview and semi-structured interviews. Five of the nine participants took part in a focus group interview and the remaining four participated in individual semi-structured interviews. All interviews were conducted and transcribed by the researcher. Inductive thematic analyses was utilised to identify themes which emerged from the data. The themes which emerged were: the person I am, the supportive roles in parenting, role models in my life, things that are important to me, the future in me. These themes reflect the factors which contribute to the participants’ resilience and can be deduced as the mediating factors which assist them in achieving healthy functioning. The risks identified are aligned with residing in a township and attending a township school, however these risks were not experienced as demotivating adversities for the participants. They rather viewed them as motivating factors to achieve a better future. Bronfenbrenner’s bio-ecological theory served as the theoretical foundation for the study and it emerged that factors which contribute to the orphaned adolescents’ resilience (maintaining factors) come from various systems. Based on the findings of the study it can be concluded that orphaned adolescents residing in grandparent-headed households, although generally of low socio-economic status, are aware of their challenges and utilise certain processes to strengthen their resilience and overcome their challenges. / Dissertation (MEd)--University of Pretoria, 2018. / Educational Psychology / MEd / Unrestricted

The No Child Left Behind Act (2001) requires schools to increase academic performance and close the achievement gaps between sub-groups of students. As schools work to increase student performance in all academic areas, educators must identify the needs of each sub-group of students they services and determine which instructional practices meet their unique needs. Students living in poverty enter school with a distinctive set of needs and therefore require instructional practices that meet these needs. The researcher in this study strived to identify instructional practices that were being used in high and low performing Title I schools and compared the similarities and differences between the practices. Data reported from the study might inform school leaders regarding what instructional practices are effective when working in schools with high concentrations of students living in poverty. This qualitative study of four Title I eligible schools in an urban district in southeastern Virginia, involved interviews and focus groups. Interviews and focus groups focused on instructional practices (strategies, programs, and other factors) that influence academic achievement of students in high and low performing Title I eligible schools. Findings revealed that high performing Title I schools used student performance data to drive instruction; focused on teaching students enriching vocabulary; used the strategies of note taking, explicit instruction, similarities and differences, nonlinguistic representation, graphic organizers, and cooperative learning; conducted mentorship programs for teachers and students; utilized computer based instructional programs with fidelity; believed in their students and cared about their students; provided professional development to teachers; and implemented student reward/recognition programs. / Ed. D.

Low-skilled, low socio-economic status, young, co-resident, working fathers: Their experience of fatherhood Using open-ended interview techniques, 23 low-skilled, low socio-economic status fathers aged 20-29 were interviewed about their experience of fatherhood. All participants were in unskilled jobs and all lived with and supported their partners and child/children. This population of fathers is generally overlooked by researchers. Because they take responsibility for some of society’s most vulnerable families and children, understanding how they conceive of their role as fathers can promote the welfare of those families and children. Participants were recruited by casual connections, snowballing and advertisement. The interviews explored the participants' experience of fatherhood and their reasons for being active and committed family members. Focus was given to how they made sense of fatherhood in terms of their life course. Participants had two interviews, the first generic and the second idiographic. Interviews were tape-recorded and later transcribed. A social constructionist approach was used: transcripts were analysed by identifying and examining the primary domains in which participants experienced fatherhood. Participants spoke of fatherhood as an affective activity, the primary object of good fatherhood being to maintain an emotional bond with one’s children. Being a good father was thought to involve eschewing deleterious family practices such as those which had marred their own childhoods. In this regard, participants saw themselves as repairing their family-of-origin's dysfunctional style. Providing was described as a core feature of fatherhood – subsidiary to, but corollary on, being an emotionally-engaged father. Good fathers were described as committed providers, albeit participants did not consider their own limited earning capacity to compromise their fatherhood. Obtaining a job and providing for one’s family was one of the ‘pro-socializing’ effects of fatherhood. Participants considered fatherhood to not only improve but to also redeem their lives, giving a purpose and focus they had lacked prior to their becoming parents. Being a good father also involved being a good partner. For many of the participants, this involved adopting non-gendered roles in the home. The sharing of housework and childcare improved home life by reducing the partner's workload. Those who failed to adopt the gender-neutral stance acknowledged this as a personal shortcoming that they planned to remedy. Fatherhood for these 23 interviewees was one of the few means by which they could obtain social value and status as adults. They lacked access to financial resources, education or supportive family connections, but fatherhood was a domain in which they could present themselves as significant members of society. It also provided a network of emotional relationships which promoted their sense of self-worth and their social and emotional wellbeing.

Magister Psychologiae - MPsych / Substance abuse is recognised as one of the greatest health and social problems in South Africa (SA). There is a need to explore the problem of substance use in the South African context in terms of the Bio-ecological Systems Theoretical Framework. All of the reviewed local and international studies on instruments that are used to measure factors associated with adolescent substance use, while yielding useful information; do not adequately address the issues of an instrument that successfully includes all the levels of the Bio-ecological Systems Theoretical Framework at the dimension level. As a result, a need for an applicable instrument exists. The overall purpose of the current study was to evaluate the content validity of the dimensions of the proposed self-administered questionnaire in terms of the Bio-ecological Systems Theoretical Framework, which will assist the factors associated with youth at risk of substance abuse in low socio economic status communities in the South African context. The study was framed in psychometric test theory focusing specifically on the procedures for content validation. It is being increasingly recognized that the development of a valid test requires multiple procedures, which are employed sequentially, at different stages of test construction. Validity is thus built into the test development from the outset. Participants were selected by means of purposive sampling. The sampling method was appropriate since the participants were required to meet certain inclusive criteria. The participants comprised of two groups of community leaders within two different communities on the Cape Flats. An adapted version of the Nominal Group Technique method was employed to collect data. The data for aim one was collected using a self administered questionnaire (Content Validity Questionnaire) consisting of two sections. The first section was presented in the form of a ranking scale with all relevant factors associated with adolescent substance use. The second section of part 1 was in the form of open-ended questions. The second aim was collected in the form of focus groups. Data was analysed quantitatively and qualitatively in the relevant sections. Data collected from the Content Validity Questionnaire (CVQ) was analysed quantitatively by means of statistical analysis making use of frequencies, and the open-ended questions of the content validity and data from the focus groups was analysed qualitatively by means of thematic analysis. The study concluded that all factors presented in the CVQ are important factors associated with adolescent substance use in the two low socio-economic statuses communities that were analysed in both the quantitative and qualitative components of the study.

Philosophiae Doctor - PhD / The purpose of the study was to gather validity evidence for a South African developed instrument designed to measure individual and contextual factors associated with adolescent substance use in low socio-economic status communities in the Western Cape, South Africa. Studies report high rates of substance use in these communities. This possibly points towards the impact of typical post-apartheid contextual factors on the development of adolescent substance use. The South African Substance Use Contextual Risk Questionnaire (SASUCRQ) measures adolescents’ subjective experiences of their own psycho-social and their communities’ functioning.

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015

Motivation Alcohol consumption is one of the major risk factors of cardiovascular disease (CVD). Excessive alcohol drinking is the fifth leading cause of death worldwide and the prevalence of alcohol abuse continues to increase especially in low-income areas of sub-Saharan Africa. The alarming rate of urbanisation seems to be the driving force for excessive alcohol intake in the developing world. In addition to its influence on CVD, heavy drinking also results in a number of non-cardiovascular consequences that include injury, risky sexual behaviour, violent crime and family dysfunction among black South Africans, contributing to high mortality. Moreover, the highest number of individuals with human immunodeficiency virus (HIV) infection in South Africa is partly attributable to high intake of alcohol. HIV remains a major concern in South Africa with significant funding diverted to address the pandemic. The continued increases in mortality from preventable outcomes such as stroke, myocardial infarction and renal failure are largely due to urbanisation, poverty and dysfunctional health systems working with limited budgets. These are some of the factors requiring in-depth study of the scientific aspects of alcohol intake in South Africa. Although there is enough evidence that links excessive drinking with hypertension and CVD, the markers of alcohol intake – self reporting of alcohol, gamma-glutamyltransferase (GGT) and carbohydrate deficient transferrin – are still not specific enough to isolate other confounding factors in the association of alcohol intake with CVD. The markers of alcohol that independently predict CVD and mortality need to be explored. Finally, the severe lack of longitudinal investigations on alcohol-related hypertension development and total mortality in black South Africans has compromised the early identification of risk factors associated with these outcomes. This study will therefore attempt to address the limited availability of longitudinal studies and stimulate interest for continued investigation. Aim The aim of this study was to investigate whether alcohol intake of black South Africans is related to specific measures of cardiovascular function (change in blood pressure (BP), hypertension development) and mortality over a period of 5 years. Methodology This study was based on the international Prospective Urban and Rural Epidemiology (PURE) study which includes 26 countries, investigating the cause and development of cardiovascular risk factors in low, middle and high income countries. This South African leg of the PURE study started in 2005 in which the baseline data was collected from 2021 black South Africans from rural and urban areas in Ikageng, Ganyesa and Tlakgameng in the North West Province. Eleven participants presented with missing data, leaving 2010 participants with complete datasets at baseline. However, data from these 11 participants was useful, especially for Chapter 4. All participants gave informed consent and the Ethics committee of the North-West University (Potchefstroom Campus) approved the study. The follow-up data collection was done in 2010. General health questionnaires, anthropometric measurements, lipid profiles and cardiovascular measurements were taken both at baseline and follow-up using appropriate methods. We also collected blood samples and performed biochemical analyses for lipid markers, liver enzymes, inflammatory markers and percentage carbohydrate deficient transferrin (%CDT). Finally, we obtained data on cardiovascular and non-cardiovascular mortality through verbal autopsy and death certificates. We made use of analysis of variance (ANOVA) and Chi-square tests to compare means and proportions, respectively. We used dependent t-tests and the McNemar test to compare baseline and follow-up variables. Furthermore, we employed single and partial linear regression analyses to correlate alcohol markers with each other and with the cardiovascular measures. Multiple regression analyses were used to correlate dependent variables in the study with various independent variables as required. Finally, we employed multivariable-adjusted Cox regression analyses to assess the association of the selected alcohol markers with mortality while adjusting for several independent variables. Results and Conclusions of each manuscript - With the first research article (Chapter 4), we aimed to compare self-reported alcohol intake estimates with GGT and %CDT, considering their relationship with percentage change in brachial blood pressure (BP) and central systolic blood pressure (cSBP) over 5 years. The results indicated that only self-reported alcohol intake independently predicted % change in brachial BP and cSBP. This was not found for the biochemical markers GGT and %CDT. Self-reported alcohol intake seems to be an important measure to implement by health systems in low income areas of sub-Saharan Africa, where honest reporting is expected. - Given the likely presence of high GGT levels in both alcohol consumption and non-alcoholic fatty liver disease (NAFLD), the second manuscript (Chapter 5) aimed to compare the cardiovascular and metabolic characteristics of excessive alcohol users and individuals with suspected NAFLD (confirmed with self-report, GGT and %CDT). We found that different sex and cardiometabolic profiles characterised excessive alcohol users and individuals suspected with NAFLD. Lean body mass and male sex were the dominant characteristics in excessive alcohol use while the NAFLD group had a dysmetabolic profile with obese women making up the higher proportion of this group. In excessive alcohol users systolic blood pressure and pulse pressure were independently associated with high-density lipoprotein cholesterol. Diastolic blood pressure showed a significant correlation with waist circumference. These disparate profiles may guide healthcare practitioners in primary healthcare clinics to identify individuals with elevated GGT levels who may suffer from NAFLD or alcohol overuse. These results emphasise the importance of modifiable risk factors as the main contributors to CVD and that lifestyle change should be the main focus in developing countries such as South Africa. - The third manuscript (Chapter 6) aimed to determine the measure of alcohol intake (selfreported alcohol intake, GGT and %CDT) that related best with hypertension development, cardiovascular and all-cause mortality over 5 years in the same population of black South Africans. We found that GGT was the only independent predictor of hypertension development, cardiovascular as well as all-cause mortality. Moreover, self-reporting of alcohol intake predicted incident hypertension, confirming our findings from Chapter 4. The third marker, %CDT, a highly specific marker of alcohol intake, was not related with any outcome variable, perhaps due to its low sensitivity. Although self-reported alcohol intake is useful in low-resource primary healthcare settings, measurement of GGT is encouraged due to its predictive value for hypertension and mortality. GGT represents alcohol intake, non-alcoholic steatohepatitis and obesity - all known to have severe cardiovascular consequences. Discussion and Conclusions Excessive alcohol intake remains a major concern in the development of hypertension, CVD and premature death in sub-Saharan Africa. Despite their weaknesses such as bias and nonspecificity, self-reporting of alcohol consumption and GGT emerged as reliable alcohol markers that independently predicted 5-year change in BP, hypertension development and total mortality in this population. Serum %CDT did not show any association with the mentioned cardiovascular markers. Finally, we were also able to show that black South Africans with suspected NAFLD (i.e. with high GGT levels who do not consume alcohol) are typically obese women, whereas lean men were more likely to have high alcohol consumption. Further prospective investigations are encouraged regarding (a) these mentioned associations, as well as (b) other self-reporting estimates such as quantity and frequency of drinking and (c) the use of %CDT as a highly specific marker of alcohol intake. The simultaneous presence of HIV infection in alcohol abuse in this population also warrants further investigation. / PhD (Physiology), North-West University, Potchefstroom Campus, 2015