With advances in neonatal, medical and surgical care there are an increasing number of infants and young children surviving with medical conditions. Many of these children have associated complex feeding difficulties as a result of the disruption to early oral feeding experiences and periods of restricted or non-oral feeding. These children are at risk of developing long-term feeding difficulties associated with sub-optimal nutrition and poor appetite regulation, delays in mastering skills that lead to eating and mealtime independence, and disruptive mealtime behaviours. Managing the extraordinary demands associated with feeding and ensuring nutrition for these children can present significant challenges for parents as well as health care professionals involved in their care. Occupational therapists are often core members of multidisciplinary teams providing hospital-based services to these children and their families. Embracing an occupation-centred perspective, participation in feeding and mealtimes are considered important co-occupations for infants, children and their parents and carers that occur within the context of parenting and family life. Understanding these contextual influences and the occupational needs of parents are essential but have been understated in the occupational therapy literature and clinical practice. This thesis describes a qualitative study using a phenomenological perspective to explore the lived experiences of parents of children with complex medical and feeding difficulties. Parents from fourteen families participated in the study. Data collection involved in-depth interviews, family mealtime observations and demographic questionnaires. Key findings indicated that parents experienced a high degree of stress in their everyday lives as a result of their children’s feeding difficulties, especially in relation to tube-feeding. Mothers’ self-image was devastated because they believed that it was their ultimate responsibility to feed and nourish their children. Differences in how parents identified with and fulfilled their parenting roles and responsibilities emerged, not just in relation to feeding but also for other childcare and domestic activities. Overwhelmingly, it was mothers who assumed the greater share of these parenting responsibilities, and in addition, expressed a sense of responsibility for preserving family unity and the need to get on with family life despite the chronic nature of their children’s problems. These findings contribute to our understanding of the occupational challenges for parents of these children, especially mothers who have a primary role in feeding, and the impact of feeding disruptions on the lives of their families. This knowledge will assist clinicians providing feeding interventions to be more sensitive and responsive to the needs of both parents and other family members. Recommendations for clinical practice are proposed. Limitations of the study are presented along with suggestions for future research.

With advances in neonatal, medical and surgical care there are an increasing number of infants and young children surviving with medical conditions. Many of these children have associated complex feeding difficulties as a result of the disruption to early oral feeding experiences and periods of restricted or non-oral feeding. These children are at risk of developing long-term feeding difficulties associated with sub-optimal nutrition and poor appetite regulation, delays in mastering skills that lead to eating and mealtime independence, and disruptive mealtime behaviours. Managing the extraordinary demands associated with feeding and ensuring nutrition for these children can present significant challenges for parents as well as health care professionals involved in their care. Occupational therapists are often core members of multidisciplinary teams providing hospital-based services to these children and their families. Embracing an occupation-centred perspective, participation in feeding and mealtimes are considered important co-occupations for infants, children and their parents and carers that occur within the context of parenting and family life. Understanding these contextual influences and the occupational needs of parents are essential but have been understated in the occupational therapy literature and clinical practice. This thesis describes a qualitative study using a phenomenological perspective to explore the lived experiences of parents of children with complex medical and feeding difficulties. Parents from fourteen families participated in the study. Data collection involved in-depth interviews, family mealtime observations and demographic questionnaires. Key findings indicated that parents experienced a high degree of stress in their everyday lives as a result of their children’s feeding difficulties, especially in relation to tube-feeding. Mothers’ self-image was devastated because they believed that it was their ultimate responsibility to feed and nourish their children. Differences in how parents identified with and fulfilled their parenting roles and responsibilities emerged, not just in relation to feeding but also for other childcare and domestic activities. Overwhelmingly, it was mothers who assumed the greater share of these parenting responsibilities, and in addition, expressed a sense of responsibility for preserving family unity and the need to get on with family life despite the chronic nature of their children’s problems. These findings contribute to our understanding of the occupational challenges for parents of these children, especially mothers who have a primary role in feeding, and the impact of feeding disruptions on the lives of their families. This knowledge will assist clinicians providing feeding interventions to be more sensitive and responsive to the needs of both parents and other family members. Recommendations for clinical practice are proposed. Limitations of the study are presented along with suggestions for future research.

With advances in neonatal, medical and surgical care there are an increasing number of infants and young children surviving with medical conditions. Many of these children have associated complex feeding difficulties as a result of the disruption to early oral feeding experiences and periods of restricted or non-oral feeding. These children are at risk of developing long-term feeding difficulties associated with sub-optimal nutrition and poor appetite regulation, delays in mastering skills that lead to eating and mealtime independence, and disruptive mealtime behaviours. Managing the extraordinary demands associated with feeding and ensuring nutrition for these children can present significant challenges for parents as well as health care professionals involved in their care. Occupational therapists are often core members of multidisciplinary teams providing hospital-based services to these children and their families. Embracing an occupation-centred perspective, participation in feeding and mealtimes are considered important co-occupations for infants, children and their parents and carers that occur within the context of parenting and family life. Understanding these contextual influences and the occupational needs of parents are essential but have been understated in the occupational therapy literature and clinical practice. This thesis describes a qualitative study using a phenomenological perspective to explore the lived experiences of parents of children with complex medical and feeding difficulties. Parents from fourteen families participated in the study. Data collection involved in-depth interviews, family mealtime observations and demographic questionnaires. Key findings indicated that parents experienced a high degree of stress in their everyday lives as a result of their children’s feeding difficulties, especially in relation to tube-feeding. Mothers’ self-image was devastated because they believed that it was their ultimate responsibility to feed and nourish their children. Differences in how parents identified with and fulfilled their parenting roles and responsibilities emerged, not just in relation to feeding but also for other childcare and domestic activities. Overwhelmingly, it was mothers who assumed the greater share of these parenting responsibilities, and in addition, expressed a sense of responsibility for preserving family unity and the need to get on with family life despite the chronic nature of their children’s problems. These findings contribute to our understanding of the occupational challenges for parents of these children, especially mothers who have a primary role in feeding, and the impact of feeding disruptions on the lives of their families. This knowledge will assist clinicians providing feeding interventions to be more sensitive and responsive to the needs of both parents and other family members. Recommendations for clinical practice are proposed. Limitations of the study are presented along with suggestions for future research.

OBJECTIVE: Substance use disorders (SUD) affect approximately 19.3 million adults in the United States. Of adults with SUDs, only 5% perceive the need for SUD treatment and 10% utilize specialty SUD treatment. The literature evidences racial disparities in utilization of SUD treatment yet presents mixed outcomes regarding race/ethnicity (i.e., White, Latinx, and Black/African-American) and gender (i.e., male, female) differences in perceived need for SUD treatment, specialty SUD treatment utilization, and barriers to SUD treatment. In addition, interaction with healthcare systems for chronic medical conditions like diabetes or hypertension may facilitate connection to SUD treatments for individuals with co-occurring SUD and chronic medical conditions, but little research exists that explores this potential facilitator. This dissertation addresses the following questions, with a focus on race/ethnicity and gender, and their interaction: 1.) What characteristics are associated with perceiving a need for SUD treatment among adults with SUD? 2.) What are the characteristics of adults who do not engage in specialty SUD treatment among those who perceived a need for SUD treatment? What were the most commonly reported barriers to specialty SUD treatment? and 3.) Is receipt of a chronic medical condition diagnosis among individuals with SUD associated with a greater likelihood of specialty SUD treatment utilization? METHODS: This study uses data from the National Survey on Drug Use and Health (NSDUH) from years 2005 through 2017. Simple and multivariate logistic regressions were conducted and interactions were tested using multiplicative terms with race/ethnicity and gender. Analyses adjusted for weights to account for the survey’s complex sampling design. RESULTS: No significant racial/ethnic or gender differences were found in association with perceived need for SUD treatment. Among adults who perceived the need for SUD treatment, less than 20% in any racial/ethnic category utilized specialty SUD treatment services. Black/African-American adults, compared to White, were more likely to utilize specialty SUD treatment and less likely to name stigma as a barrier to treatment. Black/African-American adults with co-occurring chronic medical conditions and SUD were more likely to perceive a need for SUD treatment, but similarly likely to utilize specialty SUD treatment in comparison to White adults. Women and men did not significantly differ on perceived need for SUD treatment, utilization, or barriers. CONCLUSIONS: Differences in SUD treatment utilization patterns exist in association with race/ethnicity, though not with gender. Study findings suggest the presence of specialty SUD treatment utilization disparities, with stigma contributing to lower utilization for Whites compared to Blacks/African-Americans. Higher rates of treatment utilization among Blacks/African-Americans may reflect the presence of strengths uniquely attributed to this group.

Health related absenteeism was identified as a problem in the schools in the Molopo region, needing a multi-disciplinary approach which included the parents. A conceptual framework on absenteeism was used as a guideline for the descriptive research design. Using a convenience sampling technique 426 absentees, 22 teachers and 2 school nurses filled in three separate questionnaires in ten schools selected to determine the extent of absenteeism due to health related and other problems, the control measures taken and the awareness of school personnel. Health problems were identified as the main reasons for absenteeism. Inadequate communication between the schools and parents as well as lack of guidelines on the control of absenteeism, were other problems identified. Recommendations made related to the provision of school health services that promote the health status of the pupils based on Primary Health Care principles, parental involvement in school health matters and the formulation of policies aimed at controlling absenteeism in schools. / Health Sciences / M.A. (Nursing Science)

Health related absenteeism was identified as a problem in the schools in the Molopo region, needing a multi-disciplinary approach which included the parents. A conceptual framework on absenteeism was used as a guideline for the descriptive research design. Using a convenience sampling technique 426 absentees, 22 teachers and 2 school nurses filled in three separate questionnaires in ten schools selected to determine the extent of absenteeism due to health related and other problems, the control measures taken and the awareness of school personnel. Health problems were identified as the main reasons for absenteeism. Inadequate communication between the schools and parents as well as lack of guidelines on the control of absenteeism, were other problems identified. Recommendations made related to the provision of school health services that promote the health status of the pupils based on Primary Health Care principles, parental involvement in school health matters and the formulation of policies aimed at controlling absenteeism in schools. / Health Sciences / M.A. (Nursing Science)