Background: Antiretroviral treatment (ART) has reduced the mortality rate of HIV-positive children significantly, and is known to prevent the development and progression of HIV encephalopathy. However, even with ART, perinatal HIV infection places HIV-infected children at increased risk for encephalopathy and associated developmental delays. Research is lacking in the extent of developmental delay on children established on ART, along with evidence-based occupational therapy interventions to treat these developmental delays. A play-informed, caregiver-implemented, home-based group occupational therapy intervention (PICIHBI) presents one possible service delivery option to be explored. Aim: To determine whether children attending an experimental group (PICIHBI) versus children attending a control group (conventional, individual occupational therapy intervention) would present similar results in their total developmental quotient – on the Griffiths Mental Developmental Scales (GMDS) and Paediatric Functional Independence Measure (WeeFIM). Methods: A randomised control trial, which was pragmatic in nature and single-blinded, was used. The research population was all HIV-positive children, pre-formal school-going aged (6 months – 5 years), on ART attending the Groote Schuur Hospital paediatric HIV clinic at the time of the study. Caregiver and child dyads were randomly assigned to either the experimental or control group, and attended a monthly occupational therapy session. Differences in the GMDS and WeeFIM scores of each child after 5 and 10 months' intervention were compared. Results: Inter-rater reliability was established among the five researchers performing the GMDS before baseline assessments. Forty-two participants were recruited from a possible population of 72 participants and 39 participated in the baseline assessment. Twenty-eight participants completed mid and post assessments, 15 in the experimental PICIHBI group and 13 in the control group (90% power). Baseline averages on the GMDS showed the participants scoring at a borderline mental retardation level, with better performance in the locomotor and personal-social subscales, before interventions. Both groups had an average attendance of 5 sessions. Post-interventions, average total GMDS and WeeFIM scores between the two groups revealed similar scores within the predetermined non-inferiority margin and no significant differences at any time point. Conclusion: In conclusion, the low baseline scores confirm the need for occupational therapy intervention in pre-formal school-going HIV-positive children on ART. The PICIHBI intervention demonstrates a non-inferior impact in child development in this group compared to conventional, individual occupational therapy intervention. PICIHBI thus has potential for impacting occupational therapy practice in this field by providing an alternative equivalent treatment with increased reach.

Background: The concept of client-centred practice (CCP) was first developed and implemented by occupational therapists in Canada during the early 1980s and subsequently transferred into the Tanzanian occupational therapy curriculum by international volunteer educators. Currently, the occupational therapy curriculum at the Kilimanjaro Christian Medical University College (KCMUCo) in Moshi, Tanzania covers CCP using assessment tools and models developed by the Canadian Association of Occupational Therapy. To date, no occupational therapy research has been conducted to investigate the relevance of CCP for Tanzania, or to document the perspectives of therapists in applying the principles of CCP. This study was indicated to inform the occupational therapy curriculum at the KCMUCo and the Tanzania Occupational Therapy Association (TOTA) about occupational therapy practice realities related to the implementation of CCP in Tanzania and to guide the alignment of the occupational therapy curriculum towards a local understanding of CCP or an alternative (non-Western) perspective. This study, therefore, aimed to determine the understanding and use of CCP by occupational therapists in Tanzania. Methodology: The study used a descriptive cross-sectional design. All qualified occupational therapists working in different regions in Tanzania were approached to participate in the study (N=80). A questionnaire, the Professional Questionnaire for Assessing CCP (PQACCP) was adapted for the study. The questionnaire consisted of five sections: 1) demographic and practice information; 2) an adaptation of an existing checklist on understanding CCP (Parker, 2006); 3) potential barriers to CCP; 4) enablers of CCP; and, 5) therapist opinions on the relevance of CCP for the Tanzanian context. The checklist of potential barriers and enablers was adapted from Sumsion & Smyth, (2000). Data were analysed using the SSPS software program (version 20.0). Numerical variables were checked for normality and the appropriate measures of central tendency and dispersion calculated. Frequencies and proportions were determined for categorical items. The Chi-square test of association was done to determine whether there were any observed associations between demographic variables and barriers/enablers.

Includes bibliographical references. / This study focused on women who consumed alcohol during pregnancy. The study population was situated in the West Coast/Winelands, a rural area in the Western Cape Province of South Africa. The study was done in a community which is classified as one of the many previously disadvantaged groups in South Africa. This study was done as part of a larger three-year project on Fetal Alcohol Syndrome Prevention in the Western Cape and Gauteng Provinces of South Africa. The phenomenon of drinking during pregnancy was used as a case example of health compromising occupations in the South African context. Prenatal alcohol exposure may result in brain damage that affects behaviors of those affected. The beliefs, norms, values and perceptions of mothers regarding alcohol consumption are also an important aspect in maintaining healthy pregnancies.

This thesis explored the occupational choices of young adolescents in a southern peninsula Cape Town community of Lavender Hill in South Africa. Informed by current research and prior professional and personal experiences with young adolescents in Lavender Hill, the research question asked: 'What informs occupational choice among young adolescents in Lavender Hill?' This complemented the research aim, which was to generate insight into the nature of the occupational choices of a group of young adolescents in Lavender Hill, and the factors that influenced their occupational choices.

Background: This study is a critical description and explanation of the situated nature of the professional role transition process experienced by occupational therapists working in specialised education in post-apartheid South Africa. The study posed the research question: How do occupational therapists experience the process of professional role transition within specialised education in the Western Cape? The study was framed conceptually within critical social theory and occupational science. Aim: The study aimed to describe and analyse a single instrumental case of professional role transition experienced by five occupational therapists currently working at special school resource centres in two education districts in the Western Cape, South Africa Objectives: The objectives of the study were to: Describe and explain the process of professional role transition as experienced by occupational therapists along a trajectory from 1994 to 2013; Provide insights into the occupational therapists' perceptions, thoughts, feelings and attitudes on their professional role transition experience; Determine whether there are any role changes present and the possible impact this might have on the role and scope and development of occupational therapy practice within specialised education; and Outline the influences the socio political context has on the role of occupational therapists working in special school resource centres in the Western Cape.

Incudes bibliographical references.

BACKGROUND: Two challenging concerns prompted this research. The first was post 1994 South African society’s historically entrenched dehumanized/ing condition. And the second was the ill-positionedness and ill-preparedness of occupational science accompanied occupational therapy to do something about it. Appropriate concepts to imagine and generate potentially humanizing and healing responses to violent-divided-wounded human relations were found to be lacking in both professional and public discourses. This study therefore conceived of and applied an original conceptual depiction of being human as ‘enacting humanity affirmations’. Two questions were asked: how are affirmations of our humanity enacted in everyday post 1994 apartheid South Africa? And, how is human occupation and health implicated in enacted humanity affirmations? Consistent with the values and power rationality nature of the first research question, this study was philosophically grounded in critical contemporary interpretations of Aristotle’s intellectual virtue phronesis, and the African relational ethic Ubuntu. METHODOLOGY: Case study was heuristically employed as both a method and the object of study, along with narrative enquiry to generate storied exemplars. Maximum variation sampling aimed for heterogeneity of participants. The stories which made up the instrumental collective case were selected on the criterion of encountering likely resonance within South Africa. Situated within a dehumanized/ing context, incidents-embedded instances of enacted humanity affirmations were handled as bounded systems. Information was gathered through and from multiple methods and sources, including narrative interviews, participants’ reflective journals, multiple documents review, and researcher’s notes. Data analysis proceeded from co-constructions of nine case narratives, an across-case thematic analysis, to thesis building. Together, these informed what this study’s case is about, what it is a case of, and for. Critical reflexivity was exercised by on-going attention to power issues in research interactions, and attempts to enact reciprocal gestures and shared decision-making. FINDINGS/DISCUSSION: This study is a case about everyday enacted humanity affirmations which present as remarkable, disrupting seemingly normalized systemic oppressive power dynamics. Three main themes emerged: 'spectra of relational agency possibilities'; 'embodied-embedded radical sens-abilities'; and, 'never forget how made to feel'. Interpretations and discussion of these findings make this study a case of revealing and disrupting the violent deceptive western(ized) ontological and epistemological premise that being human is a given for all. Redressing historically inflicted harm done to our humanity necessitates that the geo- and body-political epistemic positions, from where to generate applicable understandings of human occupation and health, are delinked from ‘whiteness’. CONCLUSION: This study builds a case for advancing an understanding of being human as occupation and health. Being human was found to be radically relational, and not a given but a political potentiality which manifests on a continuum of enacted harmful negations and salutogenic affirmations of our humanity. Also, cultivation of our being human as shared identity-integrity can advance humanity-health. These insights allow for potentially humanizing and healing societal responses to violent-divided-wounded human relations. This has implications for how occupational therapy and occupational science can position and prepare for being a humanizing and healing resource through research, practice, and education.

Introduction: Adults with intellectual disability (ID) have a right to be included in post-school education (PSE) opportunities such as learnership programmes. They face many barriers, however, including the fact that learning facilitators do not know how to include and teach these learners with ID in a PSE context. Problem: No literature or documented evidence has been captured about inclusive educational approaches describing how learning facilitators taught adults with ID in three learnership programmes that can be used to develop training programmes that will equip learning facilitators with the necessary skills for teaching this group of learners. Rationale: Learning facilitators need to be adequately trained, equipped and supported to meet specific learning needs of adults with ID in learnerships. This study will provide a resource of practice-based educational strategies that could serve as the basis for this training. Aim: To describe how learning facilitators in learnership programmes at Organisation X provided teaching to adults with ID. Method: An indepth, moderately structured, open-ended interview method was used to collect data from six participants. Three Universal Design for Learning (UDL) principles and related guidelines were used to inform how the interview questions were structured. Findings: The main theme was “a learnership takes time, patience and many adjustments but it has to be done” that comprised three categories: namely “dealing with intellectual disability”, “streamlining learnership strategies” and “perceiving the 'just right’ learnership”. The sub-categories identified were populated into the UDL Framework. Discussion: Learnership programmes with adults with ID are time consuming and personally demanding for learning facilitators, but adults with ID have a right to access these programmes. Training programmes for learning facilitators need to include aspects of how to deal with learners with ID, what curriculum differentiation strategies need to be streamlined, and how to create the 'just right’ learnership. Conclusions: Learning facilitators believe that learners with ID have the right to access PSE and participate in learnerships. The success of post-school learnerships lies in providing the “just right” curriculum that offers support for both educator and learner.

Title: Determinants of positive functional outcomes at 16 weeks after flexor tendon repair at a tertiary hospital in the Eastern Cape of South Africa: A descriptive, analytical study. Introduction: Flexor tendon injuries account for a substantial number of hand injuries presenting to health care facilities, yet rehabilitation following flexor tendon repair remains a challenge. There is limited research pertaining to flexor tendon rehabilitation in middle economic income countries like South Africa. Objectives: The aim was to identify determinants of positive functional outcomes sixteen weeks after flexor tendon repair at a tertiary hospital in South Africa. The objectives were: 1) to describe the functional outcomes at four, eight, twelve and sixteen weeks post flexor tendon repair using total active motion (TAM), muscle strength and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, 2) to ascertain the demographic profile for patients presenting to the hospital with a flexor tendon injury, 3) to describe the rate of recovery between the four assessment intervals, and 4) to cross-culturally translate the DASH questionnaire into isiXhosa. Method: Ethical approval was obtained through the University of Cape Town’s Human Research Ethics Committee. A quantitative, descriptive, analytical design was used. The DASH was translated as per the guidelines for cross-cultural translation by the Institute for Work and Health. All patients presenting to the target institution with a flexor tendon injury between February and August 2017 formed the sample. Twenty-two participants were recruited. Participants were assessed at four, eight, twelve and sixteen weeks post operatively using TAM, muscle strength and the DASH questionnaire. Demographic and treatment factors for each participant were compared to 16-week DASH scores using Mann-Whitney U and Kruskal-Wallis ANOVA tests. The rate of recovery was analysed using Spearman’s Rank Correlation Coefficient, Friedman’s ANOVA and Wilcoxon Matched Pairs for TAM, DASH score and muscle strength respectively. Results: Time to repair was the only factor to have statistical significance at 16-weeks post operatively (H(df=9)=15.3; p=0.05). Rate of recovery when compared to DASH (F(df=3)=12.98; p=0.005) and muscle strength (Z=3.076; p=0.002) scores showed statistical significance, though TAM did not (rs(df=2)=0.06; p=0.78). The epidemiological profile was similar to those documented elsewhere in South Africa and globally. Conclusion: The outcomes achieved in the present study were poorer than those described in the vast body of literature in the field, but similar to those described in a similar cohort elsewhere in the country. The demographic profile was similar to those previously documented in South Africa and across the globe, but with different environmental and institutional barriers. Rate of recovery appears greatest between four and eight weeks, as well as between weeks twelve and sixteen. Time to repair showed that it is not harmful to delay primary flexor tendon repair up to six days post injury. Recommendations for future policy, education, practice and research were made.

The lack of contextually relevant conceptual tools to promote play makes implementing playbased, occupation-centred practice challenging for occupational therapists working with children with HIV/Aids in low resourced settings. This doctoral thesis focussed on reviewing and generating evidence, and further proposed a play-based intervention framework for children with HIV/Aids living in a low resourced setting. Theoretical frameworks used to guide the intervention development process and content of the play-based intervention were the United Kingdom Medical Research Council (UK MRC) framework for development and evaluation of complex interventions and Cooper's Model of children's play. The development of the play-based intervention involved four phases: 1) conducting a systematic review, 2) profiling of the play of children with HIV/Aids, 3) drawing perspectives of caregivers through in-depth interviews, and 4) gaining consensus from experts on components to include in the play-based intervention framework. In phase 1, a systematic review following the PRISMA guidelines was conducted to identify evidence that support the development of play-based interventions. Eighteen studies that focused on play as an outcome and compared the play of children with Special Health Care Needs (SHCN) to that of typically developing children met the eligibility criteria. The Kmet checklist was used to evaluate the methodological quality of the studies included. The systematic review revealed paucity of research on the play of children with SHCN such as those with HIV/Aids. Phase 2 was undertaken to generate more evidence by comparing the play profiles of 44 children with HIV/Aids aged 4-7 years to that of 52, age and gender matched typically developing children. The children were video-recorded while playing with a playmate at school or clinic and home settings. The Test of playfulness was used to score the videos by two independent raters and the scores were subjected to rasch analysis. A comparison of play profiles revealed that children with HIV/Aids were significantly less playful outdoors as compared to typically developing children (t(94) = 3.57, p = 0.001). Children with HIV/Aids also had more challenges with social play skills. In phase 3, contextual understanding of the play of children with HIV/Aids was sought through in-depth interviews with fifteen purposively selected caregivers whose children with HIV/Aids had participated in phase 2 of the study. The interviews were audio-recorded, transcribed verbatim and analysed thematically. The following four themes emerged: ‘Ubuntu is no more'; ‘survival is primary (chikuru kurarama)'; ‘play affirms that my child is still like other children'; and ‘more is required for a child with HIV'. Caregivers also reported on how contextual factors such as HIV/Aids stigma, poverty and cultural beliefs shaped the play of their children. In phase 4, findings from phases 1, 2 and 3 were synthesised and presented to experts in the field of play, HIV/Aids and intervention development during a two-round Delphi study. Experts were asked about their opinions and to rate what should be included in the play-based intervention framework. Consensus agreement was reached when at least 70% of Delphi experts rated each item at 3 or higher on a 5-point Likert Scale. Experts agreed on the application of Cooper's Model of children's play as a theoretical framework, as well as principles and techniques for the play-based intervention. This study is the second in occupational therapy to report on the play of children with HIV/Aids. It is the first one to review and generate evidence to support play-based interventions targeted at children with HIV/Aids. Evidence generated in this study showcased the need for occupation-centred, play-based services for children with HIV/Aids, particularly those living in low resourced settings. The play-based intervention proposed is child-led, allowing for physical and active involvement of the child. To increase social interaction and continuity into the home environment, playmates and caregivers must be included. Unique to this play-based intervention is advocacy for more play opportunities, access to nutrition and inclusion of culturally sensitive practices. Future studies should include feasibility on various aspects of the play-based intervention before implementing randomised controlled trials to test the effectiveness of the intervention are conducted.