Submitted in fulfilment of the requirements for the Degree Philosophiae Doctor in Health Sciences, Durban University of Technology, 2017. / Background Cancer is a global concern because it affects and kills millions of people worldwide. In South Africa, patients frequently move between traditional health practitioners and radiation oncologists to seek cure of cancer, yet these health practitioners do not communicate with each other. Consequently, the treatment is often disrupted and imcomplete therefore compromising the survival of patients. The future of the health system in effective treatment of patients with cancer is dependent on health practitioners’ changing fundamentally in their co-operative practice. The aim of this study was to explore the practice of traditional health practitioners in the treatment of patients with cancer in order to describe a viable co-operative practice between them and radiation oncologists and ultimately develop traditional health practitioners as a component in the health system in the treatment of patients with cancer. Methods An exploratory descriptive qualitative study using an interpretive phenomenological approach was employed to collect data from 28 traditional health practitioners and four radiation oncologists in KwaZulu-Natal utilising snowball and stratified purposive samplings for the former and latter, respectively. Semi-structured face-to-face and group interviews were employed to collect primary data from traditional health practitioners and data from the radiation oncologists were collected through face-to-face and email interviews. Data were transcribed verbatim and analysed using framework analysis. Results It emerged that the referral of patients, in addition to external conditions, individual attributes, trusting attitudes of participants as well as organisational dynamics and philosophy of practice, were the main categories used by participants in their understanding of co-operative practice in KwaZulu-Natal. The patient is the main player in the co-operation between parties, and coordinates the health practitioners’ activities during treatment. Effective co-operative practice is time consuming and requires commitment, co-operation and training of the participants. Conclusion Considering the problems associated with treatment of cancer when patients move freely between the traditional health practitioners and radiation oncologists, resulting in interruptions in treatment, co-operative practice between the two health practitioners is paramount. The development of traditional health practitioners could result in extending their role in the management of cancer and therefore increasing the accessibility of cancer services. It follows that a workable practice between traditional health practitioners and radiation oncologists in the treatment of patients with cancer could be an inclusive health system where the parties work in parallel with the patient being the main actor in the collaboration. There should be a healthy relationship between all those involved in the collaboration in order to facilitate referral of patients between the health practitioners. / D

The purpose of the study was to investigate the factors associated with the interruption of tuberculosis treatment in the Swakopmund district of Namibia. A descriptive cross-sectional survey was conducted. Data was collected using a structured questionnaire administered by interviewers. The population consisted of both treatment interrupters and non-interrupters. The total sample was 143 respondents. The findings revealed that three factors were significantly associated with TB treatment interruption, namely a lack of formal education (p = 0.032), lack of access to media (p = 0.017), and clinic opening times (p = 0.000). Recommendations made include improving the support given to TB patients, increasing their understanding of TB and adopting new research and technology. / Health Studies / M.A. (Public Health)

Text in English / Aim: The aims of this study were to investigate the treatment outcomes of patients with MDRTB and its determinants at referral hospitals in Ethiopia. The study also aims to develop a conceptual model for enhancing treatment of patients with MDR-TB in Ethiopia. Design and methods: A concurrent mixed methods design with quantitative dominance was used to investigate treatment outcomes of patients with MDR-TB and its determinants. Results: A total of 136 (n=136) patients with MDR-TB participated in the study, 74 (54%) were male and 62 (46%) were female. Forty-one (31%) of the patients had some co-morbidity with MDR-TB at baseline, and 64% had body mass index less than 18.5kg/m2. Eight (6%) of the patients were diagnosed among household contacts. At 24 months, 76/110 (69%) of the patients had successfully completed treatment, but 30/110 (27%) were died of MDR-TB. Multivariable logistic regression revealed that the odds of unfavourable treatment outcomes were significantly higher among patients with low body mass index (BMI <18.5kg/m2) (AOR=2.734, 95% CI: 1.01-7.395; P<0.048); and those with some co-morbidity with MDR-TB at the baseline (AOR=4.260, 95%CI: 1.607-11.29; p<0.004). The majority of the patients were satisfied with the clinical care they received at hospitals. But as no doctor was exclusively dedicated for the MDR-TB centre, patients could not receive timely medical attention and this was especially the case with those with emergency medical conditions. The caring practice of caregivers at the hospitals was supportive and empathic but it was desperate and alienating at treatment follow up centres. Patients were dissatisfied with the quality and adequacy of the socio-economic support they got from the programme. Despite the high MDR-TB and HIV/AIDS co-infection rate, services for both diseases was not available under one roof. Conclusions: Low body mass index and the presence of any co-morbidity with MDR-TB at the baseline are independent predictors of death among patients with MDR-TB. Poor communication between patients and their caregivers and inadequate socio-economic support were found to determine patients’ perceived quality of care and patients’ satisfaction with care given for MDR-TB. / Health Studies / D. Litt et Phil. (Health Studies)

Successful physician-patient communication is increasingly being acknowledged as a vital aspect of healthcare today. Research in the field has not examined all aspects of patient-centered care and the aspects that have been studied have not been grounded in actual patient action. The research done in the field has largely been studied quantitatively. The present thesis research attempts to contribute to the gap in the field of physician-patient communication by qualitatively examining patient assertiveness. This thesis examines conversations between women in Portland, Oregon recently diagnosed with breast cancer talking to their surgeons about their diagnoses and treatment options. Using grounded qualitative theoretical analysis, this thesis uncovered five major themes of patient assertiveness in breast cancer care.

D.Cur. (Psychiatric Nursing Science) / Please refer to full text to view abstract

The purpose of the study was to investigate the factors associated with the interruption of tuberculosis treatment in the Swakopmund district of Namibia. A descriptive cross-sectional survey was conducted. Data was collected using a structured questionnaire administered by interviewers. The population consisted of both treatment interrupters and non-interrupters. The total sample was 143 respondents. The findings revealed that three factors were significantly associated with TB treatment interruption, namely a lack of formal education (p = 0.032), lack of access to media (p = 0.017), and clinic opening times (p = 0.000). Recommendations made include improving the support given to TB patients, increasing their understanding of TB and adopting new research and technology. / Health Studies / M.A. (Public Health)

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-04-14T17:48:56Z No. of bitstreams: 1 DISSERTAÇÃO. Raquel Malheiros Teixeira Moreira da Paz. 2015.pdf: 963760 bytes, checksum: f8739b5d5aa3bd312a29f2c19108de3d (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-04-18T12:51:58Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO. Raquel Malheiros Teixeira Moreira da Paz. 2015.pdf: 963760 bytes, checksum: f8739b5d5aa3bd312a29f2c19108de3d (MD5) / Made available in DSpace on 2016-04-18T12:51:58Z (GMT). No. of bitstreams: 1 DISSERTAÇÃO. Raquel Malheiros Teixeira Moreira da Paz. 2015.pdf: 963760 bytes, checksum: f8739b5d5aa3bd312a29f2c19108de3d (MD5) / Apesar da relevância do tema, existem poucos e divergentes estudos a respeito do conceito de abandono do tratamento e sobre os fatores predisponentes para o mesmo em serviços de saúde mental infantojuvenil. Portanto, este trabalho teve por objetivo apresentar e discutir quais os conceitos e os principais fatores associados ao abandono do tratamento de saúde mental entre crianças, adolescentes e suas famílias, em publicações científicas. Foram consultadas as bases de dados Scielo, Lilacs, Medline, PubMed e NCBI (National Center for Biotechnology Information), ultilizando - se artigos publicados desde o primeiro estudo divulgado em 1956, através dos seguintes descritores: “pacientes desistentes do tratamento”, “abandono”, “dropout” e “desistência do paciente”, correlacionados à “saúde mental” e “crianças e adolescentes”. Os resultados encontrados evidenciaram o predomínio de trabalhos quantitativos, com significativas divergências conceituais e sobre os resultados produzidos. Alguns fatores foram levantados com maior recorrência entre os estudos como possivelmente associados ao abandono do tratamento entre crianças e adolescentes, tais como a monoparentalidade e sobrecarga do cuidado na figura de um único cuidador; uso abusivo de substâncias psicoativas entre os jovens e seus pais; violência intrafamiliar; baixa escolaridade dos pais; baixo capital econômico; discrepâncias entre as expectativas dos familiares e profissionais quanto ao tratamento; atitudes e comportamentos do terapeuta como empatia e disponibilidade subjetiva; pouca clareza sobre os objetivos e métodos de tratamento; dificuldades na marcação; formas de acolhimento; vinculo terapêutico frágil, natureza das fontes de encaminhamento, dentre outros. Discute-se que conhecer os possíveis preditores para o abandono do tratamento de saúde mental possibilita que os profissionais possam identificar precocemente pacientes pertencentes ao grupo de risco para abandono, oportunizando-lhes trabalhar preventivamente e mais diretamente aspectos que dificultam a permanência desses pacientes e seus familiares na instituição. Apesar da significativa contribuição destes estudos para a produção do conhecimento científico, ressalva – se a necessidade de novos estudos de cunho qualitativo junto aos familiares, usuários e profissionais do CAPSi, a fim de compreender melhor a realidade desse espaço de cuidado tão diverso dos modelos de tratamento ofertados em outros países.

A estimulação elétriva vagal (VNS) é uma terapia adjuvante utilizada no tratamento de pacientes com epilepsia refratária que não são candidatos à cirurgia ressectiva ou que apresentam resultados limitados após procedimentos cirúrgicos. Atualmente, há evidência suficiente para corroborar seu uso em pacientes com epilepsia focal ou outros tipos de crises epilépticas. Com o intuito de estudar um método para otimizar a terapia através da redução do consumo da bateria do sistema, este projeto teve como objetivo propor uma alteração no protocolo de estimulação já existente, com alteração da frequência de 30 Hz para 20 Hz, através da avaliação de duas variáveis principais: crises convulsivas e efeitos colaterais. A análise prospectiva e duplo-cega consistiu na avaliação por 3 meses de 6 pacientes já submetidos ao implante do VNS, seguida de alteração do parâmetro e continuidade do seguimento por mais 1 mês. Os resultados revelaram que, com a estimulação a 20 Hz, houve 68% de redução da incidência de crises (p = 0,054) assim como baixa incidência de efeitos colaterais (apenas 1 dos 6 pacientes). Por conseguinte, este estudo foi um projeto piloto de curto seguimento, que demonstrou a possibilidade de redução da frequência de estimulação para 20 Hz sem comprometimento da eficácia da terapia ou aumento da taxa de complicações, com consequente aumento da sobrevida do sistema. / Vagus nerve stimulation (VNS) is an adjunctive therapy used to treat patients with refractory epilepsy who are not candidates for resective surgery or have poor results after surgical procedures. There is sufficient evidence nowadays to support its use in patients with focal epilepsy and other seizure types. In order to investigate an approach to optimize therapy and reduce battery consumption, this project aimed at proposing an amendment to the current stimulation protocol, altering it from 30 Hz to 20 Hz, through assessment of two variables: seizures and adverse events. The prospective and double-blind analysis consisted of a 3 month evaluation of 6 patients that had already been implanted with the VNS system, followed by parameter adjustment and follow-up for another month. The results revealed that, with 20 Hz stimulation, there was 68% reduction in seizures (p = 0,054), as well as low incidence of adverse events (only 1 of 6 patients). Therefore, this study was a pilot project with short-term follow-up that indicates the possibility of reducing frequency stimulation to 20 Hz without compromising therapy efficacy and without any increase in complication rates, which could further increase battery life expectancy.

M.A. (Social Work) / South Africa is a society undergoing major and rapid social change. An understanding of psychiatric services in the psychiatric hospital should also be identified within this context. The needs of the mentally ill and other interested parties will determine the extent of the services that need to be rendered. The social worker as part of the interdisciplinary team in the hospital, must have a clear perception of her professional role in order to render a relevant service. Social work must become more responsive to the consumers' needs and allow itself to be shaped by the context in which it is practised. In this study the role of the social worker in Weskoppies Hospital was identified by means of a descriptive research design with qualitative and quantitative methods of data collection. The qualitative research was done by means of in depth interviews and focus groups with interested parties. The quantitative research was done by means of questionnaires completed by patients of the hospital. A model for the role description of the social worker was derived from a literature study; the view of Lister, as described by the authors Hepworth & Larsen; the view of other authors and the results of the qualitative and quantitative research. The results of the research confirmed a need for social work services in Weskoppies Hospital. The greatest need expressed, was a need for help with material problems, followed by a need for help to be linked with other resources. Although community involvement was emphasised, there still was a need for individual counseling and support. Other important roles were also identified. The model serves as an integrated description of the role of the social worker in the hospital. From the results of the research it was thus possible to convey a clear picture of the role of the social worker in Weskoppies Hospital. Hopefully this will enable the social workers in the hospital to render a better and more understanding service to the patients, hospital and community.

D.Litt. et Phil. / The goal of this study was to determine the impact of cognitive behavioural therapy on people who meet the international diagnostic criteria for CFS, by specifically looking at symptoms and health behaviour. Whereas CFS was originally only studied from a medical perspective, recent years have seen an increased interest from psychologists. Initially the debate centered around whether CFS was a medical or psychiatric illness, but with the development of health psychology as a recognised field of its own, the focus shifted to the investigation of how medical and psychological factors work together to create the symptomatology of CFS. The approach adopted by the research team was that CFS was a biopsychosocial illness and that biological factors such as genetic predisposition, psychological factors such as cognitions and emotions and social factors such as the pressures of families and society work together to establish the health of a person. The study thus set out to gather information regarding all of these aspects in order to add to the current body of knowledge. As previous research efforts had been critisised regarding the validity of the diagnosis of the CFS patients included in their samples, an important challenge that was faced by the researcher was to establish that all the research group participants did meet with the diagnostic criteria. It also had to be ensured that their symptoms could not be accounted for by any other medical illness that was listed as an exclusion criteria for CFS. In order to achieve this patients who had not already had the necessary medical tests done, were requested to do so. The therapeutic intervention was based on cognitive behavioural principles which had been proven to be effective in the treatment of other illnesses that had a biological as well as psychological , aspect to it, for example anxiety, fibromyalgia and chronic pain. The aspects that were addressed had been found by previous researchers to be of great importance in a therapeutic intervention for CFS. These aspects included illness beliefs, information regarding CFS, locus of control and coping mechanisms, avoidance, activity levels, negative and dysfunctional thoughts, social support, lifestyle changes, stress management, sleep, exercise and personality factors. The specific techniques that were included in the intervention were self monitoring, monitoring and modifying of dysfunctional thoughts, goal setting, relaxation and systematic desensitisation. The research group consisted of 37 patients who met the internationally accepted diagnostic criteria for CFS. The control group was a contrast group of comparable size, which included only people who were free from psychological disorders and medical illnesses. The research group participated in a cognitive behavioural intervention, which was designed around the needs of each individual. They therapy was conducted at a community clinic at Rand Afrikaans University between February 1995 and October 1995. Pretests were completed upon commencement of the therapy and the posttests upon termination of the therapy. The control group completed their pre- and posttests at the average interval of the research group pre- and posttests. In order to make a multi-dimensional assessment of the impact of the cognitive behavioural intervention on CFS, various instruments were ulitised. The first instrument was a biographical questionnaire, which recorded the name, sex, age, income group, highest formal qualification, type of work, etcetera. The second questionnaire was an adapted version of the Support and Service Utilisation Schedule, which was employed to control for the other medical and therapeutic interventions that patients participated in, for example the medication taken, alternative medical practitioners visited and sources of support. The participants were asked to maintain their use of these services that they had been using for a long period and to not embark on any new therapies and treatments while they were partaking in the cognitive behavioural intervention.