Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Homeopathy, Durban University of Technology, Durban, South Africa, 2015. / Introduction In South Africa homoeopathy is relatively unfamiliar, even though it has been in existence with formal qualification from 1989 at the Durban University of Technology, (formerly Durban Institute of Technology and Techikon Natal) as well as the University of Johannesburg formerly Wits Technikon). A large portion of the South African public is unclear with regards to homoeopathic understanding and homoeopathic medicine use. South African studies exploring the perception of homoeopathy have revealed that there is a degree of ignorance or misinterpretation of homeopathy. The objectives of this study were to expand the database of knowledge regarding the patients’ experiences of homoeopathy, by investigating their experiences of homoeopathic care rendered at a PHC facility in the eThekwini district, namely, the Redhill homoeopathic clinic. This study was guided by the following grand tour question: What are the experiences of patients of homoeopathic care rendered at a primary healthcare clinic in the eThekwini District? Aim of the study The aim of this study was to determine the experiences of patients receiving homoeopathic care rendered at a primary healthcare facility in the eThekwini district. Methodology A qualitative, explorative, descriptive and contextual design was employed. Qualitative research in this study was considered the most appropriate method to gain an in-depth understanding of the patients’ experiences of homoeopathic care. Convenience sampling was used to recruit a minimum of 10 potential research participants from patients receiving homoeopathic care at the Redhill homoeopathic clinic, but the sample size was only determined once data saturation was obtained. The study population were patients who were visiting the Redhill homoeopathic clinic for the second time or more and those who had utilized homoeopathic remedies. The data was collected and analysed using Tesch’s eight-step procedure. Results Results from this study showed that the study group had knowledge of homoeopathy and that there is growth in the knowledge of homoeopathy as compared to previous studies. The researcher observed that Indian participants had a better understanding of homoeopathy than African participants. Participants showed great confidence in homoeopathy and most of them revealed a high level of satisfaction with the homoeopathic treatment and were very happy with the service delivery. Results showed that there had been an improvement of the patients’ ailments since the commencement of homoeopathic treatment. / M

Submitted in fulfillment of the requirements for the Master’s Degree in Technology: Homoeopathy, Durban University of Technology, Durban, South Africa, 2016. / Introduction Homoeopathy is recognised as a well established form of alternative medicine in the private healthcare sector of South Africa (Caldis, McLeod, Smith, 2001). Whilst local research supports the viability of homoeopathy as a primary healthcare resource; patient perception and experience with the homoeopathic service remain largely unknown (Smillie, 2010). The study addresses shortfalls in existing literature on homoeopathy, providing a qualitative evaluation of the homoeopathic healthcare service in the context of public healthcare in South Africa. The task of the study was to develop substantive theory with the aim to better understand health behaviour of patient’s utilising homoeopathic and allopathic healthcare services. Methods The study employed a qualitative study design, and explored the perceptions and experiences of patients receiving homoeopathic care at the Kenneth Gardens Homoeopathy Clinic, within the context of primary healthcare services and public sector healthcare. Data was generated through in-depth, semi-structured interviews conducted with 14 participants. Data was systematically analysed using grounded theory methods to generate substantive theory (Glaser and Strauss, 1967; Schreiber and Stern, 2001; Holloway and Wheeler, 2010). Results Data analysis revealed five main themes of influences affecting the utilisation of homoeopathic services at the Kenneth Gardens Clinic; these include context specific factors to healthcare utilisation, factors influencing healthcare utilisation, health beliefs and practices, health outcome factors and trust. The study results illustrate that participants trusted their homoeopathic provider and homoeopathic treatment outcomes; and subsequently demonstrate the direct positive influence which trust had on the utilisation of homoeopathic services in the study population. Discussion The discussion explores the significance of influences, barriers and discerning factors identified in the study on decision-making pathways in healthcare utilisation behaviour of homoeopathic and allopathic healthcare services. The significance of trust in healthcare utilisation behaviour is explored as the principle finding of the study. The study’s conceptual model is based on Anderson’s (2005) behavioural model of health service utilisation and has been adapted to demonstrate the relationship in health seeking behaviours between homoeopathic and allopathic care modalities. Recommendations The relationship between the variables illustrated in the study’s proposed adapted model need to be further tested using quantitative research methods. Trust in healthcare, and in particular with homoeopathy, is a subject which merits further exploration. / M

This dissertation presents an ethnographic account of a socially diverse, public breast cancer clinic in Johannesburg. The findings of this qualitative research radically challenge the unproblematised and overdetermined use of the categories of race and gender in existing literature concerning this disease. The growing breast cancer epidemic in South Africa affects all demographic categories of women including young women. Yet, previous research frames this as a racialised and gendered crisis. Black women have been depicted as ignorant “problem patients” who resist biomedical treatment, and all women are described as having a particular relationship to their breasted bodies and a deep fear of mastectomy. Departing from these stereotypes, this ethnography reveals unanticipated data showing, firstly, that race, class, age and level of education did not determine women’s relationship to breast cancer and biomedicine. Secondly, socially diverse women commonly experienced breast cancer as a life-threatening disease that evoked confrontation with existential concerns regarding suffering, death, family, and faith. Due to these commonalities, an intimate and powerful sociality existed amongst women at this clinic. Thirdly, within this sociality, women accepted mastectomy as a necessity in creating a healthy body. Breastlessness was normalised and women generally were reluctant of breast reconstruction, thus destabilising the conceptual relationship between breasts and gender. This dissertation’s deconstruction of the use of hegemonic social categories is a significant intervention in a context where these categories are often viewed as absolute determinants of social and health phenomena, and therefore prompts more nuanced approaches to understanding experiences of illness in post-apartheid South Africa.

Thesis (M. A. (Clinical Psychology)) --University of the North, 2002 / The aim of this study was to ascertain base-line information on knowledge, beliefs and feelings about tuberculosis among hospitalized tuberculosis patients. The study was conducted at Dr Machupe Mphahlele Memorial Hospital in the Limpopo Province of South Africa. A sample of 40 tubercuJos is patients, 21 males (52,55%) and 19 women (47,5%), was interviewed. h ·om the sample of 40, 22 patients (55%) too k part in the focus group discussions. Fourteen members of the community, who are relatives of those patients who tookpart in thestud, y were also included in the focus group discussions. The focus group discussions were aimed at better understanding of both the community and the patients' beliefs and perceptions of tuberculosis. The study revealed that the participants studied had a reasonably go od knowledge of tuberculosis. However, there was some confusio n regarding causative and risk factors of tuberculosis and some misconceptions thereof. The study has also found that traditional beliefs tend to impact on the patient's health seeking behaviour, treatment and the overall understanding of the disease.Tuberculosis treatment is still perceived by the majo rity of participants to being long, agonizing and cumbersome and there are still so me doubts as to whether tuberculosis is curable. Participants believed that tuberculosis carries social stigma and thus patients feel isolated in their communities. The results also suggested that education does play a role in the perception of the disease. Participants who had tertiary and secondary education were found to be more knowledgeable on symptoms and health beliefs of tuberculosis than those participants who had primary education, and those who did not have education at all. Factors such as age and gender did not appear to have any influence on the knowledge and feelings of patients on tuberculosis. Therefore, based on the findings, culturally sensitive health education and consideration of the patients' educational level are important variables when dealing with tuberculosis patients.

Thesis (M.A. (Clinical psychology) --University of Limpopo, 2009. / The study aimed at assessing and understanding the unmet needs and well-being among people living with HIV/AIDS. People living with HIVAIDS experience many challenges. Challenges may be characterized by medical, social and psychological challenges. Method: A cross sectional design was used. A total of (N = 200) young and adult age ranged from 20-71 years ( = 43.70, SD = 12.420) women (62%) and 75 men (37, 5%) living with HIV/AIDS who attend HIV/AIDS clinic/unit in Polokwane/Mankweng hospital complex was selected with purposive sample. Results: Four hypotheses were tested with one-way ANOVA. The findings indicated that social support (p < .001) and age (p < .04) plays a significant role in the psychological well-being of people living with HIV/AIDS. Medical challenges and gender revealed no significant results. Conclusion: It is concluded that PLWHA attend some form of support groups which will aid in alleviating the psychological distress associated with HIV/AIDS.

Thesis (MA (Clinical Psychology)) --University of Limpopo, 2009 / The aims of the study was to investigate if people living with HIV/AIDS (PLWHA) have access to health care, to determine utilisation patterns and to investigate how gender differences, socioeconomic, geographic location, and cultural beliefs influence access to and the utilisation of health care among PLWHA. Methods: This was a quantitative study based on a cross-sectional design. The study comprised of 200 participants (45% males and 55% females), of which 71% were unemployed. Twenty-eight (28%) survive by the disability grant due to the illness as well as child support grants. Sixty eight (68%) were diagnosed with HIV/AIDS for the duration of 3-5 years. Descriptives, frequencies and ANOVA were employed to analyse data. Results: Participants were found to have access to and to utilise health care services. There was no gender differences found with regard to access to and utilisation of health care, but there was however a significant (p<.05) difference in gender and educational level interaction. Educational level and geographical location were found not to influence the actual access and utilisation rather, it determined the type of health care service utilised. Participants with higher educational levels, and those who reside in urban areas were significantly (p<.05) found to utilise private health care services than primary health care. Cultural beliefs were found not to influence access to and utilise of health care services. Conclusion: Barriers outlined for non-use of primary health care services need immediate attention in order to maximise access to and utilisation of primary health care services by PLWHA.

Thesis (M.A. (Clinical Psychology)) --University of Limpopo, 2008 / The aim of this study was to investigate the psychological difficulties encountered and ways of coping by HIV/AIDS orphans in Limpopo Province. The sample was comprised of 70 children whose parent(s) died of HIV/AIDS related diseases between the ages 05 and 18 years. The data were collected through the use of face to face interview and questionnaires. The study results show that as a results of trauma resulting from taking care and witnessing ill parent(s) die, HIV/AIDS orphans suffer from sadness, helplessness, anger, guilty, aggression and frustration that often lead to withdrawal and subsequent depression, In quantitative study Beck Depression Inventory was also used to determine the levels of depression (mild, moderate, and/or severe levels) and it was discovered that HIV/AIDS orphans experience moderate to severe depression. The study further looked on whether demographic factors including (age, gender, religion, home language, number of siblings, and level of education) have an impact on the experience of depression. Qualitative study findings also discovered that HIV/AIDS orphans do not experience the relationship with their caregivers as being supportive. Furthermore, mixing with non-orphaned peers was reported to be a mission and emotionally distressing. Qualitative study also discovered that HIV/AIDS orphans lack many adults whom they can trust and who they could be able to express their feelings, as result they try to find their own ways of coping with their circumstances. However, quantitative study also looked at three ways of coping (cognitive, behavioural and avoidance ways of coping) that could be used by HIV/AIDS orphans. This was achieved through the use of ways of coping scales. The findings of this study discovered that HIV/IADS orphans use cognitive and avoidance ways of coping more than behavioural ways of coping. Furthermore, the study looked at whether there is a relationship between ways of coping and biographic factors (age, gender, religion, home language, number of siblings, and level of education). It was discovered that HIV/AIDS orphans are psychologically distressed and need to be transferred for psychological therapy after the loss of their parents.

Ischaemic heart disease (IHD), which is a Chronic Disease of Lifestyle, has been rated as one of the key illnesses that have progressively materialised as a threat across the wide demographic spectrum of South Africa’s population. Internationally, literature is relatively scarce on the psychosocial consequences of the disease for the ill person, but limited information does exist on these consequences as they affect South African individuals and their families. This study sought firstly to understand the experience of persons with IHD, their partners and medical practitioners and secondly how they coped with the illness. Participants were selected with the assistance of cardiologists at a private hospital in KwaZulu-Natal. Theoretical sampling determined the number of persons who participated in the study. Data was collected using in-depth interviews in accordance with the qualitative descriptive design and narrative inquiry that underpinned the research. Participants (13) were determined once data-saturation was reached. The data revealed that spousal support and religion/spirituality played important roles in helping people manage the illness. Genetics and lifestyle choices contributed to participants’ IHD. Not recognising their symptoms, owing to misinformation by the medical fraternity, contributed to participants not realising they were having a heart attack. Religious/spiritual coping mechanisms were among those mentioned by participants, and depression (not clinically assessed), anxiety and sadness were noted among the consequences for them. Two of the cardiologists did not acknowledge depression; nevertheless research studies have linked depression with major cardiac attacks and to surgery following cardiac problems. The data points to the lack of communication between participants and their health practitioners and the belief held by participants that the medical personnel were not particularly interested in their psychosocial wellbeing. This seems to be borne out by the limited data obtained from health practitioners. Social workers can play important roles in the health team by ensuring that the psychosocial needs of persons experiencing IHD and their families are attended to. Social workers can publish in health journals to make the medical fraternity aware of the contribution that social workers skills can make to persons who are ill. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Objective: The majority of information available on chiropractic patients originates from private practices in developed countries. However, recently reports describing chiropractic patients in South Africa have emerged, reporting on private practices and teaching clinics. Therefore, the overall purpose of this study was to determine the characteristics of patients presenting to a public chiropractic facility at the Kimberley Hospital Complex (KHC) in South Africa; and compare to the local and international private practices and teaching clinics. Methods: The period prevalence was three months in which information was extrapolated from patient files of the patients that presented to the KHC Chiropractic Clinic (KHCCC). Information that was collected included demographic data, common presenting complaints, patient history and common management protocols. Results: Data for 157 patients were recorded. The mean age of patients was 47.5 years, majority of the patients were female (70%), comprised of coloured and black patients (85%), where the greater part had a primary education level. Less than half the patients were employed in manual type of occupation, whilst almost one quarter of the patients were pensioners. By far, the greatest reason that patients visited chiropractors within the public health care sector at the KHCCC in South Africa was for chronic musculoskeletal complaints (68%). Majority presented with spinal complaints of the lower back (n=144), the most common diagnosis made was sacroiliac syndrome (48%). X-rays were the most common special investigation requested by KHCCC. The most common co-morbidities reported were hypertension, followed by diabetes and allergies. More than half the sample had undergone previous surgery. Thirty seven percent of patients received treatment for fewer than six visits. Contraindications to chiropractic treatment were indicated in only three patients. The treatment protocols that were predominantly used at the KHCCC were joint manipulation, followed by dry needling, kinesiotape and soft tissue therapy. Two thirds of all patients that were referred to the KHCCC were referred from within the medical profession. With regards to the chiropractic patients globally, similarities respect to patients in the public sector in South Africa to all sectors both locally and internationally, include factors such as majority female patients, top five anatomical locations of complaint, common usage of x-rays as a special investigation, similarities with co-morbidities including cardiovascular and endocrine, the repeated number of visits for the same complaint and manipulation remained treatment of choice. Conclusion: Although this was purely a demographic and descriptive study in nature, it gave a better understanding of patients that presented to a public hospital in a developing country like South Africa. With this demographic and descriptive information obtained in this study, it confirmed that although there is a unique population utilising chiropractic services within the public sector of South Africa, meaningful similarities have been found between patients in the different sectors in South Africa and internationally.

In severely ill hospitalised patients with diabetes mellitus (type 1 and type 2) there is an increase in metabolic rate. Insulin requirements are increased and glycaemic control becomes more difficult to achieve. The insulin sliding-scale is a form of „top up‟ therapy used to supplement the patients existing hypoglycaemic medication. In 2002, research at Livingstone Hospital found that 14 different sliding scales were used in 38 patients (Du Plessis, 2002: 79). In 2006 the nurses and doctors working in the general medical wards at Livingstone Hospital indicated that they were willing to use a standardised insulin sliding scale protocol (Smith, 2006: 56). Thus the aim of this study was to assess whether a standardised insulin protocol can be effectively implemented. The objectives of the study were to: 1) assess insulin usage via insulin sliding scales prior to the implementation of the standardised insulin protocol; 2) implement the standardised insulin protocol; and 3) reassess insulin usage after the implementation of the standardised insulin protocol. As the study involved evaluating the use of insulin via the insulin sliding scale and the implemented insulin protocol, it occurred in four phases. The preliminary phase entailed obtaining ethical approval. The pre-intervention phase included data collection in the form of a nursing questionnaire and the auditing of patient medical records using a data collection tool. The intervention phase involved education sessions on the new insulin protocol for the nursing staff, and the implementation of a standardised insulin protocol, while the post-intervention phase comprised of post-intervention data collection, which included a nursing questionnaire, a prescribers questionnaire and the auditing of patient medical records using a data collection tool. The overall impression obtained from the comparison between the pre- and post-intervention nursing questionnaire was conflicting; in some aspects the educational intervention was successful in others not. Regardless the indication obtained was that the nursing staff require more in-service training on a more regular basis as a lack of knowledge regarding diabetes mellitus as a disease state may negatively affect patient outcomes. The overall response from the nursing staff towards the insulin protocol was positive. The prescribers‟ response to the insulin protocol was conflicted. The number of correct insulin sliding scale doses administered in the pre-intervention and post intervention phase improved by 5.25 percent. The number of incorrect insulin sliding scale doses administered during the pre- and post -intervention phase decreased by 5.25 percent. These results are positive and may be due to fewer sliding scales being prescribed in the post-intervention phase and the implemented insulin protocol. Only three (5.55%; n=54) inpatients with Type 1 diabetes mellitus were placed on the implemented protocol that is, the basal bolus regime, and rarely were dose adjustments to their insulin made rendering the effectives of the protocol undesirable. Only four (7.40%; n=54) inpatients with Type 2 diabetes mellitus were placed on the implemented protocol that is, an intermediate- to long-acting insulin (Protophane®). However all four patients experienced immediate improvements in their fasting blood glucose levels. These results indicated that by adding an intermediate- to long-acting insulin (Protophane®) to the therapy of a patient with Type 2 diabetes mellitus fasting blood glucose levels decrease. This would improve patient outcomes and decrease the risk of related diabetic complications. These limited results may indicate a clinical inertia on the part of the prescribers. Unfortunately overall the educational intervention was not successful and the implementation of the protocol was not successful and did not yield the desired results.