This research focuses on the art of clowning as a tool and method of psychosocial support in situations of crisis. As this topic is notably under-addressed in scholarly research, this research aims to deepen knowledge on humanitarian clowns in the contemporary humanitarian world. By analyzing the humanitarian clown from the perspective of members of the organization ‘Clowns Without Borders’ (CWB), this research asks: What is the position, practice and function of humanitarian clowns in the humanitarian world? Besides a wider pool of data based on relevant literature, the empirical material for the analysis was collected by conducting a total of five semi-structured in-depth interviews with the representatives of the Clowns Without Borders, as well as artists working within it. In addition, secondary data has primarily been gathered from the CWB USA blog. Analysis of this data demonstrated that clowning in humanitarian settings can serve several functions. The results indicate that the humanitarian clown is a complex being and that clowns perceive their position in humanitarian world as defined by the unique human connection they establish with the people they work for. They among others can have the effect to bring about joy, happiness, self-reflection, physiological and psychosocial relief, hope, trust and community and can be perceived as an undervalued method of promoting psychosocial wellbeing in settings of humanitarian crisis.

The rationale of any national screening programme is to recognize the benefits for public health, to test a predominantly healthy population including low risk pregnant women, and to detect risk factors for morbidity in order to provide timely care interventions. The South African health care system faces many challenges that undoubtedly impact on maternal health, resulting in poor quality of care and indirectly causing maternal deaths. The government has embarked on a number of initiatives that address women’s psychosocial wellbeing during pregnancy, for example free maternity care, legalizing abortion, expanding on provider-initiated HIV counseling and testing for antenatal patients. These initiatives imply a re-look at antenatal care screening, in order to identify wider determinants of health that may have an impact on a woman’s psychosocial wellbeing. This includes amongst others, poor socio-economic conditions such as poverty, lack of social support, general health inequalities, domestic violence and a history of either personal or familial mental illness, all of which have the capacity to influence a pregnant woman’s decision to utilize health care services. The intention of this study was therefore to establish the extent of psychosocial risk assessment for pregnant women during antenatal care, with a focus on the psychosocial support.Ethical clearance was obtained from the University of the Witwatersrand Human Research Ethics Committee (Protocol no. M081013). A mixed-method approach was applied through combining quantitative and qualitative research techniques, methods and approaches to address psychosocial risk assessment and psychosocial support by midwives during antenatal care. An explanatory sequential design was used. The methodology was aimed at accommodating the diverse population involved in the study, the nature of data being sought and the number of investigations conducted. A fully mixed research approach was implemented interactively through all the stages of the study. The study took place in six phases to meet the purpose of this research. Phase 1 entailed quantitative data collection and analysis; phase 2 qualitative data collection and analysis; phase 3 report writing; phase 4 formulation of guidelines; phase 5 pilot test; phase 6 integration of results and findings, and writing of final report. The philosophical basis of the study is based on the researcher’s values and belief of holism and comprehensive assessment. Much as values are part of the study, the researcher strove to keep values as separate from the research as possible, to minimise researcher bias. The feminist standpoint theory provided the guiding epistemological framework to address the qualitative research questions for this study as the issues regarding reproduction are of central feminist concern. Pragmatism, which is considered a best philosophical basis for mixed-methods as it values both objective and subjective knowledge, was applied in this study. The methodological goal of the study was guided by two paradigms, “constructivist”, which is the basis of qualitative research and “contemporary empiricist” paradigms, which is the basis of empirical analytic research as the study used a mixed-method approach. Although the empiricist lens is the most appropriate for a sequential explanatory design, both paradigms are acknowledged in this study. A quantitative-qualitative data collection and analysis sequence was followed. The sequential explanatory approach was maintained through, for example, collecting and analyzing quantitative data first, followed by obtaining information from midwives through a questionnaire and focus group discussions, and from pregnant women through a questionnaire and focus group discussions, using the same populations. Non-probability purposive sampling was done for all data sources. All data were collected by the researcher.Qualitative data analysis consisted of the identification of themes and relationships through constant comparison of data, which enabled the researcher to establish group and across-group saturation in focus group discussions. Quantitative data was collected through the review of midwifery education regulations, documents and records. Midwives’ questionnaires with a response rate of 46%, questionnaires administered to pregnant women and the review of antenatal cards with a 94% response rate. The data sets provided multiple data sources, a characteristic of the mixed methods approach. Data were analyzed using the Stata Release 10 statistical software package. Data analysis included summary statistics i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables, and Chronbach’s alpha for internal consistency. Confidence intervals of 95% were used to report on discrete variables. Quantitative and qualitative data were initially analyzed separately to develop an understanding of the two data bases before merging the findings and results. The process provided separate and independent results that could be compared for the purposes of corroboration, complementarity and discussion. The results were compared for specific content areas, for example major themes. A tool for psychosocial risk assessment and care was developed in response to the findings from the midwives’ focus group discussions at the three clinics, the expert interviews findings, the cross-sectional survey results from midwives, the self-administered questionnaires for pregnant women, and review of the antenatal cards carried by women during antenatal care. The tool was piloted in the three clinics where data were initially obtained. The general results of the study suggest that depressive and anxiety disorders are common in pregnancy and may be associated with negative experiences during antenatal care. Adequate screening of women and recognition of emotional responses with appropriate interventions are essential to promote a woman’s healthy adjustment to pregnancy. Attempts to minimise high levels of uncertainty, anxiety and depression should be incorporated within routine antenatal care.Midwives should strive to empower women physically and psychosocially in order for women to be able to overcome any barriers to safe motherhood, with emphasis on providing information, in order for them to make informed choices.The findings from the pilot study confirmed that pregnant women experience psychosocial problems which can be identified by the use of a screening tool, howeverthere remains a need to test the tool on a larger sample which might elicit more factors that could hinder or help its implementation. The implication of the findings appears to be that midwives are willing to incorporate the psychosocial assessment tool into routine antenatal care. The findings might be used to advocate for the incorporation of the tool into routine antenatal care. While the use of this antenatal psychosocial pilot tool may increase the midwives’ awareness of psychosocial risks and form a basis for further studies, a bigger sample size and statistical power are required to provide evidence that routine antenatal psychosocial assessment would also lead to improved outcomes for mother and/or child. The final stage of the study, based on research findings, led to the development of guidelines and recommendations for psychosocial care at the midwifery regulation level, midwifery education, clinical practice level and research. Key concepts: Antenatal care; Midwife; Psychosocial risk assessment; Psychosocial support.

This paper seeks to review the national disaster plans of Jamaica from the perspective of child protection and wellbeing in emergencies. The focus of the review is on needs associated with education, psychosocial support and family reunification (including care of unaccompanied and separated children) as these needs are often given less priority in an emergency. These are referred to collectively as the non-material needs of children in emergencies. Providing for the non-material needs of children in emergencies is an important part of preventing children from experiencing physical or sexual abuse, psychological distress, neglect and harm and it is therefore vital that these are not an afterthought but an integral part of planning for an emergency. In order to review these plans a tool in the form of a checklist of measures of international standards was compiled and applied to the plans. This paper finds that the national disaster plans of Jamaica fail to meet every measure on the compiled checklist. Children are not even mentioned as a vulnerable group in need of special attention nor are measures defined to prevent them from long-term or short term harm. The limited or non-existent extent to which children are considered is furthermore found to be an issue in national disaster planning of other states. This paper therefore recommends that the national disaster plans of Jamaica, as well as other states, be revised in partnership with local stakeholders (including children, the ultimate stakeholders) taking into consideration the findings presented.

The following article is a study about counsellors working with terminally ill patients receiving Palliative care. In an effort to understand their role in the Palliative team and how they participate in the care of dying individuals, four counsellors working in four different Palliative hospices in Stockholm were interviewed by using structured interviews. The key questions concern the methods and interventions counsellors use, the risk factors that the job entails, the support they receive and finally their reflections about life and death The literature on the topic was accessed via Ersta Sköndal Högskola College library and Internet database. The results of the study reveal that Palliative Care Approach takes into consideration all aspects of an individual (physical, psychological, social and spiritual). Counsellors are part of a multidisciplinary team and their role is to focus on the social and psychological aspects. They undertake comprehensive assessments of the patient’s context and their coping strategies through the use of psychosocial theories such as Sense of Coherence and Logo therapy. Via their skilled use of core counselling skills they establish close relationships with patients and families. At the same time they are always mindful of keeping the right distance. Counsellors are the receivers of a lot of emotional pain and suffering of patients and families and as such this transference can lead to emotional exhaustion. Access to good support is an essential prerequisite for avoiding burnout. Close encounters with death leads to reflections of life and death. Counsellors need to be well developed and experienced in order to provide good quality palliative care.

Bakgrund: Av alla diagnostiserade graviditeter avslutas tio till femton procent spontant i missfall. Kvinnans reaktion vid missfall kan till stor del bero på om kvinnan blivit planerat gravid eller var ovetandes om graviditeten. Sjuksköterskor har en betydande roll för att tillhandahålla god omvårdnad till kvinnor som genomgått missfall, vilket innebär en utmaning med begränsade resurser. Syfte: Litteraturöversiktens syfte var att beskriva kvinnors upplevelser av att genomgå missfall. Metod: En litteraturöversikt baserad på 16 vetenskapliga artiklar med kvalitativ och kvantitativ ansats, som samlades in från databaserna CINAHL, PubMed, PsycINFO och Web of Science. Artiklarna har kvalitetsgranskats, systematiskt analyserats och sammanställts i resultatet. Resultat: Analysen resulterade i följande fem huvudkategorier; från förväntansfull graviditet till traumatiskt missfall, behov av omvårdnad, psykisk och emotionell påverkan, behov av stöd från hälso- och sjukvården och anhöriga samt kvarstående psykisk påverkan efter missfall. Slutsats: Varje kvinna har en unik upplevelse av att genomgå missfall. Den individuella upplevelsen baseras på diverse faktorer och kan i sin tur generera i emotionella reaktioner. Trots en tillfredsställelse av den kroppsliga vården vid missfall finns avsaknad av vård, stöd och uppföljning för konfrontering av de emotionella reaktionerna samt det psykiska måendet. För att ge kvinnor en personcentrerad, säker vård krävs att vidare forskning utförs där kvinnors specifika behov identifieras. / Background: Among ten to fifteen percent of all diagnosed pregnancies ends in a spontaneous miscarriage. Women’s reaction in case of miscarriage can due to the fact that the pregnancy was planned or if the woman was unaware of the pregnancy. Nurses have a significant role to play in providning good care for women who have undergone miscarriage, which means a challenge with limited resources. Purpose: The purpose of the literature review was to describe women’s experience of going through a miscarriage. Methods: A literature review based on 16 scientific articles with qualitative and quantitative approach, collected through the databases CINAHL, PubMed, PsycINFO and Web of Science. The articles have been quality examined, systematically analyzed and compiled in the result. Results: The analysis resulted in five main categories; from expectant pregnancy to traumatic miscarriage, need for nursing, mental and emotional impact, the need for support from the health care system and relatives as well as residual mental effects after miscarriage. Conclusion: Every woman has a unique experience of going through miscarriage. The individual experience is based on various factors and can in turn generate in emotional reactions. Despite the satisfaction of the physical treatment of miscarriage, there is an absence of care, support and follow-up for the confrontation of the emotional reactions and the mental health. To give women a person-centered, safe health care requires that further research is carried out in which women’s specific needs are identified.

Master of Public Health - MPH / Background: HIV has reached epidemic proportions globally with Sub-Saharan Africa carrying the greatest burden (71%). It is estimated that there are 37 million people world-wide infected with HIV, and an estimated 6.8 million live in South Africa. Globally there were 2.1 million adolescents living with HIV in 2014. Improved access to Antiretrotiviral Therapy (ART) has led to a steep decline in HIV incidence and HIV-related mortality. Yet despite these successes in terms of HIV treatment outcomes, HIV-related mortality amongst adolescents has increased. Adolescents are defined by the WHO as individuals between 10 and 19 years old. WHO states that adolescents have poorer access to ART, are at a higher risk of disengaging from care and have special needs to keep them motivated to remain in care. The uptake of adolescents into the South African ART programme is low and those that are enrolled into the programme have poorer adherence than their adult counterparts. Aim: The aim of the study was to explore the factors that influence adherence to ART amongst adolescents in a primary health care clinic in a low socio-economic, urban setting in Cape Town. Methodology: An exploratory qualitative design was employed where data was collected through two key informant interviews with staff from an urban primary health care clinic. Four focus group discussions and eight individual in-depth interviews were held with adolescents and young people who accessed ART at this health facility. Audio data was digitally recorded and transcribed verbatim. Data was analyzed using content analysis. Results: The study identified school commitments, strained teacher-pupil relationships, negative household dynamics and ill-treatment by non-biological caregivers as major reported barriers to adherence. In addition, poor service delivery, missing and misplaced files and long waiting times came under major criticism. Fear of intended or unintended disclosure of HIV status, perceived stigma and discrimination, treatment fatigue and having unstructured lives, profoundly influenced ART adherence. Finally, having a strong support system, disclosing to a trustworthy person and having goals and ambitions served as motivators to remain adherent to ART. Conclusions: This study highlighted the complexity of ART adherence amongst this age group due to school factors, social factors, health services factors, therapy related factors and patient factors. Interventions to improve adherence should aim to address treatment fatigue, disclosure, household dynamics, service delivery factors, as well as the impact of school commitments and symptoms of depression on ART adherence amongst adolescents.

Thesis advisor: Theresa Betancourt / Families in low- and middle-income countries (LMICs) face significant mental health and psychosocial care gaps. In recent years, researchers and practitioners have addressed these gaps by task-sharing evidence-based mental health and psychosocial support (MHPSS) interventions to nonspecialist community providers. Task-shared interventions have demonstrated effectiveness (improvements in MHPSS outcomes of intervention participants); however, quality of delivery (fidelity and competence) has rarely been examined as a factor associated with effectiveness despite implementation science models suggesting a causal link between quality of delivery and effectiveness. In this study, I apply a mixed methods approach to examine the quality of delivery by nonspecialists who are facilitating an evidence-based, early childhood development and family violence prevention program, known as Sugira Muryango, in Rwanda. Currently, Sugira Muryango is being expanded and implemented through the Promoting Lasting Anthropometric Change and Young Children’s Development (PLAY) Collaborative, which scales up Sugira Muryango to 10,000 households living in extreme poverty in Ngoma, Nyanza, and Rubavu districts. The program has strong ties to the Rwanda National Government and their social protection and policy goals. I find that nonspecialist age is significantly associated with higher initial fidelity and competence scores and smaller improvements in fidelity and competence over time. In addition, nonspecialists in Nyanza district were more likely to have higher initial fidelity and competence scores but also see smaller changes over time. Fidelity and competence were found to significantly co-vary. Multi-level growth models revealed that fidelity was not a significant predictor of changes in any child discipline outcomes or of any responsive caregiving outcomes. However, competence significantly predicted changes in some responsive caregiving practices, specifically acceptance and learning materials, and it predicted decreases in physical punishment. In semi-structured interviews, the nonspecialists provided examples of using skills such as rapport-building, empathy, and active listening to deliver Sugira Muryango effectively. Nonspecialists also provided examples of barriers to quality of delivery, including compensation and technology issues. Overall, this dissertation contributes empirical evidence to what we understand theoretically and moves towards development of best practices for monitoring and supervising nonspecialists in task-shared MHPSS interventions. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

There is growing interest in applying information and communication technology (ICT) in healthcare. The attention to ICT stems from several factors: costs of healthcare, high prevalence of somatic diseases, longer life expectancy and technological advancements. The quest to meet the growing healthcare needs has led authorities to allocate resources to develop technological solutions. Although this research investment is helpful for the information technology sector, these projects face challenges in working with multidisciplinary teams, recruiting participants and moving research to practice. This dissertation investigates the potential of ICT use in psychosocial support communication designed for people with emotional distress associated with a somatic disease (PEDASDs). The research aims to deliver design principles (DPs) for these ICTs, for three stakeholder groups: nurses, therapists and PEDASDs. The DPs focus on communication between these stakeholder groups and not on the overall ICT design. An interpretative approach was adopted to investigate the stakeholders’ unique ICT requirements. This method allows insights into the stakeholder’s world. Three studies, using semi-structured interviews, at oncology facilities in two healthcare system models (Trinidad & Tobago and Sweden), provide the empirical data. The stakeholders revealed not only their communication support needs but also other issues including the practical distresses of living with a chronic disease, limited support, lack of information, unwillingness to associate with other PEDASDs, professionalism between healthcare providers and disconnected healthcare services. Common ground, bridges and weak ties provide the theoretical framework to explore the findings. Eight DPs emerged from the studies: the healthcare system model, need to educate the stakeholders, ICT customisation, support of stakeholders’ information needs, allow access to external resources, support multidisciplinary team communication, support for self-care and support for significant others. The findings could potentially serve as a guide for ICT projects that develop artefacts for psychosocial support and provide a theoretically grounded understanding of stakeholder communication and relationships. The potential for future work includes investigating the issues of legislation and ethics, studying the needs of significant others, exploring the potential for ICTs in other healthcare system models (particularly the out-of-pocket health system) and examining the impact of social media on psychosocial support. / Det finns ett växande intresse att använda informations- och kommunikationsteknologi (IKT) inom hälso- och sjukvården. Intresset för IKT påverkas av flera faktorer: sjukvårdens kostnader, prevalensen av somatiska sjukdomar, ökad medellivslängd och teknologiska framsteg. Utmaningen att hantera de växande sjukvårdsbehoven har lett till att statliga myndigheter har allokerat resurser för att utveckla teknologiska lösningar. Trots att forskningsinvesteringarna gynnar informationsteknologisektorn i stort möter de konkreta forskningsprojekten utmaningar såsom arbete inom tvärvetenskapliga grupper, rekrytering av deltagare till studier samt implementering. Denna avhandling undersöker möjligheten att använda IKT för kommunikation av psykosocialt stöd eller vård (care). Detta stöd är utformat för personer med emotionella problem relaterade till en somatisk sjukdom (PEDASD). Forskningen syftar till att leverera designprinciper (DP) för tre intressegrupper som använder IKT: sjuksköterskor, terapeuter och PEDASD. Designprinciperna fokuserar på kommunikation mellan de tre intressegrupperna och inte på den övergripande IKT-designen. Ett tolkande tillvägagångssätt har använts för att undersöka intressegruppernas unika IKT-krav och önskemål. Denna metod gör det möjligt att studera intressegruppernas upplevelser. Tre undersökningar, som baseras på semistrukturerade intervjuer, har genomförts vid avdelningar för onkologisk vård inom två sjukvårdssystemmodeller i Trinidad & Tobago respektive Sverige. Studiens empiriska data utgörs av intervjuerna. Data har sedan analyserats utifrån det teoretiska ramverket: Common ground, bridges och weak ties. I sina svar nämnde intressegrupperna inte enbart deras behov av kommunikationsstöd, utan också annat som till exempel praktiska problem att leva med en kronisk sjukdom, begränsat stöd, brist på information, ovillighet att förknippas med andra PEDASD, de professionella relationerna mellan sjukvårdens olika yrkesgrupper samt avsaknaden av koordination inom sjukvården. Analysen resulterade i åtta designprinciper: sjukvårdssystemmodellen, behovet av att utbilda intressegrupperna, IKT-anpassning, stöd för intressegruppernas informationsbehov, tillgång till externa resurser, stöd för kommunikation inom tvärvetenskapliga forskargrupper, stöd för självhjälp och stöd till närstående. Resultaten har potential att fungera som en guide för IKT-forskningsprojekt som utvecklar artefakter för psykosocialt stöd och som presenterar en teoretiskt grundad förståelse av intressegruppers kommunikation och relationer. Resultaten pekar också på behovet av framtida forskning om lagstiftning och etik, nära anhörigas behov, potentialen för IKT inom andra sjukvårdssystemmodeller (i synnerhet system där patienter betalar mer själva) samt sociala mediers inverkan på psykosocialt stöd.

Published Article / A growing scholarship links good leadership with in-house mentoring. This article looks at how well-performing school leaders benefitted from the inhouse mentoring they received. The author reports on a qualitative investigation based on in-depth individual interviews with six primary school leaders from Gauteng, KwaZulu-Natal, Limpopo and Northwest Provence who were purposefully selected based on their receiving a national award for excellence in leadership. These awards were made by the Department of Basic Education in the category 'Excellence in primary school leadership'. The findings show that in-house mentoring benefitted participants holistically through behavioural, knowledge and skills acquisition. Behavioural acquisition included being humble and empathetic towards constructive work performance. Knowledge and skills acquisition related to sustaining the standard of teaching of core subjects, relying on committee input in a relational leadership approach and ensuring a dedicated teacher corps and positive parent involvement. The findings contribute to the discourse on inhouse mentoring for improved school leadership practice.

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