Asthma is not a disease with a single etiology but a very complex syndrome. Irrespective of a better understanding of the pathophysiology of asthma and its related therapeutic regimens the disease still escalates in prevalence and severity. Characteristic features of chronicity and remission ensures a fertile ground for non-compliance by patients. This quantitative, descriptive study set out to determine the asthma knowledge, asthma control and quality of life of adult asthmatics who attended the respiratory outpatient clinic at Tygerberg Hospital. The purpose was to determine an association between asthma knowledge, asthma control and asthma quality of life. A statistically significant association was found between asthma control and asthma quality of life, not with knowledge of asthma for either of the concepts. Important gaps in knowledge were identified namely an inability to recognise nocturnal coughing as a risk factor. The increased role of nurse practitioners in asthma care is highly recommended. / Health Studies / M.A. (Health Studies)

Thesis (MOccTher)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Participation in meaningful occupations is what defines us as human beings and is an important indicator of health and well-being. It is the way we experience the world around us and is closely linked to quality of life. As an occupational therapist at a school for learners with special educational needs, the researcher was interested in how young adults with a diagnosis of Cerebral Palsy (CP) who attended this school, experience their participation or the lack thereof in occupations and if it contributes to meaning and fulfilment in their lives? She established through informal conversation with some of these young adults or their parents, that they experience unemployment, unhappiness and poor integration within the community. The aim of this study was therefore to describe how young adults living with CP in economically disadvantaged communities within the Western Cape, experience the quality of their participation in meaningful occupations. A qualitative phenomenological study design was used, enabling the researcher to explore the value and meaning participants attach to different occupations, the participants perceptions of their experience and the factors impacting on their participation. The study population was young adults between the ages of 18-28 years with a diagnosis of CP, who attended the previously mentioned school and who exited school over the duration of the past nine years. The researcher used purposive maximum variation sampling, to ensure variation in terms of diagnosis, living arrangements, employment and marital status. Data collection took the form of ten face-to-face semi-structured individual interviews and inductive content analysis was utilized to analyse data. The following four themes emerged from the data: overcoming challenges; having equal opportunities; barriers holding me back and the future is mine to shape. These young adults participated in a variety of meaningful occupations and have learned to utilize various strategies to overcome the difficulties they faced in this process. The following factors influenced their participation positively: having meaningful relationships; accepting their disability and nurturing a positive attitude; being proud of their achievements; positive work experiences and involvement in the community. Factors contributing to these young adults not experiencing meaningful participation were the following: their perception of themselves and also how they perceived being treated by others; non-acceptance of their physical circumstances and disability; incompetence and poor self-confidence; termination of previously meaningful occupations; challenges with interpersonal relationships and unsatisfactory work experiences. The need to be as independent as possible was of utmost importance to all these young adults, as it was an indicator of being in control of their own lives. Given the above information, the researcher recommends a transition preparation program for senior phase learners that will include sessions on work habits, social skills, transportation, self-employment and integration into the community to be implemented at the school. Supported employment options should be explored as well to ensure maximum employment among these learners exiting school. A follow-up system should be established to evaluate the effectiveness of the above-mentioned program. / AFRIKAANSE OPSOMMING: Deelname in betekenisvolle aktiwiteite is uniek aan die mens en is ook ‘n belangrike aanduiding van gesondheid en welstand. Ons ervaar die wêreld rondom ons deur betekenisvolle deelname, was nou verbind word kwaliteit van lewe. Tydens haar werk as ‘n arbeidsterpeut by ‘n skool vir leerders met spesiale onderrig behoeftes, het die navorser begin belangstel in hoe jongmense met ‘n diagnose van serebraalgestremdheid (wat oudleerders is) hulle deelname aan aktiwiteite of die gebrek daaraan ervaar en of dit bydra tot betekenisvolheid en vervulling in hulle lewens. Sy het deur informele gesprekke met van hierdie jongmense of hul ouers vasgestel dat hulle ervaring ongelukkig, werkloos and swak geïntegreed in hulle gemeenskap is. Die doel van hierdie studie was dus om te beskryf hoe jongmense met ‘n diagnose van serebraalgestremdheid wat in ekonomies benadeelde gemeenskappe binne the Weskaapse Provinsie woon, die kwaliteit van hul deelname aan betekenisvolle aktiwiteite ervaar. Die navorser het ‘n kwalitatiewe fenomenologiese studie ontwerp gebruik sodat sy die volgende aspekte kon verken: die waarde en betekenis wat die studie deelnemers aan spesifieke aktiwiteite heg; hulle persepsie van hulle ervaringe, asook die faktore wat deelname beïnvloed. Die studiepopulasie was jongmense tussen die ouderdomme van 18-28 jaar oud met ‘n diagnose van serebraalgestremdheid, wat die bogenoemde skool bygewoon en verlaat het in die afgelope nege jaar. Die navorser het ‘n doelgerigte maksimum variasie steekproef gebruik, om sodoende variasie in terme van diagnose, verblyf, werk en getroude status te verseker. Data was ingesamel deur middel van tien semi-gestruktureerde individuele onderhoude. Induktiewe inhoud-analise was gebruik om die data te ontleed en die volgende vier temas het na vore gekom naamlik: om uitdagings te oorkom; om gelyke geleenthede te hê; hindernisse wat my terughou en die toekoms is myne om te vorm. Hierdie jongmense neem deel aan ’n groot verskeidenheid aktiwiteite en het deur ondervinding verskeie strategieë aangeleer om die probleme wat hulle ervaar het te oorkom. Die volgende faktore het hulle deelname positief beïnvloed: betekenisvolle interpersoonlike verhoudings; aanvaarding van hulle gestremdheid en koestering van ‘n positiewe houding; trots op hulle prestasies; positiewe werkservaringe en betrokkenheid in hulle gemeenskap. Die faktore wat bygedrae het tot swak deelname aan aktiwiteite was die volgende: hul self-persepsie, asook hul persepsie van hoe ander hulle behandel; nie-aanvaarding van hulle gestremdheid en fisiese omstandighede; swak selfvertroue en gevoelens van onbevoegdheid; die staking van vorige betekenisvolle aktiwiteite; uitdagings in hulle verhoudings en onbevredigende werkservaringe. Hul onafhanklikheid is vir hierdie jongmense van uiterste belang, want dit is ‘n aanduiding dat hulle in beheer is van hulle eie lewens. Na aanleiding van bogenoemde informasie, maak die narvorser die volgende aanbeveling: Om ‘n voorbereidings program vir senior fase leerders te begin, wat sessies van werksgewoontes, sosiale vaardighede, transport, self-indiensneming en integrasie in die gemeenskap insluit. Die moontlikheid van ondersteunde indiensneming moet ook verken word, om maksimale indiensneming onder hierdie jongmense te verseker. ‘n Opvolg sisteem moet ook in plek gestel word om die doeltreffendheid van bogenoemde program te bepaal.

Submitted in fulfillment of the requirements for the Doctoral Degree in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Background An increase in the world's population of ageing people is occurring not only in developed countries but also in developing countries. In South Africa, the proportion of the population aged 50 and over increased from 14.8% in 2006 to 15% in 2009 and is predicted to be 19% by 2030. This means that the supply of services for the elderly people should match the demand at all times, otherwise the quality of life of these senior citizens will be compromised. This study aimed at developing a model that would improve the quality of life for elderly people living in the uMhlathuze and uMlalazi sub-districts of the uThungulu district, KwaZulu-Natal. Methodology A qualitative, exploratory, descriptive design was applied for this study. A semi-structured interview guide based on the Health Related Quality of Life Theory and Maslow’s hierarchy of needs was used. Random sampling was used to select the elderly participants. Purposive sampling was used for the selection of the chairpersons of non-governmental organisations, and the District Programme Manager. Audits were conducted in the clubs that elderly people with chronic disease participate in. Data analysis followed Tesch’s steps after which themes and categories were formulated. Results Three major themes that emerged from the data analysis were social well-being of elderly people, physiological factors and psychological factors. The results revealed that elderly people experience poor living conditions and suffer poverty due to a number of factors which including the high unemployment rate of their children. Often the children are involved in substance abuse using the elderly person’s money pension money, which leaves them without any food items in the household. According to the District Programme Manager, there was a project on integrated chronic disease management that was conducted at uThungulu district by the Department of Health. The integrated chronic disease management focused on the population in general of all ages, yet in this study the focus has been on elderly people, which is why the researcher developed a model to improve the QoL of elderly people, due to their unique needs. Conclusion This research study gathered information regarding social, economic, health and environmental factors in rural areas which will help in bringing issues of elderly people’s quality of life to awareness. This research will deepen the knowledge and skills of professionals on ageing issues, especially in rural areas/communities. / D

Text in English / International studies have demonstrated that Implantable Cardioverter Defibrillators (ICDs) can have a significant impact on the Quality of Life (QOL) of patients. This is often due to factors that cause considerable psychological distress and has not been investigated in South Africa before. This research study thus investigated factors that influence QOL in patients with ICDs who are followed up in the Cardiac Clinic at Groote Schuur Hospital. The objectives were to describe demographic, clinical, ICD and patient support characteristics; to determine the prevalence of anxiety and depression; to assess QOL and to establish factors that influence depression, anxiety and QOL. The method involved a quantitative approach and a descriptive, cross-sectional and correlational design. All eligible patients with ICDs from the Cardiac Clinic were invited to participate. Participants completed a Demographic and Clinical Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the SF-36v2 Health Survey. A descriptive analysis of frequencies and summary statistics were done, followed by a regression, comparison and correlational analyses. A total of 70 patients (57 years mean, 65% male) participated in the study. The HADS mean score for anxiety was 6.50, SD 4.52 and for depression 4.96, SD 3.36. The SF-36v2 QOL Physical Component Summary (PCS) mean score was 43.83, SD 9.43 and the Mental Component Summary (MCS) was 47.81, SD 10.71. Factors associated with depression, anxiety and poor QOL included having more than 5 ICD shocks (appropriate or inappropriate). Patients who felt that the ICD influenced their lifestyle positively, was 10.46 times more like to have mental well-being. This study showed that patients with ICDs managed in the state sector, is a vulnerable population. They often live far from hospital, have a high unemployment rate and a poor income. The HADS revealed that 21.4% of the patients had depressive symptoms and 28.6% fulfilled criteria for anxiety. The SF-36v2 revealed that the QOL of patients with ICDs was significantly lower than the norm, with regard to their physical and mental well-being. The study highlights the need for psychological and social support of patients living with ICDs. Keywords: quality of life; implantable cardioverter defibrillator; sudden cardiac death; arrhythmia; anxiety; depression; HADS; SF36v2. / Psychology / M.A. (Psychology)

Asthma is not a disease with a single etiology but a very complex syndrome. Irrespective of a better understanding of the pathophysiology of asthma and its related therapeutic regimens the disease still escalates in prevalence and severity. Characteristic features of chronicity and remission ensures a fertile ground for non-compliance by patients. This quantitative, descriptive study set out to determine the asthma knowledge, asthma control and quality of life of adult asthmatics who attended the respiratory outpatient clinic at Tygerberg Hospital. The purpose was to determine an association between asthma knowledge, asthma control and asthma quality of life. A statistically significant association was found between asthma control and asthma quality of life, not with knowledge of asthma for either of the concepts. Important gaps in knowledge were identified namely an inability to recognise nocturnal coughing as a risk factor. The increased role of nurse practitioners in asthma care is highly recommended. / Health Studies / M.A. (Health Studies)

Dementia of Alzheimer‟s Type is a degenerative neurocognitive disease accounting for majority of Dementia‟s. It affects millions of people worldwide and thousands of people in South Africa. Apart from the economic burden this illness places on the country, it has detrimental effects for those who provide care for individuals with this illness, who are mostly spouses. The spousal caregivers bears great financial, social and emotional burden which worsens as the disease progresses. The aim of this study is to phenomenologically explore and describe the lived experiences of spousal caregivers in caring for the spouses with Dementia of Alzheimer‟s Type. This South African study was therefore qualitative in nature and was conducted in the province of KwaZulu- Natal, in the city of Pietermaritzburg. Eight participants were interviewed using a semi-structured questionnaire. Data was analysed using interpretative phenomenological analysis (IPA). The main findings of this study are the negative emotional affects that the caregiving role creates. Caregiver stress and strain is experienced as well as the experiences of various losses including lack of intimacy and ruined expectations for the future as the disease progresses. The caregiving role also created negative implications for the social lives of caregivers and coping mechanisms were seen to be very important. / Psychology / M.A. (Psychology)

Developments since the 20th century indicate that the wellbeing of communities makes for healthy national welfare in strong countries. Community wellbeing is thus a priority for policy makers and service providers. Conceptualization of a meaningful, holistic multidimensional measurement of community wellbeing at micro (community) level has been lacking. Such a concept and its measurement are essential when addressing social exclusion and development issues in the enhancement of community wellbeing is to produce worthwhile results. There is growing recognition that earlier understanding of community wellbeing failed to address development needs and processes at community level. Outsider stakeholder driven top-down one-dimensional community wellbeing (‘silo’) measurements did not address human development needs at community level. Meaningful measurement requires integrated frameworks addressing multidimensional issues conceptualizing wellbeing measurement at community level. Such measurement needs to be combined with the integrated inclusion of social capital influence through ‘insider-outsider’ partnerships. The research study purpose was to develop a community driven holistic, integrative wellbeing assessment model. This model could assist ‘insiders’ (community members) and ‘outsiders’ (policy makers, service providers and community development practitioners) in developing and implementing community driven initiatives towards improved wellbeing. The two main research questions were: 1) which macro level wellbeing assessment factors to consider in an aligned micro level wellbeing assessment? and 2) what is the associative relationship between wellbeing and social capital? Two descriptive sample surveys were conducted utilizing a structured questionnaire. Primary data findings contributed to finalization of a community level wellbeing assessment model. This model would enable estimation of the potential (push and pull) factors that influence the targeted success of suggested community development processes. The assessment model is community driven and owned, with spider and quadrant diagram graph tools indicating first the status of community wellbeing and social capital, then the associative relationships of wellbeing and social capital in ‘insider-outsider’ initiatives for wellbeing enhancement. / Development Studies / D. Phil. (Development Studies)

Despite the many changes that have occurred in South Africa since the end of apartheid, there are still residual effects of it, as is evidenced in the disparity of living conditions between different racial groups. It is also evident that there are differences in the work tasks and working conditions of nurses working in different work environments. This project looks at how living conditions as well as working conditions interactively affect the health, subjective well-being, and work ability of nurses. Questionnaires were completed by, and interviews were conducted with nurses from Settlers Hospital and seven municipal clinics within Grahamstown (n=152). The participation rate was approximately 71%. The questionnaires included self-report, forced-choice questions regarding basic demographics of the nurses, work conditions, living conditions, subjective satisfaction levels, as well as a simplified version of the Nordic Questionnaire of Musculoskeletal Strain (Kuorinka et al., 1987), and the Work Ability Index (WAI) (Tuomi et al., 2006). The questionnaires were translated into Afrikaans and IsiXhosa. One-on-one interviews were conducted with the participants, in order to obtain a 24-hour dietary recall, an indication of physical activity levels, as well as measurements of stature, mass, waist girth and hip girth. Factor analysis was performed to identify common variance from amongst the variables, while canonical correlations examined the interaction between the sets of factors. It was found that variables relating to demographic factors, living conditions, and working conditions were closely linked to each other. Factors from each of these groups were associated with life, health, and job satisfaction, anthropometric measures, musculoskeletal strain, and WAI scores. Satisfaction levels appeared to be largely determined by socioeconomic status, while anthropometrics, WAI scores, and levels of musculoskeletal strain were associated with levels of smoking and drinking, race, age, stature, position and tenure.

This study examines the extent to which the Siyazondla food programme, which is a woman based project, empowers women with agricultural skills and knowledge to alleviate poverty and improve their quality of lives in Ducats North area in East London. The investigation is based on the argument that when a woman is empowered, poverty will be reduced and the quality of life will improve. Through the use of qualitative research methodology, all women who are the main beneficiaries of the Siyazondla programme in Ducats North village were interviewed. Findings seem to indicate that although women in the project manage to produce good crops to feed their families, they are still not sufficiently empowered with skills and education to improve their quality of lives. This was found to be exacerbated by the fact that the officials assigned for the programme are to a greater extent inefficient and lack relevant knowledge to support beneficiaries. Most importantly, it was revealed that there is lack of monitoring and evaluation of the programme by government and this was considered to be the major constraint to successful implementation of the programme and in ensuring that poverty is alleviated in the area. It is on the basis of these findings that the study recommends that in order to yield positive results and ensure that women in the programme are empowered, there is a need to change the deeply embedded patriarchal perceptions and discriminatory practices and attitudes that seem to undervalue women‟s work. This will require greater awareness of women‟s contribution to agriculture, and the recognition of the role played by women in food security and poverty alleviation, coupled with a strong commitment from the government to empower rural women in agriculture.

MENVM / Department of Geography and Geo-Information Sciences / Fuel wood is regarded as a major source of energy around the world, particularly in developing nations. Most rural communities around the world, consider forests as the repository of stored energy. The high dependence on forests as a source of fuel wood has a major impact on vegetation because trees take a long time to regenerate to maturity, hence high dependence leads to deforestation. Fuel wood is used for household needs, such as cooking and heating and its uses contribute to the emissions of Green House Gases (GHG) such as CO2, CH4, and Black Carbon amongst others. The study assesses household energy use, the amount of carbon dioxide emitted from the combustion of fuel wood, the extent of de-vegetation and strategies to ensure sustainable energy provisions in the case study areas. Primary and secondary methods were used to collect data. The data were analysed using Statistical Package for the Social Sciences (SPSS 21.0), showing the frequency distribution, measures of central tendency and chi-square to determine the extent of fuel wood used in relation to electricity. The primary data were collected through personal observations, field surveys, interviews and questionnaires, while secondary data included the 2011 South Africa Census data and remote sensing images, which with the aid of GIS, were used in mapping the vegetation change.