Doctor Scientiae / Following the introduction of the Health Act of 1995, the Primary Healthcare Package for South Africa, a set of norms and standards was developed in 2000, to ensure good quality of care and to act as a guide to provide good service at this level of care. Related to this, and bringing health services to the people, was the aspect of rehabilitation. It was highlighted that rehabilitation services should be restructured and strengthened in order to improve access to these services for those who did not have them before. This led to the development of the National Rehabilitation Policy in 2000, which focused on improving accessibility to all rehabilitation services, in order to facilitate the realisation of every citizen’s constitutional right to have access to healthcare services, but this policy was not implemented. During 2002, the Department of Health produced a strategic plan for the reshaping of public health services in the Western Cape. This initiative, Healthcare 2010, the Future for Health in the Western Cape 2020, mapped the way forward to improve substantially the quality of care provided by the health service. This plan was based on the primary healthcare approach and aimed to shift patients to more appropriate levels of care. It became evident that in order to move forward with the 2020 vision, there needed to be a greater understanding of the current situation. This study focused primarily on the aspect of rehabilitation, with a specific focus on systematic review and three dimensions of the process of care, namely patient information; service provider information; and realised access. These dimensions assisted in evaluating the rehabilitation service in order to understand what was happening in the delivery of rehabilitation services, focusing on the experiences of patients with physical disabilities, as well as service providers and caregivers, and realised access that included satisfaction of all participants in the rehabilitation centres. Hence the aim of this study was to evaluate the process of care at three selected rehabilitation centres in the Western Cape Province within the contextual framework of the National Rehabilitation Policy (NRP) and the United Nations Convention Rehabilitation Policy for People with Disabilities (UNCRPD). To assist in achieving this aim, objectives were developed as follows: to determine the reported barriers and facilitators to rehabilitation services through a systematic review; to determine the profile of patients with disabilities accessing rehabilitation services at three rehabilitation centres in the Western Cape Province; to determine the profile of service providers providing rehabilitation service to patients with disabilities attending rehabilitation centres in the Western Cape Province; to explore clients’ perceptions of and satisfaction with the rehabilitation services; to explore caregivers’ perceptions of and satisfaction with the rehabilitation services; to explore the experiences of service providers with the rehabilitation services; and to map the links between the experiences and perceptions of the key stakeholders. This was an evaluation study, which was primarily descriptive, with the focus on process evaluation. Process evaluation provides an indication of what happened, and why. The study was conducted at three rehabilitation centres in the Western Cape Province. Voluntary participation of patients, service providers and caregivers was gained by signing a consent form. Both qualitative and quantitative methods of data collection were used in this study. Questionnaires were used for quantitative data collection and SPSS version 17 and 21 was used to analyse the data. Focus group discussions and in-depth interviews, which were based on interview guides and tape recorded, were used to gather information on experiences and perceptions of all the participants. Quantitative data capturing was checked for errors by using excel spread sheets, where data was entered twice in two different spread sheets and checked for differences, as responses were coded by using numbers. Qualitative data was checked for errors by following the trustworthiness process where data was transcribed verbatim, and where necessary translated by two different translators to ensure accuracy. The researcher consulted with the supervisors during data analysis to enhance quality in the coding process and identification of themes and relevant quotations. Results showed that barriers to rehabilitation outnumbered facilitators of the rehabilitation process. There was a gap identified in the profile of the patients with regards to their rehabilitation needs. Records of the patients had missing information posing a challenge to data collection and possible presenting a distorted picture of service provision. However, records showed that not all rehabilitation professionals were not consulted during the rehabilitation process of care. Ninety-five percent (95%) of the clients consulted with physiotherapists, whereas only 4% consulted social workers. Rehabilitation service providers did not reflect a rehabilitation team. There was a shortage of rehabilitation service providers, in that some centres had full time staff while other centres only had sessional rehabilitation professionals. Service providers were negligent with some of the processes to be followed when consulting clients, such as getting consent to treat the patient and educating patients regarding their ailments, which then affected satisfaction of the patients. However, there were also positive aspects like treating patients with respect and allowing patients to ask questions during consultation. Caregivers on the other hand were satisfied with the rehabilitation process, as they found the centre easily accessible for their family members and were involved in the rehabilitation of the patients. In conclusion, the rehabilitation process was satisfying to the participants of this study. The main challenge that patients and caregivers experienced was financial constraints. Staffing remains a problem in rehabilitation centres in the Western Cape Province, as there were not enough staff for rehabilitation service delivery at these selected rehabilitation centres. Other staff members were not utilised during the rehabilitation process. These findings raise issues for the Western Cape Department of Health to consider regarding rehabilitation, as people with disabilities are not receiving optimal care. The study makes recommendations to the Department of Health in the Western Cape Province regarding the improvement of the rehabilitation process of care.

Program evaluation is becoming increasingly important in pediatric rehabilitation settings that adhere to FCS philosophy. This philosophy recognizes that each family is unique, that parents know their children best, and that optimal child functioning occurs within a family context. However, researchers know little about the specific evaluation activities occurring in these settings or the extent to which evaluators uphold FCS philosophy in their activities. The primary goal of this study is to examine the strengths, limitations, and consequences of current evaluation practice, including its compatibility with FCS philosophy. As a secondary goal, the study aims to understand the promise and prospects of alternative evaluation approaches that, in theory, are compatible with FCS philosophy. To address these goals, this study uses a mixed-methods approach and includes three phases. Phase 1 involves a survey of staff members involved with program evaluation at 15 Canadian pediatric rehabilitation centres. It determines the level of program evaluation occurring in these settings, verifies on the motivation for evaluation, and describes the degree to which evaluation activities are consistent with the FCS philosophy. Phase 2 involves interviews with staff members and explores the values, factors, and conditions that support and inhibit the evaluation of family-centred programs in pediatric rehabilitation settings as well as the benefits and limitations of using mainstream practices for evaluating these programs. Phase 3 then uses focus groups with staff members and interviews with parents to explore how the evaluation of family-centred programs can be improved as well as to identify the compatibility and practicality of using alternative evaluation approaches within these settings. Overall, the findings show that the amount of evaluation activities occurring within these centres is variable; that the majority of individuals working in program evaluation do not have formal training in it; and that the centres have limited resources for evaluation. The findings also demonstrate that participatory evaluation approaches are more compatible with FCS philosophy but that it might be difficult to implement such approaches given the limited resources and diverse characteristics of rehabilitation settings. In light of these circumstances, the study notes ways for improving program evaluation activities.

Program evaluation is becoming increasingly important in pediatric rehabilitation settings that adhere to FCS philosophy. This philosophy recognizes that each family is unique, that parents know their children best, and that optimal child functioning occurs within a family context. However, researchers know little about the specific evaluation activities occurring in these settings or the extent to which evaluators uphold FCS philosophy in their activities. The primary goal of this study is to examine the strengths, limitations, and consequences of current evaluation practice, including its compatibility with FCS philosophy. As a secondary goal, the study aims to understand the promise and prospects of alternative evaluation approaches that, in theory, are compatible with FCS philosophy. To address these goals, this study uses a mixed-methods approach and includes three phases. Phase 1 involves a survey of staff members involved with program evaluation at 15 Canadian pediatric rehabilitation centres. It determines the level of program evaluation occurring in these settings, verifies on the motivation for evaluation, and describes the degree to which evaluation activities are consistent with the FCS philosophy. Phase 2 involves interviews with staff members and explores the values, factors, and conditions that support and inhibit the evaluation of family-centred programs in pediatric rehabilitation settings as well as the benefits and limitations of using mainstream practices for evaluating these programs. Phase 3 then uses focus groups with staff members and interviews with parents to explore how the evaluation of family-centred programs can be improved as well as to identify the compatibility and practicality of using alternative evaluation approaches within these settings. Overall, the findings show that the amount of evaluation activities occurring within these centres is variable; that the majority of individuals working in program evaluation do not have formal training in it; and that the centres have limited resources for evaluation. The findings also demonstrate that participatory evaluation approaches are more compatible with FCS philosophy but that it might be difficult to implement such approaches given the limited resources and diverse characteristics of rehabilitation settings. In light of these circumstances, the study notes ways for improving program evaluation activities.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2016-08-25T18:56:22Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação SANTOS, RB.pdf: 1093679 bytes, checksum: 4dfc2476f164e7599ae8b5b618d48793 (MD5) / Made available in DSpace on 2016-08-25T18:56:22Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação SANTOS, RB.pdf: 1093679 bytes, checksum: 4dfc2476f164e7599ae8b5b618d48793 (MD5) Previous issue date: 2014-04-08 / Historicamente o HIV entre os usuários de drogas é transmitido com maior frequência através do compartilhamento de agulhas e seringas. No entanto, drogas como o crack e o álcool estimulam comportamentos sexuais inseguros favorecendo a transmissão do vírus por via sexual. A droga predominante no Nordeste do Brasil é o álcool, no entanto esta região concentra o maior número de usuários de crack do país. Desta forma, acredita-se que existe uma alta prevalência da infecção entre os usuários de drogas, inclusive nas cidades do interior do Nordeste. O objetivo deste estudo foi estimar a prevalência e os fatores associados a infecção pelo HIV em usuários de drogas internados ou em atendimento ambulatorial em cinco centros de reabilitação para dependência química em uma cidade de médio porte na Região Nordeste do Brasil. O delineamento do estudo é de corte transversal analisado como caso-controle. Foi conduzido em cinco centros de reabilitação para dependência química na cidade de Caruaru, Pernambuco, Brasil, no período de novembro de 2012 a novembro de 2013. Participaram da pesquisa 561 usuários de drogas lícitas e ilícitas que estavam internados ou em atendimento ambulatorial, sem limite de idade. Todos foram submetidos a uma entrevista e realização de teste rápido de HIV após assinatura do Termo de Consentimento Livre e Esclarecido ou Termo de Assentimento Livre e Esclarecido. O resultado do estudo identificou que a prevalência do HIV entre os usuários de drogas foi de 4,8%. O sexo feminino foi associado de forma independente com o HIV (p = 0,018; OR = 3,19; IC95% = 1,22 – 8,34), assim como a idade da primeira relação sexual (p = 0,012; OR = 1,17; IC95% = 1,03 – 1,33), a troca de sexo por crack (p = 0,031; OR = 2,81; IC95% = 1,10 – 7,19) e ter parceiro que usa crack (p = 0,035; OR = 3,89; IC95% = 1,10 – 13,7). O álcool é consumido por 96,3% dos participantes, mas não houve associação estatística com o HIV, assim como o uso da maconha (86,5%), do crack (82,5%), da cocaína (65,1%) e drogas injetáveis (10%). Embora os participantes do estudo tenham referido o uso de múltiplas drogas ilícitas durante a vida, percebeu-se a maior prevalência do consumo de crack entre eles. Contudo, esta investigação não mostrou associação isolada do crack ou outra droga em relação à infecção pelo HIV. No entanto, o consumo do crack estimula a prática sexual de risco, troca de sexo por crack e sexo comercial, favorecendo a infecção. Este é o primeiro estudo realizado no município de Caruaru, focando a investigação sorológica e os fatores de risco para HIV entre os usuários de drogas da região. Os achados confirmam a necessidade de implantação ou ampliação de unidades de testagem, aconselhamento e tratamento do HIV entre os usuários de droga no município. / Historically, HIV infection among drug users has generally been transmitted through the sharing of needles and syringes. However, drugs such as crack and alcohol encourage unsafe sexual behaviour, which is responsible for transmitting the virus through sex. Although the predominant drug in the north-eastern region of Brazil is alcohol, this region presents the largest number of crack users in the whole country. Hence, it is believed that there is a high prevalence of infection amongst drug users, including cities in the interior. The aim of this study was to estimate the prevalence and factors associated with HIV infection in inpatient and outpatient drug users at five drug rehabilitation centres in a medium-sized city in north-eastern Brazil. This was a case-control cross-sectional study, and was conducted in five drug rehabilitation centres in the city of Caruaru, in the state of Pernambuco, Brazil, from November 2012 to November 2013. A total of 561 licit and illicit drug users took part in the study. All participants were receiving either inpatient or outpatient care and there was no age limit. All patients underwent an interview and a rapid HIV test after signing the informed consent forms. Results of the study demonstrated that there was a prevalence of HIV among drug users of 4.8%. Females were independently associated with HIV (p=0.018; OR=3.19, 95% CI =1.22 to 8.34), together with age of the first sexual intercourse (p = 0.012; OR =1 17, 95% CI=1.03 to 1.33), the exchange of sex for crack (p=0.031, OR =2.81, 95% CI=1.10 to 7.19) and having a partner who uses crack ( p=0.035; OR=3.89, 95% CI=1.10 to 13.7). Alcohol was consumed by 96.3% of all participants; however, there was no statistical association with HIV, or with the use of marijuana (86.5%), crack (82.5%), cocaine (65.1) and injected drugs (10%). Although study participants reported the use of multiple illicit drugs during their lifetime, they presented with a higher prevalence of crack use. However, the present study did not indicate an isolated association of crack or other drugs in relation to HIV infection. Nonetheless, crack consumption encourages the risks of unprotected sex, sex-for-crack exchanges and commercial sex, thus favouring infection. This has been the first study conducted in the city of Caruaru, which focuses on serological investigation and risk factors for HIV among drug users in the region. The findings confirm the need to implement and expand testing facilities, counselling services and HIV treatment among drug users in the city.

Program evaluation is becoming increasingly important in pediatric rehabilitation settings that adhere to FCS philosophy. This philosophy recognizes that each family is unique, that parents know their children best, and that optimal child functioning occurs within a family context. However, researchers know little about the specific evaluation activities occurring in these settings or the extent to which evaluators uphold FCS philosophy in their activities. The primary goal of this study is to examine the strengths, limitations, and consequences of current evaluation practice, including its compatibility with FCS philosophy. As a secondary goal, the study aims to understand the promise and prospects of alternative evaluation approaches that, in theory, are compatible with FCS philosophy. To address these goals, this study uses a mixed-methods approach and includes three phases. Phase 1 involves a survey of staff members involved with program evaluation at 15 Canadian pediatric rehabilitation centres. It determines the level of program evaluation occurring in these settings, verifies on the motivation for evaluation, and describes the degree to which evaluation activities are consistent with the FCS philosophy. Phase 2 involves interviews with staff members and explores the values, factors, and conditions that support and inhibit the evaluation of family-centred programs in pediatric rehabilitation settings as well as the benefits and limitations of using mainstream practices for evaluating these programs. Phase 3 then uses focus groups with staff members and interviews with parents to explore how the evaluation of family-centred programs can be improved as well as to identify the compatibility and practicality of using alternative evaluation approaches within these settings. Overall, the findings show that the amount of evaluation activities occurring within these centres is variable; that the majority of individuals working in program evaluation do not have formal training in it; and that the centres have limited resources for evaluation. The findings also demonstrate that participatory evaluation approaches are more compatible with FCS philosophy but that it might be difficult to implement such approaches given the limited resources and diverse characteristics of rehabilitation settings. In light of these circumstances, the study notes ways for improving program evaluation activities.

Please read the abstract in the section 00front of this document / Thesis (DPhil (Social Work))--University of Pretoria, 2005. / Social Work and Criminology / unrestricted

This study, conducted in Pietermaritzburg and surrounding rural and township areas, is a critical exploration of the training of mid-level Community Based Rehabilitation workers with a specific focus on the ability of course participants to understand and address the oppression and empowerment of people with disabilities. The aim of the study was to develop a conceptual framework for curriculum construction of a midlevel Community Based Rehabilitation course, through examining a Community Based Rehabilitation course and the changes that were made to it. The study was conducted within a critical theory paradigm. The social model of disability and an understanding of disability as a form of oppression were the key constructs that guided the research. Participatory action research was used in the initial phase of the research, followed by a second phase that adopted a life history approach. The initial phase of the study consisted of one cycle of action research, beginning with a reflection on the existing curriculum. The action research cycle then moved through stages of planning changes to the curriculum, implementing the changes, observing the effects of the changes and reflecting again. Data collection comprised interviews with staff members, students and community rehabilitation facilitators who had previously completed the Community Based Rehabilitation course, as well as focus groups with people with disabilities and parents of children with disabilities. Several participatory rural appraisal techniques were also used with the students. The action research cycle raised further questions about how the life experiences of the students influenced their responses to the changed curriculum. This stimulated the development of the second phase of the research which used life history methodology, comprising in-depth interviews with four students. The study found that several changes occurred in the students’ attitudes and understanding as well as in some of the activities they undertook. Some students worked with rather than for people with disabilities, indicating a change in the power relationship with their clients. The students were able to analyse their own oppression and that of people with disabilities, unlike previous students. The students also engaged in social action for the rights of people with disabilities. These findings cannot be solely attributed to the changes in curriculum. However, they raise the possibility that Community Based Rehabilitation personnel can work to address the oppression of people with disabilities rather than focusing entirely on technical rehabilitation, which is a common approach in the literature. An analysis of the life histories revealed that those students identified as ‘activists’, more willingly engaged in social action during the Community Based Rehabilitation course than other students. This challenges the dominant discourse in the literature of Community Based Rehabilitation personnel as rehabilitation workers rather than activists. One key contribution of this thesis is to research methodology through its combination of life history methodology and action research in the study. A second is its proposed framework for curriculum construction that incorporates findings from the action research and the life histories. This framework, with its macroenvironment, organisational and student influences on the curriculum, contributes to the under-theorised field of Community Based Rehabilitation training. / Thesis (Ph.D.)-University of KwaZulu Natal, 2008.

South Africa as a developing country faces the challenges of providing a better life for all its citizens. The South African society is of two extremes, a small population of the wealthy and a large portion of the poor. In a growing economy there is an increase in the gap between rich and poor. The rich work to keep their wealth and the poor work but struggle to provide the bare necessities for their families. The challenges facing South Africa are of alleviating poverty, through providing adequate shelter, jobs, education and health for all South Africans. These are essential elements that are needed to create better communities and functional families. The solutions to these problems are sometimes not thought through and integrated with other sectors of society. This leads to quick fix solutions to deep routed problems which are isolated to the countries’ developments. South Africa has a deep history rooted in apartheid. Living within a post apartheid society South Africans have inherited a built environment that was aimed for specific segregated population groups. In a democratic society people have an opportunity of “equal sharing” within the economy. This leaves a large portion of the population struggling to rid themselves of poverty. These are the major issues which lead to committing crime and consequently imprisonment. This research study specifically deals with the correctional services institutions built form, rehabilitation and reintegration processes for the ex-prisoner. The built forms role in society can be far reaching and shape the life form of its inhabitants. It can facilitate a positive role in deterring the social ills of society. Presently the built environments cannot accommodate the growing and integrated population groups. The role of the correctional facilities is important in providing safe communities by removing those individuals harmful to society. A thorough approach to imprisonment, rehabilitation and social reintegration of ex-prisoners will assist in keeping safe communities. The understanding of prisons, their environment and the role of the built form with regards to social reintegration processes is important. This will assist in lessening the amount of recidivism of ex-prisoners once released. This research seeks to establish the role in which the built form can support rehabilitation for ex-prisoners in the view of reintegrating them back into society. / Thesis (M.Arch.)-University of KwaZulu-Natal, Durban, 2010.

Transition into adulthood has been regarded as a priority in health. However, there is scarcity of literature on the transition of adolescents with intellectual disability. The purpose of this study was to develop a strategy for transition of adolescents with intellectual disabilities into adulthood based on the Transition Theory proposed by Meleis, Sawyer, Im, Hilfinger and Schumacher (2000). The research objectives of this study were in three phases: Phase I: Desk review  To explore the known factors about the transition process of adolescents with IDs into adulthood.  To identify gaps in literature on the transition of adolescents with intellectual disabilities’ transition into adulthood. Phase II: Mixed method  To explore and describe the experiences of caregivers and health care professionals on the transition of adolescents with IDs into adulthood.  To investigate challenges that hamper the transition process of adolescents with IDs into adulthood. Phase III: Development of strategy  To develop a strategy for transition of adolescents with IDs into adulthood informed by findings from phases I and II. A sequential exploratory mixed method approach was used. A purposive, snowballing and simple random sampling were used to select participants for this study. The study was conducted in Special schools, Non-Governmental Organisations and Care and Rehabilitation Centres based in Gauteng province of South Africa. Triangulation of data sources and data collection methods was used to sample one hundred and forty nine (149) participants aged 21-60+ years who experienced caring for individuals with intellectual disabilities. Interpretative analysis proposed by Terrablanche. Durrheim and Kelly (2006) was used for qualitative data limited to a sample of n=29 participants. Quantitative data was analysed by use of IBM Statistical Package of Social Sciences (SPSS: 24) with a blend of descriptive and inferential statistics limited to a sample of n=120. Five themes from both qualitative and quantitative results emerged that is, transition possibility; the role of different stakeholders; the provision and development of working skills; caregivers’ knowledge and understanding of guidelines and alterations to adapt to change. The development of the transition strategy bridged a significant gap that informs nurses, teachers, parents, policy-makers and other stakeholders in supporting transition of adolescents with intellectual disabilities into adulthood. / Health Studies / D. Litt. et Phil. (Health Studies)

MPH / Department of Public Health / Background: Globally, more than one billion people, or approximately 15% of the world’s population are living with some form of disability and 80% of them are found in developing countries. There are different types of disability; these include sensory, neurological, physical, intellectual, cognitive and psychiatric disabilities. Persons with disabilities may require specialized care, resources and commitment which place a very high demand of time and responsibilities on the one caring for them. Therefore, Community-Based Rehabilitation (CBR) was promoted by the World Health Organisation (WHO) as a strategy to respond to the needs of persons with disabilities, through the provision of basic services at community level, particularly in developing countries with limited resources. Methodology: The purpose of this study was to explore and describe the challenges faced by Community-Based Rehabilitation caregivers for persons with disabilities in Vhembe District, South Africa. A qualitative phenomenological design was used to explore and develop an in-depth understanding of the CBR caregiver’s challenges. The study was conducted in three Community-Based Rehabilitation centres located within Vhembe District with a sample size of six caregivers who were purposively selected. An interview guide was developed as an instrument for data collection. Data was collected through in-depth individual interviews and analyzed using thematic analysis. Results: Six main themes emerged from the data which shed light on the CBR caregiver’s challenges, namely; Poor relationships between caregivers, government v department and families, unavailability of material and human resources, poor funding system, caregivers’ well-being, education and training and the coping strategies of CBR caregivers Conclusion: This study pointed out that there is a need for intervention from different stakeholders such as government departments, family members of persons with disability, and the community members as well for CBR caregiver’s challenges to be resolved or minimized.