Background: Hemodialysis patients (HDP) often suffer from kidney failure with comorbidities, such as depression, anxiety and stress. Physical activity (PA) has a positive influence on these comorbidities. Objective: The purpose was to determine the current level of PA and identify potential correlates influencing PA in HDP to deduce prevention approaches. Material and methods: Data were collected in 13 dialysis centers in Bavaria. A standardized questionnaire was used to analyze PA (EHIS-PAQ) and influencing factors in 240 HDP. Gender differences were calculated using the t‑test and the Mann-Whitney U‑test (significance level p < 0.05). For correlation analyses with PA, Spearman’s correlation coefficient rs and multivariate logistic regression analysis were used. Results: The results showed that HDP were on average moderately active for 76.31 min per week (standard deviation, SD 124.02 min). Male HDP were less active and showed significantly more depressive symptoms than female HDP (p < 0.05). The HDP who were more active assessed their subjective health condition on a higher level than HDP who were not active. Depression, stress, and age showed a negative association and sport-specific self-efficacy a positive association with PA (p < 0.05). Multivariate logistic regression revealed that sport-specific self-efficacy increased the chance of becoming physically active while depression reduced the chance of achieving 150 min PA. Conclusion: The majority of HDP were barely active. The results reveal the necessity to further promote PA in patients with chronic renal failure. Physicians should be aware of patients’ self-efficacy as well as depressive symptoms and develop concepts that strengthen the self-efficacy and promote the positive effects of PA on health.

Thesis (M. Pharm. (Pharmacology)) -- University of Limpopo, 2021 / Introduction: Zebediela Hospital in Limpopo Province is running an outreach programme as part of its chronic care initiative. In the programme, pharmacy personnel visit the feeder clinics attached to the hospital to dispense chronic medicines to patients. This study aimed at evaluating how this pharmacy chronic care outreach programme is performing, by looking at pharmacy personnel, nursing personnel and patients’ perceptions. Method: A cross-sectional descriptive study was conducted at the six feeder clinics attached to Zebediela Hospital in the Lepelle-Nkumpi municipality of the Capricorn district in Limpopo Province using a quantitative research method. This quantitative research was administered in the form of a survey. Questionnaires were used to collect data from patients, nursing personnel and pharmacy personnel. A total of 399 participants (n=399) took part in the study. The participants included 337 patients from six different clinics, 18 pharmacy personnel and 44 nursing personnel. Data was analysed using the SPSS version 25.0. Results: The pharmacy personnel showed that an allocation of more than three personnel per duty roster sufficed. Regarding transport used by pharmacy personnel when embarking on the Pharmacy Chronic Care Outreach Programme, 71.4% of pharmacy personnel indicated that they always used hospital transport in 83.3% of the cases. The study findings showed that, 71% of patients agreed they were satisfied with the pharmacy times for collecting medicines apart from the fact that 65.6% of patients travelled for more than two hours from their respective homes to their nearest clinic. Sixty eight percent of pharmacy personnel perceived the PCCOP model to be reducing patient waiting time at the clinics. Both the patients and nursing personnel were however not satisfied with the pharmacy personnel’s arrival time at the clinic. The other negative aspect reported was the space problem at the clinics where, 77.8% of pharmacy personnel and 54.5% of nursing personnel reported this as not user-friendly. The patients’ satisfaction levels regarding the PCCOP model for “very satisfied” stood at 64.2% and 0.6% for “very dissatisfied”. Both pharmacy and nursing personnel recommended that the PCCOP model be continued with recommendations towards improving human resources and infrastructure. Conclusion: In conclusion, both pharmacy personnel and nursing personnel showed that the outreach programme was a good initiative in the health system and it benefitted patients. However, the concerns mentioned by patients included long waiting times at the clinic and medicine stock outs. As the results show, the pharmacy chronic care outreach programme should be continued, as long as patients’ complaints can be attended to. Key words: Evaluation, Pharmacy Chronic care Outreach Programme, Zebediela

This dissertation aims to elucidate the relationships between chronic illness, depression, and developmental assets among adolescents with chronic illness and co-morbid depression. Chapter One describes the current state of evidence on the intersections between chronic illness, depression, and adolescent development, and introduces Positive Youth Development theory and the Developmental Assets Framework. Chapter Two describes an integrative review synthesizing findings from 11 cohort studies examining relationships between depression or depressive symptoms and chronic illness-related disease control, self-management behaviors, illness-related morbidity, and quality of life among adolescents. Chapter Three describes a cross-sectional study comparing the number and types of developmental assets between adolescents with differing health statuses and examining relationships between assets and co-morbid depression using data from the 2016 National Survey of Children’s Health. Chapter Four describes a qualitative study exploring ways that developmental assets were discussed by 16 adolescents and young adults who lived with chronic illness and co-morbid depression during adolescence and uploaded videos to YouTube, a public video-sharing platform. Chapter Five summarizes key findings of this dissertation, outlines strengths and limitations, and discusses implications for future research, policy, and practice.

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Most prior research on stress and hemodialysis has focused on physical, psychological and staff-patient dimensions. Little research has been conducted on the correlates of stress experienced by dialysis patients in th~ context of the family. The purposes of this investigation were to operationalize 12 propositions from a model synthesizing 50 years of family stress research and to determine the applicability of the propositions for a population of in-center dialysis patients. The two dependent variables were family vulnerability to stress and family regenerative power. The independent variables were selected on the basis of the relative absence in the dialysis literature, and the applicability to dialysis patients and their families. A 41-item closed-ended interview schedule was designed by the investigator, analyzed for validity and reliability by a panel of experts, and pretested on a small group of dialysis patients. Six dialysis centers in Western Virginia participated in the investigation and 207 of a possible 215 patient interviews were completed. Pearson product-moment correlation coefficients were calculated for each of the relationships within the hypotheses. Four hypotheses received strong support: the greater the amount of crisis, the greater the vulnerability; the greater the family positional influence, the less the vulnerability; the greater the personal influence, the greater the vulnerability; and, the greater the marital adjustment, the greater the regenerative power. Four hypotheses received moderate support: the greater the positional influence, the lower the family regenerative power; the greater the anticipation socialization, the less the vulnerability; the greater the extended familism, the greater the regenerative power; and, the greater the regenerative power, the greater the family level of reorganization. Several additional correlations were reported which helped explain the findings related to the hypothesis testing. Methodological, theoretical and practical implications were discussed and recommendations for future research were made. / Ph. D.

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Thesis (M.A. Education (Community and Continuing Education)) -- University of Limpopo, 2015 / This report describes the research conducted at Kgotlelelang Basadi Home-based Care centre, in the Capricorn District Limpopo Province of South Africa. The centre serves four villages: Ngwanamago, Makata, Matobole and Thaba. Statement of the problem It seems the home-based caregivers of chronic patients at Kgotlelelang Basadi HBC centre do not have the necessary qualifications, knowledge, skills, and health care and protective resources such as gloves, thermometers and masks. It looks like the homebased caregivers are not adequately and continuously trained as there are always new discoveries and developments with regard to the treatment of diseases. It apprears they perform their duties without sufficient support by relevant institutions like clinics and hospitals. Furthermore, it appears the home-based caregivers are not recognised, and are also undermined. The aim of the study is to explore the educational needs and assets of home-based caregivers for homebound chronic patients at Kgotlelelang Basadi Home-based Care centre. After establishing the educational needs and assets of home-based caregivers I recommended the formulation of possible relevant educational programmes. In an attempt to achieve the said aims, the following research questions were formulated and put forward in chapter 1. Objectives  To establish the existing qualifications of home-based caregivers for home-bound chronic patients at Kgotlelelang Basadi HBC Centre.  To determine the relevancy of the existing educational programmes of home-based caregivers for home-bound chronic patients.  To contribute towards formulating relevant educational programmes of home-based caregivers for home-bound chronic patients.

Die gesin is die sentrum waarbinne die kind se vorming tot volwaardige volwassenheid plaasvind. Indien een van die ouers met 'n chroniese fisieke siektetoestand gediagnoseer word, mag dit moontlike implikasies inhou vir die ouer, die kind, maar ook ander gesinslede. Die chroniese siektetoestand en die implikasies wat dit vir die siek persoon inhou is bestudeer. Daarbenewens is die dinamiek van die gesin, waarbinne die ouer en die kind met mekaar in interaksie is, ontleed. Om te bepaal wat die effek van die chroniese fisieke siektetoestand van die ouer op die kind is, is 'n literatuurstudie onderneem. Dit is daarna geverifieer met gevallestudies wat ondemeem is. Die gevallestudies het die bevindinge van die literatuurstudie bevestig. Dit blyk dat die chroniese siektetoestand van die ouer 'n invloed op die wording van die kind het. Die siektetoestand is 'n voortdurende stressor binne die gesin, wat veroorsaak dat kind(ers) affektiewe-, kognitiewe-, gedrags- en sosiale probleme manifesteer. Daar moet aanpassings gemaak word om die stres binne die gesin te minimaliseer. Riglyne is saamgestel om die terapeut, wat hierdie kind(ers) en gesinne begelei, te help. / The family is the system within which the child develops and eventually attains maturity. When a patient is diagnosed with chronic disease, it has certain implications not only for the parent, but also for children and other members of that family. A liteature study was undertaken to determine the impact of the chronically ill parent on the child. This study was then verified with specific case studies done by the author. These case studies confinned the findings of the literature study. It would seem that the chronic illness of a parent has a definite impact on the development of a child. The parent's illness is a constant stressor within the family, causing children to manifest affective, cognitive, behavioral as well as social problems. Certain adjustments have to be made to minimize stress within such a family. Guidelines are provided to assist the therapist in dealing with these children and families. / Psychology of Education / M. Ed. (Voorligting)

published_or_final_version / Psychology / Doctoral / Doctor of Philosophy