Thesis (MA (Psychology))--University of Stellenbosch, 2007. / The South African government has legalised abortion with the intention of reducing deaths from clandestine and illegally performed abortions. With this Act came the freedom of choice regarding termination of pregnancies for most women who found themselves in the midst of unintended pregnancies and could not carry them to term. The aims of this study were to examine the process of decision making, the role of perceived support and women's psychological outcomes to abortion taking into consideration the accessibility to psychological interventions and mental stability prior to the procedure. Personal, semi-structured interviews were conducted with five women aged between 22 and 24 years who had legal, induced abortions within the first trimester of their pregnancies. Interviews were conducted within at least two months after the abortion had been performed. A qualitative analysis of the findings revealed that responses to abortion are influenced by the decision-making process, perceived social support, and the dynamics of the relationships in which the child is conceived. These factors play a vital role in the ultimate psychological outcome and adjustment to the abortion process. The women's responses involved negative and positive emotions towards the resolution of the unintended pregnancy. Negative emotions included among others, feelings of shame, embarrassment, guilt and sadness. These were associated with the loss. The predominantly expressed positive emotion was relief. The conclusion yielded was that the relationship between the two consenting adults is significant and it is influential in the decision making, perceived support and therefore the response to abortion.

Thesis (MA (Psychology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: In all or most cultures, the experience of infertility has the potential to threaten the well-being of individuals and relationships. The marital relationship of couples experiencing infertility might be impacted negatively by infertility-related stress. This study aimed primarily to examine the nature of the relationship between perceived infertility-related stress, experienced by husbands and wives in infertile couples, and four specific aspects of the marital relationship. In addition, it was examined whether there were significant differences in four specific aspects of the marital relationship between infertile couples at the onset of different types of infertility treatment, and a pregnant control group. This cross-sectional, baseline study utilised standardised self-report questionnaires to make onceoff assessments of infertility-related stress and four specific aspects of the marital relationship: communication, satisfaction with the sexual relationship, intimacy, and marital adjustment. The demographic characteristics of the participants were also recorded. A total of 84 women and 32 men from two infertility clinics in the Western Cape (N = 116) were studied. From calculating Pearson correlation coefficients, highly significant correlations (p < .001) were found between infertility-related stress and all aspects of the marital relationship as measured in this study. Multiple regression analyses revealed communication as an important predictor of aspects of the marital relationship, in addition to infertility-related stress as a predictor. ANOVAs revealed no significant differences in specific aspects of the marital relationship between the infertile groups and the pregnant control group. The findings suggest that high levels of infertility-related stress might be detrimental to the wellbeing of the marital relationship of couples experiencing infertility. In addition, the importance of communication as a buffer against the potential negative effects of infertility-related stress was emphasised. Future research should incorporate a longitudinal design and investigate the nature of the relationship between infertility-related stress and the marital relationship. / AFRIKAANSE OPSOMMING: Infertiliteit word in alle of die meeste kulture beskou as ’n krisis wat die welstand van individue en verhoudings kan bedreig. Die huweliksverhouding van pare wat infertiliteit ervaar kan negatief beïnvloed word deur infertiliteitsverwante stres. Die primêre doelstelling van hierdie ondersoek was om die aard van die verhouding tussen waargenome infertiliteitsverwante stres, soos ervaar deur die mans en vroue in infertiele pare, en vier spesifieke aspekte van die huweliksverhouding te ondersoek. Bykomend is daar ook ondersoek of daar beduidende verskille voorgekom het in vier spesifieke aspekte van die huweliksverhouding tussen infertiele pare aan die begin van verskillende tipes van infertiliteitsbehandeling en ‘n swanger kontrolegroep. Hierdie deursnee-, basislyn ondersoek het van gestandaardiseerde selfrapporteringsvraelyste gebruik gemaak ten einde eenmalige assesserings te doen van infertiliteitsverwante stres en vier spesifieke aspekte van die huweliksverhouding: kommunikasie, tevredenheid met die seksuele verhouding, intimiteit, en huweliksaanpassing. Demografiese besonderhede van die deelnemers is ook ingesamel en aangeteken. In totaal het 84 vrouens en 32 mans (N = 116) van twee infertiliteitsklinieke in die Wes-Kaap aan die ondersoek deelgeneem. Met die berekening van Pearson korrelasiekoëffisiënte is hoogs beduidende korrelasies (p < .001) gevind tussen infertiliteitsverwante stres en die vier gemete aspekte van die huweliksverhouding. Op grond van meervoudige regressieontledings het kommunikasie na vore gekom as ‘n belangrike voorspeller van aspekte van die huweliksverhouding, bykomend tot infertiliteitsverwante stres. ANOVA’s het geen beduidende verskille in spesifieke aspekte van die huweliksverhouding tussen infertiele groepe en die swanger kontrolegroep getoon nie. Die bevindinge dui daarop dat hoë vlakke van infertiliteitsverwante stres nadelig kan wees vir die huweliksverhouding van pare wat infertiliteit ondervind. Daarbenewens moet die belangrikheid van kommunikasie as ‘n buffer teen die potensiële negatiewe gevolge van infertiliteitsverwante stres beklemtoon word. Toekomstige navorsing sal baat by ’n longitudinale ontwerp en daar behoort voortgegaan te word met ondersoeke na die verband tussen infertiliteitsverwante stres en die huweliksverhouding.

Thesis (MA (Psychology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Family resilience refers to the family’s ability to overcome adversity using inherent and/or acquired strengths and resources. The aim of this study was to identify factors contributing to the successful adaptation, or resilience, of families following the birth or diagnosis of a child with a developmental disability. The study is based on the theoretical frameworks of family resilience proposed by McCubbin and McCubbin (1996) and Walsh (2003), namely the Family Resiliency Model of Family Stress, Adjustment and Adaptation and the Family Resilience Framework. The study population in this study comprised 40 families with a child with a developmental disability living in the Boland region of the Western Cape. One parent from each family was asked to complete a number of quantitative measuring instruments and answer an open-ended question aimed at identifying the strengths and resources contributing to the family’s adaptation. Quantitative data was analysed through analyses of variance, Pearson product-moment correlations and a multiple regression analysis. The qualitative data was analysed using thematic content analysis. These analyses revealed that an acceptance of the situation, positive patterns of family communication, commitment and support within the family unit, and a positive attitude with regard to new experiences and challenges facilitate family adaptation and resilience, while negative patterns of communication within the family were found to be inversely related to family adaptation. An inverse association was also found between age of the child with a disability and family adaptation. These findings suggest some possible avenues of intervention by which the adaptation of families with a child with a developmental disability in South Africa can be facilitated or supported. / AFRIKAANSE OPSOMMING: Gesinsveerkragtigheid verwys na die gesin se vermoë om terugslae en teenspoed te oorkom deur die gebruik van bestaande en aangeleerde sterktes en hulpbronne. Die doel van die huidige studie was om kwaliteite te identifiseer wat tot die aanpassing, en dus veerkragtigheid, van gesinne met ‘n kind met ‘n ontwikkelingsgestremdheid bydra. Die studie is gebaseer op die teoretiese raamwerke wat deur McCubbin en McCubbin (1996) en Walsh (2003) voorgestel is, naamlik die Family Resiliency Model of Family Stress, Adjustment and Adaptation en die Family Resilience Framework. Veertig gesinne van ‘n kind met ‘n ontwikkelingsgestremdheid wat in die Bolandgebied in die Wes-Kaap bly, het aan die studie deelgeneem. ‘n Reeks kwantitatiewe vraelyste en ‘n oopeinde-vraag is deur een ouer van elke gesin voltooi. Hierdie vraelyste en oopeinde-vraag was gerig op die identifisering van sterktes en hulpbronne wat tot die suksesvolle aanpassing van die gesin bydra. Die kwantitatiewe data is ontleed deur gebruik te maak van variansieontleding, die berekening van Pearson-produkmomentkorrelasies en meerregressie-ontledings. Die kwalitatiewe data is ontleed deur gebruik te maak van tematiese inhoudsontleding. Die kwantitatiewe en kwalitatiewe ontledings het getoon dat aanvaarding van die situasie, positiewe kommunikasie tussen gesinslede, toegewydheid tot die gesin, gesinseenheid en ‘n positiewe houding om krisisse as `n uitdaging te beskou, belangrike veerkragtigheidskwaliteite is, terwyl negatiewe en opruiende kommunikasie in die gesin omgekeerd met aanpassing verband hou. ‘n Omgekeerde verband is ook gevind tussen gesinsaanpassing en die ouderdom van die kind met ‘n gestremdheid. Hierdie bevindings kan bydra tot die ontwikkeling van ingrypingsprogramme waardeur die aanpassing van Suid-Afrikaanse gesinne met ‘n kind met ‘n gestremdheid gefasiliteer en ondersteun kan word.

Thesis (MA)-- Stellenbosch University, 2010. / ENGLISH ABSTRACT: The experience of fear is a normal phenomenon in the development of children. However, the often marginalised population of children with visual impairments, is one which has been neglected in past fear research. As far as could be ascertained, no research assessing the fears of children with visual impairments has been carried out the past 18 years, and studies within the South African context are non-existent. Previous research has suggested that children, who have a physical disability, are more prone to the development of a psychopathology than their non-disabled peers. It has also been suggested that, due to their physical limitations, children with visual impairments would express a higher prevalence of anxiety and fear. Therefore it is important to identify these children's fears, to enable those involved in their day-to-day lives to gain a greater understanding of their emotional world. The present study aimed to determine whether significant differences exist between the fear profiles of middle-childhood South African children with visual impairments when compared to their sighted counterparts. A differential research design was employed, and results were examined across the four independent variables of gender, age, culture, and vision. A total of 129 assenting children from three schools in the Western Cape participated in the present study, including 67 children with varying degrees of visual impairments, and 62 gender- and age-matched controls. All the children were administered a short biographical questionnaire and Burkhardt's (2007) child friendly South African Fear Survey Schedule for Children (FSSC-SA). The administration of these measures was adapted according to the children's degree of visual impairment. Results of the FSSC-SA indicated that the most feared item for the children with visual impairments was “Fire - getting burned”, while the children without visual impairments feared “Getting HIV” the most. The 10 most common fears related mainly to situations in which the possibility of danger and harm is present, with the majority of fears loading onto Factor I (fear of danger and death) of the FSSC-SA. Consistent with previous research, gender differences were apparent across number, level, and pattern of fear, with girls consistently being more fearful than boys. There was no significant relationship between age or culture and self-reported fear. In terms of the three sub-groups of visually impaired children, the children with severe visual impairment reported the highest number and level of fear. However, in general terms, the fear profiles of the two overall groups (children with and children without visual impairments) did not differ significantly, thus showing that the worlds, in which these children live, are not as different as was originally anticipated. In conclusion the present study's contributions as well as shortcomings are discussed, along with recommendations for future research. / AFRIKAANSE OPSOMMING: Vrees is 'n normale ervaring tydens die ontwikkeling van kinders, alhoewel die gemarginaliseerde populasie van kinders met visuele gestremdhede een is wat dikwels in navorsing oor vrees afgeskeep is. So ver as wat die navorser kon vasstel, is geen studies oor hierdie populasie die afgelope 18 jaar uitgevoer nie, en studies binne die Suid-Afrikaanse konteks bestaan glad nie. Vorige navorsing stel voor dat kinders met gestremdhede meer geneig is tot die ontwikkeling van psigopatologie as kinders sonder 'n gestremdheid in hul portuurgroep. Daar is ook voorgestel dat kinders met visuele gestremdhede as gevolg van hul fisieke beperkinge meer vrees en angs sal toon. Dit is dus belangrik om hierdie kinders se vrese te identifiseer, sodat die mense wat by hul alledaagse lewe betrokke is, 'n beter begrip vir hul emosionele wêreld kan hê. Die doel van die onderhawige studie was om vas te stel of daar beduidende verskille tussen die vreesprofiele van middelkinderjare-kinders met visuele gestremdhede bestaan in vergelyking met hul siende portuurs. Die studie het 'n differensiële navorsingsontwerp gevolg, en die resultate is bestudeer aan die hand van vier onafhanklike veranderlikes, naamlik geslag, ouderdom, kultuur en visie. 'n Totaal van 129 instemmende kinders van drie skole in die Wes-Kaap het deelgeneem aan die onderhawige studie. Die steekproef het 67 kinders met verskillende vlakke van visuele gestremdheid ingesluit, sowel as 62 kinders van vergelykbare ouderdom en geslag in die kontrolegroep. Die deelnemers moes 'n kort biografiese vraelys invul, sowel as Burkhardt (2007) se kindervriendelike Suid-Afrikaanse Vreesopnameskedule vir Kinders (FSSC-SA). Die toepassing van die meetinstrumente is aangepas volgens die kinders se graad van visuele gestremdheid. Resultate van die FSSC-SA het getoon dat kinders met visuele gestremdhede die meeste vrees getoon het vir “Vuur - om te verbrand”, terwyl die mees gevreesde item vir die kinders sonder visuele gestremdhede, die vrees “Om MIV op te doen” was. Die 10 algemeenste vrese het veral verband gehou met situasies waar daar 'n moontlikheid bestaan van gevaar of seerkry, en die meeste van hierdie items het meestal op Faktor I (vrees vir gevaar en die dood) gelaai. In ooreenstemming met vorige navorsing, het geslagsverskille duidelik geblyk ten opsigte van die aantal, vlak en patroon van vrees, met dogters wat konsekwent meer vrees as seuns vermeld het. Daar was geen beduidende verhouding tussen ouderdom of kultuur en self-gerapporteerde vrese nie. Ten opsigte van die drie subgroepe waarin die kinders met visuele gestremdhede ingedeel was, het die kinders met 'n ernstige visuele gestremdheid die hoogste aantal en vlakke van vrees gerapporteer. Oor die algemeen het die vreesprofiele van die twee oorhoofse groepe (kinders met en kinders sonder visuele gestremdhede) nie beduidend verskil nie, en dus blyk dit dat die wêrelde waarin hierdie twee groepe leef, nie so verskillend is as wat aanvanklik gedink is nie. Ten slotte, word die waarde en tekortkominge van die onderhawige studie bespreek, sowel as aanbevelings vir toekomstige navorsing voorgestel.

Digitized using a Konica Minolta 211 PCL Scanner. 300dpi (OCR). / Thesis (MA (Psychology))--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: Most portrayals in the media, research and clinical literature of teenage pregnancy and motherhood concentrate on the negative consequences for the teenager, the baby and society. Although these portrayals do capture the experience of some of the cases, they fail to grasp the complexity of these teenagers' life choices and the alternative positive impact teenage pregnancy and motherhood may have on their lives. This qualitative study focuses on the autobiographical narrative of the teenager as she experiences pregnancy and becomes a mother. The sample consists of eight participants from a rural community outside Stellenbosch, South Africa. One pre-birth interview as well as three interviews after the birth of the baby were audio taped and transcribed. Responses showed significant data with regards to the impact of the emotional experience of teenage pregnancy and motherhood on the teenager, as well as her experience of herself, changes in her life as well as the nature of the pregnancy and motherhood experience. To date, the literature does not account for the unique and individual nature of how teenage pregnancy and motherhood impacts the individual. In contrast, this research illustrates the changes in the thoughts, emotions and behaviours of teenagers when they become mothers. / AFRIKAANSE OPSOMMING: Die meeste uitbeeldings in die media, navorsing en kliniese literatuur met betrekking tot tiener swangerskap en moederskap fokus op die negatiewe gevolge vir die tiener, die baba en die samelewing. Alhoewel hierdie uitbeeldings tog die ervaringe van sekere van die gevalle verteenwoordig, misluk dit om die kompleksiteit van die tieners se lewenskeuses vas te vang, asook die alternatiewe positiewe impak wat tiener swangerskap en moederskap op hulle lewens kan hê. Hierdie kwalitatiewe studie fokus op die outobiografiese naratiewe van die tieners soos hulle swangerskap en moederskap ervaar. Die deelnemers bestaan uit agt tieners vanuit 'n plaasgemeenskap buite Stellenbosch, Suid-Afrika. Een onderhoud tydens die tiener se swangerskap sowel as drie onderhoude na die geboorte van die baba is opgeneem en getranskribeer. Betekenisvolle data ten opsigte van die impak van die emosionele ervaring van tiener swangerskap en moederskap, asook die tiener se ervaring van haarself, veranderinge in haar lewensstyl en die aard van die swangerskap en moederskap ervaring het duidelik na vore gekom in die onderhoude. Tot op hede neem die literatuur nie die unieke en individuele aard van hoe tiener swangerskap en moederskap die individu beinvloed, in ag nie. In teenstelling illustreer hierdie navorsing die veranderinge in die denke, emosies en optrede van die tieners soos hulle moeders word.

Digitized using a Konica Minolta 211 PCL Scanner. 300dpi (OCR). / Thesis (MA (Psychology))--University of Stellenbosch, 2006. / AFRIKAANSE OPSOMMING: Hierdie studie ondersoek die uitvoerbaarheid van die implementering van 'n benadering genaamd Kort Motiverende Onderhoud (KMO) in die konteks van die behandeling van tuberkulose (TB) in Suid-Afrika. TB is 'n ernstige bedreiging vir wereldwye gesondheid en is nog nie onder beheer gebring nie, ten spyte van die feit dat dit geneesbaar is. Sedert die beskikbaarheid van effektiewe medisyne-middels, is die oorsaak vir die voortdurende verspreiding van die siekte gesien as 'n probleem van gebrekkige deurvoerbaarheid van die behandeling. Hierdie eng begrip van die epidemie is deur die psigologiese en sosiale wetenskappe, asook andere, verbreed. Daar is baie debatering oor en om die onderwerp van deurvoerbaarheid en die internasionale TB beheer beleid, bekend as Direkte Observerings-Behandeling, Kortkursus (DOBK). Sekere deskundiges argumenteer dat DOBK 'n onvoldoende respons is tot die uitdaging van die verbetering van deurvoerbaarheid en die kontrolering van TB. Dit skyn asof die meelewende aspekte van die TB behandeling nagelaat word in die TB beleide en protokol en sommige beweer dat hierdie faktor sowel as gebrekkige aandag aan ander sistemiese faktore verantwoordelik is vir swak programuitvoering. Suid-Afrika is 'n voorbeeld hiervan, waar die kommunikasie tussen verpleegsters en TB pasiente beskryf word as outoriter, verpleegstergesentreerd en taakgeorienteerd. 'n Pasientgesentreerde benadering (PGB) is 'n wyse waarop die pasientversorger kommunikasie en die bevredigingsvlak van die pasient bevorder word en sommige promoveer dit as a wyse om die behandelingsdeurvoerbaarheid en genesingsuitkomste te verbeter. Die uitdaging is egter dat die konsep van 'pasientgesentreerdheid' op verskeidenheid van wyses geinterpreteer en geimplimenteer kan word. KMO is 'n PGB tot kommunikasie wat bestem is om 'n gees van samewerking te bevorder en om mense se gemengde gevoelens oor gedragsverandering by te le. KMO as 'n aanpassing van Motiverende Onderhoudvoering, is 'n spyskaart van konkrete vaardighede of middels wat gesondheidsvoorsieners in onderhoude rakende geneeskundige gedragsverandering kan gebruik. KMO is gebaseer op teoriee oor gedragsverandering en word gebruik in 'n wye verskeidenheid van genesingsbehandeling, insluitende deurvoerbaarheidsbehandeling. Alhoewel dit selde in minder ontwikkelende lande toegepas is en nog nooit in TB, is KMO suksesvol toegepas in ander besige kontekste vir gesondheidsvoorsiening. Die ontwerp van die huidige studie oor die lewensvatbaarheid van KMO in die konteks van TB behandeling in Suid-Afrika het ontstaan uit die ontwerp van 'n groter studie wat ander intervensies vir 'n PGB ingesluit het. Die doelstellinge van die huidige studie was om die konteks te beskrywe en wat gebeur het gedurende die intervensietydperk en om die uitvoerbaarheid van KMO te verduidelik. / ENGLISH ABSTRACT: This thesis explores the feasibility of implementing an approach called Brief Motivational Interviewing (BMI) in the context of tuberculosis (TB) treatment in South Africa. TB is a serious threat to global health and has not been controlled despite the fact that it is curable. Ever since effective drugs became available, continued spread of the disease has been understood as a problem of poor adherence to treatment. This narrow understanding of the epidemic has been broadened by psychological and social science perspectives among others. There has been much debate around the topic of adherence and the international TB control policy known as Directly Observed Treatment, Short-course (DOTS), as some suggest that it is an incomplete response to the challenge of improving adherence and controlling TB. The caring aspects of TB treatment seem to be neglected in TB policies and protocols, and some argue that this and the lack of attention to other systemic factors are responsible for poor programme performance. South Africa is an example of this, where the communication between nurses and TB patients has been described as authoritarian, nursecentred and task-oriented. A patient-centred approach (PCA) is a way of improving patient-provider communication and patient satisfaction, and some promote it as a way of improving treatment adherence and health outcomes. The challenge, however, is that the concept of 'patient-centredness' can be interpreted and implemented in a variety of ways. BMI is a PCA to communication that is designed to promote a spirit of collaboration and resolve people's mixed feelings about behaviour change. An adaptation of Motivational Interviewing, BMI is a menu of concrete skills or tools that health providers can use in consultations about health behaviour change. BMI is based on theories about behaviour change and has been used to address a wide variety of health behaviours, including treatment adherence. Although seldom applied in less developed country settings and never before applied in TB, BMI has been successfully applied in other busy health care settings. The design of the present study of the feasibility of BMI in the context of TB treatment in South Africa evolved within the design of a larger study that included other interventions designed for a PeA. The present study aims were to describe the context and what happened during the intervention period and to describe BMI's feasibility. Using elements of participatory action research, BMI communication training was developed and implemented with TB staff based in four urban primary health care facilities. A grounded theory approach was used to describe the dynamics of the implementation process and generate a theory about what made BMI more or less feasible in this context. A multidisciplinary team contributed to the study design. Data were gathered largely through participant observation, focus groups and key informant interviews and generated volumes of diverse materials including field notes, training materials, video and audio-taped interactions. The data were analysed using the inductive approach to grounded theory analysis promoted by Glaser (1992) and relied on theoretical sampling and constant comparative analysis. The quality and trustworthiness of the data were ensured through an emphasis on researcher reflexivity and triangulation of the perspectives of different materials, participants and health facilities. The study was implemented as a pilot BMI training process at one facility in Port Elizabeth (Eastern Cape Province) followed by expanded training targeting TB staff of three facilities in Cape Town (Western Cape Province). Data analysis resulted in a categorised description of the research settings, the interactions and relationships among patients, providers, managers and researchers, the training interventions and the way participants responded to it during each phase of the process. Although seemingly similar at the outset, analysis began to show that dynamics of implementation at each facility were complex and multidimensional. The categories that were generated during each cycle of implementation were used to shape the categories selected for the next. Examining the categories across the four health facilities yielded a grounded theory with seven core categories regarding the role of: (1) the personal qualities of the TB staff involved, (2) the way staff moved in and out of the TB service, (3) the leadership, hierarchy and staff dynamics in the health facilities, (4) the pressurised working conditions of TB staff, (5) the poverty of patients, (6) mismatches between the TB programme's protocols and BMI, and (7) the capacity of staff to innovate and improve care. These findings are discussed in terms of the way they respond to the study's research questions and the way the grounded theory categories relate to each other. Their significance is understood from a social constructivist perspective as bound within the context of the study. The findings are also compared to the theoretical perspectives included in the study design and new literature on the diffusion of innovations in service organisations. Recommendations are made for future context-focused research and adherence related intervention development. If interventions like BMI are to be implemented successfully in contexts such as those included in this thesis, policy-makers and managers need to consider the ways in which working conditions, policies and protocols and patient poverty may be counter-productive, and focus on the innovative potential of health staff and teams for delivering patient-centred care.

Digitized using a Konica Minolta 211 PCL Scanner. 300dpi (OCR). / Thesis (MA (Psychology))--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The first objective of the present study was to determine whether the Theory of Planned Behaviour (TPB) could predict Willingness to Participate (WTP) in a future Phase III HIV vaccine trial among high risk adolescents in the Western Cape. The second objective was to determine whether the additional predictor variables of Self perceived risk of HIV infection, Knowledge of HIV vaccines and HIV vaccine trials, Attitudes toward HIV I AIDS and Health-promoting behaviours could further explain WTP in a future Phase III HIV vaccine trial among adolescents. A convenience sample of 224 adolescents attending secondary schools located in an African township on the Cape Flats was recruited for the present study. Hierarchical logistic regression analyses indicated that the TPB significantly improved the prediction of WTP in an HIV vaccine trial. Prediction success was 79.9%. Of all the predictor variables, only Subjective norms significantly predicted WTP in an HIV vaccine trial (OR = 1.19,95% C.L = 1.06-1.34). A second stepwise logistic regression analysis showed that Subjective norms (OR = 1.19, 95% c.I. = l.07-1.34) and Attitude towards participation in an HIV vaccine trial (OR = 1.32,95% C.L = 1.00-1.74) were significant predictors of WTP in an HIV vaccine trial. Prediction success was 80.4%. These findings provide support for the Theory of Reasoned Action (TRA) and suggest that psychosocial factors may play a role in WTP in a future Phase III HIV vaccine trial among adolescents. HIV vaccine trial preparedness programs targeting adolescents should aim to influence group norms positively and promote positive attitudes toward participation in a future Phase III HIV vaccine trial. / AFRIKAANSE OPSOMMING: Die eerste oogmerk van die huidige studie was om te bepaal of die teorie van beplande gedrag (TBG) die bereidwilligheid tot deelname (BTD) aan 'n toekomstige fase III-MIV-entstofproefneming onder hoe risiko adolessente in die Wes-Kaap kan voorspel. Die tweede oogmerk was om te bepaal of die bykomende voorspellingveranderlikes, naamlik selfwaargenome risiko vir MIV -besmetting, kennis van MIV -entstowwe en MIV -entstofproefnemings, houdings jeens MIV /Vigs en gesondheidsbevorderende gedrag BTD in 'n toekomstige fase III-MIV entstofproefneming kan verduidelik. 'n Geriefsmonster van 224 adolessente wat sekondere skole gelee in 'n dorpsgebied in Kaapstad, bywoon, is vir die huidige studie gewerf. Hierargiese logistiese regressie-analises toon dat die TBG die voorspelling van BTD aan 'n MIV -entstofproefneming aanmerklik verbeter het. Voorspellingsukses was 79.9%. Van al die voorspellingveranderlikes het slegs subjektiewe norme BTD aan 'n MIV -entstofproefneming beduidend voorspel (RK = 1.19, 95% VI = 1.06-1.34). 'n Tweede stapsgewyse logistiese regressie-analise toon dat subjektiewe norme (RK = 1.19, 95% VI = 1.07-1.34) en houding jeens deelname aan 'n MIV-entstofproefneming (RK = 1.32,95% VI = 1.00-1.74) beduidende voorspellers van BTD aan 'n MIV -entstofproefneming was. Voorspellingsukses was 80.4%. Hierdie bevindinge verleen steun aan die teorie van beredeneerde aksie (TBA) en doen aan die hand dat psigososiale faktore moontlik in die toekoms 'n rol in BTD aan 'n fase Ill-MIV-entstofproefneming onder adolessente kan speel. Programme wat op adolessente se gereedheid vir entstofproefnemings afgestem is, behoort te poog om groepnormne positief te beinvloed en positiewe houdings jeens deelname aan 'n toekomstige fase III -MIV -entstofproefneming te bevorder.

Thesis (MA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Treatment outcome research strives towards objective estimates of disorder-specific treatment efficacy and has been applied to most psychiatric disorders. However, due to shortcomings in outcome research designs, problems still remain regarding the interpretation and generalisability of treatment outcomes. This is despite the development of research methodology criteria such as the Gold Standards, currently viewed as essential criteria for well-controlled cognitive-behavioural outcome research. The objectives of this assignment are (a) to assess the Gold Standards as criteria for treatment outcome research by means of a qualitative overview and evaluation of exposure treatment studies for PTSD, and (b) to make recommendations for the expansion and/or modification of these criteria. An assessment of five selected treatment outcome trials, based on the Gold Standards, showed significant limitations in the scope of the Gold Standards regarding (a) the inclusion of target symptoms in the research hypotheses, (b) estimates of treatment adherence, (c) guidelines for statistical analyses of attrition points, (d) the ethical implementation of exposure treatment, and (e) estimates of significant clinical change. It is concluded that the Gold Standards are not sufficient to ensure valid and reliable treatment outcomes. Recommendations are made for the expansion of four of the existing Gold Standards parameters and three additional criteria are proposed. Key words: treatment outcome research, Gold Standards, post-traumatic stress disorder, exposure therapy. / AFRIKAANSE OPSOMMING: Navorsing oor behandelingsuitkoms streef na objektiewe resultate oor die uitkoms van behandeling vir spesifieke psigiatriese versteurings. Nogtans, weens tekortkominge in die ontwerp van uitkomsstudies, word talle probleme steeds ervaar met die interpretasie en veralgemeenbaarheid van die resultate van die studies. Dit is die geval ten spyte van die ontwikkeling van navorsingskriteria soos die "Gold Standards" wat huidig as die belangrikste kriteria vir uitkomsstudies op die gebied van die kognitiewe gedragsterapie aanvaar word. Hierdie projek het ten doelom (a) die Gold Standards as kriteria vir uitkomsnavorsing te assesseer deur middel van 'n kwalitatiewe oorsig en evaluering van vyf geselekteerde uitkomsstudies van blootstellingsterapie vir post-traumatiese stresversteuring, en (b) om aanbevelings te maak ter aanvulling enJofwysiging van die Gold Standards. Evaluasie van die studies het betekenisvolle beperkings in die Gold Standards se omvattenheid uitgelig in terme van (a) die insluiting van teikensimptome in die navorsingshipoteses, (b) die skatting van behandelingvoitrekking ("treatment adherence"), (c) riglyne vir die statistiese analise van data oor attrisie, (d) die etiese implementering van blootstellingsterapie, en (e) skattings van betekenisvolle kliniese verandering. Dit blyk dat die Gold Standards nie voldoende is om geldige en betroubare resultate oor behandelingsuitkomste te verseker nie. Aanbevelings word gemaak vir die hersiening van vier van die Gold Standards kriteria en drie addisionele kriteria word voorgestel. Sleutelwoorde: behandelingsuitkomsnavorsing. Gold Standards, post-traumatiese stresversteuring, blootstellingsterapie.

Thesis (MSc)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Differences between the therapist and the client such as differing genders, social classes, races, cultures and languages, inevitably influence the therapeutic situation. This research assignment reviews the literature available concerning multicultural counselling. the variables which therapists contend with in a multicultural therapeutic situation and the state of multicultural therapy in South Africa. The main body of this assignment focuses on the training experiences. as well as the countertransfcrential experiences. of therapists from a minority group with specific attention given to South African Chinese therapists. Also included are helpful ways of addressing the potential difficulties that arise in a therapeutic relationship where the culture or race of the therapist and client differ. In closing, this assignment asks what gaps exist in the literature with regard to South African Chinese therapists and what further research would be required to fill these gaps. / AFRIKAANSE OPSOMMING: Verskille tussen die terapeut en die kliënt. soos verskillende geslagte. sosiale klasse. rasse. kulture en tale. beïnvloed die terapeutiese situasie onvermydelik. Hierdie navorsingsopdrag hersien die literatuur wat beskikbaar is ten opsigte van multikulturele voorligting. die veranderlikes waarmee terapeute te doen kry in 'n multikulturele terapeutiese situasie en die toestand van multikulturele terapie in Suid- Afrika. Die vernaamste deel van hierdie opdrag fokus op die opleidingservarings. asook die teenoordragervarings. van terapeute wat van 'n minderheidsgroep afkomstig is, met spesiale aandag aan Suid-Afrikaanse Chinese terapeute geskenk. Ook ingesluit is nuttige maniere om die potensiele struikelblokke wat in 'n terapeutiese verhouding ontstaan. waar die kultuur of ras van die terapeut en kliënt verskil. aan te spreek. Om afte sluit. hierdie opdrag bevraagteken die leemtes wat voorkom in cl ie Iiteratuur met betrekk ing tot Su id-A Crikaanse Ch inesc terapeute en watter verdere navorsi ng sal benodig word om hierdie leemtes te vul.

Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Two recent local studies of relapse among individuals who had attended inpatient alcohol rehabilitation programmes in the Western Cape found relapse rates of up to 60%. A high incidence of comorbid anxiety, low self-efficacy and avoidant coping style were principal reasons cited for relapse. The following literary review was undertaken in an effort at better understanding current findings on the comorbid relationship between alcohol abuse/dependency and anxiety, and on dysfunctional coping styles and relapse. It also reviews current literature and theory concerning the treatment of alcoholics using the Relapse Prevention (RP) model of therapy. Based on these findings, recommendations are made for the application of RP to the clinical psychology groups run for alcohol abusing/dependent inpatients at Neuro Clinic D, Stikland Hospital, Western Cape. Relapse Prevention Therapy was selected because of its integrated approach to addressing both substance abuse and the inadequate coping styles that often render people vulnerable to anxiety, depression and relapse. It was also chosen because of the more constructive, less punitive approach it takes to substance dependence/abuse and the issue of lapses and relapse. The recommendations made in this review should not, in any way, be seen as criticism of the existing programme at Neuro Clinic D. They are, essentially, the individual reflections of the author based on the four months he spent conducting clinical psychology groups in the unit and the findings of two local studies that looked at some of the reasons for relapse following treatment in this and other local facilities. The specific focus on the groups run by clinical psychologists should also not be seen as ignoring the important and valuable work done by other professionals in the unit; notably those in psychiatry, nursing, social work, occupational therapy and pastoral care. On the contrary, information gathered by these professionals is vital to the team effort of rehabilitation, and the identification of psychosocial stressors and cognitive patterns that place people at risk of relapse. / AFRIKAANSE OPSOMMING: Twee onlangse plaaslike studies van terugvalonder pasiënte wat binnepasiëntalkoholrehabilitasieprogramme in die Weskaap bygewoon het, het terugvalkoerse van tot 60% gerapporteer. 'n Hoë voorkoms van komorbiede angs, lae sin van self-vermoë en 'n vermydende streshanteringstyl was die hoofredes aangevoer vir die terugval. Die volgende literatuur-oorsig is onderneem in 'n poging tot 'n beter begrip van huidige bevindinge oor die komorbiede verhouding tussen alkoholmisbruik/afhanklikheid en angs, en oor wanfunksionele streshanteringstyle en terugval. Die oorsig beskou ook huidige literatuur en teorie aangaande die behandeling van alkoholiste deur middel van die Relapse Prevention (RP) model (Terugvalvoorkomingsmodel) van terapie. Op grond van hierdie bevindinge word aanbevelings gemaak VIr die toepassing van RP op die kliniese-sielkundegroepe aangebied VIr alkoholmisbruikende/afhanklike binnepasiënte by Neurokliniek D, Stiklandhospitaal, Weskaap. RP is gekies op grond van sy geïntegreerde benadering tot beide substansmisbruik en die onvoldoende streshanteringstyle wat dikwels mense kwesbaar maak vir angs, depressie en terugval. Die model is ook gekies as gevolg van die meer konstruktiewe, minder strafgerigte benadering tot substansafhanklikheid/misbruik en tot val en terugval. Die aanbevelings in hierdie oorsig moet in geen opsig beskou word as kritiek op die bestaande programme in Neurokliniek D nie. Hulle is, in wese, die individuele gevolgtrekkings van die skrywer gebaseer op sy vier maande ondervinding met sielkundegroepe in die eenheid en op die bevindinge van twee plaaslike studies wat ondersoek ingestel het na sommige van die redes vir terugval na behandeling in hierdie en ander plaaslike fasiliteite. Die spesifieke fokus op die groepe wat deur kliniese sielkundiges bestuur word moet ook nie gesien word as 'n geringskatting van die belangrike werk van ander professionele mense in die eenheid nie, in die besonder dié in psigiatrie, verpleging, maatskaplike werk, arbeidsterapie and pastorale sorg. In teendeel, inligting ingesamel deur hierdie mense is lewensbelangrik vir die spanpoging van rehabilitasie, en vir die identifisering van psigo-sosiale stressors en kognitiewe patrone wat pasiënte vatbaar maak vir terugval.