Thesis (MA)--University of Stellenbosch, 2002. / ENGLISH ABSTRACT: This study explores patterns of separation and/or connection in the narratives of the respondent, a female farm worker living and working in the Western Cape, South Africa. The major objective of this qualitative case study is to examine the possible construction, co-existence and interaction of separation-connection themes in the reality of the respondent. Founded within the social constructivist tradition, an approach that assumes reality to be constructed through language and within relationships, a window on the respondent's narrative construction of her reality, relationships and separation-connection processes was obtained. To compliment the explorative nature and social constructionist approach of the study, Grounded Theory and Narrative Analysis were administrated. Through the analysis the two central themes, separation and connection, manifested on two different levels - firstly on a content level (what the participant has to say regarding the themes) and secondly on a process level (what is happening between participant and researcher). Findings provided a preliminary understanding of the techniques the respondent implores to construe a sense of separation and connection. Results confirmed the co-existence of separation-connection themes and indicated a possible interaction between the two constructs. Findings also provided a glimpse on the experiences and impact of the separation-connection process in the idiom of the respondent. / AFRIKAANSE OPSOMMING: Die studie belig patrone van binding en/of skeiding in die narratiewe van die respondent, In vroulike plaaswerker in die Wes-Kaap, Suid-Afrika. Dié kwalitatiewe gevallestudie is gerig op In ondersoek van die potensiële konstruksie, naasbestaan en interaksie van binding- en/of skeidingstemas soos wat die respondent dit beleef en verwoord. Deur die fundering van die navorsing in die sosiaal-konstruktivistiese tradisie, In benadering wat glo dat die realiteit in verhoudings via taal gekonstrueer word, is toegang tot die respondent se narratiewe konstruksie van haar realiteit, verhoudings en binding- en/of skeidingstemas verkry. In ooreenstemming met sosiaal-konstruktivistiese aannames, het die data-analise Narratiewe Analise en Grounded Theory metodiek behels. Met behulp van die ontleding het die twee sentrale konsepte, binding en skeiding, op twee vlakke gemanifesteer - eerstens op In inhoudsvlak (dit wat die respondent daaroor vertel) en tweedens op In prosesvlak (dit wat tussen die respondent en die onderhoudvoerder gebeur). Die resultate bied In voorlopige verstaan van die wyses waarop die respondent binding en/of skeiding konstrueer. Bevindings bevestig die naasbestaan van binding- en skeidingstemas en dui op In moontlike interaksie tussen dié twee konstrukte. Die studie verskaf ook In blik op die respondent se ervaring van die konstrukte in haar eie idioom.

Thesis (DSc (Psychology))--University of Stellenbosch, 2007. / Fears are a normal part of development but excessive fears may interfere with daily functioning and may reflect serious anxiety problems. In order to determine whether fears are excessive or not, as well as to implement prevention programmes, an assessment instrument is needed that is socially and scientifically relevant to the context in which the child lives. Furthermore, normative data is necessary in order to understand the concept of fear. The primary aim of the study was to develop a measuring instrument that is scientifically and socially relevant within the South African context. This entailed a qualitative stage where semi-structured interviews were conducted with 40 middle childhood children attending four local primary schools in the Stellenbosch area. These interviews were transcribed and analysed for emerging themes. The emerging themes were then added to the existing Fear Survey Schedule for Children-Revised (FSSC-R). Reliability analyses were conducted on the data obtained by the adapted FSSC-R. Item-total correlations and exploration of the item construct resulted in 23 items being deleted. The remaining items on the scale demonstrated good internal consistency (α = 0,97). The factor structure of the remaining items was explored by means of principal factor analysis with varimax rotation. Various factor solutions were explored and the five-factor solution was found to be the best conceptual fit for the data. The five factors are: Factor I-Fear of Danger and Death, Factor II-Fear of the Unknown, Factor III-Worries, Factor IV-Fear of Animals, Factor V-Situational Fears. The adapted scale is a South African version of Ollendick’s FSSC-R and is referred to as the FSSC-SA. The secondary aim was to determine the content, number, level and pattern of fear of a selected group of middle childhood South African children, living in the Western Cape, based on the results of the South African Fear Survey Schedule for Children (FSSC-SA). This entailed a quantitative stage. The adapted FSSC-R was completed by 646 middle childhood children between the ages of 7 and 12 years, attending four primary schools in the Stellenbosch area in the Western Cape Province. The participants were also requested to complete a biographical questionnaire before they completed the adapted FSSC-R. Culture was defined with respect to the main representative cultural communities in the Stellenbosch area, namely black, coloured and white. The results of the South African fear instrument indicate that the most feared item for the South African children is ‘getting HIV’. The ten most common fears indicate that fears are to a certain extent universal but that some fears also reflect the context in which a child lives. Furthermore the added items also featured among the most fear eliciting items suggest that these items reflect the societal concerns, issues and fears of South African children. Black South African children displayed the highest number as well as level of fear, followed by the coloured South African children and then the white South African children. This was also applicable to the pattern of fear. Gender differences are apparent with respect to number, level and pattern of fears with girls consistently expressing more fears than boys. This applies to all cultural groups. In conclusion, implications of the present study’s results in the South African context as well as shortcomings and recommendations for future studies are discussed.

Thesis (DPhil (Psychology))—University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Extensive research over the past 30 years has shown that reliable, sensitive, responsive and empathic care of the infant by the mother or mother-substitute in the early months facilitates the development of secure attachments in infants, and ultimately their healthy development towards competent adulthood and future relationships with others. This study analyses interviews with 17 mothers selected from an intervention proven successful by means of a randomized controlled trial. The intervention took place in Khayelitsha, a peri-urban settlement close to Cape Town, South Africa, and was delivered by previously untrained lay counsellors to at risk mothers and infants. Supervision and training of the counsellors was provided by the author. Mothers were purposively selected on the basis of being experienced by counsellors as easy, difficult to reach, young/immature mothers and HIV-positive mothers, and were interviewed by a clinically trained interviewer not involved in the project individually and in groups. Counsellors’ process notes, exploring the impact, relevance and meaning that the intervention had for the recipient mothers, as well as the supervisor’s notes were also used as data. The findings identify what changes mothers reported, their experiences of the intervention, cultural issues in the intervention, and mothers’ suggestions for modifications to the programme. The results are discussed in light of theories of change emerging from the literature on psychotherapy change research and research on community-based interventions. The study shows that though results of randomized controlled trials are necessary for policy planning, in-depth interrogation of the design and process issues at stake in complex community-based studies yield complementary data which are also important to consider. Finally, the study considers the implications of this understanding of process for the future dissemination of the training and application of this programme, as well as policy, research and funding challenges. / AFRIKAANSE OPSOMMING: Wydstrekkende, uitgebreide navorsing van die afgelope 30 jaar toon dat betroubare, sensitiewe, aandagtige en empatiese sorg vir die peuter deur die moeder of moeder-plaasvervanger, die vorming van veilige bindings, sowel as die uiteindelike gesonde ontwikkeling van bevoegde volwassenheid en toekomstige verhoudings met andere fasiliteer. Hierdie studie analiseer onderhoude met 17 moeders, gekies uit 'n intervensie wat bewys is deur middel van 'n ewekansige kontrole toetsing. Die intervensie het plaasgevind in Khayelitsha, 'n peri-stedelike nedersetting naby Kaapstad, Suid-Afrika, en is uitgevoer deur voorheen onopgeleide vrywilliger beraders wat moeders en peuters wat blootgestel is aan risiko bedien. Supervisie en opleiding van die beraders is deur die outeur voorsien. Moeders is vooraf uitgekies deur die beraders, volgens die criteria: maklik en moeilik bereikbaar, jong/onvolwasse moeders, en HIV positiewe status. 'n Klinies opgeleide onderhoudvoerder wat onbetrokke is by die res van die projek het met die moeders individueel en in groepskonteks onderhoude gevoer. Beraders se prosesnotas wat die impak, relevansie en betekenis van wat die invervensie vir die moeders ingehou het, sowel as die supervisor se notas is ook gebruik as data. Die bevindings is bespreek in die lig van veranderingsteorieë wat uit die literatuur oor psigoterapie veranderingsnavorsing, sowel as navorsing oor gemeenskapsgebaseerde intervensies vorendag gekom het. Die studie toon dat hoewel bevindings van ewekansige kontrole toetsing nodig is vir beleidsbeplanning, in-diepte ondersoek van die proses en ontwerp kwessies ter sake in komplekse gemeenskapsgebaseerde studies komplimentêre data lewer wat ook belangrik is om in ag te neem. Ten laaste oorweeg die studie die implikasies van hierdie ondersoek van proses vir toekomstige disseminasie van die opleiding en toepassing van hierdie program, sowel as beleid, navorsing en befondsings uitdagings.

Thesis (DPhil (Psychology))—University of Stellenbosch, 2007. / Very little is known about the experiences of black children living in poverty in South Africa. This compromises the delivery of appropriate psychological services. This dissertation considers the contribution that psychoanalytic infant observation might make to a needs assessment process within the community psychology paradigm. To date, infant observation has predominantly been used for training psychotherapists and other professionals in Western contexts. The goal of the present project was to conduct a "classical" observation of a mother and child in a lowincome South African community in the first year of the infant's life, in order to ascertain what kind of description it would yield. The question was whether such a description is useful for the needs assessment process, and ultimately, whether infant observation is a viable tool for psychologists working in low-income communities in South Africa. The study was set in a poor, semi-rural, so-called coloured township in the Western Cape. The data were analysed using an intersubjective psychoanalytic lens and a social constructionist grounded theory approach. In overview, the findings relate to two main areas, namely a) the nature and content of the resultant description, and b) the effect of the process. The analysis of the case material showed that the observation produced an extremely detailed account of the experience of poverty and oppression, involving the way in which it influences all relationships, including the one between mother and child. The knowledge gained offers clear pointers to the kind of intervention that would benefit the particular infant in the present study, and potentially other infants in vulnerable social contexts as well. One surprising outcome was the extensive way in which the observation functioned therapeutically for the whole family. It is therefore concluded that infant observation can provide a very rich contribution to low-income communities on a number of levels, if it is able to make both the theoretical and practical adjustments needed. It is thus argued that it is necessary to look at infant observation in more critical ways, both in terms of how it has traditionally been conceptualised and how it is and can be applied across all contexts.

Thesis (DPhil (Psychology))--University of Stellenbosch, 2006. / South Africans are often subjected to violence and trauma. However, many can tell stories that speak of resilience in the face of trauma. Against this background, this social constructionist study aims 1) to contribute to the growing body of knowledge of the consequences of trauma, as well as of resilience, in a low-income community in South Africa; and 2) to describe a narrative therapy approach to trauma - an approach that is thought to emphasise context, resilience, empowerment and ecological well-being. The study was set in the high-violence community of Lavender Hill, with participants being individuals or families exposed to violence. Interviews guided by ideas and practices of narrative therapy were used to gather data about trauma and resilience in this community. In an effort to establish how trauma and resilience were constructed by participants themselves, first and last interviews were analysed, using constructivist grounded theory. The areas of concern were: i) the daily impact of trauma on thoughts, emotions and behaviour; ii) the conflict between speaking out and staying silent; and iii) the impact of trauma on relationships with self, others and God. These became the main categories for the discussion of the consequences of trauma. Findings supported the notion that persons working with trauma survivors in South Africa should be aware of how complex, multi-layered and context-bound the consequences of trauma are when they design interventions. To reach the second aim of the study, the application of narrative therapy ideas and practices were described by focusing on five case studies. The case studies were discussed in relation to different notions of recovery and therapeutic change. Emphasis was placed on double-storied accounts of trauma that included attending to alternative, hope-inspiring stories of participants’ lives. It was shown that a narrative approach to therapy offers contextual and resilience-focused practices that are geared toward empowerment of individuals, families and communities. As such, the argument that narrative therapy is particularly relevant and appropriate in the context of a low-income South African community, was supported.

Thesis (DPhil)--University of Stellenbosch, 2000. / 218 leaves printed on single pages, preliminary pages i-xvii and numbered pages 1-200. Includes bibliography and list of tables. / Digitized at 600 dpi grayscale to pdf format (OCR), using a Bizhub 250 Konica Minolta Scanner. / ENGLISH ABSTRACT: Little is known about women's sexuality and even less about female adolescent sexuality. Sex researchers have neglected women, young women and specifically young women of colour and of lower socio-economic status. These gaps in sex research have to be addressed for at least two important reasons. In the first place an understanding of female adolescent sexuality will enhance our understanding of female development in general. More specifically, the prevalence of reproductive health problems like sexually transmitted diseases (STDs) and unplanned pregnancies among female adolescents warrant urgent attention. This study attempted to address the need for data on female sexuality by focusing on coloured female adolescents in the Stellenbosch district. This target group has been chosen because of the extent of adolescent reproductive health problems, specifically the prevalence of teenage pregnancy, in the low-income coloured community. The objective of the study was to gain an understanding of adolescent female sexuality in a specific community. This goal was reached by collecting quantitative and qualitative data about sexuality from a group of high school learners from a historically coloured community in the Stellenbosch district. Structured questionnaires were used to elicit the quantitative data. The quantitative data were analysed to determine the following (i) the range of sexual behaviours, and (ii) the prevalence of high-risk behaviours that the respondents engaged in. The quantitative results indicate that the research respondents did not represent a sexually high-risk community. Sexual intercourse was limited to a relatively small number of respondents. The sexual behaviour of these respondents, in general, did not differ meaningfully from the sexual behaviour reported in other adolescent communities. Open-ended interviews were used to generate the qualitative data. Twenty-five sexually active girls were interviewed. The grounded theory method was used to analyse the qualitative data and to explore the respondents' constructions of sexuality. Lack of sexual agency and need for connection were identified as the core categories in the interview data. The interview data indicated that the respondents had limited sexual agency and the researcher argued that mothers and boyfriends, as agents of the community, were prominent contributors to sexual disempowerment. The use of the term "coloured" is controversial. It is viewed by some as derogatory, whilst others argue the importance of a 'coloured' identity. Here and throughout the term "coloured" will be used descriptively. The researcher concluded that a new discourse of sexual agency for young women must be developed. / AFRIKAANSE OPSOMMING: Daar bestaan min data oor vroulike seksualiteit en selfs nog minder oor vroulike adolessente seksualiteit. In die verlede het seksnavorsers vroue, jong vroue en spesifiek gekleurde en lae sosio-ekonomiese vroue verwaarloos. Hierdie tekortkominge in seksnavorsing behoort om ten minste twee belangrike redes aangespreek te word. Eerstens sal 'n begrip van vroulike adolessente seksualiteit ons begrip van vroulike ontwikkeling in die algemeen bevorder. 'n Meer spesifieke rede is dat die die vookoms van reproduktiewe gesondheidsprobleme soos seksueel-oordraagbare siektes en onbeplande swangerskappe onder vroulike adolessente, dringende aandag vereis. Hierdie studie het gepoog om die behoefte aan data oor seksuele gedrag in verskillende Suid-Afrikaanse gemeenskappe aan te spreek deur te fokus op "kleurling" vroulike adolessente in die Stellenbosch-distrik. Hierdie groep is geselekteer vanwee die omvang van adolessente reproduktiewe gesondheidsprobleme, veral die voorkoms van tienerswangerskappe, in die "kleurling" gemeenskap. Die doel van die studie was om 'n begrip te kry van adolessente vroulike seksualiteit in 'n spesifieke gemeenskap. Kwantitatiewe en kwalitatiewe data is versamel oor die seksualiteit van 'n groep hoerskoolleerders wat woonagtig was in 'n histories "kleurling" gemeenskap in die Stellenbosch-distrik. 'n Gestruktureerde vraelys is gebruik om die kwantitatiewe data in te win. Die kwantitatiewe data is geanaliseer om (i) die reeks van seksuele gedrag wat by die respondente voorkom en (ii) die voorkoms van hoe risiko seksuele gedrag onder die respondente te bepaal. Die kwantitatiewe resultate het aangedui dat die navorsingsrespondente nie 'n hoe risiko groep verteenwoordig nie. Seksuele gemeenskap was beperk tot 'n relatiewe klein hoeveelheid respondente. In die algemeen, het die seksuele gedrag van die respondente nie betekenisvol verskil van die seksuele gedrag wat gerapporteer is vir ander adolessente populasies nie. Oop-einde onderhoude is gebruik om die kwalitatiewe data te genereer. Onderhoude is gevoer met vyf en twintig seksueel aktiewe meisies. Die "grounded theory" metode is gebruik om die kwalitatiewe data te analiseer en die respondente se konstruksies van seksualiteit te eksploreer. Gebrek aan seksuele agentskap en behoefte aan konneksie is geidentifiseer as die kernkategoriee in die onderhoudsdata. Die onderhoudsdata het aangedui dat die respondente oor beperkte seksuele agentskap beskik. Die navorser het aangevoer dat moeders en mansvriende, as agente van die gemeenskap, 'n prominente bydrae tot gebrek aan seksuele bemagtiging maak. Die navorser het tot die konklusie gekom dat 'n nuwe diskoers van seksuele agentskap vir jong vroue ontwikkel behoort te word.

Dissertation (DPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The aim of this study was to develop a HIV intervention programme tailored for South African adolescents with visual impairments. A further aim was to pilot and evaluate this tailored programme. This investigation was deemed necessary in the light of the growing HIV pandemic in South Africa, which has proliferated over the last 10 years. Adolescents and young adults are among the most vulnerable to HIV infection, and this does not exclude adolescents with visual impairments. Despite the perceptions among sighted people of asexuality in adolescents with visual impairments, they are a vulnerable group for HIV infection. The motivation for this study is the fact that very little literature is available on HIV/AIDS and people with visual impairments, and that this vulnerable group is marginalized in HIV/AIDS campaigns internationally. As far as we could ascertain, there have been three HIV prevention initiatives for people with visual impairments in South Africa, none of which was fully researched and evaluated, and all of which used existing generic interventions but transcribed into Braille and large print format. The reality is, many adolescents with visual impairments, as is the case with sighted youths, are sexually active, and the absence of research on HIV prevalence and HIV prevention needs in this sector, is conspicuous. An urgent need exists to tailor HIV preventative programmes for this vulnerable sector. The dearth of research on HIV/AIDS and people with visual impairments motivated the choice of a key informant study to investigate the effects that HIV/AIDS and other concomitant issues have on persons with visual impairments, prior to the design of any intervention. A purposive sample of key informants who are working among people with visual impairments on a daily basis, most of whom had visual impairments themselves, was selected. Information gathered from the key informant study was combined with the lessons from a review of available literature on health promotion programmes and HIV prevention programmes in particular to develop an HIV/AIDS intervention programme to be piloted and evaluated for its effectiveness. The design of the programme took account, in addition, of broader contextual issues such as power and gender issues, and the marginalization and stigmatization of disabled people. The theoretical framework which forms the basis of the programme was informed by elements of a number of cognitive theories in the health promotion field, and especially the Informational-Motivational-Behavioural model (IMF). The programme was designed to empower participants and to create an environment of reallife experiences in which they could acquire important negotiation skills, decision-making skills, and practical skills to use condoms and HIV/AIDS knowledge to facilitate attitude and behaviour change. The next objective of this research was to implement the intervention programme of eight sessions designed for adolescents with visual impairments and to investigate the outcome on participants in this study. For this purpose an experimental design, one experimental group and three control groups (n= 56), not randomly assigned, was used to test the effect of the programme on participants in the intervention group compared to the control groups, who received a health promotion programme of four sessions. All participants were learners at the only two schools for learners with visual impairments in the Western Cape Province of South Africa, and they were allocated into treatment or control conditions on the basis of the school grades in which they were already placed. The empirical investigation utilized a questionnaire that was developed and transcribed into Braille as well as large print. Following a small pilot study, the questionnaire was finalized and administered to all four groups (pre-test, to determine baseline differences; post-test, to determine the immediate effect of the programme; and follow-up [3 months later] to determine longer term effectiveness). An analysis was done to assess the internal consistency of the measuring constructs of the questionnaire, and satisfactory internal consistency was found, with Cronbach’s alpha scores ranging between 0.72 and 0.92. Quantitative data were analyzing using multivariate techniques, beginning with a repeated measures MANOVA analysis and, once an overall significant F ratio between variables, time and groups (F=2.009, p<0.05); a significant F ratio between groups and variables (F=4.211, p<0.01), and significant F ratio between time and groups (F=2.611, p<0.01), had been found, we continued with more focused analyses. Baseline results revealed no statistical differences between the four groups. There were statistically significant improvements in knowledge of HIV/AIDS for both the experimental group and two of the control group, but these differences were not maintained at follow up. Significant differences in attitudes towards HIV/AIDS were found for the experimental group and for one of the control groups. Though there were significant changes in both knowledge and attitudes, therefore, it cannot be claimed that the intervention itself was responsible for knowledge and attitudinal change. There was some evidence for diffusion of innovation in terms of HIV knowledge from the experimental group and the control group situated at the same school. Changes in reported HIV risk behaviour were not recorded to a significant degree, a fact which may have been attributable in part to small sample size. Qualitative process information was used to get a sense of the experiences of participants and the concomitant issues they discussed during the intervention. The qualitative data revealed a host of contextual factors relevant to issues of HIV/AIDS and sexuality in this group, including experiences of stigmatization as people with visual impairment, negotiating masculinity in the context of visual impairment, gender oppression of women and resistance to this, and a general atmosphere of myths and silences around HIV/AIDS in particular and sexuality in general. Despite the limited impact of the programme, this pilot study revealed important issues for adolescents with visual impairments regarding HIV prevention which require further investigation. Participants in the experimental group indicated that they learned a lot from this programme and suggested that it be given to younger adolescents to enable them to acquire these vital skills prior to active sexual engagement and the involvement in any form of unprotected sex. A number or recommendations are made for further well-documented and evaluated research in this field. / AFRIKAANSE OPSOMMING: Die doel van die studie was om ’n MIV-intervensieprogram te ontwikkel wat op Suid- Afrikaanse adolessente met gesigsgestremdhede gemik is. ’n Verdere doel was om ’n proeflopie van die pasgemaakte program te doen en dit te evalueer. Hierdie ondersoek is nodig geag in die lig van die groeiende MIV-pandemie in Suid-Afrika, wat oor die afgelope tien jaar vinnig versprei het. Adolessente en jong volwassenes tel onder die kwesbaarstes vir MIV-infeksie, en dit sluit nie adolessente met gesigsgestremdhede uit nie. Ongeag die persepsies omtrent aseksualiteit in adolessente met gesigsgestremdhede onder diegene wat nie gesigsgestremd is nie, is eersgenoemde ’n kwesbare groep vir MIV-infeksie. Die motivering vir hierdie studie is die feit dat baie min literatuur vir mense met gesigsgestremdhede beskikbaar is, en dat hierdie kwesbare groep wêreldwyd in MIV/VIGSveldtogte gemarginaliseerd is. Sover ons kon vasstel, was daar drie MIV-voorkomingsinisiatiewe vir mense met gesigsgestremdhede in Suid-Afrika, waarvan nie een ten volle nagevors en geëvalueer is nie, en wat almal bestaande generiese intervensies gebruik het wat in Braille en grootdruk-formaat omgesit is. Die werklikheid is dat baie adolessente met gesigsgestremdhede – nes die geval is met jeugdiges sonder gesigsgestremdhede – seksueel aktief is en dat die afwesigheid van navorsing oor MIV-voorkoms en MIVvoorkomingsbehoeftes in hierdie sektor opvallend is. Daar is ’n dringende behoefte aan pasgemaakte MIV-voorkomende programme vir hierdie kwesbare sektor. Die gebrek aan navorsing oor MIV/vigs en mense met gesigsgestremdhede het die keuse van ’n sleutelinformantstudie gemotiveer om die invloed wat MIV/vigs en ander gepaardgaande kwessies op mense met gesigsgestremdhede het, voor die ontwikkeling van enige intervensie te ondersoek. ’n Doelgerigte steekproef van sleutelinformante wat op ’n daaglikse grondslag onder mense met gesigsgestremdhede werk, waarvan die meeste self gesigsgestremd is, is gekies. Inligting wat van die sleutelinformantstudie verkry is, is gekombineer met die lesse uit ’n oorsig van die bestaande literatuur oor gesondheidsbevorderingsprogramme – in die besonder MIV-voorkomingsprogramme – om ’n MIV/vigs-intervensieprogram te ontwikkel wat as loodsprojek kon dien en wat vir doeltreffendheid geëvalueer kon word. Die ontwerp van die projek het, daarbenewens, ag geslaan op breër kontekstuele kwessies soos mags- en genderkwessies en die marginalisering en stigmatisering van mense met getremdhede. Die teoretiese raamwerk wat die grondslag vir die program vorm, is op elemente van ’n aantal kognitiewe teorieë op die gebied van gesondheidsbevordering, en spesifiek die inligtingmotivering- gedragsmodel geskoei. Die program is ontwerp om deelnemers te bemagtig en om ’n omgewing van lewenservaringe te skep waarbinne hulle belangrike onderhandelings-, besluitnemings- en praktiese vaardighede kon ontwikkel om kondoomgebruik te bevorder, asook kennis omtrent MIV/vigs om houdings- en gedragsverandering te fasiliteer. Die volgende doelwit van hierdie navorsing was om die intervensieprogram van agt sessies wat vir adolessente met gesigsgestremdhede ontwerp is, te implementeer en om die resultate ten opsigte van die deelnemers aan die studie te ondersoek. Met hierdie doel voor oë is ’n eksperimentele ontwerp – een eksperimentele groep en drie kontrolegroepe (n=56), wat nie ewekansig toegewys is nie – gebruik om die invloed van die program op deelnemers in die intervensiegroep te toets teenoor dié op die kontrolegroepe, wat aan ’n gesondheidsbevorderings-program van vier sessies deelgeneem het. Alle deelnemers was leerders by die enigste twee skole vir leerders met gesigsgestremdhede in die Wes-Kaap, Suid-Afrika. Hulle is op grond van die skoolgraad waarin hulle reeds geplaas is, aan behandelings- of kontroletoestande toegewys. Die empiriese ondersoek het ’n ontwikkelde vraelys gebruik wat sowel in Braille getranskribeer is as in grootdruk gedruk is. Ná afloop van ’n klein loodsstudie is die vraelys gefinaliseer en aan al vier groepe toegedien (voortoets, om die basisverskille vas te stel; na-toets, om die onmiddellike invloed van die program vas te stel; en opvolg [3 maande later] om doeltreffendheid op langer termyn vas te stel). ’n Ontleding is gedoen om die interne konsekwentheid van die meetkonstrukte van die vraelys te assesseer: voldoende interne konsekwentheid is gevind, met Cronbach se alfapunte wat tussen 0.72 en 0.92 gewissel het. Kwantitatiewe data is met behulp van meervariaattegnieke ontleed. Eers is ’n herhaaldemeting- MANOVA-ontleding gedoen en daarna – nadat ’n algeheel beduidende F verhouding tussen veranderlikes, tyd en groepe (F=2.009, p<0.05); ’n beduidende Fverhouding tussen groepe en veranderlikes (F=4.211, p<0.01) en ’n beduidende F-verhouding tussen tyd en groepe (F=2.611, p<0.01) gevind is – is dit deur meer gefokusde ontledings gevolg. Basislynuitslae het geen statistiese verskille tussen die vier groepe getoon nie. Daar was statisties beduidende verbeteringe in kennis oor MIV/vigs in sowel die eksperimentele groep as die twee kontrolegroepe, maar hierdie verskille is nie met die opvolgtoets volgehou nie. Beduidende verskille in houding jeens MIV/vigs is by die eksperimentele groep en een van die kontrolegroepe gevind. Hoewel daar beduidende veranderinge in sowel kennis as houdings gevind is, kan daar nie beweer word dat die intervensie self vir die kennis- en houdingsveranderinge verantwoordelik was nie. Daar was ’n mate van bewys vir diffusie van innovering wat betref kennis oor MIV van die eksperimentele groep en die kontrolegroep by dieselfde skool. Veranderinge in aangemelde MIV-risikogedrag is nie in ’n beduidende mate aangeteken nie, ’n feit wat gedeeltelik aan die beperkte grootte van die steekproef te wyte kan wees. Inligting uit ’n kwalitatiewe proses is gebruik om ’n indruk te skep van die ervaringe van deelnemers en gepaardgaande kwessies wat hulle tydens die intervensie bespreek het. Die kwalitatiewe data het ’n reeks kontekstuele faktore blootgelê wat vir kwessies van MIV/vigs en seksualiteit in hierdie groep tersaaklik is, met inbegrip van ervaringe van stigmatisering as mense met gesigsgestremdhede, die hantering van manlikheid binne die konteks van gesigsgestremdheid, genderonderdrukking van vroue en weerstand hierteen, asook ’n algemene atmosfeer van mites en stilswye oor MIV/vigs in die besonder en seksualiteit in die algemeen. Ten spyte van die beperkte impak van die program het hierdie loodsstudie belangrike kwessies vir adolessente met gesigsgestremdhede betreffende MIV-voorkoming blootgelê wat verdere ondersoek noodsaak. Deelnemers in die eksperimentele groep het aangedui dat hulle baie uit hierdie program geleer het en het voorgestel dat dit aan jonger adolessente aangebied word om hulle in staat te stel om hierdie noodsaaklike vaardighede te ontwikkel voordat aktiewe seksuele betrokkenheid en betrokkenheid by enige vorm van onbeskermde seks plaasvind. ’n Aantal aanbevelings vir verdere goed gedokumenteerde en geëvalueerde navorsing op hierdie gebied word gemaak.

Thesis (PhD)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping. / AFRIKAANSE OPSOMMING: Primêre gesondheidsdienste in Suid Afrika is tans in 'n proses van transisie. Die toenemende druk wat die VIGS-epidemie op gesondheidsdienste plaas, maak dit eweneens moeilik vir gesondheidswerkersom aan te pas by 'n gedurig-veranderende stelsel. Dit bring mee dat moraal laag is, baie werkers die publieke sektor verlaat en gehalte van dienslewering verswak. Hierdie situasie noodsaak dat programme ontwikkel moet word om gesondheidswerkerste ondersteun in hul werk, sodat hulle beter toegerus is om kwaliteit sorg aan pasiënte te verleen. Hierdie proefskrif beskryf aksienavorsing wat gedoen is met die doelom ondersteuningsprogramme vir gesondheidswerkers en hulpwerkers in openbare primêre gesondheidsdienste te ontwikkel. Individuele en in-groepsverband in-diepte onderhoude, asook fokusgroepbesprekings en konsultasies met gesondheidswerkers en middelvlak-bestuurders is gevoer om data in te samel. Data-ontleding was gedoen volgens die gegronde teorie aanslag en die Atlas.ti 4.1 sagteware pakket Is vir hierdie doel gebruik. Teorieë van psigoanalise en oop stelsels is deurgans geraadpleeg met die interpretasie van bevindinge. Die navorsingsproses bestaan uit vier siklusse van aksienavorsing. In die eerste navorsingsiklus is ~ie aard van stress in the publieke primêre gesondheidstelsel ondersoek. Die tweede siklus behels 'n beskrywing van die ervaringe van twee personeelgroepe soos hulle gereed gemaak het om aspekte van hulonderskeie dienslewering te integreer met die oprigting van 'n gemeenskaplike gesondheidsentrum. Die derde siklus beskryf die implementering van 'n kort program wat gerig is daarop om middel-vlak en diens-bestuurdersvaardighede aan te leer om personeel beter te ondersteun. Eksterne invloede het meegebring dat hierdie opleidingsprogram nie ten volle uitgevoer kon word nie. In die finale siklus is onderhoude met geselekteerde deelnemers gevoer om te bepaal hoe deelname aan die aksienavorsingsproses hulle in hul persoonlike hoedanigheid asook In die uitvoering van hul pligte beïnvloed het. Die huidige navorsing stel voor dat die psigodinamiese benadering 'n gepaste komponent van aksienavorsing in publieke gesondheidsomgewingskan wees, omdat hierdie benadering Insig kan verleen tot die onbewuste prosesse wat gesondheidswerkersse belewenis van stres beïnvloed, en verder ook die potensiaal het om gesondheidswerkers en bestuurders tot alternatiewe funksionering en hantering van stres te motiveer.

Thesis (PhD)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Pregnancy is a vulnerable time in settings such as sub-Saharan Africa, and is associated with exposure to a multitude of physiological, social and psychological risks. High HIV prevalence, and the fact that many women will test for HIV for the first time during their pregnancy, has raised concern about women‘s psychological health during pregnancy. Depression during the antenatal period is of public health concern as it has been shown to be associated with poorer foetal and delivery outcomes, risky behaviours, and poorer uptake of antenatal care. Antenatal depression is a predictor of postnatal depression, and postnatal depression has been associated with poor maternal sensitivity and attachment in mothers which is known to result in increased behavioural and developmental difficulties in children. The aim of this research was to provide a clear, in depth and culturally sensitive understanding of the manifestation of depression in pregnant women in a rural area with high HIV prevalence in South Africa. The research method included a diagnostic assessment of depression in 109 women in their third trimester of pregnancy, and an in-depth qualitative examination of the contextual framework within which HIV testing and depression are experienced with a sub-sample of 56 women. The quantitative results demonstrated that the prevalence of antenatal depression was high (46.7%), with close to half of the women being diagnosed with depression. Presentations of depression most frequently included disturbances in mood, loss of interest and suicide ideation. Symptoms which overlap with common side effects of pregnancy such as loss of energy and weight change did not result in an overestimation of depression. Likewise, very little evidence of the somatisation of depression, or particular cultural barriers to the diagnosis of depression based on DSM-IV criteria was found. Rates of suicide ideation were high and equally common among HIV positive as HIV negative women. Factors significantly associated with depression included living within a family homestead, access to a regular source of income and practical support from a partner. Both income and partner support had a negative association with depression. Living away from a family or parental home had a positive association with depression. The results showed that the Edinburgh Postnatal Depression Scale (EPDS) was effective in identifying depression and that a shorter three item version was as effective as longer versions. A positive score for depressed mood on the EPDS was significantly associated with HIV, suggesting that the EPDS is a good screening tool for elevated psychological risks among HIV positive women post HIV testing. Qualitative results showed that having an unsupportive partner and the occurrence of relationship or familial conflict played an important role in the development of emotional distress during pregnancy and resulted in a high number of unwanted pregnancies. Partner and familial conflict was intertwined with cultural practices which govern the acceptability of childbearing among unmarried women and the social recognition of partnerships and paternal responsibilities. Testing for HIV was considered a stressful life event for all women regardless of their HIV status and was a particularly negative life event for women who tested HIV positive or for women who had concerns over partner infidelity. Disclosure among HIV positive women frequently lead to increased partnership conflict. Qualitative findings suggested that depression and emotional distress after HIV testing did interfere with women‘s ability to engage with prevention messages. Women who were coping well with learning their HIV positive status had high levels of family disclosure and subsequent family support in common. The implication of this research is that it is important that public health programmes screen for depression among childbearing women. These data suggests that a shorter three item version of the EPDS along with screening for partner and family support or conflict would effectively detect most women at high risk for depression. Likewise, public health interventions for women with depression which are implemented in primary health care facilities and in isolation of the partnership and familial context within which depression occurs are not likely to be effective. Further research is needed to establish the precise prevalence of antenatal and postnatal depression in women at high risk for HIV; to validate the effectiveness of a shorter screening tool in resource limited settings; and to establish risk and protective factors, and trimester specific risks which could inform the design of cost effective interventions in poorly resourced settings. / AFRIKAANSE OPSOMMING: Swangerskap in Afrika, suid van die Sahara, is ʼn kwesbare tydperk met blootstelling aan ʼn menigte fisiologiese, sosiale en sielkundige risiko‘s. Die hoë voorkoms van HIV en die feit dat baie vrouens gedurende swangerskap vir die eerste keer vir HIV wil toets, het ‗n besorgdheid oor vrouens se sielkundige gesondheid gedurende swangerskap laat ontstaan. Depressie gedurende die voorgeboortelike periode is van belang vir publieke gesondheid, want daar is bewyse wat dui op ‗n verband tussen depressie en swakker fetale en geboorte resultate, riskante gedrag en verminderde gebruik van voorgeboortelike sorg . Voorgeboortelike depressie is ʼn indikasie van moontlike nageboortelike depressie en nageboortelike depressie word geassosieer met swak moederlike sensitiwiteit en die gebrekkige vorming van ‗n band tussen moeder en kind; wat reeds bewys is om te lei tot verhoogde gedrags- en ontwikkelingsprobleme in kinders. Die doel van hierdie navorsing was om ʼn duidelike, indiepte en kulturele-sensitiewe begrip van die manifestasie van depressie in swanger vroue in ʼn landelike omgewing met hoë HIV voorkoms in Suid Afrika te verkry. Die navorsingsmetode sluit in ʼn simptomatiese beraming van depressie by 109 vroue in hul derde trimester van swangerskap en ʼn indiepte kwalitatiewe ondersoek na die kontekstuele raamwerk waarbinne HIV toetse en depressie ondervind word met ʼn sub-steekproef van 56 vrouens. Die bevinding was dat die voorkoms van voorgeboortelike depressie hoog was, 46.7 %, met feitlik die helfte van die vrouens wat met depressie gediagnoseer is. In die meeste gevalle het die voorkoms van depressie gepaard gegaan met ʼn verandering in gemoedstoestand, ʼn verlies aan belangstelling en selfmoordgedagtes. Simptome wat ooreenstem met algemene newe-effekte van swangerskap, soos verlies aan energie en verandering in gewig, het nie bygedra tot ʼn oorberekening van depressie nie. Soortgelyk is baie min bewyse gevind dat somatosasie van depressie, of spesifieke kulturele grense, tot die diagnose van depressie gebaseer op DSM-IVkriteria bydra. Die oorweging van selfmoord was hoog en algemeen tussen beide HIV-positiewe en HIV-negatiewe vouens. Faktore wat aansienlik met depressie geassosieer word, sluit in om in ʼn familiegroep te bly, toegang tot ʼn vaste bron van inkomste en die praktiese ondersteuning van ʼn lewensmaat. Beide inkomste en die ondersteuning van ʼn lewensmaat het ʼn negatiewe verbintenis met depressive. Om nie by familie of in ʼn ouerhuis te bly nie het ʼn positiewe assosiasie met depressive. Alhoewel HIV-status verband hou met depressie, was dit nie uitermate die geval nie, alhoewel daar ʼn gebrek aan statistiese kragdoeltreffendheid was om die effek van HIV vas te stel, gegee die beperkte grootte van die steekproef. Die resultate het getoon dat die EPDS graderingsinstrument effektief was om depressie te identifiseer en dat ʼn korter driepunt weergawe daarvan net so effektief was soos die langer weergawe. ʼn Positiewe telling vir ʼn depressiewe gemoedstoestand op die EPDS het ʼn betekenisvolle assosiasie met HIV en dui daarop dat die EPDS ʼn goeie graderingsinstrument is vir verhoogde sielkundige risiko by HIV-positiewe vrouens, selfs al is HIV-positiewe vrouens in dié steekproef statistieksgewys nie meer geneig tot depressie as HIV-negatiewe vrouens nie. Kwalitatiewe resultate toon dat ʼn lewensmaat wat nie ondersteunend is nie en die voorkoms van verhoudings- of familiekonflik ʼn belangrike rol speel in die ontwikkeling van emosionele angs gedurende swangerskap en dit het gelei tot ʼn groot aantal ongewenste swangerskappe. Konflik met ʼn lewensmaat en met familie was verweefd met kulturele gebruike wat die aanvaarbaarheid van geboortes onder ongetroude vrouens beheer en die sosiale erkenning van verhoudings en die vader se verantwoordelikhede. ʼn HIV-toets is as ʼn stresvolle lewensgebeurtenis beskou deur alle vroue, ongeag van hulle HIV-status en was ʼn besondere negatiewe lewensgebeurtenis vir vroue wat HIV-positief getoets het of vir vroue wat bekommerd was oor hulle lewensmaats se getrouheid. Onthulling van die HIV-status van positiewe vrouens het gereeld tot verhoogde konflik in verhoudings gelei. Kwalitatiewe bevindings dui daarop dat depressie en emosionele angs na ʼn HIV-toets inmeng met ʼn vrou se vermoë om ag te slaan op voorkomingsboodskappe. Vroue wat die kennis van hulle HIV-positiewe status goed hanteer het, het hoë vlakke van bekendmaking van hulle status en die ondersteuning van hulle familie in gemeen. Die implikasie van die navorsing is dat dit belangrik is vir publieke gesondheidsorgprogramme om te toets vir depressie onder swanger vroue. Die resultate dui daarop dat ʼn korter driepunt weergawe van die EPDS, saam met ʼn ondersoek na die ondersteuning van of konflik met ʼn lewensmaat en familie, effektief kan wees om vroue met ʼn hoë risiko vir depressie te identifiseer. Soortgelyk, publieke gesondheidsingryping in primêre gesondheidsorg fasiliteite vir vroue met depressie wat in isolasie van die lewensmaat en familie konteks, waar depressie voorkom geadministreer word, is onwaarskynlik om te slaag. Bevindings onderskryf die belangrikheid van ondersteuning vir die familie om effektief te kan reageer en herstel van stresvolle faktore soos onbeplande swangerskappe en HIV-diagnose, in ʼn konteks wat swaar deur HIV geaffekteer word, aangesien dit ʼn voorkomende effek op depressie kan hê. Verdere navorsing is nodig om die presiese voorkoms van voorgeboortelike en nageboortelike depressie in vrouens met ʼn hoë blootstelling aan HIV vas te stel; om die sukses van ʼn korter graderingsinstrument in arm omgewings te staaf; en om die risiko en beskermende faktore vas te stel en trimester spesifieke risiko‘s wat die ontwerp van ʼn koste-effektiewe ingryping in gebiede met ontoereikende hulpbronne kan beïnvloed.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Reading problems have become a worldwide phenomenon, even in a first world country like America. Literacy figures in South Africa are even worse. Results of the PIRLS study indicated that the reading skills of 80% of South African children are not fully developed by the time they reach grade 5. In recent literacy tests South African children did worse than children from African countries like Mozambique, Botswana, Swaziland and Tanzania. Despite everything that is being done to improve literacy and numeracy, South African children do not reach their potential. Many South African schools are labeled as being „dysfunctional‟ and 79% of schools do not have libraries. This is a complex matter with multiple causes. Reading programs may contribute to addressing this issue. There are different types of reading programs and it can take place at different levels. One type of program includes the use of pets. The aim of the present study was to determine the effect of an animal-assisted reading program on the reading skills of grade 3 children in an Afrikaans medium primary school in the Western Cape. The secondary aim was to determine whether this type of reading program could also have an influence on other factors related to reading, like reading self-concept, self-efficacy, anxiety and school attendance of grade 3 children. All the grade 3 children were assessed with a series of tests. Those who were identified by the ESSI Reading Test as unskilled readers (N=102) were randomly assigned to three experimental groups and one control group. The Dog Group (n=27) read to a dog with a facilitator present, the Facilitator Group (n=24) read to a facilitator while the Teddy Bear Group (n=26) read to a teddy bear with a facilitator present. The Control Group (n=25) continued with their normal school activities. Collection of the data took place before the start of the reading program (Time 1) and directly after completion of the program (Time 2) with a follow-up measurement eight weeks later (Time 3). Once a week during the 10 week animal-assisted reading program all the children read for approximately 20 minutes from grade 1, grade 2 and grade 3 level reading books which they chose themselves. The children were called from their classrooms, individually, to another room where they could read calmly and peacefully to either a dog and a facilitator, or to a facilitator, or to a teddy bear and facilitator, depending on the group they were in. During Time 2 and Time 3 the Dog Group performed significantly better in the ESSI Reading Test than the other three groups. The reading comprehension of the Dog Group, as measured by the Neale Individual Reading Test, also improved significantly compared to that of the other three groups. Mixed results were found regarding reading self-concept, self-efficacy and anxiety. The shortcomings of the present study and recommendations for further research are also discussed. / AFRIKAANSE OPSOMMING: Leesprobleme is ʼn wêreldwye probleem, selfs in eerstewêreldlande soos Amerika. In Suid-Afrika is die geletterdheidsyfers selfs baie swakker. Die resultate van die PIRLS-studie dui daarop dat 80% van Suid-Afrikaanse kinders se leesvaardighede nie ten volle ontwikkel is wanneer hulle graad 5 bereik nie. Suid-Afrikaanse kinders het ook swakker gevaar in ʼn geletterdheidtoets as kinders van lande soos Mosambiek, Botswana, Swaziland en Tanzanië. Ten spyte van alles wat gedoen word om geletterdheid en syfervaardigheid te verbeter, vaar Suid-Afrikaanse kinders baie swakker as hul potensiaal. Baie Suid-Afrikaanse skole word geëtiketteer as „disfunksioneel‟ en 79% van skole het geen biblioteke nie. Hierdie saak is kompleks en die oorsake veelvuldig. Leesprogramme mag moontlik ʼn bydrae lewer om hierdie kwessie aan te spreek. Dit kan verskeie vorms aanneem en kan op verskillende vlakke plaasvind. Een tipe program behels die gebruik van troeteldiere. Die doel van die huidige studie was om die effek van ʼn troeteldier-ondersteunde leesprogram (TOL) op die leesvaardighede van graad 3-kinders in ʼn Afrikaansmedium laerskool in die Wes-Kaap te bepaal. Verdere doelstellings was om te bepaal of hierdie tipe leesprogram ook ʼn invloed kon hê op ander leesverwante faktore soos leesselfkonsep, self-effektiwiteit, angs en ook die skoolbywoning van graad 3-kinders. Al die graad 3-kinders is getoets met ʼn reeks instrumente en dié wat deur die ESSI Leestoets geïdentifiseer is as nievaardige lesers (N=102) is verder ewekansig toegewys aan drie eksperimentele en een kontrolegroep. Die Leeshondgroep (n=27) het vir ʼn leeshond en leesfasiliteerder gelees, die Leesfasiliteerdergroep (n=24) het vir ʼn leesfasiliteerder alleen gelees terwyl die Teddiebeergroep (n=26) vir ʼn teddiebeer en ʼn leesfasiliteerder gelees het. Die Kontrolegroep (n=25) het voortgegaan met hul normale skoolaktiwiteite. Data-insameling het plaasgevind voor die aanvang van die leesprogram (Tyd 1), direk ná voltooiing van die leesprogram (Tyd 2) en ʼn opvolgmeting het ag weke later (Tyd 3) plaasgevind. Tydens die 10-weke-troeteldier-ondersteunde leesprogram (TOL) het die kinders in elk van die groepe vir ongeveer 20 min. gelees uit graad 1-, 2- en 3-vlak boekies wat hulle self gekies het. Die kinders is individueel uit die klas geneem na ʼn ander lokaal in die skool waar hulle rustig vir óf die leeshond en ʼn leesfasiliteerder, óf die leesfasiliteerder alleen óf ʼn teddiebeer met ʼn leesfasiliteerder gelees het, afhangende van die groep waarin hulle was. Kinders in die Leeshondgroep het beduidend beter gevaar in die ESSI Leestoets tydens Tyd 2 en Tyd 3 as die kinders in die ander drie groepe. Die leesbegrip van die Leeshondgroep, soos gemeet deur die Neale Individuele Leestoets, het ook beduidend verbeter in vergelyking met dié van die ander drie groepe. Gemengde resultate is gevind met leesselfkonsep, self-effektiwiteit en angs. Die tekortkominge en aanbevelings vir verdere navorsing word ook bespreek.