Includes bibliographical references (leaves 107-118).

Current re-engineering of primary mental health care in South Africa is directed towards providing a continuum of care for people with serious mental disorders in order to relieve the cost and resource burden of longterm hospitalisation. In the Western Cape, Healthcare 2030 has been adopted as the guiding vision for health system reform. Residential-based rehabilitation programmes have been introduced to assist mental health service users to improve their functioning in occupations of daily life so that they are better equipped to cope with community living. Problem: There is limited South African occupational therapy research into male mental health service users' perspectives on the contribution that residential-based rehabilitation programmes makes to their community integration, despite the high numbers of males using the service. Purpose: To inform public mental health services on the contribution of a residential-based rehabilitation programme to the community integration of men with serious mental disorders. Research question: How does participation in a residential-based rehabilitation programme contribute to the community integration of men with serious mental disorders? Objectives of the study: To identify what men with serious mental disorders consider community integration to be, and to describe the key elements within the residential-based rehabilitation programme that influenced their community integration. Research design and methodology: An instrumental case study design was used to guide the research methodology and five male participants were identified through purposive sampling. Observations, semi-structured interviews, community maps and document analysis w ere used as data collection tools. Data was audio-recorded and transcribed f or inductive and thematic cross-case analysis. Ethical principles of beneficence, autonomy and non-maleficence were upheld throughout the research process. Findings: One theme and three categories emerged in the findings. The theme, 'It's a catch-22 situation', comprises three categories, namely: 'It's not just what you call it'; 'There's no one size for all'; and 'It's tricky choosing between places to go and things to do'. Conclusion: Male mental health service users who participate in a residential-based rehabilitation programme will be better prepared for community integration if they are involved in co-constructing their recovery plan so that it is more personalised.

Includes bibliographical references (leaves 87-96). / This collective case study explores the occupations of women who live and/or work in a rural farming community and who are at risk of having children with Foetal Alcohol Syndrome (FAS). Although FAS is incurable, it is completely preventable. This study approached the issue of FAS from an occupational perspective, highlighting historical and current political, economic, social and individual influences on the occupational engagement of study participants. In-depth unstructured interviews were conducted with three famale farm workers from a rural farming community in the Western Cape, South Africa. Other methods of data collection included direct observation, field notes and an interview with a key informant and gatekeeper. Four themes emerged from a process of inductive analysis. The findings show that despite progressive human rights and labour law policies in South Africa participants still experience extreme forms of occupational injustice. A central theme of suffering is associated with the harsh lives of these three female farm workers. Although feelings of worthlessness, helplessness and powerlessness persist, a strong sense of hope helps these women to make it through yet another day. Ond day they will rise amidst their circumstances, like fully baked bread. Ineffective coping strategies to deal with the stress of having to survive within this context lead to occupational risk behaviour (e.g. abusing alcohol), and hence occupational imbalance. Strategies for addressing individual coping mechanisms are suggested. Deconstructing disabling environments and building support for women in the home and work environment as a combined strategy for all role players (government, local authorities, farmers and farm workers) should be geared towards facilitating healthful participation in occupation of choice. A broader occupational repertoire should be provided from which farm workers can choose.

BACKGROUND: The academic learning of HIV positive children is often negatively impacted by cognitive and learning deficits associated with HIV, and usually leads to poor performance at school. Occupational therapy, a profession that promotes and enhances participation in meaningful occupations, has yet to demonstrate its impact in promoting the occupation of academic learning in HIV positive children on ART. OBJECTIVES: This study investigates and compares the impact of two occupational therapy interventions; conventional one-on-one occupational therapy (control group) and play-informed caregiver-implemented home-based intervention (PICHIBI) (experimental group), in promoting academic learning for HIV positive children aged 5 to 8 year olds on ART. METHODS: The research project followed a pragmatic, single-blinded, randomised baseline, mid and post-test control-group design. From a possible population of 60 dyads who attend the Groote Schuur Hospital (Cape Town, South Africa) ARV clinic, 27 child-caregiver dyads (n=27) were recruited. One dyad was excluded from the study, due to home circumstances, leaving 26 dyads that went through the randomisation and allocation process into the two intervention groups. Randomisation was carried out by a central computer system, before the start of the intervention period. The final total sample (n=23) completed the intervention, a slight decrease from the recruited sample size. Four dyads were lost to follow up after the baseline test. This resulted in 12 dyads in the control group and 11 dyads in the experimental group. Baseline, mid (after 5 months of the intervention) and post (after 10 months of intervention) test data was collected using the Griffiths Mental Developmental Scales-Extended Revised (GMDS-ER) and the short form Beery-Buktenica Visual Motor Integration test , 5th edition (Beery-VMI) as outcome measures. RESULTS: Following randomisation there were minimal variations in the baseline demographics and measurements for the two groups, with the exception of a significant difference in time on ART (p=.021). The majority of each group had suppressed viral loads. The total sample showed delays in all the performance components linked to academic learning at baseline, that is, low for visual motor integration and visual perception, below average for motor coordination, borderline delay in language, and practical reasoning, and low average in eye hand co-ordination, performance and the overall level of functioning (general quotient). Severe delays (<70) were detected in the control group at baseline for visual perception, and at post test for language. Average scores (90-109) at post test for visual perception and motor co-ordination were only seen in the experimental group. No statistical significance was noted for between-group differences at baseline, mid and post test. For within-group changes, statistically significant improvements were observed in the following performance components linked to academic learning: in the experimental group, visual motor integration from baseline to mid test (p=.019); in the control group, visual perception from baseline to post test (p=.009) and visual perception baseline to mid test (p=.001), and in performance from baseline to mid test (p=.027). Following interventions the overall GMDS-ER quotient scores for both groups improved with 70% of the experimental group and 58.3% of the control group scoring more than -2 z-score. In the total sample, the level of severe delay at baseline (68.2%) improved to only 8 out of the 23 (36.4%) of the total sample showing a severe overall delay post intervention. These scores still classified the groups as below average (90-109) under the GMDS-ER UK classifications. Despite these scores, 95.7% of the total sample progressed to the next grade during intervention, with only one child repeating a grade. CONCLUSION: Improvements were seen in both groups from baseline to post test. The advantage of PICHIBI however is that it is better suited for expanding access to occupational therapy services in a context where the occupational therapist/patient ratio in the public health sector is low. The continued underperformance of both groups in academic learning outcomes post intervention, displays the need for ongoing intervention for HIV-infected school going children. This information will inform occupational therapy practice, guide policies and legislations relating to academic learning for children with HIV on ART, in South Africa. It is recommended that future research look into using a larger sample size for generalisability of findings, consider conducting a longitudinal study linking results with school report outcomes and comparing the effects of the intervention at various levels of health care.

Includes bibliographical references (leaves 157-165).

Includes abstract. Includes bibliographical references.

Includes abstract. Includes bibliographical references.

Includes abstract. / Includes bibliographical references (leaves 161-169). / This qualitative interpretive biographical inquiry describes the nature of the occupational participation of men in Lavender Hill who drop out of school. School dropout was constructed as an occupational transition for the purposes of this study and the occupational participation of men who drop out of school was considered in relation to this. Study participants were selected using purposive, maximum variation sampling. Achieving a sense of fidelity in the research process was critically considered, because of its complexities in relation to the use of biography. Ethical principles were rigorously applied...

The purpose of this study was to determine whether an adapted Roland Morris Disability Questionnaire (ARMDQ) could be used to determine functional status in subjects with chronic mechanical low back pain, and thereby assist the surgeon in deciding on the appropriateness of spinal fusion surgery for individual patients. The study aimed to detem1ine whether the Roland-Morris Disability Questionnaire (RMDQ) improved its ability to measure function and different aspects of function through the addition of a 26-item scale (AddS). The study design was retrospective and descriptive. A convenience sample of 42 subjects who consulted one Orthopaedic surgeon working in a private practice in the South Peninsula Municipal area of Cape Town, South Africa, was drawn. All subjects were diagnosed with chronic mechanical low back pain and no other known pathology. Subjects consulted the surgeon between August 2000 and July 200 I. All subjects had completed the adapted RMDQ (ARMDQ). A series of analyses were performed in which the items in the AddS scale were compared with those of the RMDQ to assess the degree to which they enhanced the performance of the RMDQ. Although there was a high correlation between the two scales (R=. 72; P<.00), Cronbach's alpha showed the reliability of the RMDQ to be higher than the AddS and the ARMDQ. This finding was supported in a number of subsequent analyses. There was a low correlation between the rating for surgery and total RMDQ scores (r=.40; P<.01). Despite deficiencies in the RMDQ, it is recommended as the basis for comparison in future studies within a variety of South African contexts.

Background: Caregiver self-efficacy (CSE) supports the capabilities of caregivers to engage in parenting activities including stimulating development in their children. Human immunodeficiency virus (HIV) remains a prevalent concern in South Africa, even with the use of antiretroviral treatment. Children with HIV are compromised in their health and development which adds to the general stress of families rearing HIV-positive children. Stress has a negative effect on CSE. However, studies indicate that CSE can be improved through parent-mediated intervention. Caregivers’ engagement in the intervention may grow their skills to promote development in their HIV-positive children. This may have a positive influence on CSE. Occupational therapists working in governmental paediatric HIV clinics developed a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for HIV affected families to be implemented. This study evaluates the effectiveness of PICIHBI on CSE. Aim: The aim of the study is to determine if the CSE levels in a group of caregivers of HIV-positive children aged 6 months to 8 years 0 months on ART, after receiving play-informed caregiver-implemented home-based intervention (PICIHBI) are not inferior to CSE levels in an equivalent group of caregivers with children receiving conventional one-on-one occupational therapy. Method: The study applied a pragmatic, randomised control trial with caregiver-child dyads attending the antiretroviral clinic at Groote Schuur Hospital, Cape Town. The control group received conventional child-directed occupational therapy on an individual basis and the experimental group received caregiver-directed, PICIHBI in a group format. The Parenting Self-Efficacy Measure (P-SEMI), Parenting Sense of Competency (PSOC) scale, and the General Self-Efficacy Scale (GSE) measured self-efficacy at baseline, half way and at the end of the yearlong, monthly interventions. Results: Sixty-four caregiver-child dyads were recruited and assessed at baseline. Thirty-nine dyads were retained in the study, completing the measures at all three test points. Results revealed that baseline CSE was high for both groups. There was a significant change (p < .001) in the P-SEMI total scale in both groups from baseline to mid-test and mid-test to post-test. In both groups the CSE scores decreased from baseline to mid-test and then increased from mid-test to post-test. There was not a significant difference in CSE results between baseline and post-test on the P-SEMI total scale for either groups. There were no significant differences between test points for the other scales and subscales for both groups. Conclusion: The results suggest that PICIHBI has a non-inferior effect on CSE to that of conventional occupational therapy. This suggests that PICIHBI is comparable to conventional occupational therapy and could be implemented as an alternative intervention without comprising the effects on CSE. Employing PICIHBI as an alternative intervention could provide a number of benefits including the development of caregiver skills, a larger reach within the population, and contextually driven intervention that is embedded in children’s home environments. Various influencing factors are proposed to explain the patterns of CSE demonstrated in the groups. Neither group showed a significant increase in CSE from baseline to post-test and thus further investigation and intervention development is required to specifically demonstrate enhanced CSE in this context. Intervention attendance for both groups was poor. This is the first investigation on the effects of PICIHBI on CSE which can inform further research to develop best occupational therapy practice in the vast population of HIV affected families.