The purpose of this study was to examine parents’ motivational beliefs for involvement in a Comprehensive School Health approach (locally called Healthy Active Schools, or HAS) at their child’s school. Literature suggests that parents’ role construction and parents’ self-efficacy are the most salient influences on parents’ decision to become involved at their child’s school. Twelve parents involved at two urban public elementary schools were interviewed. Questions were based on Hoover-Dempsey and Sandler’s model of parental involvement (1995, 1997, 2005c). Qualitative multiple case study analysis additionally utilized Penner’s (2002) model of sustained volunteerism and Bandura’s collective efficacy theory (1997, 2000; Goddard, Hoy, & Woolfolk-Hoy, 2004) to clarify findings. Results suggest most parents’ strong active role construction and negative valence grounded their parent-focused role orientation. School case study analysis revealed that the principal’s leadership, the structure of the HAS committee and the school’s climate uniquely influenced parents’ beliefs. Individual parent case analysis revealed four distinct patterns of parents’ motivational beliefs for HAS involvement. Future research is warranted to further examine the decisive impact of parents’ health and prosocial values on their decision to become involved specific to a CSH approach type of involvement. Additional case studies in local schools, school districts and provinces are recommended to illuminate unique contextual influences and the potential for the emergence of collective efficacy; including consideration for parents’ belief construct general invitations from the school would contribute to gaining a deeper understanding within this domain. Finally, the link between parents’ motivational beliefs of empowerment and their sustained motivation for involvement needs to be explored further.

Like the rest of the western world, the UK faces a significant increase in the prevalence of diseases associated with lifestyle. Smoking rates have reduced, but increasing obesity has contributed to alarming increases in diabetes. Discovery of the correlation between behaviour and poor health has, since the 1970s, resulted in public health policies emphasising behaviour change, and personal responsibility; an emphasis that survived later research which demonstrated social, genetic and psychological determinants on behaviour and health. The latest version of the NHS constitution exhorts us to ‘recognise that you can make a significant contribution to your own, and your family’s, good health and wellbeing, and take personal responsibility for it.’ This thesis seeks to clarify the meaning and extent of personal responsibility for health, and at its core are four papers published in peer-reviewed journals. The first clarifies the concept concluding that it is best understood in a tripartite conception of a moral agent having obligations and being held responsible if he fails to meet them. The following two papers discuss the nature of the obligations, using utilitarian reasoning and arguments from analogy. First, an exploration of the moral obligations for our own health is undertaken via an analysis of the practice of tombstoning, jumping from height into water. I conclude that the obligations are of process rather than outcome, consisting of an epistemic duty to determine the health related consequences of our acts, and a reflective duty to consider these consequences for us and for those who share our lives. Second, following an examination of the moral status of blood donation, I conclude that despite its presentation as a praiseworthy and supererogatory act, it is more properly regarded as a prima facie obligation, supported by arguments from beneficence and justice. The final paper discusses the final part of the tripartite conception of personal responsibility for health: being held responsible. I discuss the nature of blame and extend the tombstoning analogy as a way of testing my own intuitions in response to an imagined adult son who has undertaken this dangerous activity. I argue that the notion of blame is not generally allowed as part of the patient – professional relationship, and yet without considering blame, the concept of personal responsibility for health is incomplete. I conclude that if the epistemic and reflective duties, individually applied, conclude that an obligation is owed, it is owed to those within personal relationships, and holding people responsible for their health-effecting behaviour is also best undertaken within these relationships. I conclude the thesis by considering the implications for professional practice. Inevitably this leads to consideration of the promotion of personal autonomy in health care. A more relational account of autonomy is suggested. Facilitating the epistemic duty so that individuals are better able to understand the risks of their behaviour requires rethinking of the way that health promoting material and information are presented.

Society's dramatically mounting population of Seniors is creating a demand to increase our knowledge of senior health program participation and of what promotes 'Healthy Aging'. This thesis is concerned with factors that affect seniors' participation in health promoting programs. There are two distinct aspects to this study, one is an experiment and the other is a survey. The experiment component of the thesis predicts that potential program participants' giving advice on a projected program topic, more than giving information will increase self-esteem, internal locus of control and thus program participation. The survey aspect of the thesis is designed to discover other factors which affect participation and health concerns. The project deals with psychological constructs such as locus of control, self-esteem and life satisfaction put to the use of social work concerns such as increasing program participation, health awareness and resource use. One hundred and twenty persons aged 60-75 were randomly selected from the files of Matsqui-Abbotsford Community Services and randomly assigned to 3 groups of 40 persons each. Group 1 & 2 were administered Wallston & Wallston & DeVallis' Multidimensional Health Locus of Control Scales and Rosenbergs’Self-Esteem Scale before and after the two experimental interventions of giving advice or information on the same health topics. Both groups also responded to Diener & Emmons & Larsen & Griffin's Life Satisfaction Scale, Chapin's Organizational Participation Scale and some questions about family, friends, smoking, health and demographics. Group 3, the control group, was not interviewed. After regular intervals all groups were invited to participate in three progressively involving 'Healthy Aging' pursuits. Statistical analysis does not support the hypothesis that giving advice increases self-esteem, life satisfaction, participation or 'internality' of health locus of control. Participation in formal organizations correlates with other forms of sociability and knowledge about prevention, while smoking co-relates positively with social isolation. Health internality is associated with greater self-reported health, life satisfaction, more contact with family and not associated with sociability outside of the home. / Arts, Faculty of / Social Work, School of / Graduate

D.Litt. et Phil. / Health and social issues have a reciprocal relation and this is evident in the South African context. Poverty that includes poor living conditions, unemployment and the consequent low income results in disease and malnutrition. A vicious circle exists between poverty and disease. The HIV/Aids pandemic results in people being in need of care, not being able to work nor provide for their next of kin, children being orphaned and taking over the parental role, without emotional and material means. Chronic diseases, for example tuberculosis, hypertension, diabetes and chronic psychiatric disease assume enormous proportions and influence the person-and-environment interaction, which is the social work focus. Health and social issues can therefore not be seen as separate entities. Social workers should then form an integral part of health care services. The social work service rendering in the Health Sector should be effective, efficient and appropriate. Effective, efficient and appropriate health care social work services will encompass people-centred, developmental, preventative, promotative primary health care approaches with emphasis on participation, partnership and self-determination. An effective and appropriate service will rely on home-based and community-based strategies. Health care social work is however fragmented and social workers in the Health Sector practice within different governmental and non-governmental organizations. Health care social work in the Gauteng Health Department where the researcher did the research, is largely curative, rehabilitative, hospital-based, individual-based and relies on institutional care. It is therefore ineffective, inefficient and inappropriate. A shift towards an effective, efficient and appropriate health care social work service is essential especially when the reciprocal relationship between health and social issues in South Africa are taken into account. The researcher decided therefore to develop a community-based model for health care social work with emphasis on a people-centred and developmental approach emphasizing participation, partnership and self- determination of the people. This model will be utilized on a primary health care level within a community health centre and community context where the health care social worker will form part of a multi-disciplinary health care team. The main goal of this study is the development of a community-based model for health care social work. The objectives to attain the main goal of describing a community-based model for health care social workers were: ♦ To explore and describe the thoughts and experiences regarding the perceived needs with reference to the general health of the following patients: Patients who attend provincial community health centres to address their health needs; Patients who are representative of the diversity of all South African citizens and therefore include White, Black, Coloured and Indian population groups; Patients who qualify in terms of their income to utilize Governmental health services and who do not belong to medical schemes; Patients from formal, well organized and structured communities with different community resources, as well as patients from informal settlements without structured community services; Patients of different age and gender groups; and Patients with acute and chronic, including life threatening medical conditions. ♦ To describe the needs of patients after interviews were conducted and data had been analyzed; ♦ To explore and describe the needs that health care social workers can address and the intervention strategies that they can utilize in doing so; ♦ To explore and describe the priority needs that a health care social worker could address and the intervention strategies they could utilize in doing it, in the opinion of the following multi-disciplinary health care team members: Medical doctors; Nursing staff; Allied health professionals (physiotherapists or their assistants, occupational therapists or their assistants, speech therapists, dieticians, pharmacists and community based rehabilitation workers); ♦ To describe specific needs and services which health care social work exclusively or most effectively can address according to ranking on a scale; ♦ To develop a community-based model for health care social work according to the needs that a health care social worker can address and which will result in an effective and appropriate health care social work service; ♦ To evaluate the tentative model; and ♦ To revise the intervention and describe guidelines to operationalize the model. The research design utilized to attain these objectives was based on a research model that the researcher developed. The researcher developed the research model by utilizing The Intervention Design and Development model (Rothman & Thomas, 1994) qualitative research for interviews with patients, observations and field notes, data analysis and literature control. Quantitative research designs were included in the model and consisted of the Delphi technique and Lickert scale. Levels of theory generation were also included in the model and the researcher developed level of theory generation for the research based on the levels of theory generation of Dickoff et al. (1968) and Chinn and Kramer (1995). The research model that the researcher developed for developing a community-based model for health care social work encompasses certain phases and research activities, as well as theory generation and reasoning strategies. The reasoning strategies included analysis induction, synthesis, derivation and deduction. The first phase of the research was the problem analysis and project-planning phase of the research. The researcher carried into effect the following research activities. The researcher determined the feasibility of the research project; gained entry to and cooperation from setting and identified and involved role-players in the research. The identification and involvement of the role-players encompassed the sampling and the pilot study. The second phase of the research was the information gathering, analysis and synthesis phase of the research. This phase included research activities, as well as levels of theory generation. The research activities that were followed during this phase started with the conducting of semi-structured interviews with twenty-two patients and observations and the keeping of field notes. Ethical issues were addressed during this phase and formed part of the interviewing and observation process. Data analysis of interviews, with an independent coder, and literature control to affirm the findings of data analysis followed as part of the research activities. The researcher then utilized the Delphi technique with nine experts in health care social work. The aim of this was to establish the patient’s needs, established during data analysis, that a health care social worker could address and the intervention strategies that they could utilize. These needs and intervention strategies were established by questionnaires and a group session was held to reach consensus of data. The above-mentioned data established from health care social work experts were then compiled into a Lickert scale for twenty-five multi-disciplinary health care team members. The aim of the scale was to establish the needs that health care social work could address exclusively of most effectively, as well as the intervention strategies that they could utilize in the opinion of the multi-disciplinary health care team members. A final literature control completes the research activities of the information gathering, analysis and synthesis phase in order to establish if literature exist that verifying the results of the data obtained and if these could assist in the development of a communitybased model for health care social work. The levels of theory generation followed in the information gathering, analysis and synthesis phase of the research consist of the following: The first level of theory generation consisted of factor isolating theory. The researcher utilized concept analysis. Concepts were firstly identified and the researcher identified the concept health. The concept health is a central concept in all the policy documents and theory that were utilized in the problem analysis of the research. The concept health was also central in the data analysis and literature control of the interviews with patients. The concept health was then defined and refined by utilizing dictionaries and thesauruses, as well as utilizing sources of evidence namely, a model and contrary case, evidence of people and professional literature. The researcher then classified the concept health and the related concepts. The second level of theory generation, factor relating and structuring followed during the information gathering, analysis and synthesis phase of the research. The researcher related factors and associated them through statements that indicate interrelationships. The third level of theory generation consisted of the situation relating level followed by predicting relationships between concepts utilizing if-then statements. The third phase of the research was the design and early development phase. The researcher utilized the fourth level of theory generation that consisted of the situation producing level of theory generation to conduct the research activity of the creating and describing of the theoretical model for community-based health care social work. The last phase of the research consisted of the theory testing and evaluation phase of the research. The research activities that were followed encompass the planning of evaluation, selection of evaluation methods and then the evaluation process. The evaluation process was done with a panel of nine experts utilizing a specific questionnaire in the form of a Lickert scale. The panel consisted of academic staff from the Universities of the Witwatersrand, Pretoria and Randse Afrikaanse University from social work and nursing as well as multi-disciplinary health care team members from community health centres and social workers from different practice settings. The second part of the evaluation process was done during doctoral seminars where peer evaluation was done by health care social workers, medical doctors, nursing staff and allied health workers from different levels of service rendering including the Gauteng Health Department’ Head Office, community-based centres and different levels of hospitals. Participants from private hospitals also attended the doctoral seminars. The researcher then utilized the evaluation results to identify design problems and to revise the community-based model for health care social work. The final level of theory generation was then done in the theory testing and evaluation phase of the research to operationalize the model by describing guidelines for operationalization. The methods of trustworthiness that were followed during the research included the four criteria of Lincoln and Guba (1985) of credibility, transferability, dependability and conformability. The researcher finalized the research by indicating the conclusions from the research, specifying the limitations of the research and providing recommendations for social work practice, education and research. The research document might be marked by repetition of content, but this was necessary because chapter six, the model, as well as chapter eight, the guidelines for operationalizing the model, form the basis for health care social work practice at community health centres. These chapters could then be extracted from the research document as a tool for implementation. / Prof. J.B.S. Nel Prof. A. Nolte

Magister Public Health - MPH / Chronic diseases pose public health concerns globally with an increasing trend in developing countries. The development of interventions to minimize or prevent the burden associated with chronic diseases has therefore become a necessity. In 2002 the School of Public Health of the University of the Western Cape developed a health club intervention in Khayelitsha. This intervention focused on promoting healthy lifestyles, particularly improved diet and physical activity. The objectives of this study was to determine whether members were more physically active than non-members and to determine whether members made healthier dietary choices than non-members. / South Africa

Philosophiae Doctor - PhD / Diabetes mellitus, an international pandemic, is one of the greatest threats to global public health. It is estimated that 70% of patients with diabetes are living in developing countries. Since the inception of the Primary Health Care approach in South Africa in 2004, the number of patients with diabetes has doubled to an estimated 1.5 million South Africans. The overall aim of the study was to develop, implement and determine the effectiveness of a health promotion intervention for adult clients with type 2 diabetes mellitus from a South African urban community. The overarching design of the study was that of mixed methods, specifically the parallel mixed design. The first phase of the study was to determine the current practices regarding the management of diabetes mellitus and the study sample comprised of three hundred and thirty five adult clients with type 2 diabetes mellitus and eighteen health care professionals of randomly-selected community health centres (CHCs) in the four sub-structures of the Cape Metropolitan District. Data was collected from the adult clients with type 2 diabetes mellitus with structured, self-administered questionnaires and focus group discussions while semi-structured interviews were done with the health care professionals. The second phase of the study aimed to design a health promotion programme and both a review of the literature and a Delphi study were done to develop the proposed programme.

Philosophiae Doctor - PhD / Schools, world-wide, have been regarded as important settings for health promotion and health education. Research indicate that schools constitute a crucial setting for programmes that aim at promoting the health of children, young adults, their families and their community, and could make a positive contribution to the overall health of the society. The psychosocial theory of human development proposes to understand and describe the importance of psychosocial health and well-being of children, in their different stages of development, across the life span, as well as how the different environments of the child's rearing could either add, or hinder, optimal development. Healthy Early Childhood Development, which includes physical, social-emotional, as well as linguistic/cognitive development, is fundamental to success and happiness, not only during childhood, but throughout the course of life. This study, therefore, aimed to design a School Health Index Score Card that assesses psychosocial health and well-being in Early Childhood Development at primary schools in the rural Western Cape. The School Well-Being Model serves as a conceptual framework for this study and is based on Allardt's Sociological Welfare Theory,which assesses well-being as an entity in a school setting. This model takes into account the impact of family, social relationships, personal self-fulfilment and health aspects of children. This study used a mixed methodological sequential explanatory design that consisted of two distinct phases (with 2 stages in each phase) within a participatory action research framework. A needs assessment and a systematic review was conducted in phase 1 followed by phase 2, action planning-design of a school health index score card and a Delphi technique study. Quantitative, numeric, data were collected and analysed using the Statistical Package for Social Sciences V23 (SPSS) for descriptive and inferential statistics first, while the qualitative data were collected and analysed secondly in sequence for this design. The qualitative process helped to explain, or elaborate, on the quantitative results obtained from the respondents by means of a self-administered questionnaire that consisted of three sections; demographical information and the adaptation of the (i) Pediatric Quality of Life Inventory (PedsQL) and (ii) Strengths and Difficulties Questionnaire. The data were collected from teachers, principals, community leaders, parents/primary caregivers, members of school governing bodies, school nurses, social workers, health promotion officers, experts in early childhood development and school psychologists of learners in Grade R to Grade 3 at three primary schools in the rural Western Cape, South Africa. The systematic review of previous studies revealed that, (i) instruments are often designed to identify physical ailments, the individual’s ability to adjust to particular situations, psychiatric diagnosis, educational and intellectual abilities, as well as the personal characteristics of children over their entire lifespan, (ii) that promotion of psychosocial health and well-being challenges in early development does promote positive child development outcomes in later life, and (iii) the use of a valid and reliable instrument to assess psychosocial health and well-being in schools could have a number of advantages for children, their families, teachers and the community. The findings of the current study also indicated that, (i) parents/primary perceived their children to be experiencing challenges in school functioning, social functioning and physical functioning continually and, (ii) teachers perceived the learners to be experiencing social behavioural, hyperactive and behavioural challenges continually at school. Schools play an integral part in the lives of children and their families, by supporting children to form social and emotional relationships at school. Overall, this current study suggested that the School Health Index Score Card was considered to be user friendly, as well as a useful tool to assess the psychosocial health and well-being challenges of learners at primary schools in a South African context. / National Research Foundation (NRF) / 2020-04-30

A mandatory two year fitness, health screening and education program was conducted in a fire protection district to assess the impact on selected fitness, medical and absenteeism variables. The study evaluated the archival data from a program that had already been conducted. Absenteeism measured as occupational injury and personal illness were reviewed two years prior to the program and during the two year program period. Medical evaluation and fitness testing were also conducted during the program. Individualized exercise prescriptions were developed for each participant from the fitness profiles derived from testing. The firefighters were given two hours each work shift to complete their prescribed physical training. Wellness education topics were provided during training sessions at the fire stations. A quasi-experimental factorial design was used to evaluate the program. All fitness measures showed improvement. Total cholesterol, triglycerides and diastolic blood pressure declined as well. A repeated measures MANOVA showed a significant multivariate effect for the linear combination of variables consisting of physical fitness, health screening and absenteeism. A reduction in injury-related absenteeism resulted in a decline in the workers' compensation premium and saved this fire district an estimated $68,741 over two years. It appears that this mandatory health promotion program improved physical fitness and reduced absenteeism due to occupational injury.

This study explored Facebook™ to capture the prevalence of driving safety promotion user groups, obtain user demographic information, to understand if Facebook™ user groups influence reported driving behaviors, and to gather a sense of perceived effectiveness of Facebook™ for driving safety promotion targeted to young adults. In total, 96 driving safety Facebook™ groups (DSFGs) were identified with a total of 33,368 members, 168 administrators, 156 officers, 1,598 wall posts representing 12 countries. A total of 85 individuals participated in the survey. Demographic findings of this study suggest that driving safety promotion can be targeted to young and older adults. Respondents' ages ranged from 18 to 66 years. A total of 62% of respondents aged ≤24 years and 57.8% of respondents aged ≥25 years reported changing their driving-related behaviors as a result of reading information on the DSFGs to which they belonged. A higher proportion of respondents ≥25 years were significantly more likely to report Facebook™ and YouTube™ as an effective technology for driving safety promotion. This preliminary study indicates that DSFGs may be effective tools for driving safety promotion among young adults. More research is needed to understand the cognition of Facebook™ users as it relates to adopting safe driving behavior. The findings from this study present descriptive data to guide public health practitioners for future health promotion activities on Facebook™.

This study explored Facebook™ to capture the prevalence of driving safety promotion user groups, obtain user demographic information, to understand if Facebook™ user groups influence reported driving behaviors, and to gather a sense of perceived effectiveness of Facebook™ for driving safety promotion targeted to young adults. In total, 96 driving safety Facebook™ groups (DSFGs) were identified with a total of 33,368 members, 168 administrators, 156 officers, 1,598 wall posts representing 12 countries. A total of 85 individuals participated in the survey. Demographic findings of this study suggest that driving safety promotion can be targeted to young and older adults. Respondents' ages ranged from 18 to 66 years. A total of 62% of respondents aged ≤24 years and 57.8% of respondents aged ≥25 years reported changing their driving-related behaviors as a result of reading information on the DSFGs to which they belonged. A higher proportion of respondents ≥25 years were significantly more likely to report Facebook™ and YouTube™ as an effective technology for driving safety promotion. This preliminary study indicates that DSFGs may be effective tools for driving safety promotion among young adults. More research is needed to understand the cognition of Facebook™ users as it relates to adopting safe driving behavior. The findings from this study present descriptive data to guide public health practitioners for future health promotion activities on Facebook™.