The low physical activity (PA) levels of children have become a national public health concern in South Africa. Moreover, the quality of Physical Education (PE) in South African schools has been compromised by challenges resulting from the subject’s reintroduction after a long absence from the school curriculum. Up to date no study has investigated the effects of a quality PE programme, within the prescriptions of the South African Curriculum and Assessment Policy Statement (CAPS), on the PA and fitness levels of twelve to thirteen years old South African children. Furthermore, no PA measuring instrument exists that has been validated specifically for South African children of this age group, with which to conduct such a study. The objectives of this study were therefore, firstly, to validate a standardised PA questionnaire for Grade 7 learners in a South African context; secondly, to evaluate the effects of an enhanced quality PE programme presented by well-trained teachers, on the PA levels, and thirdly on the physical and motor fitness of Grade 7 learners in Potchefstroom, South Africa. For the first objective, 108 schoolchildren aged twelve to thirteen years (boys, n=45; girls, n=63) from two primary schools in Potchefstroom participated in this study to validate the Children’s Leisure Activities Study Survey (CLASS) for children in a South African context. Test-retest reliability of the questionnaire was examined with an interval of 3 weeks, while validity was assessed by comparing measurements of the reported minutes in PAs from questionnaire responses with ten physical fitness parameters using the Eurofit test battery. Data analysis included Cronbach’s alpha coefficients, paired t-test and intra-class correlation coefficients (ICC), and Spearman correlation coefficients (r). The results showed substantial internal consistency and significant intra-class correlations estimates for all intensities of PA and sedentary time (ST). Non-significant differences were found in the means of test and retest measurements. Aerobic fitness was significantly correlated with all intensities of PA and ST, and the results of several of the other fitness tests had significant associations with vigorous PA. For the fulfillment of the second and the third objectives, 110 Grade 7 learners (experimental school, n = 40; control schools, n = 70) were studied. The twelve-week PE intervention programme was presented according to the prescriptions of the CAPS which allocates one hour per week to PE, but included 5 quality-enhancing components namely well-trained teachers, homework activities, a reward system, improvised apparatus and the monitoring of activity intensity. Data was collected by means of the validated CLASS questionnaire, anthropometric measurements as well as physical and motor fitness tests, by means of the Eurofit test battery. Data analysis included Kruskal-Wallis and Wilcoxon signed-rank tests, a series of analyses of covariance (ANCOVA), Tukey’s post hoc analysis, and interpreting effect sizes for practical significance. The results showed practically and statistically significant increases in moderate PA, vigorous PA, and total PA as well as decreases in sedentary behaviours. Furthermore, the learners’ data on physical and motor fitness levels showed statistically significant improvements among most of the experimental groups with regard to six of the ten fitness parameters. Based on these results, it can be concluded that the enhanced quality PE programme is effective in improving the PA, physical and motor fitness levels of South African primary school children. Therefore it is recommended that PE programmes in South Africa include the quality-enhancing components used in this intervention programme. Moreover, the modified CLASS questionnaire is a valid and reliable measure of PA among South African Grade 7 schoolchildren. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2015

Until recently, the health professions have largely followed a medical model, which seeks to treat patients by focusing on medicine and surgery, and gives less importance to beliefs and to the faith in healing, in the physician, and in the doctor-patient relationship. This reductionist view of patients being only material body is no longer satisfactory. Patients and healthcare professionals have begun to value the role of elements such as faith, spirituality, hope and compassion in the healing process. The effect of such spiritual elements in health and quality of life has led to research in this field in an attempt to move towards a more holistic view, which included the non-material dimension. The goal of this study was to explore the understanding of spirituality among healthcare professionals and patients at the CHBAH. The primary research question, which this study attempted to answer, was: What is the understanding of spirituality among the healthcare professionals and patients at CHBAH? In view of this primary research question, the following secondary research questions were formulated: * What does a literature review produce regarding spirituality in healthcare and what are the current practices related to spirituality in healthcare. * What are the views of healthcare professionals and patients concerning the relevance of spirituality in their day-to-day lives and healthcare interventions? * What are the spiritual needs of patients and to what extent does spirituality contribute towards their coping with health-related issues? * Which practical and scientific recommendations can be offered to healthcare professionals regarding including/incorporating spirituality in healthcare services in CHBAH? In view of the aim, the researcher identified the following specific objectives for this study: * To explore spirituality in healthcare by means of a literature review; * To explore and describe the views of medical social workers and other healthcare professionals about the relevance of spirituality in a healthcare setting; * To explore and describe the understanding of spirituality among healthcare professionals and patients in CHBAH; * To propose a protocol as an organizational framework on the incorporation of spirituality in healthcare at CHBAH. This protocol should be implemented during social workers‟ and other healthcare professionals‟ interactions with patients. Chapter 1 provides an introduction, problem formulation, goal, research question and the objectives of this study and a brief overview of the methodology. Chapter 2 focuses on the description of research methodology that was utilised in this study. Chapter 3 is composed of a literature study on spirituality and the religions identified and explored in CHBAH, as well as existing practices related to spirituality in health care. In Chapter 4, the data generated through narratives from focus-group discussions and healthcare professionals‟ spiritual journey is processed and reported. In Chapter 5 a proposed protocol for inclusion of spirituality in healthcare services in CHBAH is presented and discussed in detail Chapter 6 consists of the conclusions and summary of this study. / PhD (Social Work), North-West University, Potchefstroom Campus, 2014

The HIV epidemic does not only affect people living with HIV or AIDS but has a large impact on the children. They are being stigmatised by association. There is paucity in research on HIV stigma interventions. In addition, existing interventions aimed at reducing HIV stigma are not community based and very few are aimed at HIV-affected children. The purpose of this study was to assess the change on psychological well-being of HIV-affected children after a Community based HIV Stigma Reduction and Wellness Enhancement Intervention, and to explore and describe their experiences thereof. This study formed part of a larger Community based HIV Stigma Reduction and Wellness Enhancement Intervention project. A mixed method convergent parallel design involving quantitative and qualitative data collection, analyses and integration of findings was applied. The sample was drawn from populations in the greater Potchefstroom urban area and rural Ganyesa in the North West Province. The children as participants in this study were children of PLHA in the larger study and were recruited using snowball sampling (n=11) and were between the ages 15 and 21 years. The quantitative component utilised a one group pre-test-repetitive-post-test design which was analysed by using IBM SPSS (ver. 20) by comparing t-test scores and F-ratios in ANOVA. The qualitative component of the study employed a holistic multiple case study approach and qualitative interpretive description and data were analysed by using thematic content and document analyses. The results indicated no significant difference between the urban and the rural groups in the subscales and total scores of mental well-being. The results of the total scores projected that the participants’ mental health was in the region of moderately mentally healthy. The in-depth interviews confirmed the three dimensions of the subscales indicating that they have verbalised similar experiences to the itemised subscales of emotional, social and psychological well-being. The intervention was a meaningful experience to the children. They gained knowledge about HIV stigma and how to cope with it; as well how to build relationships amongst themselves and with the PLHA. They gained a better understanding of their parents suffering from HIV and other PLHA as well as support of one another being in this difficult situation. Conducting the project led to them becoming empowered to act as leaders in HIV stigma reduction. The results of the in-depth interviews showed that the children gained a greater awareness of the process of the stigma and experienced a general increase in their knowledge throughout the workshop and the project. They formed meaningful relationships with other children and deepened their relationships with their parents and other PLHA. The children were empowered through these interventions to advocate against HIV stigma despite the challenges they faced. They gained confidence and experienced personal growth through their participation in the project. It is recommended that the findings of the study be applied in education to raise awareness of HIV stigma among psychology students and for training of practicing psychologists on their role in reducing HIV stigma and enhancing well-being of the PLHA and those living close to them. It could also be meaningful if the intervention were to be used for practice purposes where support is given to the newly diagnosed PLHA and those associated with them. Further research can be done to test sustainability of the intervention in a different context and with a bigger sample. / Thesis (MA (Research Psychology))--North-West University, Potchefstroom Campus, 2013.

The HIV epidemic does not only affect people living with HIV or AIDS but has a large impact on the children. They are being stigmatised by association. There is paucity in research on HIV stigma interventions. In addition, existing interventions aimed at reducing HIV stigma are not community based and very few are aimed at HIV-affected children. The purpose of this study was to assess the change on psychological well-being of HIV-affected children after a Community based HIV Stigma Reduction and Wellness Enhancement Intervention, and to explore and describe their experiences thereof. This study formed part of a larger Community based HIV Stigma Reduction and Wellness Enhancement Intervention project. A mixed method convergent parallel design involving quantitative and qualitative data collection, analyses and integration of findings was applied. The sample was drawn from populations in the greater Potchefstroom urban area and rural Ganyesa in the North West Province. The children as participants in this study were children of PLHA in the larger study and were recruited using snowball sampling (n=11) and were between the ages 15 and 21 years. The quantitative component utilised a one group pre-test-repetitive-post-test design which was analysed by using IBM SPSS (ver. 20) by comparing t-test scores and F-ratios in ANOVA. The qualitative component of the study employed a holistic multiple case study approach and qualitative interpretive description and data were analysed by using thematic content and document analyses. The results indicated no significant difference between the urban and the rural groups in the subscales and total scores of mental well-being. The results of the total scores projected that the participants’ mental health was in the region of moderately mentally healthy. The in-depth interviews confirmed the three dimensions of the subscales indicating that they have verbalised similar experiences to the itemised subscales of emotional, social and psychological well-being. The intervention was a meaningful experience to the children. They gained knowledge about HIV stigma and how to cope with it; as well how to build relationships amongst themselves and with the PLHA. They gained a better understanding of their parents suffering from HIV and other PLHA as well as support of one another being in this difficult situation. Conducting the project led to them becoming empowered to act as leaders in HIV stigma reduction. The results of the in-depth interviews showed that the children gained a greater awareness of the process of the stigma and experienced a general increase in their knowledge throughout the workshop and the project. They formed meaningful relationships with other children and deepened their relationships with their parents and other PLHA. The children were empowered through these interventions to advocate against HIV stigma despite the challenges they faced. They gained confidence and experienced personal growth through their participation in the project. It is recommended that the findings of the study be applied in education to raise awareness of HIV stigma among psychology students and for training of practicing psychologists on their role in reducing HIV stigma and enhancing well-being of the PLHA and those living close to them. It could also be meaningful if the intervention were to be used for practice purposes where support is given to the newly diagnosed PLHA and those associated with them. Further research can be done to test sustainability of the intervention in a different context and with a bigger sample. / Thesis (MA (Research Psychology))--North-West University, Potchefstroom Campus, 2013.

This study focuses on the use of a bridging technique to overcome contact–making barriers in adolescents. Contact is regarded as an integral part of all human experiences, but barriers (also called contact boundary disturbances) often hinder effective contact–making with the environment. To overcome contact boundary disturbances, several model bridges were constructed prior to the study and these were used as a metaphor during the intervention phase with adolescents. The goal of the research was to determine whether a technique called “bridging” could overcome contact boundary disturbances in adolescents in therapy. The research was conducted from an existential–phenomenological Gestalt approach. Combined quantitative and qualitative approaches were followed and a single system experimental design, A–B–A–A, was applied. A total of 14 adolescent participants between the ages of 11 and 14 were purposefully selected from three different schools in the Gauteng Province, South Africa, as well as their parents and teachers. Quantitative data were collected from the pre–intervention assessment, the post–intervention assessment and a follow–up assessment where questionnaires were completed by the researcher for each of the adolescent participants. The follow–up assessment was done four weeks after the postassessment in order to determine the consistency of the intervention. These questionnaires were analysed according to the semantic differential scale, and raw scores were plotted on line and bar graphs in order to assess the contact skills and contact boundary disturbances in the participating adolescents. Qualitative data were collected through semi–structured interviews with parents and teachers and through therapeutic interventions with adolescents. The data were analysed using the Creswell spiral and the a priori and inductive coding approaches. Three main themes were identified which were contact boundary disturbances, personal emotional factors and behavioural factors. Quantitative and qualitative data results and findings were discussed in context, to the relevant literature. The findings of the data indicated that the bridging technique can be useful in working with adolescents in therapy to overcome contact–making barriers. / Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2012.

The increasing prevalence of childhood obesity worldwide is viewed as a global epidemic (World Health Organization, 2010). It is associated with a variety of health problems as well as physical– (cardio–respiratory endurance, flexibility, muscular strength, muscular endurance, and body composition), and motor proficiency (fine manual control, manual coordination, body coordination, and strength–and–agility) (Asayama et al., 2003:644; Okely et al., 2004:242; Tokmakidis et al., 2006:870). As far as the South African context is concerned, there is little research examining these relationships and the effect of physical intervention there upon, in nine– to 12–year old children. The first and second objectives of this study were to determine whether obesity would influence the physical– and/or the motor proficiency of nine– to 12–year–old South African children. The third and fourth objectives of this study were to determine the effect of a multidisciplinary intervention on the physical– and the motor proficiency of nine– to 12–year–old obese children. For objectives one and two, a cross–sectional study was performed on 280 children (128 boys and 152 girls), with an average age of 10.6 years (±1.05). Anthropometric–, physical– and motor measurements were obtained by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005). Body mass index (BMI) cut–off points were used to classify the children as normal, overweight, or obese (Cole et al., 2000). The data was analysed with regard to the above–mentioned objectives with the Statistica computer program, by means of descriptive statistics, Spearman rank correlations, and variance analyses. The results show that the physical fitness variables, cardio–respiratory endurance and muscular strength, particularly leg muscular strength, showed significant decreases with an increase in BMI. A progressive, but insignificant, decrease was found in muscular endurance with an increase in BMI, while flexibility showed the weakest relationship to BMI. The motor variables strength–and–agility weakened significantly with an increase in BMI, while fine manual control, manual coordination, and body coordination showed the weakest relationships to BMI. Variance analysis showed further significant relationships among BMI, cardio–respiratory endurance, muscular strength, and running speed–and–agility (p<0.05). It can be concluded that health–promoting physical fitness and the motor proficiency of young South African children are negatively influenced by obesity and intervention strategies are recommended to promote the quality of life of such children. For objectives three and four, an availability random sample of 37 experimental subjects, with an average age of 11 years (±0.99) was taken, where 20 subjects (seven boys and 13 girls) took part in a multidisciplinary intervention programme, and 17 subjects (six boys and 11 girls) formed part of a control group. Body composition, physical–, and motor proficiency were analysed by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005) during baseline measurements, on completion of the intervention programme, and after a follow–up period of three months. The results, which were analysed with a repeated–measures analysis, Bonferroni–post–hoc analysis, and dependent and independent t–tests, show that the intervention programme brought about a significant change in all the body composition variables, excluding body height. Flexibility, muscular strength, and abdominal muscular endurance, as well as one of the four fine manual control test items (folding paper), two of the 12 body coordination test items (tapping feet and fingers - opposite sides synchronised, and standing on one leg on a line - eyes closed), and six of the seven strength and agility test items (shuttle run, stepping sideways over a balance beam, one–legged stationary hops, one–legged side hops, two–legged side hops, and sit–ups), showed significant differences from the control group on completion of the intervention programme. The results indicate that the intervention brought about differences in body composition and physical– and motor proficiency and also showed a sustainable effect over a period of three months on body fat percentage, subscapular skinfold and leg muscular strength. From this, it can be deduced that young obese children need sustained guidance to be able to maintain the lifestyle adaptations that are required by obesity interventions. It can be concluded that the physical– and motor proficiency of children is negatively influenced by obesity, that a multidisciplinary intervention programme improves the body composition profile of obese children and has a positive effect on the physical– and the motor proficiency of obese nine– to 12–year old South African children, although the effect is not sustainable without ongoing, controlled intervention. / Thesis (Ph.D. (Kinderkinetics))--North-West University, Potchefstroom Campus, 2012.

This study focuses on the use of a bridging technique to overcome contact–making barriers in adolescents. Contact is regarded as an integral part of all human experiences, but barriers (also called contact boundary disturbances) often hinder effective contact–making with the environment. To overcome contact boundary disturbances, several model bridges were constructed prior to the study and these were used as a metaphor during the intervention phase with adolescents. The goal of the research was to determine whether a technique called “bridging” could overcome contact boundary disturbances in adolescents in therapy. The research was conducted from an existential–phenomenological Gestalt approach. Combined quantitative and qualitative approaches were followed and a single system experimental design, A–B–A–A, was applied. A total of 14 adolescent participants between the ages of 11 and 14 were purposefully selected from three different schools in the Gauteng Province, South Africa, as well as their parents and teachers. Quantitative data were collected from the pre–intervention assessment, the post–intervention assessment and a follow–up assessment where questionnaires were completed by the researcher for each of the adolescent participants. The follow–up assessment was done four weeks after the postassessment in order to determine the consistency of the intervention. These questionnaires were analysed according to the semantic differential scale, and raw scores were plotted on line and bar graphs in order to assess the contact skills and contact boundary disturbances in the participating adolescents. Qualitative data were collected through semi–structured interviews with parents and teachers and through therapeutic interventions with adolescents. The data were analysed using the Creswell spiral and the a priori and inductive coding approaches. Three main themes were identified which were contact boundary disturbances, personal emotional factors and behavioural factors. Quantitative and qualitative data results and findings were discussed in context, to the relevant literature. The findings of the data indicated that the bridging technique can be useful in working with adolescents in therapy to overcome contact–making barriers. / Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2012.

The increasing prevalence of childhood obesity worldwide is viewed as a global epidemic (World Health Organization, 2010). It is associated with a variety of health problems as well as physical– (cardio–respiratory endurance, flexibility, muscular strength, muscular endurance, and body composition), and motor proficiency (fine manual control, manual coordination, body coordination, and strength–and–agility) (Asayama et al., 2003:644; Okely et al., 2004:242; Tokmakidis et al., 2006:870). As far as the South African context is concerned, there is little research examining these relationships and the effect of physical intervention there upon, in nine– to 12–year old children. The first and second objectives of this study were to determine whether obesity would influence the physical– and/or the motor proficiency of nine– to 12–year–old South African children. The third and fourth objectives of this study were to determine the effect of a multidisciplinary intervention on the physical– and the motor proficiency of nine– to 12–year–old obese children. For objectives one and two, a cross–sectional study was performed on 280 children (128 boys and 152 girls), with an average age of 10.6 years (±1.05). Anthropometric–, physical– and motor measurements were obtained by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005). Body mass index (BMI) cut–off points were used to classify the children as normal, overweight, or obese (Cole et al., 2000). The data was analysed with regard to the above–mentioned objectives with the Statistica computer program, by means of descriptive statistics, Spearman rank correlations, and variance analyses. The results show that the physical fitness variables, cardio–respiratory endurance and muscular strength, particularly leg muscular strength, showed significant decreases with an increase in BMI. A progressive, but insignificant, decrease was found in muscular endurance with an increase in BMI, while flexibility showed the weakest relationship to BMI. The motor variables strength–and–agility weakened significantly with an increase in BMI, while fine manual control, manual coordination, and body coordination showed the weakest relationships to BMI. Variance analysis showed further significant relationships among BMI, cardio–respiratory endurance, muscular strength, and running speed–and–agility (p<0.05). It can be concluded that health–promoting physical fitness and the motor proficiency of young South African children are negatively influenced by obesity and intervention strategies are recommended to promote the quality of life of such children. For objectives three and four, an availability random sample of 37 experimental subjects, with an average age of 11 years (±0.99) was taken, where 20 subjects (seven boys and 13 girls) took part in a multidisciplinary intervention programme, and 17 subjects (six boys and 11 girls) formed part of a control group. Body composition, physical–, and motor proficiency were analysed by the 'Fitnessgram' (Meredith & Welk, 1999) and the 'Bruininks–Oseretsky Test of Motor Proficiency–II' (Bruininks & Bruininks, 2005) during baseline measurements, on completion of the intervention programme, and after a follow–up period of three months. The results, which were analysed with a repeated–measures analysis, Bonferroni–post–hoc analysis, and dependent and independent t–tests, show that the intervention programme brought about a significant change in all the body composition variables, excluding body height. Flexibility, muscular strength, and abdominal muscular endurance, as well as one of the four fine manual control test items (folding paper), two of the 12 body coordination test items (tapping feet and fingers - opposite sides synchronised, and standing on one leg on a line - eyes closed), and six of the seven strength and agility test items (shuttle run, stepping sideways over a balance beam, one–legged stationary hops, one–legged side hops, two–legged side hops, and sit–ups), showed significant differences from the control group on completion of the intervention programme. The results indicate that the intervention brought about differences in body composition and physical– and motor proficiency and also showed a sustainable effect over a period of three months on body fat percentage, subscapular skinfold and leg muscular strength. From this, it can be deduced that young obese children need sustained guidance to be able to maintain the lifestyle adaptations that are required by obesity interventions. It can be concluded that the physical– and motor proficiency of children is negatively influenced by obesity, that a multidisciplinary intervention programme improves the body composition profile of obese children and has a positive effect on the physical– and the motor proficiency of obese nine– to 12–year old South African children, although the effect is not sustainable without ongoing, controlled intervention. / Thesis (Ph.D. (Kinderkinetics))--North-West University, Potchefstroom Campus, 2012.

AFRIKAANS : Rasionaal: Die Suid-Afrikaanse konteks is heterogeen van aard en word gekenmerk deur ʼn kontinuum van ontwikkelende tot ontwikkelde gesondheidsdienste. Daar word beraam dat 55% van kinders (0-3 jaar) in landelike Suid-Afrikaanse gebiede woon, waar armoede heers en die infrastruktuur onvoldoende is. Die ongunstige omgewings omstandighede van talle kinders woonagtig in Suid-Afrika verhoog die risiko vir gestremdhede en plaas babas en kleuters in ʼn groter gevaar vir die ontwikkeling van ʼn kommunikasieafwyking, wat die behoefte aan effektiewe Vroeë Kommunikasie Intervensie (VKI) dienslewering in dié konteks beklemtoon. Primêre Gesondheidsorgklinieke (PGS) kan beskou word as die ideale konteks binne die Suid-Afrikaanse realiteit waar VKI programme en VKI dienslewering geïmplementeer kan word. Deur VKI dienslewering binne die Primêre Gesondheidsorgklinieke te implementeer, kan samewerkende dienslewering tussen VKI en Primêre Gesondheidsorg verhoog word. Beide die Primêre Gesondheidsorgmodel en die VKI benadering stel voorkoming en die vroeë identifikasie van afwykings as sentrale doelwit voor. Die implementering van VKI in die Suid-Afrikaanse Gesondheidsorgsisteem is deur talle navorsers geïdentifiseer as die wyse waarop die dienste aan babas en kleuters wat ʼn risiko toon vir die ontwikkeling van ʼn kommunikasieafwyking bevorder kan word. Deur die implementering van VKI dienslewering op die vlak van Primêre Gesondheidsorgklinieke, kan die basiese beginsels van VKI naamlik, dienslewering wat gemeenskapsgebaseerd, familie-gesentreerd, omvattend en gekoördineerd is, geïmplementeer word. Doel: Die hoofdoel van hierdie studie was om te bepaal in watter mate Gesondheidsorgklinieke in die Wes-Rand streek as konteks vir die toepassing van VKI kan dien. Metode: ʼn Beskrywende kwantitatiewe opname is as navorsingsontwerp vir beide fases benut. Ten einde die doel van die studie te bereik, is die navorsing in twee fases uitgevoer, omdat die navorsingsproses kronologiese verloop het en daar eerstens in fase een gefokus is op die konteks vir diensverskaffing, en tweedens in fase twee op die diensverskaffers. Fase een het ʼn konteks analise behels om sodoende die fisiese konteks waarbinne die sorggewers en hul kinders wat ʼn risiko vertoon vir die ontwikkeling van ʼn kommunikasieprobleem dienste ontvang, te beskryf en te evalueer deur die voltooiing van ʼn afmerklys wat vooraf deur die navorser opgestel is. Fase twee het ʼn triangulasie navorsingsmetode benut deur gebruik te maak van ʼn gestruktureerde onderhoudskedule, sowel as die voltooiing van ʼn opgestelde vraelys. Die afmerklys in fase een, die gestruktureerde onderhoudskedule, en die vraelys in fase twee het as data-insamelingstegnieke vir die navorsingsprojek gedien. Respondente en Deelnemers: Vir Fase 1 is 12 Primêre Gesondheidsorgklinieke in die drie sub-distrikte van die Wes-Rand distrik benut vir die konteksanalise. Vir Fase 2 is agt terapeute in hulle gemeenskapsdiensjaar wat werksaam is in die Wes-Rand distrik as deelnemers benut vir die bespreking van die vooraf geïdentifiseerde temas gedurende die gestruktureerde onderhoudskedule. 34 gemeenskapsverpleegkundiges van die Wes-Rand distrik is as respondente gebruik vir die voltooiing van die vraelys. Bevindinge: Die bevindinge het daarop gedui dat die Primêre Gesondheidsorgklinieke nie voldoende toegerus is vir die verskaffing van VKI dienslewering nie, ten spyte van die teenwoordigheid van risikofaktore onder die kliniekpopulasie. Verder was daar geen VKI bemarkings-, evaluasie- en intervensiemateriaal in die klinieke beskikbaar nie. Resultate het egter daarop gedui dat daar op ʼn weeklikse basis by elkeen van die Primêre Gesondheidsorgklinieke die moontlikheid bestaan van ʼn VKI span, aangesien daar ʼn spraak-taalterapeut, arbeidsterapeut, fisioterapeut, dieetkundige, maatskaplike werker, mediese dokter en verpleegkundige weekliks op dieselfde dag beskikbaar is. Die gemeenskapdiensjaarterapeute was positief ten opsigte van vroeë identifikasie en sekondêre voorkoming as sleutelkomponente van VKI. In teenstelling met die terapeute se positiwiteit t.o.v. vroeë identifikasie en voorkoming en in ooreenstemming met die bevindinge in Fase 1, was die terapeute van mening dat VKI tans nie suksesvol binne die Primêre Gesondheidsorgklinieke geïmplementeer sal kan word. Die gemeenskapsverpleegkundiges se kennis rakende VKI en aspekte wat verband hou met VKI was nie bevredigend nie. Die verpleegkundiges se houding jeens ʼn spanbenadering was positief, wat aan die spraak-taalterapeute die geleentheid bied om in samewerking met die verpleegkundiges die implementering van VKI binne hierdie konteks te motiveer en te implementeer. Gevolgtrekking: Die resultate van die navorsing hou implikasies in vir die rol van die spraak-taalterapeut ten opsigte van gemeenskapsgebaseerde intervensie, voorkoming, vroeë identifikasie, en die opleiding en bemagtiging van sorggewers en spanlede wat betref VKI binne die Suid-Afrikaanse Primêre Gesondheidsorgklinieke. Die behoefte aan verdere navorsing in die veld is deur die bevindinge van die studie beklemtoon. ENGLISH : Rationale: The South- African context is a heterogeneous context that is characterized by a continuum of developing to developed health care services. It is estimated that 55% of children (0 to 3 years) live in rural areas with insufficient infrastructure and under extreme conditions of poverty. Children living in South Africa are at greater risk for the development of a communication disorder due to the unfavourable environmental circumstances that they live in, which emphasizes the need for Early Communication Intervention (ECI) services in South Africa. Primary Health Care Clinics can be seen as the ideal context within South Africa where ECI programs and service delivery can be implemented. Both the Primary Health Care Model and the principles of ECI service delivery focuses on prevention and early identification of developmental disorders as their main goal. Many authors view the implementation of ECI in South Africa’s health system as the way in which the appropriate services can be provided to babies and infants that are at-risk for a communication disorder. Implementing ECI on the level of the Primary Healthcare will allow for the provision of services that are in accordance with the basic principles of service delivery stipulated by ASHA (1989), namely services that are community-based, family-centered, coordinated and comprehensive. Aim: The main purpose of the study was to determine the degree in which the Primary Health Care Clinics in the West-Rand district can be used for the implementation of Early Communication Intervention (ECI). Method: An exploratory, descriptive and contextual research design was implemented for both phases, which incorporated both quantitative and qualitative paradigms. This study was conducted in two phases. In Phase One a context analysis was conducted, where by a checklist was completed by the researcher, in order to describe and evaluate the context where children who are at risk for the development of a communication disorder, and their parents, may receive services. In Phase two a triangulation method was followed and the researcher made use of a structured interview to discuss the themes and a questionnaire in order to obtain information regarding the perception of the nurses and community service therapists on ECI services and the implementation of ECI services in the Primary Health Care Clinics. The checklist in phase one, the structured interview, and the questionnaire in phase two were used as data collection methods during this research project. Respondents and Participants: For the context analysis in Phase One, 12 Primary Health Care Clinics in the West-Rand district were used. Phase Two utilized 8 therapists as participants that were employed by the Wes-Rand health district to complete their community service year. 34 community nurses, employed by the West-Rand district were utilized as respondents and completed the questionnaire. Results: The findings of the study indicated that the Primary Health Care Clinics were not appropriately equipped for the implementation of ECI service delivery, despite the presence of risk-factors under babies and children visiting the clinics. There were no available ECI marketing-, assessment-, and intervention material at the clinics. It is promising to have found that there is the possibility of the implementation of an ECI team at each of the clinics, seeing that there is a speech-language therapist, occupational therapist, physiotherapist, dietician, social worker, medical doctor and nurse available on the same day on a weekly basis. The community service therapists were positive regarding early identification and the secondary prevention of communication disorders as key components of the ECI process. In contrast with their positive attitudes towards these aspects, they were of the opinion that due to proposed challenges in this context, at this stage, it will not be possible to implement the ECI process in the Primary Health Care Clinics. The community nurse’s knowledge regarding ECI and the aspects related to ECI were not appropriate. Despite this, they demonstrated a positive attitude towards the implementation of a team approach, which gives the speech-language therapist’s the opportunity to work with the nursing staff in a team approach, to implement ECI within the Primary Health Care Clinics. The participants in Phase Two were aware of the importance of ECI and the need for ECI services in this context, but they were of the opinion that the implementation of ECI in this Primary Health Care Context would not be possible due to a variety of reasons. The respondents in Phase Two demonstrated inappropriate knowledge and awareness regarding ECI, communication development, communication disorders and the role of the speech-language therapist and audiologist in the Primary Health Care Context. The majority of the respondents were positive about in-service ECI training, regardless of their limited knowledge thereof. Conclusion: The results have implications for the role of the speech-language therapist in terms of community-based intervention, prevention, early identification, parent training and informing colleagues about ECI within the South African Primary Health Care Clinics. The need for further research in this field is emphasized. Copyright / Dissertation (MComm Path)--University of Pretoria, 2009. / Speech-Language Pathology and Audiology / Unrestricted

The purpose of this study was to explore the psychosocial problems encountered by Black patients with tetralpegia once discharged from the hospital. Phenomenology as a research strategy was used with the aim of understanding the worldview of patients. The medical aspects of spinal cord injury were discussed, firstly with emphasis placed on the incidence of spinal cord injury, causes of spinal cord injury, different levels of tetraplegia and the management of patients with tetraplegia. The psychosocial problems encountered by black patients with tetralpegia once discharged from the hospital were discussed. The emphasis was placed on the patients’ emotional reaction to the injury, adjustment towards the injury and the guidelines for social work intervention with regard to the patient with tetraplegia. Ten respondents participated in the study after they were selected by using availability sampling and the study revealed the following. Tetraplegia results in a variety of psychosocial problems for both the patient and his/her family, which are: Negative marital relationships and desertion by the healthier spouse. Disturbed family relationships. Negative self-esteem and lack of self-confidence due to physical limitations. Poor quality of life, stigmatization by the community and inaccessibility in as far as public transport is concerned. Tetraplegia triggers psychological, social and financial problems. It is therefore concluded that social work intervention in the initial phase of the injury will ensure that the patients’ psychosocial problems are explored and attended to, to prepare the patients for the difficult life thereafter. / Dissertation (MA (SW) Health Care)--University of Pretoria, 2007. / Social Work and Criminology / MA (SW) / unrestricted