This study examines the design, implementation and evaluation of a communication skills training programme for adherence counsellors in a paediatric HIV clinic. Effective communication is a pre-requisite skill for any counselling interaction. For both prevention and treatment, counselling is a critical component of the healthcare team response to the HIV epidemic. Given the shortages of healthcare workers in sub-Saharan Africa, task-shifting of the counselling role to less-trained cadres of workers is commonplace. In the multilingual, multicultural South African context, taskshifting coupled with the complexity of the message in paediatric HIV presents enormous challenges. In-service support for counsellors is lacking. Counsellor burn-out and fatigue is commonplace affecting the quality of counselling interactions. Measuring the quality of communication in a multilingual context poses ethical and methodological challenges and is a neglected area of research. Traditional communication and counselling assessments appear to be largely taxonomic; lack cultural and linguistic sensitivity; and fail to acknowledge communication as a dynamic, two-way process. Mindful of these issues, this study utilized a non-taxonomic approach. Verbal and non-verbal communication was analysed before and after the implementation of in-service training which was tailored to the specific research context. The training comprised a two day multidisciplinary team workshop followed by individual training. This consisted of video feedback and analysis of counsellors’ own sessions and was attended by four counsellors. Results were recorded over an eighteen month period. Twenty-two consultations between counsellors and caregivers were video-recorded, transcribed verbatim and analysed using a hybridized form of linguistic analysis. Findings that demonstrated consensus, substantiation and cross-consultation occurrence were triangulated with thematically analysed interview data, patient questionnaires and researcher reflections. These methods are more sensitive to process than checklist approaches and individualised, complex dynamics emerged. Communication barriers and facilitators were identified before training. Variations in communicative competence between counsellors appeared to be unrelated to prior training. After training, counsellors asked more open-ended questions, encouraged caregivers more, provided simpler explanations of treatment regimens and checked understanding more effectively. In response, caregivers initiated more questions. These findings suggest that communication training improves treatment literacy and results in interactions that are more patient-centered. Despite this evidence, the results suggest limitations to the impact of communication training given the lack of agency of women in South Africa. Interactions included frank and open discussion about cultural beliefs. However, this benefit may be lost due to poor healthcare team cohesion. In their roles as mothers and caregivers themselves, counsellors are effective patient advocates and bring their own lifeworld experience to the counselling interaction. These shared stories are testimonies to the resilience of women living in poverty. Whilst allowing for greater exploration of patients’ cultural beliefs and explanatory models, communication training has limited impact in assisting counsellors with dealing with issues such as disclosure, non-adherence and scepticism about biomedicine. Results indicate conflict between patient-centeredness and perceived desired medical outcomes. Caregivers and counsellors appeared to engage in ritualistic dialogue when discussing certain topics suggesting that a shared lifeworld between caregiver and counsellor is insufficient to overcome barriers from the meso (institutional) and macro (broader socio-political) context. An awareness of the impact of context is critical to our understanding of communication in a clinical setting. The results from this research have implications for the role of the counsellor within a multidisciplinary team and establish a need for communication specialists to work in a clinical setting within the HIV epidemic.

Magister Psychologiae - MPsych / According to the findings of this study, childcare workers caring for HIV-positive children working in a residential care setting, have similar experiences and challenges to nurses, community-based caregivers and primary caregivers, such as coping with loss and contagion fear. Nonetheless, caring for HIV-positive children poses unique challenges for the caregiver, calling for flexibility and situation-dependent coping strategies.

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

<p>Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care.</p>

Magister Public Health - MPH / Aim: To establish whether a family centered approach to HIV care in which HIV positive adults are counseled on the importance of having their children tested results in the adults bringing their children under the age of five years for testing and or accessing HIV care, and to explore challenges faced by caregivers in bringing children for testing and care. / South Africa

Afrikaans text / Die studie ondersoek die leemte aan teoreties gefundeerde riglyne om pleegouers in die bekendmakingsproses van hulle kind se MIV-positiewe status te ondersteun Die studie geskied binne die teoretiese raamwerk van ʼn intervensienavorsingsmodel. In die empiriese navorsing is die vrese en probleme van pleegouers by die bekendmakingsproses ondersoek. Daar is bevind dat hierdie vrese en probleme in ag geneem moet word in die beoogde riglyne. Die kognitiewe ontwikkeling van die kind is deur middel van ʼn literatuurstudie ondersoek om vas te stel watter kennis, denke en inligting die kind op verskillende ouderdomme begryp. Daar is bevind dat kinders wat MIV-positief is, moontlike agterstande ondervind en dat die riglyne gevolglik gebaseer moet word op die toenemende ontwikkeling van die kind, met begrip vir individuele ontwikkelingsverskille. Voorts is bevind dat pleegouers se eie gereedheid ʼn belangrike rol speel. Alhoewel die pleegouer die bekendmakingsproses self moet aanvoer en hanteer is dit belangrik dat die pleegouers deur ʼn interdissiplinêre span ondersteun en begelei sal word. / This study investigates the absence of theoretical grounded guidelines to support foster parents when disclosing paediatric HIV. The study was done within the theoretical framework of an intervention research model. The empirical research investigated the fears and problems experienced by foster parents during the disclosure process. It was found that these fears and problems should be taken into account when compiling guidelines. The child‟s cognitive development was researched by way of a literary study in order to determine what knowledge, thoughts and information the child is able to grasp at different ages. It was found that children who are HIV positive could possibly lag behind and that the guidelines should therefore be based on the accumulative development of the child, with consideration given to individual developmental differences. Furthermore, it was established that foster parents‟ own readiness plays an important role. For this reason the foster parents should be supported and guided by an interdisciplinary team, but that they themselves should take care and execute the process of disclosure. / Social Work / M. Diac. (Spelterapie)

Afrikaans text / Die studie ondersoek die leemte aan teoreties gefundeerde riglyne om pleegouers in die bekendmakingsproses van hulle kind se MIV-positiewe status te ondersteun Die studie geskied binne die teoretiese raamwerk van ʼn intervensienavorsingsmodel. In die empiriese navorsing is die vrese en probleme van pleegouers by die bekendmakingsproses ondersoek. Daar is bevind dat hierdie vrese en probleme in ag geneem moet word in die beoogde riglyne. Die kognitiewe ontwikkeling van die kind is deur middel van ʼn literatuurstudie ondersoek om vas te stel watter kennis, denke en inligting die kind op verskillende ouderdomme begryp. Daar is bevind dat kinders wat MIV-positief is, moontlike agterstande ondervind en dat die riglyne gevolglik gebaseer moet word op die toenemende ontwikkeling van die kind, met begrip vir individuele ontwikkelingsverskille. Voorts is bevind dat pleegouers se eie gereedheid ʼn belangrike rol speel. Alhoewel die pleegouer die bekendmakingsproses self moet aanvoer en hanteer is dit belangrik dat die pleegouers deur ʼn interdissiplinêre span ondersteun en begelei sal word. / This study investigates the absence of theoretical grounded guidelines to support foster parents when disclosing paediatric HIV. The study was done within the theoretical framework of an intervention research model. The empirical research investigated the fears and problems experienced by foster parents during the disclosure process. It was found that these fears and problems should be taken into account when compiling guidelines. The child‟s cognitive development was researched by way of a literary study in order to determine what knowledge, thoughts and information the child is able to grasp at different ages. It was found that children who are HIV positive could possibly lag behind and that the guidelines should therefore be based on the accumulative development of the child, with consideration given to individual developmental differences. Furthermore, it was established that foster parents‟ own readiness plays an important role. For this reason the foster parents should be supported and guided by an interdisciplinary team, but that they themselves should take care and execute the process of disclosure. / Social Work / M. Diac. (Spelterapie)