Thesis (MScMedSc (Rehabilitation))--University of Stellenbosch, 2008. / Stroke is the second commonest cause of mortality worldwide and remains a leading cause of adult physical disability. It is estimated that sixty percent of South African stroke survivors require assistance with at least one activity of daily living. This burden is predominantly on the shoulders of mostly untrained caregivers. The process of enabling caregivers to make choices conducive to their own health as well as the health of the stroke survivors is multidimensional. One of the cornerstones of this process is the provision of information. In 1995, the Centre for Rehabilitation Studies of the University of Stellenbosch started to develop a training package for stroke care at home. The training takes the form of an interactive workshop and a booklet with practical information. The aim of this study was to refine and pilot this booklet for implementation with the training. The study found that existing guidelines to evaluate the appropriateness of written material for developing communities (measured by Hugo’s grading model), were inadequate. Consequently, a new checklist, based on twenty existing checklists, was compiled. This list, as well as the Suitability Assessment of Material (SAM), was used to evaluate the booklet and make recommendations for a pre-pilot refinement. Even though this checklist has not been validated, it revealed similar results to the SAM when applied to the booklet. After cosultation with the authors, improvements were effected to the booklet The booklet was tested with four samples of the target audience. The functional literacy of the participants was determined using a standardised literacy test. A fifth sample completed a questionnaire on their preference between the pre- and postrefined booklet. Experts in the field of rehabilitation and graphic design also commented on the booklet. This study confirmed the need of stroke survivors and their caregivers for written health information. The refined booklet was found to be an appropriate tool to address the needs of the target audience. The participants perceived the booklet as useful and comprehensible and the readability level was shown to correspond with the tested literacy level of the samples. However, there is a need for printed material on topics related to stroke not currently covered in the booklet, e.g. spasticity. This study showed that the checklist could be used to tailor written health information that is preferred by the target audience. It confirmed that the testing of printed material with stakeholders could expose additional gaps after applying the checklist. Recommendations for further improvements were made based on the comments of the participants. It is foreseen that the new checklist could be a valuable tool for developing future written health material. Finally, it is recommended that an interdisciplinary team that includes a graphic designer be involvement from the planning stages.

Thesis (DTh (Practical Theology and Missiology))--University of Stellenbosch, 2005. / The basic premise of this study is that the congregation is the key to providing homebased pastoral care support to HIV-positive people in poor contexts. In so doing, the church does not only perform a social function to poor HIV/AIDS-affected families, but it also acts in accordance with the calling of mediating God’s Kingdom (diakonia), thus spreading the gospel, and showing unconditional sacrificial love and compassion. The Church embodies the gospel, which is the instrument of hope and salvation to despairing HIV/AIDS-people in the community.

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

Alzheimer's disease (AD) is a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and results in behavioral changes and lack of communication. Family members and caregivers of persons with Alzheimer’s disease can assume added responsibilities and stress due to the progressive and degenerative component of this disability and places an added strain on the family system. This study was designed to examine predictors of quality of life of persons living with AD and to examine caregiver burden and predictors of quality of life of persons living with AD. This study hopes to empower the caregivers and test the resiliency model of family stress, sense of coherence and social support while incorporating individual patient and family needs by surveying caregivers involved with working with patients with AD. Specific aims of the study include validating relationships of the resiliency model while determining the importance of family resiliency, the sense of coherence, social support and the role of psychosocial interventions specifically Validation Communication Intervention (VCI), to reduce caregiver burden and to predict the quality of life in persons with Alzheimer’s disease. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

This study is a Time 4 (T4) follow-up interview of ninety-three caregivers of persons who experienced a first stroke between 2 to 4 years (mean = 36 months) prior to the T4 interview. The first wave of data collection occurred within two months after the stroke. The second and third waves occurred six and twelve months, respectively, after the first interview. The caregivers were identified by the person with stroke as being the person closest to him/her who would be responsible for care after the stroke. Data were gathered at all four interviews using reliable and valid measures for depressive symptomatology (CES-D; Radloff, 1977), psychological well-being (IPWB; Berkman, 1971), and caregiver burden (Zarit, 1980). The contribution of social support to caregiver well-being was also investigated. Additional areas of investigation at T4 included coping strategies (F-Copes; McCubbin, Larsen, and Olson, 1981), caregiver adjustment, and the respondents' perception of themselves as "caregivers". The mean scores of depressive symptomatology, perceived burden, negative well-being, and positive well-being did not change significantly over the four points in time. However, the percentage of the sample having CES-D levels of 16 and above (indicating potential diagnosis of clinical depression) decreased by ten percent between T1 and T4. About ten percent of the respondents who were at risk for clinical depression at T4 reported high levels of depressive symptoms at all four interviews. Respondents who specifically thought of themselves as "caregivers" (sixty-two percent) were significantly more likely to report high levels of depressive symptoms, to experience high levels of strain and caregiver burden, and to be caring for persons who were more severely impaired by the stroke than those who did not. Caregiver characteristics contributed more to the variance in depressive symptoms and psychological well-being than did characteristics of the stroke. However, depressive symptomatology and perceived burden were significantly associated with both the functional capacity of the person with stroke and with an index of stroke severity comprised of communication impairments and negative personality/behavior changes since the stroke. The findings from this study have implications for stroke management programs, caregiver intervention planning, and health care policy.

Doctor of Philosophy / Persons with acquired brain injury require continuing support and care in various aspects of their lives many years post-injury. Their care and support are mainly provided by family members. While respite is one of a range of critical support systems for carers and people with life-long disability, very little is known about respite in the area of acquired brain injury. The majority of the research on respite has been undertaken in developmental disability, mental health and in aged care, but there is no research to date about respite from the perspectives of the person with a disability, the carer and respite provider. There is also no research that examines these perspectives in the acquired brain injury literature. This study was aimed to address this gap in the literature by investigating respite from the perspectives of the person with acquired brain injury, the carer and the respite provider. It also examined the profile of respite services being provided in the Australian state of New South Wales as there had not been a comprehensive mapping of respite before. Survey methodology was used to gather information from persons with acquired brain injury and their carers who were members of the New South Wales Brain Injury Association, which is the peak advocacy association of people with brain injury. The same methodology was used to gather similar information from members of Interchange Respite Care New South Wales, which is a peak association representing respite providers in the state. The survey questionnaires were developed and designed after an extensive review of the literature, and were reviewed by experts in the fields of respite, disability and acquired brain injury. The survey questionnaire was also trialled on a sample of families. The survey questionnaires for the three participant groups shared several common sections, such as demographic information; factors influencing respite use; expectations of respite; and satisfaction with respite services used by persons or carers. The responses from the three participant groups were analysed and compared using logistic regression and descriptive statistics. The key findings of the study are (a) several characteristics or factors of the person with acquired brain injury and their carer were significantly associated with the use of respite, (b) there were several common factors that all three participant groups reported to influence respite use, and (c) there were several common expectations of respite among the three participant groups. Some of the characteristics or factors that were significantly associated with respite use included the severity of disability, the high level of dependency of the person with acquired brain injury, and the number of days spent in a coma. Common factors reported by all three participant groups to influence respite use included the stress level of the carer and the severity of disability. Factors reported to influence respite use appear to be consistent with the literature in developmental disability. There were common perspectives regarding the expectations of respite among all three participant groups, such as the need for trained and qualified respite staff; a wider range of respite services and more flexibility of respite service provision. The study also indicated a reported lack of sufficient respite for persons with acquired brain injury and their carers. Some of the findings of the study appeared to be consistent with the research literature on acquired brain injury; such as the majority of carers being mainly female; there is a reliance on informal networks for the care and support of the person with acquired brain injury; and the majority of the persons with acquired brain injury being male. The study also found that many respite providers in New South Wales had extensive experience in running a respite service. The findings of the study have important implications for policy direction and development, practice and service delivery, and research. In terms of policy direction and development, implications explored included: a flexible funding model that is responsive to the needs of carer and person with acquired brain injury, and adequately trained and qualified staff and volunteers play an important role in respite provision. Further research is required to understand empirically the benefits and quality of life outcomes over a period of time, such as what types and extent of respite are more beneficial for certain demographic profiles. The study highlights the perspectives of persons with acquired brain injury, their carers and respite providers. Respite is an important support system to enable persons with acquired brain injury to receive the continuing care and support from their carers. Respite in acquired brain injury is a new field that merits further research as it holds the potential for addressing the needs of people with acquired brain injury and their carers.

The purpose of this study was to explore how Korean American caregivers view dementia caregiving and analyze the role of culture in their attitude toward caregiving. Demographic characteristics, stressor factors, social support factors, and cultural factors were examined in the model. Stressor factors were measured by care receivers' problem behaviors, duration of caregiving, and amount of caregiving. Social support factors were composed of the amount of social support and the quality of social support. Cultural factors included level of acculturation, years in the U.S., filial piety, and familism. The study compared a group of spouse caregivers with a group of children providing care in order to investigate the differences in their attitude toward caregiving. In addition, the interaction effect between social support and acculturation on dementia caregiver's attitude toward caregiving was examined. Eighty five Korean American dementia caregivers participated in the survey through a convenience sampling method. Among the Korean American dementia caregivers, child caregivers showed a more positive attitude toward caregiving then spouse caregivers. The effects of social support on caregivers' attitude toward caregiving did not vary with the level of acculturation. Hierarchical multiple regression analysis indicated that, among the study factors including stressor factors, social support factors, and cultural factors, only social support factors contributed significantly to Korean American dementia caregivers' positive attitude toward caregiving. Among the predictors of Korean American dementia caregivers' attitude toward caregivng, the amount of caregiving per day was the most significant variable, followed by the quality of social support and care receivers' problem behaviors. Higher levels of daily caregiving and higher quality of social support were positively related to positive attitude toward caregiving. A higher level of care receivers' problem behaviors was negatively related to positive attitude toward caregiving. Comparison of the beta coefficients from the spouse caregiver group and nonspouse caregiver group revealed that there was a discrepancy of predictors of Korean American caregivers' attitude toward caregiving between the two caregiving groups. The model had a better fit for immigrant spouse caregiver groups indicated by significantly different R² from spouse caregivers and non-spouse caregivers, 85% and 33%, respectively. The results of this study imply the importance of incorporating cultural diversity in social policy. Because of the salient findings in this study, inclusion of content on increasing and enhancing quality of social support is recommended for social work practice with Korean American dementia caregivers.

Doctor of Philosophy / Persons with acquired brain injury require continuing support and care in various aspects of their lives many years post-injury. Their care and support are mainly provided by family members. While respite is one of a range of critical support systems for carers and people with life-long disability, very little is known about respite in the area of acquired brain injury. The majority of the research on respite has been undertaken in developmental disability, mental health and in aged care, but there is no research to date about respite from the perspectives of the person with a disability, the carer and respite provider. There is also no research that examines these perspectives in the acquired brain injury literature. This study was aimed to address this gap in the literature by investigating respite from the perspectives of the person with acquired brain injury, the carer and the respite provider. It also examined the profile of respite services being provided in the Australian state of New South Wales as there had not been a comprehensive mapping of respite before. Survey methodology was used to gather information from persons with acquired brain injury and their carers who were members of the New South Wales Brain Injury Association, which is the peak advocacy association of people with brain injury. The same methodology was used to gather similar information from members of Interchange Respite Care New South Wales, which is a peak association representing respite providers in the state. The survey questionnaires were developed and designed after an extensive review of the literature, and were reviewed by experts in the fields of respite, disability and acquired brain injury. The survey questionnaire was also trialled on a sample of families. The survey questionnaires for the three participant groups shared several common sections, such as demographic information; factors influencing respite use; expectations of respite; and satisfaction with respite services used by persons or carers. The responses from the three participant groups were analysed and compared using logistic regression and descriptive statistics. The key findings of the study are (a) several characteristics or factors of the person with acquired brain injury and their carer were significantly associated with the use of respite, (b) there were several common factors that all three participant groups reported to influence respite use, and (c) there were several common expectations of respite among the three participant groups. Some of the characteristics or factors that were significantly associated with respite use included the severity of disability, the high level of dependency of the person with acquired brain injury, and the number of days spent in a coma. Common factors reported by all three participant groups to influence respite use included the stress level of the carer and the severity of disability. Factors reported to influence respite use appear to be consistent with the literature in developmental disability. There were common perspectives regarding the expectations of respite among all three participant groups, such as the need for trained and qualified respite staff; a wider range of respite services and more flexibility of respite service provision. The study also indicated a reported lack of sufficient respite for persons with acquired brain injury and their carers. Some of the findings of the study appeared to be consistent with the research literature on acquired brain injury; such as the majority of carers being mainly female; there is a reliance on informal networks for the care and support of the person with acquired brain injury; and the majority of the persons with acquired brain injury being male. The study also found that many respite providers in New South Wales had extensive experience in running a respite service. The findings of the study have important implications for policy direction and development, practice and service delivery, and research. In terms of policy direction and development, implications explored included: a flexible funding model that is responsive to the needs of carer and person with acquired brain injury, and adequately trained and qualified staff and volunteers play an important role in respite provision. Further research is required to understand empirically the benefits and quality of life outcomes over a period of time, such as what types and extent of respite are more beneficial for certain demographic profiles. The study highlights the perspectives of persons with acquired brain injury, their carers and respite providers. Respite is an important support system to enable persons with acquired brain injury to receive the continuing care and support from their carers. Respite in acquired brain injury is a new field that merits further research as it holds the potential for addressing the needs of people with acquired brain injury and their carers.

The purpose of this study was to determine how pain in PLHIV on community home based care programme was managed using the Roy adaptation model (RAM) as the theoretical framework. This study used a descriptive mixed method research design which allowed for the research topic to be investigated and described in terms of both narrative qualitative accounts and descriptive statistics. A sequential exploratory approach was adopted in which qualitative data collection was conducted in the initial phase followed by quantitative data collection. Ten qualitative interviews, guided by the components of the RAM were conducted in the initial phase and a structured interview schedule (questionnaire) partially based on the result of the qualitative phase and (which was also structured in accordance with the RAM) was administered to 120 respondents who met the inclusion criteria of being on CHBC. Convenience sampling was used to select study participants and respondents in both phases of the study. Peripheral neuropathy was the most common pain syndrome experienced by patients. More females suffered numbness/tingling sensation of toes, followed by chest pains than their male counterparts. Pain experienced was moderate to severe which was not treated effectively. The study findings could assist health care providers, policy makers and researchers to invest into improving pain management for PLHIV, strengthen education of patients and their primary caregivers on the causes of pain and modalities to employ for pain relief and implement palliative care guidelines for PLHIV. / Health Studies / D. Litt. et Phil. (Health Studies)