Sexuality is an integral part of health and well-being. Despite a 30-year history of adolescent sexuality research, there has been little that has focused on more than risky sexual behaviour. For example, there has been little research on conceptions of sexuality and pathways to sexual health. In part, this is because sexual health has been often defined as the lack of risky behaviour and health problems. In the studies reported here, components of female sexual health were identified and tested, including behaviours and cognitions, among groups of girls in their late teens and early 20s. After a review of the literature, four sets of factors appeared central to identifying female sexual health. These factors included sexual subjectivity, sexual agency, psychosocial well-being and sexual exploration. The first factor, sexual subjectivity, had previously been described as important to female sexual well-being, but had been developed within feminist theories and studied with qualitative methodologies. After a thorough review of the literature, no psychometrically sound measure of sexual subjectivity was found. Therefore, an instrument to assess sexual subjectivity was constructed and validated through a series of studies. Partially as expected, five factors were found - sexual body-esteem, entitlement to sexual pleasure from oneself, entitlement to sexual pleasure from a partner, sexual self-efficacy in achieving sexual pleasure, and sexual self-reflection. In additional cross-sectional and longitudinal (6-month, 2 waves) studies, associations between sexual subjectivity, sexual agency, psychosocial well-being, and sexual experience were examined. The results showed that there were concurrent associations between sexual subjectivity and measures of sexual agency and some measures of psychosocial wellbeing. Results also showed that females with more sexual experience (i.e., experience with sexual intercourse, self-masturbation, noncoital orgasmic responsiveness, and same-sex sexual experience) were relatively higher in sexual subjectivity and sexual agency. However, well-being was similar in sexual experience groups when they were compared. In longitudinal analyses, changes in sexual subjectivity, sexual agency and psychosocial well-being were examined for the whole sample and among subgroups defined by levels of sexual experience. Comparisons were also made between those girls who commenced sexual intercourse during the course of the study, those who remained virgins, and those who were nonvirgins at the first assessment. Main effects generally validated cross-sectional findings. Girls who commenced first sexual intercourse relatively earlier increased in self-esteem over time, compared to their virgin counterparts. Girls who reported a history of self-masturbation and noncoital orgasmic responsiveness, and girls who reported no history with either behaviour, increased in sexual body-esteem and self-esteem over time, but the former group of girls were relatively higher in sexual body-esteem and self-esteem than the latter group of girls. Girls who reported a history of one, but not the other of self-masturbation and noncoital orgasm did not change over time. Results also indicated that girls' transition to first sexual intercourse had little association with sexual subjectivity, but some findings were suggestive of a need for further research. Future research, and study strengths and limitations are discussed. There is a need to examine sexual subjectivity as both an antecedent and an outcome using longer time lags with several waves of assessment so that the linkages between sexual subjectivity and other factors can be determined. The implications of sexual subjectivity and sexual exploration for sexuality education are also discussed.

Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2008.

The aim of this study was to determine the psychometric properties of the Mental Health Continuum - Short Form (MHC-SF) (Keyes, 2006a) in an African context. This 14-item self-report questionnaire that measures mental health was developed in a Western individualistic context, which differs from the more collectivistic African cultural context in South Africa. The MHC-SF consists of three subscales, namely Emotional well-being, Social well-being and Psychological/personal well-being. Participants (N^IOSO) from urban (n=451) and rural (n=599) settlements completed the MHC-SF and other measures indicating positive and negative facets of psychosocial functioning in a one-shot cross-sectional survey design with the aid of 16 trained fieldworkers. Scales included to determine concurrent/criterion-related validity were the Affectometer 2 (short version) (AFM) (Kammann & Flett, 1983), the Satisfaction with Life Scale (SWLS) (Diener, Emmons, Larsen & Griffin, 1985), the Community Collective Efficacy Scale (revised) (CCES) (Carrol, Rosson & Zhou, 2005), the Generalized Self-Efficacy Scale (GSE) (Schwarzer & Jerusalem, 1993), the New General Self-Efficacy Scale (NGSE) (Chen, Gully & Eden, 2000), the Sense of Coherence Scale (SOC-29) (Antonovsky, 1987,1993) and the General Health Questionnaire (GHQ-28) (Goldberg & Hillier, 1979). Results indicated a Cronbach alpha reliability coefficient of 0,75 for the total MHC-SF and acceptable inter-item and item-total correlations for the items. Item 4 had an eta-squared value indicating a large effect size, and thus had a negative impact on reliability. Mean inter-item correlations ranged between 0,19 and 0,30 and item-total correlations between 0,13 and 0,51. Concurrent/criterion-related validity was satisfactory. Confirmatory factor analysis yielded three factors. A three-factor model, omitting item 4, had the best fit in structural equation modelling. Six percent of the participants were languishing, Psychosocial well-being in an African context 73%) were moderately mentally healthy and 21%> were flourishing. More participants from the urban settlement flourish than from the rural settlement. It was concluded that the MHC-SF is reliable and valid for further use in research in an African context. / Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2008.

This study forms part of a larger SANPAD project focusing on a comprehensive community-based HIV stigma reduction and wellness enhancement intervention, responding to the continuous burden of HIV stigma on both national and international levels and the paucity of research in sustainable HIV stigma reduction interventions. HIV stigma is considered all over the world as a complex, far-reaching and powerful phenomenon that continues to affect people living with HIV (PLWH) and also people living close to them (PLC). The impact of stigma has far reaching effects on aspects like the wellness of PLWH and PLC, but also on the health behaviour of PLWH. There is paucity in research on the lasting effect of HIV stigma reduction interventions, intervention within a community context, as well as in urban and rural settings. The research objectives of this study were to test the change-over-time in HIV stigma experiences of PLWH and stigmatization by PLC with regard to the psychosocial well-being of PLWH and PLC, and with regard to health behaviour of PLWH in both urban and rural settings, following a comprehensive community-based HIV stigma reduction intervention. A quantitative experimental single system research design with a pre-test and repetitive post-tests were conducted by means of purposive voluntary sampling for PLWH and snowball sampling for PLC. The intervention was based on three tenets, namely a) the sharing of information on HIV stigma and coping with it, b) the equalisation of relationships between PLWH and PLC through increased interaction and contact, and c) empowerment of both PLWH and PLC towards leadership in HIV stigma reduction through practical knowledge and experiences of planning and implementing HIV stigma reduction projects in their own communities. Several valid and reliable scales and instruments were used to measure effect. The initial analysis indicated no statistically significant difference between stigma experiences of PLWH and stigmatisation by PLC from urban and rural settings, or between psychosocial well-being of PLWH and PLC or health behaviour of PLWH from the two different settings. The urban-rural data was therefore pooled for the further analysis. The similarity of data could possibly be ascribed to the fact that most of the participants were Setswana-speaking and living in the North West Province. Stigma experiences as well as stigmatisation could be decreased and the decrease could be sustained over a year through the comprehensive community-based HIV stigma reduction intervention. The findings also showed that changes-over-time in psychosocial well-being following the intervention were better sustained by the PLC than the PLWH. Results furthermore indicated that HIV stigma reduction positively influenced the health behaviour of the PLWH. Recommendations for further HIV stigma reduction and wellness enhancement include the continued application of this comprehensive community-based HIV stigma reduction and wellness enhancement intervention, with its supporting tenets, content and methodology. This intervention should, however, be expanded into urban and rural communities, and to different cultures as well. It would be meaningful to build HIV stigma reduction community-based networks. More effort could be made to specifically include a workshop for PLWH on psychosocial well-being as well. HIV stigma interventions should be an indisputable part of health behaviour change workshops for PLWH. / PhD (Nursing), North-West University, Potchefstroom Campus, 2014

This study forms part of a larger SANPAD project focusing on a comprehensive community-based HIV stigma reduction and wellness enhancement intervention, responding to the continuous burden of HIV stigma on both national and international levels and the paucity of research in sustainable HIV stigma reduction interventions. HIV stigma is considered all over the world as a complex, far-reaching and powerful phenomenon that continues to affect people living with HIV (PLWH) and also people living close to them (PLC). The impact of stigma has far reaching effects on aspects like the wellness of PLWH and PLC, but also on the health behaviour of PLWH. There is paucity in research on the lasting effect of HIV stigma reduction interventions, intervention within a community context, as well as in urban and rural settings. The research objectives of this study were to test the change-over-time in HIV stigma experiences of PLWH and stigmatization by PLC with regard to the psychosocial well-being of PLWH and PLC, and with regard to health behaviour of PLWH in both urban and rural settings, following a comprehensive community-based HIV stigma reduction intervention. A quantitative experimental single system research design with a pre-test and repetitive post-tests were conducted by means of purposive voluntary sampling for PLWH and snowball sampling for PLC. The intervention was based on three tenets, namely a) the sharing of information on HIV stigma and coping with it, b) the equalisation of relationships between PLWH and PLC through increased interaction and contact, and c) empowerment of both PLWH and PLC towards leadership in HIV stigma reduction through practical knowledge and experiences of planning and implementing HIV stigma reduction projects in their own communities. Several valid and reliable scales and instruments were used to measure effect. The initial analysis indicated no statistically significant difference between stigma experiences of PLWH and stigmatisation by PLC from urban and rural settings, or between psychosocial well-being of PLWH and PLC or health behaviour of PLWH from the two different settings. The urban-rural data was therefore pooled for the further analysis. The similarity of data could possibly be ascribed to the fact that most of the participants were Setswana-speaking and living in the North West Province. Stigma experiences as well as stigmatisation could be decreased and the decrease could be sustained over a year through the comprehensive community-based HIV stigma reduction intervention. The findings also showed that changes-over-time in psychosocial well-being following the intervention were better sustained by the PLC than the PLWH. Results furthermore indicated that HIV stigma reduction positively influenced the health behaviour of the PLWH. Recommendations for further HIV stigma reduction and wellness enhancement include the continued application of this comprehensive community-based HIV stigma reduction and wellness enhancement intervention, with its supporting tenets, content and methodology. This intervention should, however, be expanded into urban and rural communities, and to different cultures as well. It would be meaningful to build HIV stigma reduction community-based networks. More effort could be made to specifically include a workshop for PLWH on psychosocial well-being as well. HIV stigma interventions should be an indisputable part of health behaviour change workshops for PLWH. / PhD (Nursing), North-West University, Potchefstroom Campus, 2014

The aim of this study was to determine the psychometric properties of the Mental Health Continuum - Short Form (MHC-SF) (Keyes, 2006a) in an African context. This 14-item self-report questionnaire that measures mental health was developed in a Western individualistic context, which differs from the more collectivistic African cultural context in South Africa. The MHC-SF consists of three subscales, namely Emotional well-being, Social well-being and Psychological/personal well-being. Participants (N^IOSO) from urban (n=451) and rural (n=599) settlements completed the MHC-SF and other measures indicating positive and negative facets of psychosocial functioning in a one-shot cross-sectional survey design with the aid of 16 trained fieldworkers. Scales included to determine concurrent/criterion-related validity were the Affectometer 2 (short version) (AFM) (Kammann & Flett, 1983), the Satisfaction with Life Scale (SWLS) (Diener, Emmons, Larsen & Griffin, 1985), the Community Collective Efficacy Scale (revised) (CCES) (Carrol, Rosson & Zhou, 2005), the Generalized Self-Efficacy Scale (GSE) (Schwarzer & Jerusalem, 1993), the New General Self-Efficacy Scale (NGSE) (Chen, Gully & Eden, 2000), the Sense of Coherence Scale (SOC-29) (Antonovsky, 1987,1993) and the General Health Questionnaire (GHQ-28) (Goldberg & Hillier, 1979). Results indicated a Cronbach alpha reliability coefficient of 0,75 for the total MHC-SF and acceptable inter-item and item-total correlations for the items. Item 4 had an eta-squared value indicating a large effect size, and thus had a negative impact on reliability. Mean inter-item correlations ranged between 0,19 and 0,30 and item-total correlations between 0,13 and 0,51. Concurrent/criterion-related validity was satisfactory. Confirmatory factor analysis yielded three factors. A three-factor model, omitting item 4, had the best fit in structural equation modelling. Six percent of the participants were languishing, Psychosocial well-being in an African context 73%) were moderately mentally healthy and 21%> were flourishing. More participants from the urban settlement flourish than from the rural settlement. It was concluded that the MHC-SF is reliable and valid for further use in research in an African context. / Thesis (M.A. (Psychology))--North-West University, Potchefstroom Campus, 2008.

Compared to other kinds of caregivers, caregivers of persons living with dementia (PwD) are at higher risk of experiencing social isolation, emotional distress, and depressive symptoms which can adversely affect their psychosocial well-being. This study uses longitudinal data and multilevel modeling to explore trajectories of change over the course of a choir intervention in affect, social engagement, and caregiver distress. A multilevel coupled model of change was employed to examine two time-varying associations within-person and between-persons: (1) the association between social activities and affect, and (2) the association between caregiver distress and affect. The social activities coupling model (between-persons) found that increasing engagement in social activities was significantly associated with an increase in positive affect. The caregiver distress coupling model (within-person) found that higher levels of caregiver distress were significantly associated with decreases in positive affect. The caregiver distress coupling model (between-persons) found that higher levels of caregiver distress were significantly associated with increases in negative affect. The choir intervention may have a positive impact on caregiver psychosocial well-being but there are many factors to consider (i.e., dementia trajectory) that influence psychosocial well-being. This study advances our understanding of the impact of an arts-based intervention (i.e., community-based choir) as a source of support for caregivers of PwD. Findings can inform efforts to develop community art-based programs to support family caregivers. / Graduate / 2021-12-10

Negative health effects on an unborn fetus have been related to cigarette smoking during pregnancy. Very little research examines stress, self-esteem, depression, and disordered eating in pregnant women who smoke. A study, Tennessee Intervention for Pregnant Smokers (TIPS), recruited pregnant women from five prenatal practices to help them quit smoking before giving birth. Using an expanded 5A’s (Ask, Advise, Assess, Assist, Arrange) model and motivational interviewing, the intervention was implemented by trained health educators over the course of 4 prenatal visits. Women in the study who successfully stopped smoking before delivery had significantly healthier infants than the women who did not. A subset of the sampled 1063 pregnant women with complete data on measures of interest will be analyzed for the current study. We hypothesize that the following factors will differ significantly among pregnant women who never smoked, women who smoked but quit prior to birth, and women who smoked and did not quit prior to birth: stress, as indicated by the stress subscale of the Prenatal Psychosocial Profile (PPP); self-esteem, as indicated by the self-esteem subscale of the PPP; depressive symptoms, as indicated by the Center for Epidemiologic Studies Depression Scale (CESD-10); and disordered eating, as indicated by the Eating Attitudes Test (EAT-26). Additionally, we hypothesize that the odds of pregnant women quitting smoking prior to birth will be predicted by stress, self-esteem, depressive symptoms, and disordered eating. One-way Analysis of Variance (ANOVA) tests will be conducted to compare scores on respective measures for the three groups based on smoking status. A logistic regression will be conducted to assess the degree to which aforementioned variables predict odds of smoking cessation in pregnant smokers. The implications of this research can be used to improve future intervention programs to reduce the adverse health effects of children born to mothers who smoke.

Philosophiae Doctor - PhD / The growing interest in the well-being of children who have been orphaned due to HIV/AIDS is widely reflected in the emerging body of research. Children orphaned by AIDS-related causes are identified as a vulnerable population of youth who display lower levels of psychosocial well-being and experience increased psychosocial distress. While HIV-related stigma remains a salient risk factor hindering the psychosocial well-being of children orphaned by AIDS, the concept remains elusive and poorly understood. Hence, the call for a comprehensive understanding to support an effective response to stigma reduction, and for the systematic identification and response to the psychosocial needs and challenges of children in the context of HIV/AIDS. The overall aim of this study was therefore to develop a model to understand the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS. A mixed method, exploratory, sequential design situated within a theory generative research approach was implemented in four sequential phases geared towards model development. The specific objectives of this study were to: (1) review existing literature focusing on the relationship between HIV-related stigma and the psychosocial well-being of children orphaned by AIDS (systematic review); (2) explore children orphaned by AIDS perceptions and experiences of HIV-related stigma (qualitative exploratory design); (3) develop a model that offers an understanding of the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS (a theory generative design); and (4) determine the functionality of the developed model through the use of the Delphi technique (a modified Delphi technique). The systematic review conducted in Phase I indicated the presence of HIV-related stigma, which inhibited the psychosocial well-being of children orphaned by AIDS. The findings further highlighted the mediating role of maladaptive coping strategies and social support likely to reduce healthy psychosocial well-being and cause psychosocial distress among children orphaned by AIDS. Similarly, the findings arising from the qualitative exploration in Phase II indicated that children orphaned by AIDS were highly perceptive and experienced HIV-related stigma as a result of parental illness and death. These experiences negatively affected the psychological, emotional, and social well-being, self-concept and self-esteem, and future orientation of children orphaned by AIDS. The theory generative design in Phase III identified, classified, and defined six focal concepts upon which the model is based, namely, (1) enacted stigma, (2) perceived stigma, (3) internalized stigma, (4) coping strategies, (5) psychosocial well-being, and (6) interpersonal relations. The developed relationship statements of the model indicated: (1) the bidirectional relationship between enacted, perceived, and internalized stigma; (2) the mediating role of coping strategies; (3) the direct and indirect influences of HIV-related stigma on the psychosocial well-being of children orphaned by AIDS; and (4) the contextual role of interpersonal relationships in which the process of stigmatization may unfold. The modified Delphi technique conducted in Phase IV indicated that the developed model was simplistic, clear, generalizable, accessible, and important for use in research and practice. The developed model will aid future studies by providing a theoretical lens through which HIV-related stigma and its influence on the psychosocial well-being of children orphaned by AIDS may be viewed. HIV-related stigma should be considered strongly when addressing the well-being of orphaned children, so that tailored programs, interventions, and services may be set in place to effectively bring about the reduction of stigma and ensure the psychosocial well-being of children. The recommendations set out serves to further inform practice and programs and form a baseline for future empirical research focusing on HIV-related stigma and the psychosocial well-being of children orphaned by AIDS.

Stress, self-esteem, depression, and disordered eating were analyzed among three groups of pregnant women in Tennessee Intervention for Pregnant Smokers (TIPS): never smoked, smoked but quit prior to birth, and smoked but did not quit prior to birth.