Thesis (MA)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The topic of antiretroviral adherence remains a subject of continued importance, as it is
associated with positive health outcomes amongst patients attending public healthcare
facilities. Available literature on adherence behaviour mainly focuses on the psychological
and behavioural barriers, while overlooking the multitude of structural barriers within the
patient’s environment affecting the patient’s adherence to antiretroviral treatment and care.
The present study provides a unique perspective on adherence behaviour amongst persons
living with HIV and receiving antiretroviral treatment, as it identifies important structural
barriers to clinical attendance and pill-taking.
The sample for this study were selected from patients attending an infectious diseases
clinic at a major peri-urban secondary hospital and receiving antiretroviral therapy, nurses
and doctors providing health services to patients, and patient advocates providing
psychosocial support to patients under the auspices of a local non-governmental organisation.
The participants included in this study were selected by means of convenience sampling to
participate either in semi structured interviews or focus group discussions. Participants were
assured of the confidentiality of the process and their anonymity in both cases. Both semi
structured interviews and focus groups were digitally recorded and transcribed after which
transcriptions were entered into Atlas.ti for textual analysis. Transcriptions were thematically
analysed according to the perceptions of various participants. The main themes that emerged
from the present study included individual barriers, poverty-related barriers, institutionrelated
barriers, and social and community-related barriers.
The results of the present study were triangulated by considering the concurrences and
discrepancies between the patients, clinicians and patient advocates on the main, and
subthemes. These themes were then discussed according to Bronfenbrenner’s (1972)
Ecological Systems Theory, which divided the main themes identified according to the different systems operating within the patient’s environment, i.e. the micro-, exo-, and
macrosystem. The microsystem included both individual psychological and behavioural
barriers and poverty-related barriers. Institutional barriers were considered within the exosystem
of the patient’s ecological environment. And the social and community-related
barriers were considered within the macrosystem of the patient’s ecological environment.
The significance of this study lies in the identification of adherence behaviour as the
product of the patient’s environment through the examination of triangulated data. Future
research may include effective ways in which patients can be assisted in developing the
necessary skills to cope with their environment and to enhance social support. The
development of strategies to support newly-enrolled patients also still needs investigation. / AFRIKAANSE OPSOMMING: Volgehoue antiretrovirale behandeling bly ‘n onderwerp van voortdurende belang omdat dit
geassosieer word met positiewe gesondheidsuitkomste onder pasiënte wat van openbare
gesondheidsfasiliteite gebruik maak. Beskikbare literatuur oor volhoudings gedrag fokus
grootliks op sielkundige en gedragshindernisse, terwyl veelvuldige strukturelehindernisse
binne die pasiënt se omgewing steeds misgekyk word. Dié studie bied ‘n unieke perspektief
op volhoudingsgedrag onder MIV-positiewe pasiënte wat tans antiretrovirale terapie ontvang,
aangesien dit belangrike strukturele hindernisse tot kliniek bywoning en die neem van
medikasie identifiseer.
Dié steekproef sluit pasiënte in wat tans antiretrovirale terapie by ‘n aansteeklike
siektes-kliniek by ‘n peri-stedelike sekondêre hospitaal ontvang. Dit sluit ook dokters en
verpleegsters in wat gesondheidsdienste aan dié pasiënte verskaf, en pasiënt- advokate wat
psigo-sosiale ondersteuning aan pasiënte verskaf onder die vaandel van ‘n plaaslike nieregerings
organisasie. Dié deelnemers is deur middel van gerieflikheidssteekproef geselekteer
om aan semi-gestruktureerde onderhoude of fokusgroepbesprekings deel te neem.
Deelnemers van albei groepe is van hul anonimiteit en die vertroulikheid van die proses
verseker. Beide die semi-gestruktureerde onderhoude en die fokusgroepbesprekings is
digitaal opgeneem en transkripsies is daarvan gemaak, waarna die transkripsies in Atlas.ti
gelaai is vir tekstuele analise. Transkripsies is tematies geanaliseer volgens die persepsies van
die verskeie deelnemers. Die hooftemas wat na vore gekom het, sluit in individuele
hindernisse, armoedeverwante hindernisse, institusieverwante hindernisse asook sosiale en
gemeenskapsverwante hindernisse.
Resultate van dié studie is getrianguleer deur die verskille en ooreenkomste te vind
tussen pasiënte, klinici en pasiënt-advokate oor die hoof- en subtemas. Die hooftemas is toe
volgens Bronfenbrenner (1972) se Ekologiese Sistemeteorie verdeel in die verskillende sisteme teenwoording in die pasiënt se omgewing, naamlik die mikro-, ekso-, en
makrosisteem. Die mikrosisteem het individuele sielkundige en gedragshindernisse asook die
armoedeverwante hindernisse ingesluit. Institusieverwante hindernisse is binne die
eksosisteem van die pasiënt se ekologiese omgewing beskou en sosiale en
gemeenskapsverwante hindernisse is beskou binne die makrosisteem van die pasiënt se
ekologiese omgewing.
Die belang van dié studie lê in die identifisering van volhoudingsgedrag as produk
van die pasiënt se omgewing, soos beskou deur die Ekologiese Sistemeteorie. Toekomstige
navorsing kan fokus op effektiewe maniere waarop pasiënte bygestaan kan word om die
nodige vaardighede te ontwikkel om hul omgewing beter te kan hanteer en beskikbare sosiale
ondersteuning te kan verbeter. Die ontwikkeling van strategieë om nuwe pasiënte by te staan,
benodig ook verdere navorsing.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/6539 |
| Date | 03 1900 |
| Creators | Vermeulen, Jacomina Hendrina |
| Contributors | Kagee, S. A., University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Psychology. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 194 p. |
| Rights | University of Stellenbosch |
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