Dissertation (DPhil)--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: The aim of this study was to develop a HIV intervention programme tailored for South
African adolescents with visual impairments. A further aim was to pilot and evaluate this
tailored programme. This investigation was deemed necessary in the light of the growing
HIV pandemic in South Africa, which has proliferated over the last 10 years. Adolescents
and young adults are among the most vulnerable to HIV infection, and this does not exclude
adolescents with visual impairments. Despite the perceptions among sighted people of
asexuality in adolescents with visual impairments, they are a vulnerable group for HIV
infection.
The motivation for this study is the fact that very little literature is available on HIV/AIDS
and people with visual impairments, and that this vulnerable group is marginalized in
HIV/AIDS campaigns internationally. As far as we could ascertain, there have been three
HIV prevention initiatives for people with visual impairments in South Africa, none of which
was fully researched and evaluated, and all of which used existing generic interventions but
transcribed into Braille and large print format. The reality is, many adolescents with visual
impairments, as is the case with sighted youths, are sexually active, and the absence of
research on HIV prevalence and HIV prevention needs in this sector, is conspicuous. An
urgent need exists to tailor HIV preventative programmes for this vulnerable sector.
The dearth of research on HIV/AIDS and people with visual impairments motivated the
choice of a key informant study to investigate the effects that HIV/AIDS and other
concomitant issues have on persons with visual impairments, prior to the design of any
intervention. A purposive sample of key informants who are working among people with
visual impairments on a daily basis, most of whom had visual impairments themselves, was
selected. Information gathered from the key informant study was combined with the lessons
from a review of available literature on health promotion programmes and HIV prevention
programmes in particular to develop an HIV/AIDS intervention programme to be piloted
and evaluated for its effectiveness. The design of the programme took account, in addition, of
broader contextual issues such as power and gender issues, and the marginalization and stigmatization of disabled people. The theoretical framework which forms the basis of the
programme was informed by elements of a number of cognitive theories in the health
promotion field, and especially the Informational-Motivational-Behavioural model (IMF).
The programme was designed to empower participants and to create an environment of reallife
experiences in which they could acquire important negotiation skills, decision-making
skills, and practical skills to use condoms and HIV/AIDS knowledge to facilitate attitude and
behaviour change.
The next objective of this research was to implement the intervention programme of eight
sessions designed for adolescents with visual impairments and to investigate the outcome on
participants in this study. For this purpose an experimental design, one experimental group
and three control groups (n= 56), not randomly assigned, was used to test the effect of the
programme on participants in the intervention group compared to the control groups, who
received a health promotion programme of four sessions. All participants were learners at
the only two schools for learners with visual impairments in the Western Cape Province of
South Africa, and they were allocated into treatment or control conditions on the basis of the
school grades in which they were already placed. The empirical investigation utilized a
questionnaire that was developed and transcribed into Braille as well as large print.
Following a small pilot study, the questionnaire was finalized and administered to all four
groups (pre-test, to determine baseline differences; post-test, to determine the immediate
effect of the programme; and follow-up [3 months later] to determine longer term
effectiveness). An analysis was done to assess the internal consistency of the measuring
constructs of the questionnaire, and satisfactory internal consistency was found, with
Cronbach’s alpha scores ranging between 0.72 and 0.92.
Quantitative data were analyzing using multivariate techniques, beginning with a repeated
measures MANOVA analysis and, once an overall significant F ratio between variables, time
and groups (F=2.009, p<0.05); a significant F ratio between groups and variables (F=4.211,
p<0.01), and significant F ratio between time and groups (F=2.611, p<0.01), had been found,
we continued with more focused analyses. Baseline results revealed no statistical differences between the four groups. There were statistically significant improvements in knowledge of
HIV/AIDS for both the experimental group and two of the control group, but these
differences were not maintained at follow up. Significant differences in attitudes towards
HIV/AIDS were found for the experimental group and for one of the control groups. Though
there were significant changes in both knowledge and attitudes, therefore, it cannot be
claimed that the intervention itself was responsible for knowledge and attitudinal change.
There was some evidence for diffusion of innovation in terms of HIV knowledge from the
experimental group and the control group situated at the same school. Changes in reported
HIV risk behaviour were not recorded to a significant degree, a fact which may have been
attributable in part to small sample size.
Qualitative process information was used to get a sense of the experiences of participants and
the concomitant issues they discussed during the intervention. The qualitative data revealed
a host of contextual factors relevant to issues of HIV/AIDS and sexuality in this group,
including experiences of stigmatization as people with visual impairment, negotiating
masculinity in the context of visual impairment, gender oppression of women and resistance
to this, and a general atmosphere of myths and silences around HIV/AIDS in particular and
sexuality in general.
Despite the limited impact of the programme, this pilot study revealed important issues for
adolescents with visual impairments regarding HIV prevention which require further
investigation. Participants in the experimental group indicated that they learned a lot from
this programme and suggested that it be given to younger adolescents to enable them to
acquire these vital skills prior to active sexual engagement and the involvement in any form
of unprotected sex. A number or recommendations are made for further well-documented
and evaluated research in this field. / AFRIKAANSE OPSOMMING: Die doel van die studie was om ’n MIV-intervensieprogram te ontwikkel wat op Suid-
Afrikaanse adolessente met gesigsgestremdhede gemik is. ’n Verdere doel was om ’n
proeflopie van die pasgemaakte program te doen en dit te evalueer. Hierdie ondersoek is
nodig geag in die lig van die groeiende MIV-pandemie in Suid-Afrika, wat oor die afgelope
tien jaar vinnig versprei het. Adolessente en jong volwassenes tel onder die kwesbaarstes vir
MIV-infeksie, en dit sluit nie adolessente met gesigsgestremdhede uit nie. Ongeag die
persepsies omtrent aseksualiteit in adolessente met gesigsgestremdhede onder diegene wat
nie gesigsgestremd is nie, is eersgenoemde ’n kwesbare groep vir MIV-infeksie.
Die motivering vir hierdie studie is die feit dat baie min literatuur vir mense met
gesigsgestremdhede beskikbaar is, en dat hierdie kwesbare groep wêreldwyd in MIV/VIGSveldtogte
gemarginaliseerd is. Sover ons kon vasstel, was daar drie MIV-voorkomingsinisiatiewe
vir mense met gesigsgestremdhede in Suid-Afrika, waarvan nie een ten volle
nagevors en geëvalueer is nie, en wat almal bestaande generiese intervensies gebruik het wat
in Braille en grootdruk-formaat omgesit is. Die werklikheid is dat baie adolessente met
gesigsgestremdhede – nes die geval is met jeugdiges sonder gesigsgestremdhede – seksueel
aktief is en dat die afwesigheid van navorsing oor MIV-voorkoms en MIVvoorkomingsbehoeftes
in hierdie sektor opvallend is. Daar is ’n dringende behoefte aan
pasgemaakte MIV-voorkomende programme vir hierdie kwesbare sektor.
Die gebrek aan navorsing oor MIV/vigs en mense met gesigsgestremdhede het die keuse van
’n sleutelinformantstudie gemotiveer om die invloed wat MIV/vigs en ander gepaardgaande
kwessies op mense met gesigsgestremdhede het, voor die ontwikkeling van enige intervensie
te ondersoek. ’n Doelgerigte steekproef van sleutelinformante wat op ’n daaglikse grondslag
onder mense met gesigsgestremdhede werk, waarvan die meeste self gesigsgestremd is, is
gekies. Inligting wat van die sleutelinformantstudie verkry is, is gekombineer met die lesse
uit ’n oorsig van die bestaande literatuur oor gesondheidsbevorderingsprogramme – in die
besonder MIV-voorkomingsprogramme – om ’n MIV/vigs-intervensieprogram te ontwikkel wat as loodsprojek kon dien en wat vir doeltreffendheid geëvalueer kon word. Die ontwerp
van die projek het, daarbenewens, ag geslaan op breër kontekstuele kwessies soos mags- en
genderkwessies en die marginalisering en stigmatisering van mense met getremdhede. Die
teoretiese raamwerk wat die grondslag vir die program vorm, is op elemente van ’n aantal
kognitiewe teorieë op die gebied van gesondheidsbevordering, en spesifiek die inligtingmotivering-
gedragsmodel geskoei. Die program is ontwerp om deelnemers te bemagtig en
om ’n omgewing van lewenservaringe te skep waarbinne hulle belangrike onderhandelings-,
besluitnemings- en praktiese vaardighede kon ontwikkel om kondoomgebruik te bevorder,
asook kennis omtrent MIV/vigs om houdings- en gedragsverandering te fasiliteer.
Die volgende doelwit van hierdie navorsing was om die intervensieprogram van agt sessies
wat vir adolessente met gesigsgestremdhede ontwerp is, te implementeer en om die resultate
ten opsigte van die deelnemers aan die studie te ondersoek. Met hierdie doel voor oë is ’n
eksperimentele ontwerp – een eksperimentele groep en drie kontrolegroepe (n=56), wat nie
ewekansig toegewys is nie – gebruik om die invloed van die program op deelnemers in die
intervensiegroep te toets teenoor dié op die kontrolegroepe, wat aan ’n
gesondheidsbevorderings-program van vier sessies deelgeneem het. Alle deelnemers was
leerders by die enigste twee skole vir leerders met gesigsgestremdhede in die Wes-Kaap,
Suid-Afrika. Hulle is op grond van die skoolgraad waarin hulle reeds geplaas is, aan
behandelings- of kontroletoestande toegewys. Die empiriese ondersoek het ’n ontwikkelde
vraelys gebruik wat sowel in Braille getranskribeer is as in grootdruk gedruk is. Ná afloop
van ’n klein loodsstudie is die vraelys gefinaliseer en aan al vier groepe toegedien (voortoets,
om die basisverskille vas te stel; na-toets, om die onmiddellike invloed van die program vas
te stel; en opvolg [3 maande later] om doeltreffendheid op langer termyn vas te stel). ’n
Ontleding is gedoen om die interne konsekwentheid van die meetkonstrukte van die vraelys
te assesseer: voldoende interne konsekwentheid is gevind, met Cronbach se alfapunte wat
tussen 0.72 en 0.92 gewissel het.
Kwantitatiewe data is met behulp van meervariaattegnieke ontleed. Eers is ’n herhaaldemeting-
MANOVA-ontleding gedoen en daarna – nadat ’n algeheel beduidende F verhouding tussen veranderlikes, tyd en groepe (F=2.009, p<0.05); ’n beduidende Fverhouding
tussen groepe en veranderlikes (F=4.211, p<0.01) en ’n beduidende F-verhouding
tussen tyd en groepe (F=2.611, p<0.01) gevind is – is dit deur meer gefokusde ontledings
gevolg. Basislynuitslae het geen statistiese verskille tussen die vier groepe getoon nie. Daar
was statisties beduidende verbeteringe in kennis oor MIV/vigs in sowel die eksperimentele
groep as die twee kontrolegroepe, maar hierdie verskille is nie met die opvolgtoets volgehou
nie. Beduidende verskille in houding jeens MIV/vigs is by die eksperimentele groep en een
van die kontrolegroepe gevind. Hoewel daar beduidende veranderinge in sowel kennis as
houdings gevind is, kan daar nie beweer word dat die intervensie self vir die kennis- en
houdingsveranderinge verantwoordelik was nie. Daar was ’n mate van bewys vir diffusie
van innovering wat betref kennis oor MIV van die eksperimentele groep en die kontrolegroep
by dieselfde skool. Veranderinge in aangemelde MIV-risikogedrag is nie in ’n beduidende
mate aangeteken nie, ’n feit wat gedeeltelik aan die beperkte grootte van die steekproef te
wyte kan wees.
Inligting uit ’n kwalitatiewe proses is gebruik om ’n indruk te skep van die ervaringe van
deelnemers en gepaardgaande kwessies wat hulle tydens die intervensie bespreek het. Die
kwalitatiewe data het ’n reeks kontekstuele faktore blootgelê wat vir kwessies van MIV/vigs
en seksualiteit in hierdie groep tersaaklik is, met inbegrip van ervaringe van stigmatisering as
mense met gesigsgestremdhede, die hantering van manlikheid binne die konteks van
gesigsgestremdheid, genderonderdrukking van vroue en weerstand hierteen, asook ’n
algemene atmosfeer van mites en stilswye oor MIV/vigs in die besonder en seksualiteit in die
algemeen.
Ten spyte van die beperkte impak van die program het hierdie loodsstudie belangrike
kwessies vir adolessente met gesigsgestremdhede betreffende MIV-voorkoming blootgelê
wat verdere ondersoek noodsaak. Deelnemers in die eksperimentele groep het aangedui dat
hulle baie uit hierdie program geleer het en het voorgestel dat dit aan jonger adolessente
aangebied word om hulle in staat te stel om hierdie noodsaaklike vaardighede te ontwikkel
voordat aktiewe seksuele betrokkenheid en betrokkenheid by enige vorm van onbeskermde seks plaasvind. ’n Aantal aanbevelings vir verdere goed gedokumenteerde en geëvalueerde
navorsing op hierdie gebied word gemaak.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/18630 |
| Date | 03 1900 |
| Creators | Philander, J. H. (John Henry) |
| Contributors | Swartz, Leslie, Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | vi, 242 leaves : ill. |
| Rights | Stellenbosch University |
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