Browsing by Author "Myezwa, Hellen"

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Exercise in Ghanaian, postmenopausal women with an increased body mass index (bmi), above 25 KG/M²
(University of the Witwatersrand, Johannesburg, 2023-08) Bonsu, Isaac Mensah; Myezwa, Hellen; Corlia, Brandt; Ajidahun, Adedayo Tunde
Postmenopausal women frequently experience weight gain in addition to an increased tendency for central fat distribution. The development of metabolic syndrome and systemic inflammation caused by excess body weight (overweight and obesity), particularly in the form of visceral fat deposition in postmenopausal women, increases the risk of cardiovascular disease, diabetes, and mortality. The reported high prevalence of excess weight among Ghanaian postmenopausal women generated an inquiry into the experiences of postmenopausal women with excess weight gain. This study aimed to develop and test the effect of a culturally adapted exercise-based programme for weight loss in Ghanaian postmenopausal women. The study used a mixed-method approach with five studies to address the study's aim. A quantitative study was conducted to determine the prevalence of excess weight gain and associated socio-demographic risk factors among postmenopausal women. The results showed a high prevalence of excess weight gain of 73.2%, 91.8%, and 91.0% using body mass index (BMI), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) respectively among 378 women. Education and ethnicity were the predictors of excess weight gain (WHR) among the participants. Despite the extensive body of research on an exercise program for weight loss, these results suggest gaps in weight management. Physical activity, lifestyle, and sociocultural levels of the women were investigated quantitatively to determine contributing factors associated with the high prevalence of excess weight gain. The results showed that the majority (55.2%) of the participants had 1 to 2 days per week of moderate physical activities for 1 to 20 minutes per day during the last 7 days. This finding showed that participants are not meeting the physical activity recommendation of 150-300 minutes of moderate-intensity per week for older adults by World Health Organization (WHO) guidelines on physical activity and sedentary behaviour. Housewives and unemployed participants had a higher risk of weight gain, especially when assessed with WHR and WHtR. Most participants (59.7%) had poor eating habits and cultural beliefs regarding body size impacts their decisions regarding weight loss. A qualitative study was conducted with the study group of postmenopausal women with excess weight, twenty-four participants, and four focus group discussions (FGD), to explore their current weight management approaches or practices. From the analysis of FGD, three major themes emerged from the study namely, (i) perception of body weight, (ii) measures to reduce body weight, and (iii) support for adherence to the weight management program. Sub-theme under the perception of body weight revealed that weight gained was viewed as the presence of diseases and admired by society as a culturally accepted body image. Diet-related changes, a combination of diet modification and physical activity, and weight management supplements emerged as measures to reduce excess weight. Support for adherence to the weight program included health education, access, affordable exercise facilities, and social support. Based on literature reviews and findings from the three studies conducted as part of the project, a culturally appropriate exercise programme for weight loss was developed and validated by the Delphi study. A Delphi consists of three rounds among international (twelve) and local (twenty-one) experts with a high participation rate of 33 (80.5%) of the 41 participants was conducted. A consensus was reached on all the thirty-two (32) items related to health assessment, pre-exercise parameters, exercise dosage and physician referral after the third round. The developed culturally informed exercise-based weight loss programme was tested using a single-blind randomized controlled trial. A total of 226 postmenopausal women were randomized into exercise (113) and control (113). Anthropometrics (BMI, WHR, WHtR WC, HC and body weight) and body composition (body fat, visceral fat, muscle mass) were measured pre and post-12-week intervention. Using a repeated-measures linear mixed model, the evidence from the analysis demonstrates that except for waist-to-hip ratio (WHR), there were statistically significant reduction in body weight, BMI, WHtR, visceral fat, and total body fat in the exercise and control groups. Muscle mass increased significantly (+0.21 kg), whereas hip circumference (-2.46 cm) and waist circumference (-1.39 cm) decreased significantly compared with the control group. Within the exercise group when stratified by BMI, there were higher reductions in BMI (1.01kg/m2 vs. 0.46kg/m2), WC (2.18cm vs. 0.22cm), body weight (2.12kg vs. 1.17kg) and body fat (1.84% vs 1.6%) in obese women compared to overweight women. Weight loss programmes should be traditionally induced within the specific setting to encourage full participation and reduce the dropout rate. Implication for health professionals to prescribe physical activity in postmenopausal women’s treatment plan. In conclusion, the findings resulting from this research may improve health providers' cultural awareness and knowledge. This project is expected to help healthcare professionals improve the care given to postmenopausal women with weight excess to decrease the incidence of morbidity and mortality. It is anticipated that this initiative could direct the development of a modified culturally-sensitive weight loss programme for women in different stage in life and use with other ethnic groups.
Mainstreaming HIV/AIDS in physiotherapy education and practice
(2009-09-01T11:47:12Z) Myezwa, Hellen
This thesis centres around the issues concerning HIV/AIDS and physiotherapy education, curriculum and practice. In particular, this thesis examines which HIV specific content should be included in a physiotherapy curriculum and ultimately presents a conceptual framework for HIV input into the curriculum. There is a vast body of literature available on HIV. For physiotherapists, however, apart from a brief review given by Nixon and Cott (2000) using the ICIDH, no comprehensive literature is available that places information on HIV into a framework that speaks to physiotherapists as part of the rehabilitation fraternity. The literature on impairments is descriptive and buried in the medical model as symptoms. Section one of the literature review placed the literature in such a framework and provided a comprehensive description using the ICF and related aspects that concern physiotherapists. The ICF captures all the elements of current rehabilitation theory and practice and the literature is presented in an ICF framework. In addition, important background information on prevalence, its determinants, treatment approaches and subsequent impacts were reviewed. As most of the literature available still remains in the medical model, the conditions that manifest and from which patients develop impairments, were reviewed. The effects of HIV on body systems are extensive and pervasive. In each body system HIV has direct effects on mature and maturing cells e.g. progenitor cells and mature muscle cells. In the musculoskeletal system HIV impacts on functional systems and organs resulting in pathophysiological changes that manifest as impairments such as muscle wasting. Conditions manifesting in all body systems were reviewed and outlined. Impairments such as pain, breathlessness and proximal muscle weakness were reported in the literature. In addition to impairments, analysis of the literature revealed studies that had found high levels of functional and activity limitations as well as impacts on Health-related Quality of Life in HIV. The literature also presents the current status of physiotherapy interventions. Many studies have reported that exercises are a safe and effective mode of intervention not-withstanding the limitations encountered. The second part of the literature review focussed on aspects concerned with curriculum. Previous studies have focused on establishing baseline knowledge, attitudes and practices (KAP) to HIV and the impact of training programmes on KAP. What the actual content was for health workers, in particular physiotherapists and the approach to incorporating HIV into curricula is a gap in the literature. To inform the overall aim, with context-appropriate HIV content, this study undertook a number of studies in order to obtain the necessary information on HIV, specific to physiotherapy. Therefore the overall approach was a mixed methods one employing both a quantitative and qualitative study mix. The first and second studies informed the clinical picture and were both cross-sectional and descriptive. In both studies descriptive statistics were used to analyse data, especially in determining the absence or presence of conditions. Study 1 sought to establish the level of referral to physiotherapy by retrospectively examining the patient records of patients admitted with HIVrelated conditions over a period of one year. Of the 732 patient records reviewed, 139 (19%) had diagnoses considered suitable for physiotherapy and 3% were referred to physiotherapy. Study 2 aimed to establish a relevant overview of the functional and participation limitations of people living with HIV. Two groups of patients were studied i.e. an in-patient group and an outpatient group. The out-patient group was from a well resourced mining out-patient setting. The ICF checklist was utilised to collect the data and statistical analysis was performed to indicate the presence or absence of impairments, activity limitations and participation restrictions. A logistic regression was done to determine the odds of activity, limitation or participation restriction given certain levels of domains. Both groups showed high levels of impairment. For the in-patient group loss of muscle power 75%(n=60) energy and drive 75%(n=60), disturbed sleep 71%(n=56), emotional problems 62%(49), mild-severe pain 80%(66), weight maintenance difficulties and diarrhoea were apparent. In the out-patient mining group memory problems, energy and drive functions 36%(n=18), sleep 24% (n=12) and emotional functions 28% (n=14), seeing 32% (n=17), hearing, vestibularproblems 28%(n=14) and pain 55%(n=28), blood pressure and respiratory problems 24%(n=12), weight maintenance 63%(n=32), sexual functions 22%(n=11) and reduced proximal muscular power 24%(n=12) were encountered. The in-patient group had high levels of activity limitations and participation restrictions, while the out-patient mining group did not. There was association between the different domains and in the in-patient group gender (p=0.02) and marital status (p=0.01) were likely to influence the activity and participation levels and the experience of the environment. The remaining three studies involved aspects related to informing the curriculum component of this thesis. Study 3 audited the universities’ curricular documents to establish what the current curriculum included. Seven of the eight universities that offer physiotherapy training were reviewed and their curricula were generally scanty on information regarding HIV/AIDS. When compared to the areas outlined as a result of the literature review, the study of the patients and focus groups with clinicians and academic staff, revealed some gaps, in particular; the types of conditionsand the influence of HIV on other body systems which are pertinent to the clinical reasoning process for the physiotherapist: The philosophy of care and approach to management and the physiotherapists’ role in HIV prevention, treatment and care were evident gaps. Study 4 sought to develop a framework of HIV content for a physiotherapy curriculum. This was done by integrating the results found so far and verifying and enriching this data by gaining clinicians’ and academics’ insights and perceptions around HIV, based on their clinical and educational experience. Focus group discussions were conducted and a qualitative approach was undertaken for data analysis. A framework for curricula content emerged from this exercise. In study 5 the framework of HIV content was used to develop a questionnaire that was sent out in the Delphi survey to academic staff with the aim to test the level of consensus. Eighty three components of the curriculum under four outcome areas (Appendix 7.2) were sent to 68 academic staff who were identified. Of the 68 academic staff, 58 were available and 47 responded and consented to participate. All but two topics obtained consensus set at 80% and the remaining two obtained consensus in the second round. The final chapter discusses the results of these studies and illustrates how these results on HIV affect and can be applied to the physiotherapy curriculum, when applied to the UNAIDS mainstreaming criteria. Applying the mainstreaming principles to the process of including HIV content into the curriculum, ensures that the process is not done in a piece meal fashion but encompasses all important facets which were identified. The programme, if systematically implemented, could result in a coordinated outcome accounting for all the important facets. A conceptual framework is drawn from the results of this thesis illustrating the three levels of curriculum taxonomy: At the micro level, through the body systems, the meso level through the role of physiotherapy, dealing with internal and external domains and teaching approaches. The macro level is accounted for by the facilitatory activities such as advocacy among clinicians and academics and forming strategic partnerships at all levels.
Prevention care for secondary health conditions among people living with spinal cord injuries: research protocol
(Springer Nature, 2019-03) Pilusa, S.; Myezwa, Hellen; Potterton, Joanne
Objective: People living with spinal cord injuries are at a high risk to experience preventable secondary health conditions in their lifetime, which can lead to rehospitalisation and death. Given the fact that spinal cord injury is a long term disability requiring on-going care, there is need to strengthen prevention of secondary health conditions. This study aims to establish factors influencing prevention care for secondary health conditions among people living with spinal cord injuries in a metropolitan area in order to develop a prevention model of care. Results: A record review of patients living with spinal cord injuries will be conducted to identify the prevalence of secondary health conditions and associated factors. Semi-structured interviews will be conducted on patients living with spinal cord injuries, their caregivers and therapists to explore the contextual factors (personal and environmental factors) influencing the prevention of secondary health conditions. Thematic analysis will be used to identify the themes. Nominal group technique will be used to develop the prevention model of care for secondary health conditions. This study will be conducted at a tertiary and specialised rehabilitation hospital in South Africa.
Supervisor coaching of PhD students in the Faculty of Health Sciences University of the Witwatersrand
(2017) Myezwa, Hellen
This study determined the supervision experience of PhD students in the Faculty of Health Sciences at the University of Witwatersrand. The extent of coaching behaviours was assessed. Other supervision behaviours that were determined and aligned with coaching were: research academic support, personal and autonomy support, behaviours to support self-efficacy and satisfaction with the supervisor. Supervision of PhD students is important to the Faculty of Health Sciences at the University of the Witwatersrand as it aligns to the universities strategic goals. A review of the literature revealed a dearth of literature on coaching and supervision. There are a few articles emerging that assess the impact of coaching within supervision. Autonomy of PhD students is linked to facilitation and the mentoring role and the supervisors‟ ability to adapt and be flexible. These skills are linked to coaching and coaching may be a key part of the supervisors‟ style. Coaching and supervision are recognised as potentially important elements in PhD post graduate supervision and success. To determine the extent of coaching, a cross sectional, correlational survey using a structured questionnaire was used. Data collection was undertaken using an online web-based platform that allows for the design, capture and analysis of data (REDCAP). The questionnaire comprised validated statements per phenomena in the areas supervisor availability and satisfaction, academic, personal, coaching and autonomy support and student self-efficacy. Descriptive statistics were used to determine the extent to which each phenomenon was experienced. Each section was tested for internal reliability and correlations established across all measures. All students registered for a PhD for more than six months in the Faculty of Health Sciences were invited to participate in the study. There was a thirty-two percent return rate. Low to moderate levels by participants in coaching behaviours, personal support, supervisor availability and research academic support were experienced. Satisfaction with the supervisor showed low to moderate levels while self-efficacy and autonomy support had high scores. All components of supervision correlated with each other with the exception of autonomy support and self-efficacy. This lack of relationship may point to students finding their own forms of support outside the supervisor. Specific relationships were apparent between supervisor behaviours and coaching and satisfaction with supervision. This study is the first to establish supervisory behaviours including coaching in the Faculty of Health sciences at the University of the Witwatersrand. Given the low to moderate levels of supervision behaviors experienced in this study, all supervision behaviors need to be enhanced. The results show linkage to coaching approaches in providing satisfaction with supervision received. Provision of personal support through coaching may lead to gaining autonomy, self-efficacy and student growth.