Electronic Theses and Dissertations (PhDs)

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Browsing Electronic Theses and Dissertations (PhDs) by Keyword "UCTD"

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    Contextually responsive support and development strategies for generalist occupational therapists delivering hand-injury care in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Stormbroek, Kirsty van
    Hand injuries are common in South Africa and safe and effective hand therapy is critical to appropriate care. By necessity, this care is delivered by non-specialist occupational therapists working in challenging settings, despite hand therapy commonly being considered a specialist area of practice. Safe and competent management of hand injuries by therapists is crucial for achieving a return to full participation in daily life. It is therefore necessary to describe what the support and development needs of these non-specialist occupational therapists are, and how these needs can be met effectively and sustainably. This project aimed to describe how the support and development needs of generalist occupational therapists delivering hand-injury care within the South African public health sector can be met in a contextually responsive manner. A multi-method approach was chosen, with a separate study design employed for each of the three studies. The policy context is an essential aspect of contextually responsive intervention; therefore the first study aimed to develop policy-based principles for hand rehabilitation services delivered by occupational therapists in South Africa. A descriptive qualitative approach was employed, and framework analysis, as a content analysis method, was undertaken. Local and international policies (n=29) were included in the analysis, and eighteen principles were generated that articulate the goal of rehabilitation (principle 1), prescribe the nature of rehabilitation (principles 2-6), and outline the enablers of rehabilitation (principles 8-18). These generic principles are applied to the practice of hand-injury care in South Africa. Contextually responsive intervention responds to the needs and experiences of service providers. Study two (which consisted of Study 2A and Study 2B) used a qualitative instrumental case-study design to describe generalist occupational therapists’ experience of delivering hand –injury care in order to identify their support and development needs and to describe how these can be met in a contextually responsive manner. Study 2A undertook this aim with a group of novice occupational therapists (n=9) completing a compulsory year of state service directly after graduation and made use of an online community of practice for data collection. Study 2B used site visits and in-depth interviews to collect data from fully registered occupational therapists (n=6) working in diverse public health settings in South Africa. Reflexive thematic analysis was used to generate rich themes, which informed recommendations for the support and development of therapists extrapolated from both studies. Study 3 sought to combine the evidence produced by Studies 1 and 2 with the diverse perspectives of service users, other service providers, local and international scholars, educators and professional bodies. The aim of the study was to identify capacity strengthening strategies for generalist occupational therapists responsible for delivering hand-injury care in the South African Public Sector. A hybrid consensus development conference was used to facilitate the presentation of relevant evidence. A stakeholder panel (n=14) followed a nominal group guided by a skilled facilitator. The panel generated and ranked ideas, which were developed into ten prioritized areas for action. Extensive ideas within each of these ten areas were recorded. These areas formed the foundation of the guidelines developed by the project. A pragmatist approach to evidence synthesis was used in the final stage of the project to systematically generate guidelines for the support and development of generalist occupational therapists delivering hand-injury care in South Africa. Eleven guidelines were developed, with the first guideline addressing the need to align hand-injury care services with professional values (1), including the mandate to improve participation and inclusion. Five guidelines address generalist occupational therapists’ direct need for support and supervision (2), resources (3), core competencies for hand-injury (4), the creation of a learning stratosphere to support this (5), as well as the imperative to nurture resilience (6). The final five guidelines address factors that are indirectly essential to therapists capacity to deliver hand-injury care: the need to strategize and operationalize (7), strengthen health systems (8), build stronger communities (9), strengthen human resourcing (10), and strengthen the medical and surgical management of hand injuries and conditions (11). Finally, key implications for practice, learning and development, leadership and management, policy, and research are proposed
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    Sedentary behaviour in a sample of south african office-based workers
    (University of the Witwatersrand, Johannesburg, 2024) Phaswana, Merling; Gradidge, Philippe
    Background Sedentary behaviour is associated with cardiometabolic diseases amongst office- bound workers, primarily through extended sitting and engaging in low-energy- demanding activities during work hours. Similar to developed countries, South African workplaces are experiencing an increasing prevalence of obesity and related cardiovascular diseases, with sedentary behaviour and physical inactivity being the main contributors. However, there is limited data on the effectiveness of sedentary behaviour strategies in improving South African office-based workers' cardiometabolic risk markers. Objectives This study aims to assess the effectiveness of the height-adjustable sit-to-stand work on cardiovascular parameters in a cohort of office-based workers and to explore the perceptions of these workers about the feasibility and suitability of this intervention to reduce occupational sitting time. Methods A mixed-methods study design was used on office workers from the University of the Witwatersrand and a credit bureau company in South Africa. The qualitative papers used in-depth semi-structured interviews to explore office-based workers' perceptions and experiences using sit-to-stand workstations. The interview audio was recorded audio using Microsoft Teams (version 11, Microsoft Way, United States) and Phillips (DVT4010 Voice Tracer, Vienna, Austria). All transcripts were checked against the recordings to verify accuracy and credibility, and grammatical editing was adopted where necessary. For quantitative measures, participants were randomised into an intervention or control group to collect measures at baseline and 12 weeks in a cohort of South African desk-based workers. These biomarkers include anthropometry, sedentary behaviour and physical activity, sleep duration, blood pressure, glucose, glycated haemoglobin (HbA1c) and lipid profile. The cross- sectional paper quantified sedentary behaviour, overall physical activity, and the association with select cardiometabolic risk factors. The randomised control trial evaluated the short-term effects of height-adjustable sit-to-stand workstations on cardiometabolic risk markers. Descriptive and inferential statistics were used to describe and compare baseline and follow-up changes in the intervention. Results The height-adjustable sit-to-stand workstation was deemed feasible and well-accepted by our participants. Participants expressed that it motivated them to stand up and work and effectively alleviated discomfort associated with prolonged sitting. Most (68.0%) of the study participants were women, with a mean age of 40.2 ± 9.3 years. Our participants spend an average of 8 to 10 hours in sedentary behaviour. Both systolic (β: -0.234, p = 0.037 mmHg) and diastolic blood pressure (β: -0.250, p <0.001 mmHg) were inversely associated with accelerometery-measured light physical activity. However, there was no relationship between accelerometery- measured sedentary behaviour and cardiometabolic risk factors after analysis. The 12-week randomised control trial showed small improvements with blood pressure - 0.26 (d =1.10 mmHg) and Light physical activity -0.26 (d=3.57 min/day). We observed trivial effects, with most of our cardiometabolic outcomes including body mass index (BMI) -0.11 (d=1.07 kg.m2). Most participants withdrew early from workplace intervention due to the design and functionality of the height-adjustable sit-to-stand workstation. Conclusions This study adds to the limited evidence on environmental workstation modifications for reducing sedentary behaviour. Our findings show that South African office workers spend a substantial amount of time sitting during work hours and support the need for public health workplace interventions to mitigate the potential health risks associated with such sedentary behaviour. This study confirms that short-term height-adjustable sit-stand interventions effectively reduce workplace sitting time and promise to improve cardiometabolic health outcomes, suggesting that clinically significant effects might be noticed in long-term interventions. Therefore, future studies should consider individual preferences, workstation design, functionality, education, and motivation to ensure successful implementation, utilization, and compliance with sit-to-stand workstations