Electronic Theses and Dissertations (PhDs)
Permanent URI for this collectionhttps://hdl.handle.net/10539/37991
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Item Developing a management framework for predicting adherence to HIV care and treatment in Eswatini(University of the Witwatersrand, Johannesburg, 2024) Mango, Thabiso; Kasese-Hara, Mambwe; Mulaudzi, MamakiriThe primary objective of this research was to develop a management framework for predicting adherence to HIV care and treatment in Eswatini. To achieve this goal, the study delved into the comprehension of adherence to HIV care and treatment among people living with HIV/AIDS (PLHIV); identified psychological factors influencing adherence to HIV care and treatment; evaluated Theory of Planned Behavior (TPB)- based indicators to assess their effectiveness in predicting adherence behaviour to HIV care and treatment before commencing antiretroviral therapy (ART); and validated the applicability of the TPB in predicting adherence to HIV care and treatment. The study employed a sequential exploratory mixed methods approach in its research methodology. An initial qualitative study was conducted to explore the adherence beliefs of newly diagnosed PLHIV towards HIV care and treatment. The process involved gathering qualitative data on the beliefs of 19 recently diagnosed HIV-positive patients from a local HIV Clinic in Manzini, Eswatini. A thematic analysis revealed 226 beliefs, which were then condensed into 45 themes to establish the final set of significant beliefs categorised under TPB precursors: behavioural outcomes, subjective standards, and perceived behavioural control. The results of this qualitative study played a crucial role when constructing the TPB questionnaire, as the data gathered from the study were used as variables in creating the questionnaire. The TPB questionnaire, derived from the qualitative research, was distributed to 152 participants as part of the main quantitative study. This investigation unveiled the complex interplay between individuals' perceptions of social norms, attitudes, and perceived behavioural control in shaping their adherence to HIV care and treatment. While the opinions of influential figures in participants' lives were significant, the study found that participants' personal beliefs and attitudes towards adherence had a more substantial influence. During a span of 12 months, the 152 participants were closely observed, and their adherence to HIV care and treatment was assessed at baseline and endline points to evaluate the predictive validity of the TPB measure. The analysis of the collected data revealed that, despite participants appearing to adhere to their medication regimen iv based on clinic visits and self-reported pill usage, their viral loads remained detectable. This study underscored the drawbacks of solely relying on self-reported data and emphasized the necessity of employing alternative approaches to accurately assess levels of adherence. The study revealed limitations in the application of the TPB in addressing adherence to HIV care and treatment in developing nations with socioeconomic challenges. The original TPB model mainly concentrates on predicting and explaining behavioural intentions but overlooks the objective evaluation of the observed behaviour. When assessing adherence to HIV treatment, it is crucial to analyse the effectiveness of the behaviour being observed to identify the elements that lead to good adherence. This research suggests expanding the existing TPB model to overcome its limitations by including factors other than observable behaviour. A conceptual management framework for HIV care and treatment based on the TPB was developed to overcome the shortcomings of the TPB in predicting adherence to HIV care and treatment in underdeveloped countries. Four crucial additions were incorporated: (1) an enhanced behavioural intention (2) developmental challenges driven by socio-economic factors (3) subjective confirmation regarding the behavioural action, and (4) behavioural validation of the behavioural action. In addition to various aspects, it recommended that the conceptual framework developed by this study to manage HIV/AIDS care and treatment based on the TPB should undergo a validation process before its implementation with the aim of validating its effectiveness.Item Neurocognitive Rehabilitation for an Adolescent HIV Population: The Case of Sustained Attention(University of the Witwatersrand, Johannesburg, 2024) Zondo, SizweThe Human Immunodeficiency Virus (HIV) continues to be a significant disease burden. In terms of neurocognitive health, HIV crosses the blood-brain barrier, resulting in neuronal dysregulation and compromised neurocognition. Of further import, antiretroviral drugs are indicated to have limited permeability in the central nervous system and do not reverse compromised neurocognition, sequent HIV neuroinvasion. The objectives of the study were to investigate the efficacy of HIV cognitive rehabilitation therapy (HIV-CRT) in adolescent HIV. The first aim was to investigate the evidence for the cognitive rehabilitation of HIV in adolescent and geriatric samples, sequent neuroHIV. This investigation resulted in the publication of a meta-analysis detailing the efficacy of attention remediation in neuroHIV. The second aim was to examine the efficacy of fNIRS neuroimaging in measuring hemodynamic responses in the prefrontal cortex in adolescents neuroHIV. This investigation resulted in the publication of an article detailing the efficacy of fNIRS in detailing changes in oxygenated haemoglobin in adolescents living with neuroHIV. The third aim was to pair fNIRS optical neuroimaging with behavioural data to investigate changes associated with brain training at a cortical and behavioural level. The execution of the above aim resulted in the publication of an article detailing the procedures and methods to achieve the enquiry. The fourth article, under review, details findings related to neural efficiency and attention training. The final manuscript, under preparation, details functional connectivity outcomes related to attention training. To enable the analysis of the published articles, an initial cohort of 42 adolescents (mean age = 17.28) living with HIV participated in the study. Following attrition, the sample was reduced to 26 participants. Thirteen participants were assigned to the treatment group (n = 13; mean age = 16; SD = 1.2), which received cognitive rehabilitation to remediate attention. Thirteen children acted as controls (mean age = 17; SD = 1.3). Pre- and post-intervention data were analysed using behavioural and optical imaging data. 5 Findings indicated that HIV-CRT (attention) is associated with decreased oxygenated haemoglobin (HbO) and increased functional connectivity in the Central Executive Network (CEN). Contrary to expectation, HIV-CRT was associated with minimal behavioural gains, as indicated by neuropsychological assessments. Taken together, findings seem to suggest that in adolescent neuroHIV, customised HIV-CRT promotes cortical efficiency. However, brain training does not translate to immediate behavioural improvements at post-assessment. Summarily, findings suggest that cortical plasticity may precede near-and-far cognitive transfer gain in adolescents neuroHIV.Item An exploratory study to understand the mental health care needs of university students(University of the Witwatersrand, Johannesburg, 2023-10) Mudau, Tondani; Jithoo, Vinitha; Dietrich, JananBackground: Despite high levels of psychological distress, university students are reluctant to seek counselling on campus. University students have easy access to data and regularly use their phones for academic and personal purposes. A mental health application (app) designed specifically for university students has the potential to address mental health challenges and promote help-seeking amongst university students. This study aimed to explore the prevalence of psychological distress amongst university students, the sources of their distress and common coping strategies. The study then investigated students’ and counsellors’ perceptions of using a mental health app as a coping mechanism for psychological distress. Finally, the study developed, tested, and evaluated a mental health app specifically designed for university students. Methods: A multiphase mixed methods research design comprising three phases was used to collect quantitative and qualitative data through surveys, in-depth interviews, and focus group discussions. Data were collected, analysed and interpreted within the technology acceptance model (TAM) and cognitive behavioural theoretical frameworks. Phase 1 collected data to determine the prevalence of psychological distress, common coping strategies and mobile phone use amongst university students. Phase 2 integrated quantitative and qualitative data from Phase 1 to determine the feasibility of a mental health app, and thereafter developed the mental health app. Phase 3 tested and evaluated the usability of a mental health app with students and counsellors. All quantitative data were collected using the web-based application, Research Electronic Data Capture, and analysed using Statistical Analytics Software Enterprise Guide 7.1. All qualitative data were analysed through thematic analysis and by using NVivo version 12 Pro. Results: Overall, 1 221 students and nine counsellors were enrolled in the study. Phase 1 enrolled 1 100 students in an exploratory survey, 62 in focus group discussions, and six counsellors for in-depth interviews. Socio-demographic data Phase 1: A majority of participants (72.72%) were female, within the 18–20 age group (64.6%), and in their first-year level of study (46.2%). A vast majority (94.1%) were enrolled at the University of the Witwatersrand, with many enrolled in the faculty of humanities (36.1%). Most participants were South African citizens (95.6%) and from an urban location (61%), and 20.09% had been previously diagnosed with a mental health challenge. Prevalence of psychological distress: The Kessler-10 and student stress inventory were used to determine the prevalence of psychological distress. The results show that most participants (60.5%) reported very high levels of psychological distress, while 53% reported moderate levels of stress. Male students were more likely than female students to have very high levels of psychological distress (71.4%) and mild stress (63.3%). Third-year students were more likely than first- and second-year students to have high levels of psychological distress (65%) and moderate stress (59%). Coping strategies: The Brief-COPE-28 was used to determine common coping strategies amongst students. The results show that students with moderate or severe stress used emotion-focused (mean: 30.6 [SD = 5.71] vs 28.8 [SD = 6.21]; p < .0001) and avoidance coping styles (mean: 16.3 [SD = 3.82] vs 13.2 [SD = 3.51]; p < .0001) more than those with mild stress. A larger proportion of female than male students used denial (mean: 3.50 [SD = 1.77] vs 1.54 [SD = 3.13]; p = 0.001), emotional support (mean: 5.03 [SD = 1.96] vs 4.50 [SD = 1.82]; p = 0.0001), informational support (mean: 2.00 vs 1.88, p = 0.0001), behavioural disengagement, (mean: 3.63 [SD = 1.63] vs 3.82 [SD = 1.52]; p = 0.001), and religion (mean: 5.53 [2.24] vs 4.63 [2.17]; p = 0.001) as coping strategies. Students within the 18–20 age group had higher scores for religion as a coping strategy (mean: 5.53 [SD =2.2 2] vs 4.93 [SD = 2.23]; p = 0.0003). First-years were more likely to use problem-solving coping styles than postgraduate students (mean: 22.5 [SD = 5.86] vs 22.5 [SD = 5.29] p = 0.0165). Mobile phone use: Results from a sociodemographic questionnaire show that a majority of participants (98.7%) owned a smartphone and 66.9% owned a phone with Android software. Most (81%) reported having easy access to data and only a few (26.6%) had used an online health app for their health needs. Students’ and counsellors’ perceptions of psychological distress and using a mental health app to address mental health challenges: A semi-structured interview guide was used to collect qualitative data. Thematic analysis based on the TAM and cognitive behavioural theory frameworks categorised qualitative data under six main themes: (1) students’ conceptualisation of distress, (2) common mental health challenges, (3) perceptions of factors leading to distress, (4) facilitators of using a mental health app intervention, (5) barriers to using a mental health app intervention, and (6) perceived usefulness of the app. Sociodemographic data Phase 3: Three counsellors and 59 students were enrolled in the survey. Most students (64%) were female, within the 21–24 age group (63%), and in their third year of study (37%). More than half the student participants were enrolled at the University of the Witwatersrand (54%) and 29% within the humanities faculty. App testing: The app had eight categories for participants to test (information, coping strategies, take a test, seek help, journal, podcasts, videos, and settings). A majority of participants assessed coping strategies (73%) and information (69%), followed by the seek help (47%) and take a test (45%) category. Podcasts (23%) and settings (15%) were the least assessed categories. Perceived ease of use: The belief that users will require minimal effort using the technology was assessed using the Mobile Application Rating Scale (MARS). The overall MARS score showed excellent internal consistency (Cronbach alpha = 0.93) and was highly correlated to the app’s overall star rating (r = 0.72, p < 0.0001). The overall mean for the total MARS scale was 88.1. The MARS subscales were high quality and exceeded the (3.0) mean threshold: engagement (3.84), functionality (3.52), aesthetics (4.25), information (4.36), and subjective quality (3.45). Conclusion: The findings reveal that psychological distress is prevalent amongst university students, suggesting a need for student-friendly mental health interventions. A mental health app has the potential to address this need. This study found that most students own smart mobile phones and have easy access to data, indicating that a mental health app is a viable intervention. The qualitative findings demonstrate students’ willingness to use a mental health app for psychological distress. Barriers to using the app included a lack of face-to-face therapy, over-reliance on the app, fear of misdiagnosis, and lack of accessibility and affordability. Facilitators to using the app included previous experience with apps, convenience, accessibility, and confidentiality. These aspects were considered when designing the app, for it to be student friendly. Students and counsellors suggested that, for the app to be useful, it should provide information and coping strategies, offer support, engagement, and security. Therefore, the mental health app intervention in this study was developed based on these characteristics. The designed mental health app was evaluated by students and counsellors, who rated the app to be of high quality and easy to use. This outcome is positive and should be explored further. Future studies can longitudinally test for the app’s effectiveness with students experiencing psychological distress.Item Towards the development of a screening tool for Anorexia Nervosa in men(University of the Witwatersrand, Johannesburg, 2022) Reeves, Megan Moya; Laher, SumayaAnorexia Nervosa (AN) in men is still not wholly understood and is often misdiagnosed. The primary aim of this tri-phasal exploratory, mixed methods study was to propose content domains and items that may be used to inform the development of future quantitative tests to screen for AN in men. It has been reported that there is currently no quantitative instrument available, which has been specifically designed to measure anorexic symptomatology in men (Darcy et al., 2012; Murray et al., 2012). The quantitative content domains and test items developed in this study may be used in future self-report screening measures to help improve the accurate recognition of AN symptoms in men. These items will help to counter the effects of gender biases evident in current AN screening tools and biases held by clinicians and psychiatrists that are reported when screening for AN in men. These test items and content domains were developed in the third phase of this study and were derived from the findings of the first two phases. In phase one, a comprehensive thematic list of symptoms reportedly experienced by men diagnosed with AN was developed from an integrative literature review of peer-reviewed journal articles published between July 2000 to July 2013 on PsychINFO, SA ePublications, and Google Scholar. The data from phase one were supplemented by a thematic analysis of 14 interviews with South African clinical psychologists and psychiatrists, conducted under phase two, which deconstructed their beliefs regarding AN in men. Ultimately, the study’s three phases cumulatively showed how the symptoms reportedly experienced by men differed to those of women, deconstructed the beliefs held by a sample of South African clinical psychologists and psychiatrists, recommended a gender sensitive and identity based conceptualisation of AN that served to explicate theory, and finally proposed original test items that may be used in future research to develop a test to more validly and reliably screen for AN symptomatology in men.