3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item A study of women reminded by short message service for elective gynaecological surgery: a randomized controlled trial(2014-03-31) Potgieter, J. F. A.Wireless communicating networks are becoming more and more utilized. By using Short Message Service (SMS) via mobile phones, patients can be contacted regarding blood results, follow-up appointments and reminders for chronic medication.In this study the use of SMS was put to the test in South Africa, a middle income country. Objectives: 1. To evaluate whether there is better compliance in patients who received a SMS, reminding them of the date of elective surgery, as opposed to patients who did not receive a reminder SMS. 2. To describe demographic and clinical information of women who are booked forelective gynaecological surgery at Chris Hani Baragwanath Academic Hospital Methods: This study was undertaken at Chris Hani Baragwanath Academic Hospital, which offers a gynaecological elective surgery list on every working day.As with any busy hospital, it is not uncommon for women to wait lengthy periods of time for their surgery Participants were recruited and followed-up between 30th May 2011 and 14th of December 2011. Eligible criteria included all women scheduled to undergo surgery with a waiting list of at least one month. Women who did not have mobile phones and women who objected to receiving SMS communications from the researcher on their mobile phones were excluded. Participants less than 18yrs, inability to read English SMS and refusal to participate in the trail were excluded. This was a double-blinded randomized controlled trial, which assessed the impact of a reminder SMS, in addition to the traditional methods of ensuring return for gynaecological surgery on patients remembering to avail themselves for surgery on their specific date. These numbers were randomized by block randomization into intervention group and control group. The Research Randomiser Form v4.0 program was used. Twenty nine patients were randomized to the intervention group who received a reminder SMS and 29 patients to the control group who did not receive the reminder SMS. Only patients with personal cell phones were included in the study. The participants as well as the researcher were blinded and only the supervisor knew who of the participants were randomised in either group. Results: A total of 58 patients were enrolled in this study. Participants included in the study were allocated numbers. The study showed that even though the shortest waiting period was < 2 months and the longest >5 months there was no significant difference in the number of patients that returned for surgery (53% versus 47%). Most of the patients in this study were African, unemployed and agesranged from 17 – 78 years. The primary reasons for their return in order of frequency were the presence of a mass (60%), pain (59%) and bleeding (36%). One of the major findings of this study was that older patients tended not to return for surgery. Surprisingly, patients who waited longer from the time of booking of surgery to the date of surgery, tended to return more frequently. The main reasons for not returning were that patients did not have money for transport and four patients were unreachable and hence lost to follow-up. Conclusion: This study failed to show that reminders by SMS for elective gynaecological surgery are effective. It also demonstrated that older women were more likely not to return for surgery. Perhaps their ability to read or respond to SMS is more limited than younger women. The other significant finding of this study contrary to expectation is that longer waiting periods seemed to encourage a better return rate.Item Interprofessional communication in a rural hospital.(2013-09-27) Longman, CaitlinBackground: South Africa is a diverse country in terms of its cultures, languages, socioeconomic variety and community beliefs and this is reflected in our health care setting. Communication is a critical feature of adequate medical care and an understanding of potential barriers to communication is important particularly in understanding under-resourced rural health care settings. The health community is comprised of different professionals who are required to communicate interdependently on a daily basis to ensure the best quality of care for their patients. Little research has been done on the role of interprofessional communication in a rural setting. Purpose: The aim of this research project is to describe and understand the influence of systemic and interpersonal factors on communication processes between health care professionals working in a rural hospital context. Method: The research study used a qualitative design and the application of social interaction theory, specifically Goffman’s framework was used to understand the phenomena studied. The study involved 52 health professionals and included: doctors, nurses, clinical associates, social workers, pharmacists, dieticians, physiotherapists, occupational therapists, speech and language therapists, audiologists and administrative staff. The data in this research were derived from ethnographic observations in the hospital, and focus groups and interviews with participants. Profession-specific vignettes were used during the focus groups to stimulate discussion. A SiSwati speaking research assistant helped with the collection of data and aided in translation and transcriptions. Data from the 52 interviews, 8 detailed xiv observations and 12 focus groups were analysed using thematic analysis. Findings: Numerous systemic and interpersonal themes were derived from the data. The study found that health care professionals felt isolation from both the wider medical community as well as the local community which influenced interprofessional communication. Systemic influences included the impact of the rural setting, changes in health systems (the proposed National Health Insurance scheme) and access to provincial support. Interpersonal themes included management, power, responsibility, handover, recognition of roles, blame, conflict and language issues. One of the most prominent interpersonal themes to emerge was the identity of the health care worker which was interlinked with their professional role, status, power, race, language and community identity. Participants’ thoughts about the way forward for the hospital also emerged. Conclusion & implications: Systemic and interpersonal factors do influence health care workers’ interprofessional communication. Social interaction theory explains some of the complex communication interactions but they do not account for important systemic influences. Goffman’s front and backstage is beneficial in identifying communication in a rural hospital however systemic and interpersonal categories were found to be more useful in this setting. The implications from this study are important for policy, theory and practice such as communication training programmes for rural healthcare teams as well as site specific models of training. Speech and language therapists are communication experts and therefore could be playing a greater role in the development of team communication.Item The impact of communication skills training in the management of paediatric HIV : examining the process of designing, implementing and evaluating a communication skills training programme for adherence counsellors in the South African context.(2010-11-15) Evans, MelanieThis study examines the design, implementation and evaluation of a communication skills training programme for adherence counsellors in a paediatric HIV clinic. Effective communication is a pre-requisite skill for any counselling interaction. For both prevention and treatment, counselling is a critical component of the healthcare team response to the HIV epidemic. Given the shortages of healthcare workers in sub-Saharan Africa, task-shifting of the counselling role to less-trained cadres of workers is commonplace. In the multilingual, multicultural South African context, taskshifting coupled with the complexity of the message in paediatric HIV presents enormous challenges. In-service support for counsellors is lacking. Counsellor burn-out and fatigue is commonplace affecting the quality of counselling interactions. Measuring the quality of communication in a multilingual context poses ethical and methodological challenges and is a neglected area of research. Traditional communication and counselling assessments appear to be largely taxonomic; lack cultural and linguistic sensitivity; and fail to acknowledge communication as a dynamic, two-way process. Mindful of these issues, this study utilized a non-taxonomic approach. Verbal and non-verbal communication was analysed before and after the implementation of in-service training which was tailored to the specific research context. The training comprised a two day multidisciplinary team workshop followed by individual training. This consisted of video feedback and analysis of counsellors’ own sessions and was attended by four counsellors. Results were recorded over an eighteen month period. Twenty-two consultations between counsellors and caregivers were video-recorded, transcribed verbatim and analysed using a hybridized form of linguistic analysis. Findings that demonstrated consensus, substantiation and cross-consultation occurrence were triangulated with thematically analysed interview data, patient questionnaires and researcher reflections. These methods are more sensitive to process than checklist approaches and individualised, complex dynamics emerged. Communication barriers and facilitators were identified before training. Variations in communicative competence between counsellors appeared to be unrelated to prior training. After training, counsellors asked more open-ended questions, encouraged caregivers more, provided simpler explanations of treatment regimens and checked understanding more effectively. In response, caregivers initiated more questions. These findings suggest that communication training improves treatment literacy and results in interactions that are more patient-centered. Despite this evidence, the results suggest limitations to the impact of communication training given the lack of agency of women in South Africa. Interactions included frank and open discussion about cultural beliefs. However, this benefit may be lost due to poor healthcare team cohesion. In their roles as mothers and caregivers themselves, counsellors are effective patient advocates and bring their own lifeworld experience to the counselling interaction. These shared stories are testimonies to the resilience of women living in poverty. Whilst allowing for greater exploration of patients’ cultural beliefs and explanatory models, communication training has limited impact in assisting counsellors with dealing with issues such as disclosure, non-adherence and scepticism about biomedicine. Results indicate conflict between patient-centeredness and perceived desired medical outcomes. Caregivers and counsellors appeared to engage in ritualistic dialogue when discussing certain topics suggesting that a shared lifeworld between caregiver and counsellor is insufficient to overcome barriers from the meso (institutional) and macro (broader socio-political) context. An awareness of the impact of context is critical to our understanding of communication in a clinical setting. The results from this research have implications for the role of the counsellor within a multidisciplinary team and establish a need for communication specialists to work in a clinical setting within the HIV epidemic.Item Democracy : a reality check for early childhood development practitioners.(2009-01-07T07:48:05Z) Huggett, Eleanor AnneThe majority of educators/practitioners practicing in South Africa today were either educated under the apartheid regime or experienced a post apartheid education that was given by people socialized under the apartheid regime. Therefore, there is a strong possibility that democratic practice in schools is compromised due to the socialization of the practitioners. ECD practitioners’ perceptions on democracy and how they implement democratic practices in their workplace are explored in order to begin to identify the elements of a learning and working environment that could promote the values of a liberal democracy. A dialogic, participatory approach using questionnaires, focussed group discussions, personal interviews and critical incidents, investigated relevant issues such as perceptions of democracy, socialization, leadership, adult education and the impact of crime and HIV/Aids within the ECD context. The findings show that democracy is recognized as a positive and welcomed development in South Africa. There is a genuine ‘spirit of ubuntu’ present and the participants relish the diversity in their midst. A common feature between all groups is the concern over crime and corruption. However, it also revealed that although the surface levels of understanding of the principles of democracy are similar between various groups, the in-depth perceptions regularly differ. Improved avenues for legitimate communication between participants at all levels is advised, not only to discuss differences but also common ground. Understanding the factors that promote democratic principles such as cultural interaction, diversity, etc. could help both the participants of this study and other ECD practitioners in creating and promoting legitimate democratic practice in the workplace.Item Inclusive education of primary school aged children with Down Syndrome in Gauteng Province, South Africa.(2008-06-11T05:47:04Z) Klompas, Michelle ShanaThe study documented three case studies of primary school aged children with Down Syndrome attending ordinary public schools in Gauteng province, South Africa by employing an adapted ecosystemic model (Donald, Lazarus & Lolwana, 2002). Triangulation and content analysis was employed to analyse the data obtained from a parent questionnaire; parent, teacher and teaching assistant interviews; documented reports; school observations; an educator rating scale; a speech-language assessment and audiological screening. The study found that inclusive education had been successful for the participating children. Their communicative impairments impacted on the domains of communication, academic skills and socialization in the inclusive school context and had the greatest influence on their functioning in the ordinary school. The unique perceptions, attitudes and experiences of the children’s parents and educators were found to have a profound impact on the inclusive education process. The study found that systemic factors influencing inclusive education within the South African context acted as barriers and challenges to the successful inclusive education of the children and that their parents were the most influential and contributing force to the success of the process. Paramount implications for the systems and subsystems involved in the inclusive education process, clinical practice of Speech-Language Pathology and for the advancement of theory and research are discussed. A valuable proposed inclusive education process for the learner with Down Syndrome in the South African context is set out.Item The Communicative Opportunities Afforded Parents of Premature Infants who had Graduated from a Neonatal Intensive Care Unit (NICU)(2006-10-27T06:56:17Z) Crisp, LynziThis study endeavored to explore the opportunities afforded parents to develop optimal communication with their infants during their experience of the NICU in a private-sectored hospital. Six sets of parents participated in a semi-structured interview and completed a short questionnaire. They were interviewed one year after their infants were discharged from the NICU. The interview and questionnaire probed the three main components that are known to influence the development of optimal communication between parents and their infants in the Neonatal Intensive Care Unit (NICU): the infant’s prematurity and medical condition; the nature of the NICU; and the parents’ ability to adjust and adapt to the challenges faced during the NICU experience. The data obtained was analysed qualitatively using a constant comparative method. Six main themes emerged: preparedness; contact with the infant; bonding; information; support; and previous parenting experience. The findings reflected that the parents were afforded limited opportunities for the development of adequate infant-parent interaction. The implications of this study highlight the need for appropriate developmental and family-centred care to be implemented within NICUs in private-sector hospitals, the role of the speech-language therapist in the NICU team to be defined, and future research into the nature of the care provided within NICUs in South Africa.