3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The assessment of health promoting lifestyle knowledge, stroke related risk factors and quality of life of stroke survivors in the Mofolo, Chiawelo, and Stretford communities of Gauteng, South Africa(2024) Sebulele, Tshepang ChriseldahIntroduction Factors that contribute to the risk of developing a stroke are largely modifiable such as eating a healthy diet, exercising, and having regular health screenings for early detection of disease. An understanding of the stroke survivor’s level of health promoting lifestyle knowledge, assessing their risk factors for stroke, and assessing their quality of life will shed light into understanding the factors contributing to the increased rates of stroke and developing appropriate health promotion programmes. Aim To determine clinical and demographic factors, the prevalence and knowledge of stroke risk factors and health promoting lifestyle amongst stroke survivors in the Mofolo, Chiawelo and Stretford communities of Gauteng and how these factors affect the quality of life of stroke survivors in those communities. Methodology Demographic and clinical information was collected using a questionnaire, prevalence of stroke risk factors was assessed using the stroke risk card, health promoting lifestyle was assessed using the Health Promoting Lifestyle Profile II, quality of life was assessed using the EuroQol-5 Dimension, and knowledge of stroke risk factors and warning signs was assessed using the assessment of stroke risk factors and warning signs of stroke survivor’s questionnaire. All data was collected at baseline and then again reassessed after three months. All data gathered were analysed using STATISTICA, categorical data from the demographic’s questionnaire were analysed using percentages and frequencies, continuous data from the stroke risk card, EuroQol-5 Dimension (EQ-5D), HPLPII and the stroke risk knowledge questionnaires was analysed using descriptive statistics calculating mean and standard deviation as well as median and Interquartile ranges. Results A total of 156 participants were assessed at baseline with only 49 (31%) returning for threemonths follow up. Hypertension was identified as the most prevalent risk factor for developing a stroke at baseline (65%) and at follow-up (73%). Eighty two percent had good health promoting lifestyle profiles at baseline and 78% at follow-up. Knowledge of stroke risk factors and warning signs was good (67%) at baseline and (53%) at follow-up. Sixty five percent of the participants were partially independent for mobility at baseline when compared to 73% at follow-up. Only 6% of participants rated their overall health as 100% at both baseline and follow-up. Conclusion Stroke survivors in the Chiawelo, Mofolo and Stretford communities of Gauteng are at an increased risk of stroke from clinical factors such as high prevalence of hypertension. Interestingly, stroke survivors in this study were shown to have good health promoting lifestyles and stroke risk factor knowledge. More research needs to be conducted in stroke survivors living in communities of similar profiles to understand the factors that increase their risk of stroke. Subsequently, the knowledge gained from further research can assist in the development of interventions such as continuous monitoring of stroke survivors blood pressure, cholesterol and blood glucose levels and creating health promotion campaigns specifically designed for stroke survivors to educate them on the lifestyle changes that assist to reduce the risk of stroke.Item Choice/Freedom and Happiness/Well-Being in a time of ecological limits(2019) Hestenes, MathewThis Research Report analyzes happiness/well-being as a normative conception and as an empirical phenomenon. This report explores happiness specifically in relation to the 21st century ecological crisis of overconsumption and overproduction. The report interrogates divergent conceptions/theories of happiness (whether normative or empirical) both in trying to understand the causes of ecological problems and in seeking a potential solution in resolving these problems. The report critiques all the major normative theories of happiness/well-being (hedonism, life satisfaction and desire/preference satisfaction). It argues that each normative theory carries structural limitations in analyzing 21st century problems and in potentially resolving them. The report then interrogates empirical-natural/physical theories of happiness/well-being. Whilst these theories are empirical many authors utilize their foundations to construct normative theories. The report argues that, overall, the emotional state theory is the most helpful in addressing happiness and development in a context of ecological crisis. The emotional state theory is essentially a hybrid normative/empirical theory, as happiness is encompassed in a person’s emotional condition understood according to empirical models (emotions/affects, moods/mood dispositions and central affective states) and in the normative idea of self-fulfillment). After the philosophical-psychological analysis of happiness/well-being this report analyzes/critiques and illustrates the complexities of choice/freedom’s relationship to happiness/well-being. This report is particularly interested in choice/freedom’s relationship to happiness/well-being because of the linkage of both concepts to the economic system. This report argues that the economic system at its core is a choice/freedom phenomenon. Economies are made up of individual micro choice actors and macro choice architects. The micro choice actors are individuals involved in the micro production and consumption of resources. This reports analysis of happiness/well-being particularly relates to the macro choice environment. The macro choice architects are national/global economic policy organizations/departments/officials who structure the micro choice environment in divergent ways utilizing divergent economic models/theories, such as gross domestic product (GDP) or human development/capabilities. These models create divergent environments that provide divergent choices/freedoms to attain divergent bundles of resources. Some structured environments have narrower choice/freedom sets; these require less consumption and production to achieve. Other structured environments have significantly wider choice/freedom sets, requiring mass consumption and production. Utilizing 21st century notions of ecological limits/boundaries this report argues that significantly wider choice sets are ecologically harmful and models asserting that choice/freedom sets should be continually expanded are not realizable under 21st century conditions. Furthermore this report critiques the over-emphasis on choice/freedom as a constituent of happiness/well-being. This report critical illustrates that wider choice/freedom sets do not provide choice actors with increasingly greater happiness/well-being. In fact psychological research illustrates that wider choice/freedom sets place many burdens onto individual choice actors’ cognitive system. Finally this report utilizes two case studies, Denmark and Bhutan to analyze the relationship between happiness/well-being and choice/freedom under 21st century conditions. The reason this report selected Denmark and Bhutan is based on their vital contributions to happiness research. Since 1972 Bhutan is renown for utilizing Gross National Happiness (GNH) as their indicator for economic progress over GDP.1 This move radically challenged conventional economic growth models. Since 2011 Denmark is regularly ranked number one in international happiness reports, particularly the UN published World Happiness Report (WHR).2 A deep divergence in happiness is noted in these reports between Bhutan and Denmark. For example in 2016 the WHR ranks Denmark 1st whilst Bhutan is ranked 84th.3 In Bhutan, the report notes the over-restriction of choice freedom in favor of a culturalist conception of happiness/well-being. Instead of being free to choose which values appeal to them, the Bhutanese are rather coerced into a state endorsed value system. This report argues that this drastically affects their ability to achieve happiness/well-being. In contrast to Bhutan, Denmark does not restrict choice sets in such a demanding fashion. Instead individuals are largely free to choose a philosophy of life (pluralism) and how they spend their time. This report argues that Denmark’s environment provides wide enough choice/freedom sets for individuals to achieve happiness/well-being, whilst not being so wide that the negativities associated with increased choice arise. Ecologically Denmark is also concerned in resolving the 21st century ecological crisis. Thus Denmark-Bhutan is a nice comparison as both countries are talked about in regards to happiness/well-being and ecological considerations, whilst each structures the choice/freedom-happiness/wellbeing relationship in a different way. This provides an interesting discussion that will be explored in this report.Item Indefinite loss : parent caregivers' experiences of caring for their adult child in the South African context.(2014-07-03) Sedgwick, RuthannWhile it is recognised that the burden on the caregiver of a person who has suffered a neurological event is great, research into the experience of caregiving and the effects of cognitive-communicative difficulties on intergenerational families is lacking. Studies examining these experiences within a multicultural and multilingual setting such as South Africa are few. The effects of neurogenic communication disorders in family systems also require further investigation. This study explores parent caregivers’ experiences of caring for their once-independent adult child, who are now faced with the reality of parenting for the second time. A qualitative research design was employed. Eighteen parents of adult children who have suffered TBIs, strokes or brain tumours were interviewed. The data obtained were analysed by means of thematic analysis. Themes associated with caring for an adult child, specifically in the South African context, are identified and discussed. These themes related to the parent caregiver’s experience of loss – loss of their child due to physical and cognitivecommunicative difficulties as well as the loss of their own dreams and plans for the future. Multiple roles within intergenerational family systems, support and information are identified as significant factors in either minimising or exacerbating their experience of loss. These themes are explained within a Family Systems Theory framework and assist in identifying both positive and negative factors that impact on experiences of caring for an adult child. It stresses the importance of the implementation of sustainable programmes and support services specifically catering for parents of adult children with neurological communication disorders.Item "Emotion processing, neuropsychiatric symptoms and quality of life after a stroke".(2011-04-08) Blumenau, JeanineCerebrovascular disease is one of the leading causes of death among persons aged 50 and above and when a stroke does not result in death, it can cause residual cognitive, motor and behavioural disabilities. Emotional effects of brain injury range from reduced quality of life to various neuropsychiatric disturbances and are of great interest in the South African context and throughout the world as they pose a major obstacle to the rehabilitation process. This study explored the relationship between emotion processing, neuropsychiatric symptoms and quality of life specifically, how they operate following a cerebrovascular accident. In order to achieve this, an adult population of high functioning stroke survivors completed the emotion processing scale (EPS), Minnesota Multiphasic Personality Inventory (MMPI-2) and comprehensive quality of life inventory (ComQOL-A5) and a factor analysis provided statistical evidence suggestive of intercorrelations among the variables. The results lent support to this theoretical relationship and determined the structure of this relationship as follows: The satisfaction with quality of life after a stroke that relates to traditional masculine or feminine roles, when not fulfilled, related to neuropsychiatric symptoms of general maladjustment i.e. schizophrenia and psychopathic deviate. The second factor encompassed symptoms of general anxiety both internally and externally directed: Internally directed anxiety included symptoms of hypochondriasis and hysterical conversion, while externally directed anxiety included neuropsychiatric symptoms of paranoia. The third factor was associated with mood modulation in that elevated mood connected to neuropsychiatric symptoms of hypomania and depressed mood connected to symptoms of depression and social introversion. Finally, emotion processing and psychasthenia made up the last principal component, namely emotion modulation. This meant that avoidance of emotional iv content, suppression of emotion, unprocessed emotion etc. related to neuropsychiatric symptoms of obsessions or compulsions. High functioning stroke survivors’ behaviours were thus characterised by general maladjustment, anxiety, and symptoms related to mood and emotion modulation. This study underlies the importance of diagnosing, treating and monitoring stroke survivors’ emotional alterations and suggests the usefulness of its application in clinical settings to evaluate the effectiveness of treatments or more general interventions to improve the neuropsychiatric sequelae and quality of life of stroke survivors. Improved understanding of these constructs from the stroke survivor’s perspective has obvious impact for the therapeutic interventions inherent in stroke rehabilitation and as such, contributes towards the fields of neuropsychology, neuropsychotherapy and the social sciences.Item Botox to reduce drooling in South African neurologically impaired children : a retrospective study.(2009-03-20T09:22:10Z) Hay, Nicola MichelleDrooling management in the neurologically impaired pediatric population is a challenge. Surgery is considered an invasive procedure, while behaviour modification techniques, correction of situational factors and oral-motor therapy do not always produce sustained improvement. In recent years Botox® has been investigated. This study comprised analyses of clinical data obtained from a Drooling Treatment Project (DTP) conducted at a school for special needs children in South Africa. The aims of the DTP were to establish the response of drooling in a number of different contexts, following bilateral submandibular salivary gland injections of Botox®. Two groups of children were involved, 7 children with cerebral palsy and 2 children with operculum syndrome. Drooling was assessed in 5 different situations and at different time points pre- and post Botox® injection up to 6 months. Parents’/primary caregivers’ perceptions of drooling and treatment with Botox® were also measured using an interview form and a quality of life questionnaire. Results showed that drooling was reduced in all situations, with significant reductions in the general and communicating situations. These results indicate that the context in which drooling occurs is an important factor and suggest the value of considering the situational context when making drooling judgements. Further, there was a difference in the pattern of response between the 2 groups. This finding has implications, not only for future research, but also for models of explanation of the effects of Botox®. Most parents/primary caregivers felt their children’s lives and their own had improved following the Botox® injection and would repeat the treatment. Clinical and research implications are discussed, with reference to the South African context.