School of Therapeutic Sciences (ETDs)

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Developing strategies for alleviating caregiver burden among informal caregivers of persons with severe mental disorders in Bushbuckridge, Mpumalanga province
(University of the Witwatersrand, Johannesburg, 2025) Silaule, Olindah Mkhonto; Adams, Fasloen; Nkosi, Nokuthula
Background: Globally, implementation of deinstitutionalisation led to a shift from institutional to community care of persons with severe mental disorders. This move calls for informal caregivers including families, relatives, friends, or neighbours to become key role players in the care and management of persons with severe mental disorders. The role of informal caregiving results in stress that consequently leads to caregiver burden. In South Africa, limited evidence exists on the extent of the burden experienced by the informal caregivers of persons with severe mental disorders and strategies for supporting these informal caregivers in their role are lacking. This study aimed to explore the burden of care to inform the development of strategies for alleviating burden among informal caregivers of persons with severe mental disorders in Bushbuckridge, Mpumalanga province. Methods: This study used a three-phased mixed methods approach with a multiphase design to facilitate a comprehensive investigation of caregiver burden among informal caregivers and to develop the multilevel strategies for alleviating the burden. Sequential and concurrent methods were combined to collect quantitative and qualitative data across five studies that were conducted to address the study objectives. Results: The established extent of burden revealed that most informal caregivers (44.7%) reported moderate-to-severe levels of objective burden, and 35.9% reported moderate-to-moderate levels of subjective burdens. Objective burden levels were significantly associated with age, gender and residence (p = 0.025, p = 0.034, and p = 0.038, respectively), while subjective burden was significantly associated with daily caregiving (p = 0.012). The exploration of lived experiences revealed that most informal caregivers experienced burden with subsequent impact on their emotional, mental, and physical health. The subsequent burdens were attributed to dealing with the chronic nature of severe mental disorders, role and financial strain, and stigmatisation from family and community. To deal with their caregiving demands informal caregivers expressed reliance on their internal resources, including resilience and resourcefulness. Expressed support needs included access to mental health services, and empowerment and social support from family, government, and religious and community organisations. The findings identified the need for conducting health screenings among the informal caregivers, as well as the need for strategies to support informal caregivers to complement their internal coping resources. The findings of the scoping review revealed that most studies were conducted in Asian countries. Psychoeducation and support group interventions were identified as predominant strategies for alleviating caregiver burden. The service provider’s perspectives revealed that the current state of formal and informal community mental health services is inadequate to meet the needs of the informal caregivers. Conclusion: The study’s findings informed the development of strategies for alleviating caregiver burden among informal caregivers in a low-resourced setting. The complexity of caregiver burden requires multilevel strategies, namely caregiver-driven, health worker-driven, community-based, intersectoral, policy, and legislature strategies across the individual, interpersonal, organisational, community, and policy levels. Caregiver empowerment, family and peer support, development of caregiver-orientated institution and community-based services, task sharing, and task shifting were identified as overriding strategies relevant for alleviating informal caregiver burden in a low- resourced setting
Development of an interprofessional education and collaborative practice curriculum for health science students at Sefako Makgatho Health Sciences University
(University of the Witwatersrand, Johannesburg, 2023-09) Pitout, Susara Johanna Susanna; Barnard-Ashton, Paula; Adams, Fasloen; du Toit, Sanetta Henrietta Johanna
A South African university required a contextually relevant, Interprofessional Education and Collaborative Practice (IPECP) curriculum. The study aimed to develop and validate an IPECP curriculum for health sciences students at Sefako Makgatho Health Sciences University (SMU). Planning the IPECP curriculum necessitated both a robust theoretical foundation and pragmatic problem-solving and comprised three phases. Phase I, the situational analysis included a scoping review of global peer-reviewed literature, focus groups with students and lecturers, and a university-wide needs survey. Brookfield’s lenses of critical reflection and reflexivity condensed results of the situational analysis into factors guiding curriculum planning. Phase II included a curriculum map analysis of profession-specific curricula of the eleven professions: occupational therapy, physiotherapy, speech language pathology and audiology, human nutrition and dietetics, nursing, medicine, radiography, pharmacy, dentistry, dental therapy, and oral hygiene. The curriculum mapping involved consultation with professions’ representatives in combination with information extracted from LOOOP, an electronic curriculum mapping programme. The analysis identified the gaps in addressing interprofessional collaboration core-competencies and highlighted common topics, in the professions’ specific curricula. From the curriculum foundation laid by Phase I and II, an IPECP curriculum framework and design principles were conceptualised using a Curriculum Development Research design. In Phase III, the proposed SMU-IPECP curriculum and accompanying design principles were refined during iterative stages of design, development, testing and revision. Internal and external participants validated the curriculum by rating the relevance, consistency, practicality, and feasibility of the four-year, longitudinal curriculum. A modified Delphi guided consensus on the design principles. The curriculum escalated interprofessional role development from mere exposure to immersion, striving for competent representation in research, ethics and Primary Health care. The build-up followed a trajectory from a professional individualised role in the team, to students fulfilling a dual identity of professional and an interprofessional practice-ready practitioner, who practices in an evidence-based collaborative way as a primary health care advocate, in their final year. The curriculum validation highlighted affordances and constraints for future implementation. During validation, participants agreed on the design and commended the proposed IPECP curriculum. Although the curriculum was planned for a specific university, the theoretical design principles developed through this research process could potentially be customised to fit similar university contexts.