4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Adolescent health in rural South Africa: building an evidence-base to inform a health promotion intervention supporting healthier lifestyles(University of the Witwatersrand, Johannesburg, 2024) Seabi, Tshegofatso Martha; Kahn, Kathleen; Wagner, Ryan GBackground Low- and middle-income countries (LMICs), including South Africa, face the persisting double burden of malnutrition, with undernutrition and overnutrition coexisting within the population. This issue is particularly pronounced among rural adolescents, who experience limited access to healthcare services, inadequate infrastructure, poverty, and a scarcity of nutritious foods. Addressing this double burden of malnutrition is essential for improving the health outcomes of rural adolescents and breaking the intergenerational cycle of malnutrition. Community health worker-led interventions have shown promise in promoting healthier lifestyles in this population, making it crucial to understand the feasibility and acceptability of such interventions. Aim This thesis aims to provide context-specific information on the changing distribution of Body Mass Index (BMI) and views on obesity among rural South African adolescents to inform the development of a targeted behaviour change intervention. Furthermore, it seeks to determine the feasibility, acceptability, and overall experience of implementing a complex intervention aimed at promoting healthier lifestyles in this population. Methods Using a mixed methods approach focusing on adolescents 12-20 years of age living in rural South Africa. This work is nested within the MRC/Wits rural public health and health transitions research unit (Agincourt) Health and Demographic Surveillance System, which is where the sample was drawn and provided explanatory variables such as SES. This work includes data from two studies with comparable measures, conducted in 2007 (n= 1309) and in 2018 (n=518), this study analysed comprehensive data on the prevalence and trends of BMI, including both undernutrition and overweight/obesity, among rural adolescents in 2007 and 2018. This was done through weight and height measures. Growth z-scores were used to determine stunting, underweight and overweight and overweight/obesity was generated using the 2007 WHO growth standards for adolescents aged up to 17 years and adult cut-offs of BMI of <=18.5 for underweight and =>30 kg/m2 for overweight and obese respectively for adolescents 18 to 20 years. Qualitative data was collected in the form of focus group discussions and in-depth interviews. Pre-intervention, three focus group discussions were held with male (n = 16) and female adolescents (n = 15) focusing on obesity to capture views, attitudes and perceptions surrounding obesity. Post-interventions, six focus group discussions were held with male and female adolescents. In-depth interviews were conducted with adolescents (n=20), parents (n=5) and CHWs (n=3), focusing on the feasibility and acceptability of the health promotion intervention. All qualitative data were analysed using inductive thematic analysis. Results This study found that there is a persistent double burden of malnutrition amongst rural adolescents. The pattern of underweight and overweight/obesity remains similar between 2007 and 2018, with an increase in overweight and obesity, and a decrease in underweight observed across different age and gender groups throughout this period. The prevalence of stunting and underweight, particularly in males in both 2007 and 2018 was substantial although lower in the later year. Adolescents expressed conflicting views of obesity, highlighting their knowledge of the cause and long-term consequences of obesity. In regard to the intervention, participants expressed support for the CHWs and the community-based intervention guided by them. The findings demonstrated the feasibility of providing the intervention to adolescents in a rural context, with modifications needed to ensure participant uptake, such as changes to the time and location. Responses from participants show how the intervention, which included dietary and quantity modifications, was acceptable to adolescents. The gathered information in this study serves as a foundation for developing a health promotion intervention tailored to the specific needs and circumstances of rural adolescents, considering both undernutrition and overweight and obesity. Conclusion This research provides valuable context-specific insights into the burden of malnutrition and perceptions of obesity among rural South African adolescents, considering the complexities of the double burden of malnutrition. The findings contribute to the development of tailored health promotion interventions that address both undernutrition and overweight/obesity in this population. Understanding the feasibility and acceptability of such interventions is vital for successful implementation and sustainability in rural communities.Item Impact of a rural context in Kwazulu Natal on primary caregiver's management of pain innon-communicating children with severe neurological impairment(University of the Witwatersrand, Johannesburg, 2024) Pretorius, Jeanette; Franzsen, DeniseUntreated pain is known to have negative consequences on the development and wellbeing of “non-verbal” children with severe neurological impairment (SNI). Healthcare workers and caregivers must ensure that pain is managed in this population, even though pain may be difficult to assess. Occupational therapists need to understand how context affects the management of pain experienced by a child with SNI, as well as its impact on the care of the child. This study determined how a rural KwaZulu Natal context impacted how primary caregivers recognized and manage pain and the care of their child with SNI. Methods: A multiple descriptive, embedded case study design using a demographic and pain questionnaire, with cross sectional design. There were nine respondents’ qualitative and quantitative information content analysis and descriptive statistics were used to report. Results: Financial, environmental, emotional and physical strain factors associated with the rural context were identified may be adding to the burden of care and affecting the occupational performance of the child with SNI and their caregiver. Specific difficulties included limits in access to clean running water, the practice of bed sharing and poor infrastructure affecting access to healthcare facilities. Primary care givers also mentioned their other responsibilities in the house and the physical strain of caring for a child with SNI affected them and their child. Despite this, all primary care givers were able to recognise and act when their child was in pain and relied on crying duration and intensity as a reliable sign of pain in their child. All primary care givers were confident in their ability and method of recognising and addressing pain in their child with SNI. More experienced primary caregivers used fewer signs to recognise when their child with SNI was in pain. Conclusions: A rural African context is associated with barriers and opportunities for the care, the recognition- and management of pain in children with SNI. More research related to supporting participation and occupational performance by addressing the effects of pain in children with SNI on the child and the primary caregiver living in rural contexts is requiredItem Exploring Grade 10 physical science teachers’ pedagogical approaches to the Electricity topic in selected Vryheid rural schools, KwaZulu-Natal Province(University of the Witwatersrand, Johannesburg, 2023-10) Zulu, Sphamandla Innocent; Nkambule, ThabisileIn a context often characterised by lack of resources, with its peoples’ agencies often ignored, how do teachers teach difficult yet practical science topics in rural classrooms? This question was asked in a context where teaching is described as a complex task. Without overlooking teachers‘ individual agency, teaching science in rural schools is an arduous undertaking. Science teachers require sufficient and appropriate content knowledge and pedagogical knowledge for enhanced science teaching and learning experiences. Understanding teachers‘ pedagogical knowledge was the interest of this study. Therefore, the purpose of this study was to explore teachers‘ pedagogical approaches during the Electricity lessons in Grade 10 rural classrooms and examine teachers‘ pedagogical reasoning for the observed teaching approaches. The paucity of physical science education research in rural schools has not been able to offer an account of teachers‘ pedagogical approaches and what influences their pedagogical practices within rural classrooms. Hence, the current study as introductory for other science education researchers in researching physical science teaching and learning in rural schools. The present study used Mavhunga‘s (2012) topic specific pedagogical content knowledge (tsPCK) as a theoretical framework focusing on all five components of the theory. To supplement tsPCK, Scott et al.‘s. (2011) pedagogical link-making (PLM) was also used in identifying and discussing the nuances of teachers‘ pedagogical approaches during electricity lessons. I used a collective case study design and adopted a qualitative research approach and classroom observations, video-stimulated recall interviews (VSRI‘s), and semi-structured interviews as methods of data generation. The case study focused on three teachers from Vryheid rural schools in KwaZulu-Natal Province of South Africa, to investigate their classroom practices, particularly, pedagogical approaches to Electricity topic and factors that shape their teaching of the topic. The three teachers were purposefully and conveniently selected. To guide this case study investigation, the main research question of the study was: How do Grade 10 rural physical science teachers teach the Electricity topic? The findings of this study revealed that the teaching of Electricity topic requires multiple representations at symbolic, macro, and sub-microscopic levels; and that explicit links of these representations are vital for science knowledge building. Teachers used mostly symbolic level, with some teachers limitedly representing the Electricity topic macroscopically through practical work (hands-on practical work and demonstrations). Important also was the contextualized level of representations including analogies that teachers used to teach the topic. Moreover, teachers constantly worked with learners‘ prior knowledge in their facilitation methods while also considering curricular sequencing and content skills linkage made within and across the lessons. Also, some observed electricity concepts or processes proved to be difficult for teachers to teach, while, I acknowledge the various conceptual teaching approaches that teachers used to ensure deep understanding of the topic of Electricity including those concepts that seemed difficult to teach. Other observable teachers‘ approaches included the dominance of question and answer teaching approach and teacher-centered approach, with some subject-matter centered approach and limited learner-centered approach. All three teachers taught the same topic differently. During VSRI and semi-structured interviews, teachers commented on their teaching for assessment purposes. Teachers‘ pedagogical approaches were influenced by various factors including teachers‘ teaching and learning experiences, learners‘ prior knowledge, teaching for compliance, teaching for assessment (examination), availability and appropriate use of science laboratory apparatus for Electricity topic. Given the findings of this study, I recommend among other things, research intervention intending to equip rural teachers with pedagogical skills for teaching physical science topics including Electricity topic.Item Rehabilitation outcomes measurement instruments usage in KwaZulu-Natal and Gauteng healthcare(University of the Witwatersrand, Johannesburg, 2022) Buthelezi, Mnqobi BasilThere is a lack of rehabilitation outcome data collection and use in South Africa. Important to note in this study discussion are Rehabilitation Outcome Measures which are tools (FIM, BI, MRS, FAI, NEADL) used to collect data and measure the extent of change during and post-rehabilitation period. This research purpose aims to evaluate the awareness, and use of rehabilitation outcome data measuring instruments, the available capacity, opportunities of learning and constraints that exist across different settings in public and private rehabilitation healthcare in KZN and GP. A quantitative research strategy was utilised. A cross-sectional, survey design plan of data collection framework was used. Face-to-face primary data collection was conducted in the proposed research sites. Purposive sampling targeting 13 rehabilitation public-private healthcare facilities in KZN, and GP was used. Stratified sampling together with 100% sampling in a small population was conducted. Community of Rehabilitation Multidisciplinary Teams (RMTs) of seven (7) members in public and private hospitals, composed of medical officer(s), nurse(s), clinical psychologist(s), physiotherapist(s), occupational therapist(s), speech/audio therapist(s) and social worker(s) took part in the study. SPSS assisted in results analysis; frequencies and non-parametric Chi-square of independence statistics were utilised to sort any significant associations. Results indicated that 253 subjects participated in the study. Analysed results suggested that n=153 (60.5%) participants were not provided with rehabilitation outcome measuring tools by the facility they were working for. Results suggested a significant negative association in Public Rural Settings (FIM=49.7%, BI=43.8%, MRS=41.9%, p=0.001, FAI=17.6%, p=0.037) and Public Urban Settings (FIM=43.2%, BI=36.5%, MRS=40.5%, p=0.001 and FAI=35.3%, p=0.037) of public healthcare facilities as they were not using rehabilitation OMs. A significant association in use of rehabilitation OMs was found in Private Urban Rehabilitation Healthcare facilities (FIM=56.0%, BI=35.6%, MRS=64.5%, p=0.001 and FAI=47.1%, p=0.037). Public healthcare facilities in KZN and GP were not using rehabilitation outcome measures, while GP Private rehabilitation healthcare facilities were using them. In conclusion, it is recommended that National Rehabilitation Policy (NRP) is subjected to reviews to incorporate standardisation of rehabilitation OMs. A diagnostic evaluation exercise is necessary for Theory Of Change development focusing on rehabilitation healthcare services