4. Electronic Theses and Dissertations (ETDs) - Faculties submissions

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    I thought I was dying”: Menstruation experiences, knowledge gaps, and knowledge-seeking practices among young black South African women
    (University of the Witwatersrand, Johannesburg, 2024) Mahumapelo, Mmabatho; Lewins, Kezia
    This research studies how (if at all) and to what degree knowledge about menstruation and menstrual health is disseminated; how it is received and from whom; how the quality of the source is determined, and how the information received shapes the recipient’s understanding of their own body. I contribute to existing literature by investigating how black South African women gather knowledge on menstruation and how the sources of information they encounter shape their perceptions and experiences of menstruation. By drawing upon literature on the menstruation experiences of women in the Global South and especially the African continent, I explore and analyse how the intersectionality of gender, socioeconomic status, religion, culture, and tradition shape what and how South African girls learn about menstruation pre-menarche, at the onset of menarche and post-menarche. Semi- structured interviews with young black South African women of menstruating age from diverse backgrounds in South Africa reveal retrospective accounts of their menstruation experiences from menarche until date. Through these interviews, I establish the important knowledge sources on menstruation in the lives of these women and uncover the effectiveness and reliability of these sources for knowledge on menstruation. I also explore the possibility of knowledge gaps, communication delays and the subsequent knowledge seeking strategies applied to meet any learning deficits. I explore how primary networks such as parents, schools, friends, and peer groups influence menstruators, and consider the awareness of, access to and use of alternative resources like digital media and mHealth tools like period tracking apps to build on prior knowledge. The study draws upon feminist, shame, and self-policing (Foucault) theories to explain the social inferences about menstruation. In addition, I apply Jaccard et al.’s (2002) five aspects of communication to explain how sharing and receiving knowledge on menstruation is influenced by the characteristics of those who are engaging in the communication, their context, the content of the message communicated and how the message is delivered. The study shows that girls and young women pick up information from multiple sources and knowledge accumulates as they progress on their menstruation journey. In some cases, information on menstruation is shared actively by parents or primary caregivers and schools while in other cases, menstruators learn about aspects of menstruation passively. Where information received is insufficient, girls and young women rely on online sources like Google, social media platforms like Twitter and TikTok, and period tracking apps for knowledge. This research contributes fresh insights to the discussion of menstruation in South African women by placing menstruation at the forefront of discussions with youth about sexual and reproductive health.
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    Experiences of healthcare workers using the AwezaMed translation application in antenatal settings
    (University of the Witwatersrand, Johannesburg, 2023-06) Cason, Caroline Marian; Slemming, Wiedaad; Wilken, Ilana
    Introduction: Language barriers impede quality health care service in South Africa. Trained interpreters could alleviate this problem, but they are not employed in public or private health settings. Health care workers rely on informal interpreters, who do not necessarily provide an adequate service, and may be resentful of this extra task. AwezaMed is a smart application developed by the Council for Scientific and Industrial Research (CSIR) with content developed for maternal health settings. The aim of this study was to assess usability and user experience relating to AwezaMed. Methods: A user experience study was conducted using mixed methods. The systems usability scale (SUS) was employed, surveying 12 users, to generate a quantitative score, representing the overall usability of the system. Interviews were conducted with 14 users and analysed thematically to identify themes of usability and user experience, and recognise factors which contribute to use of the application. Results: The application (app) achieved a total score of 66.25, rating it between ‘OK/Fair’ and ‘Good’. Understandability, operability, attractiveness, and trust were important usability themes. Users also reported using the app as an aid to language learning. Factors which influenced the use of the app included previous experience with mHealth, experiencing a language barrier in health settings, and unavailability of, or problems with interpreters. Discussion: While the app was received positively, it did not meet users’ expectations, as two-way communication could not be achieved. Due to the often-strained relationship between healthcare workers and informal interpreters, there remains a demand for a usable, trustworthy mHealth solution. A framework is proposed, based on these findings, to evaluate mHealth translation applications in South Africa in the future.
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    Business model innovation for digital health entrepreneurship in primary healthcare in South Africa
    (University of the Witwatersrand, Johannesburg, 2024) Chindongo, Dalitso
    Introduction and Background: The study investigates the real-life encounters of entrepreneurs in the digital health sector in South Africa, with a focus on their innovative approaches in improving primary healthcare services. It compares seven different digital health ventures (A - G), and explores the challenges related to accessing high quality healthcare, examining how incorporating digital health technologies (DHTs) and developing creative business models is improving Primary Healthcare services in South Africa. Research Problem and Objectives: The central research question examines how digital health entrepreneurs can enhance the accessibility and quality of healthcare services through innovative business models, thereby addressing the challenges identified in primary healthcare. Methodology: For this research a qualitative approach was taken, involving a multiple case study of the seven digital health ventures operating in South Africa. The data collection comprised semi-structured interviews with CEOs/Founders and performing document analysis. The Business Model Canvas and Systems Thinking frameworks were employed in analyzing the gathered data. Key Findings: Accessing Quality Healthcare Challenges: Digital health ventures are tackling geographical and socio-economic challenges through telehealth and mobile health (mHealth solutions). Real world experiences demonstrate how these digital health ventures connect healthcare professionals with specialists, enhancing access for rural and underserved areas that make use of Primary Healthcare services in South Africa. iii The focus is on personalized and community specific interventions that prioritize patient centered care adapted to local settings, going beyond the generic digital health tools analysed in existing literature on digital health entrepreneurship. The incorporation of Digital Health Technologies (DHTs) The digital health ventures demonstrate real world use cases of DHTs like using AI based analysis, for treatment and telehealth for monitoring from a distance. These uses are in line with. going beyond the knowledge found in current research on Digital Health. Research results illustrate the significance of customizing DHT implementations to address community requirements shedding light on the obstacles and possibilities of merging technologies, in various healthcare settings. Innovative Business Models: The digital health ventures employ unique and customized revenue models, such as subscription fees and strategic partnerships, that go beyond the generic models discussed in the literature. Case studies based on the digital health ventures, illustrate the practicalities of partnership models, showcasing collaborations with healthcare providers and public health organizations, which enhance the understanding of business model adaptability in the digital health ecosystem. Conclusions and Implications: The study concludes that innovating business models, in primary healthcare could transform healthcare services in South Africa. Digital health entrepreneurship not only improves primary healthcare outcomes, but also enhances patient engagement. The research also emphasizes the significance of forming partnerships, establishing sustainable revenue models, and implementing supportive policies to maximize the advantages of digital health solutions.
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    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, Janan
    Background: 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.
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    A model for the acceptance and use of mHealth in South Africa: A UTAUT and TTF perspective
    (University of the Witwatersrand, Johannesburg, 2023) Livhuwani Grace, Mongwe; Hughes, Mitchell; Kekwaletswe, Ray
    Scaling up high impact community based mHealth interventions is one of the agenda items mentioned in the National Digital Health Strategy of South Africa for the period 2019 -2024. Although many mHealth interventions have been explored, many of them end up in the pilot phase and do not reach full implementation. A common theme which was found as a possible driver of scalability is designing an mHealth application that considers usability and acceptability by users. The purpose of this study was to synthesize a model for the acceptance and use of mHealth in the South African health sector. A positivist research approach was used to test the adoption factors using the Task-Technology Fit (TTF) and the Unified Theory of Acceptance and Use of Technology (UTAUT). Seven factors that could potentially impact the adoption of mHealth technology in South Africa were tested. The data for the study was collected through an online survey questionnaire which was shared through social media platforms. Results of this study were used to answer questions related to factors that have an impact on the adoption of mHealth applications in the health sector in South Africa. The study found that when adoption factors were combined into the UTAUT and TTF model, the only factor that was significant was facilitating conditions. The study findings in this regard were not consistent with other studies and it is therefore recommend that other scholars explore the reasons for these differences. The other factors were found to be significant when bivariate regression was used to compare the factors to the dependant variable of user acceptance and use of mHealth technology. The study further found that the combined model of Task Technology Fit has a positive impact on the adoption of mHealth technology in South Africa. The implication of the finding is that mHealth designers should build the functionalities of the innovation with the idea of making the task that the innovation supports easier to perform