Faculty of Humanities (ETDs)

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An Exploration of Audiologist and Patient Communication during Adult Tinnitus Management Sessions in Gauteng, South Africa
(University of the Witwatersrand, Johannesburg, 2023) Stonestreet, Micaela Ruth; Kanji , Amisha; Watermeyer, Jennifer
Introduction: Tinnitus is a prevalent symptom of hearing loss and can have a significant impact on quality of life. Recently a large body of research exploring patient-centred care and communication practices in audiology has emerged. However, there remains a paucity of research on communication in tinnitus management consultations. Aims: The aim of this study was to explore interactions between audiologists and patients in initial adult tinnitus management sessions. The objectives of this study were to observe the communication processes of audiologists in this setting, as well as explore how audiologists negotiate complexities such as patient expectations, emotions, decision-making and goal setting with patients. Methodology: This study implemented a multimethod exploratory qualitative design incorporating interactional analysis of video recorded audiological initial tinnitus consultations, triangulated with participant interviews. The research was conducted at two hospitals in the public healthcare sector of Gauteng, South Africa. The data comprised of seven video-recorded interactions between five audiologists and seven patients, supplemented with interviews with all 12 participants after the tinnitus consultations. The video-recorded interactions were analysed by means of a hybrid sociolinguistic analysis approach with principles of interactional sociolinguistics and theme-oriented discourse analysis. The video- recorded data was triangulated with the interview data in order to strengthen the analysis and overall confirmability of the study. Results: The findings of this study highlight six communicative actions that contribute to patient-centred communication in initial adult tinnitus management sessions, namely: agenda setting, breaking from a scripted approach, prioritisation of patient concerns, engaging in emotional and psychosocial topics, shared decision-making and expectation setting. The results of this study show that audiologists are not consistently implementing these 5 communicative actions within their adult tinnitus management consultations, which has implications for patient-centred care. Conclusions: The study provides insights into the current communication practices of audiologists in adult tinnitus management sessions in South Africa. The research highlights both the strengths and weaknesses of audiologists in their use of effective communication strategies and patient-centred care, specifically in information exchange, responsiveness to patients’ emotions and psychosocial stressors, and shared decision-making. Audiologists need to consider how they can transform the concepts of patient-centred care and effective communication into practical actions within their tinnitus management. These findings can raise awareness among audiologists about their communication practices in tinnitus management consultations. Additionally, they offer insights into practical communication strategies that can be implemented into tinnitus management consultations and provide valuable insights for future researchers, educators and policymakers.
Disability and Masculinity: How Young Men with a Disability Navigate Masculinity in South Africa
(University of the Witwatersrand, Johannesburg, 2024) Moonsamy, Michaela Anne; Langa, Malose
This research project aimed to contribute to the body of knowledge in the global south literature on masculinity by exploring how young men with a physical disability construct and navigate masculinity. Theories such as Ecological systems theory, Social identity theory and Gender role strain theory served as the theoretical framework. Semi-structured interviews were used as the data collection method. There were seven participants in total, five identifying as black and two identifying as Indian, all with varying degrees of physical disabilities. Participants were selected using purposive snowball sampling. Interpretive phenomenological analysis was used to analyse the data. Five themes were constructed from the data: How young men with disabilities define their masculinity; Challenges of not meeting Hegemonic Masculinity Standards and the coping strategies used to manage these challenges; Disability and its contribution to identity formation; Relationship with others: living with a disability and how this relationship affects masculine identity; and Embodying masculinity. The study revealed that young men with a disability reject/reformulate hegemonic masculine ideals to standards they can meet but can also simultaneously draw from hegemonic ideals. In addition, various challenges faced by men with a disability were explored as well as how relationships affect identity formation while living with a disability. Limitations and future recommendations are discussed.
Contraceptive use Transition and Fertility Dynamics and Reproductive Health Outcomes in Zambia
(University of the Witwatersrand, Johannesburg, 2024) Phiri, Million
Background: Improving access to and utilisation of contraceptive methods has been a major global goal of maternal health and development programming for over four decades now. Despite the benefits associated with contraceptive use, the prevalence in Zambia is still low. The country’s population policy has identified high fertility rate, population growth rate and maternal mortality rate as hindrances to the country’s socio-economic development agenda. Although the contraceptive prevalence rate in Zambia is still low, it has been increasing steadily from 15.2% in 1992 to 34.2% in 2001 and then from 40.8% in 2007 to 49.0% in 2018 among women of reproductive age. The sources of the observed increase in the contraceptive rate use were not known. This is because previous studies in Zambia concentrated on examining factors associated with using contraception use rather changes in usage. This study achieved the four specific objectives: (i) describe how contraceptive use has changed in Zambia over time regarding levels and trends; (ii) explore the geographic, social, economic, environmental and demographic factors that explain contraceptive use transition in Zambia; (iii) examine how contraceptive use transitions have affected fertility dynamics (iv) examine how contraceptive use transition has affected reproductive health outcomes in Zambia. Theoretical framework: The theoretical framework used in this study reflects the fact that a woman’s choice to use contraceptive is affected by a complex interplay of social, economic and interpersonal relationships at household or neighborhoods levels. It is in this regard that this study adopted the empowerment and social capital theories, reflecting social phenomena which operate at different level to influence contraceptive use. As such, contraceptive use can be viewed as a function of the level of empowerment among women, their access to social capital, and the degree to which gender inequality and problematic social norms are present in their social environment. The key woman empowerment elements include participation in the decision- making process, education attainment, access and ownership of resources, access to information, employment opportunity, and higher socioeconomic status. Methodology: This study employed a mixed methods research design to examine factors explaining contraceptive use transition in Zambia. Quantitative analysis used a pooled dataset comprising a sample of 44,762 fecund sexually active and non-pregnant women aged (15-49 years) captured in the demographic and health surveys (DHSs) conducted between 1992 and 2018. The DHS is a cross-sectional study which applies a two-stage stratified cluster sampling design to select Enumeration areas and households. Furthermore, qualitative data analysis was conducted on the data collected through focus groups (FGD) with women of reproductive age (n=4) and key informant interviews with key staff (n=10) from the Ministry of Health and stakeholder organisations implementing family planning programmes in Zambia. All the FGDs and key informant interviews were conducted in Lusaka and Chongwe districts. The first objective was achieved by conducting descriptive and trend analysis on data to examine the changes in contraceptive use overtime. Qualitative data was used to explain the reasons behind the observed changes in contraceptive use transition. Analysis for the second was done in two steps. The outcome variable for this study is current contraceptive use. All sexually active women in the DHS were asked a question “Are you currently using any contraceptive method to prevent a pregnancy”. The first step involved application of multilevel regression analysis to examine the influence of both individual and community factors on current contraceptive use in Zambia. The second step involved utilisation of multivariable nonlinear decomposition technique (Blinder Oaxaca decomposition techniques) to measure the contribution effects of both individual and contextual factors to the observed changes in contraceptive use in Zambia. This was also complimented by qualitative data to explain to ii | P a g e explain quantitative results. Objective three was achieved through application of multivariable Blinder- Oaxaca decomposition regression techniques to examine the effects of contraception use changes over time on fertility rate and maternal health outcomes in Zambia. Using a multivariable decomposition regression analysis technique is an improvement over previous similar research works that have been conducted in Zambia. All DHS analysis took into account the complex survey design and statistical significance was determined at α0.05. Key findings: Study findings show that in Zambia's contraceptive prevalence rate rose 30.8 percentage points (14.2% to 45.0%) throughout the analysis period, 1992 to 2018. This translates to an average of 1.2% annually. The major share of contraceptive use increase in Zambia happened between 1992 and 2001 (16.7%). The least change was during 2013 and 2018 (0.2%). Findings show that the rate of increase in CPR has been declining over time, even though overall CPR has increased during the analysis period. The findings show that overall, contraceptive use among sexually active women has increased significantly in Zambia, despite regional, residential, and socioeconomic differences. The study's findings support the proposed research hypothesis that contraceptive use has increased significantly in Zambia. Overall, both changes in women’s compositional structure and changes in women's contraceptive behaviour significantly contributed to the change in contraceptive use in Zambia. Multivariable decomposition analysis of the determinants of change in contraceptive use has revealed that between 1992 and 2018: increase in proportion of women with secondary education (5.20%), reduction experience of child mortality (7.70%), reduction in the proportion of women desiring 6 or more children (5.63%) and increase in proportion of woman decision with making autonomy (3.33%) were the major contributors to the trend change in contraceptive use among sexually active women in Zambia. Results from the decomposition analysis reveal that the observed increase in contraceptive use in Zambia has significantly affected reduction and fertility rate and teenage pregnancy. The study results confirm the hypothesis that the increase in contraceptive use has contributed to the reduction in fertility rate and teenage pregnancy. Conclusion: Contraceptive utilisation among sexually active women in Zambia has shown a steady and significant progressive increase of 30.8 percentages over the 26-year period from 1992 to 2018. The larger increase in contraceptive use happened during the period 1992-2001. Although there are still regional and area disadvantage in contraceptive prevalence rate, the gap in utilisation between urban and rural areas has narrowed. Women’s compositional factors have contributed differently to contraceptive use increase observed in the country. The observed increase in contraceptive use in Zambia is largely due to changes in the contraceptive behaviour of sexually active women. Positive change in women’s contraceptive behaviour could be attributed to the country’s huge investment in family planning programming by government and stakeholders. However, improvement in women compositional factors, such as education, decision-making autonomy, access to family planning information and child mortality experience reduction among other individual and community-level factors were key in driving contraceptive use transition. Therefore, as emphasized in the empowerment and social capital theories, social change among women is key in influencing contraceptive use transition. Furthermore, the study has established that the noted increase in contraceptive use in Zambia has positively contributed to fertility rate decline. iii | P a g e Implications of results The findings of this current study imply that both changes in women’s social factors and changes in the contraceptive use behaviour of sexually active women in Zambia have been driving contraceptive use transition in Zambia. This signifies that the investments in family planning programmes have been yield expected results by changing contraceptive behavior of women. The study findings further suggest that understanding social context is key to inform the design of new FP strategies and strengthening of exiting interventions aimed at further improving acceptance and utilisation of contraceptive methods among women. Contribution to knowledge of the study The study has made a contribution to research by delineating social factors that have contributed to the observed contraceptive use transition in Zambia. Such findings have not been explored before in the context of family planning research in Zambian. Furthermore, the study has provided evidence of how the observed increase in contraception use in the country has affected fertility, teenage pregnancy rates, and prevalence of unintended births. This information is relevant for understanding the country’s population and maternal health dynamics. The findings not only validate the relevance of core principles of the empowerment and social capital theories in explaining contraceptive use transition in Zambia, but also shed light on other theoretical aspects that should be considered when understanding contraceptive use transition. Future research Future studies should examine rural-urban and regional variations of the determinants of contraceptive use transition. This will generate information to inform regional specific interventions. More so future studies should examine the factors that may influence a person's decision to utilise contraception in the future among sexually active adolescent girls. Doing so will generate data to inform the design of future family planning programmes that appeal to specific target groups. Furthermore, an in-depth qualitative research is required to understand how to overcome barriers of contraceptive use behaviour relating gender norms, cultural beliefs and religious values.
The moral permissibility of coercive treatment in psychiatry
(University of the Witwatersrand, Johannesburg, 2024) Talatala, Mvuyiso; Coates, Ashley
The advent of psychopharmacological interventions in the middle of the 20th century accompanied by the improvements in psychotherapy has improved the outcomes of treatment of mental illness from the dark days of chronic institutionalisation in mental asylums to the ushering in of an era of deinstitutionalisation. Today it is established that psychiatric treatment is beneficial to people with mental illness and untreated mental illness has negative biopsychosocial consequences. However, some people with severe mental illness such as those with schizophrenia and bipolar disorder or other disorders such as anorexia nervosa, refuse psychiatric treatment despite its established benefits. In these cases, coercive treatment, which is involuntary psychiatric treatment without the patient’s consent, may be a consideration even if these people are not infringing on the rights of others. If coercive treatment is considered in these people with mental illness, there could be concerns about respect for autonomy and the infringement of coercive treatment on their rights. In this research report the autonomy of people with mental illness and the respect for their rights is weighed against the benefits of psychiatric treatment. It is argued that in some cases of mental illness the objection to psychiatric treatment may be non- autonomous as the person with mental illness may lack decisional capacity. It is further argued that psychiatric treatment has benefits that far outweigh the temporary infringement on rights by coercive treatment. The overall argument of this research report is therefore that coercive treatment in psychiatry is morally permissible, and that society has a moral obligation to treat people with mental illness even if that treatment includes coercive treatment in selected cases.
The experience of premature infancy within the mother- infant dyad in neo-natal high care unit: A psychoanalytic exploration
(University of the Witwatersrand, Johannesburg, 2024) Canin, Nicole; Bain, Katherine
The experience of prematurity is disruptive and traumatic for both mother and infant, potentially placing the parent-infant relationship at risk. Given the risks involved as well as the prevalence of premature births, this is an area that requires engagement and research. In an attempt to address the paucity of psychoanalytically oriented research endeavours into the topic of prematurity, this study explored the experience of premature birth for mothers and infants in a neonatal high care ward through the lens of psychoanalytic theory. A psychoanalytically oriented ethnographic approach was utilised integrating object relations and intersubjective psychoanalytic theory with developmental psychology. This implied a focus on the influence of the mothers’ previous relational traumas on her experience of premature birth and use of dissociative defences. Maternal narratives from interviews as well as observational material from three premature mother-baby dyads allowed for in-depth exploration of maternal states of mind, intersubjectivity within mother-premature infant dyads, and infant responsivity. The study design required high levels of researcher reflexivity and the impact of the researcher’s subjectivity was explored. Insights were also offered into the process of conducting psychoanalytically oriented research within this sensitive context. Key findings included the fact that the trauma of engaging with a premature infant appears to reactivate dissociated self-states associated with childhood experiences of loss and absence for mothers. The study suggested that although the vulnerability of the infant is relevant, maternal states of mind play a bigger role in either supporting or derailing the development of the parent-infant relationship. The study also demonstrated the premature infant’s capacity, when appropriately supported, for communication and engagement.
Executive Functioning in a HIV-positive Paediatric Sample
(University of the Witwatersrand, Johannesburg, 2024) Mes, Nike; Cockcroft, Kate; Zondo, Sizwe
High prevalence of Human Immunodeficiency Virus (HIV) poses significant public health challenges in regions like Sub-Saharan Africa, especially among children and adolescents. Despite advancements in reducing vertical mother-to-child transmission and increasing access to antiretroviral therapies, paediatric populations continue to face substantial neurocognitive challenges associated with HIV infection. This study aimed to establish a profile of executive functioning in a South African paediatric population using cognitive measures (the NEPSY-II) and a behavioural rating scale (the BRIEF) to elucidate the cognitive impact of HIV. Assessing executive functions in children presents challenges due to their multifaceted nature, with cognitive measures and behavioural rating scales offering differing insights. As such, a secondary aim of this paper was to examine the inter-correlations between these measures. The participant group was comprised of 40 children living with HIV in Johannesburg, South Africa, aged 10-16. Normative data for comparisons were obtained from the NEPSY-II and BRIEF manuals, as well as a sample of NEPSY-II raw scores for South African youth without a central nervous system disease (Truter et al., 2017). Significant differences were found between the HIV+ group and comparison samples. Specifically, HIV+ children showed poorer performance in working memory, inhibitory control and cognitive flexibility compared to their typically developing peers. These results provide insights into executive function challenges faced by HIV+ children and adolescents, emphasising the importance of early intervention and support.
The responses of the Gauteng Department of Social Development to homelessness during the COVID 19 lockdown: A case study of two Tshwane and Johannesburg homeless shelters
(University of the Witwatersrand, Johannesburg, 2024) Ngcobo, Noluthando; Chilenga-Butao, Thokozani
How homelessness presents itself in Gauteng is complex and to dissect this phenomenon, the study undertook to explore the responses and approaches to homelessness during the COVID 19 pandemic and from these, establish how the department conceptualizes homelessness, what policies informed the approaches, and lastly, explore whether these interventions were successful or not. Having used document analysis and semi-structured interviews with social workers, the study made key recommendations for the DSD to take into consideration for future interventions. Of great concern is the lack of policy and a legislative framework that guide strictly the DSD’s interactions with homeless people. The study further found that factors including unemployment, migration and urbanisation, and substance abuse are structural factors that attribute to the persistent nature of homelessness in Gauteng. If the DSD seeks to truly eradicate homelessness, the study recommends that more resources need to be invested into sustainable interventions, improving intergovernmental relations as the problem is greater than the confines of the department, and developing solid policy and legislation.
An exploratory study of Soweto matriculants lived experiences during the COVID-19 pandemic
(University of the Witwatersrand, Johannesburg, 2024) Mthembu, Nolwazi Londiwe; Rolando, Hayley-Haynes
A few articles have been published on the COVID-19 pandemic. These studies suggest that COVID-19 might perpetuate and intensify current vulnerabilities among learners in South African schools. The aim of this study was to explore the experiences of learners in South Africa, Gauteng, Soweto, during the COVID-19 pandemic. Bronfenbrenner’s Ecological system’s theory was used to frame this study. Following the researcher's goal to immerse herself in the participants' unfiltered experiences, a qualitative approach was most appropriate for this study. The researcher utilized non-probability sampling with a predetermined criterion for the characteristics of the learners she wished to sample. Nine matriculants from a school in Soweto who matriculated in 2021 were included in the sample. Open-ended questions were used in a semi-structured interview with an interview schedule to elicit information about the participants' experiences of their 2021 matric year. Following the Wits Research Committee's approval and ethical clearance, ethical issues were carefully considered. After the interviews were conducted, the recurring results were analyzed by looking for common themes among all nine participants. The final findings of the study compromised of the unique, yet similar experiences of the participants. It was further established that most participants remain optimistic of the future, despite the unfavourable experiences encountered during their matric year. The principal research question that guided this study was ‘What were the experiences of the 2021 matriculants in Soweto during the COVID-19 pandemic?’
Everyday Working Memory: The Ecological Validity of Three Working Memory Tests
(University of the Witwatersrand, Johannesburg, 2024) Mnisi, Nqobile Nompumelelo; Cockcroft, Kate
Working memory plays a crucial role in adaptive functioning, yet the ability of traditional working memory tests to predict real-life challenges remains uncertain. Despite their everyday use in laboratory settings, there needs to be more research on the ecological validity of the n- back test, Symbol Span subtest, and Digit Span subtest in capturing everyday life problems related to working memory. This gap is especially noticeable in South Africa, where cultural and contextual factors may influence working memory performance and its impact on daily functioning. This study aimed to address this research gap by assessing the ecological validity of three working memory tests, the n-back test, the Symbol Span subtest, and the Digit Span subtest, in predicting everyday life problems related to working memory. Sixty-nine bilingual and multilingual young adults aged 18 to 25 completed a demographic questionnaire, the Working Memory Questionnaire (WMQ), and the three working memory tests. The data was analysed using descriptive statistics, correlation analyses, and ordinal logistic regression analyses. Significant correlations were found between various working memory tests and specific working memory questions, providing valuable insights into the relationships between these variables. These findings contribute to the understanding of working memory assessment and have implications for everyday functioning, particularly in educational settings, highlighting the relevance of working memory in cognitive processes.
Psychologists in training’s Assumption about Mind and Brain in Psychopathology and Clinical Work
(University of the Witwatersrand, Johannesburg, 2024) Mavundla, Patricia Lungile; Pitman, Michael
Research Purpose: The study's objective was to understand how psychologists in training endorsed models of illnesses for mental disorders. The results aimed to understand how they differed in their levels of training, and the results for the theoretical orientations endorsed analysed the mean significance for both the clinical and counselling training groups. Methodology: The study was conducted using first-year master's clinical and counselling psychology students, and the total sample was N = 28. The study's population was drawn from six universities in South African and investigated using a quantitative research design. A survey was used to gather data from the participants, and the data was analysed using the IMB Statistical Package for the Social Sciences (SPSS) software version 27. An analysis of variance test (ANOVA) was used to analyse the data and four research questions compared how the level of endorsement differed across different models of mental disorders, determined any trends for the different levels of endorsement which differed depending on which training programs the participants received, it also determine whether the theoretical orientation of training receiving differed, and lastly determined whether the effects training received differed based on the individual psychotherapy the participants received. The research questions were used as the framework for the study, with four mental disorders used as items, eight models of illness used to analyse the theoretical orientations endorsed, and a Maudsley Attitude Questionnaire (MAQ) used as a measure for the items. Results: The results indicated a significant difference between the clinical and counselling groups. A line graph illustrated how the mental disorders were endorsed differently, and as a result, the level of endorsement for the social realist model of illness (M=15.28, SD=2.05) was highly endorsed, and the Nihilist model of illness (M=8.21, SD=2.69) was the least endorsed. Discussion: Participants from diverse institutions had an impact on how well they understood the different mental disorders and endorsed the models of illnesses. Considering that there was not enough data entry, there were a few deviations with the data collection and the results could not comply with a larger population of trainee psychologist. Conclusion: The outcome of this study aims contribute to research in academia in terms of understanding the factors that influence the choice of treating mental disorders and may help enhance psychologists’ choice of choosing the correct models of illnesses as a part of intervention in their clinical work.

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