A systematic review of the utility of psychological assessment tools in the diagnosis and treatment of psychopathology in South Africa post 1994

Nkosi, Sanele
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A psychological test encompasses any procedures which involve educational, occupational and psychological assessment as well as the measurement of dysfunctional (abnormal) or normal behaviours. In the context of South Africa, the field of psychological assessment is still met with suspicion due to how these tests were used in the past in ways which marginalised already disadvantaged populations within the country. The implementations of the Employment Equity Act in 1998 along with other legislative policies went some way towards improving psychological assessment practices in South Africa. However, despite attempts to improve the administration and use of assessment instruments, the topic of the utility of these tools in a South African context remains largely unanswered. The aim of this study was to systematically review the available literature in the field of psychological assessment in South Africa in order to obtain in-depth understanding of the utility of psychological assessment tools in the diagnosis and treatment of patients with various psychopathologies. The study also aimed to identify the types of psychological assessment tools commonly used to diagnose and treat patients with various psychopathologies. Additionally, the study aimed to identify and focus on the barriers to using psychological assessment tools in a country as multicultural and multilingual as that found in South Africa as well as looking at the benefits of using these assessment tools. This review was conducted in accordance with PRISMA guidelines. Studies included in the review were South African studies, conducted in the context of psychological assessment and published in English from 1994 onwards. Eight studies with heterogeneous study designs were included in the current review. Using the Critical Appraisal Skills Programme tool, all included studies were determined to be of high quality. The included studies were summarised and analysed using a thematic synthesis approach. Five dominant themes were identified along with 19 sub-themes. The dominant themes included: (1) Barriers for assessment in the context of South Africa, (2) Description of Psychological assessments in South Africa, (3) Consequences of poor administration of psychological assessment tools, (4) Strategies to improve use of psychological assessment tools in South Africa, and (5) Benefits to utilizing psychological assessment tools in South Africa. From this review, it is evident that the continued use of psychological assessment tools in the context of South Africa has some utility, specifically in the context of clinical settings. However, three main challenges were highlighted which may affect the perception of psychological 4 assessment in the country. These challenges included a lack of trained mental health care specialists to administer and interpret assessment tools. Secondly the linguistic and cultural differences within a country as multicultural and multilingual as South Africa calls into question the use of western developed and normed instruments in this context. Finally, the lack of financialresources to aid the training of future practitioners and the development of assessment tools within the country remains a challenge. Failure to address these challenges may lead to a renewedpublic mistrust of assessment instruments in addition to overburdening already strained health care facilities in the country. This review offers valuable insight for South African practitioners and policy makers. These insights might also be useful for other resource-constrained countries.
A research project submitted in partial fulfilment of the requirements for the degree Master of Arts in Clinical psychology to the Faculty of Humanities, School of Human and Community Development, University of the Witwatersrand, 2021