Browsing by Author "Struthers, Patricia"
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Item Building a health-promoting schools conceptual framework model as a strategy to address barriers to learning and to promote healthy development of school-aged children(University of the Western Cape, 2014) Ntagungira, Egide Kayonga; Struthers, Patricia; Van Hove, GeertAfter suffering almost total collapse. Rwanda has made impressive post-genocide progress. Many children of school going age are now attending school, but regrettably, only half complete primary school. High numbers of orphans, disabled children and a growing number of children from child-headed households still suffer the consequences of the poverty inherited from the past. Health problems include HIV/Aids, STIs, malaria, tuberculosis, enteric diseases, mental health problems, hunger and malnutrition. Use of drugs and substance abuse, unwanted pregnancies, lack of support services, unavailability of teaching and learning materials, inflexible curricula and poor teaching methodologies also contribute to learning breakdown. It is against this background that this thesis was conducted to investigate the development of a health-promoting schools model to provide an appropriate strategy to address barriers to learning and to promote healthy development of school children in Rwanda. Two research questions were the focus of this research, first, how does a health-promoting schools model provide an appropriate strategy to address barriers to learning and to promote healthy development of school-aged children in Rwanda and second, what are the participants’ views on and understanding of the model and its potential use in their schools? A mixed methods research design that employed both qualitative and quantitative approaches was used. The study followed sequential implementation: Phase 1 was concerned with the identification of the components for the model. It was a case study of four schools, two rural schools and two urban schools in Kigali City. The sample included 60 teachers, pupils, principals and parents from schools and nine key informants who were policymakers from the Ministries of Education and Health and Social Welfare, line institutions and the UNICEF. Data collection strategies included focus group discussions, semi-structured, in-depth individual interviews, a transect walk and observations. Data analysis was through content analysis. Eight themes emerged out of the data: school leadership and management; school health policies; pupil wellbeing; school partnership with parents, families and local communities; school health services; factors affecting teaching and learning for all children; teacher wellbeing; and a healthy physical school environment. These themes became the components that informed the development of a health-promoting schools model. In Phase 2, the degree of understanding of this proposed model and its components were investigated in each school community.Item Caregivers' satisfaction with physiotherapy services at a cerebral palsy clinic in Kampala, Uganda(University of the Western Cape, 2006) Omare, Helen; Struthers, PatriciaINTRODUCTION: The evaluation of satisfaction with health care service provision is important when trying to provide quality care. Satisfaction with service provision has been found to be related to the expectations prior to receiving the service and the actual experience of the service. OBJECTIVES: To explore the expectations and satisfaction that caregivers of children with cerebral palsy havewhen they attend physiotherapy services. Methods: A qualitative study using two focus groups. A semi-structured interview guide was used to facilitate the focus group discussions. Data was collected and thematic analysis was undertaken PARTICIPANTS: Nine caregivers, five mother, three grand mothers and one grandfather, participated in the focus group discussions. SETTING: A cerebral palsy clinic in Kampala, Uganda. Intervention: No intervention but an interview schedule was used to obtain information. RESULTS: The caregivers were satisfied with seeing an improvement in the children's abilities, the outcome of the home programme and the assistive devices. Not all the caregivers were satisfied with the knowledge they had gained and the development of their skills. Caregivers were dissatisfied with regards to communication with the physiotherapists. CONCLUSION: Physiotherapy plays an important role in the improvement of cerebral palsy children's physical abilities and knowledge given to caregivers but physiotherapists need to improve in their communication skills.Item Experiences of caregivers of children with spastic cerebral palsy regarding splinting in Uganda(2013) Tusiime, Christine; Struthers, PatriciaSplinting is one of the many strategies used globally for managing neuromuscular impairments related to cerebral palsy. In Uganda, some children with cerebral palsy who have been provided with splints return to the physiotherapy department with contractures or deformities. A qualitative research methodological approach was used to understand and describe the experiences of caregivers of children with cerebral palsy regarding splinting in Uganda. The theoretical framework used was the bio-psychosocial model of disability. Purposive sampling was used to select 24 caregivers of children with spastic cerebral palsy who received splints in 2010 at two research settings in Uganda. In-depth interviews were conducted with all the participants at their homes using an interview guide. The data collected was transcribed verbatim and translated from Luganda to English. Inductive content analysis was used to analyse the data. Six themes concerning experiences emerged, namely: caregivers‟ expectations and beliefs; acquisition of splints; knowledge and skills; attitudes to splinting; compliance and benefits of splinting. The results of this study show the overwhelming challenges caregivers face while their children require splinting. When considering providing splints to children, the results highlight the need, to take into account the personal (child) factors, the splint characteristics and the environmental (family and community) factors. There is a need to provide information on splints to both the children with cerebral palsy and their caregivers.Item External stakeholders and health promoting schools: complexity and practice in South Africa(Emerald, 2014) Preiser, Rika; Struthers, Patricia; Mohamed, Suraya; Cameron, Neil; Lawrence, EstellePurpose: This paper examines the role of two higher education institutions in the Western Cape, South Africa, and how their initiatives and collaboration brought about a particular Health Promoting Schools (HPS) program in a resource poor setting. The aim of this paper is to reflect on the importance of the role that external systemic actors and stakeholders can play in the process of designing and implementing HPS programs in resource poor settings. Design/methodology/approach: In this paper a complex systems approach is employed to describe two different participatory methods of engagement with HPS by higher education institutions. On the one hand, engagement took place in terms of a formal and funded project, directed at the organizational level of the school, with capacity building as its aim. On the other hand, engagement was initiated informally (as part of a service learning project) via collaboration with the formal project, directed at the individual level of learners in the school. Findings: In recognizing the complex nature of planning and implementing HPS programs, the paper demonstrates that HPS approaches could benefit from engaging with resources outside the ambit of institutional health and educational policies and structures. Originality/value: By acknowledging the systemic nature of implementing HPS strategies, novel collaborations emerge as a result. The paper highlights the important role that external stakeholders such as higher education institutions play in creating and sustaining tailor-made HPS programs for schools based in resource poor settings.Item Functioning, disability and health in people living with HIV on antiretroviral therapy in Rwanda(University of the Western Cape, 2014) Kagwiza, Jeanne Nyirankumbuye; Struthers, Patricia; Jelsma, JenniferThe study aimed to explore the need for and nature of care that PLWH living in Rwanda receive from their health care providers using a bio-psychosocial framework. A further aim was to determine if the Kinyawanda version of the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0), which was used to gather the functional data, was valid within the Rwandan context. A mixed methods approach was used. A quantitative survey was used to determine the profile and the prevalence of disability among PLWH, by measuring impairment, activity limitation and participation restriction amongst PLWH who are also on antiretroviral treatment. In addition the relationship between functioning and medication was explored. A Kinyarwanda version of the ICF core set of questions and the WHODAS 2.0 outcome instrument was used. Face-to-face interviews were conducted among PLWH at 15 selected hospitals representing all provinces in the country. The final sample size included 502 PLWH. Participants‘ health status showed that the longer they had HIV and had been on antiretroviral treatment, the more likely they were to have impairments. Pain (69%) and fatigue (83%) were more prevalent than any other problems found in all domains measured under impairments. Problems with mobility function (57%) scored the highest prevalence under activity limitations, and problems in participation/social functions had the highest prevalence in comparison to the other domains. The mean score of the different domains were significantly different with participation scoring the highest (46%, with 100% the worst score rate)Item HIV/AIDS management: the roles of physiotherapy(University of the Western Cape, 2009) Munishi, M.; Frantz, Jose M.; Struthers, PatriciaBACKGROUND: HIV/AIDS is a major health problem that has affected many people globally and it is the primary cause of death in Sub-Saharan Africa. Approximately 68% of the global total i.e. 22.5 million people living with HIV/AIDS (PLWHA) are in Sub-Saharan Africa. With antiretroviral therapy, PLWHA now live longer and present with various opportunistic neuro-musculo-skeletal and cardio-pulmonary conditions. PURPOSE: To explore the global, regional and local existing literature concerning knowledge, attitude and roles of physiotherapy in the management of PLWHA. METHOD: A retrospective search of articles published between January 1990 and March 2008. Outcome measures: Documented information concerning physiotherapy management of PLWHA, including physiotherapists' knowledge and attitudes, based on inclusion criteria. RESULTS: The search yielded 17 reviews of good or reasonable quality. Physiotherapy rehabilitation can address impairment and activity limitation. There is some evidence that aerobic training with a progressive exercise component is effective in improving the cardio-vascular system, distribution of adipose tissue and on quality of life. There is evidence that ice or dry-towel massage has a positive effect on neuropathic pain. Evidence from case studies suggests that joint mobilization, soft tissue mobilization, stretching, and the use of micro-current, pressure garments and orthotics may be effective. There was no evidence of the effect of other physiotherapy roles mentioned including chest physiotherapy, counseling and health education. CONCLUSION: There is some evidence that exercise is safe and beneficial to PLWHA. Further studies are needed to determine if other physiotherapy techniques are effective for treating PLWHA.Item Mentoring and coaching in promoting publications in the Department of Physiotherapy at a local university in South Africa(AOSIS, 2010) Frantz, Jose M.; Rhoda, Anthea; Rowe, Michael; Phillips, Julie; Karachi, Farhana; Mlenzana, Nondwe; Pharaoh, Hamilton; Steyl, Tania; Struthers, PatriciaA growing shift towards research and evidence based practice in academia is associated with requirements to disseminate research results in the form of publication in peer reviewed journals. Mentoring has been identified as an important component of developing young authors, as it increases confidence and competence, and facilitates professional development. This led to the formation of a support group to stimulate peer-review publication in the physiotherapy department at the University of the Western Cape. The Kirkpatrick Framework of Evaluation was used to evaluate the success of the mentoring process which made use of a participatory action research methodology. The writing group consisted of nine academic members of staff and took place over ten weeks. The programme included writing, giving feedback, discussion and peer review on a weekly basis. Focus group discussions were taped and transcribed in order to evaluate the mentoring process by identifying relationships within the data and categorising key concepts, which were shaped into a thematic framework. The findings indicated that participants experienced a variety of emotions throughout the programme, with an overall feeling of personal growth by the end. In addition, participants also reported improved writing, reviewing and communication skills. Six months following the programme, six participants had submitted at least one article to a peer reviewed journal. It is clear from this study that some academics still find the task of writing and reviewing articles daunting, and that guidance and support in the form of a writing programme can be useful.Item A mobile school-based HCT service – is it youth friendly?(Taylor & Francis Open, 2016) Lawrence, Estelle; Struthers, Patricia; Van Hove, GeertBACKGROUND: Despite an increase in HIV Counselling and Testing (HCT), few young people have been tested. It has been suggested that they do not test because formal health services (where HCT is provided) are often not youth friendly. The World Health Organisation describes a youth-friendly health service (YFHS) as one which is accessible, equitable, acceptable, appropriate, and effective. A mobile school-based model has been implemented by a non-governmental organisation in Cape Town in an attempt to make HCT more youth friendly and accessible to young people. The objective of this study was to explore whether this mobile school-based HCT service is youth friendly. METHODS: The study was descriptive, using three qualitative data collection methods: observation of the HCT site at two secondary schools; interviews with six service providers; and direct observation of 21 HCT counselling sessions. KEY RESULTS: The mobile school-based HCT service fulfilled some of the criteria for being a YFHS. The service was equitable in that all students, irrespective of race, gender, age, or socio-economic status, were free to use the service. It was accessible in terms of location and cost, but students were not well informed to make decisions about using the service. The service was acceptable in that confidentiality was guaranteed and the service providers were friendly and nonjudgemental, but it was not considered acceptable in that there was limited privacy. The service was appropriate in that HCT is recommended as an intervention for decreasing the transmission of HIV, based on evidence and expert opinion; however, in this case, HCT was provided as a stand-alone service rather than part of a full package of services. Moreover, studies have suggested that young people want to know their HIV status. The service was ineffective in that it identified students who are HIV positive; however, these students were not assisted to access care. CONCLUSION: Providing HCT in the school setting may make HCT more accessible for students, but it needs to be provided in an equitable, accessible, acceptable, and effective way.Item “The pen is a powerful weapon; it can make you change”: The value of using reflective writing with adolescents(Occupational Therapy Association of South Africa, 2017) Wegner, Lisa; Struthers, Patricia; Mohamed, SurayaINTRODUCTION: Adolescent programmes have been criticised for implementing activities but not allowing opportunities for reflection. One way that reflection can be facilitated is through writing. This paper describes the use of reflective writing with adolescents as part of a health promoting schools project in Cape Town, South Africa. METHOD: The project included an annual leadership camp for adolescent learners. A descriptive, qualitative study was conducted to describe how the learners responded to writing as a means to express their feelings about, and experiences of, the camp. Thirty learners participated in two writing sessions resulting in 53 written reflections that were analysed thematically. FINDINGS: Three themes emerged: (1) Reflections on self; (2) Reflections on self in relation to others; and (3) Reflections on writing. Participants reflected on connecting with complex, positive and negative feelings, and felt that reflective writing had enabled them to express themselves with courage and honesty, connect with themselves, identify weaknesses and let go of negative emotions and feelings. Furthermore, writing was perceived as being non-judgmental, providing a sense of relief and release, and evoking emotions. CONCLUSION: Reflective writing enabled the participants to acknowledge personal changes and development, and provided insight into their feelings and experiences. This study shows the value of reflective writing for use by health professionals such as occupational therapists, as a tool for empowerment in the pursuit of health and wellbeing.Item Research productivity of academics in a physiotherapy department: a case study(Health and Medical Publishing Group, 2010) Frantz, Jose M.; Rhoda, Anthea; Struthers, Patricia; Phillips, JulieObjective: Research productivity is an important activity among academics. This study was done to document the research productivity of the academics of a physiotherapy department in South Africa. Method: An archival research design was used to document the research productivity for the physiotherapy department between 2002 and 2009. Data were analysed by two independent reviewers and consensus was reached on the information to be included in the study. Results: Among the nine academics there were 67 publications, 20 articles in progress, 7 under review and 63 conferences attended. While the overall research productivity of the department seems to be good, the bulk of the productivity rests in the hands of the senior academics. Conclusion: There is a need to facilitate the acquisition of research skills in academic staff, particularly in upgrading staff to PhD level and improving publication output.Item School-based HIV counselling and testing: providing a youth friendly service(2012) Lawrence, Estelle; Struthers, PatriciaHIV counselling and testing (HCT) is an essential element in the response to the HIV epidemic. Thereare still major gaps in research about the best ways to provide HCT, especially to young people. School-based HCT is a model which has been suggested for providing HCT to young people in a youth friendly manner. This study was aimed at producing recommendations for providing a youth friendly school-based HCT service using the World Health Organisation (WHO) framework for youth friendly health services. It was conducted in six secondary schools in Cape Town, where a mobile HCT service is provided by a nongovernmental organisation (NGO). It was an exploratory descriptive study, using a mixed-methods approach. Twelve focus group discussions (FGDs) were held with learners to explore their needs with regards to school-based HCT. An evaluation (which consisted of observation of the HCT site, service provider interviews and direct observation of the HCT counselling process) was done to determine whether the mobile school-based HCT service was youth friendly. A learner survey was conducted with 529 learners to investigate the factors that influence the uptake of HCT and to explore learners’ behaviours and experiences under test conditions. In the FGDs, learners said that they wanted HCT to be provided in schools on condition that their fears and expressed needs were taken into account. They wanted their concerns regarding privacy and confidentiality addressed; they wanted to be provided with information regarding the benefits and procedure of HCT before testing took place; they wanted service providers to be competent to work with young people, and they wanted to be assured that those who tested positive were followed up and supported. On evaluation of the mobile school-based HCT service, it was evident that the service did not meet all the needs of the learners nor did it have all the characteristics of a youth friendly health service. The model of ‘mass testing’ used by the NGO did not fulfil learners’ expressed need for privacy with regards to HCT. Service providers were friendly and on-judgemental but had not been trained to work with young people (especially marginalised groups e.g. young men who have sex with men). The information needs of learners were not addressed, and learners were not involved in the provision of the HCT service. Learners who tested positive were not assisted in accessing care and support. The learner survey revealed a high uptake of HCT (71% of learners) at schools with learners who do not identify themselves as Black, with female learners and older learners being more likely to have had an HIV test. Factors that influenced uptake of HCT were complex, with learners reporting many different motivators and barriers to testing. Of concern was the low risk perception of learners with regards to HIV infection and the fact that learners who tested HIV positive were not being linked up with treatment and care. Based on the findings of the study, recommendations were made for proving youth friendly school based HCT. A multisectoral approach, with learner and community involvement, was suggested in order to provide a service which is equitable, accessible, acceptable, appropriate and effective.Item Sports for learners with physical disabilities in ordinary public primary schools in the Western Cape, South Africa(Africa Association for Health, Physical Education, Recreation,Sport and Dance/LAM Publications Limited, 2011) Wegner, Liezel; Struthers, PatriciaIn the Western Cape, learners with physical disabilities are accepted into ordinary schools (a school that is not a special school) as a part of the inclusive education initiative. This article reports on a survey designed to determine the types of sports that are available for learners with physical disabilities in ordinary public primary schools and the factors influencing their participation in sport. The study sample included 31 learners with physical disabilities (learners with movement or mobility difficulties or who used an assistive device) attending seven ordinary public primary schools, one teacher from each school and one teacher from each of eight conveniently selected special schools. Three questionnaires were used, one for the learners, another for the teachers at the ordinary schools and the third for the teachers at the special schools. Analysis was done using SPSS Version 15. The main findings of the study were that 32% (n=10) of learners participated in sports. They were expected to participate in the type of sports that were already offered at the school. No adapted sport was offered specifically for these learners. Most learners wanted to participate in swimming. Fewer types of sports were offered in ordinary schools than in special schools. Barriers to participation included poor teacher preparation and inadequate financial support. The shortage of support from school staff, occupational therapists and physiotherapists in addition to inadequate financial support needs to be addressed by the Department of Basic Education and Department of Sport and Recreation to enable the learners to participate in sports at ordinary schools.Item The use of information and communication technology by South African physiotherapy students(South African Society of Physiotherapy, 2009) Rowe, Michael; Struthers, PatriciaThe global shift toward the use of information and communication technology (ICT) in health education and practice has been shown to enhance both the educational opportunities and the support provided to students and healthcare professionals. This study aimed to investigate the use of ICT by South African physiotherapy students and what their experiences and perceptions were regarding their use of ICT as part of their studies. The study design was a cross-sectional, descriptive survey using a self-administered questionnaire. The survey population included all of the undergraduate physiotherapy students from six of the eight universities offering the physiotherapy degree in South A frica (N=1105). The sample size consisted of 529 students from the survey population who completed and returned questionnaires, indicating a response rate of 48%. The results of the study showed that the use of ICT by South African physiotherapy students varied according to task, racial group and university attended. Furthermore, the reported use of ICT for communication, research and continuing professional development was low. In conclusion, this study indicates that with a move toward the use of ICT to enhance health education and practice in South A frica, certain groups of physiotherapy students may be at a disadvantage if required to make use of ICT as a means of improving communication, enhancing education, participating in lifelong learning opportunities and accessing support.Item Validity and reliability of the South African health promoting schools monitoring questionnaire(Oxford University Press, 2016) Struthers, Patricia; Wegner, Lisa; de Koker, Petra; Lerebo, Wondwossen; Blignaut, RenetteHealth promoting schools, as conceptualised by the World Health Organisation, have been developed in many countries to facilitate the health-education link. In 1994, the concept of health promoting schools was introduced in South Africa. In the process of becoming a health promoting school, it is important for schools to monitor and evaluate changes and developments taking place. The Health Promoting Schools (HPS) Monitoring Questionnaire was developed to obtain opinions of students about their school as a health promoting school. It comprises 138 questions in seven sections: sociodemographic information; General health promotion programmes; health related Skills and knowledge; Policies; Environment; Community-school links; and support Services. This paper reports on the reliability and face validity of the HPS Monitoring Questionnaire. Seven experts reviewed the questionnaire and agreed that it has satisfactory face validity. A test-retest reliability study was conducted with 83 students in three high schools in Cape Town, South Africa. The kappa-coefficients demonstrate mostly fair (j-scores between 0.21 and 0.4) to moderate (j-scores between 0.41 and 0.6) agreement between test-retest General and Environment items; poor (j-scores up to 0.2) agreement between Skills and Community test-retest items, fair agreement between Policies items, and for most of the questions focussing on Services a fair agreement was found. The study is a first effort at providing a tool that may be used to monitor and evaluate students' opinions about changes in health promoting schools. Although the HPS Monitoring Questionnaire has face validity, the results of the reliability testing were inconclusive. Further research is warranted.