Browsing by Author "Van Hove, Geert"

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    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, Geert
    After 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.
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    A mobile school-based HCT service – is it youth friendly?
    (Taylor & Francis Open, 2016) Lawrence, Estelle; Struthers, Patricia; Van Hove, Geert
    BACKGROUND: 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.
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    School-based HIV counselling and testing: providing a youth friendly service.
    (University of the Western Cape, 2012) Lawrence, Estelle; Struthers, Patricia; Van Hove, Geert
    HIV counselling and testing (HCT) is an essential element in the response to the HIV epidemic. There are 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 non-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 leaners 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 providing 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.