Research Articles (Occupational Therapy)

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Transformation through Occupation
(Taylor & Francis group, 2004) Wegner, Lisa
Working in the context of a developing country such as South Africa provides a multitude of challenges for professionals in all fields. The last few years since democratisation have seen a transformation in the way occupational therapy is being practiced in South Africa, as the profession redefines itself to meet the needs of the people. The book “Transformation through Occupation” provides an outlet for the voice of South African occupational therapists to be heard, and showcases occupational therapy intervention with groups, communities and populations characterised by poverty, disadvantage and social problems
Leisure boredom and high school dropout in Cape Town, South Africa
(Elsevier, 2008) Wegner, Lisa; Flisher, Alan J.; Chikobvu, Perpetual; Lombard, Carl; King, Gary
This prospective cohort study investigated whether leisure boredom predicts high school dropout. Leisure boredom is the perception that leisure experiences do not satisfy the need for optimal arousal. Participants completed a self-report questionnaire which included the Leisure Boredom Scale. The original cohort of grade 8 students (n ¼ 303) was followed up twice at 2-yearly intervals. Of the 281 students at the second follow-up, 149 (53.0%) students had dropped out of school. The effect of leisure boredom on dropout was investigated using logistic regression taking into account the clustering effect of the schools in the sampling strategy, and adjusting for age, gender and racially classiﬁed social group. Leisure boredom was a signiﬁcant predictor of dropout (OR ¼ 1.08; 95% CI: 1.01–1.15) in students 14 years and older, but not so in younger students (OR ¼ 1.0; 95% CI: 0.95–1.05). The study has shown that measuring leisure boredom in grade 8 students can help identify students who are more likely to drop out of school. Further research is needed to investigate the longitudinal association between leisure boredom and school dropout.
Understanding leisure-related program effects by using process data in the HealthWise South Africa Project
(American Academy for Park and Recreation Administration, 2008) Caldwell, Linda L.; Younker, Anita S.; Wegner, Lisa; Patrick, Megan E.; Vergnani, Tania; Smith, Edward A.; Fisher, Alan J.
As the push for evidence-based programming gathers momentum, many human services programs and interventions are under increased scrutiny to justify their effectiveness across different conditions and populations. Government agencies and the public want to be assured that their resources are being put to good use on programs that are effective and efficient. Thus, programs are increasingly based on theory and evaluated through randomized control trials using longitudinal data. Despite this progress, hypothesized outcomes are often not detected and/or their effect sizes are small. Moreover, findings may go against intuition or “gut feelings” on the part of project staff. Given the need to understand how program implementation issues relate to outcomes, this study focuses on whether process measures that focus on program implementation and fidelity can shed light on associated outcomes. In particular, we linked the process evaluation of the HealthWise motivation lesson with outcomes across four waves of data collection. We hypothesized that HealthWise would increase learners’ intrinsic and identified forms of motivation, and decrease amotivation and extrinsic motivation. We did not hypothesize a direction of effects on introjected motivation due to its conceptual ambiguity. Data came from youth in four intervention schools (n = 902, 41.1%) and five control schools (n = 1291, 58.9%) who were participating in a multi-cohort, longitudinal study. The schools were in a township near Cape Town, South Africa. For each cohort, baseline data are collected on learners as they begin grade 8. We currently have four waves of data collected on the first cohort, which is the focus of this paper. The mean age of the sample at wave 3 was 15.0 years (SD = .86) and 51% of students were female. Results suggested that there was evidence of an overall program effect of the curriculum on amotivation regardless of fidelity of implementation. Compared to the control schools, all treatment school learners reported lower levels of amotivation in wave 4 compared to wave 3, as hypothesized. Using process evaluation data to monitor implementation fi147 delity, however, we also conclude that the school with better trained teachers who also reported higher levels of program fidelity had better outcomes than the other schools. We discuss the implications of linking process data with outcome data and the associated methodological challenges in linking these data.
Healthwise South Africa: cultural adaptation of a school-based risk prevention programme
(Oxford University Press, 2008) Wegner, Lisa; Flisher, Alan J.; Caldwell, Linda L.; Vergnani, Tania; Smith, Edward A.
There is a need for effective prevention programmes aimed at reducing risk behaviour among South African adolescents. Health Wise South Africa is a school-based programme designed to reduce sexual and substance use risk behaviour, and promote positive use of leisure time among high-school learners (students). Based on successful programmes in the United States of America, Health Wise was developed for use in South Africa and pilot tested in four South African high schools. We carried out a process evaluation to establish the fidelity of implementation and make sure HealthWise was culturally relevant. Data sources comprised focus groups with educators and learners, lesson evaluations and observations, and interviews with school principals. Qualitative analysis of data highlighted pertinent cultural and contextual factors and identified areas for modifying Health Wise in order to promote better programme-consumer fit. These areas centred on time, language, and leisure. We noted a dynamic tension between the educators’ desire to adhere to plan, and to make adaptations in accordance with learners’ needs and the context. Ultimately, researchers need to find a balance between fidelity of implementation and programme adaptation to obtain effective programmes that are culturally acceptable to local consumers.
Inconsistent reports of sexual intercourse among South African high school students
(Elsevier, 2008) Palen, Lori-Ann; Smith, Edward A.; Caldwell, Linda L.; Flisher, Alan J.; Wegner, Lisa; Vergnani, Tania
Purpose: This study aims to describe patterns of inconsistent reports of sexual intercourse among a sample of South African adolescents. Methods: Consistency of reported lifetime sexual intercourse was assessed using five semiannual waves of data. Odds ratios related inconsistent reporting to demographic variables and potential indicators of general and risk-behavior-specific reliability problems. Results: Of the sexually active participants in the sample, nearly 40% reported being virgins after sexual activity had been reported at an earlier assessment. Inconsistent reporting could not be predicted by gender or race or by general indicators of poor reliability (inconsistent reporting of gender and birth year). However individuals with inconsistent reports of sexual intercourse were more likely to be inconsistent reporters of substance use. Conclusions: These results suggest that researchers need to undertake efforts to deal specifically with inconsistent risk behavior data. These may include modification of data collection procedures and use of statistical methodologies that can account for response inconsistencies
Adolescent substance use: a prospective longitudinal model of substance use onset among South African adolescents
(Informa Healthcare, 2009) Patrick, Megan E.; Collins, Linda M.; Smith, Edward A.; Caldwell, Linda L.; Flisher, Alan J.; Wegner, Lisa
Substance use onset among Colored adolescents between eighth and ninth grades in an urban area of Cape Town, South Africa was examined using latent transition analysis. Longitudinal self-report data regarding substance use (N = 1118, 50.9% female) were collected in 2004 and 2005. Results indicated that the pattern of onset was similar across genders; adolescents first tried either alcohol or cigarettes, followed by both, then dagga (cannabis), and then inhalants. The prevalence of lifetime cigarette use was slightly greater for females; dagga (cannabis) and inhalant use were greater for males. The similarity of developmental onset in the current sample to previous international work supports the promise of adapting prevention programs across contexts. The study’s limitations are noted.
Leisure boredom and adolescent risk behaviour: a systematic literature review
(Taylor & Francis, 2009) Wegner, Lisa; Flisher, Alan J.
There has been very little research investigating leisure boredom and risk behaviour among adolescents in South Africa. A systematic review of literature was conducted to synthesise current knowledge within the field of leisure boredom and risk behaviour among adolescents. An online and a hand search for relevant articles were conducted using keywords. This resulted in the retrieval of 25 articles that met the inclusion criteria. It was evident that the experience of leisure boredom is influenced by a variety of different factors, not least of which is the environment or context within which adolescents are situated. A key finding was how few studies have focussed on leisure boredom and risk behaviour in adolescents, particularly in the developing world. Also, gaps in the knowledge basis were identified, thus providing direction for future research. The review focuses attention on leisure boredom as a factor contributing to risk behaviour in adolescents. Expanding knowledge in this area is useful for individuals and organisations concerned with adolescent health, education and development.
Leisure constraints for adolescents in Cape Town, South Africa: a qualitative study
(Taylor and Francis, 2010) Palen, Lori-Ann; Patrick, Megan E.; Gleeson, Sarah; Caldwell, Linda L.; Smith, Edward A.; Wegner, Lisa; Flisher, Alan J.
This study identified leisure constraints, constraints negotiation strategies, and their relative frequencies among 114 high school students from one under-resourced area of South Africa. Through focus group discussions, participants identified intrapersonal, interpersonal, structural, and sociocultural constraints to leisure, suggesting some degree of universality in this previously documented typology. Intrapersonal constraints were mentioned most often. Whereas participants readily identified ways to overcome interpersonal and structural constraints, strategies for overcoming intrapersonal and sociocultural constraints were not mentioned frequently, suggesting a potential need to help adolescents identify and employ these types of strategies.
A qualitative assessment of South African adolescents’ motivations for and against substance use and sexual behavior
(Wiley-Blackwell, 2010) Patrick, Megan E.; Palen, Lori-Ann; Caldwell, Linda L.; Gleeson, Sarah; Smith, E.D.; Wegner, Lisa
Focus groups (N 5 15 groups; 8 with girls, 7 with boys) with adolescents in high schools near Cape Town, South Africa, were used to conduct a qualitative investigation of reported reasons for using and not using substances and for having and not having sex. Adolescents reported Enhancement, Negative States, Social, and Aversive Social motivations for both sub- stance use and sexual behavior. In addition, being addicted as a reason for using drugs and rape as a context for sexual behavior were frequently reported. Motivations against behaviors included Physical/Behavioral Consequences, Ethical Objections, Social Disapproval, and Incompatible Activities and Goals reasons. Preventive interventions should address existing motivations for and against substance use and sexual behavior to acknowledge adolescents’ experiences in context.
Through the lens of a peer: understanding leisure boredom and risk behaviour in adolescence
(Occupational Therapy Association of South Africa, 2011) Wegner, Lisa
There has been very little research investigating leisure boredom and risk behaviour among adolescents in South Africa. Using a qualitative approach, this study investigated adolescents’ perceptions of leisure boredom and risk behaviour during free time. The sample of participants comprised three groups of adolescent: a community group, a school group and a group who had dropped out of school. Participants documented their free time experiences by taking photographs that were later discussed in focus groups. The findings showed that the participants were bored in their free time mainly because they had nothing to do. The low socio-economic environment where they lived contributed to occupational deprivation and imbalance in their free time, maintaining or ‘trapping’ the adolescents within the situation and contributing to feelings of boredom. The participants spent much of their free time ‘hanging out’ on street corners or in backyards, which allowed them to socialise, but inevitably led to boredom. Participants felt that boredom was part of life, although some perceived it to be ‘dangerous’ because it often led to risky behaviour. In conclusion, the study showed that for the participants, leisure is an occupational concern due to the occupational deprivation and imbalance occurring within their free time. Occupational therapists should consider how leisure boredom influences adolescent health, wellbeing and development, and plan interventions accordingly.
Predicting substance use behavior among South African adolescents: The role of leisure experiences across time
(SAGE Publications, 2011) Sharp, Erin Hiley; Coffman, Donna; Caldwell, Linda L.; Smith, Edward A.; Wegner, Lisa; Vergnani, Tania; Mathews, Catherine
Using seven waves of data, collected twice a year from the 8th through the 11th grades in a low-resource community in Cape Town, South Africa, we aimed to describe the developmental trends in three specific leisure experiences (leisure boredom, new leisure interests, and healthy leisure) and substance use (cigarettes, alcohol, and marijuana) behaviors and to investigate the ways in which changes in leisure experiences predict changes in substance use behaviors over time. Results indicated that adolescents’ substance use increased significantly across adolescence, but that leisure experiences remained fairly stable over time. We also found that adolescent leisure experiences predicted baseline substance use and that changes in leisure experiences predicted changes in substance use behaviors over time, with leisure boredom emerging as the most consistent and strongest predictor of alcohol, cigarette, and marijuana use. Implications for interventions that target time use and leisure experiences are discussed.
Curriculum transformation: a proposed route to reflect a political consciousness in occupational therapy education
(Occupational Therapy Association of South Africa, 2012) De Jongh, Jo-Celene; Hess-April, Lucia; Wegner, Lisa
Introduction: Curriculum review is an ongoing, dynamic, long-term process that forms part of occupational therapy education. The Department of Occupational Therapy, University of the Western Cape (UWC) recently responded to the challenge of becoming socially responsive and politically relevant by engaging in curriculum review. The review revealed that political reasoning was not clearly delineated previously in the curriculum. In response to this problem, over a period of several years we engaged in a process of curriculum transformation so that students become politically conscious. Methods: The process entailed environmental scanning, feedback from teaching staff and clinicians, students’ evaluations, regular curriculum revision meetings, academic development meetings, workshops and seminars. A qualitative study using a cooperative enquiry approach was conducted to analyse the data. Findings: From the analysis the following themes emerged: (1) identifying the essence of occupational therapy education at UWC, (2) understanding political practice on a theoretical and then a personal level, (3) integrating and operationalising political consciousness into the curriculum. We discuss the debates and critical questions raised in our efforts to develop a curriculum that prepares graduates to be politically conscious and socially responsive. Finally, we present key strategies for the way forward. Conclusion: Curriculum transformation around a political practice of occupational therapy does not merely mean just a change in curriculum content, but requires the internalisation of a political consciousness by educators individually and collectively.
Translational research in South Africa: evaluating implementation quality using a factorial design
(Springer Verlag, 2012) Caldwell, Linda L.; Smith, Edward A.; Collins, Linda M.; Graham, John W.; Lai, Mary H.; Wegner, Lisa; Vergnani, Tania; Mathews, Catherine; Jacobs, Joachim
Background: HealthWise South Africa: Life Skills for Adolescents (HW) is an evidence- based substance use and sexual risk prevention program that emphasizes the positive use of leisure time. Since 2000, this program has evolved from pilot testing through an efficacy trial involving over 7,000 youth in the Cape Town area. Beginning in 2011, through 2015, we are undertaking a new study that expands HW to all schools in the Metro South Education District. Objective: This paper describes a research study designed in partnership with our South African collaborators that examines three factors hypothesized to affect the quality and fidelity of HW implementation: enhanced teacher training; teacher support, structure and supervision; and enhanced school environment. Methods: Teachers and students from 56 schools in the Cape Town area will participate in this study. Teacher observations are the primary means of collecting data on factors affecting implementation quality. These factors address the practical concerns of teachers and schools related to likelihood of use and cost-effectiveness, and are hypothesized to be "active ingredients" related to high-quality program implementation in real-world settings. An innovative factorial experimental design was chosen to enable estimation of the individual effect of each of the three factors. Results: Because this paper describes the conceptualization of our study, results are not yet available. Conclusions: The results of this study may have both substantive and methodological implications for advancing Type 2 translational research.
Linking Life Skills and Norms with adolescent substance use and delinquency in South Africa
(National Institute of Health, 2013) Lai, Mary H.; Graham, John W.; Caldwell, Linda L.; Smith, Edward A.; Bradley, Stephanie A.; Mathews, Catherine; Vergnani, Tania; Wegner, Lisa
We examined factors targeted in two popular prevention approaches with adolescent drug use and delinquency in South Africa. We hypothesized adolescent life skills to be inversely related, and perceived norms to be directly related to later drug use and delinquency. Multiple regression and a relative weights approach were conducted for each outcome using a sample of 714 South African adolescents ages 15 to 19 years (M = 15.8 years, 57% female). Perceived norms predicted gateway drug use. Conflict resolution skills (inversely) and perceived peer acceptability (directly) predicted harder drug use and delinquency. The “culture of violence” within some South African schools may make conflict resolution skills more salient for preventing harder drug use and delinquency.
Adaptation to the worker role: The vocational experience of South African male ex offenders
(OMICS International, 2014) Soeker, Mogammad Shaheed
Objectives: The study is aimed at exploring, describing and understanding the experiences and perceptions of male ex-offenders with regard to adapting to their worker roles after they have been released from prison. Methods: The research methodology utilised was positioned in the qualitative research paradigm, specifically using the tradition of interpretivism. To gather data from the participants, focus groups and face to face interviews were conducted, consisting of broad questions followed by probes to gain an in-depth description of participants’ experiences and perceptions. Participants: Five males who were classified as being ex-offenders participated in the focus groups and one female (key informant) participated in two semi structured interviews. Results: Four themes emerged that reflected the vocational experience of male ex- offenders: 1) A sense of distrust, 2) A sense of support: Giving back to the community through learning and doing, 3) A change in lifestyle and 4) Working towards change through capacity building. For the purpose of this article, Theme 3- A change in lifestyle, will be discussed in depth as it explored the adaptive process that male ex- offenders experienced when adapting to their worker roles post release from prison. Conclusions: The findings of the study suggest that occupational therapy practitioners as well as correctional service personnel should utilise context specific vocational rehabilitation programmes that enhance the exoffender’s ability to find employment once they have been released from prison. Practitioners should be aware of both the internal and external adaptation strategies when planning vocational rehabilitation and community reintegration strategies.
Occupational therapy students’ perceptions of the challenges they experience in adapting to a psychiatric fieldwork placement.
(International Research Journals, 2014) Soeker, Mogammad Shaheed
Background: Mental health in Occupational Therapy is experiencing a decline in preference for practice. Aim: This study explored occupational therapy students’ perceptions of the challenges they experience in psychiatric fieldwork. Methods: The researcher used a qualitative research design and collected data by means of focus groups with 8 final year occupational therapy students and 1 interview with a key informant. Findings: Five themes emerged: 1) Listening but not hearing, 2) Boxed thinking 3) Helping hands, 4) Losing the training wheels: Gaining independence and 5) An ideal psych programme. Implications: The barriers to learning identified in this study should be eliminated and the facilitators encouraged. The study highlighted that all theory be taught in the class lectures before the students enter their fieldwork placement. It was also recommended that multimedia sources such a video clips or recorded treatment sessions be used in formal lectures in order to familiarise students to the reality of psychiatry.
The influence of divorce on the occupations of primary school going children in the Western Cape, South Africa: The perspective of the child and a relevant counsellor
(Nova Publishers, 2014) Soeker, Mogammad Shaheed
There have been a number of studies over the years that propose that divorce could create turmoil in children’s lives. Many theorists agree that divorce is a stressful life transition needing adjustment for both the parent and/or child. This study determined how divorce influence childrens` participation in scholastic and leisure activities. The study was positioned in the qualitative research paradigm, specifically using focus groups and face to face interviews to collect data. The participants consisted of one male and three females (aged 8-12 years) and one adult female (key informant). Four themes emerged viz. 1) Listening but not hearing, 2) Adapting by doing, 3) Helping hands and 4) In the ideal world. The findings of the study indicate that children could benefit from family centred treatment programmes and should be involved in counceling post divorce. The barriers or challenges include feelings of sadness and hopelessness, inability to communicate and express feelings to parents and a change in social interaction and leisure activities. The facilitatory factors included having closer family networks, having a parental figure at home to assist with occupational needs, having positive peers support groups and counseling as a form of support.
Not STRAIGHT forward for homosexuals: A look at the lived experiences of homosexual men, living in Cape Town, with regard to their worker roles.
(IOS, 2015) Soeker, Mogammad Shaheed; Bonn, G.L.; de Vos, Z.; Gognozi, T.; Pape, C.; Ribaudo, S.
The South African constitution protects the rights of gays; however in the workplace gays experience discrimination and marginalization. As a result of marginalization they struggle to reach their potential regarding career development and the fulfilment of their worker role. Objective: The study explored the experiences and perceptions of gay males with regard to acquiring and maintaining their worker roles. The study is phenomenological and qualitative in design. Eleven of these men participated in two focus groups. One male participated in two in-depth interviews and one interview was conducted with a key informant. Three themes emerged: 1)Being boxed in, 2) The glass ceiling, 3) This is where I can wear my feather boa. The study findings clearly depicted the many barriers experienced by homosexual men and how this negatively impacts on their worker role. Minimal facilitatory factors exist, to assist gay males in regard to their worker role. It was found that homo-prejudice still exists in South Africa and its workplaces and has a negative impact not only on gay men's worker role but also their well-being. This significantly highlights the great need for occupational therapy intervention in the lives of these gay men, and their workplaces.
The use of Danielson’s framework in developing a new fieldwork training setting for 3rd year occupational therapy students from the University of the Western Cape
(The Occupational Therapy Association of South Africa, 2015) Erasmus, Jane; Vermeulen, Nicola
Charlotte Danielson developed a framework for teaching to assist novice educators. Her framework considers four domains, namely Planning and Preparation, The Classroom Environment, Instruction and finally Professional Responsibilities. This article describes the adaptation of Danielson’s Framework in the development of a new fieldwork setting for third year occupational therapy students. The description of the process that was followed illustrates how the four domains were used to guide the development of a new fieldwork setting, which would meet the requirements of the university as well as the needs of a group of six third year occupational therapy students who were doing their first fieldwork practice in this new setting. The conclusion shows that this Framework proved to be a suitable one to guide the process of developing a fieldwork setting.
Forced sexual experiences and sexual situation self-efficacy among South African youth
(Wiley, 2015) Miller, Jacqueline A.; Smith, Edward A.; Coffman, Donna; Mathews, Catherine; Wegner, Lisa
Nearly 20% of South African youth experience forced or coerced sexual intercourse. Understanding the factors associated with forced sex is important for informing prevention programs aimed at reducing sexual violence and HIV and AIDS. Multilevel regression models test the association between sexual situation self-efficacy and forced sex among 2,893 South African adolescents. Findings suggest that youth are more likely to experience forced sex after periods of time when their levels of self-efficacy are lower than their average levels of self-efficacy. Furthermore, youth who are lower on their self-efficacy compared to their peers are more likely to experience forced sex. Implications for prevention research are discussed.

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