Department of Occupational Therapy

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The adaptation of the model of occupational self-efficacy for returning individuals living with tuberculosis to work
(University of the Western Cape, 2018) Jainodien, Ayesha; Soeker, Shaheed; Smith, Mario
Tuberculosis (TB) and multi-drug resistant (MDR) TB have been identified as one of the largest health problems in the world, and notably recognized as a big issue in democratic South Africa. Socio-demographic factors such as poverty and unemployment were identified to be major contributing factors to the epidemic. Individuals with TB reportedly have poor levels of occupational self-efficacy and found it challenging to return to work after prolonged hospitalization. The Model of Occupational Self-Efficacy (MOOSE) has been used effectively to assist individuals with traumatic Brain Injury (TBI) to return to work. Adaptation of the MOOSE was recommended for application with other syndromes associated with long hospitalization and absence from work. The aim of the study was to adapt the MOOSE for clients living with tuberculosis and to aid them in returning to work. The study was conducted through exploratory research. Semi-structured interviews were conducted with ten purposively selected key informants from private and public health facilities in the Western Cape. The data was analysed through thematic analysis from which six themes emerged. Themes One, Two and Six describe the barriers experienced by the participants when returning to work following their diagnosis of PTB or MDR-TB. Theme Three, Four and Five discussed the factors that facilitate the resumption of the worker role for the PTB and MDR-TB survivors. The findings of this study were used to inform the adaptation of the MOOSE for use with patients living with TB. Ethics clearance was obtained from the Biomedical Research Ethics Committee (BMREC) of UWC. Permission was given by the Department of Health to conduct the study on the clinical platform. All ethics principles were upheld.
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.
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.
Best practice interventions for improving executive functioning in individuals returning to work post traumatic brain injury: A systematic review
(University of Western Cape, 2021) Hutchinson, Lauren; Soeker, Shaheed
The recovery process for traumatic brain injuries (TBIs) can be lengthy and taxing on the patient, family and healthcare resources. Part of this recovery process includes interventions for the improvement of executive functioning (EF) required for high level functioning such as return to work (RTW). However, evidence for best practice interventions to improve EF for RTW post TBI is lacking. Randomised control trials (RCTs) evaluating interventions for EF for RTW post TBI are available but have not been synthesised. The review aimed to determine the best practice interventions for improving EF for successful RTW post TBI. Method: A systematic review using a predetermined search strategy to find relevant titles published from inception to June 2020 in six electronic databases (EBSCOhost and PUBMED [both including MEDLINE]; CINAHL, Cochrane Database for Systematic Reviews, OT Seeker, and Taylor and Francis Online) was conducted following ethics approval by the Institutional Ethics Review Board.
Boys are victims, too: the influence of perpetrators’ age and gender in sexual coercion against boys
(SAGE Publications, 2018) Miller, Jacqueline A.; Smith, Edward A.; Caldwell, Linda L.; Mathews, Catherine; Wegner, Lisa
Sexual coercion among adolescent boys in South Africa is an underresearched topic despite the frequency of such events. Although quantitative research has illuminated the prevalence of sexual coercion toward boys, it has provided little understanding of the context of sexual coercion for adolescent boys. Given the often severe consequences of sexual coercion, it is important to further understand these experiences to inform prevention efforts. The current study aims to provide a more nuanced understanding of the context of sexual coercion. Data come from the baseline assessment for a translational research evaluation of a school-based intervention. The current study focuses on a subset of early and middle adolescent boys who reported experiencing sexual coercion (n = 223). Analyses examine boys’ reports of their perpetrators’ characteristics and details about the sexual coercion encounter. Logistic regression is used to examine how coercion tactics used by the perpetrator differs depending on the perpetrator’s age and gender. Eighth-grade boys were most likely to report that their perpetrator was a similar-aged female and that perpetrator’s age played a particularly important role in what tactics were used. Adult perpetrators were more likely to use physical force, threaten them, harass them electronically, and drink or use drugs at the time. Results provide important insight into boys’ experiences of sexual coercion that have implications for both future research and intervention efforts. Although much research is needed on the topic, intervention programs should recognize that both male and female adolescents can be victim and perpetrator.
Client confidentiality: Perspectives of students in a healthcare training programme
(Health & Medical Publishing Group, 2016) Nortje, Nico; De Jongh, Jo-Celene
BACKGROUND. Confidentiality is an important ethical principle for all health professionals and also has a legal bearing on duty. One of the most difficult issues health professionals face in their daily fieldwork practice is a conflict between their professional duties, as illustrated in keeping a patient’s medical information confidential, and having empathy with a family member’s need to know. This moral dilemma is difficult for students to circumvent and therefore this paper presents healthcare students’ perspectives of confidentiality. METHODS. We aimed to explore healthcare students’ views and experiences of confidentiality as an ethical principle by adopting a qualitative explorative approach. Purposeful sampling was undertaken where specific individuals with specific experiences were identified. Data were collected by means of written responses from two open-ended questions and analysed thematically. Two themes emerged. CONCLUSION. Confidentiality, as with other ethical principles, is an important obligation of a good client-therapist relationship as identified by students. However, the students’ responses illustrate that it cannot be absolute, and cognisance must be taken as to when it is acceptable, and even desirable, to override confidentiality because of conflicting, greater duties.
Clients' perceptions of an occupational therapy intervention at a substance use rehabilitation centre in the Western Cape
(Occupational Therapy Association of South Africa (OTASA), 2015) Bell, Teneil; Wegner, Lisa; Blake, Lauren; Jupp, Leigh; Nyabenda, Fides; Turner, Tamryn
Substance use among adolescents is a significant health and social problem and affects occupational performance. While occupational therapy interventions are available at substance use rehabilitation centres in the Western Cape, little is known about clients' perceptions of the usefulness of these interventions. A qualitative study was conducted to address this gap, specifically exploring clients' perceptions of the usefulness of the intervention on their occupations post discharge. The occupational therapist at a particular centre was interviewed as a key informant. Eight participants who attended the aftercare programme at the centre took part in three focus groups. Four themes emerged from the analysis of data: "We taking the drugs away, but we need to give them something back in that place"; "I don't want to be that person I was in the past"; "Keeping me clean"; "Take us out into the life". Participants perceived skills development, work training, life skills and leisure exploration to be useful. However, team members' roles and treatment objectives should be clarified to the clients to ensure that clients understand why they are participating in therapy. Finally, there should be more community-based, out-patient support programmes for adolescents so that the appropriate services are more easily accessible.
A Commentary of occupational justice and occupation-based community development frameworks for social transformation: The Marikana event
(South African Journal of Occupational Therapy, 2021) Mthembu, Thuli Godfrey
Background: The Occupational justice framework is significant in enabling communities to collaborate with occupational therapists to strengthen social vision and enhance occupational potential. It has been highlighted that the occupational justice framework could be used in conjunction with Occupation-based Community Development programmes to enrich social transformation through engagement in community-led occupations. However, little is known about the applicability of both occupational justice and Occupation-based Community Development frameworks in designing programmes for communities that experienced collective trauma. Purpose: This commentary explores the Marikana event in terms of the occupational justice framework and its outcomes of occupational injustice. It further unpacks the occupation of protest and the factors predicting protest using the Marikana event. Conclusion: The applicability of Occupational Justice and Occupation-based Community Development frameworks can help occupational therapy clinicians, educators, and students collaborate with communities through a cycle of critical consciousness to achieve social vision, transformation, and healing. Recommendations are provided in relation to community-centred occupational therapy practice, education, and future research within a South African context. (PDF) A Commentary of Occupational Justice and Occupation-based Community Development Frameworks for Social Transformation: The Marikana Event. Available from: https://www.researchgate.net/publication/350810812_A_Commentary_of_Occupational_Justice_and_Occupation-based_Community_Development_Frameworks_for_Social_Transformation_The_Marikana_Event [accessed Sep 20 2021].
Covid-19 and higher education: a qualitative study on academic experiences of African international students in the Midwest
(Applied Research in Quality of Life, 2023) Majee, Wilson; David, Ifeolu; Kehinde, Omoshola; Tefera, Gashaye M
COVID-19 pandemic has harshly impacted university students since the outbreak was declared in March 2020. A population impacted the most was international college students due to limited social networks, restrictive employment opportunities, and travel limitations. Despite the increased vulnerability, there has been limited research on the experiences of African-born international students during the pandemic. Using an exploratory qualitative design, this study interviewed 15 African-born international students to understand their experiences during the pandemic. Thematic analysis revealed that the COVID-19 pandemic influenced participants’ academic life directly via an abrupt shift to online learning and indirectly through disruptions in an academic work routine, opportunities for networking, and career advancement, resulting in lower academic performance and productivity. These experiences were worsened by other social and regulatory barriers associated with their non-immigrant status. The study findings suggest an increased need for institutional and community support for international students as vulnerable populations during a crisis to promote sustained academic success.
A cross-sectional descriptive study of occupational therapy students’ perceptions and attitudes towards spirituality and spiritual care in occupational therapy education
(Springer, 2016) Mthembu, Thuli Godfrey; Roman, Nicolette V.; Wegner, Lisa
Spirituality and spiritual care both have received increased attention over the course of this past decade from different disciplines. However, for many years, in the occupational therapy profession, the importance of spirituality and spiritual care seems to be controversial because it is unclear how these concepts are integrated in occupational therapy education. Although occupational therapy students are being educated to consider a holistic and client-centred approach, spirituality is not regarded within this framework which diminishes the integrity of holistic approach. In South African occupational therapy education, it is unclear whether any single course on teaching and learning of spirituality and spiritual care exists. Thus, the aim of this study was to describe occupational therapy students’ perceptions and attitudes regarding spirituality and spiritual care in occupational therapy education. A cross-sectional descriptive study design of undergraduate occupational therapy students from one educational institution was used. Data included demographic characteristics, responses on Spiritual Care-Giving Scale (SCGS), Spiritual and Spiritual Care Rating Scale (SSCRS) and Spirituality in Occupational Therapy Scale (SOTS). A response rate of 50.5 % (n = 100 out of 198) was achieved. In the SCGS, among the factors only factor 1 had the highest mean value score showing consistent agreement about spirituality, whereas in the SSCRS only three factors were found to have highest mean score and one with lowest mean score. In SOTS, participants had a highest score mean in relation to formal education and training about spirituality. Thus, in the integration of spirituality and spiritual care a holistic approach needs to be considered in education to enhance students’ knowledge of how to address mind, body and spirit needs.
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.
A descriptive, qualitative study of the challenges that individuals with Autism Spectrum Disorder experience when transitioning from skills training programs into the open labor market in Cape Town, South Africa
(IOS Press, 2020) Soeker, Mogammad Shaheed
BACKGROUND: There is limited existence of qualitative research on adults with Autism Spectrum Disorder (ASD), who are transitioning between skills training programs and finding employment in the open labor market, in South Africa. OBJECTIVE: The aim of this current study was to explore the experiences and perceptions of individuals living with ASD, regarding transitioning from a skills training program to working in the open labor market. PARTICIPANTS: The data were collected through semi-structured interviews with ten participants, who were diagnosed with ASD, and working in the open labor market, as well as five key informants, who have worked with autistic individuals in a skills training program. METHODS: The data collected, using an explorative, descriptive, qualitative method, were analyzed using thematic analysis, and resulted in three emerging themes. RESULTS: Theme one: The 'disorder' in the workplace -The individual and collective barriers that individuals experience in the workplace are described, including social, emotional, and communication difficulties, as well as the stigmatization experienced by persons with a disability. Theme two: Making the workplace work -The facilitative support that individuals are exposed to, in the form of intervention from occupational therapists, sensory psychologists, and other forms of skills training programs, are described. In addition to supportive intervention, the relationships and networking within, and outside of the workplace, are discussed in theme two. Theme three: What works for me -The individual adaptations made by the participants, in the form of unique coping mechanisms in the workplace, as well as in the home environment, are discussed. CONCLUSION: It was observed that, while there are barriers to the transitioning of autistic individuals into the open labor market, there are enablers that facilitate a less challenging transitioning process, in the form of family and workplace support, as well as skills training, and self-identified coping mechanisms. © 2020 - IOS Press and the authors. All rights reserved.
Determinants of return to work and the development of a return to work programme for stroke survivors in Osun state, Nigeria
(University of the Western Cape, 2019) Olaoye, Olumide Ayoola; Soeker, Shaheed; Rhoda, Anthea
Background: Stroke is acknowledged globally and among Nigerian rehabilitation researchers as a public health problem that leave half of its survivors with significant neurological deficits. The attendant sequelae of stroke affects the functional ability, limits activity performance and participation of stroke survivors within the community. The inability to re-establish pre-existing roles after stroke further poses additional challenges on the society, friends and families of the stroke survivor with regards to cost and burden of care. Although stroke disrupt the career pathway of working age survivors briefly, recurrently or permanently; a systematic pathway that facilitates job placement and retention at work for stroke survivors could reduce the devastation and burden caused by unemployment following stroke. As this vocational rehabilitation pathway and programme is currently unavailable for stroke survivors, this study aimed to design a RTW intervention programme that could facilitate the work re-entry for stroke survivors in the state of Osun, Nigeria. Method: The study utilized a multi-phase mixed method research design that was guided by the Intervention Mapping (IM) framework to achieve its objectives. This consisted of three iterative phases that informed one another with the findings culminating into the developed return to work programme for stroke survivors in Osun State. Phase one used a convergent mixed method parallel approach to obtain baseline information on the RTW process, the impairments, activity limitation, and the participation restrictions experienced by stroke survivors in Osun state, Nigeria in two distinct stages that involved a cross-sectional survey and qualitative interviews. The cross sectional survey administered questionnaires that included the Work Rehabilitation Questionnaire, the International Classification of Functioning, Disability and Health (ICF) Brief Core Sets for vocational rehabilitation (VR) and the Work Impact Questionnaire (WIQ) using the face to face method. Descriptive statistics such as measure of central tendencies and frequencies as well as inferential statistics such as logistic regression analysis were performed on the questionnaire data. The qualitative study involved concept mapping using in-depth interviews with stroke survivors who have and those that have not RTW. The transcripts from the in-depth interviews were analysed using the thematic content method. Phase two entailed a scoping review of literature that reported on interventions aimed at facilitating RTW of stroke survivors. The last phase of the study involved a Delphi study with experts in the field of stroke and vocational rehabilitation. The Delphi survey was conducted over three rounds with the final draft of the RTW programme emerging at the third round. Results: Two hundred and ten stroke survivors with mean age 52.90±7.92 responded to the quantitative stage of the phase thereby yielding a response rate of 76.36%. Sixty three point eight percent of the respondents had returned to work with half of them in full time employment (32.9%) while 36.2% had not returned to work. The majority of the respondents identified that travel to and from work (43.8%) and access at work (43.3%) had an impact ranging from ‘quite a bit’ to ‘extreme’ on their ability to work on the WIQ. The results from the quantitative stage further showed that more than ten percent of the respondents experienced complete problem in four components of activity and participation domains of the ICF brief core sets for VR and these include remunerative employment (21.4%), acquiring new skills (17.1%), non-remunerative employment (16.7%), as well as acquiring, keeping and terminating jobs (14.3%). Similarly, energy and drive functions (41.9%) and higher level cognitive function (36.2%) were indicated as culminating in moderate to severe problems in more than a third of the respondents while the “performance of complex interpersonal relationship” and “exercise tolerance function” resulted in no or little difficulty for the respondents. The findings from the logistic regression analysis showed that the combination of side of body affected by stroke (left), type of vocational rehabilitation programme, symptoms of stroke, environment, body function impairments as well as activity and participation problems were the factors that predict RTW after stroke. The logistic regression model significantly explained 55.0% to 75.4% of the variance in RTW after stroke and correctly classified 89.0% of all the cases/respondents. Results from the qualitative stage of the first phase suggests the lived experience of returning to work after stroke to have entailed three themes that was represented by a concept map. The first theme revealed that “it was difficult to live with stroke” for the survivor. The second theme revealed that the stroke survivors’ environment could either worsen or lessen the difficulty experience while the third theme highlighted the various issues that directly impacted on the resumption of worker role of the participants. The scoping review phase (phase two) identified that RTW interventions for stroke survivors falls into three core components which includes 1) intervention components that interface with the stroke survivor; 2) intervention components that interfaced with the workplace and; 3) components that describe strategies of implementation. These core components are interventions that could guarantee an effective RTW for strokes survivors when included in a RTW programme. In the third phase which was the concluding phase of the study, 13 experts in the field of stroke and vocational rehabilitation unanimously agreed at the third round of Delphi that the content of RTW programme for stroke survivors should include an assessment phase, work intervention training phase, work test placement phase and clients full participation in worker role phase that will span a 12 week duration. The developed RTW programme, conceptualized as Stroke Return to Work Intervention Programme (SReTWIP) was designed to be individually tailored to meet the need of the stroke survivor and implemented by an interdisciplinary team that will include the OT and PT as key members. Equally, the stroke survivor is expected to be involved in the decision making process throughout the duration of the SReTWIP. And finally, the programme is to be coordinated by a case manager who will be a member of the interdisciplinary team. Conclusion: It can be concluded that 63.9% of stroke survivors in Osun State, Nigeria return to work. Problems pertaining to lack of energy and drive functioning; higher level cognitive functioning; acquiring new skills; handling stress and psychosocial demands; travel to and from work and access were the common body impairments and problems with activities and participation restrictions that the stroke survivors encountered. Similarly, the study concludes that a multi-faceted programme, the SReTWIP, comprising of four interconnected phases of interventions that targets multiple factors such as personal and environment factors influencing work resumption is likely to be more effective in facilitating quick RTW after stroke.
Development and implementation of an occupation-based community development programme with women to address the prevention of non-communicable diseases, in a low socio-economic community of the Western Cape
(University of the Western Cape, 2024) Kalam, Aziza; Hess-April, Lucia; Wegner, LIsa
While non-communicable diseases (NCDs) were historically regarded as diseases of the wealthy, they are now a concern amongst people living in poverty and those who are vulnerable in society. NCDs kill approximately 71% of the global population which equates to 41 million deaths each year, mostly affecting people living in poverty. Health-risk factors for NCDs include poor diet, lack of exercise, excessive use of alcohol and tobacco, and are mostly preventable. NCDs are preventable but may be inherited through health-risk behaviours and lifestyles. Women, in their roles as mothers are the ideal agents of change who could influence the behaviour and occupational choice of the next generation as they are ideally positioned within their families and communities to be empowered to take ownership of their health and well-being. The aim of this study was to develop and implement an occupation-based community development programme to address the prevention of NCDs with women in a low socio-economic community of the Western Cape. The objectives of the study were to explore and describe: 1) the women’s perceptions of NCDs; 2) how the women perceived their current health-risk behaviours and occupational choices, 3) their occupational needs for participation, 4) their enablers in relation to their occupational participation; 5) the selection and design of occupation-based strategies to address the health-risk factors for NCDs and 6) the process of implementation to empower the women to prevent health-risk factors for NCDs. The critical research paradigm was adopted, and a qualitative, participatory action research design integrated within the occupation-based community development practice framework, was utilised. A total of 27 women aged 20 to 65 years living in a low socio-economic community near Cape Town, South Africa participated in the study over a period of two and a half years.
The development of a model to enhance entrepreneurial skills of women with acquired brain injury
(University of Western Cape, 2021) Darries, Zareena; Soeker, Shaheed
Acquired brain injury (ABI) is a major public concern since the consequences thereof are far reaching as the long-term effects can be different for each individual and can impact on their lives in different ways. Individuals with ABI can experience both short-term and long-term cognitive, emotional, physical as well as behavioural changes that can make community reintegration and resumption to work more challenging. The particularly low return to work (RTW) outcomes for individuals sustaining ABI have been well documented, showing that women with ABI are at a greater risk of not returning to work compared to men with ABI. In the last decade South Africa demonstrated a disability prevalence rate of 7.5%, indicating that disability was more prevalent among women compared to men. As a result of the limited opportunities in the formal labour market in South Africa, opportunities for women in general and those with ABI entering the job market remains low.
The development of a return to work intervention programme for stroke survivor (SReTWIP): A Delphi survey
(Springer Nature, 2020) Olaoye, Olumide Ayoola; Soeker, Shaheed Moghammad; Rhoda, Anthea
Even though clearly defined pathways for vocational re-entry are well recognized for conditions such as mental health, musculoskeletal dysfunction (MSD) and traumatic brain injury (TBI), none has been identified for stroke. There has been a lack of consensus regarding such clear pathways to vocational re-entry and the essential contents of return to work (RTW) interventions for stroke survivors. As part of a larger study aimed to design a RTW programme for stroke survivors, this study describes the concluding process through which Stroke Return to Work Intervention Programme (SReTWIP) was developed.
Doing a leisure activity because there is nothing else to do: Related outcomes and intervention effects for adolescents
(Taylor & Francis, 2019) Motamedi, Mojdeh; Caldwell, Linda L.; Weybright, Elisabeth H.; Jones, Damon; Wegner, Lisa; Smith, Edward A.
This study examined whether a leisure-focused intervention, HealthWise, was related to reduced youth polysubstance use and delayed sexual debut via reducing how often youth did leisure activities because there was nothing else to do. HealthWise was compared to a no-intervention control for 5,610 high school students from eighth to tenth grades in townships near Cape Town, South Africa. Three specific leisure activities were examined: spending time with friends, playing sports, and going to parks. Among girls, spending time with friends because there was nothing else to do significantly mediated the effect of HealthWise on reducing frequent polysubstance use in the past month. For boys, spending time in parks because there was nothing else to do mediated the effect of HealthWise on delayed sexual debut. Results partially supported the HealthWise logic model of impacting risky behaviors via leisure and the value of prevention programs addressing the reasons behind leisure choices.
Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes
(BioMed Central Ltd, 2020) Oga-Omenka, Charity; Bada, Florence; Agbaje, Aderonke; Dakum, Patrick; Menzies, Dick; Zarowsky, Christina
Introduction: Persistent low rates of case notification and treatment coverage reflect that accessing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge, even though it is provided free of charge to patients. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic characteristics. Our study aimed to identify the reasons for Nigeria’s low rates of case-finding and treatment for DR-TB. To achieve this, we analyzed elements that facilitate or hinder equitable access for different groups of patients within the current health system to support DR-TB management in Nigeria. Methods: We conducted documentary review of guidelines and workers manuals, as well as 57 qualitative interviews, including 10 focus group discussions, with a total of 127 participants, in Nigeria. Between August and November 2017, we interviewed patients who were on treatment, their treatment supporter, and providers in Ogun and Plateau States, as well as program managers in Benue and Abuja. We adapted and used Levesque’s patient-centered access to care framework to analyze DR-TB policy documents and interview data. Results: Thematic analysis revealed inequitable access to DR-TB care for some patient socio-demographic groups. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Health system factors including positive provider attitudes and financial support provided to the patients facilitated equity and ease of access. However, limited coverage and the absence of patients’ access rights protection and considerations in the treatment guidelines and workers manuals likely hampered access. Conclusion: In the context of Nigeria’s low case-finding and treatment coverage, applying an equity of access framework was necessary to highlight gaps in care. Differing social contexts of patients adversely affected their access to DR-TB care. We identified several strengths in DR-TB care delivery, including the current financial support that should be sustained. Our findings highlight the need for government’s commitment and continued interventions.
Educators’ and students’ needs regarding teaching and learning strategies for integrating spirituality and spiritual care in occupational therapy education
(Sabinet, 2018) Mthembu, Thuli G.; Wegner, Lisa; Roman, Nicolette V.
Spirituality and spiritual care are both generating considerable interest as part of holistic and client-centred approaches of the profession of Occupational Therapy. Concerns have been raised regarding the teaching and learning needs of occupational therapy educators and students regarding spirituality and spiritual care. The aim of this study was to explore educators’ and students’ needs regarding teaching and learning strategies for integrating spirituality and spiritual care in the South African occupational therapy education. An interpretive, qualitative exploratory-descriptive approach was used with nine educators and 29 students who were purposively recruited from a university in the Western Cape Province, South Africa. Four focus group discussions were used for data collection and thematically analysed and managed in Atlas.ti 7. Two themes emerged: “We actually use transformative learning as a pedagogical approach,” and “We need philosophical guidelines for integrating spirituality”. These results imply that the transformative learning theories could contribute significantly to the integration of spirituality and spiritual care in occupational therapy education. Additionally, the findings support the use of critical reflection and consciousness-raising as teaching and learning strategies for spirituality. Overall, the findings indicated that the phases of transformative learning could be used to integrate spiritualty and spiritual care in occupational therapy education. This study suggests a basis for development of guidelines to assist the educators and students to address the need for integrating spirituality in the occupational therapy classroom.
The effect of an injury prevention programme on the lower limb soft tissues in fast bowlers an intervention study
(University of the Western Cape, 2008) Govender, Craig; Frantz, J.M.; Stretch, R.A.; Dept. of Physiotherapy; Faculty of Community and Health Sciences
The aim of the study was to determine the effect of astatic stretching programme on injury prevention. Educational pamphlets and a static stretching regime were implemented to the experimental group.

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