Philosophiae Doctor - PhD (Occupational Therapy)

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    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.
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    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.
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    Factors influencing return to work after a cardiac incident and the development of a return to work intervention programme for individuals with cardiac diagnoses in the Western Cape, South Africa
    (University of the Western Cape, 2021) Ganie, Zakeera; Soeker, M.Shaheed
    Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programmes have been documented to improve functional abilities, but little is known about the return to work rate after cardiac rehabilitation. Access to cardiac rehabilitation programmes in the Western Cape is limited. This study aimed to determine the return to work rates and influencing factors after cardiac rehabilitation as well as to design an intervention programme that is accessible and could facilitate return to work for individuals with cardiovascular disease.
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    The evaluation of the integrated client-centred intervention programme (ICIP) for clients with MDR-TB at DP Marais Hospital in the Western Cape
    (University of Western Cape, 2020) Firfirey, Nousheena; Hess-April, Lucia; Soeker, Mogammad Shaheed
    Although TB is a curable communicable disease, poor adherence to TB treatment is a major barrier to TB control in South Africa as it increases the risks of morbidity, mortality and drug resistance at individual and community level. As a result, multi-drug-resistant TB (MDR-TB) has become a serious public health issue. Underpinning this study was the assumption that a client-centred approach to treatment of MDR-TB clients, with a hospital programme which adopts an integrated multidisciplinary approach that is client-centred and is not purely biomedically driven, would improve treatment outcomes of MDR-TB clients.
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    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.