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Doctoral Degrees (Psychology)

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    Analysis of policy for protection of HIV positive adolescent girls against vulnerabilities faced in using contraception in Malawi.
    (2022) Bulage, Patience.; Govender, Kaymarlin.
    There are challenges faced in accessing and using contraception by adolescent girls, but the reality is worse for adolescent girls living with HIV. Thus, it is important to investigate the extent to which current policies in Malawi put into account the vulnerabilities faced by this sub-population. This study therefore sought to answer the following research questions: 1. What are the structural and socio-cultural issues affecting the use of contraception among AGLHIV in Malawi? 2. What policy provisions are in place in Malawi to address the issues/risks faced by AGLHIV during reach and use of contraception? 3. What implementation challenges affect the effectiveness of the available policy provisions? This study was guided by the healthy policy triangle (HPT) framework and it was qualitative in nature, using both secondary and primary data collection methods. The findings include; • Access to contraception by adolescent girls living with HIV is hampered by several structural and socio-cultural issues, mainly; the mode of service provision, supply chain and infrastructural challenges, age restrictions, conditioned access, as well as integration challenges. The socio-cultural issues include; the high momentum for children, male dominance, social labelling, non-disclosure of HIV serostatus to sexual partners, social sensitivity, perpetuation of harmful content, and a general lack of social support, and poor risk perception. • The available provisions include those addressing gender-based violence, discrimination and stigma, community engagement, confidentiality, and emphasis on adolescent girls and young women. However, most of the provisions are broadly stated and gaps exist too. • Effective implementation is affected largely by cascading challenges, lack of sufficient funding, limited political will, low comprehension of policy directives, limited participation of target population, coordination challenges, social resistance, effects of decentralization, low capacity of implementing partners and the slow pace of behaviour change among the targeted population and communities. While the policy environment in Malawi is seemingly favourable, undertones exist around harmonization, and representation of interest groups, mainly PLHIV groups. Policy makers ought not to continue ignoring the importance of formulating HIV-sensitive policies which can give way to social protection programs for the most vulnerable within the society, given the benefits of a healthy youthful population.
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    Narratives from women using the dapivirine vaginal ring in an open label extension study by Kalendri Naidoo.
    (2022) Naidoo, Kalendri.; Mansoor, Leila Essop.; Montgomery, Elizabeth T.
    In sub-Saharan Africa, women and girls represented 63% of new Human Immunodeficiency Virus (HIV) infections in 2020. Adolescent girls and young women (AGYW) aged 15–24 years are twice as likely to be living with HIV as compared to young men. Therefore, efforts to develop and roll out safe, effective and acceptable HIV prevention products for women, are continuing. An important example of a female-initiated HIV prevention strategy is the dapivirine vaginal ring which showed a 27% reduction in HIV-1 incidence in the Microbicides Trials Network (MTN)-020/A Study to Prevent Infection with a Ring for Extended Use (ASPIRE) study and by 31% in the International Partnership for Microbicides (IPM)-027 The Ring study. The dapivirine vaginal ring was subsequently tested for safety and adherence in the Open Label Extension (OLE), MTN-025/HIV Open-label Prevention Extension (HOPE) study. The MTN-032/Adherence in HOPE and ASPIRE (AHA) study was a two-phase exploratory sub-study of the ASPIRE (AHA part 1, after ASPIRE and before HOPE study initiation) and HOPE (AHA part 2, after HOPE was completed) studies which utilised single qualitative indepth interviews (IDIs) to explore social conditions and issues related to participation around the use of the dapivirine vaginal ring as well as suitable approaches to market the study product. I report on the narratives from women participating in the AHA study (Part 2) within the context of known safety, partial product efficacy and choice, focusing on what motivated women to join the HOPE OLE study, women’s understanding of the vaginal rings’ efficacy, how they understood it to work in their bodies to prevent HIV and barriers and motivators to vaginal ring adherence.
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    Exploring migration experiences and mental health among refugees and asylum-seekers in Durban, South Africa: guidelines for mental health promotion interventions.
    (2020) Tesfai, Aron Hagos.; Meyer-Weitz, Anna.
    Background: Refugees and asylum seekers flee war, state violence, persecution and economic hardships. They tend to be very poor, vulnerable and are often excluded from the health and socio-economic activities of the hosting communities. In these contexts, refugees and asylum-seekers are found to be among high-risk groups for mental health problems, especially those that resettle in Low-and-Middle Income Countries. Further, mental health issues of refugees are worsening in light of the sustained conflict and forced migration the world is witnessing. For a long time now, the need for mental health promotion among refugees has been a public health concern. However, it seems there has been limited research undertaken in Africa, particularly in South Africa regarding the migration experiences and mental health of refugees. This study therefore aimed to explore refugees’ and asylum-seekers’ migration experiences particularly the stressors, psychological problems and coping strategies at pre-, transit-, and post-migration stages. Understanding migration experiences provides an essential background for developing mental health intervention guidelines to promote psychological wellbeing among refugees. Methodology: The study utilised a sequential exploratory mixed-method strategy that allows first qualitative data collection and analysis followed by a second phase of quantitative data collection and analysis that builds on the results of the first qualitative phase. The main purpose of utilising this design was to initially explore the migration experiences of refugees and to understand their explanations and descriptions of migration and mental health experiences qualitatively. Then the quantitative phase aimed at expanding the initial qualitative results using a much larger sample. Based on a descriptive phenomenological method, qualitative data was collected from 14 purposefully selected participants using face-to-face interviews. The data was analysed using the five steps phenomenological descriptive analysis. A cross-sectional survey was utilised to collect data from 195 conveniently sampled respondents. A survey questionnaire was used to collect data and it included demographic questions and the following measures: Refugees Stress Scale (RSS), Post- Migration Living Difficulties Questionnaire (PMLD), Refugees’ Defenceless Scale (RDS), Connor-Davidson Resilience Scale (CD-RS), General Health Questionnaire (GHQ - 28) and Post-Traumatic Stress Disorder Checklist - civilian version (PCL -5). The data was analysed using the Statistical Package for the Social Science (SPSS version 25). Techniques of exploratory factor analysis, independent samples t-tests, ANOVA, Pearson- moment correlation coefficient and regression models were used to analyse the quantitative data. Results: The qualitative results revealed that throughout migration refugees have experienced life-threatening events and gross violation of human rights emanating from state-organized-violence, conflict and xenophobic violence or criminal attacks. Further, refugees also suffered from economic hardships mostly due to lack of employment opportunities, not knowing where they were going, travelling alone, lack of basic necessities, persecution and lack of security. As a result, their mental health experiences attest emotional and psychological distress resulting from the immediate stressors and lingering migration stressors. The participants described experiencing symptoms of PTSD, anxiety and depression throughout the migration process and beyond. The psychological distress of refugees who fled recently and experienced traumatic events have been further stressed by the lack of basic necessities in South Africa, is notably worrisome. Refugees were dealing with very negative experiences using different coping mechanisms, mainly, faith and religiosity, escaping danger, using hopeful thoughts and relying on some social support. The quantitative results revealed threats to life, forced separation from family, not having a clear vision about ones’ future, limited freedom and police or military follow-ups or beating as most common pre-migration stressors. The post-migration stressors are mainly insecurity and vulnerability that includes xenophobic threats, lack of job opportunity/ unemployment, worries about their children, discrimination, separation from family, unable to return to their original home in an emergency time and fear of repatriation. Regarding psychological distress, anxiety and insomnia are found as the most prevalent symptoms of distress, followed by social dysfunction, somatic complaints and depression. About one third of the participants are experiencing major symptoms of PTSD. Conclusion: The prevalence of psychological distress is relatively lower in this study when compared to other studies among African refugees, however, refugees who fled recently from traumatic experiences are found to be notably stressed with major PTSD symptoms. Further, lack of basic needs, minimal financial income and insecurity are found to be determinants of mental health of refugees. Mental health promotion interventions for refugees should consider their primary needs, health inclusive of mental health screening at entry and to follow-up by addressing their psychological problems through both individual and community-based psychosocial interventions to enable refugees to take better control of their health and wellbeing within an supportive and enabling environment.
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    Beyond belonging? White settler entitlement and the dynamics of nativeness, autochthony and nostalgia in South Africa.
    (2022) Maseko, Sibusiso.; Durrheim, Kevin Locksley.
    White settlers continue to impose themselves as owners of contemporary settler colonies (Veracini, 1999; Moreton-Robinson, 2015). Their imposition not only translates into making settler colonies their permanent homelands, but also engenders deep sense of entitlement to them (Veracini, 1999; Moreton-Robinson, 2015). Despite the transition from an era of outright colonial rule to modern-day liberal democracies, colonial based asymmetries of power between White settlers and Indigenous groups remain resolute. Commonly, these asymmetries of power present as race-based hierarchies that shape the political, social and economic landscape of these societies. Hence, White settlers’ entitlement claims to contemporary settler colonies are central to the continuing problem of racial inequality because they rationalise, maintain and even reproduce their enjoyment of historical privileges. While Indigenous groups, who are the victims of settler colonial conquest, continue to exist on the margins of these societies (Veracini, 1999; 2008; Moreton-Robinson, 2015). The social psychology of intergroup relations has hardly paid attention to how White settlers continue to exercise dominance over contemporary settler colonies by advancing entitlement claims. In this thesis, I attempt to address this gap in literature by examining how White nativeness, White settler autochthony beliefs and White settler nostalgia, reinforce race-based hierarchies. Mainly, I argue that White settlers’ enduring sense of entitlement to settler colonies reinforces race-based hierarchies through the construction of a White native status and the mobilisation of White settler autochthony beliefs and nostalgia. My primary aim in this thesis is to show how White settlers’ psychological entitlement to settler colonial territory, reinforces preference for race-based hierarchies. To do this, I first undertake a theoretical examination of how White settlers construct and assert nativeness to settler colonies. Second, I undertake an empirical examination that investigates how psychological expressions of entitlement to settler colonies, through White settler autochthony and White settler nostalgia reinforce race-based hierarchies. In my theoretical examination, I argue that White settlers have constructed themselves as de facto natives by mobilising settler mythologies. And their assertion of a de facto White native status enables the mobilising of White settler autochthony and White settler nostalgia. This is because autochthony beliefs are a powerful set of ethical and moral ideals that award rightful ownership of a territory based on first arrival and investment of time and labour. While collective nostalgia is a deep yearning for a place and time in the history of the group (Wildschut et al., 2014). Autochthony beliefs and collective nostalgia are psychological orientations are typically used by native groups express entitlement to territory. Hence, in my empirical examination, I argue that autochthony beliefs and collective nostalgia are expressions of psychological entitlement to territory that White settlers use to reinforce racebased hierarchies, because they help them justify racial asymmetries and reflect their assertion of a de facto White native status.
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    Older men’s experiences of masculine identities across the lifespan.
    (2023) Zank, Andrea.; Lindegger, Graham Charles.; Quayle, Michael Frank.
    The primary focus of this research was to investigate how men have experienced their masculinity across their life journeys as men, as revealed in retrospective accounts of life transitions. The research especially sought to understand how masculine identities were narrated and negotiated across the lifespan in retrospective accounts as, to date, most research on masculinity has adopted a cross-sectional perspective that does not consider the challenges of ageing in producing and maintaining a masculine identity across the lifespan. With a theoretical framework combining thematic analysis (TA) and interpretative phenomenological analysis (IPA), and honouring the idiographic commitment of IPA to small samples of very detailed interviews, multiple in-depth narrative interviews were undertaken with 10 men who were 60 years or older. These volunteers were sampled with purposive and convenience snowballing. Although the research took place in a specific context of South Africa in which the population is highly diverse and complex, the sample was relatively homogenous due to the research (1) an intentional focus on exploring ageing for men who previously had access to access to resources and the (2) the location of the study in retirement villages that are still racially homogenous a quarter of a century after apartheid. In-depth, repeated, partly unstructured interviews were used to access retrospective accounts of masculine identities across the lifespan. Five areas were focused on in the analysis: productivity along the lifespan, family / relationships, health in the present and over the lifespan, ageing and living in Africa. The men defined themselves by traditional masculine identities and did not freely volunteer non-traditional masculine experiences. Their accounts of masculinity were oriented to the lifespan social clock, in other words, to accounting for achieving various milestones (or not) of masculinity on schedule (or not). Although these older men did not fulfil the hegemonic or dominant ideals, such as being young and virile, they did not present themselves as being invisible or genderless. Various strategies were used to protect, maintain and reframe their masculine identities, for example, stoic acceptance, denial and relying on their wives to bridge the gap, such as accessing medical intervention, while the men were able to continue Mostly the men presented their masculine identities as being consistent with dominant norms and unchallenged (denying age-related decline by omission). Where the men spoke of being in subjugated positions they often followed this account in various ways in which the subjugated position was discounted and their hegemonic status re-established by emphasising hegemonic qualities that they possessed or subscribed to. In the present study, men avoided discussing the inevitability of old age when recounting their life journey as men retrospectively. However, the perspective of time is still an important concept in understanding how they produced their masculinity. The present study shows that social expectations for masculine identities are dynamic, evolve over the lifespan and are sensitive to the “social clock”, in other words, to normative expectations about what men should do and achieve at different life stages. Men are pressured to achieve masculine developmental social expectations on time, despite it becoming increasingly difficult to maintain the accepted standards of hegemonic and dominant masculinities. The implications for understanding masculinity in relation to ageing are discussed.
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    A co-evolutionary approach to data-driven agent-based modelling: simulating the virtual interaction application experiments.
    (2023) Igwe, Kevin Chizoba.; Durrheim, Kevin Locksley.
    The dynamics of social interactions are barely captured by the traditional methods of research in social psychology, vis-à-vis, interviews, surveyed data and experiments. To capture the dynamics of social interactions, researchers adopt computer-mediated experiments and agent-based simulations (ABSs). These methods have been efficiently applied to game theories. While strategic games such as the prisoner’s dilemma and GO have optimal outcomes, interactive social exchanges can have obscure and multiple conflicting objectives (fairness, selfishness, group bias) whose relative importance evolves in interaction. Discovering and understanding the mechanisms underlying these objectives become even more difficult when there is little or no information about the interacting individual(s). This study describes this as an information-scarce interactive social exchange context. This study, therefore, forms part of a larger initiative on developing efficient simulations of social interaction in an information-scarce interactive social exchange context. First, this dissertation develops a context for and justifies the importance of simulation in an information-scarce interactive social exchange context (Chapter 2). It then performs a literature review of the studies that have developed a computational model and simulation in this context (Chapter 3). Next, the dissertation develops a co-evolutionary data-driven model and simulates exchange behaviour in an information-scarce context (Chapter 4). To benchmark the data-driven model, this dissertation develops a rule-based model. Furthermore, it creates agents that use the rule-based model, integrates them into Virtual Interaction APPLication (VIAPPL) and tests their usefulness in predicting and influencing exchange decisions. Precisely, it measures the agent’s ability in reducing in-group bias during interaction in an information-scarce context (Chapter 5). Likewise, it creates machine learning (adaptive) agents that use the data-drivel model, and tests them in a similar experimental context. These chapters were written independently; thus, their objectives, methods and results are discussed in each chapter. Finally, the study presents a general conclusion (Chapter 6).
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    Psychological capital, individual antecedents and work related outcomes in the recruitment industry of South Africa.
    (2014) Shaik, Zurayda.; Buitendach, Johanna Hendrina.
    Despite various studies by multifarious scholars on the management–union relationship, lesser attention has been focussed on the influence exacted by this relationship on Organisational Development (OD). This study, therefore, was focussed on the influence of the relationship between management and unions on OD, and the locus was eThekwini Municipality. The original stimulus for this study emanated from the need to operate transformative and developmental municipalities, using OD as a tool while simultaneously dealing with the disharmonious relationship between management and unions, which appears to be standing in the way. The research questions and objectives were developed in support of the above stated aim, together with the theoretical framework which is based on Societal Corporatism. The theory dovetails into what is termed World Class Manufacturing (WCM) which equates to a World Organisation. WCM consists of five (5) building blocks on which the research questions are formulated. The literature review is based on the five (5) building blocks of productivity measurement, flatter and non-hierarchical structures, continuous upgrading of education and skills, union co-operation and fewer grades. The study is positioned along the lines of the constructivist epistemological approach, and therefore the research design employed is the qualitative design method, and the strategy used is structured face-to-face interviews, based on the narrative phenomenological and grounded theory approaches. EThekwini Municipality was chosen as the study site and the sampling method used was the purposive sampling based on nonprobability approach. The sample size of ten (10) Units consisted of Senior Managers, Union Management, Shop stewards and OD Practitioners. The results obtained from the interviews were organised in terms of 5 major themes. The results amongst others delineated that 100% of respondents agreed that the management-union relationship with regards to OD in eThekwini was not healthy, which supported the need for this study. The results in terms of other themes also supported the negative influence, with tall structures, poor productivity, disintegrated v education and skills development initiatives, absence of union cooperation and the proliferation of grades in the municipality grading system, very prominent. The recommendations for a complete turnaround are also presented in terms of each theme with 60% - 100% of respondents in agreement with the need to change for the better. Inter alia, structures must be flattened through the Municipal Manager invoking Section 22 of the MSA stringently, development and implementation of the productivity measurement and improvement policy, training of managers in labour relations and union officials in management practices, the empowerment of the Skills Unit (EMA) by increasing the budget significantly, joint decision making and strategic planning with unions by management to increase union cooperation. The study also proved its heuristic value with several recommendations being escalated for further study.
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    “At home” at the University of KwaZulu-Natal?: a study of experiences of exclusion amongst academic staff.
    (2021) Nzuza, Nompumelelo.; Durrheim, Kevin Locksley.
    The study aimed to examine how academic staff feels excluded in the institution based on race and gender. The objectives were developed following the current scenario and existing studies conducted in this domain. Six in-depth interviews were conducted with the staff members of UKZN. The interviews were then analysed through the use of thematic analysis. The two main themes that emerged from the interviews were; 1) discontent with the institutional environment and 2) belonging to the university as mediated by race. The study set out to determine whether staff members felt a sense of belonging based on race and gender. However, the study's main conclusion was that academic staff do not feel excluded at the university based on race, but there were masculine spaces that were alienating to female academics. The dissatisfaction felt by the lecturers was directed at the university’s management and the adverse institutional environment that they were creating. The lecturers had 2 different responses; one group of lecturers withdrew from the university and felt that they could not change the status quo. They saw themselves as powerless and inferior to management. The other lecturers identified strongly as a unit and were vocal about their dissatisfaction with management, and they were engaged and resisted management’s dominance.
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    The social construction of HIV risk and implications for HIV testing health practices amongst sexually active youth at a South African university.
    (2021) Chebitok, Betty.; Van der Riet, Mary Boudine.
    The dominant discourses related to HIV and AIDS in South Africa still construct HIV as a huge threat, and position sexually active youth between the ages of 15-24 years as at risk of, and living with, HIV. While an effort to manage HIV infection through practising safer sex is relevant to mitigate sexual transmission, it can be challenging to control the sexual practices of youth, or persuade them to condomise, if they do not prioritise this form of sexual risk. This should leave HIV testing as their primary self-protective strategy (and a priority health issue), but this is not necessarily the case. Research suggests that sexually active youth are not engaging actively in HIV testing. This study addressed this issue by investigating how sexually active university students aged 18-24 years at the University of KwaZulu-Natal on the Pietermaritzburg campus constructed HIV risk; how they constructed and positioned themselves and others in relation to HIV risk; how their constructions and positioning worked, and what they achieved by using them in this way, in relation to their own practice of HIV testing. Convenience, purposive and snowball sampling methods were used to recruit five male and 15 female student participants. In-depth interviews were conducted with all participants, and the data were analysed discursively. The findings of this study were that the majority of participants constructed HIV as an immense and overwhelming threat in terms of its prevalence in South Africa and on the Pietermaritzburg campus, and a few others constructed it as being a minimal threat. Their justifications for these constructions drew on existing discourses in advertisements, the mass media, educational awareness programmes, health research, interactions with health care providers and peers, and their experiences of health care on, and off campus. In terms of participants’ positioning in relation to HIV risk, most of them positioned themselves as being at risk but not at fault, but rather as potential victims of health policies that treat HIV using antiretroviral therapy, rendering it invisible in the ‘everyday’ life. Some of these participants referred to their experiences of a partner cheating, or the possibility of them cheating, and exposing them to risk situations, while others attributed their risk to other people’s destructive behaviours, such as at risk of a violent rapist; an unknown male figure who is positive, and at risk from non-sexual transmission routes, such as exposure to contaminated blood, or ‘touching others’. This positioning adopted by these participants positions them as unable to defend themselves against HIV, and as victims. A consequence of this positioning is that other people are made responsible for creating one’s HIV risk, and one is dependent on these people to avoid HIV transmission. In terms of participants’ engagement with HIV testing, their testing practices suggest that they do not test regularly, and that testing is not part of their management of HIV risk. Those who reported testing did it in a crisis. They were concerned about being infected with HIV after engaging in unprotected sex, or concerned about being betrayed by a partner and being exposed to HIV risk, or concerned about symptoms related to having AIDS. This study concludes that although most participants constructed and positioned themselves as being aware of how serious the threat of HIV is in their setting, they distanced themselves from this risk. This relates to the negative identity of being HIV positive, having a visible sickness, with a body severely affected, wounded, degraded, and attacked, which then also puts one at risk of stigma. In this situation, the positions which are available to them are limited, and the discourses that are available in their context limit their health actions and practices, particularly their engagement with HIV testing as a protective practice. It is as if prioritising HIV prevention through testing does not help them in the development of their desired identity. In fact, it seems to generate a negative HIV identity, and this works to undermine the value of HIV testing in their everyday life. Thus, their avoidance of HIV testing is one of their many small actions to protect themselves from the negative identity, and from knowing it, and others from associating it with them. To address this avoidance of HIV testing, this study recommends that health interventions need to focus on subtle aspects of HIV risk amongst youth, such as the cultural meanings they attach to it, their positioning in relation to it, and their ways of responding to it through testing in terms of what informs their practices, and how and why their processes around testing are maintained and sustained (and what they are), rather than simply enhancing students’ knowledge and improving coverage in the HIV testing services on, and off Pietermaritzburg campus. More discursive qualitative research on the topic of HIV risk and HIV testing amongst students across the University of KwaZulu-Natal campuses is suggested to understand how HIV testing strategies and interventions on its campuses have worked. In view of this, this study provides baseline information within which the findings of subsequent work could be compared.
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    Struggle songs and multidimensional black identities: a phenomenological study on the meaning of struggle songs for black university student activists in the province of KwaZulu-Natal, South Africa.
    (2021) Sekhesa, Thabo.; Mkhize, Nhlanhla Jerome.
    This study sought to explore the meaning that contemporary black student activists from universities in KwaZulu-Natal, South Africa hold towards the struggle songs that they sing. This study was undertaken to gain some understanding into how black student activists use struggle songs to define and construct their identities. A qualitative exploratory design was used. This study was divided into two phases. Phase 1 of the study included the sampling of the commonly sung struggle songs (2015-2018) by black student activists from the YouTube platform (N=21). Political Discourse Analysis (PDA) (van Dijk, 1997) was used to analyse these songs. Phase 2 employed individual interviews with black student activists (N=10). Interpretive Phenomenological Analysis (IPA) (Smith & Osborne, 2003) was used to analyse these interviews. The Multidimensional Model of Racial Identity (MMRI) (Sellers et al., 1998) was the theoretical framework used in this study. A comprehensive understanding of the political history of South Africa and its racial tensions provided the canvas upon which the songs and the lived experience of singing them could be interpreted and understood. Major findings from the study were that discourse strategies such as topics, textual schemata, local semantics, lexicon, syntax, rhetoric, expression structures and speech acts were employed in struggle songs sung by student activists. These discourse strategies were used to varying degrees in the songs to construct the identities of the student activists who sang them. The findings of the study are substantiated by the African notion that the process of constructing an identity is an incomplete and ongoing one to achieve full humanity. Student activists who participated in this study experienced the songs as tools that enabled them to identify with and re-experience the anger and pain of apartheid tyranny. This in turn motivated them to fight against injustice. The conclusion of this fight was interpreted to be a state of generalised acknowledgement of injustices perpetrated against black people in South Africa and the continued pursuit of a just and fair society. The overarching theme of these songs is that of encouragement to become a contemporary black activist who is brave and determined in their quest for the achievement of a complete humanity for all.
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    Addiction and recovery from whoonga : an interpretative phenomenological analysis of the lifeworld of youth from INK townships "in recovery” = Ukubhenywa noku simama ekubhemeni iwunga : kuhlungwa ngokuhlolisisa nge-phenomenology ehumushayo umhlaba wezimpilo zentsha yasemalokishini ase-INK “esimamayo”.
    (2020) Khumalo, Richard Thabane.; Mkhize, Nhlanhla Jerome.; Mayaba, Phindile Lungile.
    In dealing with a rampant increase in addiction to whoonga or nyaope, a heroin variant drug that has taken hold amongst Black youth in South African townships, the employment of addiction treatment that includes harm reduction measures is advanced. Complementary to these approaches, this study speaks to addictions to whoonga from an ecological perspective, a macro level approach concerned with eliminating addictions by identifying their root causes. In seeking solutions and intervention from the environment that begets addictions, recovery draws empirical evidence from overcoming addiction, a science of factors prompting, sustaining, and supporting abstinence and long-term recovery. This is a person-centred approach that begins with an understanding of recovery from experiences of those “in recovery”, people who are in the process of resolving their addiction issues, to advance interventions that people would identify and be familiar with. To make sense of addiction and recovery from whoonga from the perspective of those who were involved, six young Black African males between the ages of 20 and 33, who had desisted from whoonga use for an average of 3.3 years, were recruited from the communities of Inanda, Ntuzuma, and KwaMashu (INK) townships, north-west of Durban. Participants were recruited through snowballing, and by using advertisements. Participants were interviewed indepth, and one-on-one at their original homes, using semi-structured interviews. These interviews were guided by an interview schedule derived from literature on addiction treatment, self-change models, as well as recovery frameworks. Interviews were recorded and transcribed. Transcripts were subjected to interpretative phenomenological analysis (IPA), a qualitative methodology derived from hermeneutic phenomenology that was developed within psychology to add an idiographic component. To understand what addiction and recovery from whoonga meant for participants, four superordinate themes: becoming iphara, being iphara, curative confrontations (becoming human) and nurturing potentials (approximating citizenship), guided discussions. Results show that addiction to whoonga transformed participants in profound and deleterious ways. Addiction was characterised by a state of being iphara, a term that describes the embodiment of dedicated whoonga use. While whoonga addiction was initiated in pursuit of pleasure, escaping difficult life situations, and boredom, and where the influence of friends and peers dominated, it soon became a burden that began with the body becoming the site for pain. The state of being a whoonga addict is described as a preoccupation with the drug and the now, in which there is a deficiency of care for oneself, others, and other life concerns. Largely because of crime committed in the pursuit of the next fix, whoonga addicts are marginalized and ostracised by the community and family members. Other than isolation, to be an iphara is a perilous and precarious lifestyle, in which vigilante attacks from the community retaliating would put addicts’ lives and the lives of those close to them in danger. Arrests presented criminal records with huge implications for future employability. Recovery from whoonga was founded on survival instincts and a sense of self-preservation when difficult conditions as an addict were presented to participants’ lives. The crossroads within whoonga addiction lives jolted participants to the correct orientation to the truth, demanding reorientation to the present, that involved the evaluation of the past and concerns with the future. Although desistance can be coerced, an inner resolve to end addiction lives was deemed necessary; and such bolstered courage to attempt desistance. Desistance involved the use of Methadone: this was difficult particularly for participants who desisted from whoonga use without recourse to medication and professional help. Recovery marks a sense of growing and maturing; taking responsibility for oneself and others, which are efforts of becoming umuntu/human; making amends with peers, family members, and the community. Participants in this study present evidence of overcoming whoonga addiction. They offer an opportunity for the emergence of recovery support in the creation of peer recovery-support groups. Participants would model recovery, presenting hope to those addicted and the community, that overcoming whoonga addiction is a reality. Such should alleviate stigma and create pressure on the unwilling. Peer-recovery groups provide communities of former whoonga addicts with a place to go to. Such communities are best positioned to support early recovery experiments in empathic and non-judgemental ways. To filter preventative measures, reorientation of youth to traditional African ways that support and bolster a sense of pride in who they are, is necessary. Instilling mechanisms of earning membership to the community, and guidance on navigating transition to adulthood, for example, rites of passage amongst youth, would be necessary. The message is that actions and behaviours reverberate, affecting their communities. For youth to understand the plight of own communities, teaching individual responsibility to the health and welfare of communities, is important for prevention. Iqoqa locwaningo Ekuhlahleni indlela iNingizimu Afrika ezobhekana ngayo nokubhebhetheka kokusetshenziswa kwesidakamizwa esibizwa ngewunga noma i-nyaope, nokuyisidakwamizwa se-heroin exutshiwe esesithathe isizinda kwintsha eMnyama ehlala emalokishini, kuhlongozwa ukulandelwa kwezinhlelo eziphakamisa ukusetshenziswa kokulashwa kwezidakamizwa umhlabawonke nezifaka izinhlelo ezehlisa umonakalo odalwa izidakamizwa. Ekuhlangabezeni ngokulekelela lezizindlela, lolucwaningo lubheka ukubhenywa kwalesisidakamizwa ngokusibheka ngokwesimo semvelo, nokuyindlela ebanzana efaka ukuqedwa kokubhenywa kwezidakamizwa ngokuthola izimbangela eziyizinzika edala ukubhenywa kwezidakamizwa. Ukuthola izixazululo nendlela okungangenelelwa ngayo ngokwezendawo edala ukuhuqwa kwalezizidakamizwa, ukusimama ezidakamizweni kuhlongoza ukuqhakambiswa kwezindlela abantu abasimama ngayo ekubhemeni izidakamizwa, nokuyisayensi yokusimama efaka ukuthi yini eyenza abantu baqalise ukusimama, bakulondoloze futhi balekeleleke ukuthi baziyeke futhi baqhubeke bengazibhemi izidakamizwa. Lokhu kubeka phambili umuntu ombandakenyayo, okuqala ngokuthi siqondisise kahle ukuthi abantu abasimamayo, nabaziyekile izidakamizwa benzenjani, ukuze sikwazi ukuthola izisombululo ezizojwayeleka kubantu ngoba zisuselwa kulokho abakwaziyo nokwenzekayo ezimpilweni zabo. Ukuqondisisa kahle ukubhuqabhuqwa nokusimama ekubhuqwabhuqweni ukubhema iwunga kususelwa kwizindlela abayibona ngayo labo abambandakanyekileyo, izinsizwa eziMnyama eziyisithupha ebezineminyaka esukela kwamashumi amababili kuya kumashumi amathathu nantathu, nababesebeyiyekile ukuyibhema iwunga isikhathi esingangeminyaka emithathu nezinyanga ezintathu sebebonke, batholakale kumphakathi wamalokishi aseNanda, eNtuzuma naKwaMashu, kwinyakatho ntshonalanga yeTheku. Ababambe iqhaza kulolucwaningo batholakala ngokuthi bamemane, kwasetshenziswa nezikhangiso. Kwaxoxwa nabo kabanzi kwizinkulumo ubuso nobuso besemakubo. Lezizingxoxo zazingakhululekile ngokuphelele ngoba zazilandela imibuzo eyayihleliwe. Lemibuzo ehleliwe yasuselwa kwimibhalo nezingcwaningo ezidlule kwizifundo zokulashwa kokubhuqabhuqwa izidakamizwa, ukuziguqula kwabantu ngokwabo kanye nakwizinhlaka zokusimama ezidakamizweni. Lezizingxoxo zaqoshwa zabhalwa phansi umcwaningi. Lemibhalo yabe isihunyushwa kusetshenziswa i-interpretative phenomenological analysis (IPA), nokuyindlela yokucwaninga e-qualitative, esuselwa kuhlobo lwe-phenomenology ehumushayo eyabe isifakwa ukuhluza iidiography ngaphansi kwazo izimfundiso zoMoya. Ukuthi ingenziwa njani lendaba yewunga izosuselwa kwizinhlaka zokusimama. Ukuqondisisa ukubhenywa nokusimama ekubhemeni ADDICTION AND RECOVERY FROM WHOONGA: AN IPA vi iwunga, kuzosetshenziwa lezizingqikithi ezikhuluma ngo: Ukuqala ube iphara; Uma usuyiphara, Ukunqwamana nezimo ezinzima kodwa ezilulamisayo (Usuqala uba umuntu), bese kuba ukwenza izinto eziqhubekisela phambili impilo uzokwazi ukubuyela usebenze njengomuntu ojwayelekile (okungukwenza izinto ezisimamisayo neziwubuntu). Imiphumela yalolucwaningo itshengisa ukuthi ukubhuqwabhuqwa iwunga kwabashintsha ngendlela egxilayo nenemiphumela emibi kubona siqu sabo, nokuchazwa njengokuba iphara nokungukuba isimo sobuhambuma. Nakuba ukuqala ukubhema iwunga kwakungukuhubha intokozo nokuthanda izinto, kubalekelwa izimo ezinzima emakhaya nesimo sokungenzi lutho, lapho kudlange ukushomana nokuthokozisa abangani, iwunga yabe isisuka iba umthwalo, okwaqala ngomzimba usugqamisa ukuba sezinhlungwini. Ukuba iphara kuchazwa njengokunaka iwunga kuphela nentokozo yamanje, lapho umuntu akasenandaba naye, abanye abantu kanye nokwenza ezinye izinto ezibalulekile empilweni. Ngenxa yobugebengu, ukuba iphara kusho ukunyongozwa umphakathi nemindeni, bakukhiphela ngaphandle. Ngaphandle kokunyongozeka, ukuba iphara impilo enobungozi lapho intukuthelo yomphakathi ongahlasela ubeke impilo yakho kanye neyomndeni wakho encupheni kungenzeka. Uma beboshwa babuya benamarekhodi obugebengu okwenza kubenzima ukuqasheka. Ukusimama ukubhema iwunga kutholakala lapho impilo isikubhincisela nxanye sekusele ukuzisindisa wena sekufike izimo ezinzima ezihambisana nokuphila impilo yokubhema iwunga. Lesisimo sokukhetha sihlokolozwa ukuzibuzisisa nokubheka impilo ngendlela eyiqiniso ephoqa ukuthi umuntu abuke isimo lapho ekhona, abuke emuva bese ecabanga ngekusasa. Nakuba ukushiya iwunga kungaphoqwa, uma kusuka ngaphakathi kuyaye kumthwale umuntu ukuthi amelane nezinhlungu zokuyeka. Kwasetshenziswa i-Methadone ukuyeka iwunga, kunzima kakhulu ukuyiyeka, ikakhulukazi kulabo abavele bayeka bengasebenzisanga muthi bangaya nakwabezempilo. Ukusimama kunokufana nokukhula, uyimele impilo ubenendaba nokuzinakekela unakekele nalabo abaseduze kwakho, okuyimizamo yokuba umuntu, uphinde uzwane nabantu, imindeni, abangani kanye nomphakathi Ababambiqhaza basivezela ubufakazi bokuyekeka kwewunga. Basinika ithuba lokuqala izindlela zokulekelela labo abafuna ukuyiyeka, kanye nalabo esebeyiyekile, bengabuyeli. Bangahlahla indlela etshengisa abanye ukuthi iwunga iyayekeka. Bangahlanganyela ndawonye basize laba abasandakuyiyeka ngendlela engezobanyongoza bezozwelana nabo ngosizi abalwaziyo bonke. Ukubhenywa kwewunga emalokishini kuqeda isithunzi, lapho uma ubuntu bufundiswa kwintsha kungaveza izindlela zokuziphatha, nokubaluleke ekuqhubekezeleni umphakathi phambili. Lokhu kungasiza ukuthi balulame nokuthi bengayiqali nokuyiqala iwunga.
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    Body image and antiretroviral therapy adherence among adolescents and young people living with HIV in Durban, South Africa.
    (2021) Nyamaruze, Patrick.; Govender, Kaymarlin.
    Background: The benefits of antiretroviral therapy (ART) for treating HIV among adolescents and young people living HIV (AYPLHIV) may be undermined by non-adherence to ART. Several reasons for non-adherence to ART have been reported among young people including internalised HIV-related stigma, body image concerns, and depression. Research into how AYPLHIV experience and make sense of feared or actual body changes is limited, yet these changes have emotional and psychological implications which may curtail adherence to ART. This doctoral thesis investigated the relationship between body image and various psychosocial factors; and explored the perceptions and feelings about body appearance among AYPLHIV in Durban, South Africa. Method: A cross sectional, convergent parallel mixed method approach was adopted in which quantitative and qualitative data were concurrently collected in the same phase of the research process using non-probability sampling. For the quantitative part of the study, a total of 76 AYPLHIV (15-24 years) were conveniently sampled. Qualitative data were obtained through a series of semi-structured in-depth interviews with a sub-set of 18 AYPLHIV who were purposively and conveniently recruited from the quantitative sample. Descriptive statistics, Pearson Product Moment correlations, and mediational analyses were used to analyse the quantitative data whereas thematic analysis was used for the qualitative data analysis. Results: The converging quantitative and qualitative results from this study provide evidence that body image is a significant issue among AYPLHIV and is differentially associated with various psychosocial factors. Self-esteem and adherence to ART were indirectly associated through a two-step path of internalised HIV-related stigma and then body appreciation. Findings from the qualitative analysis showed physical and psychosocial effects of living with HIV among young people including weight loss, body dissatisfaction and social withdrawal. Coping mechanisms such as social support networks and physical exercises were highlighted as important in counteracting the physical and psychosocial effects of negative body image and living with HIV. Conclusion: The findings from this study suggest that body image concerns are central to the health and well-being of AYPLHIV as they are related to several psychosocial challenges. The findings underscore the need for development of multi-pronged interventions to boost body image.
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    Personality as a predictor of job stress among teachers' college lecturers in Zimbabwe.
    (2021) Senderayi, Patrick.; Mkhize, Nhlanhla Jerome.
    This quantitative-dominant mixed methods sequential explanatory study sought to investigate how personality predicts job stress in a sample of Zimbabwean teachers’ college lecturers from an agrarian collectivistic culture. Key concepts were illustrated using the five-factor model of personality, the Cultural Transactional Theory of Stress and Coping, and the Job-Demands- Resources model. 211 lecturers were surveyed using four self-report measures; Occupational Stress Survey, Oldenburg Burnout Inventory; Coping Orientations to Problems Experienced, and the Big Five Personality Test. Thirty (30) participants were purposefully selected using maximal variation sampling for the in-depth interview. Multiple linear regressions identified dominant personality traits that predicted job stress, burnout and coping. Correlation analyses determined the shared associations between personality traits and dominant job stress, burnout, and coping dimensions. Extraversion was a weak predictor of demands and control. Extraversion, neuroticism, and conscientiousness showed a low correlation with exhaustion. Coping was related to conscientiousness, neuroticism, and openness to experience. Lecturers reported an immense workload, which was made more stressful by under-staffing and large classes. They disengaged from their jobs because these were mechanical and routine. Lecturers reported exhaustion caused by the pressure of deadlines, which caused imbalance in work-life. They also used a range of coping strategies to mitigate the negative impact of job stress and burnout. This study adds to the existing literature on the stress of lecturers, and provides some evidence to support the universality of traits. Implications of stress, burnout and coping are highlighted.
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    Defining and understanding organisational culture dimensions within the African context : a reconceptualisation of Schein's model.
    (2020) Ramiah, Subashnee.; Buitendach, Johanna Hendrina.; Petrus, Ruwayda Chantelle.
    This study was undertaken due to the limited research concerning organizational culture within Africa. The purpose of this study was to explore and recognise how African organisations define and understand the different dimensions of organisational culture and how this compares to Schein's model of organisational culture. The study used a qualitative approach to gather and interpret data, resulting in a model used within Africa to understand the different organisational culture elements and applied in the institutions that contributed to the research. This study introduced organisational cultural dimensions for African countries that should be used to ensure employees and organisations remain productive, efficient and relevant. The dimensions that were found per Africa are organisational culture, strategy, and values that have further subthemes discussed. The sub-themes identified were goals, procedures, leadership, performance management, induction and communication, customer service, recognition and teamwork. These are relevant as they provide deeper context into the broad organisational dimensions identified in the study. This provides a way forward for organisations in Africa as this research provides a framework for them to understand the dimensions that would influence their organisational culture.
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    An analysis of community based health approaches in the delivery of integrated sexual, reproductive health and HIV services for adolescents with disabilities in Siaya County, Kenya.
    (2019) Mbanga, Paul James.; Govender, Kaymarlin.
    There is evidence of widening health disparities among vulnerable groups and inadequacies in the public health care system in sub-Saharan Africa (SSA), including Kenya. In particular, adolescents with disabilities (AWDs) confront many challenges in accessing health services. Their increasing primary care needs and rights in terms of sexual and reproductive health (SRH) is beyond the capacity of the conventional health system. While the Community Based Health Care (CBHC) approach has improved basic health services for maternal and child health as well as HIV and AIDS interventions, its capacity and utility to address the SRH and HIV interventions required by AWDs is not adequately studied in Kenya. Furthermore, debates persist on the overall quality of services provided through such primary health care systems. This study therefore investigated the CBHC approach as an option for improving AWDs‘ access to and use of Kenya‗s state-run adolescent SRH and HIV services in Siaya County of rural Kenya. The descriptive qualitative case study design used systems theory that featured Urie Bronfenbrenner‗s bio-ecological (Person-Process-Contexts-Time) and the World Health Organisation‘s (WHO‘s) (building blocks) health systems assessment frameworks as the main models to conceptualize, design, collect, analyze and interpret the data. Qualitative methods of data collection were used to explore purposively selected CBHC programs, and included semi-structured interviews, focus group discussions, observations, case narrations and record reviews. The study exposed serious institutional level inadequacies of the existing CHBC approaches, which were largely mediated by the disabling operating environment in the county health system. These ranged from poor staffing, inadequate financing, inadequate family support and community care, and unresponsive policy and legislation frameworks that lack enforcement mechanisms. Furthermore, the study found challenges associated with personal attributes including age, gender, type of disability, schooling and awareness of risks and available community-based services. Sexual and xii gender- based violence against the backdrop of an irresponsive justice system dominated the plight of AWDs in the county. As a result of analysing these factors, the evidence suggests a need to address the unique challenges surrounding the multi-dimensional issues that mediate access to and use of healthcare for adolescents living with disabilities to achieve equitable access to SRH & HIV services. In particular, the government should foster positive mechanisms of supporting community- based programs through co- financing with donors to expand the resource base for effective health services delivery, including SRH and HIV services for AWDs. Moreover, responsive policies and legal frameworks that were inclusive in approach to community care for AWDs would need to be clearly enunciated and enforced by the government and its stakeholders. Lack of data related to AWDs should be addressed to facilitate effective programming.
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    Donor-NGO accountability mechanisms and the implications for HIV and AIDS: perspective from NGOs on service effectiveness in South Africa.
    (2019) Mpofu, Limkile.; Govender, Kaymarlin.; Whitman, Jim.
    The study investigates the nature and extent of HIV and AIDS donor accountability mechanisms to see whether they were diminishing NGOs' capacity to achieve positive outcomes for beneficiaries. In particular, it focuses on the degree to which accountability mechanisms might inhibit NGOs from achieving the outcomes they share with the donors. The study examines the operations of both national and international NGOs that work on HIV and AIDS, focusing on the mechanisms of accountability to their donors, both public and private because the advent of HIV pandemic globally and especially in sub- Saharan Africa brought with it the urgency for actions and responses beyond the public sector. The study analyzed how the power disequilibrium between donors and recipient NGOs limits development outcomes. The focus would often shift from addressing the beneficiaries' needs at the grassroots level to the donors' administrative requirements. An in-depth interpretive case study approach was adopted to study five HIV and AIDS NGOs in Gauteng, South Africa. The researcher chose South Africa because it has the largest and most high-profile HIV pandemic globally, with an estimated 7.2 million people living with HIV in 2017. The study's findings were analyzed and interpreted through the lens of the basic accountability mechanism theory of Julia Steets. The study findings revealed that accountability is not a ‘one size fits all’ concept and practice because of the socio-economic and cultural differences that exist in different contexts. The study revealed the dynamic and complex relations between the HIV /AIDS NGOs and donors in their efforts to serve the beneficiaries. Donor dependency and service distribution affected interactions between donors, NGOs and beneficiaries. The study concluded that NGOs cannot be simultaneously concerned with accountability on the scale now often required of them without impacting their operations. They are experiencing severe difficulties mediating the tensions between balancing donor organizational interests and beneficiaries' interests as the NGOs’ administrative burden of accountability mechanisms has detracted time and resources from their main work of providing services and from developing equitable accountability mechanisms between themselves and the beneficiaries of their projects. This limits NGOs’ capacities to develop further community level interventions and detracts from close relations with beneficiaries in ways that address what the beneficiaries say they need with regard to HIV/AIDs services. Overall, the study is a contemporary attempt to contribute towards theory development in contextual accountability in the donor-NGO development structure. Key Words: Accountability Mechanisms, Accountability Practices, HIV & AIDS NGOs, Donors, Beneficiaries, Programs, service delivery, sanctions and rewards, Donor-NGO relations.
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    An autoethnographic study of my experience with breast cancer.
    (2020) Johns, Lucinda Theresa.; Sliep, Yvonne.; Richards, Roselee.
    My breast cancer experience facilitated the exploration of my intersectional identities within an autoethnographic framework. I contextually reflected on my personal and professional identities within the interactional lens of silence and vulnerability. The qualitative methodology of autoethnography allowed me to use autobiographical self-reflective data collection that included self-narrative, poetry, photographs, presentation, intersecting academic and community spaces. The data collection informed the analytical intersecting chapters that reflect the research question and the associated three objectives: (1) to explore the transformative nuances of my breast cancer in relation to my intersecting identities, (2) examine how my profession as an academic and psychologist had an influence on meaningmaking of my illness and healing and (3) investigate the contextual contributions of interconnectivity within communities. The concluding chapter reasserts the intersecting matrix of my identities as I navigated through my breast cancer experience. This elaborate autoethnographic process ultimately contributes to existing knowledge and the national narrative of breast cancer within the South African context.
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    Eye movement desensitisation and reprocessing therapy in the treatment of sugars addiction (a derivative of heroin) : gaining control over cue reactivity and cravings.
    (2021) Dawood, Naseema Hoosen.; Meyer-Weitz, Anna.
    Eye movement desensitization and reprocessing therapy (EMDR) developed by Francine Shapiro is an integrative psychotherapeutic approach that has been described as one of the most well researched forms of psychological treatment, however there are few empirical studies investigating the effects of EMDR therapy on addiction. The purpose of this study was to investigate the effects of EMDR therapy on cravings and cue reactivity in sugars “heroin based” addicted persons and to determine whether the EMDR therapy process is useful in reducing or extinguishing the psycho physiologic intensity of a craving. This research attempted to fill the hiatus in the literature related to EMDR therapy in craving management, as well as a clearer understanding and management of the sugars scourge in KwaZulu-Natal. A quasi-experimental study with a control and experimental arm was conducted and supported with clinical interviews over different time periods. Seventy participants from the two inpatient rehabilitation facilities in KwaZulu-Natal were assigned to one of two therapeutic conditions, viz. EMDR therapy and relaxation training, of which 35 participants from one of the rehabilitation facilities received two sessions of EMDR therapy (experimental group) and 35 participants from an alternate facility received two sessions of relaxation training (control group). Non-parametrical statistics were used to analyse and compare the craving experiences of the experimental and control groups. The superiority of one treatment over the other could not be demonstrated suggesting that EMDR therapy and relaxation training tend to be equally efficacious in managing cue reactivity in sugars addicted persons. Whilst there were no statistical differences between the experimental and control group, the clinical interviews revealed that the EMDR therapy group participants were more confident about their recovery and more knowledgeable about the addictive processes that encouraged their continued use of sugars. Further research is needed with larger and varied samples to determine the superiority of the one treatment over the other. Whilst the findings of the present study cannot be generalized due to the small sample size, it has important clinical implications for craving management. It is hoped that the study will not only contribute to a greater understanding of the effects of the therapeutic processes in the treatment and management of cravings in sugars addicted persons but will also stimulate further research in this field.
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    The prevalence and magnitude of cognitive dissonance in post-purchase evaluation.
    (1997) Brijball Parumasur, Sanjana.; Thomson, Elza.
    Abstract available in PDF.
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    Addressing the treatment gap for perinatal depression within an integrated primary health care model: development and feasibility study in the Dr Kenneth Kaunda District, North West Province.
    (2020) Kathree, Tasneem.; Petersen, Inge.
    Background: Perinatal depression (PND) is a common mental disorder (CMD) with onset either during pregnancy or in the postnatal period, with potentially harmful inter-generational impacts on families, and by extension on communities. In South Africa a combination of high prevalence rates for PND, an estimated treatment gap of 75 percent for CMDs, and a large medically uninsured population poses a public health and social burden. Compounding the issue, there is a lack of awareness of and minimal attention paid to PND in scarce-resourced primary health care (PHC) settings in South Africa. Consequently, screening, referral and treatment for PND is low to absent, as are targeted pharmacological and psychosocial therapies for PND. Internationally, evidence supports the concepts of both collaborative care and task-sharing to address PND in low-and middle-income countries (LMIC). In South Africa however, despite support for the integration of mental health services into general health care, promotion of perinatal mental health care, and endorsement of task-sharing in mental health care, promoted by a national mental health policy framework, there is an absence of clear strategies to address PND in the mandated maternity care guidelines in PHC. In response to this service and evidence gap, the aim of this study was to co-develop and evaluate the feasibility of a culturally and contextually appropriate integrated model of care for PND with PHC service users and service providers. The research aimed to contribute towards the body of evidence towards the development of integrated, PHC-based, task-shared collaborative care for PND in South Africa and other LMIC. The study was guided by explanatory models of illness and the UK Medical Research Council framework for complex interventions. Methods: Set in an urban 24-hour service community health centre in the Dr Kenneth Kaunda District, North West province, and nested within the larger PRogramme for Improving Mental health CarE (PRIME) project, the study was undertaken using a phased approach. The first step was an in-depth review of the literature on task-shared care, integrated or collaborative care for PND, particularly in LMIC, and the platforms, models and cadres used in task-shared care for PND. These essential components for task-shared PND care in LMIC were identified and guided the development of the interview schedules for both service users and service providers. In-depth semi-structured interviews were conducted with 20 service users to understand their perceptions, attitudes to task-shared care and recommendations to address PND, using thematic analysis to analyse the data. This work comprised the first phase of the study. In the second phase, nurses (n=10), HIV counsellors (n=20) and operational managers (n=4) were interviewed to gauge their clinical understanding of PND, attitudes to task-shared mental health care and recommendations to address PND. This was followed by a participatory workshop which included nurses, managers and specialists to co-develop a model of care for PND. An additional six key informants were interviewed for institutional perspectives and guidance on the model. Framework analysis was used to analyse the data in this phase. In the third phase, a quasi- experimental cohort design was used to recruit perinatal care attendees (n=54) to evaluate depression outcomes, feasibility and acceptability of the model. Primary care nurses consulting women attending antenatal and postnatal services were trained to identify women with depressive symptoms using a short maternal depression screening tool, and clinical assessment. Pregnant and postnatal women (6-48 weeks postpartum) who had mild/moderate depressive symptoms were referred to an existing 9-session manualized counselling intervention addressing common triggers of depressive symptoms, based on cognitive behavioural approaches, provided by a co-located non-specialist counsellor. Women with moderate/severe depressive symptoms were referred to both the counsellor and upwards for specialist assessment and treatment. Participants were administered a questionnaire including the Patient Health Questionnaire 9 (PHQ9). Service users (n=31) identified by nurse clinicians and referred for counselling and/or further treatment were assigned to the intervention arm, and service users (n=23) not identified with PND by the nurse, but who screened positive on the PHQ-9 were assigned to the control arm. Participants were interviewed at baseline and four months after baseline to assess change in PHQ-9 scores. Qualitative process evaluations were also conducted with five service user participants and eight health workers after the four-month assessment to identify evidence of feasibility and acceptability, challenges and recommendations. Results: The qualitative results from the first phase indicated support for task-shared care and produced service-user recommendations to address the need for psychoeducation, support groups and counselling, either at community or facility-levels for PND. The second phase service provider engagement (participatory workshop) culminated in the co- development of a task-shared, collaborative care model for PND, with strengthened referral pathways, based on the nurse clinician screening, diagnosing, and referring onward to either a facility-based non-specialist counsellor, a doctor or a mental health specialist. In the third phase, an evaluation of the task-shared, collaborative care model with strengthened referral pathways to a co-located psychosocial intervention delivered by non-professional mental health workers at PHC level, indicated a clinically significant decline in depression scores (10- point reduction) in the intervention arm from baseline (M=14.3, SD 2.9), and at four- month follow-up (M=4.3, SD 4.5). Qualitative data indicated that participants experienced the counselling intervention as beneficial and acceptable. The non-specialist, co-located counselling was viewed by most nurses as beneficial although there were recommendations to streamline the screening and diagnosis process. Process indicators suggest that the model is feasible and acceptable. Conclusion and recommendations: This study has contributed new applied knowledge regarding the development and evaluation of a task-shared, integrated, collaborative care model for PND at PHC level in South Africa, providing evidence of feasibility and acceptability of the model of care. The favourable results suggest the potential for a larger effectiveness study, based on the recommendations and lessons garnered from this study. At the time of this report, the policy developments within the mental health landscape demonstrate a level of awareness among a minority of policy-makers, researchers and health care providers of the need to promote perinatal mental health. However, the lessons from this study suggest that key policy level changes are required which include but are not confined to the adoption and reporting of mental health data elements and indicators for PND, and adaptations to the maternity guidelines to include detection in the form of brief screening, assessment, diagnosis and referral for PND. With reference to task-shared mental health care, the inclusion of social workers in counselling treatment plans, and the identification of appropriate cadres, trainers, training, and supervision for non-specialist mental health counsellors are critical factors that require concerted political will and effort.