Doctoral Degrees (Centre for Communication, Media and Society)

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An exploration of community radio, culture and health communication among rural and semi-urban dwellers in the central region of Ghana: a case study of Covid-19 and Radio Peace.
(2022) Essel, Emmanuel.; Govender, Eliza Melissa.
The mainstream global COVID-19 communication for development and social change approaches, instituted by the neoliberal forces, hinge on information dissemination targeting individual behavioural change to halt the spread of the virus (Dutta et al., 2020). Ghana’s public health communication about COVID-19 has primarily employed persuasive approaches using mainstream channels to share the WHO-approved non-pharmaceutical interventions (NPIs): personal hygiene, mass masking, social distancing and pharmaceutical measures. However, the adequacy of mainstream approaches to meet the COVID-19 communication needs among marginalised communities is unclear. This study focuses on pandemic responses and explores community participation through counter-discursive platforms like community radio. This thesis explores how local cultures influence the ability, modality and extent of community members’ participation in the workings of community radio in promoting COVID-19 relevant health communication. This study uses qualitative data from three semi-urban and rural community radio host districts in Ghana collected between July and December 2021. Radio Peace, a community radio station in Winneba, Ghana’s Central Region, serves as a single case study. Purposive sampling was employed to select participants from the Effutu Municipal, Awutu Senya West, and Gomoa West Districts, Ghana’s Central Region. By using the culture-centred approach and participatory communication, eight (8) focus group discussions (FGDs) and eleven (11) in-depth interviews (IDIs) were conducted to understand how community radio attends to the communicative needs of marginalised people living within the selected communities. Data were analysed using reflexive thematic analysis. The findings suggest that community radio enhances the agency of marginalised people by providing an accessible public sphere for community-level dialogue concerning COVID-19 prevention using indigenous language. However, the involvement of marginalised people in Radio Peace’s COVID-19 communication intervention was limited by structural factors. These include indecorous language during on-air discourses, economic challenges of batteries to power radio sets, irregular community visits by the station’s staff, transmission challenges, and difficulty in calling into programmes due to jammed telephone lines. The study concludes that social, economic and cultural contexts significantly influence active listeners’ ability to participate in community radio interventions that pertain to COVID-19 communication. It also considers that community radio effectively communicates COVID-19 prevention messages that offer active listeners opportunities to be involved meaningfully in the interventions. Thus, the study proposes the socio-cultural model for the future conception, design and implementation of COVID-19 communication interventions for community radio in a manner that allows for marginalised people’s meaningful participation in such responses. Access, social capital and community participation are critical for effectively implementing the socio-cultural model for COVID-19 communication using community radio. The success of the socio-cultural model for COVID-19 communication hinges on a nuanced understanding of the beneficiary communities’ local needs, values, structural factors and economic capabilities.
An exploration of the social-cultural factors that influence oral pre-exposure prophylaxis uptake and integration into sexual and reproductive healthcare services for young women in KwaZulu-Natal.
(2019) Nota, Phiwe Babalo.; Govender, Eliza Melissa.
In the past, HIV prevention efforts have disappointingly focused on reducing individual risk, with insufficient attention to socio-cultural, economic, structural, and other contextual factors that increase vulnerability to HIV. However, public health efforts towards HIV prevention now focus on combination strategies. This strategy recognizes that the integration of biomedical, social and structural interventions in mitigating the HIV and AIDS epidemic will translate to population-level impact. In Southern Africa, young women are disproportionately vulnerable to HIV infection, with women between the ages of 15 to 24 twice more likely to be infected than men. However, the licensure of oral pre-exposure prophylaxis (PrEP) and the South African National Department of Health policy on the integration of oral PrEP in sexual reproductive health (SRH) services creates renewed hope for young women who are often unable to negotiate safe sex practices. Nevertheless, the effectiveness of biomedical technologies is influenced by socio-cultural, structural and economic factors. This underscores the need to understand; (a) Populations that will consider using oral PrEP, (b) The likely socio-cultural challenges or opportunities that will influence acceptance, uptake and adherence of oral PrEP, and (c) How to integrate oral PrEP in already existing SRH services in a manner that ensures optimal adherence to oral PrEP to key population groups. This study sought to find effective ways in which oral PrEP can be integrated into SRH services in South Africa, KwaZulu-Natal (KZN). To attain an in-depth understanding of this topic, participatory visual methodologies in the form of journey mapping workshops and one-on-one interviews with 15 young women taking oral PrEP were facilitated. The participatory approach to this inquiry created an enabling space for young women to engage in dialogue about oral PrEP. Young women need to be placed at the centre of the response to HIV and AIDS in a meaningful way that will facilitate sustainable interventions in the fight against HIV and AIDS. Two nurses from both research sites were also interviewed to yield healthcare providers perspectives into the study inquiry. The study has the potential to inform policymakers on how existing SRH services can be improved to multi-dimensional systems that support oral PrEP uptake and adherence by young women at high risk of HIV. Findings of this study support the conclusion that oral PrEP needs to be integrated into already existing SRH services in ways that are context-specific and culturally relevant for communities. The young women in this study explicitly shared the various social and cultural factors that will influence them accessing oral PrEP in SRH services within their local clinics. Issues related to the structure, services offered and healthcare provider’s attitudes will affect acceptance, uptake and adherence of oral PrEP by young women in rural and urban KZN communities.
Exploring the role of adolescent youth-friendly services (AYFS) in primary health care clinics that offer HIV and sexual reproductive health (SRH) services for adolescent girls and young women in Vulindlela, KwaZulu-Natal, South Africa.
(2020) Vukapi, Yonela.; Govender, Eliza Melissa.
In sub-Sahara Africa, adolescent girls and young women (AGYW) bear a disproportionate burden of sexual and reproductive health (SRH) risks, where HIV infection and adolescent fertility are a major concern. Specifically, in South Africa, it is estimated that nearly 2 000 AGYW between the ages of 15 to 24 years are infected with HIV every week. Furthermore, it is estimated that by 2019, 15,6% of females between the ages of 15 and 19 years in South Africa had begun childbearing. Consequently, systemizing and expanding the reach of quality AGYW health service provision is part of the South African National Adolescent and Youth Health Policy. To promote accessibility, efficiency, quality, and sustainability of adolescent youth-friendly health services (AYFS) in primary health care clinics, national response to the HIV and SRH needs of AGYW need to be prioritized. It is for this reason that AGYW is a key focus in this study. This study was conducted in Vulindlela, in the uMgungundlovu district in KwaZulu-Natal. This area reports high levels of HIV infection, with notable high fertility rates among AGYW. The study was conducted in 3 primary health care clinics that have initiated the AYFS programme, providing HIV and SRH care to AGYW. This study has three aims: (1) to investigate whether primary health care clinics offer youth-friendly HIV and SRH services to AGYW (2) to assess the current strategies employed in primary health care clinics to make HIV and SRH services adolescent youth-friendly and (3) to explore the potential of adolescent youth-friendly services in influencing HIV and SRH care among AGYW. This study is framed by the culture-centered approach (CCA) in understanding AGYW’s experiences when accessing HIV and SRH services in primary health care clinics. CCA is founded on the principles of listening to the voices of the margins that have hitherto been unheard in policy and programming circles. Purnell’s cultural competency model (CC) of health care nurses is also crucial for AYFS to effective among AGYW. This model encourages health care nurses to understand the heritage and culture in which their patients come from in order to provide acceptable and suitable HIV and SRH services. A participatory action research design was adopted, where data collection was threefold: a PhotoVoice workshop, focus group discussion and individual interviews. Key findings from this study highlighted that lack of congruent care, administration, time management, shortage of infrastructure and health care nurses negative attitudes were identified as the main deficits to AGYW SRH care clinic. However, AYFS in primary health care clinics could encourage HIV and SRH care among AGYW. Having younger health care nurses at the clinic was one strategy that AGYW alluded to in this study. AGYW also mentioned that having a separate building for AYFS would improve their adherence to HIV and SRH services like HIV testing, family planning and antenatal care. This study highlighted the need for greater understanding of the socio-cultural perceptions of health care workers’ perceptions of adolescent sexual and reproductive health, and the provision of HIV and SRH services. This study found that HIV and SRH services are currently not youth-friendly for AGYW across all three clinics in which the study was conducted. AGYW described that the clinic structure does not have enough space to, and therefore hinders their privacy at the clinic. Health care nurses attitudes and the lack of communication between AGYW and nurses at the clinic were some of the key findings in this study. On the contrary, health care nurses find it challenging to focus one patient at the clinic because of shortage of clinical staff and administrative staff.
Processes and participation in HIV and AIDS communication : using bodymapping to explore the experiences of young people.
(2013) Govender, Eliza Melissa.; Tomaselli, Keyan Gray.; Durden, Emma.; Dalrymple, Lynn I.
HIV and AIDS is one of the biggest challenges facing South African young people today (Govender, 2010). Young people are at risk, partly through their own behaviour and partly through the attitudes, expectations and limitations of the societies in which they grow up (Panos AIDS Briefing, 1996).The are many HIV prevention programmes developed globally and nationally, specifically for young people but the pandemic still escalates rapidly. The fourth decade now calls for multidimensional approaches when communicating HIV prevention for young people. This thesis explores how young people can contribute to this multidimensional approach through their active participation in the various phases of developing HIV projects. The study does this through a sample of eight youth-focused HIV organisations in KwaZulu-Natal and a sample of students from the University of KwaZulu-Natal, to gain more insight into participation of young people in the development of HIV programmes. Bodymapping, a visual and art-based method, was used to explore young people’s understanding of HIV, their perceptions of HIV programmes and the possibilities of their participation in the developing of further HIV projects. The study used a grounded approach and applied principles of participatory action research to collect data in four phases. The first phase used interviews and focus group discussions with eight sample organisations to give insight into the programmes offered to young people and how they engage and make sense of their participation within these programmes. The second phase draws on previous bodymapping workshops that have been conducted with students from UKZN and young people in various communities to explore the application and relevance of bodymapping. In the third phase, data is presented on two bodymapping workshops conducted, to engage with young people about their contribution to the development of HIV programmes. The final phase draws on two focus group discussions, conducted with bodymapping participants, to examine their experiences and interpretation of the bodymapping process. Some of the key findings indicate that a blanket approach to HIV programmes will not always work, as young people’s sexual behaviour needs to be explored within a wider socio-ecological framework that recognises the inter-relational and interconnected system in which they make their sexual choices. The data indicates that youth and organisations strongly support the importance of participation and the inclusion of participants when developing HIV projects. However, discussions about participation indicated that while young people could identify the importance of participation, they still lacked an understanding of how to participate and how they could learn more about their lived experiences through participation. This was evident in the data where there was a distinction in how participation was defined from those in the UKZN group and those from rural KZN. In understanding what constitutes participation, young people are better positioned to aid the process of developing effective HIV related projects that are participant specific. I argue that bodymapping can be used as a process to initiate and aid the participation of young people in the various phases of developing HIV projects. A three level model for applying bodymapping and planning processes has been developed to encourage participation with young people where the first step ensures that young people define what participation means to them. This becomes the foundation for how communication practitioners and academics make sense and theorise participation from a participant informed perspective. Bodymapping was pivotal in this process of engaging young people in self-reflection and introspection which encouraged a process of dialogue towards better understanding and defining participation from a participant perspective. Bodymapping in this way can be identified as a catalyst that encourages dialogue as part of communication for participatory development.
(Re)positioning communication for enhanced multidrug-resistant tuberculosis treatment adherence in South Africa: towards an integrated communication model for young women.
(2019) Mugoni, Petronella Chipo.; Lubombo, Musara.; Govender, Eliza Melissa.
Tuberculosis (TB) is a significant public health threat in South Africa, which has been the leading cause of natural mortality over many years (Statistics South Africa 2018; Statistics South Africa 2017; ENCA 2015a). Although TB has been largely eradicated in the Global North and available literature explains how this was achieved, in developing countries like South Africa incidence of not only TB, but drug-resistant forms of the disease continue to grow (Shah et al. 2017). There are many explanations for these trends, including unavailability of less noxious anti-TB medications, serious side effects and lengthy treatment timelines, drug stock-outs, context-determined structural, socioeconomic, cultural and gender-based barriers to treatment adherence and inadequate or ineffective patient and community education about the disease (Shringarpure et al. 2016). Concerns occur on the backdrop of health systems that overly privilege biomedical responses to TB, to the detriment of all other interventions. Scholars protest that ‘The TB literature is written almost entirely from a biomedical perspective, while recent studies show that it is imperative to understand lay perceptions to determine why people who seek treatment may stop taking treatment’ (Cramm et al. 2010:2). Extant literature acknowledges the unsuitability, on its own, of the biomedical approach to reducing burdens of TB in epidemic countries like South Africa (Daftary et al. 2015). This recognition is accompanied by impetus to develop and apply theory-based strategies to encourage long-term adherence to TB treatment. Scholars insist that there are several health behaviour theories with potential to improve understanding in this area (Daftary et al. 2015; Munro et al. 2007). This research responds to the question of how health communication and promotion strategies can practically contribute to improving multidrug-resistant TB (MDR-TB) treatment adherence and clinical outcomes among a defined vulnerable population in KwaZulu-Natal province, South Africa. It aims to contribute knowledge to the under-researched area of non-biomedical responses to sub-optimal adherence to long-term DR-TB treatment in high TB/HIV burden areas (O’Donnell et al. 2017). Primary qualitative data was collected through focus group discussions and key respondent interviews with 20 purposefully selected participants in eThekwini Metro, KwaZulu-Natal, from March to September 2018. Ten of the participants comprised the case study of this research; culture-sharing young women, many of them isiZulu-speaking, aged 18 to 34 years from low socioeconomic communities being treated for MDR-TB at one public hospital in the Metro. The study proposes a ‘how to’ for MDR-TB health promotion in high burden areas. vii It finds that vulnerable young women's sub-optimal adherence to MDR-TB treatment is exacerbated by patriarchy, stigma and cultural beliefs and practices. Culturally prescribed family collaborative approaches to health-seeking among Zulu people urge for the incorporation of female elders, intimate male partners and older children into young women’s treatment. In contexts like eThekwini Metro where many MDR-TB patients demonstrate strong cultural beliefs and practices, emphasising biomedical treatment for individual patients as the denominator of treatment requires reconsideration. Findings also suggest that MDR-TB programmes would benefit from borrowing from HIV communication interventions by implementing standardised individual, couples’ and family counselling at intervals during the nine to 36 months of treatment to enhance patients’ adherence. Consideration should also be given to engaging traditional health practitioners as important partners in health promotion. Further, educating patients and communities about MDR-TB treatment should be bolstered through health promotion and communication via school curricula, culturally proximate television and radio (soap operas, dramas and hard news) programmes and Facebook and WhatsApp. Social media is important because it allows for low-cost group, one-on-one and anonymous exchanges and discussions of health information.
The role of communication in addressing sociocultural factors that influence pregnant women to drink alcohol in Durban, KwaZulu-Natal.
(2021) Akpan, Udoh James.; Dyll, Lauren Eva.; Govender, Eliza Melissa.
The World Health Organisation report (WHO, 2016) states that one in 10 women consumes alcohol during pregnancy globally, and 20% of these women binge drink. Drinking while pregnant harms the foetus with the possible consequence being Fetal Alcoholic Spectrum Disorder (FASD). South Africa has the highest reported FASD prevalence rates in the world. The South African Department of Health (DoH) recognises this as a severe public health issue affecting pregnant women. Studies show that the factors that motivate maternal drinking are more socio-cultural than medical and psychological. There have been global efforts to address this public health issue with pregnant women but the phenomenon still persists. This study addresses the issue by exploring the localised responses of pregnant women who drink while pregnant in Durban, KwaZulu-Natal, through a qualitative investigation of the sociocultural factors that encourage alcohol consumption amongst this population. The study employed Participatory Health Communication as the theoretical framework and mobilised the Social Behavioural Change Communication (SBCC) as the process to identify and analyse the socio-cultural issues in Durban. This theoretical framework and process was supported by the Culture-Centred Approach (Dutta, 2008) to engage with the influence of culture and structure to understand the socio-cultural factors that contribute to their health choices and possible avenues for agency to address this. Communication plays a central role in this agency. The study adopted the Applied Thematic Analysis (Guest, McQueen and Namey, 2012) to interpret the data gathered from interviews with the participants at King Edward VIII Hospital. The study found that social and environmental factors are family, friends and access to shebeens and taverns in the neighbourhood which support a drinking culture that encourages social tolerance of alcohol consumption and the reluctance to stop drinking. The study identified the need for ongoing communication through preferred communication channels that are readily available for women to request support. The study found the importance to extend beyond knowledge acquisition, but to mobilise communication as a culturally nuanced tool to facilitate psycho-social support during times of alcohol consumption when pregnant.

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Browsing Doctoral Degrees (Centre for Communication, Media and Society) by Author "Govender, Eliza Melissa."