Psychology

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A 'forbidden zone' sexual attraction in psychotherapy.
(1999) Stevenson, Irene Rosemary.; Wassenaar, Douglas Richard.
Therapist-client sexual involvement has been shown to have damaging effects on clients, therapists and the mental health professions. As sexual attraction necessarily precedes sexual involvement, the incidence, experience and management of sexual attraction to clients was investigated in a sample of 485 South African clinical psychologists (return rate 23%). Evaluation of training and attitudes to sexual involvement with current and former clients and to other forms of touch in therapy were also investigated. Survey data from 111 psychologists reveal that 63.1% (79.1% of men and 52.9% of women) have been sexually attracted to clients, at least on occasion, while 97.1% have never become sexually involved with a client. Most (61.4%) do not feel anxious, guilty or uncomfortable about the attraction, although more women (50%) than men (26.5%) do. More than half (58.2%) felt that their sexual attraction had benefited the therapy process, while 76.1% believed that it had never been harmful. Men reported significantly more frequent benefit than women. In managing their sexual attraction, 60.8% sought support from supervisors, peers and their own therapists, while 31.9% worked through the feelings on their own. Ethical practice and welfare of clients were more important reasons for refraining from acting on sexual attraction than fear of legal or professional censure. Ethics codes consulted reflect the lack of nationally endorsed guidelines. Almost half (45.7%) had received no education about therapists' sexual attraction to clients, while only 10.6% had received adequate education. Education about the ethics of therapist-client sexual involvement was rated as significantly more adequate than training about therapists' sexual attraction to clients. Most (74.2%) said that their training was useful in helping them to make informed decisions about sexual involvement with clients. The majority (92.5%) felt that education on these issues should be a required part of training for clinical psychologists. Sexual involvement with former clients was considered less unethical than with current clients (65.2% vs 98.9%). 55.9% believe that there are circumstances in which sexual involvement with former clients might not be unethical, particularly depending on time since termination. Appropriate time between termination of therapy and sexual involvement ranged from immediately (1.8%) to never (44.1 %). Certain forms of touch are considered ethical, although attitudes varied depending on context and form. A handshake was rated to be always ethical by 66.3%, while 83.2% believe kissing is never ethical. There was lack of consensus about hugging and holding hands. Implications of findings and directions for future research are discussed.
A formative evaluation of a child abuse prevention programme in KwaZulu-Natal.
(2022) Makhathini, Sinothile Andile Sinegugu.; Frizelle, Kerry Lyn.
Background Abuse against children has been a concerning social phenomena in South Africa for many years, yet there are only a few child abuse prevention programmes that have been developed and designed to try and address this issue. Such prevention programmes aim to create awareness, educate children and families, assist with reporting cases, and provide trauma counselling and safe houses. Formative evaluations are important an important part of tracking the success in offering and managing prevention interventions. Aim: The aim of the study was to conduct a formative evaluation of a child abuse prevention programme at the Open Door Crisis Care Centre (ODCCC). To do so this study explored, from the perspective of social workers responsible for running the programme, the roles the social workers play in the organisation, the design of the child abuse prevention programme, the facilitators’ experiences in facilitating the child abuse prevention programme, the challenges faced in the implementation of the child abuse prevention programme, how those challenges can be overcome, and the areas that the child abuse prevention programme can be improved on. high workload, (3) political interference, (4) lack of funding, and (5) the lack of volunteers. These challenges are further exacerbated by the COVID 19 pandemic. Conclusion: The ODCCC child abuse prevention programme has been instrumental in helping the victims of child abuse by offering a range of services including counselling, shelter, support groups and awareness campaigns in the surrounding communities and schools. Recommendation: The social workers in the current study recommend the Department of Social Development to prioritise child abuse prevention programmes in South Africa and avail funding to these programmes across the country. As demonstrated in the current study, the child abuse prevention programme faces huge challenges, and a lack of funding is a major obstacle in the implementation of this programme. Methodology: The study adopted a qualitative design. The researcher conducted semi -structured interviews with four social workers to collect data and used thematic analysis to interpret and analyse the data collected. Findings: The findings show the ODCCC child abuse preventive programme, from the social workers perspective, provides essential services such as counselling, safe shelter, support groups and awareness campaigns for those affected by child abuse in the surrounding community. The social workers employed at ODCCC view their roles as improving the general well-being of abused children and their families by assisting them in meeting their fundamental needs which include reporting of abuse to the police, referral to a doctor to gather evidence, and preparation for court. The creating awareness has been a powerful tool because children are more cautious and aware of grooming. The findings further highlight that the ODCCC child abuse prevention programme is facing many challenges, these challenges are; (1) shortage of social workers, (2)
A pilot investigation into the phenomenon of murder-suicide in Durban, KwaZulu-Natal.
(2003) Townsend, Kerry Lynne.; Wassenaar, Douglas Richard.
Research on murder-suicide within the South African context has been limited with the last published study in 1992 (Roos, Beyers, & Visser, 1992). This particular study investigated the phenomenon of murder-suicide in the city of Durban using techniques previously applied in a broad range of international studies (Berman, 1979; Cooper & Eaves, 1996; Rosenbaum, 1990). The study served as a pilot for a broader national study. The aim of this pilot study was to investigate the incidence of murder-suicide in the sample and to generate demographic profiles of perpetrators and victims. It was hoped that the results from this study would pioneer the development of accurate base rates of murder-suicide in South Africa as there are currently no statistics of South African murder-suicide rates or characteristics. The sample consisted of 21 murder-suicide cases with 43 individuals in total having died from the murder-suicide events. The sample covered all murder-suicides in the Durban Metro area over the years 2000 and 2001. A Durban Metro Murder-Suicide Incidence Form was used to collect the data from post mortem examination reports at Gale Street Mortuary. Corresponding police reports where available substantiated this data. The incident rate of murder-suicide in Durban over the two-year period was found to be higher than the international average. This may be attributed to the violent social context in which the study took place. The reliability of this finding would be influenced by the small sample size. Typical profiles of perpetrators and victims were generated. The typical profile of a perpetrator was found to be a Black male aged 32 years with a secondary school education and currently unemployed or working in the police or security sector. He was typically be the boyfriend or spouse of the victim and committed the homicide and suicide using a firearm. The typical profile of a victim was a Black female aged 26 years with at least a secondary school education and currently unemployed. She was typically the spouse or girlfriend of the perpetrator. Her death would usually be attributed to multiple gunshot wounds to the head or chest. The findings suggest that Durban's murder-suicides profiles follow similar patterns to those observed internationally.
A qualitative exploration of lecturers’ experiences in teaching and assessment of students with disabilities at the University of KwaZulu-Natal.
(2023) Leahy, Kelly Louise.; Makhaba, Vukani Luvuyo.
Since the advent of democracy in South Africa, an inclusive education policy was implemented in the education system to address barriers to learning. Although this has increased the enrolment percentage of students with disabilities in higher education institutions (HEIs), a disjunction between policy and practice remains in HEIs in South Africa. Challenges in implementing inclusive education may stem from teaching practices and assessment methods which have not been adjusted appropriately in response to the inclusion of a diverse student body. While the experiences of students with disabilities in HEIs have received considerable research interest, the experiences of lecturers appear to be an understudied research area, particularly within the South African context. This research study drew on the theoretical framework of Differentiated Instruction and qualitatively explored the lived experiences of lecturers in teaching and assessing students with physical disabilities within a South African HEI. Data for the study was collected through individual semi-structured interviews with eight lecturers within the College of Humanities at the University of KwaZulu-Natal (UKZN), Howard College campus, and analysed using Braun and Clarke’s thematic analysis. The findings suggested an emphasis on deficit thinking among lecturers in higher education. In addition, the study revealed that both challenging and positive experiences with these students emerged during teaching and assessment which may hinder or promote the inclusion of students with physical disabilities, respectively. Conclusively, the findings suggested that further progress is required in the institution to support lecturers and their students. Recommendations to enhance inclusivity in the institution may include the incorporation of, and access to inclusive pedagogy, greater awareness and sensitisation, a reduction in attitudinal and physical accessibility barriers, and the promotion of shared responsibility and collaborative effort among relevant stakeholders.
A qualitative study exploring the experiences of unemployed youth in Chatsworth, South Africa.
(2023) Husain, Mahomed Shuaib.; Mntambo, Ntokozo.
Unemployment among the youth is a common occurrence in today’s times. Most places of occupation seek employees with at least three years of experience. As a result, fresh graduates find themselves in a position of despair and hopelessness. In an attempt to help the youth to find suitable jobs, the government must provide the youth with viable job opportunities. This study aimed to investigate how unemployment affects the lives of the youth. This research report has been compiled based on six unemployed youth living in the Chatsworth area in South Africa. The research study was conducted using a qualitative approach through structured interviews. The results revealed that most unemployed youth had been miserable and felt as if they had no purpose in life due to being unemployed. The implications of the findings of this study are important and helpful to both job seekers and prospective employers.
A review of Applied Behaviour Analysis (ABA) as a method of early intervention for foundation phase learners living with Autism in South Africa.
(2023) Govender, Rivendri.; Buthelezi, Nontobeko Precious Angela.
Background: Applied behaviour Analysis (ABA) is a form of intervention that is primarily used in the treatment of Autism Spectrum Disorders (ASD) and is based on the premise that behaviours are caused by external stimuli resulting in the implementation of a reward and punishment system in order to discourage or encourage behaviours. Aim: This study is aimed at evaluating the effectiveness of the Applied Behaviour Analysis model as a method of intervention for foundation phase learners who were diagnosed with ASD. Methodology: Embedded within the Theory of Learning and Development, data was collected through the analysis of secondary data retrieved from case files from The Star Academy (South Africa). The study population focussed on foundation phase learners who were diagnosed with ASD and were receiving ABA intervention as the primary method of intervention and purposive sampling was employed in the selection of the case files. Results: The findings of the study revealed that the ABA method of intervention, has an array of areas of functionality which were targeted within each domain of functioning. This allowed the child to acquire a complete repertoire of skills in a natural manner. Conclusion: This research study concludes that the Applied Behaviour Analysis method of intervention is effective in the treatment of Autism in foundation phase learners within a South African context.
A social science perspective on literature relating to medically prescribed stimulants: a systematic review.
(2022) Rode, Bo Staci.; Collings, Steven John.
Introduction: Ritalin, Concerta and Adderall are well-known medical drugs used to treat and manage attention-deficit/hyperactivity disorder (ADHD). Over the past couple of decades, there has been an increase in the medical prescriptions, consumption, and research of medically prescribed stimulants (MPS). A review of the literature indicated that common areas of enquiry were the use and wrongful use of MPS and suggested a great emphasis on academics and educational settings. The research indicated an ever increasing presence of MPS and reinforced the need for a consolidated overview of the available literature so that there is a deeper understanding and a guide for future research. Method: A systematic review was conducted; this was guided by the Cochrane Framework. A predetermined inclusion and exclusion were utilised, and various journal databases were searched using the JBI Reviewers Manual three-phase search strategy. The articles were analysed for eligibility for the study and then underwent coding. SPSS was used to analyse the data and measures of frequency and measures of central tendency were used. Results: This review included 167 research articles. Of that, 67.1% of them were from the USA and 89.8% of them emerged from first-world countries. Questionnaires and surveys were the most common data collection method, with 59.9% of the reviewed articles using them, and statistical analysis was the most common data analysis method, recording 46.1% of articles with this analysis method. Adults (over 18s) were the most common sample group, recording 67.1% of articles and 66.5% of the articles focused and investigated student populations. The top emerging themes associated with MPS use were academics (46.1%), prescriptions (13.8%), socioeconomic/demographic factors (12%) and attitudes and perceptions (7.2%). The top emerging themes associated with MPS wrongful use were academics (46.7%), attitudes and perceptions (12%), socioeconomic/demographic factors (8.4%) and prescriptions (6%). The majority of the data collection took place in a tertiary education setting (57.5%). Conclusion: This review recorded an abundance of MPS literature focusing on academics or an academic setting, suggesting these are frequently linked in the literature. There is an uneven representation in the literature, with minimal amounts of research emerging from developing/third-world countries. It also indicated the high concern over the wrongful use of MPS and the need for further investigations into different settings to form a comprehensive understanding of MPS.
A socio-ecological analysis of postgraduate students lived experiences while at university.
(2022) Khoza, Sisanda Natalie.; Hlengwa, Wellington Mthokozisi.
The study explored the experiences of postgraduate students at a South African tertiary institution. The intention was to understand the challenges that entwined postgraduate studies and the coping mechanisms employed by students during their postgraduate studies. In this qualitative study, the participants were interviewed utilizing a semi-structured interview schedule: with the consent of the participants the interviews were recorded using an audio-recorder. The data obtained was thematically analyzed, which gave rise to various themes. The following themes emerged: students’ motivation to enroll in postgraduate studies: the graduate unemployment problem, implications of lack of funding at postgraduate level, non-monetary challenges at postgraduate level: mental health issues, postgraduate workload, online learning challenges, coping mechanisms, social relationships, and support during postgraduate studies. The findings of this research study indicated that financial, academic, and psycho-social support positively impact postgraduate students’ experiences at university. Nonetheless, that lack of financial aid, mental health issues, postgraduate workload and online learning challenges negatively impact postgraduate student experiences.
A study of cross-cultural and gender differences in the experience of jealousy.
(2002) Jones, Helen Louise.; Wassenaar, Douglas Richard.
Gender differences in the experience of jealousy have been the subject of research interest since the work of Freud. Recent research seems to indicate that males may be more distressed by their partners' sexual infidelity, whereas females are possibly more upset by emotional infidelity. Evolutionary psychologists believe these gender differences are the result of different adaptive problems faced by males and females over the course of evolutionary history. This view has been criticised by social psychologists and feminist theorists, who assert that gender differences in the experience of jealousy are the result of socialisation practices and power imbalances in society. This study examined gender differences in the experience of jealousy in a cross-cultural sample. The results provided only partial support for the evolutionary model. Strongly significant gender differences were found, but the difference was driven mostly by a large majority female dislike of emotional infidelity. Males across the sample were ambivalent, selecting sexual and emotional infidelity as approximately equally distressing. Significant cultural differences were found, suggesting that cultural factors may play a part in the experience of jealousy.
A survey of researchers' ethics, law and human rights dilemmas, resources and needs in HIV vaccine trials (HVTs) in Africa.
(2011) Phalane, Tshegofatso Precious.; Wassenaar, Douglas Richard.
This study investigated the Ethic, Law, and Human rights (ELH) dilemmas of researchers involved in preparing for and/or conducting HVTs in African countries. Furthermore it investigated availability of ELH material resources and infrastructure necessary for the successful conduct of HVTs. The study employed both qualitative and quantitative research methods. The main ethical challenges that researchers face when conducting HVTs include; high seroconversion rates, determining social value, working collaboratively with participants and communities, and paying trial participants. Legal challenges faced by researchers included; termination of participants who meet study inclusion criteria due to demands to do so from their parents and/or male partners, and in some countries lack of support from health care service providers when it comes to caring form trial participants. Understanding of consent age in African countries by communities was reported as a human right concern for researchers. The study concludes that researchers conducting or preparing to conduct HVTs in African countries face different ethics, law and human rights challenges when conducting HVTs at their sites and these challenges need to be addressed in order to improve the conduct of HVTs in Africa.
Academic staff perceptions of performance management : a qualitative study.
(2016) Mazibuko, Lindani Thando.; Isaacs, Dean Lee.
Performance management as a tool of managing human recourses has flourished into the higher education sector, with more and more universities employing it to manage the performance of academics (Simmons, 2002). This research is a qualitative exploration of the individual and personal lecturer or university academic’s experiences and perceptions of performance management. The research study conducted seven semi-structured, thirty to forty-minute-long interviews with seven university academics to ascertain their individual, personal, subjective perceptions, opinions and experiences of performance management within higher education institutions. Participants recognised the importance and positives of performance management, but also expressed frustration with the conception, implementation and execution of performance management. Performance management is viewed by academics as being detached from the realities of a university context, due largely to the pro-profit and bureaucratic approach employed in the entirety of the process. Participants desired an inclusive, qualitative, less bureaucratic approach to the conceptualisation of what constitutes ‘good performance’. This approach must also honour the changing environment and context of contemporary universities that is driven less by neoliberal norms.
Access to antiretroviral treatment by children in KwaZulu-Natal Province : a qualitative exploratory study into factors influencing poor access.
(2009) Phili, Rogerio.; Meyer-Weitz, Anna.
South Africa and the province of KwaZulu-Natal (KZN) has one of the greatest HIV burdens in the world with an estimated 5.7 mHIion people living with HIV/AIDS. One of the interventions that the government introduced to address this situation was the provision of antiretroviral treatment (ART) to those individuals that are eligible for HIV treatment in order to reduce the morbidity and mortality. Despite widespread availability of ART in KZN, children do not access ART to the extent that adults do, and therefore continue to die because of HIV and AIDS. This qualitative study explored the psychosocial and health system factors that influence paediatric access to ART in KZN from parents and caregivers perspectives. The ecological theory and the social cognitive theory was used to formulate an interview schedule used in conducting the in-depth interviews with adults (parents or guardians) who were bringing their children for ARTservices and those attending these services themselves and not their children at Edendale and King Edward Hospitals in KZN. Purposive sampling was used to select clients for interviews and thematic was done in accordance with the aims and objectives of the study. A total of 42 participants were interviewed in this study. The low uptake of child ART was found to be influenced by several psychosocial and economic factors such as the poor knowledge about ART, stigma and disclosure associated with HIV, extent of support provided by parents/caregivers, parent's own ART was a determinant for bringing children for ART, use of traditional / alternative medicines, disintegrated families, especially the issue of multiple caregivers, complexity of paediatric ART, poor referrals of children from community institutions, unsatisfactory service at clinics, and some health policy and legislation with respect to health care for HIV-infected children that had an unintended effect of restricting child access to ART as well as poverty related Issues. Improving knowledge and self-efficacy related to ART, prevention of mother to child transmission ofHIV, re-training of health workers on child issues and addressing stigma and discrimination and other psychosocial and institutional problems and logistics could help to improve the low paediatric uptake of ART.
Access to success: qualitative accounts of successful Access/Foundation Program students from University of KwaZulu-Natal Pietermaritzburg Campus.
(2019) Mbatha, Nokwethemba Hlobisile.; Munro, Nicholas.
Higher education in South Africa has undergone numerous changes over the past few decades. These changes have focused on addressing the discriminatory practices that the past apartheid laws (e.g. Bantu Education Act) have had on higher education in South Africa. As such, higher education in South Africa has been on an ongoing process of positive transformation so as to provide equal opportunities for previously disadvantaged groups of students. The increase of participation in higher education through the expansion of formal access for all learners, was one strategy that was used to contribute to the transformation of higher education. In recent years, conversations in higher education have shifted towards increasing epistemological access and success for students. This study aimed to explore success stories and accounts of students who entered the University of KwaZulu-Natal (UKZN) through access programmes. The study sought to explore how academically successful students who started their university studies through UKZN access programmes account for their academic success, what aspects of the university environment enabled and constrained these students’ academic success, and what aspects of their personal history enabled and constrained their academic success. The findings of this study revealed that there are various aspects in a student’s life that contribute to their success in university. These aspects range from academic factors, to family background, and to social and personal challenges. The findings from this study (such as sub-theme 1:1 attention and motivation, sub-theme 1:2 preparation and transitioning sub-theme 1:3 smaller classes and style of lecturing) are presented according to three thematic clusters, namely 1) The benefits of an access programme for academic success, 2) Explaining academic success by access programme students, and 3) Challenges that impacted on access programme students’ academic success. Within the three thematic clusters, eight sub-themes were identified as factors that either contributed to the participants’ academic success or were challenges that impacted on the participants’ academic success. The findings of this study highlight aspects that are worth considering when working towards optimising student success in university. For instance, it was evident in the findings that doing the access programme prepared students for transitioning into university and equipped them with the foundational skills needed for academic success. As such, the researcher highlighted the need for higher education institutions to enhance support programmes or even extend programmes (such as the access programme) to all students entering university so as to assist them with transitioning and to equip them with the skills needed for academic success. The findings also highlighted the challenges that successful non-traditional students encounter during their studies such as finances, language/communication barriers and time management amongst other challenges. The awareness of the realities that successful access programme students experience is important especially for institutions and other stakeholders who are intending optimise student success by addressing challenges that present themselves in the students studying experience.
Acculturation and disordered eating : an exploration of disordered eating practices across cultures.
(2000) Kramers, Anne Louise.; Wassenaar, Douglas Richard.
Research suggests that the eating disorders (anorexia nervosa and bulimia) represent a caricature of the sociocultural values placed on young women to achieve thinness and beauty ideals. Although eating disorders have long been thought to occur only in White, "Western" cultures, more recent research suggests that women from different cultural groups are presenting with unhealthy eating attitudes and behaviours. In South Africa's pluralistic cultural context, the effects ofcontinuous first-hand contact between cultures (acculturation) is an important area of research, especially in light ofthe hypothesised etiological role ofsociocultural factors in eating disorders. The present study aims to address the association between acculturation and disordered eating in a non-clinical sample of nursing students in Pietermaritzburg. Additionally, it aims to contribute to the development of a local acculturation instrument. The South African Acculturation Scale (SAAS) was developed based on the work of Berry (1976), Berry, Trimble and Olmedo (1986) and Berry (1997). The Individualism-Collectivism (INDCOL) scale (Hui, 1988) and the Eating Disorder Inventory (EDI, Garner & Olmsted, 1984) were included in the questionnaire profile A pilot study was undertaken on 28 students in the health arena, in order to assess the psychometric properties of the assessment instruments. The results of the pilot study yielded adequate reliability co-efficients for the SAAS, although the INDCOL scale yielded unexpectedly inconsistent results. The formal study adopted a cross-sectional design on a population of 155 nursing students. The sample consisted of37 Blacks, 33 Whites, 11 Indians and 7 Coloureds between 19 and 28 years of age. Additionally, the sample included 49 Blacks, 3 Whites, 11 Indians and 4 Coloureds greater than, or equal to 29 years ofage. The research findings suggest that both Black and White respondents display a propensity towards disordered eating. Black respondents scored higher on measures of the psychological correlates of eating disorders, and Whites scored higher on the attitudinal and behavioural measures of disordered eating. Partial support was obtained for the hypothesis that assimilation and individualist values are correlated to eating disorder pathology. The findings suggest that acculturating young women from diverse cultural and racial backgrounds present with a degree of risk for the development of eating disorders.
Acholi indigenous methods for healing and re-integrating survivors of violent conflict into the community: a case of Gulu and Kitgum, Northern Uganda.
(2017) Adibo, Josephine.; Mkhize, Nhlanhla Jerome.
This study explored Acholi indigenous methods for healing and re-integrating survivors of violent conflict into the community in Gulu and Kitgum, Northern Uganda. The healing mechanisms of Acholi indigenous healing and reintegration methods have not previously been documented. This study sought to describe how survivors of violent conflict in northern Uganda experienced these methods. The study also sought to identify the specific problems for which these methods were prescribed, the ritual processes as experienced by the participants, and their perceived healing mechanisms. A qualitative research paradigm was used. Fifty (50) participants were selected using purposive sampling. Male and female survivors of violent conflict comprised the sample. Elders, who officiated in these rituals, were also interviewed. Data, in the form of interview narratives, was analysed using Voice-Centered Relational (VCR) method. The findings indicated that the healing rituals were performed in various specific sequences dependent on the nature of the atrocities committed. The most commonly used rituals were nyonotongweno, culukwor and matoput, in that order. The rituals were performed for a range of reasons, incorporating cleansing and protection of the survivors, their families, as well as the communities into which they were returning, from the bad spirits of the deceased that were never appeased. The rituals healed through spirituality— an appeal to a force greater than humanity — the presence and participation of the community, compensation of the aggrieved clan, and open forgiveness. The place of healing, as well as the healing of the spaces where the violence took place, attest to the holistic, as opposed to the individualistic, orientation of western versus indigenous methods. The contaminating effects of the violence extend beyond individuals and the community to the environment itself, hence the need to heal spaces where violence occurred. Most participants perceived the rituals in positive terms. Influences of religion and globalisation were noted amongst those that perceived the rituals in negative terms. The fact that women who were sexually violated during the conflict were unable to resume a conjugal relationship with their spouses, even after the rituals, points to the profound influence of gender. This calls for further investigation into the effectiveness of healing rituals in cases where sexual violence against women is involved.
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.
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.
Adolescent boys living with HIV.
(2011) Blackbeard, David Roy.; Lindegger, Graham Charles.
This qualitative research identified constructions of masculinity among seven adolescent boys who were HIV positive, purposively sampled from the age range of 13 to 16 years and were members of a clinic-based HIV support groups. Central to this research was the critical use of the concept of ‘hegemonic masculinity’, defined as the legitmation of gendered power through masculinity ideals, embodied practices and imperatives. The framework of dialogical self theory was used for exploring the dynamics of individual and group positioning around hegemonic masculinity and this theory was compared with other approaches such as discursive theory. Using multiple research methods within a qualitative design, this research identified individual and group ideals and practices held by the adolescent boys, with a key focus on how young men maintained ‘positions’ in relation to hegemonic masculinity, be these forms of masculinity that retained complete or partial identification with hegemonic masculinity or versions of masculinity that were alternative to the hegemonic form. The study was situated at the intersection of masculinity with the experience of living with a chronic medical condition, and the relatively homogenous and small sample provided an indepth basis for understanding the instantiation of masculine identity in a situation of fairly unique challenges and complexity. A combination of semi-structured interviews, focus groups, autophotography, reflective writing, biographical drawings and biographical interviews were used to match an interpretive, inductive research process, with reflexivity and research ethics as key considerations. Interviews were carried out by the researcher and two of the support group facilitators, creating an opportunity for reflexivity around the complexities of qualitative interviewing. Multiple methods of data analysis were used to analyse and ‘dialogue’ multi-sourced verbal and visual data. Thse methods consisted of thematic analysis, an adaptation of critical narrative analysis for selected texts and content analysis of visual data. The findings suggested that there were active processes of positioning masculine identity at individual and group levels and that positions in relation to hegemonic ideals were emotionally invested. Two hegemonic versions of young masculinity were identified as sets of ideal standards and embodied practices. ‘Township young masculinity’ was a peer-approved version identified with physical invulnerability, risk-taking and an ideal of attaining ‘influence and affluence’ through exceptional performances. ‘Aspirant young masculinity’ was a future orientation towards attaining a commodity masculinity, identified with an independent provider roles and signified through visible displays of ownership both material and symbolic. Interpreting findings from dialogical self theory, it appeared that some of the boys, at some times, established a distance from hegemonic imperatives by taking personally agentive, independent I-positions. This carried the risk of impulsively reacting to hegemonic imperatives without the support of collective identities and social relationships. Some boys developed Ipositions that were contradictory to produce new and more tenable I-positions. This process appeared to be more sustainable when it was connected with a group or collective identity such as being a member of the support group or being a person living with HIV. Some of the boys maintained alternatives through ‘metapositions’ that were made available through contexts or resources which offered alternative perspectives and possibilities. Dilemmas faced included managing the hegemonic imperative of being sexually active as an HIV positive young man or prioritising health where the hegemonic standard promoted physical risk-taking. It was apparent that despite interviewer expectations, the participants did not foreground an HIV positive identity but instead defined themselves foremostly as young men. One of the solutions to these dilemmas was to modify but maintain some alignment or identification with masculinity ideals. Here, the constraints of being HIV positive meant that maintaining health was more important than conforming to masculinity ideals or a reframing of masculinity within the physical, social and symbolic barriers of having a potentially life-threatening illness. The challenge of this solution was that its sustainability relied to a large extent on the availability of safe ‘dialogical’ spaces such as the HIV support group. Some of the boys found ‘principled’ alternatives to hegemonic masculinity from community or cultural values. Some of the boys identified with hegemonic standards but had to constantly defend against the anxiety of not being able to embody these hegemonic standards.
Adolescents living with HIV and AIDS in Chiredzi district, Zimbabwe: experiences of disclosure, stigma, sexuality and social support to treatment adherence.
(2020) Jimu, Christopher.; Govender, Kaymarlin.
The study explores experiences of disclosure, stigma, sexuality and social support to treatment adherence for HIV positive adolescents in Chiredzi district, Zimbabwe.This qualitative study adopts a multiple interpretive case study methodology to explore the intricacies of living with HIV as an adolescent. Twenty (n=22) adolescents aged between 13 and 19 were recruited to participate in this study while attending social support or when they came to collect their medication. Individual in-depth interviews were carried out asking adolescence about their personal romantic lives, experiences and difficulties they must face while living with HIV/AIDS. Findings revealed that adolescents living with HIV (ALHIV) are confronted with stigma and discrimination while simultaneously grappling with emotional issues such as dealing with disclosure. Consequent to these challenges, adolescents (particularly males) adopt several coping mechanisms to deal with the difficulties and these include (but not limited to) non-disclosure of their seropositive status to their sexual partners thereby risking reinfection and exposing their partners to HIV. Social support was minimal. Non-disclosure of seropositive status contributed to poor adherence to or defaulting HIV medication. Further, findings further attest to the fact that adolescents refrain from disclosing their HIV status because they want to fit in with their peers and romantic partners. Presumably, this justifies why, while there has been a decline in the number of new HIV infections among all ages, there has been a significant escalation in HIV infection among the adolescent population, amid a high incidence of virological failure. Evidently, statistics will maintain an upward trajectory if proper measures are not implemented. The study concludes that a life-cycle approach to HIV prevention and management is crucial in responding to adolescent HIV/AIDS challenges because risks of HIV infection, the challenges of accessing services and the solutions to these challenges change at different stages of someone’s life. This scenario justifies the adoption and implementation of the principle of biomedical holistic approach in order to find suitable education programmes for the community, health workers and adolescents.
Adolescents' perceptions of parenting practices with respect to substance abuse.
(2008) Pillay, Yogovani.; Meyer-Weitz, Anna.
Substance use among adolescents in South Africa is a growing concern. While a growing body of research is outlining the ability of parents to influence and moderate the uptake of risk behaviours, limited literature is available in South Africa on the links between parenting practices and substance use. The present study explored adolescents’ perceptions of parenting practices with respect to their substance use behaviours. Eight focus group discussions were conducted with grade 8 and 9 school-going learners from four purposively selected public high schools in the eThekwini region of KwaZulu-Natal. The discussions were informed by constructions of the Integrated Model of Change (I-Change Model) and appropriate literature. Data was analysed thematically. This study provides further evidence that parenting behaviours can influence adolescent behaviour. The findings suggest that specific parenting practices pertaining to parent-child communication, parental support, warmth, and monitoring can have an influence on adolescent alcohol and tobacco use. Negative parenting may lead to disruptive behaviour, vulnerability to peer pressure and subsequent substance use. It is recommended that early intervention and prevention programs for substance use include aspects of parenting practices that influence adolescent substance use.

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