Masters Degrees (Centre for Disability and Rehabilitation Studies)

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Challenges faced by occupational therapists and teachers in the implementation of vocational programmes in selected special needs schools for learners with severe intellectual disability in the metro district within the City of Cape Town
(Stellenbosch : Stellenbosch University, 2023-03) Solomon, Elana Tina; Ned, Lieketseng; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Introduction: Vocational programmes run by Occupational therapists (OTs) and/or vocational teachers in the special needs school context can play a significant role in the vocational development of learners with severe intellectual disability. They can also lead to positive postschool employment outcomes or opportunities in the open labour market. However, challenges such as limited resources in the implementation can have a direct impact on the post-school employment outcome of these learners. Aim: This study explored the challenges that Occupational Therapists and teachers faced in the implementation of vocational programmes in selected special needs schools for learners with Severe Intellectual Disability in the metro district within the City of Cape Town, South Africa. Methods:A qualitative descriptive design was used to allow the opportunity to gather in-depth information and to bring consciousness of the lived challenges. Eighteen Severe Intellectual Disability schools in the metro were contacted, 12 participants (six OTs and six teachers) from six special needs schools, volunteered and partook in the study. One-on-one semi-structured interviews with teachers and occupational therapists were done. An interview schedule was used as a tool and all interviews were transcribed and translated into English verbatim. Thematic analysis was applied to analyse data. Findings: The data showed that OTs and teachers encounter many challenges in the implementation of vocational programmes in special needs schools for learners with SID. Seven themes derived from the data included: (1) Poor to lack of proper facilities/resources, (2) Inadequate support systems, (3) Challenges with the DCAPS curriculum, differentiation and integrated learning areas, (4) Learner skills and limitations, behaviour and emotional challenges, (5) Lack of training, guidelines and support, (6) Accessing work-based learning (Job shadowing) and (7) Advising and facilitating opportunities for learners with SID. The overall ability of participants to successfully implement the vocational programmes at their respective special needs schools was hindered by inadequate support, resources and lack of relevant training. This study also highlights the issues of existing policy and the lack of a mandatory policy on vocational programmes for special need schools. Conclusion: The participants’ experiences provided knowledge on the challenges in the implementation and added value to the existing literature. To address the challenge, a multi-faceted policy framework is much needed in the South African context that includes a set of principles for effective implementation, procedures, responsibilities, and comprehensive support plans for vocational programmes for special needs schools for SID. The recommendations propose ideas that can be used by policy makers and educational institutions to better support OTs and teachers and improve post-school employment outcomes for learners with SID.
Exploring barriers and facilitators to return to work for clients with spinal cord injuries, in Cape Town, South Africa
(Stellenbosch : Stellenbosch University, 2018-03) Ngemntu, Sharon Nokuzola; Mji, Gubela; Ned, Lieketseng; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Background: Spinal cord injury is a catastrophic event, characterised with loss of function below the level of the lesion and increased dependence on family and societal support. The researcher has been working as an Occupational Therapist in a centre for physical rehabilitation of clients with physical impairments, including those with spinal cord injuries, for more than five years. She has observed that only a small percentage of clients with spinal cord injuries that have completed their rehabilitation programme were able to go back to work after the injury. After examining statistics of the clients seen in the period January-December 2001, when working at a local tertiary Hospital’s Work Assessment Unit in February 2014, the researcher was then further motivated to explore barriers and facilitators to return to work for clients with spinal cord injuries. Hence the aim of this study is to explore barriers and facilitators to return to work for clients with spinal cord injuries. Method: A qualitative study design was implemented to explore views of clients, managers/supervisors of clients with spinal cord injuries and rehabilitation professionals with regard to barriers and facilitators to return to work of clients with spinal cord injuries. Semi-structured interviews were conducted with 13 participants, including clients with spinal cord injuries, a manager of one of the persons with disabilities participating in the study, and Occupational Therapists involved in physical rehabilitation (including rehabilitation of persons with spinal cord injuries) or vocational rehabilitation (work assessment or return to work). Interview schedules were used to conduct interviews, which were recorded and later analysed thematically. Results: The findings highlighted return-to-work barriers related to inaccessible and non-supportive environment, the employers’ attitudes, injury-related issues, the challenging job demands of the previous work as well as transport issues. The facilitators indicated were provision of assistance and support (received from family, friends, church and work); the role of rehabilitation and rehabilitation team members and other role players as well as the necessity of reasonable accommodation in successfully reintegrating persons with spinal cord injuries. Triangulation was done and two common themes emerged amongst the three groups of participants (clients with spinal cord injuries, Occupational Therapists and the Manager) and these indicated the support received by persons with spinal cord injuries and the process of reasonable accommodation which facilitated integration to work. Conclusion: The study findings indicated a need for support for persons with spinal cord injuries, making sure the environment is accessible or conducive for return to work, putting reasonable accommodation measures in place and involvement of all stake holders in the successful reintegration of persons with spinal cord injury to work. These measures could assist all stake holders involved in understanding the needs of persons with spinal cord injury, the responsibility of each of the stakeholders and knowledge about available resources in fostering a smooth transition back to work for spinal cord injury clients.
Exploring the experiences of persons with mobility impairments in accessing health care in Cofimvaba, South Africa
(Stellenbosch : Stellenbosch University, 2021-12) Tshaka, Babalwa Blossom; Ned, Lieketseng; Visagie, Surona; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Background: Persons with disabilities are experiencing difficulties when accessing health care due to barriers despite the existing policies. Persons with disabilities in urban areas experience fewer barriers in accessing health care as compared to those in rural areas. There still is inequality in accessing health care for persons with disabilities (PWDs). Some persons with disabilities stopped accessing public health care hence this study explored experiences of persons with mobility impairments in accessing health care who stopped accessing health care in Cofimvaba, a rural isiXhosa community in the Eastern Cape. Aim of the study: The aim of the study was to explore experiences of persons with mobility impairments in accessing health care as why persons with mobility impairments stopped accessing health care in Cofimvaba, Eastern Province, South Africa. Study Objectives ● To identify challenges faced by persons with mobility impairments in accessing health care in Cofimvaba. ● To explore why persons with mobility impairments stopped accessing health care in Cofimvaba. Method: A qualitative methodology was followed using a descriptive approach study design to explore lived experiences of persons with mobility impairment who stopped accessing health care before December 2018. Snowballing sampling was used which involved building a sample through referrals. Referrals were received from the Community Health Workers who identified participants. Semi-structured interviews were conducted in isiXhosa with five participants who stopped accessing health care using a self-developed interview guide. I used an inductive approach which is a bottom up approach, and data and themes were derived from the content of the data itself. Data analysis: The six phases of inductive thematic analysis, as a bottom up approach, was used to analyse all interview data. Findings: Themes that emerged from the semi-structured interviews conducted with participants revealed challenges experienced by PWDs in accessing health care. Persons with mobility impairments in Cofimvaba experienced major challenges such as geography (long distance,) broader transport challenges (lack of transport and accessibility of transport), indirect costs to care (transportation cost), not having sickness needs and minor challenges such as physical infrastructure difficulties (inaccessible toilets and acceptability issues), attitude of health professionals and attitudes of public taxi drivers during the process of accessing health facilities. Psychological and social factors Conclusion: The study findings indicated that persons with disabilities are experiencing a combination of structural environmental and service delivery process challenges, especially those in rural areas, when accessing health care that leads to them stopping to access health care. The recommendations include intervention strategies that will assist in improving access to health care for persons with disabilities in Cofimvaba.
Exploring the vocational training strategies for enhancing the transitioning of persons with intellectual disability into supported employment : a case study of Mitchell’s Plain/Klipfontein sub-structure
(Stellenbosch : Stellenbosch University, 2021-12) Adams, Samantha; Ned, Lieketseng; Kahonde, Callista K.; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: The issue of unemployment as a national priority and strategy for poverty reduction has been at the forefront of the socio-political agenda in South Africa for many decades. Persons with Intellectual Disability (PWID) are particularly marginalised from decent employment opportunities due to low levels of education and skills training. The aim of this study was to explore the vocational training strategies used by service providers for enhancing the transitioning of PWID into supported employment (SE) by answering the question, What are the vocational training strategies used by service providers to enhance the transition of persons with intellectual disability into supported employment within the Mitchell’s Plain/Klipfontein sub-structure? Methodology: This study used a single instrumental case study design. A purposive sample of 12 participants was recruited as volunteer participants and selected according to specific inclusion criteria; four PWID, four carers and four service providers. Using qualitative data collection methods, semi-structured interviews were conducted with all participants. All interviews were transcribed and translated into English verbatim and thematically analysed. Document analysis was also used as supplementary data to provide context. Findings: PWID have very few options to engage in vocational training platforms that translate into SE. Carers value the vocational training received at various protective workshops but their unmet expectations for PWID to enter the employment sector is a concern. Communities are under-resourced; therefore, protective workshops are the primary vocational training opportunity for PWID. Protective workshops use learnerships as a transition method with job coaches, functional capacity evaluations and job shadowing as strategies to measure job readiness. Unfortunately, these strategies do not translate into SE nor do they guarantee any type of entry into other competitive employment opportunities. This is because the current protective workshop model has not fully integrated an inclusive community-based approach into their best practice model despite the emphasis of CBR as the recommended approach within the revised policy framework. Additionally, the policy guidelines as mandated by the Department of Social Development are not clearly defined and respective service providers develop best practice models at their discretion in partial fulfilment of their service delivery mandate. Conclusion: Protective workshops can be a key facilitator for transforming the way in which PWID are introduced to the labour market and their success in future employment opportunities. As the primary vocational training platform for PWID, protective workshops are well established within their network of service providers, funders and the community. Despite efforts to transform the protective workshop strategy through the inclusion of SE as a step towards employment, the outcomes of transitioning still remain very low. There are gaps in the sustainability of vocational training strategies due to the partial fulfilment of policy implementation and the successful integration of SE as the preferred model within the sub-structure. There is a need to strengthen the existing intersectoral collaboration to reduce fragmentation of services and clearly define roles and responsibilities of service providers. Person-centred transition planning should extend beyond individual rehabilitation and provide holistic support that positions PWID inclusively within their community and family. Strategic community networking may allow for opportunities to access services and information to PWID, service providers and also potential employers. Protective workshops as an effective strategy for transition can only be fully effective once the above factors are addressed and strategically aligned with deliberate focus on inclusive policy development and implementation.
Factors which facilitate a State-Owned Enterprise in the Western Cape, to recruit persons with disabilities to meet employment equity targets
(Stellenbosch : Stellenbosch University, 2021-12) Maclean, Natasha Suzanne; Ned, Lieketseng; Geiger, Martha; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Introduction: Gaining employment is an important life activity for everyone. However, employment statistics for persons with disabilities remain poor despite numerous policies and guidelines for employers being available. Disability in the workplace can present complexities that are difficult to encapsulate using only policy documents or guidelines. The achievement of employment equity targets in the disability category is an indicator that a company has successfully recruited and employed persons with disabilities. This study explores how a State-Owned Enterprise in the Western Cape has managed to navigate these challenges successfully. Aim of the study: To explore and identify factors which enable a State-Owned Enterprise in the Western Cape, to meet their employment equity targets for recruiting persons with disabilities. Methods: A qualitative single, embedded case study was conducted that is exploratory in nature. Data collection methods included document review and semi-structured interviews. Interview participants, including Human Resources Employees (HRE) and Employees with Disabilities (EWD) based at the Western Cape branch of the State-Owned Entity were purposively sampled. An interview schedule was used to guide in-depth, semi-structured interviews. A total of seven participants, including three HRE and four EWD, willingly participated in the study. Thematic analysis was used to analyse data. Results: The core value of diversity is embraced and embedded in the leadership of this company. Robust mechanisms have been put in place to monitor, report and be accountable for achieving Employment Equity Targets. Disability is a separate category within the Employment Equity Targets. An inclusive environment is created for PWD, in consultation with PWD. The company executes disability awareness and sensitivity training continuously, provides reasonable accommodation for PWD and creates a safe place for disclosure of disability. Talent acquisition takes place in a manner that is attractive and accessible to PWD. Support structures for PWD and partnerships with disability organisations facilitate the recruitment and sustained employment of PWD. Conclusion: This study explored and identified the factors which facilitate the successful recruitment and employment of PWD. It also explored how barriers that have been encountered were overcome. Diversity as a core value is embedded into the leadership and brand of this company, which is attractive to PWD. Leadership implements strategies to ensure that policies are put to practice. To be successful in recruiting and employing PWD, inclusivity is designed within the company and the necessary support structures are put in place. The same type of leadership is called for in government to ensure policies are implemented to uphold the rights of PWD in broader society. This would further facilitate the workforce participation of PWD. Recommendations: Provision of accessible transport for PWD should be prioritised at a governmental level. Increased tertiary education and skills development opportunities should be made available to PWD. Improved benchmarking should be implemented to ensure universally accessible public buildings, spaces and workplaces. Self-efficacy is a skill that all PWD should acquire to improve their employment prospects. It would also be beneficial for PWD looking for employment to register with specialised recruitment agencies, disability organisations and NGOs
Participatory outcomes, quality of life and barriers faced by stroke survivors in the rural Eastern Free State
(Stellenbosch : Stellenbosch University, 2016-12) Cook, Petri Johan; Visagie, Surona; Ned, Lieketseng; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies
ENGLISH SUMMARY : Introduction: It is widely recognised that rehabilitation forms an integral part of the process to enable stroke survivors to achieve functional independence, community integration and quality of life. Environmental barriers may however negatively influence achievement of these goals. Aim of the study: To describe functional, participation and quality of life outcomes as well as barriers experienced by stroke survivors in the catchment area of the Thebe District Hospital Complex. Methods: A quantitative, descriptive study was conducted. Data was obtained from 38 participants who suffered a stroke and received care between 1 January 2012 and 31 December 2014 at the Thebe/Phumelela District Hospital Complex. In total 176 names where obtained from the data base. Lack of or incorrect contact details and high mortality rates left 43 participants of whom 38 consented to participate. The ICF core set for stroke was utilized to develop tools to collect data on activities, participation and environmental barriers. Quality of life was determined with the WHO QOL Bref. Descriptive analysis of data was done using an Excel spreadsheet. Results: Functional and participatory outcomes were mostly limited to residential activities. Family relationships were good, but 66% of participants struggled to maintain intimate relationships. Community integration was limited with most participants unable to independently walk outside (55%), use public transport (55%) and drive (84%). Participation in social activities (66%), religious activities (63%), accessing services (71%), playing sport (89%), engaging in politics (66%), managing personal finances (61%), and accessing employment (74%) was difficult to impossible for many participants. The majority (82%) of participants reported a quality of life ranging between neutral and very poor. Recurring depressive affect was found to influence 58% of participants on a regular basis. Social health had the lowest mean score (46.3) of the four quality of life domains. The most severe environmental barriers perceived by participants included climate (82%), a lack of finances and assets (61%), mobility products (61%), as well as inability to access public buildings (76%) and, transport- (61%), education- (79%), housing- (66%), and labour (82%) services, systems and policies. The majority of participants (63%) received therapy for less than a month. Twenty one participants (55%) received follow up therapy at a local clinic. Few participants (11%) received vocational rehabilitation and no skills assessments, employer education or reasonable work accommodations were done. Conclusion: Poor functional-, participatory- and quality of life outcomes were achieved by stroke survivors in the rural Eastern Free State. Environmental barriers and impairments impacted negatively on functional-, participatory-, and other outcomes of stroke survivors. Rehabilitation service provision requirements, as stipulated by the National Policy, were not met. Recommendations: Establishing a stroke rehabilitation protocol is essential, ensuring a holistic approach by core disciplines from hospital discharge to community integration and productive activity through a model of multi sectoral collaboration. Accessibility of services to stroke survivors needs to be ensured through infrastructure development and sustainable transport solutions. Patient data systems must be optimised to allow accurate and efficient data retrieval.
Return to work after stroke; rate, facilitators and barriers in Buffalo City, South Africa
(Stellenbosch : Stellenbosch University, 2018-03) Patterson, Stacey Louise; Visagie, Surona; Ned, Lieketseng; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : Background: Stroke is an alarming medical and public health problem globally. Effects of stroke are strongly linked to an increase in burden of care and loss in productivity. Literature shows that a large proportion of stroke survivors do not return to work (RTW). Objectives: How many stroke survivors returned to work and what variables influence returning to work for stroke survivors in the Buffalo City Metropolitan Municipality (BCM), Eastern Cape, South Africa? Methods: A descriptive, mixed methods study was conducted between March 2015 and March 2017. Quantitative data was collected from 40 participants. Demographic data, work history, and barriers and facilitators were identified with use of the International Classification of Functioning, Disability and Health. Qualitative data was collected from seven purposively selected participants using a semi-structured interview and was thematically analysed. Results: Only 32% of participants successfully returned to work following their stroke. Those that returned to work had a low Modified Rankin Scale (mRS) and tended to have employment in white-collar work. Main barriers for returning to work that have been identified included: poor functional use of the affected arm and leg, poor memory, difficulty with speech and poor support and guidance from healthcare professionals and employers. Main facilitators included: dislike of being bored, financial needs to support one’s self and family, enjoyment of work as well as supportive and understanding healthcare professionals and employers. Conclusion: The RTW rate after stroke in BCM is low. Identification of goals and collaboration between all role players should commence at the earliest time possible, so as to begin the process of return to work.
The role of wheelchair basketball in enhancing re-integration of people with spinal cord injuries into the community
(Stellenbosch : Stellenbosch University, 2024-03) Thobela, Nothemba Siphosakhe; Ned, Lieketseng; Derman, Wayne; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY: Introduction: Participation of people with spinal cord injury in wheelchair basketball has the potential to enhance re-integration back into their community. This can be done by eliminating personal barriers such as, development of secondary complications and improving physical independence, lack of psychosocial and peer support and poor self-confidence and self-esteem associated with self-isolation in people with a spinal cord injury. However, challenges such as lack of access to spinal cord injury rehabilitation facilities, poor access to recreational facilities and resources and poor family support during early rehabilitation continue to hinder their participation. Aim: This study explored the o explore the role wheelchair basketball plays to support community re-integration of people with SCI into their community within the Western Cape Province. Methods: A qualitative, ethnographic design was used to gather in-depth information of lived experiences of wheelchair basketball players with spinal cord injury. There was one local wheelchair basketball club that was actively running and from that club, eighteen participants were identified as eligible for the study. Of the eighteen participants, only five met the criteria of the study, and only five agreed to participate in the full study. The fifth participant withdrew from the study before data collection could commence. Two community integration questionnaires, one subjective and one objective, were completed by the four included participants followed by a semi-structured interview using an interview guide. The questionnaires were scored, and the interviews transcribed in verbatim. Thematic analysis was used to analyse all data. Findings: The data showed that participants expressed that they integrated more into their community when they participated in a wheelchair basketball team. Three themes with sub-themes were identified and included: Theme 1: Improved functional independence. Theme 2: Improved inclusivity and socialization Theme 3: Improved self-esteem and self-confidence Conclusion: The participants experiences provided knowledge on how participating in wheelchair basketball can be used as a medium to bridge the gap between rehabilitation and successful and sustainable community re-integration for those with a spinal cord injury. Wheelchair basketball has the potential to address multiple challenges experienced by those with a spinal cord injury. Unfortunately, the sport itself is under supported by local and national government, local wheelchair basketball clubs are under-resourced and do not have the finances to successfully implement and run multiple clubs or have the platform to create awareness and promote engagement in the clubs. The recommendations propose ideas where the department of health and the department of sports and recreation can improve participation opportunities by providing resources such as safe venues, transportation, and basic equipment to the wheelchair basketball clubs that would make the sport more accessible. This could provide opportunities for awareness, growth, and sustainability of the sport, which could furthermore encourage increased participation. They could also support health and rehabilitation facilities to better create awareness and opportunities to introduce wheelchair basketball and that could be translated to integration as a part of the rehabilitation process.
Searching for “greener pastures” : a narrative study of the livelihood experiences of Zimbabwean migrants with disabilities in South Africa
(Stellenbosch : Stellenbosch University, 2019-12) Dangarembwa, Noel; Ned, Lieketseng; Geiger, Martha; Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.
ENGLISH SUMMARY : There remains a dearth of studies that examine the link between disability, migration and livelihoods at both an international and local level. Using a conceptual framework that includes the intersectional model and the push-pull model, the aim of this study was to explore the livelihood experiences of Zimbabwean migrants with disabilities who live in Cape Town, South Africa. The objectives of the study were: - To identify the factors that “push” persons with disabilities out of Zimbabwe and the “pull” factors that “draw” them to South Africa; - To gather narrative descriptions from Zimbabwean migrants with disabilities in South Africa about their livelihood experiences; - To identify contextual factors that influence the livelihood experiences of Zimbabwean migrants with disabilities in South Africa; - To describe the effect of the intersection of various identity markers such as disability, nationality, poverty, gender, and migrant status, on the livelihoods of Zimbabwean migrants with disabilities in South Africa. Using narrative inquiry as a methodological approach, narrative interviews were used to collect data. The data was analysed at three levels: 1) a narrative analysis approach to produce whole life stories; 2) an analysis of narratives approach to generate themes from the storied data and 3) a deeper level of analysis which is integrated in the discussion of findings and that seeks to further comprehend the data. The findings of this study indicate that all participants were “pushed” out of their country of origin (Zimbabwe) by primarily political instability and economic hardships which made it hard for them to sustain their livelihoods. Participants were “pulled” to the host country (South Africa) by what they perceived to be “greener pastures”, in a country which seemingly “flows with milk and honey”. Once Zimbabwean migrants with disabilities arrived in South Africa, they assumed layers of identities that shaped the way through which they experienced the oppression that characterised their livelihoods in a terrain in which they are generally regarded as “good for nothing people” who migrate to South Africa to squander the resources of the host nation. However, participants did not passively receive oppression, but they claimed their agency and actively engaged in numerous shifts and adaptations in South Africa in ways that enabled them to establish and sustain their livelihoods. Among other identity markers, disability, migrant status and poverty intersect to frame the livelihood experiences of Zimbabwean migrants with disabilities in South Africa. Conclusion: the use of a narrative methodology was appropriate for illuminating the livelihood experiences of Zimbabwean migrants with disabilities in South Africa, because it allowed the co-construction of knowledge through dialogue and interaction with participants. There is need for the governments of both the country of origin (Zimbabwe) and the host country (South Africa) to pay attention to the livelihood experiences of persons with disabilities, so as to address their needs and concerns through policy and practice, thereby enhancing their well-being. It is my hope that this study will prompt further studies, in order to broaden the migration and disability knowledge particularly in Africa.

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