Masters Degrees (Psychology)

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Adolescents' experiences of living with obsessive-compulsive disorder (OCD) within a South African context : a qualitative study
(Stellenbosch : Stellenbosch University, 2023-10) Pestana, Katia; Coetzee, Bronwyne; Lochner, Christine; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
ENGLISH ABSTRACT: Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterised by recurrent, repetitive and intrusive thoughts (obsessions) and/ or repetitive behaviours or mental acts (compulsions). The obsessive-compulsive (OC) symptoms cause substantial impairment and distress; in children, they interfere with developmental adaptation and daily functioning. The 2019 coronavirus pandemic (COVID-19) may have triggered and reinforced obsessive thinking and compulsive behaviours, and such aggravation might, in turn, correlate with poorer functioning and worsening of quality of life (QOL) of individuals with OCD. Available literature regarding the impact of OCD on everyday functioning and QOL has been mainly quantitative in nature. Moreover, research studies mostly include adults with OCD. There are currently no published qualitative studies that attempt to explore the influence of COVID19 on the everyday lives of children and adolescents with OCD. Therefore, the present study aimed to qualitatively explore the subjective experience of living with OCD from the perspectives of adolescents (12-18 years old) and their parents within a South African context. The second aim was to qualitatively explore how COVID-19 has impacted South African adolescents with OCD from their own perspectives as well as that of their parents. Eight adolescents (6 females and 2 males) and eight parents (8 females) took part in online semi-structured interviews. All the participants provided written informed consent and assent, and were given assurance that their identities would be kept strictly confidential and anonymous. The interviews were conducted online via Zoom or MS Teams and were audio-recorded with permission. Thereafter, the interviews were transcribed verbatim and entered into a qualitative software programme and thematically analysed. In total, 8 themes and 17 sub-themes were identified and analysed through the lens of the Ecological Systems Theory (EST). The thematic analysis uncovered participants’ subjective experiences of living with OCD. This is the first study to qualitatively explore how OCD impacts on the everyday life of youth, also within the context of the COVID-19 pandemic and lockdown phases, from the perspectives of adolescents and their parent/s. The findings were that OCD is debilitating, with a substantial impact on all domains, including home, social functioning, and schoolwork. Adolescents with OCD (and their parents) reported extreme guilt and shame because of OC symptoms and an inability “to be themselves.” Results on the impact of COVID-19 were mixed. Some participants reported exacerbated symptoms (e.g., worse contamination fears and increased compulsive washing) in this context, whereas others denied any impact. Overall, these findings offer deeper insight into the subjective experiences of living with OCD, also during the COVID-19 pandemic, from the perspectives of adolescents and their parents. The findings highlight the importance of involving parents in treatment strategies and emphasizes the need for well-defined guidelines to assist parents in effectively implementing at-home reinforcement of therapeutic teachings. Moreover, the data accentuate the importance of psychoeducational programs at schools and in the community, to increase awareness and coping with OCD, specifically in children and adolescents.
Barriers to and facilitators of adherence to intravenous chemotherapy among breast cancer patients at a tertiary hospital in the Western Cape
(Stellenbosch : Stellenbosch University, 2022-04) Kepkey, Brigitta Blumé; Coetzee, Bronwyne; Kagee, Ashraf; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: Worldwide, breast cancer is the most commonly diagnosed cancer as well as the leading cause of cancer-related death among women. The estimated incidence of breast cancer is expected to rise, with the majority of breast cancer cases occurring among women in low and middle-income countries (LMIC) such as South Africa, where adherence to treatment for cancer remains a challenge. Adherence to treatment for cancer is essential in order for breast cancer patients to achieve optimal health and treatment outcomes. In South Africa, factors that affect adherence to intravenous chemotherapy, one of three treatment options available to breast cancer patients, have not been well-documented within the literature. The qualitative research study reported on here is an effort to explore the factors that influence adherence to intravenous chemotherapy among breast cancer patients at a tertiary hospital in the Western Cape, South Africa. The perspectives of breast cancer patients, family members and healthcare workers, including doctors and nurses from the breast clinic and chemotherapy unit at the tertiary hospital, have been elicited. Participants in the present study included nine breast cancer patients, three family members and eight healthcare workers. Using semi-structured interviews, data describing participants’ perspectives of the adherence-related factors of patients were collected. Through the lens of the Ecological Systems Theory (EST), nine main themes and 21 sub-themes were identified and interpreted using thematic analysis and a qualitative software programme. The most salient barriers to adherence identified at the microsystem level were treatment side effects and transport and finances. The most salient facilitators of adherence to treatment were patients’ self-motivation to complete treatment as well as symptom improvement as a result of chemotherapy. The most salient barriers identified at the mesosystem level was lack of social support and the most salient facilitators of adherence were shown to be social support received from relatives and friends as well as healthcare workers. At the exosystemic level, the most salient barrier to adherence was lack of oncology-trained staff and the most salient facilitators of adherence were the fee subsidy and hospital transport. The research study’s findings demonstrated that breast cancer patients’ adherence to treatment was shaped and influenced by their interactions with family, friends, healthcare workers as well as poverty-related and institution-related factors. Patients’ understanding, knowledge and access to information regarding breast cancer and its treatment mechanisms also served as important determinants of adherence.
Barriers to and facilitators of the transition to adult care among HIV-infected youth in the Western Cape
(Stellenbosch : Stellenbosch University., 2020-03) Mbebe, Sylvie; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Background. South Africa has the highest rate of HIV-infection in the world, and with nearly one-third of all new HIV-infections occurring in the age group 15−24 years, adolescents and young people bear the burden of this disease. As children and young people move through their developmental stages, those living with chronic illnesses also move through the healthcare system, transitioning from paediatric services to adult services. Ideally, when those receiving paediatric care reach late adolescence (15–19 years) or early adulthood (19–25 years), they should transfer to adult care so that they can start managing their own health. However, in resource-limited settings like South Africa, little is understood of the transition process and the factors that may contribute to or hinder the process. As such, the aim of this study was to explore the barriers to and the facilitators of transition to adult HIV care among HIV-infected youths in the Western Cape from the perspectives of healthcare providers who provide paediatric and adult HIV healthcare services. Methods. I used purposive sampling methods to recruit participants for this study. Data gathering included in-depth, semi-structured interviews with 24 healthcare providers (pharmacists (n=7), doctors (n=3), nurses (n=8), sisters (n=2), counsellors (n=1)) and three additional hospital staff (one data capturer and two administrative clerks). The interviews were audio-recorded and transcribed verbatim for the purposes of thematic analysis. I analysed the data using ATLAS.ti computer software. Further, I used an observation schedule to document the moment-by-moment occurrences in the patient waiting rooms of the two healthcare facilities included in this study. Results. Four themes and 10 subthemes that captured participants’ sentiments on the barriers to and facilitators of transition to adult care emerged from the data. The four themes were (1) understanding and conceptualization of transition; (2) individual factors affecting transition; (3) healthcare system factors affecting transition; and (4) social factors affecting transition. Participants understood transition to mean different things, including a change in the medication regimen, a change of clinic or a change of doctor. Some were not familiar with the term. Barriers to transition included a lack of transition readiness, the unfriendly clinic environment, services gaps, a lack of knowledge about HIV, a lack of communication, adolescents’ developmental stage, home environments and broad contextual issues (such as poverty and inequality, the breakdown of family, and stigma). Further issues were related to service provision, such as inadequate resources in the clinic, insufficient training, lack of policies, and fragmented services. Participants suggested that an increase in the number of healthcare professionals and the employment of younger staff could be of benefit. They also suggested that training and preparatory programmes could provide adolescents with adequate support and prepare them for transition. Participants furthermore proposed ongoing individual counselling sessions for transitioning adolescents as well as a tracking system for defaulters from adult clinics. Others suggestions included the creation of youth-friendly clinics with integrated healthcare systems only for youths; training of healthcare providers in adolescent medicine, and the creation of centres and programmes for youths in their communities. Participants also highlighted the importance of the implementation of continuous HIV awareness programmes and resources for HIV-infected youths and their families. Conclusion. The findings from this study demonstrate that the transition to adult care is not always easy. Understanding the barriers to and facilitators of the transition to adult care will help guide informed initiatives and strategies that can improve the transition process from the paediatric to the adult healthcare setting. Targeting the needs of adolescents during the process of transition has the potential to improve adolescents’ adherence to treatment and to promote long-term health outcomes.
Caregivers' perceptions of their involvement in children's mental health and mental health services: A qualitative study amongst caregivers of primary school aged children in the Western Cape, South Africa
(Stellenbosch : Stellenbosch University, 2022-03-09) Gericke, Hermine; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: Introduction. The poor mental health of children and young people is a global crisis. South African children are at an increased risk of developing mental health problems due to their exposure to multiple risk factors, including poverty, HIV/AIDS, and poly-victimisation. Children and young people who are at risk of developing a mental health problem depend on their parents or caregivers (any person responsible for the daily care of a child) to recognise problems and access appropriate mental health support. Studies, most of which were conducted in high-income countries, have shown that parents/caregivers experience a plethora of barriers and facilitators associated with recognising problems within their children and accessing services for a variety of reasons including systemic-structural, attitudinal, and family circumstances. However, it is unclear how South African parents/caregivers perceive their involvement in recognising and responding to their children’s mental health problems. In this study, I sought to explore how South African parents/caregivers conceptualise mental health and how they deal with potential mental health problems in the family context. I also sought to explore how they perceive their role in their children’s mental wellbeing, and the barriers and facilitators associated with this role. Methods. Participants were 31 parents/caregivers of primary school aged children. I conducted in-depth, semi-structured interviews with 10 parents/caregivers of children (aged 11–14) attending a primary school in the Western Cape area. Secondary data from interviews with a further 21 participants in similar contexts were incorporated. I analysed the data as a single corpus using reflexive thematic analysis and ATLAS.ti version 8 software. Findings. I identified four superordinate themes: (1) understandings of mental health terminology, (2) coping with mental health problems, (3) the parents’/caregiver’s role in children’s mental health and mental health services, and (4) barriers/facilitators to parent/caregiver involvement in children’s wellbeing. Although participants struggled to articulate their understanding of mental health terminology, they made use of various models to explain the cause of mental health problems and showed great awareness of the consequences if these problems are left untreated. Participants made use of several strategies to ensure their emotional availability to their children so that they could recognise and respond to mental health problems. However, participants face multiple barriers and can rely on different facilitators in their involvement. Lack of knowledge and resources to deal with wider contextual factors, such as poverty, other responsibilities, family dynamics, and poly-victimisation, often cause participants to use avoidance as a coping mechanism. Participants also found it difficult to recognise emotional distress and mental health problems and distinguish between problematic and normal adolescent behaviour. Participants often believed their children’s mental health problems were not serious enough to warrant engagement with child and adolescent mental health services, and even if they did wish to do so, they did not know where to seek support. Although participants found it acceptable to seek support from their social networks, they were often concerned over confidentiality and trust. Participants who have engaged with mental health services, often through referrals, reported positive experiences and valued a good therapeutic relationship, knowledge, and the support they received. Conclusion. The findings highlight the need for parent/caregiver support in understanding, recognising, and appropriately responding to their children’s mental health problems. Supporting parents/caregivers on these fronts will promote their availability and appropriate mental health help-seeking for children experiencing a mental health problem. The findings highlight the need for further research and the development of appropriate interventions.
Coping strategies and quality of life in patients with multiple sclerosis (MS): A South African online perspective
(Stellenbosch : Stellenbosch University, 2020-12) Ackerman, Inge; Pretorius, Chrisma; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: The primary aim of this study was to explore the relationship between coping strategies used by individuals with multiple sclerosis (MS) and their quality of life (QoL) in the context of South Africa. Two hundred individuals (18 years and older) diagnosed with MS were recruited from the online Facebook support group, Multiple Sclerosis South Africa Western Cape. Participants were asked to complete a survey that consisted of a biographical questionnaire, a coping questionnaire (Brief Cope) as well as a QoL questionnaire (Multiple Sclerosis International Quality of Life questionnaire [MusiQoL]). Correlation analyses were performed to explore the relationship between QoL and coping. Independent sample t-tests and one-way ANOVA’s were utilised to ascertain if there were differences in the mean coping and QoL scores between different groups (male and female) and sub-types of MS namely relapsing/remitting (RRMS), primary progressive (PPMS), secondary progressive (SPMS) and progressive relapsing (PRMS). A multiple regression was conducted to explore the predictors of QoL (independent variables: age, education, level of income, MS subtype, coping style, and dependent variable: QoL). The results of this study indicated that a relationship exists between the coping strategies used by individuals with MS and their level of QoL. Specifically, a significant positive relationship was identified between the use of emotional support, venting, positive reframing, acceptance and QoL. In contrast, a significant negative relationship was identified between the use of behavioural disengagement, mental disengagement, substance use, self-blame, and QoL. The results also highlighted a low QoL among this sample of South Africans with MS (measured with a mean global index score of 51.33 on the MusiQoL). Moreover, it was ascertained that MS sub-type had an affect on the coping strategies and QoL of individuals with MS in this sample. Finally, the results of this study also showed that planning (1.14 %), positive reframing (1.69%), acceptance (1.29 %), behavioural disengagement (1.23 %), and self-blame (9.85 %) account for some of the iii variance in the QoL of this sample. The findings of this study provided greater insight into the patterns of coping and QoL of individuals with MS in South Africa. These findings also highlight that the type of coping strategies used by the MS participants in our sample had a significant negative influence on their level of QoL.
The daily functioning and quality of life of adults with obsessive compulsive disorder: a qualitative inquiry
(Stellenbosch : Stellenbosch University, 2017-03) Kohler, Kirsten Celeste; Coetzee, Bronwyne; Lochner, Christine; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: Obsessive compulsive disorder (OCD) is a highly debilitating psychiatric condition characterized by recurrent intrusive thoughts and images (obsessions) and/or repetitive behaviours aimed at reducing the distress associated with the obsessions. In the absence of treatment, OCD substantially influences the individuals daily functioning (sleep, productivity, leisure, socialising), and quality of life (QOL) (family, friendships and relationships, academics and work, self-esteem). Current literature reports mainly on quantitative findings regarding the influence of OCD on an individual‘s daily functioning and QOL. Consequently, the lack of in-depth knowledge on the influence of OCD on day-to-day functioning and QOL from the perspectives of patients themselves limits our understanding of this disorder. The present study aimed to qualitatively explore the experiences of adults (18 years and older) diagnosed with OCD within South Africa with a focus on the impact of OCD on their daily functioning and QOL. Twenty individuals with a primary diagnosis of OCD were selected to take part in face-to-face and telephonic semi-structured interviews. All participants gave written informed consent, and were assured of confidentially and anonymity. Interviews were audio-recorded with the permission of the participants, and transcribed verbatim. Thereafter, the transcripts were entered into a qualitative software programme and thematically analysed. Overall, six main themes and 14 sub-themes were identified, and interpreted through the lens of the Ecological Systems Theory (EST). Thematic analysis unearthed participants‘ experiences of OCD. More specifically, at the level of the microsystem, awareness of the disorder and its impact on cognitive processes, sleep, daily routine, leisure and socializing was described. At the level of the mesosystem, social support (and absence of support) received from family, friends and colleagues were considered important. Here participants also described the extent to which OCD influences family functioning. At the level of the exosystem, the impact of OCD on work and academic attendance and performance was salient. At the level of the macrosystem, the use of healthcare services was described. Finally, at the level of the chronosystem participants elaborated on the experience of OCD over time and the use of several strategies that allowed them to cope with, manage and accept their condition. The findings of this study demonstrated that participants experienced poor QOL and functioning in several domains of their lives. These findings are amongst the first to explore OCD qualitatively in a South African sample. Findings may inform practice by providing clinicians with the information necessary to adjust their treatment strategies and to tailor to the needs of the individual. Furthermore, these findings provide clinicians, patients and their families and researchers with a better understanding and greater insight into OCD. Future research should include the perspectives of family members, friends and healthcare professionals in order to capture the impact of the disorder on all those involved.
Emotion regulation in trichotillomania (hair-pulling disorder): the role of stress and trauma
(Stellenbosch : Stellenbosch University, 2019-04) Demetriou, Salome; Lochner, Christine; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
Introduction: Trichotillomania (hair-pulling disorder, or TTM) is characterized by pathological hair-pulling, repeated unsuccessful attempts to stop the behaviour, and significant distress. Various affective states (e.g. tension, stress or pleasure) occur before, during or after hair-pulling, and difficulties in regulating these have been noted in TTM. When applied to TTM, the emotion regulation (ER) model is based on the argument that pulling serves to regulate emotions. However, this appears to be an arduous relationship. For example, stress may increase hair-pulling as a way to assuage feelings of extreme anxiety and depression, whereas hair-pulling and its sequelae may also increase stress levels. There is also evidence to suggest significantly greater severity of childhood trauma in individuals with TTM compared to controls. However, the relationship between stress, childhood trauma and ER in TTM is not yet known. This study aimed to address this gap in our knowledge, by firstly comparing the rates of these variables in TTM with matched healthy controls. A second aim was to investigate whether there was a relationship between hair-pulling severity and difficulties in ER. A third aim was to investigate whether there was a relationship between stress, childhood trauma, and ER difficulties in TTM, while controlling for the presence of mood and anxiety disorders. Methods: The majority of the data included in the study formed part of a larger ongoing study. Fifty-six adults with TTM and 31 sex- and age-matched controls were included. Participants in this study completed a battery of questionnaires, which included the Perceived Stress Scale (PSS), the Childhood Trauma Questionnaire (CTQ) and the Difficulties in Emotion Regulation Scale (DERS). The data were analysed using the Statistical Package for the Social Sciences (SPSS v. 22). Findings: Stress (p = .03), childhood trauma (p = .03), and difficulties in ER (p < .01) were all significantly increased in TTM patients compared to the healthy controls. Second, there was no statistically significant relationship between hair-pulling severity and difficulties in ER. Last, a combination of stress and childhood trauma explained 28.7% of the variance in ER difficulties in TTM [F (2.51) = 7.00, p < .01). However, stress was the only variable that significantly correlated with difficulties in ER in TTM (ß= .47, p < 0.001). Conclusion: As one of the first studies to explore ER in TTM in-depth, the study findings suggested significantly increased stress, childhood trauma, and difficulties in ER in individuals with TTM. While individuals with TTM had greater difficulty in regulating their emotions compared to healthy controls, the data showed no significant relationship between TTM severity and ER difficulties. In keeping with the ER model, one would expect that increased pulling could be used as an attempt to regulate emotions – however this data did not support this hypothesis. Rather, increased stress in TTM individuals significantly explained difficulties in ER. It may be argued that stress and difficulties in ER seem to be more closely related than hair-pulling and difficulties in ER. This suggests that the ER model may not be the best model to explain the phenomenon of pathological hair-pulling. Further research into the underlying mechanisms and dynamics of stress, trauma and ER in TTM may assist in finding a more appropriate explanatory model. In the clinic, emphasis should be placed on the assessment of difficulties in ER in patients with TTM and on addressing modifiable features (such as stress) associated with such difficulties, in addition to reducing hair-pulling.
The experiences of learning facilitators in the Western Cape who work with children on the autism spectrum in mainstream schools
(Stellenbosch : Stellenbosch University, 2021-03) Elliott, Mignon; Coetzee, Bronwyne; Truter, Ben; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by deficits in social communication (present in multiple contexts) and restricted and repetitive behaviours, interests and activities. However, each individual’s autism condition is unique, often presenting with co-occurring diagnoses like ADHD and anxiety disorders. Due to the characteristics mentioned above, children with ASD have barriers to learning. This makes it difficult for them to function independently in a mainstream classroom setting. Following an international move towards inclusive education, South Africa passed a bill in 2001, The White Paper 6: Special Needs Education – Building an Inclusive and Training System (WP6). The WP6 allows for the inclusion of all individuals in the mainstream education system and promotes quality education for all learners, including those with ASD. However, children with ASD require additional assistance (emotionally, academically and socially) in classrooms if they are to be successfully included in mainstream schools. The learning facilitator takes the role of assisting such learners. Learning facilitators provide specialised support for individuals with barriers to learning in mainstream schools and are essential to the inclusion process. Given the fact that learning facilitation is a relatively new field in South Africa, there is a paucity of literature on the topic. This qualitative study using semi-structured interviews answers the research question of how learning facilitators in the Western Cape experience working with children on the autism spectrum in mainstream schools. A total of 18 participants were interviewed, all of whom provided written informed consent. The participants were furthermore assured of their anonymity. The interviews were audio-recorded and transcribed verbatim, after which the interviews were analysed using a qualitative software programme. The thematic analysis extracted the experiences of the participants, and the emerging themes were subsequently augmented by the ecological systems theory (EST) as laid out by Bronfenbrenner. Six themes and 19 subthemes were identified using thematic analysis. The findings revealed a lack of understanding of the learning facilitator’s role and a need to clarify the facilitator’s function in the mainstream school environment. Learning facilitators reported that training is inconsistent, leaving most facilitators feeling unprepared. Learning facilitators who did receive more consistent training and had open communication with key role players expressed having a more positive experience and feeling more supported. However, the majority reported feeling unsupported. The participants viewed working together and considering each child as unique as pivotal for successful inclusion. These findings provide evidence that learning facilitators support children with ASD in mainstream schools, each according to their needs. Future research could include the development of training programmes and support groups for learning facilitators. Additionally, it would be helpful for mainstream schools to consider the employment of learning facilitators for all classrooms, as this will assist those South African teachers in challenging environments.
Exploring fatigue amongst people living with multiple sclerosis in the Western Cape
(Stellenbosch : Stellenbosch University, 2022-04) van Niekerk, Nicolaas Jacobus; Coetzee, Bronwyne; Pretorius, Chrisma
ENGLISH SUMMARY: Rationale and Aim Multiple sclerosis fatigue (MS-F) is a distressing and disabling symptom of multiple sclerosis (MS) that is commonly experienced by people with multiple sclerosis (PwMS). Whilst a substantial body of knowledge exists on MS-F, phenomenological insight into the significance of MS-F within PwMS’s lives is sparce – both globally and nationally. Consequently, the present study sought to explore the lived experiences of MS-F amongst MS-F sufferers in the Western Cape (WC). To this effect, the present study aimed to identify and clarify how PwMS in the WC understood MS-F as a feature of life (FOL). This includes how PwMS in the WC perceived and made sense of: (a) MS-F as a symptomatic experience, (b) MS-F impacts on daily life, (c) MS-F management, and (d) coping with MS-F. Worldview and Theoretical Orientation The present study assumed a constructivist worldview. As such, this study ascribed to a relativist ontology as well as a transactional and subjectivist epistemology. Furthermore, interpretative phenomenological analysis (IPA) was adopted as a theoretical orientation to guide the research. Here IPA guided the research through its theoretical foundations of phenomenology, hermeneutics, and ideography. Research Design and Methodology To elucidate lived experiences, an exploratory and cross-sectional research design was employed. Through purposive sampling, 12 MS-F sufferers living in the WC were recruited according to specific inclusion/exclusion criteria. These participants completed a biographical questionnaire, the Patient-determined Disease Steps (PDDS), and the Chalder Fatigue Scale (CFQ) for descriptive purposes. Additionally, they also participated in individual semi-structured telephonic interviews to collect experiential accounts of living with MS-F. These interviews were audio recorded and transcribed. Hereafter, I selected the six most data rich and sophisticated accounts for subsequent IPA analyses. Results The present study identified four understandings (i.e. superordinate themes) as characterising participants’ lived experiences of MS-F. Participants understood MS-F as a symptom through its symptomatic features. Here participants perceived MS-F as a lack of energy, an ever-present inconsistency of life, and a subjective mind-body phenomenon. Furthermore, participants understood MS-F as restricting their capacity to participate in the world. This understanding comprised notions of a restricted functional capacity and losses of both independence and spontaneity. MS-F management was understood as the planned accommodation of MS-F through energy maintenance. Here MS-F management was perceived as preparatory in nature whilst energy maintenance signified a route to realising MS-F management. Lastly, participants understood coping with MS-F as the acceptance of the fatigued self and a fatigued life. Here, coping involved an acceptance of MS-F and its restrictions on life as well as an acceptance of MS-F as a FOL. Conclusion MS-F is a meaning-laden phenomenon. It is a symptom with a considerable intrapersonal presence and has substantial implications and consequences for life. Here the present study provides a more person-centred insight into the significance of MS-F within PwMS’s lives. These findings may prove valuable to existing theory as well as to those working with MS-F sufferers.
Exploring narratives as a tool to manage psychosocial distress in children hospitalised for tuberculosis in the Western Cape, South Africa
(Stellenbosch : Stellenbosch University, 2024-03) October, Caitlin Danielle; Hoddinott, Graeme; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
ENGLISH ABSTRACT: Background: Children who are hospitalised for long periods are at risk of developing emotional, behavioural and social difficulties. Hospitalisation for any reason is known to be a stressful experience for children. Some interventions aimed at alleviating the psychosocial distress associated with long-term hospitalisation among children have been successful, although none have focused specifically on children hospitalised for tuberculosis care in South Africa. “Courageous Curly” is a set of narrative tools (a story with activities for use by hospital staff to facilitate the child’s understanding of their hospitalisation) adapted from successful interventions and further developed in Cape Town. Aims: I aimed to explore children’s experiences of a pilot implementation of Courageous Curly to inform further refinement. My specific objectives were: 1) To describe how children talk about their experiences of being in hospital for TB, 2) To observe and document how children interact with the teacher and each other during the presentation of Courageous Curly, and 3) To describe how children talk about their experiences of being in hospital for TB treatment after they have participated in Courageous Curly. Methods: The study followed an exploratory qualitative design situated within the narrative paradigm. To achieve objective 1, I analysed case descriptions of interviews by doing a secondary analysis with children hospitalised with MDR-TB at Brooklyn Chest Hospital to identify the negative experiences children had during hospitalisation. To achieve objective 2, I conducted observations of the Courageous Curly story being told to children at the school situated at BCH over a period of 13 days. To achieve objective 3, I interviewed children (n=6) about their experience of hearing the Courageous Curly story. I analysed the data of all three objectives through thematic analysis. Findings: Children had four types of negative experiences due to hospitalisation, namely: negative emotions, behavioural responses, a lack of knowledge of being admitted to BCH, and a lack of understanding of other individuals at BCH. Children were able to participate in Courageous Curly and interacted well during implementation. Children who had experienced Courageous Curly said that they enjoyed it and that it made them feel better about being in hospital. Conclusion: Similar to children hospitalised for other reasons, children who are hospitalised for TB care experience psychosocial distress due to long-term hospitalisation. Participants in this study enjoyed participating in the narrative intervention, Courageous Curly, and they used it to narrate their own experiences while participating in the activities as part of the story. Such interventions are crucial for mitigating the potential negative effects on psychological, social, emotional development and well-being in children who are hospitalised for prolonged periods. The initial evidence of the pilot project with Courageous Curly is that it is possible to implement it with good participation from children. Children enjoyed participating in Courageous Curly, and it positively influenced their experience of hospitalisation. Further research is needed to refine and evaluate its effectiveness in multiple contexts.
Exploring the acceptability of a visual intervention to improve paediatric adherence to antiretroviral therapy in South Africa
(Stellenbosch : Stellenbosch University, 2019-04) Bradshaw, Melissa Elizabeth; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Near-perfect levels of adherence are required by children five years and younger on ART in order to achieve optimal treatment outcomes. Caregivers of children on ART are fundamental in ensuring their child achieves high levels of adherence, as they are responsible for administering medication to the child. Caregivers require the necessary adherence-related information, motivation, and behavioural skills to ensure their child remains adherent to ART. However, these components are often affected by caregiver, child, and medication regimen characteristics, as well as contextual and healthcare related factors. Whilst there are a number of children who are non-adherent to ART, effective interventions targeted at this age group are not available. Visual interventions, such as the Petrie device demonstration developed in accordance with the IMB-model, has shown potential in enhancing medication adherence, and may be appropriate for use with caregivers of children on ART. In this study, I explored the acceptability of the Petrie device demonstration with caregivers of young children on ART. Participants included in the study were eleven caregivers to children five years and younger on ART, attending outpatient clinics within the City of Cape Town Municipality, South Africa. Data describing participants’ understanding and beliefs of their child’s diagnosis and treatment, medication knowledge, and adherence-related factors were collected using questionnaires. Interviews and a brief questionnaire were used to determine how participants reacted to the device after seeing it. The quantitative data was analysed using descriptive analyses Thematic analysis was used to analyse the qualitative data. Participants reported high levels of adherence despite experiencing various barriers to adherence. The Petrie device demonstration was found to be acceptable to participants. The demonstration increased adherence-related knowledge and motivation, which led to some participants suggesting changes in medication administration behaviour that they intended to implement. As the demonstration may prove effective in enhancing adherence to ART, future research should be conducted to determine the efficacy of the device in doing so. Whilst the demonstration appears suitable for use as part of routine clinical practice, aspects of implementation and feasibility require further work.
Parenting a child with autism spectrum disorder (ASD) in the context of Covid-19 in South Africa: A qualitative study
(Stellenbosch : Stellenbosch University, 2022-04) Karrit, Miriam; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: Autism spectrum disorder (ASD) is defined as a neurodevelopmental disorder characterised by restricted and repetitive behaviours, activities, and interests, as well as deficits in social communication. Even in ideal circumstances, parenting a child with ASD can be stressful and impact on emotional well-being due to these characteristics. The 2019 coronavirus pandemic (Covid-19) created a high degree of disturbance to the lives of parents raising a child with ASD. In order to help children with ASD deal with these challenges (unpredictable and complex changes), parents provided specialised support, encouragement, and access to activities that enabled them to master key developmental tasks. It was crucial to investigate the challenges faced by parents raising a child with ASD in South Africa during the pandemic as there was a paucity of literature on the matter. In this qualitative study, I aimed to explore parents’ experiences of parenting a child with ASD in South Africa in the context of Covid-19 in order to determine challenges they faced and how they coped with these. To answer my research question and address my objective, I conducted semi-structured interviews with a total of 23 parent participants (raising children with ASD between the ages of 6 and 12), all of whom provided written informed consent for this. The participants were assured of their anonymity. The interviews took place telephonically or online via Zoom meetings and were audio-recorded using a Dictaphone. I transcribed the interviews verbatim, subsequently analysing the data engendered thematically, using ATLAS.ti version 9. By using thematic analysis, I identified four themes and 12 subthemes that provided insight into the parents’ experiences. The four main themes were as follows: Pandemic challenges- restrictions, routines and remote working, parenting and interpersonal relationships in conditions of confinement, help-seeking and sources of support, finding ways to cope amidst a crisis. The main finding was that parenting a child with ASD during lockdown was complicated and challenging. Indeed, parents reported that their children faced many challenges when it came to adhering to disease containment measures such as the lockdown itself and mask-wearing, social distancing, and hand sanitising. These measures required explanation from parents to children. In terms of interpersonal relationships at home, parent-child ones were affected in a negative or positive manner, given that the family spent more time together. Parents faced challenges balancing their work or house duties against the needs of their children, especially those who were on the frontline of the pandemic such as healthcare workers. Even though some parents enjoyed support during the pandemic, all parents highlighted the need for additional help. While some used adaptive coping strategies, others took to maladaptive ones such as substance abuse, isolation, and overeating, which impacted them and their child negatively. These findings provide initial evidence that parents of children with ASD in South Africa need additional support in order to effectively manage the Covid-19 pandemic. Future research could include the experiences of raising adolescents with ASD in the context of Covid-19 in South Africa. Moreover, future research might focus on assessing the emotional well-being and stress of parents of children with ASD – and under different levels of restriction.
Structural brain differences and motor functioning in prenatally Methamphetamine exposed children in Cape Town
(Stellenbosch : Stellenbosch University, 2017-12) Du Toit, Stefani; Roos, Annerine; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: Rates of methamphetamine use amongst pregnant women in South Africa is alarmingly high, rendering a large number of infants and children at risk for the adverse consequences of prenatal methamphetamine exposure (PME). Indeed, little is known about the effect of PME on brain and cognitive development in exposed children, especially in lowand middle-income settings like South Africa. The aim of the study was to contribute to the small, but growing, body of research that focuses on the brain development and motor performance of prenatally MA exposed children. The objectives were: (1) to examine the effect of PME on motor development in exposed children at the age of 8 years, compared to unexposed children of the same age; (2) to examine the effect of PME on structural brain volumes and cortical thicknesses of the brain in exposed children at the age of 8 years, compared to unexposed children; and (3) to investigate whether a correlation exists between altered brain development and motor function. Participants were 8 year old PME children (n = 17), and unexposed children (n=16) recruited from a local school and day care centre in the northern suburbs of Cape Town. PME children and unexposed controls completed two neurocognitive assessments (Beery Visual Motor Integration (VMI) test and Grooved Pegboard Test), assessing various aspects of motor function. Both groups also underwent magnetic resonance imaging (MRI). Independent sample t-tests showed that PME children scored significantly lower on measures of visual-motor integration, visual-motor coordination and fine motor development, when compared to unexposed children. Hierarchical regression analysis considering potential confounding anthropometric and socio-demographic variables and group effects, confirmed that poorer motor scores observed amongst PME children was as a result of PME. Analysis of variance (ANOVA) by group revealed that PME children had reduced cortical thickness in several brain areas that were associated with motor function.Overall, the findings of this study contribute to the growing body of literature available on the effect of PME on brain and motor development, especially in the South African context.

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