Doctoral Degrees (Occupational Therapy)

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A critical ethnography of the Vona du Toit Creative Ability Model (VdTMoCA) in the South African occupational therapy context
(Stellenbosch : Stellenbosch University, 2022-12) Zelda, Coetzee; van Niekerk, Lana; Duncan, Eve; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: Background: The Vona du Toit Model of Creative Ability (VdTMoCA) influenced South African occupational therapy education and practice for over 40 years. Limited empirical evidence for the Model exists. A first study verified the original levels of Creative Ability in 2010. Philosophical assumptions underpinning the Model are not known, nor whether they align with the original assumptions. Increasing utility of the Model warrants verification for practitioners to practice confidently when using the VdTMoCA. With little empirical evidence, the Model may resemble a sacred text. Methods: Critical ethnographic methodology was chosen to elicit critical encultured interpretations about the ontological, epistemological, methodological and axiological philosophical assumptions underpinning the VdTMoCA for three generations of occupational therapists: the Progenitor, first- and second-generation respondents. First-and secondgeneration respondents were selected by criterion sampling. Collected data included original academic documents, ethnographic interviewing and observations. Data was analysed inductively, deductively and across cases using five levels of analysis. Findings: Three themes describing the creative ability mindset emerged: “humans and their reality”, “creative ability and practice” and “application [of creative ability] in occupational therapy”. The findings show intergenerational agreement with the Progenitor’s original philosophical assumptions about the Model when used with persons with a medical condition, accessing a Westernized healthcare service context. Outliers arose when the Model was interpreted in its original form for community living where different cultures and unequal resources are present. Conclusions: Findings suggest philosophical and theoretical expansions of the VdTMoCA to include how creative ability is/can be developed for practice in naturalistic contexts. Specifically, the assumption that “motivation to do”, a patterned motivational response, arises not only between people (P) and their occupations(O) but is also stimulated from the relationship with contexts(C). Therefore, motivational factors present in naturalistic contexts must form part of the motivational dimension (P0C) for intervention.
Development and feasibility of an educational intervention to improve participation for people with spinal cord injury from Gaza, Palestine
(Stellenbosch : Stellenbosch University, 2023-12) Abu Mostafa, Moussa Kleib; Plastow, Nicola Ann; Savin-Baden, Maggi; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: Background: Many people with Spinal Cord Injury (SCI) in Low and Middle-Income Countries (LMICs) such as the Gaza Strip of Palestine are discharged prematurely from inpatient rehabilitation settings with inadequate skills in Activities of Daily Living (ADL). This gap may result in severe complications, e.g., pressure injuries, muscle contractures, incontinence disorders, and urinary tract infections. Consequently, participation of people with SCI (PW-SCI) in chosen purposeful activities may be limited and community participation may be restricted, leading to occupational deprivation and occupational imbalance. Resources allocated for the rehabilitation of SCI in the Gaza Strip are limited, and thus do not meet the multiple needs of PW-SCI. Moreover, many resources of health education for SCI were developed in high-income Western countries, which made them irrelevant for PW-SCI from low to middle-income countries with predominantly Islamic faith. Aim of the research: This study aimed to co-develop and evaluate the feasibility and initial effectiveness of an ADL education manual for use in inpatient SCI rehabilitation in Gaza, Palestine. Research question: Can a complex educational ADL intervention co-developed for and with patients with SCI treated in inpatient rehabilitation settings within the Gaza Strip optimise rehabilitation outcomes? Objectives: 1.To determine the effect of ADL education for inpatients with SCI in a rehabilitation setting through a systematic review and meta-analysis. 2.To co-develop an evidence-informed ADL education manual for PW-SCI (SADL-eM)using Participatory Action Research methods. 3.To test the usability of clinician-rated rehabilitation outcome measures, and acceptability of the SADL-eM, in a feasibility study. 4.To test procedures, estimate recruitment and retention, and initial effect of the SADL-eM in a pilot randomised controlled trial. Postdoctoral work this includes conducting a randomized clinical trial (RCT) while avoiding back draws of the current study. The researcher will recruit the sample from the Gaza Strip community-dwelling PW-SCI population with specific inclusion criteria to improve the reliability of the collected data. Methodology: The researcher adopted the UK Medical Research Council (MRC) framework for developing complex interventions that involve four phases, namely: development, feasibility and piloting, evaluation, and implementation. The researcher selected the study design for each phase according to the overall aim and study objectives. After obtaining the necessary ethical approval, the researcher in the development phase employed a systematic review and meta-analysis design to identify the current evidence base. Then, the researcher conducted a qualitative study that employed Participatory Action Research (PAR) to co-develop the educational model/intervention (Spinal Cord Injury Activities of Daily Living education manual). Within the feasibility and piloting phase, the researcher conducted a feasibility study to test the usability of clinician-rated rehabilitation outcome measures and patient acceptability of the SADL-eM, and a pilot study to test the procedure and to estimate recruitment, retention, and initial effectiveness of the SADL-eM.
The development of Hopscotch : an early intervention programme to improve motor skills and academic performance of grade R children in the West Coast of South Africa
(Stellenbosch : Stellenbosch University, 2022-04) Van der Walt, Janke; Plastow, Nicola; Unger, Marianne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: There is a high incidence of motor skill impairment in low socio-economic areas. Motor skill impairment among pre-school children effects their functional development, including play, social development, and academic skills and progress. These children need therapeutic input; however, therapy resources are often not accessible and motor skill impairment may remain unrecognised and untreated. This study aims to develop an accessible evidence-based motor skill intervention for grade R children in a rural low socio-economic area of South Africa, namely the West Coast. It is a five-stage study with a sequential mixed-methods design and using the theoretical model of complex intervention development. Firstly, in the absence of prevalence data for motor skill impairment in South Africa, a prevalence study using a cross-sectional descriptive study design and multi-stage cluster sampling was conducted. The study showed a high prevalence of motor skill impairment at 14.5%. Significant influencing factors identified were gender (male), lack of playground equipment, low weight and height and low socio-economic status of an area. Next, a scoping review was conducted to investigate the key elements of motor skill interventions for pre-school children. The PRIMA-SCR design was used to identify 45 studies through structured data-base searches, followed by title and abstract screening according to inclusion and exclusion criteria. The identified key elements were summarised in a proposed framework for intervention planning. A three-round Delphi study conducted with experts in the field of motor skill intervention followed on from the scoping review. The aim was to determine what the components of a feasible, cost effective motor skill intervention for pre-school children in the rural low socio-economic West Coast area would be. Consensus was reached at 75% or mean >4. A school-based, small-group intervention, facilitated by teachers under guidance and supervision of therapists was proposed. The Hopscotch motor skill intervention programme was subsequently developed, following on from the informative reviews. The result is a cost effective, school-based, 12 week intervention. A task-shifting approach was adopted where teachers facilitate the programme under the supervision of therapists. The study concludes with a protocol paper for an exploratory randomised controlled trial to determine the preliminary effect of the Hopscotch programme. A cluster randomised stepped wedge trial design is proposed to provide two randomised clusters of schools the opportunity to potentially benefit from the programme. It is envisaged that further research to evaluate the intervention will follow the pilot study. The Hopscotch motor skill-intervention programme may be a feasible solution to provide children in rural low socio-economic areas with much needed cost-effective, yet high quality intervention. The development of this complex intervention is a fluid, ongoing process and its preliminary effect is yet to be determined. The outcomes of this study suggests further research in the areas of culturally sensitive screening tools, inclusivity of intervention groups and feasibility of roll-out to other areas.
Exploring factors shaping family involvement in promoting the participation of adults with substance use disorders in meaningful occupations
(Stellenbosch : Stellenbosch University, 2019-04) Chikwanha, Theodora Mildred; Van Niekerk, Lana; Ikiugu, Moses; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : Background and rationale: Approximately 60% of re-admissions at the main acute mental health units at two of the referral hospitals in Zimbabwe comprise of adults with substance use disorders. Occupational therapy management of individuals recovering from substance use disorders at these institutions begins in the acute phase when clients are hospitalised. There are no rehabilitation programmes with defined minimum care standards in which occupational therapy is available to people with substance use disorders. Follow up of clients in their homes is also not possible due to limited financial and human resources. There is therefore no further psychosocial support or follow up rehabilitative care for clients with substance use disorders post discharge, their families take over the caring role. Aim: In this study, I explored the influence of the family on rehabilitation outcomes by examining the extent to which family involvement promoted participation in meaningful occupations by adults recovering from substance use disorders. Specific objectives: The specific objectives of this study were to: - Explore how a family member’s substance use affected his/her occupational patterns as well as those of other family members - Investigate what made it difficult or easier for families to support a family member who was undergoing occupational therapy to help modify substance use behaviour - Investigate how involvement of family members in occupational therapy interventions influenced participation in meaningful occupations by adults with substance use disorders - Develop a treatment framework for family based occupational therapy interventions for substance use disorders in the Zimbabwean context Methodology: This study was positioned within a decoloniality perspective. A qualitative design using a narrative inquiry approach was used to conduct this study. Fourteen family units with an adult family member recovering from substance use disorders participated in the study. Purposive maximum variation sampling was used during recruitment. Narrative interviews on the family`s experiences of living with an adult family member with a substance use disorder were conducted. Data were transcribed and analysed using interpretive narrative analysis strategies. Results: The theme “Reconstructing occupational participation through transactions enacted within the family context” emerged as the overarching theme during data analysis. The overarching theme comprised of two subthemes namely i) Occupational disruption from an intrapersonal and interpersonal perspective and ii) The centrality of the family in creating opportunities for participating in occupations. Exploring the connections between these subthemes and the overarching theme afforded the exploration of factors shaping family involvement in promoting the participation of adults with substance use disorders in meaningful occupations. Conclusion: The findings indicated that the family is extremely important in the management of substance use disorders. Through support from family members, the relatives who were recovering from substance use disorders were able to identify new occupational opportunities and reconstruct occupational participation. The new opportunities for occupational participation facilitated future participation in occupations that were health enhancing. These findings provided useful insights into the occupational therapy services that would be contextually relevant for individuals recovering from substance use disorders in Zimbabwe. A treatment framework which is occupation based and initiated by the families was proposed as a sustainable approach to providing post discharge occupational therapy services.
Livelihood occupations of women with disabilities in Bulawayo, Zimbabwe : a case of occupational injustice?
(Stellenbosch : Stellenbosch University, 2023-03) Chitapi, Unity Marvellous; van Niekerk, Lana; Blank, Alison; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: Introduction: Globally, persons with disability are faced with unemployment and reduced income opportunities, with an outlook that is worse for women. Barriers to employment tend to be severe for women with disabilities who occupy marginalised positions in labour markets. ‘Livelihood occupations’ are conceptualised for this research to denote everyday activities, including those that are non-sanctioned, that are done for subsistence and survival, and to broaden presentations of activities normally termed ‘work’, ‘employment’, ‘job’ or ‘productivity’ that people do for monetary and non-monetary gain. Livelihood occupations of women with disability and the experiential features thereof, are not well understood Methodology: In this dissertation, an analysis of experiences in livelihood occupational engagement for livelihoods is done using interpretative phenomenological analysis. Firstly, a scoping review was done to map literature on experiences of livelihood occupations for women with disability. The framework proposed by Arksey and O’Malley, and PRISMA extension for scoping reviews guidelines were utilized to guide the five-stage scoping review. Data from selected sources were further synthesized using deductive qualitative content analysis to fit experiential components into equity categories determined a-priori from the Equitable Total Rewards model. The equity perspective was applied to explore how experiences connote equity or lack thereof. Secondly, purposive sampling was used to select twelve participants. Nine participants were recruited from two disability organizations and three were approached individually and directly to diversify participants’ range of experiences. Twelve semi structured interviews were conducted, audio recorded, transcribed verbatim, and analysed using an interpretative phenomenological approach. To ensure trustworthiness, consistent and iterative meetings to discuss data collection and analysis were done between the researcher and supervisors. Findings: From the scoping review, fifteen sources, mainly from high income countries, were identified. Aspects of benefit and career inequity were largely evident in the experiences of the women across all sources. From the interpretative phenomenological analysis, five superordinate themes were identified. Theme 1: ‘Framing livelihood occupations’ was foundational to the four experiential themes; Theme 2: ‘Disability is always present’; Theme 3: ‘We are not in it alone’; Theme 4: ’Livelihood is part of a larger context’ and Theme 5: ‘It’s more than just engagement’. These findings are then situated into a broader theoretical framework comprised of Occupational Injustice Framework, Bourdieu’s ‘habitus, capital and field’ theory, and Sen’s Capability Approach. Conclusions: The scoping review revealed that there is considerable lack of research on experiences in livelihood occupations in low income contexts calling for further research. Women with disability reported experiencing inability to realize career goals and occupational choice. Participants’ experiences show that the women with disability have great resilience, initiative, personal causation, and volition. Intrapersonal resources, such as resilience and will, were drawn on to dispel perceptions of women with disabilities as unable, passive, and dependent. Extra-personal factors, such as relationships, COVID19, policies, opportunities, stigma, and discrimination, were influential in shaping experiential facets of livelihood occupational engagement. Occupational therapists can benefit from an understanding of experiential features of occupational engagement for livelihoods to incorporate community participation for women with disability.
Occupational justice through paid work : a qualitative study of work transitionprogrammes for youth with disabilities
(2020-03) Engelbrecht, Madri Hendrina; Van Niekerk, Lana; Shaw, Lynn; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH ABSTRACT : Background and rationale: Unemployed South African youth with disabilities form part of a disturbingly high general unemployment rate (29%) in the country. Favourable legislative and policy environments have been created for the development of the youth in general, and for the employment of people with disabilities, but remain vague on the issue of youth with disabilities, and appear to have failed to culminate into better employment outcomes for this group. The employment endeavours of youth with disabilities as a global minority, vulnerable, and designated group are under-researched; a situation that contributes to our lack of knowledge and understanding about their needs in relation to work. While we hold insights about the relationship between work, health and well-being, it is irresponsible and unjust to continue to ignore the exclusion of youth with disabilities from the occupation of work. Aim: The aim of the study was to do an in-depth exploration into how a South African work transition programme for youth with disabilities promote occupational justice through work. Objectives: The research objectives were: - to explore the work transition programme’s understanding of disability, it’s goals, operations, and employment outcomes for youth with disabilities; - to analyse manifestations of occupational justice in the programme’s goals, operations, and employment outcomes; - to explore the experiences and perspectives of youth with disabilities in relation to work and occupational justice; - to make recommendations to other work transition programmes, practitioners and policy makers regarding programme design and implementation that could promote occupational justice. Methodology: A critical ethnographic methodology was used to explore the context and operations of a work transition programme for youth with intellectual disabilities in the Western Cape Province of South Africa. A critical occupational perspective was taken in the inductive analysis process to generate knowledge about taken-for-granted truths that could underlie the way that the occupation of work may be denied to youth with disabilities. Data collection comprised qualitative methods of interviewing, documents review, focus group interviews, observation and journalling. Eight individual interviews were completed with two programme directors, a job coach and an employer. Five focus group interviews were done with unemployed and employed youth, and all available documents were reviewed. All interviews were transcribed in English, checked, corrected and uploaded to Atlas.ti for analysis. Inductive analysis comprised three phases namely, coding and categorising the data, crystalising the categories and developing preliminary themes, and final theme development. Findings: Three overarching themes developed from the data. Theme I, Along the way towards occupational justice, was categorised by information about the readiness of youth with disabilities to enter into the work transition programme, their journey of development through the programme, and the role of learnerships as a tool in work transition of this group. Theme II, Working "outside", reflected meanings of working in the open labour market for youth with disabilities. A specific experience of occupational injustice highlighted the iterative nature of work transition, and the context of the open labour market and employers' role in relation to employment of youth with disabilities were described. Theme III, Supported Employment as a counter to occupational injustice, elaborated the essence of support as an element in work transition. Categories under this theme showed different sources of support (job coach, family, employer, other youth) as imperative to work transition of youth with disabilities. Conclusions: The work transition programme promoted occupational justice by, firstly, adhering to and practicing according to a human rights-based approach (HRBA). The HRBA further informed and was strengthened by the programme's use of supported employment as a strategy to enhance the achievement of occupational justice. The programme's harnessing of support by different role players (namely the job coach, family, employer and other youth) was particularly instrumental in counteracting occupational marginalisation. The programme also proffered approaches to a restrictive open labour market, which promoted occupational justice through work for youth with disabilities. These approaches were to pursue employment opportunities in a seemingly receptive and somewhat sensitised sector of employment, and to create supported demonstrations opportunities in open labour market environments. An important conclusion of the study was that the programme staff's creativity, dedication and commitment were imperative in promoting occupational justice through the various programme activities.
Occupational resilience : an occupational therapy practice model facilitating high school participation post traumatic brain injury
(Stellenbosch : Stellenbosch University, 2018-12) Jacobs-Nzuzi Khuabi, Lee-Ann Juliana; Swart, Estelle; Soeker, Mogammad Shaheed; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health & Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY : School participation may be disrupted post traumatic brain injury (TBI). Adolescents have to adjust to their developmental stage, multiple impairments and increased dependence resulting from the TBI. This combined with contextual factors may affect their school participation post TBI. There are no clear occupational therapy guidelines facilitating school re-entry post TBI and hence inconsistencies are noted in school transition practices. Furthermore, existing school transition programs for learners with TBI are informed by the recommendations of studies conducted in developed contexts. This study therefore sought to explore the perspectives on and experiences of adolescent high school learners’ school re-entry and school participation post TBI within a developing context. It was anticipated that this would provide an improved understanding of the enablers and barriers to high school participation post TBI. The main aim of this study was to develop a practice model with a view to improve service delivery that aims to adequately prepare and support learners for high school participation post TBI. The first phase of the study included a qualitative multi-case study. Each of the eight cases consisted of an adolescent learner, his/her primary care-giver, teacher and principal. Data collection methods included document analysis, semi-structured interviews and semi-structured observation. Analysis included an inductive process, combined with cross case synthesis. The findings indicated that personal, multi-system environmental and occupational factors served as both enablers and barriers to school re-entry and school participation post TBI. Learners reported that to overcome occupational challenges and participate in the occupation of school, required a process of adaptation (i.e. adapting for and through occupation). This process of adaptation required that learners draw upon internal resources as well as navigate and negotiate the availability and accessibility of personally and culturally relevant external resources. That is, it required a display of resilience from learners. A theory generative design promoted by Chinn and Kramer (2015) and Walker and Avant (2015), was used to conduct the second phase of the study. This included an analysis of the concept of occupational resilience that was uncovered in the first phase of the study. The second phase of the study further included the construction of relationship statements; a description of the model as well as the evaluation and operationalization of the model, i.e. Occupational Resilience: An Occupational Therapy practice model to facilitate high school participation post TBI. The practice model highlights that occupational therapists may promote resilience to facilitate the participation in valued occupation (i.e. promote occupational resilience). Occupational resilience may be facilitated through a series of resilience-promoting tasks that include cultivating resilience thinking, developing and employing strategies to overcome occupational challenges, engagement in occupation and fostering an enabling environment. The model further highlights that throughout the process of facilitating occupational resilience, it is necessary to create opportunities for the adolescent to display agency. The thesis concludes with recommendations for occupational therapy practice and education. Further recommendations to the Departments of Health and Education as well as the Road Accident Fund were explicated to facilitate optimum support provision for adolescent learners with TBI.
The validity of the disabilities of the arm, shoulder and hand (DASH) questionnaire in Afrikaans for the Western Cape of South Africa
(Stellenbosch : Stellenbosch University, 2022-12) de Klerk, Susan; van Niekerk, Lana; Buchanan, Helen; Jerosch-Herold, Christina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
ENGLISH SUMMARY: The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire is a 30-item patient-reported outcome measure (PROM) designed to measure symptoms and disability in clients with upper limb injury or conditions. The measure was developed in 1996 by the Institute for Work and Health (IWH) in Canada. It has been translated and cross-culturally adapted to at least 50 languages around the world. No evidence existed for translations from the South African context. This country faces a high incidence of hand injury and conditions, especially so in the overburdened public health service sector. PROMs such as the DASH questionnaire, if validated within this context, are essential in allowing accurate self-report and demonstrating the outcomes of intervention offered. An essential requirement is however for the PROM to be available in the client’s language. The research context is that of the public health service, within the Western Cape of South Africa and specifically the Afrikaans-speaking community. This multi-phased study i) explored the evidence on the validity and clinical utility of DASH questionnaire translations from low-income to upper-middle-income countries, ii) translated and cross-culturally adapted the DASH questionnaire into Afrikaans for the Western Cape utilising the practices of Community Translation (CT) and Shared Decision Making (SDM), iii) evaluated the content validity of the new translation through an iterative process during pretesting and cognitive interviewing (CI) and iv) evaluated construct validity (specifically structural validity, internal consistency and cross-cultural validity) of the Afrikaans for the Western Cape DASH questionnaire. A sequential mixed-methods study design was followed with quantitative and qualitative components across the four phases outlined above. Phase one comprised a systematic review methodology as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Consensus-based Standards for Selection of Health Measurement Instruments (COSMIN) guidelines. Phase two considered CT and SDM in addition to recommendations for translation and cross–cultural adaptation as per the IWH. Phase three addressed content validity as per the COSMIN guidelines. Phase four utilised Classical Test Theory (CTT). Structural validity was evaluated through both Confirmatory and Exploratory Factor Analysis (CFA & EFA) utilising appropriate fit indexes. Internal consistency was calculated through Cronbach’s alpha and cross-cultural validity was assessed during Multiple Group Confirmatory Factor analysis (MGCFA) to confirm measurement invariance between the Afrikaans for the Western Cape DASH and the South African English DASH questionnaires, demonstrated through appropriate fit indexes. Phase two to four comprised a sample of participants included as per eligibility criteria considered during each phase. CT was introduced as an approach to translation and cross-cultural adaptation in the public health service context and considered Afrikaans for the Western Cape. The process of translation and cross-cultural adaptation utilising the practices of CT and SDM (introduced for the first time in the context of translation and cross-cultural adaptation of PROMs) is reported on. The content validity of the newly translated Afrikaans for the Western Cape DASH questionnaire was confirmed, and the process of CI well described to illustrate the iterative nature thereof. Structural validity was evaluated initially via CFA and subsequently via EFA when unidimensionality was not confirmed. The Afrikaans for the Western Cape DASH questionnaire yielded a two-factor structure (with internal consistency), and cross-cultural validity was evaluated through MGCFA exploring measurement invariance between the Afrikaans for the Western Cape DASH and South African English DASH questionnaire. Scalar invariance was supported and provides evidence of cross-cultural validity. The Afrikaans for the Western Cape DASH questionnaire was successfully translated and cross-culturally adapted, with evidence of content, structural and cross-cultural validity and can be utilised within the intended context.

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