Doctoral Degrees (Psychology)

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Access to health care for persons with disabilities in Madwaleni, Eastern Cape, South Africa
(Stellenbosch : Stellenbosch University, 2016-03) Vergunst, Richard; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology
ENGLISH ABSTRACT : Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at “triple vulnerability” – poverty, disability and rurality. The current study provides a local case study of these issues with the aim of informing future interventions to improve the lives of persons with disabilities. This study explores the challenges faced by persons with disabilities in day-to-day living and in accessing health care in Madwaleni, a poor rural isiXhosa-speaking community in South Africa. The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons between persons with disabilities and persons with no disabilities were explored. Results suggest that persons with disabilities in Madwaleni generally experience more problems in terms of daily living as well as health issues (including access to health care) compared to persons with no disabilities. In terms of access to health care there were primarily three types of barriers – physical barriers, attitudinal barriers and communication barriers – for persons with disabilities in Madwaleni. Persons without disabilities living in households with persons with disabilities did not, however, experience more barriers to health care than did those in households without disabilities. Implications and recommendations for the future are discussed in order to make some concrete and practical solutions in the area of disability in Madwaleni.
Adaptation in new parent married couples : key processes and qualities of resilience
(Stellenbosch : Stellenbosch University, 2016-12) Olckers, Friedel; Greeff, A. P.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Couple resilience refers to the abilities and relational processes of a couple that enable them to endure, persevere, and negotiate adversarial circumstances. Most literature on the transition to parenthood tend to focus on negative factors of this normative stage. Scholars emphasise the distinct drop in marital satisfaction, individual well-being and relationship quality, postpartum depression as well as individual and joint losses (Bateman & Bharj, 2009; Cavanaugh, 2006). An important contribution to marital literature will be to establish which factors help couple relationships to excel and succeed. The primary objective of this qualitative study was to identify, explore and describe resilience qualities and processes of new-parent married couples associated with positive adaptation to the arrival of their firstborn. The secondary objective was to determine the resemblance in qualities and processes of resilience as identified among African and White couples. The theoretical foundation of the study resides in the Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin & McCubbin, 1996), the family life cycle perspective (Carter & McGoldrick, 2003) and the Key Family Processes as outlined by Walsh (2012). Twenty-two new-parent married couples (13 White and 9 African) living in Cape Town, South Africa took part in semi-structured interviews. The analysis generated 21 themes as foundation to their couple resilience. These 21 themes represent five categories, each structured according to the identified themes. Under couple factors eight themes emerged: communication, couple time, duration of relationship before childbirth, boundaries, shared hardships, healthy lifestyle, prioritisation of the couple relationship, and time for own and couple growth and fulfilment. Individual factors comprised four themes: spousal personalities, ‘me time’, background and upbringing, and physical attributes. Baby factors presented a single theme: characteristics of the child. Parenting factors entailed: the parenting unit, routine, involved father, planning and preparation, flexibility, and practical parenting style. External factors described two themes: social support and spirituality. Despite the inclusion of two cultural groups in this study, 19 common (typical) themes (qualities and processes) were identified that new-parent married couples may exhibit. The findings give additional insight into the transition to parenthood and couple resilience by recognising an interconnectedness among different themes. This research on positive adaptation, obtained useful information on how protective and recovery resources function in South African first-time parents. Thus, the present study contributes towards the body of knowledge on the resilience construct, whilst simultaneously generating knowledge relevant to the South African context. The findings have practical implications for preventative and therapeutic interventions, which focus on either new-parent married couples, or prospective parents.
Adapting a Psychosocial Intervention to reduce HIV risk among likely adolescent participants in HIV biomedical trials
(Stellenbosch : Stellenbosch University, 2015-03) Dietrich, Janan Janine; Kagee, Ashraf; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology
ENGLISH ABSTRACT : In 2010, young people aged 15–24 years accounted for 42% of new HIV infections globally. In 2009, about five million (10%) of the total South African population was estimated to be aged 15–19 years. Current South African national sero-prevalence data estimate the prevalence of HIV to be 5.6% and 0.7% among adolescent girls and boys aged 15–19 years, respectively. HIV infections are mainly transmitted via sexual transmission. Adolescent sexuality is multi-faceted and influenced at multiple levels. In preparing to enroll adolescents in future biomedical HIV prevention trials, particularly prophylactic HIV vaccine trials, it is critical to provide counseling services appropriate to their needs. At the time of writing, there was no developed psychosocial intervention in South Africa for use among adolescent vaccine trial participants. Thus, the aim of the present study is to adapt and pilot-test a psychosocial intervention, namely, the Centers for Disease Control and Prevention (CDC) risk reduction counseling intervention of Project Respect, an intervention tasked at being developmentally and contextually appropriate among potential adolescent participants in HIV biomedical trials in the future. To achieve this overall aim, I qualitatively explored adolescent sexuality and risk factors for HIV among a diverse sample of participants aged 16–18 from Soweto. Thereafter, I developed a composite HIV risk scale in order to measure the variance in HIV risk among the sample of adolescents studied. The study followed a two-phased, mixed method research design and was informed by ecological systems theory and integrative model of behavioral prediction. The aim of Phase 1, split into phases 1a and b, was to conduct focus group discussions (FGDs) and to undertake a cross-sectional survey, respectively, to determine psychological (for example, self-esteem and depression), behavioral (specifically, sexual behavior) and social (specifically, social support, parent-adolescent communication) contexts that placed adolescents at risk for HIV infection. Phase 1a was qualitative, with data collected via nine FGDs: three involved parents of adolescents, four involved adolescents aged 16–18 years and two counselors. Nine key themes related to adolescent sexuality and risks for HIV acquisition were identified, namely: (1) dating during adolescence; (2) adolescent girls dating older men; (3) condom use amongst adolescents; (4) teenage pregnancies; (5) views about homosexuality; (6) parent-adolescent communication about sexual health; (7) the role of the media; (8) discipline and perceived government influence; and (9) group sex events. Phase 1b was quantitative and the data were collected via a cross-sectional survey to investigate the variance of risk for HIV. For Phase 1b, the sample consisted of 506 adolescents with a mean age of 17 years (interquartile range [IQR]: 16–18). More than half the participants were female (59%, n = 298). I used a three-step hierarchical multiple regression model to investigate the variance in risk for HIV. In step 3, the only significant predictors were “ever threatened to have sex” and “ever forced to have sex”, the combination of which explained 14% (R2 = 0.14; F (12, 236) = 3.14, p = 0.00). Depression and parentadolescent communication were added to steps 2 and 3, respectively, with both variables insignificant in these models. In Phase 2, I adapted and pilot tested the CDC risk reduction counseling intervention. The intervention was intended to be developmentally and contextually appropriate among adolescents from Soweto aged 16–18 years, viewed as potential participants in future HIV biomedical trials. Participants in Phase 2 were aged 16–18 years; the sample was mainly female (52%, n = 11) and most (91%, n = 19) were secondary school learners in grades 8 to 12. Participants provided feedback about their experiences of the adapted counseling intervention through in-depth interviews. I identified three main themes in this regard, namely: benefits of HIV testing services, reasons for seeking counseling and HIV testing services, and participants’ evaluation of the study visits and counseling sessions. The adapted CDC risk reduction counseling intervention was found to be acceptable with favorable outcomes for those adolescents who participated in the piloting phase. This study adds to the literature on risks for HIV among adolescents in Soweto, South Africa, by considering multiple levels of influence. Reaching a more complete understanding of ecological factors contributing to sexual risk behaviors among adolescents in the pilot-study enabled the development of a tailored counseling intervention. The findings showed the adapted CDC risk reduction counseling intervention to be feasible and acceptable among adolescents likely to be participants and eligible to participate in future HIV biomedical prevention trials. Thus, this study provides a much needed risk reduction counseling intervention that can be used among adolescents, an age group likely to participate in future HIV vaccine prevention research.
Adapting and piloting a cognitive-behavioural group therapy-based anxiety intervention programme for vulnerable children from a disadvantaged background within the South African context
(Stellenbosch : Stellenbosch University, 2019-12) Myburgh, Naomi; Loxton, H. S.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Anxiety is a prevalent psychological problem amongst children worldwide and has been identified as a concerning mental health issue in need of intervention, especially amongst vulnerable children within disadvantaged South African contexts. Within such contexts, access to mental health services is particularly limited due to a lack of resources that diminish service delivery capacity. Importantly, anxiety symptoms have demonstrated a trend towards the development of anxiety disorders and numerous associated negative outcomes in the absence of intervention. Cognitive-behavioural therapy (CBT)-based programmes have been established as an efficacious response to child anxiety disorders and effective as a preventive approach. Notably, preventive interventions have the potential to reduce demands on resources and increase reach with more universal dissemination by non-expert programme facilitators. Recent advances in CBT-based anxiety intervention research have pointed to the potential of brief, intensive formats as a cost-effective, accessible and child-friendly treatment alternative for childhood anxiety problems. The potential value of the contextual adaptation of evidence-based programmes and outcomes measures to fit with new priority populations has also been established. The adaptation of existing interventions may overcome context-specific barriers to the delivery of programmes. The current study was motivated by a dearth of intervention research in the South African context and the need for accessible, cost-effective and contextually tailored mental health services for vulnerable children in disadvantaged semi-rural farming communities in South Africa. In response, the current study was implemented in two phases. Phase 1 entailed the contextual adaptation of the group, CBT-based, Dutch Dappere Kat anxiety prevention programme, based on information obtained from multiple community consultations. This resulted in the formulation of the brief, intensive, Afrikaans Ek is Dapper (BRAVE) group CBT-based anxiety prevention programme. Phase 2 entailed a pilot study implementation and evaluation of the BRAVE programme with a mixed methods quasi-experimental design (with an immediate intervention group, a delayed intervention group, and pre-, post- and follow-up outcomes measures). A sample of 21 children (aged 9 to 14 and in Grades 3 to 7) participated in the pilot study implementation and programme evaluation on three semi-rural farm sites. Quantitative data pertaining to the preliminary effectiveness of the BRAVE programme were collected at four-time points (T1-T4). Qualitative data pertaining to the perceived effectiveness, feasibility and acceptability of the BRAVE programme were collected session-wise and at 3-months post-intervention. The pilot study mixed methods preliminary effectiveness evaluation produced promising trends in response to the BRAVE programme with a significant reduction in overall anxiety symptom scores over time. However, significance findings were variable and were interpreted with caution in the context of concerns with the outcomes measures identified in Phase 1 and the relatively small sample size of Phase 2. Qualitative data indicated promising outcomes in terms of the perceived effectiveness and benefit of the programme with reports of the acquisition, application and generalisation of programme-based coping skills post-intervention. Furthermore, feasibility outcomes were good and indicated that a brief, intensive implementation on farm sites by programme facilitators is worth considering. Finally, the programme and its adaptations yielded good acceptability as reported by both participants and programme implementation observers. The outcomes and findings of the current South African study, a first of its kind, was critically reviewed with recommendations for future research of a similar nature. Keywords: anxiety symptoms, vulnerable children, CBT-based programmes, brief intensive prevention, contextual adaptation, vulnerable children, pilot study.
Adopting transracially in the Western Cape: understanding families’ experiences in context
(Stellenbosch : Stellenbosch University, 2023-03) Luyt, Jean; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Transracial adoption was legalised in South Africa in 1991 after legislation prohibiting it was removed, but it remains controversial. International research into transracial adoption includes outcomes studies, studies on identity development of transracial adoptees and parents’ efforts at ethnic-racial socialisation. Research into transracial adoption tends to focus on the transracially adopted children and adoptive mothers with experiences of other members of the family and the transracial adoptive family as a whole only starting to get attention recently. Relevance of international research may be limited because of significant contextual differences in South Africa. Limited research into transracial adoption in South Africa includes research into the attitudes towards transracial adoption and experiences of adoptive parents, particularly mothers, and adoptees. The research tends to be exploratory, uses varied theoretical paradigms and methodology, based on small sample sizes. The experience of transracial adoption is best understood in the context of family and no research into the tasks and challenges facing the transracial adoptive family exists in South Africa. This research on the experiences of transracial adoptive families in the Western Cape, was conducted via qualitative methodology, using a family life cycle model as a theoretical framework. Using this framework allowed me to describe and investigate the experiences, challenges and tasks facing transracial adoptive families without pathologising them. Twenty-six transracial adoptive families were recruited using convenience and snowball sampling. The sample included 31 adoptive parents, (25 woman and 6 men) and eight adoptees (five adopted girls, two adopted boys and one female adult adoptee). Data gathering was conducted by means of 12 semi-structured family interviews and six focus groups. Themes emerging from iterative thematic analysis were reported according to the life stage of the adoptive family. The challenges related to the pre-placement phase are related to making the decision to adopt and managing the adoption process. In South African transracial adoptive families, barriers to biological parenthood are not the only motivation to adopt, and a significant number of transracial adoptive families have both adopted and biological children. Significant challenges faced by prospective adoptive parents in the adoption process include the demanding nature and lack of uniformity of the adoption process, post-placement bureaucracy and significant ambivalence towards adoption social workers. Post-placement, the biological family and the adoptive family are permanently joined, even if the adoptive family wishes to deny this. Creating a transracial adoptive family identity and managing relationships with biological family are ongoing challenges for the transracial adoptive family in the post-placement phase. Different aspects of these ongoing tasks become salient at different stages of the life cycle, prompted by individual development, family development and changes in the external environment. Implications for adoption policy and practice and support offered to the transracial adoptive family are discussed. The limitations to the study include the limited number of men, lack of non-adopted siblings who participated and the sample being skewed towards families with young children. This limited the opportunity to investigate aspects related to all family members and later stages in the life cycle model.
Die afstomping van gemoedsaandoeninge
(Stellenbosch : Stellenbosch University, 1924-12) Verwoerd, H. F.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
No abstract available
An assessment instrument for fear in middle childhood South African children.
(Stellenbosch : University of Stellenbosch, 2007-12) Burkhardt, Irmgard Kathe-Erla; Loxton, H. S.; Kagee, A.; University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Psychology.
Fears are a normal part of development but excessive fears may interfere with daily functioning and may reflect serious anxiety problems. In order to determine whether fears are excessive or not, as well as to implement prevention programmes, an assessment instrument is needed that is socially and scientifically relevant to the context in which the child lives. Furthermore, normative data is necessary in order to understand the concept of fear. The primary aim of the study was to develop a measuring instrument that is scientifically and socially relevant within the South African context. This entailed a qualitative stage where semi-structured interviews were conducted with 40 middle childhood children attending four local primary schools in the Stellenbosch area. These interviews were transcribed and analysed for emerging themes. The emerging themes were then added to the existing Fear Survey Schedule for Children-Revised (FSSC-R). Reliability analyses were conducted on the data obtained by the adapted FSSC-R. Item-total correlations and exploration of the item construct resulted in 23 items being deleted. The remaining items on the scale demonstrated good internal consistency (α = 0,97). The factor structure of the remaining items was explored by means of principal factor analysis with varimax rotation. Various factor solutions were explored and the five-factor solution was found to be the best conceptual fit for the data. The five factors are: Factor I-Fear of Danger and Death, Factor II-Fear of the Unknown, Factor III-Worries, Factor IV-Fear of Animals, Factor V-Situational Fears. The adapted scale is a South African version of Ollendick’s FSSC-R and is referred to as the FSSC-SA. The secondary aim was to determine the content, number, level and pattern of fear of a selected group of middle childhood South African children, living in the Western Cape, based on the results of the South African Fear Survey Schedule for Children (FSSC-SA). This entailed a quantitative stage. The adapted FSSC-R was completed by 646 middle childhood children between the ages of 7 and 12 years, attending four primary schools in the Stellenbosch area in the Western Cape Province. The participants were also requested to complete a biographical questionnaire before they completed the adapted FSSC-R. Culture was defined with respect to the main representative cultural communities in the Stellenbosch area, namely black, coloured and white. The results of the South African fear instrument indicate that the most feared item for the South African children is ‘getting HIV’. The ten most common fears indicate that fears are to a certain extent universal but that some fears also reflect the context in which a child lives. Furthermore the added items also featured among the most fear eliciting items suggest that these items reflect the societal concerns, issues and fears of South African children. Black South African children displayed the highest number as well as level of fear, followed by the coloured South African children and then the white South African children. This was also applicable to the pattern of fear. Gender differences are apparent with respect to number, level and pattern of fears with girls consistently expressing more fears than boys. This applies to all cultural groups. In conclusion, implications of the present study’s results in the South African context as well as shortcomings and recommendations for future studies are discussed.
Attempted suicide among South African adolescents living in a low resource environment : contested meanings, lived experience, and expressed support needs
(Stellenbosch : Stellenbosch University, 2020-12) Pasche, Sonja Christine; Bantjes, Jason; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Adolescent suicide is a serious public health concern, yet we do not understand the reasons South African adolescents give for their suicide attempts and the meanings they attach to their behaviour. Nor do we know how the adolescents’ caregivers and clinicians perceive their attempts, or how these experiences and understandings are framed by the socio-cultural context. The aim of this research was to provide a contextualised understanding of the phenomenon of suicide attempts by South African adolescents living in a low resource environment. I used a multiperspectival research design situated within a theoretical framework of hermeneutic phenomenology. All participants were recruited via the Child and Adolescent Mental Health unit of a large psychiatric hospital located in Cape Town. In-depth semi-structured interviews were conducted with 10 adolescents, their caregivers (n=10), and the clinicians who treated them (n=9). The adolescents also took photographs to illustrate their experience, and these were discussed during a second interview using the technique of photo-elicitation. I analysed data using Interpretative Phenomenological Analysis. All participants foregrounded the relational context of the adolescents’ suicide attempts, especially relationships with family members, which were described as both a mitigating and contributing factor to the suicide attempt. The adolescents explained how caregivers’ failure to acknowledge sexual and physical abuse, which they perceived as betrayal, led to emotional disconnection and subsequently, to precipitating a suicide attempt. In contrast, adolescents said that attachment to younger siblings and pets ameliorated their suicidality. The adolescents recounted how bonding with other suicidal peers reduced feelings of isolation, but that they also learned about suicidal behaviours from each other. Participants also spoke about how the adolescents’ suicide attempts were shaped by the socio-economic context, including exposure to poverty and high levels of violence. Both caregivers and clinicians described feelings of anxiety, powerlessness, and helplessness elicited by the adolescents’ suicidality, echoing the powerlessness reported by the adolescents. Participants did not endorse a purely psychiatric understanding of adolescent suicidal behaviour; instead they described the adolescents’ suicide attempts as an escape from pain, or an attempt to alleviate perceived economic burdensomeness. The adolescents experienced admission to a psychiatric hospital as providing safety, but also as exacerbating a loss of autonomy. Participants discussed how improved connectedness, belonging, communication, and validation of the adolescents’ experiences, to counter the adolescents’ sense of isolation and invisibility, were important for support after the attempt, and for the prevention of adolescent suicide. The participants’ accounts of the adolescents’ suicide attempts were incongruent with existing theories of suicidal behaviour, highlighting the need for adolescent specific, contextualised theories of suicidal behaviour. These findings also suggest that adolescent suicide prevention cannot solely be the responsibility of the mental health care sector, that the wellbeing of caregivers is essential for adolescent suicide prevention, and they emphasise the importance of adolescent-specific services that enhance feelings of autonomy. Potential areas for future research in the field of adolescent suicide prevention include the role of siblings, pets, and feelings of betrayal.
Barriers to and facilitators of paediatric adherence to antiretroviral therapy (ART) amongst children younger than five years in rural South Africa
(Stellenbosch : Stellenbosch University, 2015-12) Coetzee, Bronwynè Jo’sean; Kagee, Ashraf; Bland, Ruth; Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology.
ENGLISH ABSTRACT : In the context of the limited availability of antiretroviral drugs for young children and the emergence of drug resistance, excellent adherence is required to achieve an undetectable viral load (VL) and an elevated CD4 count. However, characteristics of the caregiver, child, regimen, clinic and social context affect clinic attendance and medication-taking, both of which constitute adherent behaviour. In this thesis, through the lens of Bronfenbrenner’s Ecological Systems Theory (EST), I explored the barriers to and facilitators of ART administration to children younger than five years in a rural area of South Africa with a high prevalence of HIV. The research was conducted in two phases. Phase 1 included nine interviews and three focus groups to determine how doctors, nurses, counsellors, traditional healers and caregivers understood the barriers and facilitators to ART adherence among children residing in rural South Africa. The data were transcribed, translated into English from isiZulu where necessary, and coded using ATLAS.ti version 7. At the level of the microsystem, the unpalatability of medication and large volumes of medication were problematic for young children. The characteristics of the caregivers that contribute to poor adherence were absent mothers, grandmothers as caregivers and denial of HIV amongst fathers. At the level of the mesosystem, language barriers and inconsistent attendance of caregivers to monthly clinic visits were factors affecting adherence. At the level of the exosystem, the nature of adherence counselling and training of counsellors were the most problematic features influencing adherence. At the level of the macrosystem, the effects of food insecurity and the controversy surrounding the use of traditional medicines were most salient. I concluded Phase 1 of the thesis by recommending increased supervision and regular training amongst lay adherence counsellors, as well as regular monitoring of the persons attending the clinic on the child’s behalf. In Phase 2, I purposively recruited 33 caregiver-child dyads from the Hlabisa HIV Treatment and Care Programme database. Children were divided into three groups based on their VL at the time of recruitment. Children with a VL ≥ 400cps/ml were grouped as unsuppressed (n=11); children with a VL ≤400 cps/ml were grouped as suppressed (n=12); and children with no VL data were grouped as newly-initiated (n=10). I observed caregiver-child dyads at their monthly adherence counselling visit to document information they received from adherence counsellors. I then visited caregiver-child dyads at their households to document, by means of video-recording, how treatment was administered to the child. Observational notes and video-recordings were entered into ATLAS.ti v 7 and analysed thematically. On average counselling sessions lasted 8.1 minutes (range 2 - 18). Little behaviour change counselling was conducted, even in instances where children were doing poorly on treatment. Thematic video analysis indicated five key areas of caregiver practices that may contribute to poor outcomes. These were context-related, medication-related, caregiver-related, and child-related factors and interactions between caregiver and child. Although the majority of children in this sample took their medicine successfully, the way in which medications were prepared and administered by their caregivers was problematic. I concluded Phase 2 of the thesis by recommending that with emerging drug resistance, efforts are needed to carefully monitor caregiver knowledge of treatment administration by counsellors during monthly clinic visits.
Beyond vicarious trauma: exploring adversarial growth in a sample of South African paramedics
(Stellenbosch : Stellenbosch University, 2017-03) Reinecke, Charlene Rene; Painter, Desmond; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: This qualitative study firstly explores the strategies that a sample of South African emergency medical care (EMC) practitioners, or paramedics, employ to cope with the vicarious trauma (VT) they are consistently exposed to as a result of their occupation. The paramedics work in both a public (Metro Western Cape EMS) and a private (ER24) EMC service in the Western Cape Province of South Africa. The trauma is exacerbated by the dangerous working conditions of paramedics in the country. The study secondly explores the paramedics’ responses to vicarious trauma, which may be termed posttraumatic, or adversarial growth (AG). In this regard the study deliberately applies a positive psychology approach, which facilitates the exploration of vicarious trauma from the perspective of which the results may be termed ‘adversarial growth’, with specific reference to adaptation and resilience. This signals a departure from the way consequences of traumatic events have typically been studied from a pathogenic perspective, and connects with research that has shown that the experience of trauma may result in growth through adversity that go beyond mere adjustment and coping. Positive effects are often yielded which include revised ideas, beliefs, expectations and assumptions. In-depth interviews were conducted with eighteen participants, and thematic analysis was employed to analyse their narratives. Two distinct analytic categories were identified. Factual interview responses were processed by using descriptive analysis as regards the participants’ study and training, support services, and coping mechanisms they utilize. Experiential analysis facilitated the coding of the participants’ work experiences, and four main themes were extracted, namely service, realism, changed life perspective, and mortality. The findings confirm the reality of the vicarious trauma paramedics are exposed to due to the nature of their work, as well as its effects which often result in emotional blunting and detachment. The findings further reveal how paramedics manage and cope with increasing primary trauma due to high-risk working conditions, and that the most meaningful coping mechanisms reportedby the participants are talking to colleagues, engaging in post-call evaluations, applying self debriefing, and personal introspection. The participants’ narratives capture their perceptions of growth through adversity. Their descriptions of adversarial growth not only correspond to the definition of the construct in the literature, but contribute towards further developing the definitions in the literature as presented in this study. The study found that the participants’ responses to trauma and adversarial growth are dependent on individual differences, that is, their personal characteristics and support resources, and the manner in which they appraise and proactively process the traumatic events they are exposed to. In spite of the participants’ critical and high-risk occupation where they experience vicarious and primary trauma in the fulfilment of their duties, there is evidence of the existence of psychosocial resources in this sample of paramedics which support positive functioning. Should the issues in EMC training and support services be addressed as identified in this study, it may contribute to increased positive functioning and warrants further exploration.
Breast cancer stories : exploring the multimodal narratives of twelve South African women with recurrent disease
(Stellenbosch : Stellenbosch University., 2020-03) Smit, Anri; Coetzee, Bronwyne; Roomaney, Rizwana; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Breast cancer is a major global health burden. While advances in the detection and treatment of breast cancer have improved survival rates, a considerable proportion of women with breast cancer will experience disease recurrence. With more research emphasis directed at understanding the experiences of breast cancer survivors, less is known about women’s experiences of recurrent disease. In this dissertation, I explore the breast cancer stories of 12 South African women with recurrent disease. I present and discuss the participants’ stories, as gathered across multimodal narrative data (i.e., narrative interviews, diaries and body maps), including meanings they attached to their experiences. I conducted a thematic analysis across all narrative data to understand the content of participants’ stories. Thereafter, by using the interpretive framework of Frank’s (1995) narrative types (restitution, chaos, and quest), I undertook a narrative analysis in order to examine the structure of the stories. I then synthesized the thematic and narrative analyses to identify patterns of responses across the narrative types. Three narrative types emerged: four participants described their experience of recurrence as a temporary situation, which would soon end if the necessary treatments were adhered to. These stories followed the restitution plot and maintained a linear order characteristic of this narrative type. For another participant, her cancer recurrence seemed to have caused a great deal of anxiety, which manifested in a fragmented account; lacking narrative order. I interpreted her story as a chaos narrative. The seven remaining participants described their recurrent disease as an opportunity for self-discovery, personal growth, and for helping other women with breast cancer. These stories followed the quest narrative, though, at times, contained elements of the other narrative types. Although the findings corroborate Frank’s (1995) narrative types, the stories of recurrence seemed to be more complex than conventional, episodic, illness stories. Overall, I understood participants’ meanings of recurrence to be shaped by their responses to illness (illness appraisal and coping) and tied to their identities in relation to the illness. In some stories, participants’ illness appraisals and coping strategies moved beyond Frank’s (1995) original formulation, and in a few, changes in identity seemed to transpire into changes in narrative type. I reflect on the value of a multimodal narrative methodology and the triangulation of multiple data sets in order to arrive at a complex and nuanced understanding of breast cancer stories. I discuss the findings of my study in relation to both the broader literature and Frank’s (1995) narrative types, after which I offer directions for future research investigating breast cancer stories.
Caring for caregivers : developing a psychodynamic understanding of a process of staff support for primary health care workers
(Stellenbosch : Stellenbosch University, 2005-12) Van Wyk, Brian Eduard; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping.
Common mental and substance use disorders among people seeking HIV testing
(Stellenbosch : Stellenbosch University, 2017-03) Saal, Wylene Leandri; Kagee, Ashraf; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: The baseline prevalence of common mental disorders (CMDs) and symptoms of distress, depression, anxiety and hazardous alcohol use prior to the receipt of a HIV diagnosis is unknown. The primary aim of this research was to determine the prevalence of CMDs, such as major depression, persistent depressive disorder, generalized anxiety, and alcohol use disorders among a sample of people seeking HIV testing. The second aim was to determine the extent of general distress among the sample of HIV test seekers. The third aim of the study was to determine the ability of the Hopkins Symptom Checklist (HSCL), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the Alcohol Use Disorder Identification Test (AUDIT) to discriminate between CMD caseness and non-caseness. Utilizing a cross-sectional design, 500 participants were recruited while seeking HIV testing at five non-medical testing sites in the Western Cape, South Africa. The research version of the Structured Clinical Interview for the DSM-5 (SCID-RV) was administered to assess the CMDs. Furthermore, the extent of distress, depression, anxiety and hazardous alcohol use was assessed using the HSCL-25, BDI, BAI, and AUDIT, respectively. Descriptive statistics were used to evaluate the prevalence of CMDs and receiver operating characteristic (ROC) curve analysis was used to determine the effectiveness of the screening instruments in predicting CMD caseness against the SCID as gold standard. The results demonstrated that 28.4% (95% CI [24.45, 32.35]) of the sample had at least one common mental disorder. Elevated prevalence rates for major depression (14.4%; 95% CI [11.32, 17.48]), persistent depressive disorder (7.2%; 95% CI [4.93, 9.47]), generalized anxiety disorder (3.4%; 95% CI [1.81%, 4.99%]) and alcohol use disorder (19.6%; 95% CI [16.12, 23.08]) were reported. The results further showed that the HSCL-25, BDI, BAI, and the AUDIT were effective in identifying CMD caseness. Even the subscales of the HSCL-25 were successful in detecting most of the cases of depression (MDD, and PDD) and generalized anxiety. Of the sample, 41.2% were psychologically distressed, while 21% had moderate depression, 13.6% had moderate anxiety and 34.6% reported hazardous alcohol use. The findings of the research indicated that it is important to screen people for CMDs and distress prior to communicating an HIV diagnosis as these disorders may have a negative impact on quality of life and adherence to ART. A further contribution of the study is that the screening instruments may be used as proxies in identifying people seeking HIV testing with a CMD. Given that HIV testing and mental health services are available independently, fragmented services are provided in public health facilities in South Africa. Future research may need to focus on the integration of referral trajectories with routine screening and HIV testing.
The communicative participation of adults with cerebral palsy
(Stellenbosch : Stellenbosch University, 2013-12) Levin, Karen Susan; Swartz, Leslie; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Conducted within a critical disability studies framework, this study explored the experience of communicative participation by adults with cerebral palsy who live with severe communication impairments. The concept of the participation of communicatively disabled people is relatively new, and the theoretical understanding of communicative participation is underdeveloped although participation is increasingly recognised as a central goal in rehabilitation. In addition, there is a paucity of information with reference to the trajectory of lifelong communication disability. Little is known about the communicative participation of adults with cerebral palsy in South Africa. Nine adults with cerebral palsy, who lived with significant communication impairments, participated in the study. They were between 32 and 49 years of age, and had lived South Africa all their lives. They were observed in social interactions in their daily lives on multiple occasions and took part in serial interviews over a six-month period. Using a pragmatist grounded theory approach, the data were analysed from an interpretive basis. Four main categories were constructed. The first category was “being misrecognised as a communicator”, which showed that the participants were not acknowledged as having equal moral participatory status in communicative exchanges. The second category, “contexts for communicating”, indicated that the participants lived with significant communication impairments which resulted in their experiencing limitations in a broad spectrum of life’s activities. The third category, “an embedded communicative self”, illuminated that the participants saw their communicative disabilities as embedded within a broader picture of being disabled, and that their communication impairments had a marked effect on their identity development. Through an analysis of lifetime contributions to communicative participation, the final category, “dynamic participation” revealed how communicative participation is a fluid, ever-changing process. Extending Ikäheimo’s (2010) model of social participation and recognition, a “dynamic recognition-theoretical model of communicative participation” is presented. Communicative participation is defined as a dynamic social process. It is undergirded by the moral recognition of the interactants as communicative partners, and is influenced by time as the dimension through which all communication takes place.
Conceptualising psycho-emotional aspects of disablist discrimination and impairment : towards a psychoanalytically informed disability studies
(Stellenbosch : University of Stellenbosch, 2009-12) Watermeyer, Brian Paul; Swartz, Leslie; University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Since the 1970s, the international disability movement has galvanised around the "social model" of disability, as an adversarial response to traditional, individualising "medical" accounts of disablement. The model foregrounds "disablist ideology", identifying systematic exclusion and discrimination as central mediators of disabled life. Latterly, feminist authors within disability studies have problematised the "arid" materialist orientation of the social model, for its eschewing of personal and psychological aspects of disability, and poor theorising of embodiment. Social model orthodoxy construes the psychological as epiphenomenal, diversionary, and potentially misappropriated in the buttressing of pathologising accounts of disablement. A legacy of "traditional" psychoanalytic theorising on disability implies causal links between bodily difference and psychopathology, eliding a critical interrogation of oppression in mediating the severely marginal social and economic destiny of the disabled minority. The new "critical" psychoanalytic approach to disability interprets broad social responses to disablement as the enactment of defences engaged in reaction to the universal unconscious existential conflicts evoked by disability images. The present work seeks to elaborate the integration of psychoanalysis into disability studies, towards development of a politically situated psychology of disability oppression, which creates theoretical links connecting ideology with the nature of individual subjectivity. Conceptual ideas to begin describing the psycho-emotional aspects of disablist oppression and impairment were developed via an integration of clinical data with a renewed, psychoanalytically informed critical synthesis of disability-related research from a range of disciplines. Clinical data was gathered via psychoanalytically oriented group psychotherapy with severely physically impaired university students. Full transcriptions and in-depth fieldnotes were utilised as a record of data, which was then analysed via interpretive, psychoanalytic and "interpretive auto-ethnographic" methods. Follow-up interviews were held to assess the resonance and utility of new concepts. A range of theoretical contributions was combined in illuminating the modernist cultural and political underpinnings of oppressive responses to the impaired body, and integrated with accounts of the psychological and relational predicaments of disablism gleaned from the clinical record. Topics drawn from literature, critically evaluated, developed and re-synthesised included narcissistic culture, the family, "medicalisation", social mirroring, internalised oppression, liminality, and representations of disability in charity, art and modern bioethics. The nature of countertransference dynamics in therapeutic work with disabled people was considered. Key concepts from the clinical data were developed and progressively reformulated; these included the distortion of boundaries, the discourse of loss, control, independence, identity, complicity, trauma, and the imperative to silencing the subjective experience of disabled life.
The construction and validation of a health-related quality of life measure for women with endometriosis
(Stellenbosch : Stellenbosch University, 2017-03) Roomaney, Rizwana; Kagee, Ashraf; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH SUMMARY: The purpose of this study was to construct and validate a health-related quality of life (HRQOL) measure for patients with endometriosis. The study employed an exploratory, sequential mixed methods research design, consisting of a qualitative phase, followed by a quantitative phase. The study consisted of three aims. The first aim was to describe and understand the QOL-related experiences of women with endometriosis. This qualitative phase of the study involved in-depth, semi-structured interviews with 25 women diagnosed with endometriosis. I recorded and transcribed the interviews. I used thematic analysis to code the data and identify themes. Eleven themes emerged from the data, namely psychological functioning, sexual functioning, financial impact and considerations, healthcare and medical treatment, reproductive functioning, information and knowledge, interpersonal functioning, menstrual characteristics, occupational functioning, somatic features and physical functioning. The second aim of the study was to construct items for the instrument based on data collected during the first phase. The initial item pool consisted of 314 items. I then consulted with two experts in psychometry, who provided feedback relating to the clarity, conciseness, wording and ambiguity of items. This process resulted a reduced pool of 184 items. I asked five endometriosis experts to review the items in terms of relevance. Items that the experts regarded as highly relevant were retained in the measure and items that were not regarded as highly relevant were removed from the measure. The review resulted in the retention of 64 items. I piloted these items among seven women with endometriosis in order to assess the readability of the items. The final aim of the study was to determine the test reliability, validity and factor structure of the measure. This formed the quantitative component of the study. I administered the 64-item HRQOL measure, Endometriosis Health Profile 30, Short Form Health Survey World Health Organization Quality of Life Brief scale and the Beck Depression Inventory to 203 patients with endometriosis. I conducted an item analysis and removed 16 items that displayed corrected item total correlations below .35. I then conducted an exploratory factor analysis (EFA) on the remaining 48 in order to establish the factor structure of the measure. The factor analysis identified thirteen items that either cross-loaded on more than one factor or that did not significantly load on any factor. These items were removed. The remaining 35 items produced an eight-dimension factor structure. A second EFA produced the same factor structure. I named the measure the Stellenbosch Endometriosis Quality of life (SEQOL) measure and the named the dimensions as follows: (1) Psychological well-being; (2) Income; (3) Sexual functioning and romantic relationships; (4) Reproductive functioning; (5) Vitality; (6) Occupational functioning; (7) Menstrual characteristics and (8) Support. The SEQOL and its subscales demonstrated excellent internal consistency reliability. The SEQOL produced a Cronbach’s α of .92 and the Cronbach’s α for the subscales ranged from .72 to .88. Correlations between scores on SEQOL, its subscales and other measures indicated promising validity. The initial validation indicates that the SEQOL may be a useful assessment of HRQOL in women with endometriosis, both in research and clinical practice.
The construction of intimacy in heterosexual, longterm relationships in a South African farmworker community
(Stellenbosch : Stellenbosch University, 2014-12) Adams, Arlene; Lesch, Elmien; Stellenbosch University. Faculty of Arts and Social Science. Department of Psychology.
ENGLISH ABSTRACT: Current mainstream theories of intimacy were derived from studies with primarily White, middle class participants living in developed countries. However, as social contexts shape people’s definitions, meanings and behaviours, it cannot be assumed that mainstream intimacy conceptualisations would apply to other populations. Studies of intimacy should be located in its social and historical context. Previous South African studies of Black and Coloured couples mainly emphasised HIV/Aids, interpartner violence and gender inequality, and neglected to investigate positive aspects of intimate lives of poorer communities. A lack of such context-specific data on how South African men and women construct and experience intimate relationships hinders appropriate and effective interventions. This study addressed this research gap by exploring intimacy experiences of long-term heterosexual adult Coloured couples living in a low-income semi-rural community. The objective of this qualitative study was to gain an understanding of how the participant couples expressed and experienced intimacy. The participants were 15 couples (i.e. 30 participants), between the ages of 23 and 66 years, who had been married or living together for a minimum period of two years. Qualitative semi-structured interviews were conducted to explore: (i) how couples understand intimacy, and (ii) how intimacy is expressed and experienced in committed adult heterosexual relationships. Theoretically, this study was informed by social constructionism and interviews were analysed using Braun and Clarke’s thematic analysis method. The following themes were identified: (i) closeness means being together, (ii) sex and intimacy (iii) closeness in talking (iv) expressions and experiences of intimacy/closeness through acts of care, (v) alcohol disrupts closeness (vi) family of origin and the constructions of intimacy; and (vii) community constructions and norms. Although much of the international literature suggests that mutual self-disclosure is the foundation for intimacy, self-disclosure did not feature prominently in the narratives of this study’s narratives. Closeness was expressed through sharing in practical and tangible ways. Gender was pertinent to these couples’ experiences and gender roles were fundamental to their intimacy perceptions and behaviours. Despite some contestations of hegemonic masculinity and femininity constructions, most of the participants did not demonstrate an active awareness or resistance regarding learned gender roles. They did not seem to consider these gender roles as problematic, limited or limiting, nor did they indicate alternative gender ideas. This was attributed partly to poverty and low education levels, which constrain people’s access to alternative gender perspectives. Religion and community influences also play an important role in their understanding of their role as partner. Although Christianity endorses traditional gender ideas, the participants themselves felt that their religious beliefs and practices facilitated intimate experiences, and prevented alcohol abuse and domestic violence. In conclusion, implications for policy and practice in terms of gender inequality and alcohol abuse are discussed, as are the limitations of the study.
Constructions of masculinity, sexuality and risky sexual practices of male soldiers
(Stellenbosch : University of Stellenbosch, 2006-03) Mankayi, Nyameka.; Naidoo, Anthony V.; Shefer, T.; University of Stellenbosch. Faculty of Arts and Social Sciences. Dept. of Psychology.
The spread of HIV/AIDS in South Africa has continued in spite of initiatives by government and numerous concerned community-based and non-governmental organisations to contain the pandemic. Hegemonic masculinity and traditional male sexual practices associated with such identities have only recently been identified as a key area of challenge in the HIV/AIDS pandemic and more broadly in addressing issues of gender inequality. Practices such as non-negotiation in heterosexual relationships as well as other manifestations of gender inequality remain rife. Not surprisingly, this has led to a proliferation of research on men and boys in South Africa. Yet, while critical men’s studies foreground the centrality of context in the construction of masculinities, the role of particular institutions long associated with the construction of hegemonic masculinity has not been well documented in the light of the HIV/AIDS challenge. Given that HIV infection ratios are higher among soldiers than civilians, and the masculinist culture that prevails in military settings, it is clear that soldiers are particularly vulnerable to HIV infection. This study seeks to understand how men in the military draw on notions of masculinity and heterosexuality in constructing their identity and heterosexual practices. I conducted in-depth interviews with a diverse group of 14 male soldiers aged 23 to 33. All participants were officers pursuing a career in the military who were enrolled in a tertiary institution. The interviews were audio-taped and then transcribed. All the interviews were analysed using discourse analysis, with interpretation being informed by a social constructionist theoretical framework in order to address the intersecting issues of gender, sexuality and masculinity. The discourse analysis carried out on the transcripts highlights the centrality of dominant constructions of (hetero)sexual masculinity. Key here is the ‘male sexual drive discourse’ which has been identified elsewhere in South Africa and internationally, usually coupled with traditional expectations of women’s sexuality as submissive and responsive to that of men. There is, furthermore, a prevailing notion of ‘double standards’ which reward men for risky sexual practices while condemning women for the same practices and for resisting their traditional feminine and sexual roles. The study also found that the military as a macho/masculinist institution plays a key role in exaggerating traditional identities and sexual practices for men, in particular notions of masculinity as equated with physical strength and prowess and traditional constructs of male sexuality as urgent and aggressive. These are exacerbated by the military context in which soldiers, due to the nature of their task, have socio-economic and political power over (female) members of local communities. Long periods of isolation from partners during deployment and courses could also facilitate unsafe sexual practices. The study further points to the salience of social identities such as race and class intersecting with gender in the subjective representations of masculinity and sexuality, with neither of these representations manifested as fixed or unitary. The study foregrounds how male sexual risk-taking facilitates the reproduction of hegemonic discourses on male and female sexuality that continue to repress women’s rights to sexual desire and pleasure, while legitimating hegemonic male sexual practices. The study concludes that tackling HIV in the military demands critical examination of multiple constructions of masculinity: those common to broader groups of men and those peculiar to the context of the military. It is thus argued that the development of effective intervention programmes on the one hand requires an unpacking of broader discourses on masculinity and male sexuality and on the other a specific targeting within the context of military imperatives and conditions.
Coping with destructive leadership behaviour: A qualitative study of nonphysical abuse in South African companies
(Stellenbosch : Stellenbosch University, 2019-12) Brink, Beatrix; Naidoo, Anthony V.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: Whereas there tends to be a research focus on positive and constructive leadership, the investigation of negative or destructive leadership behaviour receives less attention. Further, with the focus of leadership being the leader, research less often gives prominence to followers and the complicated dynamic between leader and follower. The main focus of this research was to explore followers’ direct experiences with destructive leadership behaviour in South African organisational contexts and coping strategies they employed to engage with this behaviour. The study was also interested in follower perceptions of the characteristics of the phenomenon of destructive leadership behaviour. In this regard, the study particularly explored participants’ perceptions of relational authenticity with the leader. To what extent does a follower’s identification with the leader in terms of congruent traits, values and social representation (i.e., socio-economic, racial, gender and age cohort) influence the coping process? Further, the study explored whether participants’ psychological capital played a role in their coping process. In order to respond to the explorative aims of the study and mindful of the complicated nuances of interpersonal social relationships in the South African work context, the study adopted a qualitative approach, which was informed by aspects of constructivist grounded theory. Locating the study within qualitative data gathering techniques, a semistructured person-to-person interview approach was followed. To complement and support the interview data, participants completed the Psychological Capital Questionnaire (PCQ) at the end of the interview. The findings indicate that the managers’ perceived destructive leadership styles had consequences for the participants, the managers themselves and the work unit, affecting the execution of tasks and the attainment of goals, as well as the well-being of other team members in the work unit. In order to cope with the negative relationship, participants tried to find control in the situation; they attempted to distance themselves from the situation, their own thoughts and emotions; they sought ways to affirm their closely held self-beliefs; indulged in positive and negative self-nurturing; tried to find solace in religion/spirituality; sought social and family support; and attempted to re-direct cognitions. These coping attempts were accomplished with varying degrees of effectiveness. Participants’ perceptions of relational authenticity with the leader played a role in perceiving the managers’ behaviour as destructive; and in coping with the destructive leader behaviour. The findings indicate that participants’ psychological capital may have played a role in their coping with the managers’ destructive leadership style. The shared experiences of the participants gave voice to their intrinsic needs to be able to live their work lives in ways that were authentic to their values as expressions of their self-concepts. When the ability to live authentic lives congruent with their self-beliefs were challenged by the destructive leadership styles of their direct managers, participants’ various coping attempts were largely aimed at re-affirming their self-beliefs.
Culture and child sexual abuse : a case study of the Krobo Municipality, Eastern region of Ghana
(Stellenbosch : Stellenbosch University, 2016-12) Attah, Dzifa Abra; Swartz, Leslie; Ofori-Atta, Angela L.; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
ENGLISH ABSTRACT: To address problems of child sexual abuse (CSA), it is important to study the cultural norms of the people it affects. To date, sub-Saharan Africa is marked as one of the worst affected regions. Yet, outside South Africa, few sub-Saharan African countries have prioritised research in this area. Knowledge of these cultural contexts may potentially provide a framework within which it may be more possible to help predict, describe and control CSA, and related consequences, effectively. The present study explored the lived experiences of the Krobo people of Ghana, specifically the meanings they ascribed to their sexuality as children and their experiences of CSA. Using Interpretative Phenomenological Analysis, these phenomena were explored from three major sources: participant observation of everyday practices in Kroboland, Ghana; interviews with Krobo people, comprising community members and community leaders; and interviews with key informants who had a history of working with children from this context. Five focus group discussions were conducted with the former, and 12 semi-structured interviews each with the latter groups. The findings shed light on cultural expectations of child care in Kroboland, which mandate collective efforts to foster and promote healthy child development. Yet, conflicting evidence from the narratives of the Krobo people showed that limited or impaired child-guardian interactions were common. Disturbed child-guardian interactions negatively affected subsequent behaviour patterns. This was evident in the ways some participants described their interactions with others. Some means by people in Kroboland sought to satisfy personal needs, desires and wishes, at times jeopardised their personal safety and sometimes involving crime. Key informants talked about the extent of child neglect, parentified children and associated CSA problems they have witnessed. Five male and four female participants shared personal accounts of CSA. For both genders, the occurrence of CSA was underscored by issues of age privilege and reciprocity. For male participants in particular, the desire to accomplish gender norms, assert masculinity and command control positioned them as willing participants. On the other hand, female participants laid emphasis on the influence of gender, emotional and financial neediness in the creation of a context of sexual risk. For male CSA survivors, sex with an older female was a welcomed passage of rite in the early stages of development. Later in life, however, sex offending, intimacy deficits and other sexually related problems became major concerns for some participants. CSA stirred up strong feelings of mistrust, hurt, pain, anger and a sense of disappointment among female CSA survivors. Some also developed a strong dislike towards the opposite sex and an aversion towards sex. Key informants indicated that CSA survivors required specialised services and support to deal with emerging problems, following CSA, as existing structures were inadequate. Nonetheless, in the aftermath of CSA, a few survivors shared aspects of personal development and growth they had achieved. An understanding of these CSA experiences is deepened by a presentation of the researcher’s own experiences of sexual harassment, during and after data collection. Study implications and recommendations for the community, and further research, are discussed.

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