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Background: Low- and middle-income countries (LMICs), including South Africa, are currently experiencing multiple epidemics: HIV and the rising burden of non-communicable diseases (NCDs), leading to different patterns of multimorbidity (the occurrence of two or more chronic conditions) than experienced in high income settings. These adversely affect health outcomes, increase patients' perceived burden of treatment, and impact the workload of self-management. This paper outlines the methods used in a qualitative study exploring burden of treatment among people living with HIV/NCD multimorbidity in South Africa. Methods: We undertook a comparative qualitative study to examine the interaction between individuals' treatment burden (self-management workload) and their capacity to take on this workload, using the dual lenses of Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) to aid conceptualisation of the data. We interviewed 30 people with multimorbidity and 16 carers in rural Eastern Cape and urban Cape Town between February-April 2021. Data was analysed through framework analysis. Findings: This paper discusses the methodological procedures considered when conducting qualitative research among people with multimorbidity in low-income settings in South Africa. We highlight the decisions made when developing the research design, recruiting participants, and selecting field-sites. We also explore data analysis processes and reflect on the positionality of the research project and researchers. Conclusion: This paper illustrates the decision-making processes conducting this qualitative research and may be helpful in informing future research aiming to qualitatively investigate treatment burden among patients in LMICs. [ABSTRACT FROM AUTHOR]

This paper explores the root causes of student unrest in South African universities and evaluates the institutional responses to these protests, otherwise regarded as social unrest. The study is lensed through social movement theory and institutional theory. The study adopted transformative paradigm under qualitative approach and participatory research design to analyze the experiences of universities in South Africa that have experienced significant social unrest in recent years. Focus group discussion was conducted with university management staff, student activists, and security officers of the selected universities. The findings showed that lack of access, socio-economic inequalities, ineffective communication, and open engagement are the primary causes of social unrest. In contrast, providing equitable access, economic liberation, effective communication, and open engagement is the possible institutional response that alleviates social unrest on university campuses. Hence, promoting equitable access and economic liberation coupled with effective communication and open engagement among stakeholders was recommended. Plain Language Summary: Causes and Institutional Responses of Social Unrest. This paper investigates why South African university students protest and how the institutions respond. Using social movement and institutional theories, the study talks to university managers, student activists, and security officers in universities with recent protests. The key issues identified are limited access, economic inequalities, poor communication, and exclusion from decision-making. The suggested solution is to focus on fair access, reducing economic disparities, improving communication, and involving everyone in decisions. The researcher recommends promoting equitable access and economic fairness, alongside better communication and inclusive decision-making, as a way to address and prevent social unrest on university campuses. [ABSTRACT FROM AUTHOR]

Tackling an important gap in the literature on political trust, this article focuses on politicians and the relevance of their other-to-self trust judgements for decision-making in public office. A unique quantitative dataset gathered from national politicians in the UK, Canada and South Africa is used to (1) examine descriptive levels of felt trust and distrust among politicians and (2) evaluate the impact of these feelings on politicians' risky decision-making. To achieve outcome (2), this article presents the results of three survey experiments in which politicians were asked to make decisions in scenarios where both the presentation and the nature of risk varied. The results indicate that MPs' perceptions of public trust and distrust do matter for risky decision-making, and that these variables moderate a reflection effect whereby MPs are otherwise more risk-averse in the face of gains and risk-taking in the face of losses. [ABSTRACT FROM AUTHOR]

Given the mixed evidence on whether women's economic and social empowerment is beneficial or not for reducing intimate partner violence (IPV), we explored the relationship between women's empowerment and IPV risk. We analyzed data from baseline interviews with married women (n = 415) from the Intervention with Microfinance and Gender Equity (IMAGE) longitudinal study in rural South Africa. IMAGE combines a poverty-focused microfinance program with a gender-training curriculum. We fitted logistic regression models to explore associations between women's economic situation/empowerment and IPV. For the multivariable logistic regression, we fitted three models that progressively included variables to explore these associations further. Women who reported "few to many times" for not earning enough to cover their business costs faced higher odds of past year physical and/or sexual violence (adjusted odds ratio [aOR] = 6.1, 1.7-22.3, p =.01). Those who received a new loan experienced higher levels of past year emotional (aOR = 2.8, 1.1-7.4, p =.03) and economic abuse (aOR = 6.3, 2.2-18.5, p =.001). Women who reported that partners perceived their household contribution as not important faced higher odds of past year economic abuse (aOR = 2.8, 1.0-7.8, p =.05). Women who reported joint decision-making or partner making sole reproductive decisions reported higher levels of past year physical and/or sexual violence (aOR = 5.7, 0.9-39.4, p =.07) and emotional abuse (aOR = 3.0, 0.9-10.2, p =.08). Economic stress and aspects of women's empowerment, alongside established gender roles within marital relationships is associated with IPV risk in rural South Africa. Although improved economic conditions for women appears to be protective against physical and sexual IPV, associations between certain indicators of women's economic situation, empowerment, and IPV are inconsistent. We need to consider complementary programming and all types of IPV in research, intervention, and policy, as different aspects of empowerment have varying associations with different types of IPV (physical, sexual, emotional, and economic abuse). [ABSTRACT FROM AUTHOR]

In the South African Individual Deprivation Measure, the individual survey, included questions about two potentially highly sensitive topics—individuals' experience of violence and their control over personal decision making. In-depth follow-up interviews were conducted with 105 consenting survey participants to determine whether participating in the survey resulted in negative impacts for individuals, particularly in relation to these two topics. Several participants found that being asked about their experiences resurfaced painful memories, but we did not find any evidence that the approach of surveying every eligible individual in the dwelling resulted in any form of harm for the survey participants. [ABSTRACT FROM AUTHOR]

Despite pregnancy spacing recommendations to optimize health outcomes among mothers and neonates, unplanned pregnancy in sub-Saharan Africa is common among women living with human immunodeficiency virus (HIV) (WLHIV). This study examined factors associated with reproductive decision-making among WLHIV to inform pregnancy-planning interventions. WLHIV in rural South Africa (n = 165) were assessed at 12 months postpartum. The relative importance of factors associated with reproductive decision-making was estimated. Women were a mean of 28 years old (SD = 5.71). Risk of mother-to-child transmission (MTCT) of HIV (Mean = 0.43; SD = 0.33) had the greatest impact on decision-making, followed by partners' desires (M = 0.22; SD = 0.18), family preferences (M = 0.18; SD = 0.13), and community opinion (M = 0.17; SD = 0.13). MTCT was most important to women with greater HIV knowledge. However, WLHIV who had been diagnosed with HIV for a longer time placed more emphasis on partner preference and community opinion, and less importance on MTCT risk. Prevention of mother-to-child transmission (PMTCT) was less important to women experiencing intimate partner violence and those with depression. Findings highlight the need for tailored, focused interventions to support the unique circumstances of WLHIV and support the inclusion of families and/or partners in the counseling process. Results underscore the need for perinatal preconception counseling for women during routine HIV care. [ABSTRACT FROM AUTHOR]

Background: Understanding patients' decision control preferences is important in providing quality cancer care. Patients' decisional control preference can be either active (patients prefer to make decisions themselves), shared (collaborative between patient, their physician, and/or family), or passive (patients prefer that the decisions are made by either the physician and/or their family). Aim: To determine the frequency and predictors of passive decision control preferences among advanced cancer patients. We also determined the concordance between actual decision-making and decision control preferences and its association with patient satisfaction. Design: In this cross-sectional survey of advanced cancer patients referred to palliative care across 11 countries, we evaluated sociodemographic variables, Control Preference Scale, and satisfaction with the decisions and care. Results: A total of 1490 participants were evaluable. Shared, active, and passive decision control preferences were 33%, 44%, and 23%, respectively. Passive decision control preferences (odds ratio, p value) was more frequent in India (4.34, <0.001), Jordan (3.41, <0.001), and France (3.27, <0.001). Concordance between the actual decision-making and decision control preferences was highest in the United States (k = 0.74) and lowest in Brazil (0.34). Passive decision control preference was significantly associated with (odds ratio per point, p value) better performance status (0.99/point, 0.017), higher education (0.64, 0.001), and country of origin (Brazil (0.26, <0.0001), Singapore (0.25, 0.0003), South Africa (0.32, 0.0002), and Jordan (2.33, 0.0037)). Conclusion: Passive decision control preferences were less common (23%) than shared and active decision control preference even among developing countries. Significant predictors of passive decision control preferences were performance status, education, and country of origin. [ABSTRACT FROM AUTHOR]

With a new planning system taking shape, and a new Bill of Rights embodied in a transformative Constitution having been introduced in South Africa in 1994, this article grapples with the dual questions as to whether the new spatial planning system fits within the spirit of the Bill of Rights, and the Bill of Rights assists the new spatial planning system in the realisation of its objectives. As a prequel to the engagement with these questions, a brief overview of the events leading to institution of the Bill of Rights and its contents is provided. This is followed by a brief historical overview of the creation of the South African spatial planning system and a summary of its key features. These features can be reduced to the following basic components: (1) meaningful participation in all aspects of spatial planning; (2) an open, inclusive and just decision-making process where information is readily available; (3) recognition of religion and culture and equal treatment in application and decision-making; (4) an awareness of environmental issues; and (5) the significance of property and housing. The way in which these components are addressed in the Bill of Rights and other parts of the Constitution provides the starting point to determine the extent to which there is a meaningful and mutually beneficial fit between the planning system and the Bill of Rights. [ABSTRACT FROM PUBLISHER]

Although prevention of mother-to-child HIV transmission (PMTCT) programs are predicated on maternal behavior change, little is known about sociocultural factors affecting material-child care practices in this arena. The authors used narrative methods (key informant workshops, questionnaires, focus groups, and case study analysis) to explore how sociocultural context shapes adolescent mothers' ability to adhere to programmatic recommendations in rural and urban South Africa. The study aims were to understand the extent to which mothers' decisions are borne out in PMTCT-related practices and to identify contextual elements that affect the link between individual resolutions and action. The results revealed rural adolescents as less likely than urbanites to successfully implement most PMTCT-related practices. HIV stigma, family decision making, and cultural norms surrounding infant feeding hampered mothers' efforts to implement practices that would decrease the risk for infant infection. Barriers to behavior change were analyzed along four domains: history, culture, gender, and power. Methodological aspects and programmatic implications are discussed. [ABSTRACT FROM AUTHOR]

The article presents an account of the book "The Militarization of South African Politics," by Kenneth W. Grundy. The book is one of the most valuable aids to understanding South African decision-making. In a clear, well-organized style the author explains the thinking behind the "Total Strategy"--an ideology developed by the military to cover political and social as well as security concerns, and was intended to counter the supposedly communist-inspired "Total Onslaught."