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Inspired by new feminist materialism, this paper seeks to reimagine existing knowledge of girls, sexuality and playgrounds by considering how the socio‐material reality may unlock girls' capacities for what is possible through play. Focusing on semi‐structured interviews of girls (aged 12–13), the paper draws attention to the playground as an 'assemblage' of human and non‐human matter that connect to illuminate other ways of being, feeling and doing. We argue that the assemblage not only creates spaces for girls to disrupt hetero‐patriarchal ideologies but simultaneously serves to reinforce them. Interventions require attention to the oppressive materialities that underpin play. [ABSTRACT FROM AUTHOR]

Background: A disability studies approach seeks to understand and address political and social issues that affect disabled individuals. Disability studies scholars employ various models of disability to address and oppose the oppression and discrimination of disabled individuals. A disability studies approach, however, has largely been absent in studies that have investigated the lived experiences of people who stutter. Aim: To examine the understandings young adult South African men who stutter hold of whether, and in what way, stuttering may be considered to be a disability. Methods & Procedures: A total of 15 men who stutter, aged 20–39 years, participated in the study. Semi‐structured interviews and two focus groups discussions were conducted to collect data for the study. The data were analysed according to a phenomenological approach and the affective turn in social research. Outcomes & Results: The results indicated that some men in this study understood stuttering as a speech disorder that can be controlled, while other men constructed stuttering as a disability, subjectively positioning themselves either as disabled or non‐disabled men. Conclusions & Implications: This article emphasizes the importance of adopting a disability studies approach when examining the lived experiences of people who stutter and enhancing intervention strategies to adequately address the disabled needs of such individuals. WHAT THIS PAPER ADDS: What is already known on the subject?: The past few decades have seen researchers investigating the personal and social experiences of people who stutter. However, empirical studies exploring the disabling experiences of people who stutter have been absent from the existing body of knowledge. What this paper adds to existing knowledge?: This research aimed to provide comprehensive insight into the disabling experiences of people who stutter. The results gave an insight into the oppression and disablism experienced by people who stutter. More specifically, the findings demonstrated how individuals who stutter are disabled by oppressive communication practices that dominate spaces of education and employment. What are the potential or actual clinical implications of this work?: Several men in this study attended speech therapy to gain control over their stuttering. For a number of participants, speech therapy proved a valuable experience, while others saw speech therapy as being out of touch with their lived reality of stuttering. Speech and language therapists are encouraged to employ a disability studies approach in order to enhance intervention strategies to adequately address the disabling needs of people who stutter. [ABSTRACT FROM AUTHOR]

This paper explores two orphaned girls' accounts of victimization and vulnerability to child sexual abuse in their family homes. Interviews with these girls revealed a trend of neglect, adversity and processes of adultification which involved accounts of sexual abuse within their family homes. According to the data, the participants are vulnerable and they experience victimization as they are routinely sexually abused by older male relatives and non‐related men and boys inside their family homes – where they are supposed to feel safe and protected. We argue that these two young girls' experiences need to be understood as consequences of the prevailing cultures of toxic heteropatriarchal masculinities which have produced and normalized the distribution of male power over girls. The kinds of interventions required to address toxic masculinities and to insulate orphan girls from sexual abuse and neglect are also discussed. [ABSTRACT FROM AUTHOR]

Background: As the prevalence of paediatric dysphagia increases, the need for long‐term non‐oral feeding has also increased. Despite these developments, little is known about caregiver experiences of transitioning a child onto long‐term non‐oral feeds, and the factors which influence the process of decision‐making and the provision of consent to do so. This paper aims to explore these factors. Methods: Semi‐structured interviews were conducted with nine participants recruited from the multidisciplinary out‐patient non‐oral feeding clinic at a hospital. Interviews explored caregiver experiences of decision‐making and the process of providing consent when transitioning their child to non‐oral feeds, as well as the support structures available to the caregivers. Interviews were audio recorded and transcribed, then analyzed using thematic analysis (Braun & Clarke, 2013) and content analysis (Neuendorf, 2016). Results: Challenges to care and quality of life, access to information and culturally relevant counselling, and the involvement of family members and significant others emerged as prominent themes. Findings suggest that quality of life was the most common motivating factor for transitioning a child to non‐oral feeding methods. Several participants suggested that support and information sharing via digital platforms were both useful and effective. Implications: The findings highlight caregivers' needs for improved access to information and social support. The findings hold implications for training of healthcare providers working in similar contexts and for models of service delivery which ensure that family‐centred intervention can be delivered in culturally and contextually relevant ways. With widespread access to smartphones, counselling should include digital messaging as a way of providing support and information sharing. Future research should focus on the complexities of counselling and the process of informed consent in settings impacted by diverse cultural, contextual and linguistic barriers, as well as the potential value of mobile health (mhealth) in ensuring improved health outcomes. [ABSTRACT FROM AUTHOR]

Abstract: This paper adopts a qualitative case study on the generalist service delivery model of I‐Care, a Durban‐based non‐governmental organization that works with male street children. Fifteen face‐to‐face interviews were conducted with 10 I‐Care employees and 5 former street children. A focus group was set up with I‐Care employees. Although existing literature is forthright about a generalist approach for children at risk, it remains unclear how to implement this approach in practice. This paper reviews a continuity of 5 fundamental social work practices for working with street children: (a) outreach work, (b) child–family and child–community mediation, (c) transitory care centres and programmes, (d) brokerage, and (e) mentorship and follow‐ups. The study analyses how these practices contribute to the capability and agency expansion of the street children and outlines challenges that service providers and former street children experience. The main challenges acknowledged are balancing between the agency and protection of street children and the adaptation of children to street life. The study proposes intervention strategies to overcome these challenges. [ABSTRACT FROM AUTHOR]

This paper reports part of the findings from a 2014 audit of shelters for street children conducted in four provinces of South Africa. The paper focuses on the assessment of the types, structure and implementation of the programmes, as well as on the adequacy of resources necessary for implementing the programmes. The overall picture that emerged from the assessment was that all shelters draw on a comprehensive and enabling legislative and policy framework to offer some elements of developmental, therapeutic and recreational programmes at the early intervention level. Overall, however, the implementation of the programmes does not effectively take into consideration the varied and interconnected factors that, within and across multiple social systems, impel children to the streets. It was thus apparent that the programmes do not adequately address the risks and opportunities of street children in South Africa, specifically within the eco‐developmental framework. Recommendations are offered for social work policy and practice to further enhance the quality and impact of programmes offered in the shelters. [ABSTRACT FROM AUTHOR]

Pre‐abortion counselling may play a key role in abortion seekers' understanding of their decision to terminate a pregnancy and the subsequent emotions that they feel. In this paper, we report on a study conducted in the Eastern Cape province of South Africa concerning womxn's experiences of the pre‐abortion counselling offered as part of the implementation of the Choice of Termination Act that governs the provision of legal abortion in the country. Using a narrative‐discursive lens, the analysis revealed four micro‐narratives in which participants appreciated non‐directive and empathic counselling, as well as being provided with information. They also indicated that the counselling was upsetting and hurtful, particularly when providers drew on the awfulisation of abortion discourse to suggest that abortion leads to terrible consequences, and foetal personhood discourse to intimate that terminating the pregnancy is wrong and other alternatives (adoption, parenting) are better. The connection between these broadly positive and negative responses may lie in the dominance of anti‐abortion discourses coupled with the powerful positioning of healthcare providers as experts. The attendant disempowerment of clients within the health clinic setting may constrain pregnant people's ability to question such 'expert' information. The implications for feminist client‐centred pre‐abortion counselling are discussed. [ABSTRACT FROM AUTHOR]

Breastfeeding is a crucial public health approach that reduces infant morbidity and mortality by providing essential nutrients and antibodies, and breast milk is easily digested. Breastfeeding and donated milk serve as a preventative measure against necrotising enterocolitis. Additionally, they protect against viruses and nosocomial sepsis. When a birthing parent's own milk is unavailable, alternative enteral nutrition for preterm or low‐birth‐weight infants is either donor human milk (DHM) or artificial formula. This study aimed to understand mothers' acceptance of the donor human milk bank (DHMB) and DHM. A qualitative phenomenological study was conducted in Limpopo Province, South Africa. The study used purposive sampling to select 23 mothers in postnatal and neonatal wards. Data collection was via in‐depth interviews using a semistructured interview guide. Manual data analysis using an interpretative phenomenological analysis (IPA) framework was used to coding. Concepts were grouped to generate themes. Three themes and nine subthemes were generated: (1) DHMBs (2) cultural perspective of DHMB, and (3) health considerations of DHM. Participants were unaware of the DHMB. Hesitancy in accepting DHM due to fear of contracting HIV was observed. Cultural beliefs are an influencing factor for use, while donation was driven by altruistic reasons, preventing waste, helping others and having previously benefited from DHM. The study found that mothers are willing to donate human milk. Willingness to donate can be increased by raising awareness about DHMB and addressing culture and safety concerns at antenatal clinics. Key messages: The study emphasises the possible willingness to accept the concept of donating and utilising donor human milk for newborns who do not have access to their mother's own milk. However, safety concerns, bonding and cultural issues should be addressed.Promoting breastfeeding and milk donation in communities requires addressing cultural and health concerns by utilising the service of community health workers.Education about safe breast milk banking before neonatal intensive care unit admission is also an important factor. [ABSTRACT FROM AUTHOR]

The concept of a focused ethnographic study ( FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts ( Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children ( IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements ( LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are women's responsibilities. [ABSTRACT FROM AUTHOR]

Background This paper reports part of the findings of a study which exposed sexual violence in schools for learners with mild intellectual disability in South Africa. Special attention was paid on factors contributing to such a problem. Methods Data were collected using focus groups and individual interviews with 16 learners with mild intellectual disability at two special schools in South Africa. This was followed by individual interviews with the school nurse and social worker, and an analysis of schools' books of incidents. Results Factors contributing to sexual violence at schools for learners with mild intellectual disability included: (i) peer pressure, (ii) concealment of reported incidents of sexual violence, (iii) unsupervised areas linked to schools and (iv) arranged relationships. Conclusion The following suggestions are put forth: (i) awareness programmes, (ii) sensitization of teachers about the consequences and prevention of sexual violence, (iii) boundaries within which the arranged relationship occurs, (iv) intensification of sexuality education and (v) supervision around the school premises. [ABSTRACT FROM AUTHOR]

ABSTRACT Twenty years after the advent of democracy in South Africa (SA), there have been some successes in the achievement of greater equality, access and inclusion for many persons with disabilities. The move towards inclusive education may, however, have had unanticipated embodied consequences for people positioned discursively as included, but who in fact may in some respects be further marginalised than they had been under apartheid. We describe ethnographic research conducted in a special needs school in SA to explore the lived experiences of children with cerebral palsy and their involvement in physical activity. Our study shows how inclusive educational practices in SA have impeded involvement in sport for some children with motor impairments because of resource limitations and other historic reasons. This paper raises important questions about the role of community psychology in recognising, naming and contributing to action around injustices, which may be hard to see but which can have profound effects on the lives and bodies of those who experience exclusion. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Migrating nursing labour inadvertently reinforces South Africa's care drain, contributes to a global care crisis and forces us to reconsider migration motivation. This paper highlights issues that complicate psychiatric intellectual disability nursing care and identifies loci for change in an attempt to redress this care challenge. Method An exploratory descriptive-interpretivist method investigated nurses' experiences of psychiatric intellectual disability work. Sixteen free association narrative interviews were collected in 2013. Thematic analysis allowed findings to emerge from the data. Results Findings reflect a number of themes: 'relational interaction', 'care burden', 'system fatigue', 'infantilising dynamic of care' and 'resources for coping'. Conclusion System fatigue contributes more to negative experiences of providing care than direct patient work, and nurses experience more relational reciprocity from patients than from institutional management. Organizations should meet nurses' needs for burnout prevention, afford them impact in implementing institutional controls, and engage in a non-exploitative and non-exclusionary way. [ABSTRACT FROM AUTHOR]

Purpose This paper aims to explore and describe health promotion strategies for adolescents orphaned by human immunodeficiency virus ( HIV) and acquired immunodeficiency syndrome ( AIDS), as well as the evaluation thereof. Introduction and Background Among the Sub- Saharan countries, such as Swaziland, Botswana and Lesotho, South Africa is rated as fourth in the list of countries with the highest number of people living with HIV and AIDS. Method The study employed phenomenological qualitative design. The population consisted of the purposively selected health promoters working in the Hammanskraal region, directly and indirectly involved with families with adolescents orphaned by HIV and AIDS. Following the focus group interviews, data were analysed using the seven steps of Colaizzi. Results Four categories and eight subcategories were concluded as the strategies for adolescents orphaned by HIV and AIDS as well as the evaluation thereof. The main categories identified were: the door-to-door outcome, workshop outputs, statistical data and community projects. Discussion It is evident that the health promotion strategies informed by the four themes will be implemented. The outcomes may raise an awareness in the community, support families and provide statistics on the impact of HIV and AIDS on families. Study Limitations The study was limited to one subdistrict and to health promoters in a rural area, therefore the results cannot be generalized to all other subdistricts including health promoters, especially those in urban areas. Conclusion The successful evaluation programme will pin out the strong points and challenges while assisting in improving the quality of work provided in the communities. Implication for nursing and health policy Continuing professional and practice development are required to maintain the standard of health care in South Africa. Therefore the policymakers need to include relevant information regarding health promotion strategies in reducing the statistics of people living with HIV and AIDS. [ABSTRACT FROM AUTHOR]

Background Self-harm is a widespread behaviour among people with mental health problems. Although guidance on how to manage self-harm is offered, it is still a behaviour that is misunderstood by many nurses. Such misunderstanding is generally attributed to the perceived motives for self-harm and lack of specialized education to manage the behaviour. As a consequence, the care provided is usually inadequate and inappropriate. Yet, research concerning nurses' reasons of users' self-harming behaviours is limited. Aim This paper reports on a study that explores nurses' explanations of the motives for self-harm in a secure adolescent unit in England. Methods The study utilized a phenomenological methodology with semi-structured individual interviews ( n = 25). The data were analysed thematically using interpretative phenomenological analysis. Results The findings indicate that the behaviour of self-harm has multiple motives. Examples of these include affect regulation, coping with distress, averting death, regaining control and attention seeking. Discussion Self-harm is a complex behaviour commonly experienced in secure environments. Nurses assume that users who self-harm are motivated by a desire to seek attention and manipulate others. Users may find these beliefs humiliating. Such feelings may increase users' risks for further self-harm. Most adolescents who self-harm experience unbearable emotions because of their past sexual abusive encounters. They self-harm to regulate these emotions. These affect regulatory functions may act as reinforcers of self-harming behaviours. Conclusions Improved understanding of self-harm and its motives may result in improved nurse-user relationships and thus safer and more effective care provision. [ABSTRACT FROM AUTHOR]

This paper reports on a two-pronged qualitative research study that used leaders' life stories and the case research method to understand the leadership of change in 14 South African organizations. We describe how leaders led the changes required to balance the imperatives emanating from South Africa's socio-political changes and return the country to the international business arena, as well as the challenges created by years of inequality and neglect of the socio-economic development of the majority of its population. We found that the leaders' life stories played a significant role in how they perceived and responded to the change situation. Four themes summarizing the actions of the leaders - namely, their efforts to embrace change, to provide hope, to connect change to African values and culture, and to champion diversity - are described. The results of the study suggest that leaders' life stories can be an important source of information about how they perceive, interpret, and respond to change. [ABSTRACT FROM AUTHOR]

Malawi is a landlocked country in Southern Africa with a population of 17.5 million. It has taken great strides in addressing disability inequality in recent years. Despite this, Malawian trade unions, educators and disability activists report wide‐reaching disability discrimination at an infrastructural and individual level. Situated at the intersections between disability studies and medical sociology, alongside work of postcolonial and Global South scholars, this article highlights how neo‐colonial and Anglocentric dominant framings of disability do not necessarily fit the Malawian workforce, as they ignore cultural and structural differences in the causes and maintenance of ill health and disability. Building on interviews with workers with disabilities, trade unionists, educators, government representatives and disability activists in Malawi's two biggest cities, the article emphasises the need to address specific local contexts; while policy asserts a model of social oppression, in practice, disability inclusion requires recognition of the social determinants of disability and inequality, and the economic, political and cultural context within which disability resides. Sharing co‐designed approaches to engaging with disability definitions, stigma, language, infrastructure and resources, this article highlights the necessity of grounding disability and medical sociological theory in localised framings and lived experiences. [ABSTRACT FROM AUTHOR]

Background: The importance of a child's first 1000 days has now been widely accepted by the medical fraternity. Yet, we do not know much about caring practices in low‐resource settings. Aim: This study aimed to investigate the caring capabilities of mothers in a low‐resource setting. Method: In this study, in‐depth interviews were conducted with 18 mothers with children aged 30 months or younger to better understand the arrangements, means and ends that inform developmental health in a low‐resource setting in South Africa. The study was conducted in a low‐income area, the former black township of Mangaung in Bloemfontein. The mothers were recruited via pamphlets, and two interviews followed. Because of Covid‐19, interviews took place via mobile phones, in Sesotho, the local language in the area. Trained fieldworkers conducted, translated and transcribed the interviews. We used thematic analysis and the capabilities approach as the theoretical framework to analyse the responses from the mothers. Findings: We used the following organizing themes: pregnancy and ante‐natal care, nutrition, cognitive and physical development, the home environment and access to health care. Although short‐term reactions to pregnancy were often negative, the longer‐term responses showed that the respondents have agency. Most of them could change their nutrition habits, breastfeed and receive adequate nutrition support from the public health system. Most experienced joy when their children reached milestones (cognitive and others), although they became anxious if milestones were not reached. They emphasized children's play and had dreams for their children's futures. Technology was often mentioned as playing a role in their children's development. A large proportion of the respondents had disrupted homes (because of absent or abusive fathers), but some had stable homes. Most of them showed substantial capability to overcome adverse home environments. The public health system helped them deal with their health problems and their children's health problems, although it also created anxiety in many cases. Our data show how they develop their capabilities and overcome obstacles organically in the face of resource limitations. Despite pregnancies being unexpected and unplanned and fathers being absent, the respondents accepted the pregnancy, adjusted their diets and social behaviour, showed agency by attending primary healthcare facilities and ensured that their children received the required vaccinations. Their extended families played an important role in providing care. Despite the sacrifices, the respondents expressed joy and helped their children function by eating, playing, socializing, learning and using their senses. Conclusion: Our sample of mothers have the agency to adapt to the demands of parenthood and childcare and overcome adversity. Our data support the notion that mothers are held disproportionately and unfairly responsible for achieving the first 1000 days ideals. Despite considerable curtailment of their functionings and capabilities, they nevertheless showed agency to ensure their health and their children's health. A holistic approach should consider these findings in designing policy interventions for children's developmental health. Patient and Public Contribution: We used paid fieldworkers to interact with the research participants. [ABSTRACT FROM AUTHOR]

Transracial adoption (TRA) represents the largest number of non‐disclosed adoptions in South Africa but remains under researched. This exploratory research investigates practices in the Western Cape, via semi‐structured interviews with adoption social workers and magistrates. Thematic analysis of data revealed the following themes: knowledge and attitudes towards the legal/policy framework of TRA; influences on placement decisions; preparation before and support offered after transracial placement; problems faced by adoption practitioners; and the Western Cape as supportive of TRA. A reluctance to engage with race and a de facto acceptance of TRA undermines a critical view of current practice. [ABSTRACT FROM AUTHOR]

Background: Children with Autism Spectrum Disorder (ASD) remain vulnerable during the Covid‐19 outbreak due to significant changes to their daily routines, social interactions and diets. In addition, these challenges may be exacerbated for children living in low‐ and middle‐income countries (LMIC) such as South Africa where there are already barriers such as poverty, access to resources and availability of support. Understanding the impact of the Covid‐19 outbreak on children with ASD is imperative in order to create awareness as well as provide equitable services and support to both children with ASD and their families. Purpose The study aimed to explore family‐reported changes for children with ASD and their reactions and responses to the Covid‐19 restrictions in South Africa. Method: A qualitative research design was employed. Twelve families consisting of different family compositions with a total of 21 family members (mothers, fathers and grandmothers) participated in the current study using semistructured interviews. Data were transcribed and analysed using a framework method for thematic analysis. Results: Findings indicated that children with ASD present with unique challenges related to Covid‐19. Negative themes such as children's obstructive reactions due to the immediate changes to their routines, increases in emotional dysregulation as well as loss of previously acquired skills as a result of lack of access to services during lockdown were reported. However, families also reported on positive changes such as improved social interactions as children became more accustomed to their new lockdown routines. Implications: The Covid‐19 response has had a negative impact on children with disabilities, specifically around access to services and support for both children with ASD and their families. While the future of the virus and impending lockdown measures is unknown, clinicians, providers and educators need to ensure that provisions are made for children's current adjustments as well as further adjustments to their current routines both during and after the pandemic. [ABSTRACT FROM AUTHOR]

Background: This study is the ninth cross‐sectional community study of fetal alcohol spectrum disorders (FASD) conducted by the multidisciplinary Fetal Alcohol Syndrome Epidemiology Research team in the Western Cape Province of South Africa. It is the third comprehensive study of FASD in a rural, agricultural region of South Africa. Methods: Population‐based, active case ascertainment methods were employed among a school‐based cohort to assess child physical and neurobehavioral traits, and maternal risk factor interviews were conducted to identify all children with FASD to determine its prevalence. Results: Consent was obtained for 76.7% of 1158 children attending first grade in the region's public schools. Case–control results are presented for 95 with fetal alcohol syndrome (FAS), 64 with partial fetal alcohol syndrome (PFAS), 77 with alcohol‐related neurodevelopmental disorder (ARND), 2 with alcohol‐related birth defects (ARBD), and 213 randomly‐selected controls. Four techniques estimating FASD prevalence from in‐person examinations and testing yielded a range of total FASD prevalence of 206–366 per 1000. The final weighted, estimated prevalence of FAS was 104.5 per 1000, PFAS was 77.7 per 1000, ARND was 125.2 per 1000, and total FASD prevalence was 310 per 1000 (95% CI = 283.4–336.7). Expressed as a percentage, 31% had FASD. Although the rate of total FASD remained steady over 9 years, the proportion of children within the FASD group has changed significantly: FAS trended down and ARND trended up. A detailed evaluation is presented of the specific child physical and neurobehavioral traits integral to assessing the full continuum of FASD. The diagnosis of a child with FASD was significantly associated with maternal proximal risk factors such as: co‐morbid prenatal use of alcohol and tobacco (OR = 19.1); maternal drinking of two (OR = 5.9), three (OR = 5.9), four (OR = 38.3), or more alcoholic drinks per drinking day; and drinking in the first trimester (OR = 8.4), first and second trimesters (OR = 17.7), or throughout pregnancy (OR = 18.6). Distal maternal risk factors included the following: slight or small physical status (height, weight, and head circumference), lower BMI, less formal education, late recognition of pregnancy, and higher gravidity, parity, and older age during the index pregnancy. Conclusion: The prevalence of FASD remained a significant problem in this region, but the severity of physical traits and anomalies within the continuum of FASD is trending downwards. [ABSTRACT FROM AUTHOR]

Introduction: Work‐related transitions following serious hand injury can be complex for people with hand injuries and rehabilitation professionals supporting the return‐to‐work process. This study explored South African occupational therapy practice related to work transitions after a serious hand injury. Methods: In this collective case study, maximum variation sampling was used to select seven occupational therapists involved in facilitating work‐related transitions for people with serious hand injuries. Participants selected at least five cases that illustrated the breadth of their practice in terms of work transitions; these cases formed the focus of the semi‐structured interviews. Data were analysed using inductive content analysis. Exemplar quotations were extracted to support emergent key themes. Results: There was one overarching theme—Ongoing appraisal of the fit between function and inherent work demands—which comprised three stages: (1) determining and facilitating readiness to work; (2) managing the risk and trauma of returning to work, and (3) implementing reasonable accommodation. The central theme comprised six strategies that were used to optimise the transition process and achieve the best possible outcome. Conclusion: The study highlighted the importance of work‐related transitions that are context‐driven, flexible, and involve multiple stakeholders. The occupational therapists demonstrated how they drew on their knowledge of local contexts to solve problems and generate effective individual strategies over the rehabilitation period. The findings may be applicable to other low‐ or middle‐income countries where the return‐to‐work process may not be as predictable as high‐income countries. [ABSTRACT FROM AUTHOR]

Positive psychology interventions have been shown to improve well‐being in various contexts. However, few studies have explored the use of these approaches in clinical settings. Considering the high prevalence of trauma and the pressure on public mental health services in South Africa, this study implemented and described solution‐focused brief therapy (SFBT) with South African trauma survivors in order to explore their experiences of hope and subjective well‐being (SWB), during and after exposure to SFBT. Using a multiple case study design, qualitative data were collected from therapeutic sessions and semi‐structured individual interviews with seven black female participants. Following thematic analysis, results indicated that SFBT contributed towards participants' experiences of hope and SWB. In particular, the therapeutic conversation, empathy and acceptance in therapy, visualising a better future and focusing on strengths instead of the trauma facilitated these experiences. SFBT may thus be an appropriate intervention to facilitate hope and SWB among trauma survivors. [ABSTRACT FROM AUTHOR]

Adequate intake of iodine is important during pregnancy because of its essential role in foetal growth and neurodevelopment. Data on iodine status of South African pregnant women are scarce, and the salt reduction policy implemented in 2016 may decrease iodine intake of South Africans. This cross‐sectional study assessed the iodine status of pregnant women residing in urban Johannesburg, South Africa. A total of 250 pregnant women were enrolled into the 'Nutrition during Pregnancy and Early Development' (NuPED) study and 312 pregnant women into the 'Assessment of dried blood spot thyroglobulin in pregnant women to redefine the range of median urinary iodine concentration that indicates adequate iodine intake, South Africa' (STRIPE‐SA) study and were included in this analysis. Urinary iodine concentration (UIC) was analysed in a spot urine sample. Thyroglobulin (Tg) was measured in serum, and thyroid‐stimulating hormone (TSH) and total thyroxine (tT4) were measured in dried blood spots. The median [interquartile range (IQR)] UIC of pregnant women was 144 (84–234) μg/L. Women in the first (n = 99), second (n = 262) and third (n = 174) trimester had a median UIC of 133 (81–316), 145 (84–236) and 156 (89–245) μg/L, respectively (p = 0.419). Median TSH, tT4 and Tg were 2.7 (2.3–3.2) mU/L, 202 (163–236) nmol/L and 9.2 (5.4–17.9) μg/L, respectively. Based on the median UIC, pregnant women residing in urban Johannesburg may be borderline iodine deficient. These findings highlight the need for ongoing monitoring of iodine status among vulnerable pregnant women, especially considering the recently introduced salt reduction policy in South Africa. [ABSTRACT FROM AUTHOR]

Richter M.S., Mill J., Muller C.E., Kahwa E., Etowa J., Dawkins P. & Hepburn C. (2013) Nurses' engagement in AIDS policy development. International Nursing Review 60, 52-58 Background: A multidisciplinary team of 20 researchers and research users from six countries - Canada, Jamaica, Barbados, Kenya, Uganda and South Africa - are collaborating on a 5-year (2007-12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care . One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses' engagement in policymaking. Methods: A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Findings: Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to 'protect' not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. Conclusions: The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level. [ABSTRACT FROM AUTHOR]

THUPAYAGALE-TSHWENEAGAE G. & MOKOMANE Z. (2013) Needs of South African adolescents orphaned by AIDS: evidence from photography and photo-elicitation. International Nursing Review 60, 88-95 Background: Available evidence shows that over half of all orphans under the age of 18 years are adolescents aged between 12 and 17 years. Despite this, the needs of adolescents orphaned by AIDS are seldom recognized or adequately addressed in policy and programmes. Instead, the focus tends to be on the needs of orphans and vulnerable children. However, there are several factors that render adolescent-specific programmes important. Purpose: Using data from an urban area in South Africa, this paper illuminates the needs of adolescents orphaned by AIDS. Method: A phenomenological study using photography and photo-elicitation was used with 15 adolescents aged between 14 and 18 years orphaned by AIDS. Results: The study participants captured different objects that were grouped under six broad themes: symbols of death, nature, people, past life, children and hope. The photographic component of the study was followed by photo-elicitation. From the meanings the adolescents made of their images, the needs of adolescents orphaned by AIDS were discerned as love, care and acceptance, safety, and security and support. Conclusion: Overall, the results showed that adolescents orphaned by AIDS want to feel secure, safe, wanted by caregivers and to feel that caregivers support them in their grieving journey. [ABSTRACT FROM AUTHOR]

Accessible Summary: For young people with intellectual disabilities and/or autism, the transition from children's residential care into adulthood during COVID‐19 has been difficult.Opportunities for greater independence were blocked because of the lockdown.Some of these young people experienced an increase in depression or other mental health difficulties.But more time at home due to public health restrictions also helped to deepen the relationship with caregivers.Service continuity is crucial, both in person and online, to support care leavers with intellectual disability and/or autism, as well as training and support to caregivers to continue with independent and interdependent living programmes at home. Background: This study focuses on young people with intellectual disabilities and/or autism who, due to child welfare concerns, have grown up in children's residential care and are now transitioning out of care at the age of 18 years towards young adulthood. This transition is termed "care leaving" and the young people in transition "care leavers". The care leaving transition can be particularly difficult for young people with intellectual disabilities and/or autism. These challenges can be magnified in a time of a global crisis like COVID‐19, which has resulted in countries being on lockdown and care leavers' transitions being curtailed. Many mental health problems have emerged due to the COVID‐19 outbreak and resultant lockdown that may negatively impact on the care leaving transition of young people with intellectual disabilities. Methods: Semi‐structured interviews were conducted with six care leavers with intellectual disabilities and their three caregivers in June 2020 in the Cape Peninsula region of South Africa to explore the impact of COVID‐19 on their transitional journeys. Findings: Three core themes emerged from the analysis: young people evidenced regression of independence, rather than the expected growth in young adult independence, due to disruptions to routines and opportunities to move out into the world; some young people experienced an exacerbation or emergence of mental health problems, which impacted on their transition to young adulthood; and young people and their caregivers experienced a deepening of caregiver relationships, which enhanced the transition of the care leaver. Conclusions: Services must continue to facilitate progress towards independence and promote personal and caregiver well‐being. Support service for care leavers with intellectual disabilities should be essential services, offered in person or online while adhering to COVID‐19 regulations. Caregivers should be trained in continuing independent and interdependent living programmes for care leavers in their care, supported through in person or online training, mentoring and supervision. Service continuity is recommended to avoid the contraction of young people's social world at a time when it should be opening up. [ABSTRACT FROM AUTHOR]

Background: Nurturing parents raise children in an engaged, flexible, emotionally expressive and supportive manner, which is associated with positive outcomes for children. While parenting research within the South African context is increasing, there is a lack of focus on nurturance within the parent–child relationship. Thus, this study sought to explore how parents nurture their children in resource‐constrained environments in South Africa. Method: A qualitative approach with an exploratory research design was used. Participants were purposively recruited via non‐governmental institutions and key informants in the communities. A sample of 77 semi‐structured interviews was conducted with participants from two rural areas, Calvinia and Lamberts Bay, in South Africa. Results: A thematic analysis of the data revealed two themes. The first theme is nurturance approaches, which encapsulate how parents nurture their children physically and emotionally. The second theme focuses on factors contributing to nurturance within the parent–child relationship with regard to parenting practices and external factors. Conclusion: Although parents are nurturing children physically and emotionally, parenting capacity needs to be improved in the South African context. [ABSTRACT FROM AUTHOR]

Background: Lack of time has consistently been reported as a major barrier to effective research evidence uptake into clinical practice. There has been no research to our knowledge that explores time as a barrier within the transtheoretical model of stages of change (SoC), to better understand the processes of physiotherapists' uptake of clinical practice guidelines (CPGs). This article explores the concept of lack of time as a barrier for CPG uptake for physiotherapists at different SoC. Methods: A six‐step process is presented to determine the best‐fit SoC for 31 physiotherapy interviewees. This process used an amalgamation of interview findings and socio‐demographic data, which was layered onto the SoC and previously identified time‐barriers to CPG uptake (few staff, high workload, access to CPGs, evidence‐based practice as priority in clinical practice, 'time is money' attitude and knowledge on the use of CPGs). Results: The analysis process highlighted the complexities of assigning individuals to a SoC. A model of time management for better CPG uptake is proposed which is a novel approach to assist evidence implementalists and clinicians alike to determine how to progress through the SoC and barriers to improve CPG uptake. Conclusions: To the authors' knowledge, this is the first attempt at exploring the construct of (lack of) time for CPG uptake in relation to the physiotherapists' readiness to behaviour change. This study shows that 'lack of time' is a euphemism for quite different barriers, which map to different stages of readiness to embrace current best evidence into physiotherapy practice. By understanding what is meant by 'lack of time', it may indicate specific support required by physiotherapists at different stages of changing these behaviours. [ABSTRACT FROM AUTHOR]

Female‐initiated HIV prevention methods, such as oral pre‐exposure prophylaxis (PrEP) and the vaginal ring, may be important risk reduction strategies for breastfeeding women. Given their novelty, information about the sociocultural context and how it influences perceptions of and support for their use during breastfeeding is lacking. To address this gap, we conducted 23 focus group discussions separately with pregnant and breastfeeding women, male partners and grandmothers (N = 196) and 36 in‐depth interviews with key informants in Malawi, South Africa, Uganda and Zimbabwe. We analysed the data using a framework analysis method. Overall, breastfeeding was the norm, and participants described the transference of health (e.g., nutrition) and disease (e.g., HIV) to children through breast milk. Participants considered the early breastfeeding period as one of high HIV transmission risk for women. They explained that male partners tend to seek outside sexual partners during this period because women need time to recover from delivery, women focus their attention on the child, and some men are disgusted by breast milk. Participants highlighted concerns about the drugs in oral PrEP transferring to the child through breast milk, but fewer worried about the effects of the vaginal ring because the drug is localized. Women, grandmothers and key informants were supportive of women using these HIV prevention methods during breastfeeding, while male partners had mixed opinions. These findings can be used to tailor messages for promoting the use of PrEP or the vaginal ring during breastfeeding in sub‐Saharan Africa. [ABSTRACT FROM AUTHOR]

Nationwide rollout of antiretroviral treatment (ART) is increasing the number of older persons living with HIV (OPLWH) in South Africa. Yet, little is known about how the sociological aspects of ageing – stigma, finances and family dynamics – impact access to ART. Qualitative interviews with 23 persons aged 50‐plus living near Cape Town highlight the barriers and facilitators to the acceptability, affordability and availability of ART access among OPLWH. Key age‐related barriers included perceived shame of sexuality and disclosing HIV status to others, perceived disrespect by clinical staff, affording transportation to clinics and pre‐existing co‐morbidities. Key age‐related facilitators included family moral and financial support, particularly from children and grandchildren, and access to social grants. Importantly, many barriers and facilitators had feedback loops, for example social grants reduced transportation barriers to clinics when ageing and poor health limited mobility. As the population living with HIV ages, it is critical to assess the ways ageing, as a social process, impacts ART access and to address these to improve older persons' HIV care. [ABSTRACT FROM AUTHOR]

Caring for children with disabilities (CWD) is a challenging task for families and service providers alike. Even though previous research has explored experiences and perceptions of families who care for CWD, research focusing on service providers' perceptions of such families is limited. Through the lens of a care framework, the present study aims to explore service providers' perceptions of families caring for CWD in resource‐poor settings in South Africa. Key informant interviews were conducted with managers of 10 organizations supported by the Nelson Mandela Children's Fund. An inductive thematic analysis was used to analyse the data. The findings revealed that family structure, poverty, service inaccessibility, negative beliefs, and stigma by community members, in addition to parental substance abuse, influenced how families care for CWD in resource‐poor settings in South Africa. These findings have implications for policy amendments regarding the care dependency grant (CDG) to ensure that it benefits all CWD and not only those who need full‐time care and services. [ABSTRACT FROM AUTHOR]

In South Africa, various treatment models from abroad have been implemented for patients diagnosed with borderline personality disorder. This report is based on a South African model that has been developed, implemented, and evaluated for mental health nurses to use in facilitating the self‐empowerment of women living with borderline personality disorder. The aim of this study was to describe the implementation of a model to facilitate self‐empowerment in women living with borderline personality disorder and to describe mental health nurses' experiences of implementing this model. A qualitative, exploratory, descriptive, and contextual research design was used for the study. Participants were mental health nurses working in an inpatient psychotherapy unit in a mental health hospital. Findings revealed that mental health nurses experienced the model as a secure framework to assist women living with borderline personality disorder in making a shift to being self‐empowered. The mental health nurses found that they had to adapt the model's timeframe to the women's own pace. Through use of the model, the mental health nurses also gained self‐leadership. This report provides evidence from mental health nurses that the model was practical and helpful in working with women living with borderline personality disorder. The mental health nurses saw signs of self‐empowerment in women living with borderline personality disorder. [ABSTRACT FROM AUTHOR]

Aim: This study explored and described nurses' experiences of factors that influenced their professional dignity in private hospitals in South Africa. Background: Patients' dignity is a nursing professional value in high regard. Nurses' dignity, in particular nurses' professional dignity, has not been valued equally. Disrespect for nurses' professional dignity impacts on nurses' motivation to provide nursing care to their full potential. Methods: Descriptive phenomenological research was conducted. Eleven professional nurses were interviewed at two private hospitals in the provinces of KwaZulu‐Natal and the Free State of South Africa. Findings: The participants were conscious of their 'professional standing due to own and others' percipience'. Their professional dignity was influenced by experiences such as perceiving one's own professional dignity; having contradictory experiences; being proud to be a professional nurse; receiving support, appreciation and respect; providing care in complex situations; performing as a professional nurse; valuing patient well‐being; and being humiliated by others. Conclusion: Preserving nurses' professional dignity is crucial and should be acknowledged and encouraged by managers, health team members and nurses. Implications for nursing/health policy: The need for preserving nurses' professional dignity necessitates the incorporation of professional dignity strategies in healthcare, nursing and education policies. [ABSTRACT FROM AUTHOR]

Background: Post‐apartheid, understanding and management of intellectual disability remain poor in South Africa, complicated by various contextual and cultural explanations used to describe and conceptualize this condition. Method: We conducted 20 semi‐structured interviews with primary caregivers and parents of children with intellectual disability residing in Khayelitsha, a low‐income setting in Cape Town, South Africa. We used Kleinman's Explanatory Models (EMs) of illness to explore terms used to describe and conceptualize this condition. Results: Carers' explanatory models included biomedical causes, injuries during pregnancy or birth, as well as spiritual causes. It was reported that there were significant difficulties in accessing services and support, and difficulties with coping in the context of extreme poverty and deprivation. Conclusions: Current findings highlight a need for collaboration between the biomedical and alternative healthcare systems in educating carers and parents regarding intellectual disability. [ABSTRACT FROM AUTHOR]

Rationale: Clinical practice guidelines (CPGs) should provide busy health care professionals with easy‐to‐use tools that support efficient uptake of current best evidence in daily clinical practice. However, CPG uptake rarely occurs at the speed of evidence production. The aim of this study was to explore the factors influencing CPG uptake among South African (SA) physiotherapists (PTs). Method: An exploratory, descriptive qualitative study design was used, within an interpretative research paradigm. A phenomenological approach was taken, as the study aimed to explore the phenomenon of CPG uptake by SA PTs and how the themes and subthemes related to each other within this phenomenon. Semistructured interviews were undertaken via telephone calls that were audiotaped and independently transcribed. An inductive and deductive thematic content analysis approach was taken where the transcript content was analysed by hand. Findings Thirty‐one PTs from the private, public, and education sectors participated in the interviews. The main themes identified were resources, training, and organizational factors. The SA PT workforce, particularly that in the public sector, is limited and patient load and need is high. Time to implement and stay up‐to‐date with current evidence were barriers for many interviewees. Participants also perceived CPG uptake as not being financially rewarding. Training in CPG uptake was mostly perceived as a facilitator, and the PTs felt that they would be more inclined to implement CPGs if they felt more confident in how to source and use CPGs, particularly if they were incentivized to undertake such training. Roles, responsibilities, and power in the health care team were perceived as being both organizational barriers and, conversely, facilitators, depending on work environments. Conclusions: The findings of this study generally concur with previous studies about PT barriers to CPG uptake; however, it provides novel information on barrier contexts in one LMIC with complex PT service delivery. [ABSTRACT FROM AUTHOR]

Objective: Deficits in healthcare quality are becoming an increasing concern globally. Within the low‐ to middle‐income country (LMIC) setting insufficient quality has become a bigger barrier to reducing mortality than insufficient access, where 60% of deaths from conditions amenable to healthcare, are due to poor quality care. Measuring quality is key towards improving the effectiveness of healthcare in this setting. Methods: A mixed methods sequential‐explanatory study was conducted, to describe what Emergency Medical Service (EMS) practitioners understood about quality systems within the LMICs, using South Africa as an example. Part 1 consisted of a cross‐sectional survey (n = 169), the results of which were utilised to develop a semi‐structured interview guide for Part 2. Interviews of participants from Part 1 explored the results of the survey (n = 20) and were analysed through content analysis to develop core categories central to the understanding of quality assessment in the LMICs. Results: Despite relatively poor knowledge of organisational‐specific quality systems, understanding of the core components and importance of quality systems was demonstrated. The role of these systems in the LMICs was supported by participants, where the importance of context, system transparency, reliability and validity were essential towards achieving ongoing success and utilisation. The role of leadership and communication towards the effective facilitation of such a system was equally identified. Conclusion: Within EMS, quality systems are in their infancy. It could be argued that this is somewhat more pronounced in the LMICs, where knowledge of organisational quality systems was found to be poor. Despite this, there was a strong general understanding of the importance of quality systems, and the role they have to play in this setting. [ABSTRACT FROM AUTHOR]

Background: Understanding critically ill patients' experiences of nursing care is an important aspect that can improve quality of care in the intensive care unit. Aim: To elicit critically ill patients' experiences of nursing care in the adult intensive care units. Design: A qualitative descriptive design was utilized. Methods: Sixteen patients who had a predicted mortality risk of above 50% within the first 24 h of admission to the intensive care unit and had been discharged to the ward were purposively selected. The study was conducted at three academic affiliated, tertiary/quaternary specialist hospitals in South Africa. Individual semi‐structured interviews were conducted with the selected participants until a point of data saturation was reached. Data were analysed using a conventional content analysis technique (Hsieh and Shannon, 2005). Lincoln and Guba's criteria for ensuring the trustworthiness of qualitative research were applied. Findings: Four major themes emerged: 'being in someone's shoes', 'communication', 'presence' and 'religion and spirituality'. Conclusions: Even though some participants' responses reflected 'good' nursing care, the majority of the participants had negative experiences in relation to the nursing care they received while admitted in the selected intensive care units. Relevance to clinical practice: This study demonstrates critically ill patients' voices and preferences of intensive nursing care and describes some issues that require not only nurses' but also managerial improvements and interventions in order to ensure quality care and, eventually, patients' satisfaction with intensive nursing care. [ABSTRACT FROM AUTHOR]

Background: Most public hospitals in African countries are overpopulated with patients suffering from conditions related to HIV and AIDS. These patients increase the burden on healthcare providers, among which are enrolled nurses. Aim: To explore enrolled nurses' experiences of caring for patients living with HIV and AIDS at a public rural community hospital in the Vhembe district of Limpopo Province, South Africa. Design: The study was underpinned by the interpretative phenomenological design. Participants: A total of 11 purposively selected enrolled nurses who met the inclusion criteria participated in the study. The sample size was based on data saturation. Method: Data were collected through semi‐structured individual face‐to‐face interviews guided by an interview guide. Interviews were audio‐recorded; and field notes were also taken. Data were analysed thematically following a framework for interpretative phenomenological analysis. Results: The study revealed that enrolled nurses are working without adequate resources. They also experience minimal support despite the negative circumstances they are exposed to in the process of caring for patients admitted with HIV‐related illnesses. Conclusions: A lack of resources, limited support and inadequate skills have a negative impact on the health care that enrolled nurses provide to patients admitted in hospital with HIV‐related ailments. Researchers recommend the importance of supporting and equipping enrolled nurses to provide quality care to patients living with HIV. Implications for nursing and health policy: The findings have highlighted the challenges faced by enrolled nurses while caring for patients with HIV. The identified gaps will assist the Department of Health in developing policies to enhance the support offered to enrolled nurses and improve the care provided to patients with HIV‐related conditions that are admitted to rural hospitals. [ABSTRACT FROM AUTHOR]

This article describes the 1‐year outcomes of youth transitioning out of a residential care facility in South Africa. Those outcomes are compared with both national data on youth in the general population and care leavers from the United Kingdom. Analysis of the outcomes of 52 care leavers showed that they had fairly secure accommodation, low levels of homelessness, and low levels of criminal involvement and substance abuse. However, care leavers were particularly vulnerable in their educational attainment and employment outcomes and ran the risk of being not in employment, education or training. This has economic and psychological consequences for youth, who are then forced to rely on others for their livelihood and it can increase their feelings of depression, isolation, and despondency. Results from this study provide insight into the challenges and needs of young people transitioning out of residential care, which provides guidance on what to prioritize for practice. This research has implications not only for improving the understanding of care leaving in South Africa and Africa, but also for the existing knowledge based on research internationally. [ABSTRACT FROM AUTHOR]

Abstract: The impact of adolescent substance abuse is widespread and significantly compromises the psychosocial well‐being of those closest to the adolescent. This is evidentially so for parents who are required to cope with the adolescent's misconduct. Using an interpretative phenomenological methodology, this article describes mothers’ experiences of living with an adolescent who is dependent on drugs. Specifically, the article explores the mothers’ accounts of the pernicious behaviours that the adolescents engage(d) in during their drug abuse period. Qualitative 1:1 interviews revealed two common forms of adolescent misconduct that the mothers had to contend with which were ‘belligerent attitudes and conducts’ and ‘pilfering behaviours’. The mothers further reported that the adolescents’ behaviours negatively impacted on the mother–adolescent relationship, producing feelings of mistrust and a lack of trust. The findings contribute to the sparse literature on parents’ experiences and thus hold implications for research and practice. Understanding the challenges that mothers contend with when adolescents engage in problematic drug use is important for the development of support interventions to help parents cope effectively. Further implications are presented in the article. [ABSTRACT FROM AUTHOR]

Background There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large-scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale. Objectives The objective of this study is to examine the process of scaling up four major country-level ECD programmes through the application of a CAS framework. Methods Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open-ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus. Results The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale-free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes. Conclusions CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field. [ABSTRACT FROM AUTHOR]

Background Despite known risks of prenatal nutritional deficiencies and studies documenting increased prevalence of poor dietary intake among nonpregnant alcohol abusers, the nutritional status of heavy drinking pregnant women remains largely unstudied. Animal models have found interactions between prenatal ethanol exposure and micronutrients, such as choline, folate, B12, and iron, and human studies have reported that lower maternal weight and body mass confer increased fetal alcohol-related risk. Methods One hundred and twenty-three heavy drinking Cape Coloured pregnant women and 83 abstaining controls were recruited at their first antenatal clinic visit. At 3 prenatal study visits, each gravida was interviewed about alcohol, smoking, and drug use and weight, height, and arm skinfolds were measured. Dietary intakes of energy, protein, fat, and major micronutrients were assessed from three 24-hour recall interviews. Results The majority of women gained less than the recommended 0.42 kg/wk during pregnancy. Whereas methamphetamine use was associated with smaller biceps skinfolds, an indicator of body fat, alcohol consumption was not related to any anthropometric indicator. Alcohol was related to higher intake of phosphorus, choline, and vitamins B12 and D. Alcohol, cigarette, and methamphetamine use were related to lower vitamin C intake. Insufficient intake was reported by >85% of women for 10 of 22 key nutrients, and >50% for an additional 3 nutrients. Conclusions Alcohol consumption during pregnancy was not associated with meaningful changes in diet or anthropometric measures in this population, suggesting that poor nutrition among drinkers does not confound the extensively reported effects of prenatal alcohol exposure on growth and neurobehavior. The poor gestational weight gain and high rates of insufficient intake for several nutrients in both the alcohol-exposed and control groups are also of public health importance. [ABSTRACT FROM AUTHOR]

Social psychologists typically conceptualize intergroup processes in terms of unequal pairs of social categories, such as an advantaged majority (e.g., 'Whites') and a disadvantaged minority (e.g., 'Blacks'). We argue that this two-group paradigm may obscure the workings of intergroup power by overlooking: (1) the unique dynamics of intergroup relations involving three or more groups, and (2) the way some two-group relationships function as strategic alliances that derive meaning from their location within a wider relational context. We develop this argument through a field study conducted in a grape-farming town in South Africa in 2009, focusing on an episode of xenophobic violence in which a Zimbabwean farm worker community was forcibly evicted from their homes by their South African neighbours. Discursive analysis of interview accounts of the nature and origins of this violence shows how an ostensibly binary 'xenophobic' conflict between foreign and South African farm labourers was partially constituted through both groups' relationship with a third party who were neither victims nor perpetrators of the actual violence, namely White farmers. We highlight some potential political consequences of defaulting to a two-group paradigm in intergroup conflict studies. [ABSTRACT FROM AUTHOR]

This article reports on qualitative research conducted in KwaZulu-Natal, South Africa, among researchers and gate-keepers of health facilities in the province. Results suggest disparate but not irreconcilable perceptions of the social value of research in provincial health facilities. This study found that researchers tended to emphasize the contribution of research to the generation of knowledge and to the health of future patients while gate-keepers of health facilities tended to emphasize its contribution to the healthcare system and to current patients. Furthermore, relations between research stakeholders were perceived to be somewhat fragile, making it difficult for stakeholders to achieve consensus about the social value of research, as well as on ways to maximize value. Interventions to negotiate a shared perspective on the social value of research would appear to be warranted, and the findings of this study suggest some focus areas for such intervention. [ABSTRACT FROM AUTHOR]

Post‐apartheid, South African agencies have been required to shift their services in fundamental ways, including offering services in previously un‐resourced areas, honouring the rights of children and families, ensuring that users, staff and governing bodies are representative of the population and providing developmental social welfare services in place of child protection‐oriented interventions only. A study of urban South African child welfare agencies provides insight into the complex task of managing and leading change. In view of overloaded change agenda and resource constraints, managers focused on effecting incremental change and prioritized the most ‘rewarding’ change efforts. Transforming practice towards a developmental approach was less successful. Structural interventions were also not prioritized. Child welfare agencies internationally face demands to transform in response to the effects of local change and globalization. The study's insights might resonate with agencies working for change in other societal contexts. [ABSTRACT FROM AUTHOR]

Objective Many studies that document child outcomes in the context of parental HIV - which has been established as a risk factor for child development - focus on older children/adolescents. Studies also concentrate on the status of the primary caregiver, not other household members who might be infected. Design This study examined the effects of caregiver and household HIV on child development (4-13 years) in South Africa and Malawi (2011-2014). Methods Data were gathered from 989 children and their primary caregivers at baseline and repeated at 12-15 months follow-up (86.5% follow-up rate). Only caregivers of a single child and caregiver/child dyads without missing data were included, providing a sample of 808 dyads for analysis. Children were divided into three groups according to caregiver-reported HIV burden: having an HIV-positive primary caregiver (19.8%), having HIV in the household (14.2%) or no HIV (66%). Results The HIV burden was positively associated with an array of negative child outcomes, often mediated by caregiver depression levels. Family HIV burden at baseline affected child behavioural problems at follow-up indirectly through carer depression ( B = 0.02; CI = 0.003, 0.06). Internalizing ( B = 0.02; CI = 0.002, 0.05) and externalizing problems at follow-up ( B = 0.01; CI = 0.0002, 0.03) were also indirectly affected by family HIV burden through caregiver depression. Conclusions The data suggest that family HIV can affect child development, emphasizing the important role of depression in the pathway to such an effect. Community-based interventions directed at alleviating parental depression in the presence of HIV may help to interrupt the cycle of family HIV and adverse child outcomes. [ABSTRACT FROM AUTHOR]

Background Internationally adults with intellectual disability are largely cared for by their families, especially in low- to middle-income countries ( LAMIC). Compared to high-income countries, little is known about their experiences in LAMIC such as South Africa. Methods Focus group discussions were carried out with 37 family caregivers ( FCGs) in the Cape Town metropole. These were transcribed and analysed thematically. Core categories were identified and validated through member checking. Results Family caregivers showed strong commitment to care despite the heavy responsibility and burden of care that women especially experience. They recognize the limited personal growth opportunities for people with intellectual disability that increases the caregiving burden. FCGs identify supports and resources in the community that assist them with their care responsibilities but often feel let down by services. Conclusions Improved family supports appropriate to the resources in LAMIC are needed especially when existing carers are no longer able to provide care. [ABSTRACT FROM AUTHOR]

This article presents findings from a longitudinal qualitative study (48 in-depth interviews with 12 women on antiretroviral treatment ( ART)) exploring the experience of living with HIV as a chronic illness in South Africa by applying the structural and interactionist perspectives on chronic illness. The structural perspective indicates that the illness experience needs to be contextualised within the wider framework of the women's hard-earned lives: throughout the interviews, the women tended to refuse singularising HIV/ AIDS and continuously framed the illness within the context of general hardship and adversity. Employing an interactionist perspective, the repeated interviews demonstrated the partial applicability of the concept of biographical disruption to the illness experience: most women experienced feelings of denial and disbelief upon diagnosis, but the availability of ART clearly mitigated the impact of HIV on their biographies. In addition, our findings demonstrate that the interaction between structural aspects, (stigmatising) social relations, and the illness (and its treatment) determines the never-ending cycle of identity appraisals, revisions and improvements, rendering the moral career of the HIV-positive women on ART a continuous work in progress. [ABSTRACT FROM AUTHOR]

The study contextualises the position of child citizens in the South African democracy and highlights how education for democratic citizenship is employed through a literacy-based approach. The qualitative study was exploratory and based on a lesson presented to nine-year-old township children by giving them language-related tasks. Through the children's voices we present the life experiences that expressed their need for basic services, education, extra facilities and security. We argue that children need to experience the benefits of democracy and education for democratic citizenship to build and sustain a resilient democratic society. [ABSTRACT FROM AUTHOR]

Background Despite acknowledgement of the complexity and challenges of the process of disclosure of HIV status to adolescents, little work has been carried out on the communication features which facilitate or hinder the process. This qualitative case study reflects the interactional dynamics of an interaction between caregiver, physician and counsellor around the topic of disclosure in a South African clinic. Methods A 40-minute encounter between a doctor, the grandmother of an adolescent with HIV/ AIDS and a counsellor around the process of disclosure was transcribed and examined in detail in relation to its structure, topics, timing and sequence as well as its movement towards a collaborative ending. Analysis was based on elements of conversational and thematic analysis. Results The session was characterized by distinct stages and the emergence of multiple voices and perspectives from the participants. The negotiated management of the session sheds light on multiple barriers to care as well as the influence of contextual factors on the process. The important mediating role of the counsellor in the triad emerges. The analysis highlights both unique features of the consultation and common challenges to clinicians when disclosing. Discussion and Conclusions The task of disclosure is complex and intricate. Results suggest team processes are critical, as are temporal and contextual factors and the need for an understanding of communication. Implications for the clinic team are discussed and suggestions made for the development of collaborative partnership based on an understanding of roles and responsibilities, time factors and enhancement of features such as trust and communication. [ABSTRACT FROM AUTHOR]