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Genetic counselling students are encouraged to become involved with support groups for genetic conditions. However, their roles within these groups are not well defined and poorly understood and ethical concerns have been raised regarding the appropriateness of such involvement. A limited number of international studies have examined the role of a genetic counsellor in a support group. These studies report broadly on the matter but lack the personal response that qualitative data produces. South African literature is even more limited and no studies (both locally and internationally) have attempted to describe the role of a genetic counsellor in a support group for Huntington disease. This study examines the role of a genetic counsellor in a Huntington Disease support group, specifically the Huntington’s Association of South Africa (HASA). A qualitative research approach was used to interview 17 people who have been involved with HASA in the past seven years. In-person and telephonic interviews were conducted with five genetic counsellors and one psychologist. Two separate focus groups were conducted with a total of 11 support group members and one genetic counsellor (who was also interviewed in-person). The interviews and focus groups were audio recorded and transcribed by a combination of an online software program named Sonix Transcription and manual transcription by the researcher herself. Thematic analysis was done and the results were grouped according to the following five themes that emerged from the data: 1) Is there a role?, 2) Information provider, 3) Emotional support, 4) Practical helper, and 5) Community member. It was found that there is a role for a genetic counsellor in a HASA support group and that the relationship that is formed though such involvement can be mutually beneficial to both the support group members and the genetic counsellor. The genetic counsellor’s role was found to be wide and included specialist and practical roles, as indicated by above mentioned themes two to five. These findings cannot be extrapolated to apply to all support groups due to the unique characteristics and function of different support groups. This was evident in this case as the two branches in SA (Western Cape and Gauteng) seem to function very differently. The research can, however, be used as guideline for involvement with other support groups. This 9 study’s findings made a unique contribution in that it documented in detail the genetic counsellor’s involvement in support groups. The study found that all the participants agreed that HASA should have access to a genetic counsellor, thus it is recommended that future studies should explore the role of a genetic counsellor in support groups for other genetic conditions, as those groups could also find it beneficial.

Background: A weekly pregnancy counselling clinic is held in conjunction with foetal medicine experts at Groote Schuur Hospital for women with pregnancies complicated by foetal anomalies. In cases with poor prognoses, termination of pregnancy (TOP) may be offered. The women receive genetic counselling where the ultrasound findings, invasive testing and TOP options are discussed. Decision-making is the focus of these sessions. The experiences and decision-making processes of the women in this clinic are poorly understood, therefore this project aims to explore these women's experiences and what factors influence their decision-making regarding TOP. Methods: Qualitative research, drawing on principles of phenomenology was used as the study design. The sample for this study are women who had a prenatal diagnosis of a serious congenital abnormality and were offered TOP. The women were identified using the Division of Human Genetics pregnancy counselling database at the University of Cape Town in South Africa. Semistructured face-to-face interviews with open-ended questions were used to collect the data and close-ended questions were used to obtain the demographic data. The interviews were recorded and transcribed verbatim. The data were analysed using a thematic data analysis approach. A total of 12 women were interviewed. Results: Five themes were identified in this study. These include "Health care services", "Home", "Being a woman", "Finding meaning", and "The aftermath". The healthcare services impacted the manner in which the women made sense of the ultrasound findings. Support (or lack of) from family and the community impacted on their decision-making. Stigma attached to having a child with a disability and/or stigma against TOP and partner relationships played a role. The women questioned their role as a woman and obligations of child-bearing. Finding meaning for the event was important and this process continued until after the delivery or after the child was born. Following the event having a burial and giving away the child's clothes were found to play a significant role in their adjustment. Discussion and Conclusion: The decision-making process was multifaceted and unique to each woman. They consulted their families, partners and community but in the end they made the final decision. The women considered a multitude of factors but it seems that there may be one deciding factor. This in depth exploration of the women's experiences has provided valuable insight into the decision-making process, which can be used to improve the services offered to patients.

This study explored the experiences of individuals within the clinical genetic service in South Africa, with inherited retinal disease. Methods: This qualitative research was based on a grounded theory approach. Semi-structured interviews were carried out after obtaining approval from the University of Cape Town Research and Ethics committees as well as from study participants themselves. Ten willing individuals were interviewed using an open-ended question guide to extract information about their experiences with vision loss including but not exclusively, concerning participants knowledge about their condition, ability to make decisions and their adaptation experiences. Interviews were audio recorded, transcribed verbatim and a reiterative thematic analysis performed on the raw data. Results: A range of themes and sub-themes emerged from the data that marked participants' experiences from the time of onset of vision loss. The main broad themes include "a roller coaster journey," "learning how to survive," "a genetic condition affecting the back of the eye, and "paving the way forward." Conclusions: The four themes presented in an almost linear fashion, marking a journey patients experienced from the onset of symptoms to the time of the interview. The initial stage of their journey was marked by difficulties and challenges exacerbated by the psychopathological responses reported in this dissertation. This stage was perceived to be prolonged and often extended into adulthood. The messages from the data support a view that the diverse and extended nature of this initial period was due to the limited support this group of participants received from the low vision specialists they consulted with. A significant impression of frustration and disillusionment was experienced by participants on not receiving information and guidance from these health care providers. Various mechanisms of support and control positively influenced patients' learning how to cope and survive their journey with visual impairment. Coping, learning what their condition is, what the causes are and the risks involved for future generations, empowered the participants in this study to obtain a view of a future for themselves and to make relevant decisions and choices necessary to realise the way ahead. Taken together though, continued education was deemed worthwhile.

The unexpected and sudden death of an infant (SUDI) is a traumatic event. SUDI is defined as all deaths occurring suddenly and unexpectedly in infants under the age of one year. Molecular autopsy is used to determine the potential genetic contribution to SUDI and may lead to screening and interventions of at-risk family members. However, the potential of this may only be realised if the family members are willing to engage in the follow-up process. Next-of-kin experiences of participating in molecular autopsy research are unknown, and not previously done in South Africa. This study explored the experiences and perceptions of bereaved next-of-kin participating in forensic genetic research on SUDI at Salt River Mortuary, Cape Town. Methods Eleven participants, including the mothers and other family members for six SUDI cases participated in the study. These participants were recruited from a larger forensic molecular autopsy study conducted at the University of Cape Town. In order to explore the experiences and perceptions of next-of-kin, a qualitative approach was used and semi structured interviews were conducted. The interviews, transcribed verbatim, were analysed through thematic analysis. The perspective from the main researcher in the larger forensic molecular autopsy study was included to holistically explore the setting in which the genetics research took place. Results Four major themes were identified, namely (i) old wounds, (ii) my booboo, (iii) the sudden death and (iv) afterthought. Their main reasons for participating in the research were to find answers and to be of value in future cases of SUDI. Grief seemed to play a significant role in their understanding and engagement with regards to their research participation. Conclusion This study found that the grief and loss of at the time of obtaining consent may play a significant role in understanding and willingness for further engagement with molecular autopsy results. Understanding has previously been implicated in the willingness to engage with genetics results, however, it has not been explored in a mortuary setting. The understanding of genetics research is critical for further engagement that may have implications for the screening of other family members and future offspring. These findings may allow researchers to better engage with participants in genetics research on sensitive topics, including SUDI.

Breast cancer is the most common malignancy affecting females globally. Hereditary breast and ovarian cancer (HBOC) syndrome is caused by pathogenic variants in BRCA1 and BRCA2 and is seen in approximately 50% of families with a strong history of breast and ovarian cancers. Predictive testing (PT) is offered to unaffected individuals with a positive family history of HBOC, with an already identified BRCA1 or BRCA2 mutation in an affected family member. There is an overwhelming amount of research that has focused on the after-effects of diagnostic genetic testing for HBOC but there has been little investigation into how individuals experience the actual PT process. The present study therefore aimed to investigate individuals’ decisions for undergoing and their experiences of PT for HBOC in a local context, by focusing on at-risk South African individuals residing in the Western Cape Province. Sixteen participants were recruited retrospectively from the breast cancer and/or clinical genetics clinics at Groote Schuur Hospital, Tygerberg Hospital and private genetic counselling practices in Cape Town. Semi structured interviews were conducted, and the interview transcripts were analysed using the framework approach for qualitative data analysis. Using this approach, five themes were identified relating to the perspectives and experiences of individuals undergoing PT for HBOC, in selected settings in the Western Cape. While some participants felt that their decision to pursue PT was influenced by their family history of cancer and the associated cancer-related distress, others felt that their decision was made out of a sense of duty to their families or in solidarity with those that were affected or received a positive test result. Overall, the participants felt that the pre-test counselling was beneficial in allowing for an improved understanding of HBOC, however not all participants felt that the pre-test counselling prepared them for receiving their results. Receiving a negative test result was often accompanied by feelings of guilt and did not exempt participants from the fear of developing cancer. Some of the concerns raised by participants that received a positive test result were centred around prophylactic intervention and its effect on body image. Overall, participants felt empowered by their mutation status and felt that they were better able to manage their risk. The need for additional support, both practical and emotional support, was particularly evident amongst mutation-carriers. The findings of this study provide valuable insight into the perspectives and experiences of this population, which could potentially impact the services that are provided to individuals undergoing PT for HBOC in similar settings.

Preimplantation genetic diagnosis (PGD) is an alternative reproductive technology integrated with in-vitro fertilisation (IVF). It is a well-established technique offering reproductive options for families at a high risk of transmitting a genetic disorder, allowing them to avoid a termination of pregnancy (TOP). Consanguineous unions are common and encouraged in many Arab communities. This can lead to an increased risk of one or more autosomal recessive disorders that may occur within the family. Traditional prenatal testing involves testing fetal cells with the option of TOP of an affected fetus. In Arab communities where TOP is restricted under Muslim law, such testing is not acceptable. For these couples and their family members, PGD is a feasible option as the fetus is diagnosed before implantation and allows for only healthy embryos to be implanted. However, undergoing PGD is relatively new in the Arabic Muslim countries and Omani patients have only recently had access to the service. This study utilised a phenomenological approach to explore the experience of Omani families who had selected to undergo PGD as a means of reducing the risk of having a child affected with a genetic disorder. Fourteen participants from eight families who underwent PGD were interviewed. Data collected were analysed using thematic analysis. The research identified five main themes; Desire for a Healthy Child; Anxiety "Taraqub"; Unforeseen; Secrecy; Me and My Partner. The PGD experience was reported as physically and emotionally distressing. Some participants felt attached to their embryos regardless of health status, while the majority did not anticipate the loss of intimacy, autonomy and control they experienced, particularly related to the insemination process. The social and religious background of participants played a significant role in the participant's perception of PGD, which has both practical and psychosocial implications. The findings of the research have provided insight into the PGD experiences of Omani families and can be used to improve the services that are currently available to these families.