Perceptions and reflections of primary healthcare professionals on mental health services in Makhanda
- Authors: Piliso, Zandisiwe
- Date: 2025-04-25
- Subjects: Primary care (Medicine) , Mental health services South Africa Makhanda , Medical personnel , Ecological Systems Theory , Mental health personnel South Africa Makhanda
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/478344 , vital:78179
- Description: Primary mental healthcare in South Africa is still in its early stages, despite policies that have been developed, such as the National Mental Health Framework Policy. Provinces such as the Eastern Cape are far behind development, which can be attributed to limited resources. The scarcity has been noted in the literature, but not extensively. Literature concentrated on healthcare professionals’ perspectives towards primary health greatly narrow, particularly in the Makhanda area. With the integration of primary mental health services, healthcare workers’ viewpoints have impacted on service delivery. This study aims to add knowledge and explore the perspectives of healthcare professionals on primary mental healthcare in Makhanda. The ecological systems theory was used as a theoretical framework for the study. Thematic analysis was used to examine the healthcare professionals’ insights and to extract meaning for the participants involved in the study. Thirteen participants were used, using purposive sampling in four primary healthcare settings. Data were collected using semi-structured and one-on-one interviews. The study revealed three themes including, (i) Scarcity of Mental Health Services, (ii) Mental Health Literacy, (iii) Barriers to the Provision and Use of Physical and Mental Health Services. The findings suggest that there are limited mental health care services in primary care and that there is a gap between service provision and physical and mental healthcare. The data also revealed that mental health literacy is limited, which links to the stigma around mental illness. Furthermore, evidence points out that more mental health education, human resources and training of healthcare professionals would further improve the mental health services in the Makhanda area. In addition, there are barriers to the provision of not only primary mental health care but healthcare, as well as a lack of medical equipment, human resources, and structural space that make it difficult for healthcare professionals to perform their jobs and affect clinic functioning, at times. Another barrier is that the perception of mental health service provision is simultaneously viewed in a positive and negative light and mainly received negatively by service users. In conclusion, healthcare professionals experience a deficiency of resources and a limited provision of mental healthcare, which highlights the lack of implementation of policies that have developed nationally and globally. , Thesis (MA) -- Faculty of Humanities, Psychology, 2025
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Examining the direct and indirect effect that individual and contextual risk factors have in predicting substance abuse
- Authors: Fouten, Elron Steve
- Date: 2024-10-11
- Subjects: Structural equation modeling , Substance abuse South Africa , Ecological Systems Theory , Path analysis (Statistics) , Personality , Confirmatory factor analysis
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/467006 , vital:76806 , DOI https://doi.org/10.21504/10962/467006
- Description: Substance abuse levels in South Africa have continued to rise, with the age of first experimentation with drugs reported as being 10 years. Several studies have shown that substance abuse has an adverse impact on users, their families and their communities, resulting in a number of social, psychological and economic struggles. Moreover, substance abuse places an increased psychological, social and financial burden on the individual and the family, as it has been related to the destabilisation of the nuclear and extended family units, permeating every area of life and affecting the very social fabric of society. This study therefore endeavoured to determine which of the individual and contextual risk factors measured by the South African Substance Use Contextual Risk Instrument (SASUCRI) best predicts substance abuse in a sample of self-identified substance abusers. Additionally, the study sought to determine the magnitude, strength and direction of the interaction of the individual and contextual risk factors in predicting substance abuse. The specific aims of the study were: 1) to build a theoretical model that best approximates the identified and measured individual and contextual factors associated with substance abuse, 2) to use structural equation modelling (SEM) to test the adequacy of the model’s fit to the data that have been collected, 3) to use SEM to statistically determine which of the perceived individual or contextual factors best predict substance abuse, and 4) to use SEM to statistically determine which combination of perceived individual and contextual factors best predict substance abuse. To achieve these aims, the study applied SEM to data collected from individuals seeking either inpatient or outpatient treatment for substance abuse in the Eastern Cape and Western Cape Provinces of South Africa, respectively. The purpose of SEM is to a priori specify a theoretical causal model consisting of a set of predicted covariances between variables, and then test whether it is plausible when compared to the observed data. The appropriateness of performing SEM exists in its ability and suitability to examine the nature and magnitude of postulated dependence relationships, while simultaneously assessing the direct and indirect relations of the variables. The theoretical causal model that was tested contained latent and manifest variables that were identified as risk factors for substance abuse. The causal model was informed by Bronfenbrenner’s (1977a, 1986) ecological systems theory (EST) and was specified to approximate the different systems of the theory. Data for the study were collected using the relatively newly developed and validated SASUCRI. The results of the confirmatory factor analysis (CFA) showed that the SASUCRI was a reliable and valid instrument to use with this population, and that the results of the structural model can be interpreted with confidence. The fit statistics, for the normal theory and related bootstrap latent path SEM, all indicate that the model is an excellent fit to the data CMIN/DF = 2.82, NFI = .946, CFI = .97, RMSEA = .04., thus achieving the study’s objective. The normal theory analysis of the paths in the diagram identified the microsystem, “Access/proximity to drugs” (APTD) and “Concerns for future” (CFF) as significant predictors of substance abuse, whereas the bootstrap analysis of the paths identified the macrosystem, APTD and CFF as significant predictors of substance abuse. This study identified 10 risk profiles that interact in the prediction of substance abuse; these are: individuals with low self-efficacy (SE) who perceive their family as lacking or having low intra-family communication, who lack positive peer support, who perceive criminal behaviours as normal, who feel a strong need to fit in, who are less religious, who have easy access to drugs, who lack a sense of community traditions and belonging, who see public displays of substance use (SU) as normal, and who lack concern for the future, are at 59% greater risk of substance abuse. Though micro level factors (low SE, lack of or low intra-family communication, and a lack of positive peer support) and meso-level factors (normalisation of criminal activity, a strong need to fit in, and being less religious) does not significantly predict abuse, they significantly interact with external factors in predicting substance abuse. Thus, it is only when they interact with factors located in the other systems (exosystem, macrosystem and chronosystem) that they become significant predictors of substance abuse. Conversely, exosystem (easy access to drugs), macrosystem (lack of a sense of community traditions and belonging, commonplace public displays of SU), and chronosystem factors (lack of concern for the future), independently are significant predictors of substance abuse. These findings carry significant public health implications by challenging the prevailing focus on individual-based interventions. Recognising that the drivers of substance abuse extend beyond individual factors, this study therefore advocates for interventions that address the broader systems contributing to the issue. This has the potential to inform more effective and holistic public health strategies. Finally, this study emphasises the need for comprehensive strategies that span different systems, acknowledging the role of family, community and societal factors. This call for complex interventions aligns with the ecological systems perspective, advocating for a paradigm shift in how we address SU by considering the broader environmental influences that contribute to the problem. In summary, this study not only contributes to the academic understanding of SU, but also has practical implications for public health policies and interventions. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2024
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Template ecological analsyis of the narratives of partner’s and family member’s of women who consumed alcohol in pregnancy
- Authors: Tsetse, Agrinette Nontozamo
- Date: 2019
- Subjects: Pregnant women -- Alcohol use -- Social aspects , Substance abuse in pregnancy , Fetus -- Effect of drugs on , Pregnancy -- Psychological aspects , Pregnant women -- Substance use , Substance abuse -- Social aspects , Ecological Systems Theory
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10962/114905 , vital:34055
- Description: Although there is increasing research on alcohol in South Africa, most of this work has an epidemiological focus. Very little research has explored alcohol use during pregnancy specifically from the perspective of the woman’s partner or family member or focused on contextual risk factors beyond the pregnant woman. This information is important to ensure that interventions are formulated based on the social contexts within which drinking in pregnancy takes place and in guiding interventions that aim to prevent prenatal alcohol use, thereby preventing the occurrence of FASDs. This study was guided by Bronfenbrenner’s Ecological Systems Theory to understand partners’ and family members’ perspectives of prenatal exposure within the actual environments in which alcohol use takes place. According to this theory, an individual exists within layers of social relationships: the family, intimate partners, friendships, and healthcare workers (microsystems), interactions among these microsystems, for example, interaction between healthcare workers and intimate partner and family and social workers (mesosystem), accessibility of alcohol in the neighbourhoods (exosystems), religion, culture and society (macro-systems) and changes of the individual and socio-historical context (chronosystem). The data were collected using a biographic narrative interpretive method of interviewing. Thirteen narratives interviews were conducted with partners and family members in a disadvantaged community in Buffalo City, Eastern Cape Province. The interviews were analysed using Template Analysis within the Ecological Systems Theory to interrogate the stories of partners and family members. According to participants, some of the reasons women consumed alcohol in pregnancy are: drinking habits before pregnancy that were difficult to break in pregnancy; women drank during the first trimester of their pregnancy because of unplanned pregnancy; women continued drinking throughout their pregnancies to cope with the emotional upset caused by the trauma of rape and losing loved ones, stress, receiving HIV-diagnosis in pregnancy, intimate partner violence, infidelity, rejection and denial of pregnancy from partners. After birth, some women continued drinking. Consequently, their children were taken away from them by social workers and family members because the parents were unable to care for the child due to alcohol use. There was lack of compliance of shebeens with liquor regulations, heavy drinking, high rates of alcohol use in pregnancy, and easy accessibility of alcohol within this study community. Pregnant women used religious coping beliefs to cope with their circumstances such as changes in their health, relationships and finances. Drinking during pregnancy is a complex problem that stems from multiple social and structural issues and interventions should therefore not only focus on the individual, but also on social networks and communities.
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