Generative Disruptive Questions: Operationalizing Diversity, Equity, Inclusion, Justice, and Accessibility in Occupational Therapy Education

Diversity, equity, and inclusion is one of five pillars upholding the American Occupational Therapy Association’s (AOTA) strategic plan. Ensuring organizational, educational and governance structures, policies, programs, and services all reflect diversity, equity, inclusion, justice and accessibility (DEIJA) is a priority for the profession. Yet, addressing DEIJA remains a significant challenge in the occupational therapy academic community. Educational programs are a gateway to the profession and play a critical role in whether minoritized persons feel they belong in occupational therapy. This paper proposes a set of Generative Disruptive Questions (GDQ) that can be used to critically examine practices within education that reflect commitment and action towards DEIJA and to facilitate focused conversations that accelerate the creation of measurable, action steps that ensure DEIJA practices are effectively addressed within occupational therapy educational programs. These questions are intended to foster authentic reflection and brave discussions that will dismantle processes and practices that perpetuate systemic injustices. These conversation starters could help faculty, staff and learners engage in courageous conversations that may, at times, be challenging, but which can lead to transformative changes. The questions promote reflective analysis of DEIJA in multiple aspects of the educational process from examination of vision and mission and DEIJA processes and practices in the broad institutional context to more focused analysis of the culture, climate, recruitment, retention, and teaching practices

A Pipeline Program to Address the South African Crisis in Human Resources for Health

Background: The WHO Africa Region faces a shortage of health workers due to inadequate production of health workers and emigration of physicians and nurses to wealthier countries. South Africa and the United States share a history of discriminatory policies and practices resulting in groups that are under-represented amongst health professionals. One US response is the Area Health Education Centers Program (AHEC), a pipeline program to recruit members of under-represented groups into the health professions. Objectives: (1) Compare and contrast the United States’ AHEC model with that developed in South Africa by Stellenbosch University Faculty of Medicine and Health Sciences SA AHEC in partnership with Morehouse School of Medicine in the United States. (2) Describe a formative evaluation of the Stellenbosch AHEC Program. Methods: Four hundred students (grades 7–12) and 150 teachers participated in SA AHEC with the goal of preparing the students to better compete for university admission. Students received after-school tutoring, holiday schools, and counselling on study skills, health careers, and university entry. Educators received continuing professional education, classroom observation, and feedback. The program was evaluated through a series of interviews and focus groups involving AHEC staff, educators, and parents and caregivers. Results: Program strengths included educator training, collaboration, and increased student maturity, motivation, and academic success. Challenges included limited time with students, the location of some sites, and the educators’ need for more engagement with AHEC staff and schools. Quarterly workshops were conducted to address challenges. Over 50% of program alumni are currently enrolled in institutions of higher education. Students will be tracked to determine whether they are able to complete their health professions studies and return to the communities where they grew up, or to similar communities. Conclusions: With appropriate adaptation and attention to context, it might be possible to implement similar programmes in other African countries. The comparison of the United States and South African models suggested that more parent and teacher participation in an advisory capacity might help to avoid some challenges

The experience of being an occupational therapy student with an underrepresented ethnic and cultural background

Bibliography: leaves 91-96

Predictors of success for African black physiotherapy students in South Africa

Ph.D. Faculty of Health Sciences, University of the Witwatersrand, 2008The research reported in this thesis investigated factors that predict academic success of African black physiotherapy students. The first part of the literature review focused on higher education and access into higher education. It refers to the National Plan on Higher Education and the international debate around widening access. Significance within the international literature is that while there has been rapid expansion in higher education numbers there has not been a parallel increase in participation by underrepresented groups. Most of the literature found on predictors of success indicates that high school performance and aptitude tests are predictors of success. It also indicates that the predictive strength of these variables reduces when race is taken into consideration and in physiotherapy it reduces in the clinical years of study. Non-cognitive variables have also been found to predict success. Although many quantitative studies on prediction of academic success have been performed, it was noted in the literature analysis that there is minimal investigation of predictors of success that have been done in the physiotherapy profession. No recent studies were found that pertain to physiotherapy specifically, and the few studies available were found not to have taken race differences into consideration. Throughout South Africa universities that have physiotherapy programmes admit students on the basis of their high school performance. Some of them use other criteria such as involvement in sports, leadership qualities and community involvement. Moreover, most African black students do not have the opportunity to fulfill these criteria and therefore other factors that may predict academic success were investigated. One hundred and twenty eight graduates (66 black and 62 white) who graduated between 2000 – 2005 from eight universities and six Heads of Physiotherapy Departments participated in the research. For the purposes of this study, graduates who completed the degree in four years or four and a half years were defined as successful and those that completed in five years and above were defined as unsuccessful. The graduates responded to a questionnaire which had two sections: Section A had closed ended questions and Section B had open ended questions. Face-to-face, in-depth interviews were conducted with Heads of Departments using semistructured interview schedule. The data were subjected first to simple descriptive statistical analysis. These analyses revealed that 59% of blacks were successful compared to 90% of whites and that there were more successful females than males. The average time taken to complete physiotherapy degree is 5 years for blacks and 4 years for white; black students were less likely to succeed in physiotherapy programmes. Frequency analysis was done using Chi square test and the results showed an association between race and success (X2 = 16.29; p < 0.01). Logistic regression was done and the results revealed that high school performance was not a predictor of success for black students and that sharing a residence room (OR = 3.09; p = 0.05), obtaining information about university support systems from classmates (OR = 6.25; p < 0.05), feeling part of the group of classmates (OR = 3.23; p < 0.05) and choosing physiotherapy as the first choice of career (OR = .33; p < 0.05) were predictors of success of black physiotherapy students. These results indicate that a supportive learning environment is conducive for black students’ academic success Responses to the open ended questions were collated for each question and then analysed using content analysis as described by Mayan (2002). Themes that emerged with regards to student success indicate that according to the respondents, a student who is determined to succeed and become a physiotherapist, who has the support they need (particularly finance and family), and favourable learning environment will be successful in their studies. Themes that emerged regarding factors that are barriers to students’ academic success were: lack of academic discipline, academic problems, psychosocial difficulties, poor learning environment. A question was raised regarding reasons of students leaving the physiotherapy programme before completion. The responses represent secondary data because it was difficult to locate students who had left physiotherapy programmes. The most cited reasons were multiple failures resulting in academic exclusion, and decision to change career. The interviews with the Heads of Department were transcribed verbatim. These transcripts were then subjected to data-reducing procedures described by Tesch (1990). Firstly the analysis confirmed that black students take an average of 5 years to complete the degree and that the failure occurred mainly in first two years of study. The analysis also revealed that there were few (2 – 10) black students admitted into physiotherapy each year particularly at the Historically White Universities although there were additional criteria that sought to widen access for black students. Secondly, themes that emerged regarding factors that are perceived to contribute to students’ academic success indicated that a successful student is a student who has adequate knowledge about the physiotherapy profession, has academic discipline, has all the relevant support needed and is integrated well with classmates. On the other hand, a student who is inadequately prepared for higher education, has poor proficiency of language of instruction, lacks financial support and has difficult social circumstances, will not be successful in his or her studies. The HODs indicated that there are support systems put in place within their departments and the university at large. The support is academic, financial and psychosocial. vi The results of this study have shown that black students are less likely to be successful than white students, and that average time taken to complete the degree is 5 years. According to Graves (2008), in America the gap between black and white graduation rates still exists and it has been found that many colleges and universities graduate black students at significantly lower rates than white students. The immediate reaction to this result in the South African context would be that the reason for this outcome is that most black students are admitted with lower high school performance. The results in this study did indeed show that the distribution of aggregate and per-subject marks was lower for black respondents than for white respondents, and that at these lower ranges there were equal chances of success and failure. In other words, in dealing with black physiotherapy students, one must look beyond the matric results to identify factors that predict success. Uncertainty about the validity of matric as a predictor of further performance has long existed for low-scoring, disadvantaged students from the previous Department of Education and Training’s, black only educational systems. The rapidly changing South African situation complicates the use and evaluation of the use of matric results for selection. A supportive learning environment has proved to be important for success of African black physiotherapy students

Access to higher education in the health sciences : a policy implementation analysis.

Doctor of Philosophy in Nursing.Access to health sciences education in South Africa is a challenging and contested area of higher education seeped in politics and history within a context of transformation. There are a large number of students wanting to study health science courses but there are limited places. The first democratically elected government in South Africa issued White Paper 3: A Programme for the Transformation of Higher Education with a vision of transforming the higher education system to one that was more representative of the country`s demographic profile. However in the absence of any guidelines for the implementation of this White Paper 3, higher education in many instances has not been transformed as the government envisaged. The aim of this study was to identify the factors affecting access to health sciences education at universities in South Africa and to develop guidelines to broaden access for social redress. This study was conducted within a pragmatic paradigm using a mixed methods sequential exploratory design in the complementarity genre. Universities offering traditional health science courses` including medicine were included in the study. The research consisted of 3 Phases – Phase 1 reviewed existing policies and practices through the review of relevant documents; Phase 2 assessed existing practices through one-on-one interviews and Policy Delphi and Phase 3 developed policy implementation guidelines and two policy briefs to broaden access using the information gathered from the literature reviewed and data collected from stakeholders. The Policy Delphi questionnaire was developed following the analysis of qualitative data collected in Phase 2 and the instrument was subjected to 2 cycles of item content validity index (I-CVI). The results indicated that achieving equity of access is multi-factorial and has diverse and complex challenges. Some of these challenges are ingrained in South Africa`s apartheid history, some are rooted in the process of access and some in the mind-set of the actors involved in access. The research identified eight categories, promotion of health science disciplines; challenges to transformation; competitiveness; health sciences sets the “bar”; alternative access; reason for choosing a health sciences profession; innovation in teaching and learning and retention and throughput rates which were related to access to health sciences education in universities. The data indicated that the student demographic has changed substantially in Health Science programmes but more could be done. Faculties of Health Sciences need to implement some strategies to reach out to the eligible students in rural and remote areas. Student success in Health science courses is relatively good as would be expected as the selection and admission criteria, is generally higher. Health Sciences at many of the universities are committed to the imperative of transformation for social redress but there are others who are caught between facilitating transformation and overwhelming demand for their programmes. Guidelines for the Implementation of the Access Policy in Health Sciences Education and the Access for Success in Health Sciences Education in Universities Policy briefs were informed by the results. Universities have implemented a number of initiatives to address the past injustice in higher education access however the issue of enabling access for those who are socio-economically disadvantaged is very much more complex and challenging to address. Transformation of health sciences education in universities is essential to the transformation of the health service to reflect a health service that is accessible, available, affordable and agreeable, something that every South African citizen

The University as a social system: Niklas Luhmann on the problem of self-descriptions

Includes abstract.Includes bibliographical references.This examination is undertaken to investigate whether the self-description provided by the University of Cape Town (UCT) regarding its race-based affirmative action in admissions is responsible for the heated debate that it continues to elicit. It begins with a close examination of Luhmann's "Social Systems" which is used to conceptualize the university itself as a social system

The effect of a teacher-based intervention programme for primary schools on learner's health-related quality of life, body mass index and physical fitness: a randomised control trial

Background: Childhood obesity, a rising problem world-wide and within South Africa, has been negatively linked with both physical fitness (PF) and health-related quality of life (HRQoL). The school environment is the ideal setting for children to obtain the skills and knowledge to increase physical activity (PA) levels and healthy diets. PA and school-based nutrition intervention programmes have been shown to have positive effects on diet and PA behaviours in children. However, there is minimal literature reporting on the effectiveness of school-based interventions in a South African setting. Aim: The primary aim of the first phase of the study was to provide a contextual background regarding the provision of PA in school-based PE programmes within a small sample of schools from which the learners in the intervention study were drawn. The primary aim of the second phase of the study was to determine the effect of a teacher-based intervention programme after six weeks for primary schools with less than the mandated amount or no specific amount of PE on learner's HRQoL, Body Mass Index (BMI) and PF. Methodology: Ten schools were randomly selected from the circuit lists within the Port Elizabeth Education District. Ten staff members from the selected schools completed the School Environment Questionnaire in order to provide a situational analysis regarding the provision of PA in school-based PE programmes. A sample of 300 learners (aged nine to eleven) from four randomly selected schools participated in the pre-testing measures in order to establish the weight status (using BMI and waist circumference (WC)), HRQoL (using the EQ-5D-Y), and PF (using the Eurofit test battery). Class teachers, from schools with less than the mandated amount of PE or no specific amount of PE, who were part of the experimental group, implemented the intervention. In order to implement the intervention, they received training and were given a PE programme booklet. The PE intervention programme was in line with the Curriculum and Assessment Policy Statement teaching plan for life skills, and was based on targeting the deficiencies found in the pre-testing fitness measurements. Post-testing measures, using the same learners, were conducted six weeks later. The obtained results were analysed using STATISTICA version 12. Results: Phase one of the study revealed that PE was provided at all schools. The curriculum was followed by 90% of schools, but only 30% had teachers with PE qualifications. PE policies and practices were being developed and/or implemented in 70% of schools, and 50% had no specific amount of time mandated to PE, or less than the mandated amount. Soccer was offered at all schools, and 80% of schools had access to an outdoor sports field and an outdoor paved area. Phase two of the study found that the control and experimental groups were not equivalent at baseline with regard to gender distribution, BMI Z-scores and interpretations, the EQ-5D-Y "looking after myself" variable, and the sit-up test. No positive significant differences were noted in BMI Z-scores, WC, HRQoL, or PF components in the experimental group after the six-week intervention. Discussion: The average duration of PE at 70% of the participating schools was longer than the national average, despite half of the schools not implementing the mandated amount of PE. Gaps in the curriculum content and unqualified PE teachers may have prevented learners from developing the necessary skills associated with PE, including the various components of PF. The six-week teacher-based intervention was found to be ineffective. Similar results were seen in other South African studies. Insignificant intervention findings may be the result of poor intervention implementation or compliance, time constraints experienced by participating teachers, and the short six-week duration of the intervention. Teachers mainly commented on the enjoyment of the intervention programme by the learners. Conclusion: This study concludes that the effects of the six week teacher-based intervention, on primary school learners' HRQoL, BMI, and PF, was insignificant. Nevertheless, all schools provided PE, despite half of the schools not implementing the amount mandated. This study provides a platform for future studies in the attempt to reduce the occurrence of obesity in school children; thereby reducing its increasing national burden on health and the economy

Characteristics of students receiving mental health services at the university of Cape Town

Bibliography: leaves 689-729.The objective of the study is to describe students presenting at the UCT-SHS-MHS; (li) to compare students presenting at the UCT-SHS-MHS with students presenting at the UCT-SHS who do NOT present at the UCT-SHS-MHS (controls); (iii) to compare students presenting at the UCT-SHS-MHS with all other students attending the University of Cape Town, and (iv) to examine the association between the number of consultations at the UCT -SHS-MHS. They are described in terms of selected demographic, academic, residential (home address), financial assistance and, where appropriate, clinical (diagnostic) variables: The study, which utilised official University of Cape Town student records, was descriptive in nature for Objective 1 and analytic in nature for Objective 2 (case-control study), Objective 3 (cross-sectional study) and Objective 4. 932 patients, 1 924 matched controls and 23 158 registered students. (i) Objective 1 (attendees) - minority groups such as Blacks (Africans, Coloureds and Indians), non-traditionally aged students, non-English first language speaking students, outof-town students and socio-economically disadvantaged students form a sizeable proportion of UCT-SHS-MHS attendees; (li) Objective 2 (patients versus controls) - non-minority groups such as English first language speaking students (rather than the minority groups reported in Objective I) utilise the UCT -SHS-MHS significantly more than the UCT -SHS; (iii) Objective 3 (patients versus the total student community) - minority groups such as Blacks (Africans, Coloureds and Indians), non-English first language speaking students, outof-town students and socio-economically disadvantaged students are significantly overrepresented amongst UCT-SHS-MHS attendees, and (iv) Objective 4 (number of consultations) - non-minority groups such as White students (rather than the minority groups reported in Objective 3) are responsible for the highest mean number of consultations at the UCT -SHS-MHS. (i) Objective 1 (attendees) - these results are largely related to the composition of the total student community although notable exceptions include female students, first year students and students whose home address is outside metropolitan Cape Town; (ii) Objective 2 (patients versus controls) - male students, non-English first language speaking students, nonArts, Music and Social Science and Humanities faculty students and students residing outside metropolitan Cape Town are either particularly unaware or extremely unsure of the potential benefits to be derived from the psychotherapeutic process; (iii) Objective 3 (patients versus the total student community) - the usage/utilisation rate is largely related to either background cultural and socio-e.conomic factors or academic-related concerns that affect students (e.g. race/population group, language and financial assistance can be closely interlinked and may relate to the set of adverse family and financial circumstances that could promote the development of mental disorders), and (iv) Objective 4 (number of consultations) - these results are largely related to the initial severity of the psychopathology, the level of resistance encountered by the student to the psychotherapeutic process employed, the need of the student for positive reinforcement from the therapist, and the range ofdependency issues affecting the student

On being a rural origin health care professional: lives, learnings and practice.

Doctor of Philosophy in Education. University of KwaZulu-Natal, Durban 2016.Rural origin health care professionals (HCPs) have been identified as those who are most likely to work in rural areas after graduation. However, there are significant challenges of access, selection and throughput for South African rural students wanting to train as HCPs. Many studies have focused on strategies for staffing rural healthcare facilities. However a life history approach has not previously been used to study the educational experiences of rural origin HCPs in South Africa, and there is a paucity of data about the lived personal and professional educational experiences of rural origin HCPs and their experiences of returning to work in rural areas after graduation. A deeper understanding of these issues using a life history approach may help in supporting rural origin students and contribute to improved staffing levels at rural healthcare institutions. Social identity theory and a generative understanding of rurality provided the theoretical framing for this study. A life history approach complemented by arts-based methods generated stories through which to gain an understanding of the complex, multidimensional, multi-layered lives of HCPs who grew up in rural areas, their personal lives in relation to others, and the context in which they grew up (time, person and place). Their developing identity is seen in their performances through the choices they make in response to everyday situations. Their learning experiences are complex and reveal that as active and critical thinkers they adopted a range of strategies to succeed at institutions of higher learning, and found platforms and communities to develop as those with knowledge and agency to change/challenge dominant and stereotypical ways of being. They demonstrate their willingness and ability to work in rural contexts, leading transformation in the healthcare setting. The findings of this study point to a new understanding of rurality – that of home and a sense of belonging where the possibility for better healthcare services exists. A junctional hub is presented as a theoretical ‘model’ to frame lived experiences and to understand rural origin HCPs’ personal and professional identity and work in a complex, interconnected, negotiated space where different forces are negotiated. This provides a platform to open up the opportunity for other ways of being, knowing and practising

Reconceptualising Health Professions Education in South Africa

Cite: Academy of Science of South Africa (ASSAf), (2018). Reconceptualising Health Professions Education in South Africa. [Online] Available at: DOI http://dx.doi.org/10.17159/assaf.2018/0021This consensus study was initiated by ASSAf as a response to the ongoing challenge of shortages of healthcare professionals. The study was conceptualised following an ASSAf workshop on the Lancet report titled Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The study aims to address the full value chain in health sciences education from student selection, through pedagogical developments, unpacking of the current bottlenecks in the system and looking at how the future health sciences education system can be financed and regulated. Objectives of the study are to provide evidence-based information and recommendations to policymakers and relevant stakeholders on how health professional education might be transformed to improve the health of the nation. This includes the various professions in health. Some of the key findings of the study include: barriers in student section; inadequate production and retention of skilled health professionals; urban-rural maldistribution of graduates; core competencies’ challenges; internship and community-service obligations and transition; and shortcomings in financing of health sciences education. Recommendations on how to address the challenges are very practical. It is envisaged that policymakers and relevant stakeholders will implement these for the revitalisation of health professions education in order to improve health of South Africans.Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI