MULTICULTURAL ASPECTS OF SUPERVISION: CONSIDERATIONS FOR SOUTH AFRICAN SUPERVISORS IN THE HELPING PROFESSIONS

MULTICULTURAL ASPECTS OF SUPERVISION IN POST-APARTHEID SOUTHAFRICAClinical supervision in psychology and social work is challenged with addressing the variouscultural, social and political factors that affect therapeutic and supervisory relationships. In thecontext of present-day South Africa with its emphasis on recruiting supervisees into the helpingprofessions from diverse racial and ethnic backgrounds, questions of race, ethnicity and culture inclinical supervision have become of considerable importance. This paper examines the literaturepertinent to supervision and presents a theoretical framework for conceptualising themulticultural development of supervisors and supervisees with a specific emphasis on the SouthAfrican context. It highlights some of the potential problems that might arise in supervisoryrelationships in which the supervisor and supervisee are racially disparate and outlinesrecommendations for clinicians to consider in their practice. Most of the research on inter-racialclinical supervision has been conducted in the United States and other countries wheremulticulturalism is part of the national landscape. This article uses this international literature andapplies it to the present post-apartheid conte

Treatment adherence in South African primary health care

Patient non-adherence to medical treatment regimens is a pressing problem in South African primary health care. The absence of a cogent research base in the South African context has meant that solutions to the problem of non-adherence continue to elude clinicians. This paper offers an understanding of patient non-adherence from the perspective of behavioural science. It focuses on the way in which adherence is conceptualised and assessed, and examines the social, economic and psychological factors associated with patient behaviour. Psychological issues that are highlighted as affecting adherence include health locus of control, self-efficacy, psychological morbidity, health literacy and quality of life. Commonly used intervention strategies to enhance treatment adherence are examined and health workers are alerted to the contributions of behavioural science in understanding this aspect of patient behaviour. SA Fam Pract 2004;46(10): 26-3

Addressing psychosocial problems among persons living with HIV

The large number of persons living with HIV in Southern Africa has implications for mental health services for this population. Data have emerged in recent years showing that a substantial number of persons living with HIV also have mental health problems. Yet, the practice of routine screening for psychiatric disorders in the context of HIV care is controversial. Moreover, common mental health problems, if left undetected and untreated, may have severe consequences for adherence to antiretroviral therapy (ART), which in turn will likely lead to severe health consequences for patients. There are high costs associated with employing professional psychologists, counsellors, and social workers to provide psychosocial support to ART users. As a result, in many contexts lay counsellors and patient advocates have been employed as a less costly alternative. High standards of training of laycounsellors, as well as on-going supervision and support to patient advocates is necessary to ensure optimal outcomes/ result

Screening for HIV-related PTSD: Sensitivity and specificity of the 17-item Posttraumatic Stress Diagnostic Scale (PDS) in identifying HIV-related PTSD among a South African sample

Objectives: The identification of HIV-positive patients who exhibit criteria for Post traumatic Stress Disorder (PTSD) and related trauma symptomatology is of clinical importance in the maintenance of their overall wellbeing. This study assessed the sensitivity and specificity of the 17-item Post traumatic Stress Diagnostic Scale (PDS), a self-report instrument, in the detection of HIVrelated PTSD. An adapted version of the PTSD module of the Composite International Diagnostic Interview (CIDI) served as the gold standard. Method: 85 HIV-positive patients diagnosed with HIV within the year preceding data collection were recruited by means of convenience sampling from three HIV clinics within primary health care facilities in the Boland region of South Africa. Results: A significant association was found between the 17-item PDS and the adapted PTSD module of the CIDI. A ROC curve analysis indicated that the 17-item PDS correctly discriminated between PTSD caseness and non-caseness 74.9% of the time. Moreover, a PDS cut-off point of ≥ 15 yielded adequate sensitivity (68%) and 1-specificity (65%). The 17-item PDS demonstrated a PPV of 76.0% and a NPV of 56.7%. Conclusion: The 17-item PDS can be used as a brief screening measure for the detection of HIV-related PTSD among HIV-positive patients in South Africa.Key Words: ROC analysis; Posttraumatic Stress Diagnostic Scale (PDS); Composite International Diagnostic Interview (CIDI); South Afric

Dietary and fluid adherence among haemodialysis patients attending public sector hospitals in the Western Cape

Objective There has been considerable debate about the extent to which social cognitive models of health behaviour apply in developing countries. The purpose of this paper was to determine the applicability of the Theory of Planned Behaviour (TPB) in predicting dietary and fluid adherence among a sample of haemodialysis patients attending public sector hospitals in the Western Cape. Design and methods A sample of 62 historically disadvantaged patients undergoing haemodialysis completed a battery of psychometric instruments measuring attitudes, subjective norms, perceived behavioural control regarding dietary and fluid adherence, health literacy, perceived social support, and self-reported dietary and fluid adherence. Interdialytic weight gain (IDWG), predialytic serum potassium levels, and predialytic serum phosphate levels served as biochemical indicators of dietary and fluid adherence. Results Regression analyses indicated that the linear combination of attitudes and perceived behavioural control significantly accounted for 15.5% of the variance in self-reported adherence (a medium-effect size) and 11.4% of the variance in IDWG (a modest-effect size). No significant predictors were identified for predialytic serum potassium and predialytic serum phosphate levels. Interpretation and conclusions The results indicate that, while the TPB may not function in the same manner as it does in Western samples, it may have some nuanced applicability among haemodialysis patients attending public sector hospitals in the Western Cape. SAJCN Vol. 21 (2) 2008: pp. 7-1

The perspectives of users of antiretroviral therapy on structural barriers to adherence in South Africa

Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet, suboptimal adherence to ART and retention in care of patients still persists and, by many accounts, is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa.Method: In this qualitative study, semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa.Results: The results of the interviews were categorised according to poverty-related, institution-related and social barriers to clinic attendance and pill-taking, which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work, transport expenses, long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity, stigma and discrimination.Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors, such as a healthcare-enabling environment, might play an important role in influencing healthcare-promoting behaviour among patients

COGNITIVE BEHAVIOURAL THERAPY IN SOUTH AFRICA: COUNSELLORS' EXPERIECES FOLLOWING A TRAINING PROGRAMME

Many South African communities experience high level of violence and other phenomena that potentially provoke symptoms of traumatic stress among residents. Cognitive behaviour therapy (CBT) has been demonstrated to be an effective psychological intervention to ameliorate symptom of trauma, but is seldom practised in South African community mental health settings. In order to determine the barriers to implementing CBT. 12 credentialed community counsellors participated in a two-day training workshop focused on CBT.  Counsellor were asked to implement CBT with their clients who presented with ymptom of PTSD. The counsellors were then asked to complete a questionnaire six-months after the training workshop in order to identify the barriers they experienced in implementing the treatment model. The chief barriers that counsellors identified included high workload and limited time, unsuitable clients, client drop out, and an inappropriate match between the counsellor's theoretical paradigm and the CBT model. These result are considered in the context of community mental health care in post-apartheid South Africa

HIV as an index stressor for PTSD: challenges and pitfalls in applying DSM criteria

Guest Editoria

Understanding the experience and manifestation of depression in people living with HIV/AIDS in South Africa

Understanding the experience of depression in people living with HIV/AIDS (PLWH) could aid in the detection and treatment of the disorder. Yet, there is limited knowledge of the subjective experience of depression amongst PLWH in low- and middle-income countries despite high rates of this disorder in this population. In the current study, semi-structured interviews were conducted with depressed adults living with HIV attending a primary infectious disease clinic in South Africa. Interview transcripts were thematically analyzed. The construct of depression was consistent with DSM-IV criteria; however, the symptom presentation was distinctive. Somatic symptoms were most prominent in participants' initial presentations because participants perceived them as medically relevant. Affective, cognitive, and behavioral symptoms were not readily reported as participants did not perceive these symptoms as pertinent to their medical treatment. We identified several idioms of distress that could assist in screening for depression in this population. A valid, contextually developed screener for depression in PLWH awaits further investigation. Such a measure could play a key role in formulating a logistically feasible method of detection and treatment for depression in this population

Subjective Well-being of Primary Health Care Patients in the Western Cape, South Africa

Background: Patients living with a chronic illness face many challenges in their lives such as an altered body image, physical pain or discomfort, the need for frequent medical visits and the negative side effects of treatment. To this extent their sense of personal or subjective well-being may be compromised by the severity and chronicity of their illness. The aim of the present study was to explore the level of subjective well-being and its relationship with coping, quality of life and support from family and friends among a sample of Black South Africans attending semi-rural public clinics for treatment for hypertension and diabetes. This study was part of a larger project on treatment adherence to medication among patients living with these conditions. Methods: A convenience sample of 117 patients aged between 22 and 82 years (M=52.36, SD=13.24), receiving treatment for hypertension (n=79) or diabetes (n=24) at three primary health care clinics in the Boland area of the Western Cape were asked to participate in this study. Of the total sample, 14 (12%) were diagnosed with both conditions. Participants were asked to complete a questionnaire battery consisting of the Satisfaction with Life Scale, the Coping Strategy Indicator, the Functioning Assessment of Non-Life Threatening Conditions and the Perceived Social Support Scale. Results: The mean score of the Satisfaction with Life Scale was 28.70, which was significantly higher than those of other studies using this mea-sure. In order to address the problem of experiment-wise error, commonly associated with the use of multiple statistical comparisons, we used the Bonferronni correction in arriving at probability levels in determining statistical significance. On average the sample as a whole appeared to be largely satisfied. The mean scores on the two of the subscales of the Coping Strategy Indicator were significantly different from those obtained from other South African samples. On the Functioning Assessment of Non-Life Threatening Conditions, the mean scores on the subscales but not the total score was significantly higher than other South African samples. Conclusions: In general, participants scored significantly higher on all of the measuring instruments compared with other South African samples, indicating high levels of life satisfaction, coping, and support from others. We found no relationship between life satisfaction and gender. Age however correlated positively with satisfaction with Life, Support from family, social and emotional well being and Quality of Life, which concurs with the findings of previous studies. Contrary to other studies we found a significant negative correlation between education and SWLS but no relationship between employment and SWLS. Our sample also reported higher levels of support from friends and family that were significantly higher than those of other South African samples. The mean scores on all the subscales of the Coping Strategy Indicator were higher than that of other South African samples. South African Family Practice Vol. 50 (3) 2008: pp. 68-68