A mini-thesis submitted in partial fulfilment for the degree of Master’s of Arts Research Psychology in the Department of Psychology University

Masters of ArtHigh rates of substance use and its associated problems afflict Cape Town, underscoring the need for easily accessible substance abuse treatment. Despite the substantial benefits for both individuals and society at large that substance abuse treatment confers, substance abusers often first have to negotiate considerable challenges in order to access treatment and accumulate these gains. That is, experiencing barriers to accessing treatment, together with the presence of socio-demographic features, rather than “need for treatment”, decides who accesses treatment. Referrals are the gateway to inpatient substance abuse treatment in the Western Cape. While several barriers to accessing treatment have been identified by prior studies, none examine these phenomena from the point of view of the agents responsible for referring substance users for treatment. Moreover, access barriers to inpatient substance abuse services are a neglected area in extant literature. To address this gap, this study explored the perceptions of referring agents‟ of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape. This enabled the researcher to compare existing access barriers to treatment as identified by prior research, to those elucidated in the study. Bronfenbrenner‟s Process-Person-Context-Time model was employed as the basis for understanding identified barriers. In accordance with the exploratory qualitative methodological framework of the study, six semi-structured individual in-depth interviews were conducted with referring agents‟ of differing professional titles who were purposefully selected and expressed a willingness to participate in the study. Interviews were audio-recorded, and transcripts were analysed and interpreted by means of Thematic Analysis. Two broad thematic categories of access barriers were identified: Person-related barriers (denial, motivation for treatment, gender considerations, disability, active TB disease, homelessness, psychiatric co-morbidity) and Context-related barriers to treatment (cultural and linguistic barriers, stigma, community beliefs about addiction and treatment, awareness of substance abuse treatment, affordability/ financial barriers, geographic locations of treatment facilities, waiting time, lack of collaboration within the treatment system, beliefs of service providers‟, lack of facilities/ resources within the treatment system, practices at inpatient facilities, referral protocol and uninformed staff). Results suggest that by targeting the aforementioned barriers, access to inpatient and outpatient treatment services can be improved, and recommendations for interventions are offered in this regard. Ethical principles such as obtaining informed consent and ensuring confidentiality were abided by throughout the study and thereafter

A qualitative study of referring agents’ perceptions of access barriers to inpatient substance abuse treatment centres in the Western Cape

Background: Despite empirical support for the individual and public health benefits of treating substance use disorders (SUDs) , access to these services is impeded by several barriers. Although many studies on access barriers have been put forward in the literature, few have explored the barriers to accessing state-funded inpatient substance abuse treatment or the views of referral agents. Methods: A qualitative study was conducted to explore referring agents’ perceptions of the barriers to accessing state-funded inpatient substance abuse treatment centres in the Western Cape Province of South Africa. Six individual in-depth interviews were conducted and analysed using theoretical thematic analysis. Results: The key barriers to emerge from the analysis pertained to referring agents’ perceptions of the following: service users, the substance abuse referral and treatment system and community dynamics. Conclusions: Recommendations are made for interventions to address the identified barriers.Web of Scienc

Reflections on the development and utility of a participatory community violence surveillance methodology

The goal of this study was to illustrate the development and utility of a community violence surveillance methodology, as a component of a larger participatory violence prevention project in a low-income South African community. Using focus group discussions, data were collected from 12 community and academic researchpartners. These discussions were audio recorded, transcribed and then thematically analysed. The findings revealed that the participatory orientation to the research enabled researchers to develop an instrument that was appropriate for the community, collaboratively. The collaborative creation of the violence surveillance questionnaire and the use of community members to implement the system after intensive capacity building instilled a sense of ownership and promoted sustainability in this project. In addition, data generated by the surveillance system provided baseline and prevalence data which could be used to advocate for violence prevention and develop relevant interventions. This process also resulted in the provision of victim support through debriefing and referrals. Future research could focus on developing and implementing similar surveillance systems in communities and monitoring the effects thereof over time.Keywords: participatory, community, violence surveillance methodolog

Caregivers’ and interventionists’ perceptions of a child-centered home visitation intervention

Home visitation is an intervention approach for families at risk of poor child outcomes. Negative outcomes include malnutrition, the risk of unintentional injuries, and child maltreatment, to mention a few. The effectiveness, appropriateness, and feasibility of Home Visitation Programmes (HVPs) remain under-researched in middle- to low-income settings. This study constitutes one component of a formative evaluation of a child-centred home visitation intervention in a low-income South African community. The aim of the study was to explore caregivers’ and interventionists’ perceptions of the content and delivery of the intervention. To this end the study employed qualitative methods, which included seven focus groups with caregivers and interventionists. The data were thematically analysed upon which four themes emerged namely human agency, accessibility to the intervention, attributes of the intervention, and safety-health behaviour, and are presented according to the Process–Person–Context–Time model. This study contributes to the science and praxis on conducting evidence-based home visitation interventions in a resource-constrained setting

Caregivers’ and interventionists’ perceptions of a child-centered home visitation intervention

Home visitation is an intervention approach for families at risk of poor child outcomes. Negative outcomes include malnutrition, the risk of unintentional injuries, and child maltreatment, to mention a few. The effectiveness, appropriateness, and feasibility of Home Visitation Programmes (HVPs) remain under-researched in middle- to low-income settings. This study constitutes one component of a formative evaluation of a child-centred home visitation intervention in a low-income South African community. The aim of the study was to explore caregivers’ and interventionists’ perceptions of the content and delivery of the intervention. To this end the study employed qualitative methods, which included seven focus groups with caregivers and interventionists. The data were thematically analysed upon which four themes emerged namely human agency, accessibility to the intervention, attributes of the intervention, and safety-health behaviour, and are presented according to the Process–Person–Context–Time model. This study contributes to the science and praxis on conducting evidence-based home visitation interventions in a resource-constrained setting

Evaluating the Effectiveness of Complex, Multi-component, Dynamic, Community Based Injury Prevention Interventions: A Statistical Framework

Dynamic violence and injury prevention interventions located within community settings raise evaluation challenges by virtue of their complex structure, focus, and aims. They try to address many risk factors simulta neously, are often overlapped in their implementation, and their imple mentation may be phased over time. This article proposes a statistical and analytic framework for evaluating the effectiveness of multilevel, multi system, multi-component, community-driven, dynamic interventions. The proposed framework builds on meta regression methodology and recently proposed approaches for pooling results from multi-component interven tion studies. The methodology is applied to the evaluation of the effec tiveness of South African community-centered injury prevention and safety promotion interventions. The proposed framework allows for complex interventions to be disaggregated into their constituent parts in order to extract their specific effects. The potential utility of the framework is suc cessfully illustrated using contact crime data from select police stations in Johannesburg. The proposed framework and statistical guidelines proved to be useful to study the effectiveness of complex, dynamic, community-based interventions as a whole and of their components. The framework may help researchers and policy makers to adopt and study a specific methodology for evaluating the effectiveness of complex intervention programs.Institute for Social and Health Studies (ISHS

Caregivers’ and interventionists’ perceptions of a child-centered home visitation intervention

Home visitation is an intervention approach for families at risk of poor child outcomes. Negative outcomes include malnutrition, the risk of unintentional injuries, and child maltreatment, to mention a few. The effectiveness, appropriateness, and feasibility of Home Visitation Programmes (HVPs) remain under-researched in middle- to low-income settings. This study constitutes one component of a formative evaluation of a child-centred home visitation intervention in a low-income South African community. The aim of the study was to explore caregivers’ and interventionists’ perceptions of the content and delivery of the intervention. To this end the study employed qualitative methods, which included seven focus groups with caregivers and interventionists. The data were thematically analysed upon which four themes emerged namely human agency, accessibility to the intervention, attributes of the intervention, and safety-health behaviour, and are presented according to the Process–Person–Context–Time model. This study contributes to the science and praxis on conducting evidence-based home visitation interventions in a resource-constrained setting.Institute for Social and Health Studies (ISHS

The relation between subjective well‐being and career aspirations amongst a sample of adolescents in low socioeconomic status communities in Cape Town

The study aimed to determine the relation between adolescents' subjective well-being and career aspirations. The study further aimed to determine the extent to which social support mediates this relation. The sample comprised 1082 adolescents in Grades 8-11, selected from schools located in low socioeconomic status communities in Cape Town, South Africa. The overall model demonstrated a nonsignificant relation between adolescents' subjective well-being and career aspirations. Across gender, the results indicated a significant relation between subjective well-being and career aspirations for the male group, but not for females. The results further indicate that social support did not mediate the relation between adolescents' subjective well-being and career aspirations for the pooled sample. However, for females, the study found a significant negative relation between social support and aspirations. We recommend targeting interventions at an institutional level, inclusive of challenging gender roles and providing information about educational and career opportunities for young people