Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

Building contexts that support effective community responses to HIV/AIDS: a South African case study

In this paper we discuss our conceptualisation of a 'health-enabling social environment', and some of the strategies we are currently using to build social contexts most likely to support effective HIV/AIDS management in southern Africa. In developing these ideas, we draw on our on-going collaboration with residents of Entabeni, a remote rural community in South Africa where 43% of pregnant women are HIV positive. The aim of this collaboration is to facilitate contextual changes that will enable more effective community-led HIV/AIDS management in an isolated area where people have little or no access to formal health or welfare support, and where HIV/AIDS is heavily stigmatised. We give an account of the three phases of collaboration to date. These include research; the dissemination of findings and community consultation about the way forward; preliminary project activities (skills training for volunteer health workers; partnership building and a youth rally) as a way of illustrating what we believe are six key strategies for facilitating the development of 'AIDS-competent' communities: building knowledge and basic skills; creating social spaces for dialogue and critical thinking; promoting a sense of local ownership of the problem and incentives for action; emphasising community strengths and resources; mobilising existing formal and informal local networks; and building partnerships between marginalized communities and more powerful outside actors and agencies, locally, nationally and internationally. We discuss some of the triumphs and trials of this work, concluding with a discussion of the need to set realistic goals when working at the community level in highly conservative patriarchal communities to tackle problems which may be shaped by economic and political processes over which local people have little control.     

Daily life with early orphanhood from HIV/AIDS: An exploratory study

This study explored the everyday lived life by South African early adolescents orphaned by HIV/AIDS. Informants were ten early adolescents (age range 12 to 14 years; females?=?6; males?=?4) from a low socioeconomic status neighbourhood of Johannesburg. The adolescents completed autobiographical essays and in-depth individual interviews on their quality of life in the school, home, and community. Thematic analysis of the data revealed the early adolescents, orphaned due to HIV/AIDS, to experience extreme sadness, anxiety, and fear. Their sense of emotional distress was compounded by living in material and relational poverty, with frequent exposure to bullying at school, and crime in their neighbourhood. Integrated psycho-social interventions addressing both material and relational poverty might enhance the physical and psycho-social well-being of adolescents with orphanhood from HIV/AIDS.     

School adjustment of adolescents affected by HIV and AIDS: A case study

The study examined the school adjustment of South African adolescents affected by HIV and AIDS . Participants were a convenient sample of 60 adolescents from a secondary school in a major South African city (females = 73 .33%, 50% affected by HIV and AIDS, grade 8 = 40%, grade 9 = 30%, grade 10 = 30%, age range = 16–18 years) . Data on their personal functioning were gathered using the Beck Youth Inventory^TM and the Enhanced School Support Inventory (ESSI) . The data analysis comprised between-group and within-group comparisons, using the t-test statistic . Findings suggest that adolescents affected by HIV and AIDS had significantly lower psychological and behavioural functioning than their typical other peers . Results also show that these affected learners had lower school adjustment than their typical peers . The schools environment can support comprehensive interventions to addresses psychosocial vulnerability among adolescents affected by HIV and AIDS .     

Resourcing single parents in a South African community rural setting: an exploratory study

This study investigated the resource needs of single parents as child carers. Participants were a purposive sample of 40 single parents (female?=?70%, Black?=?95%, rural 80%; age range 30 to 55 years old). Data on resource needs of single parents were collected using semi-structured individual interviews. The data were thematically analyzed. The findings indicated that single parents need relationship and socio-emotional, material and time use supports to be successful in their carer roles. Resourcing single parents in their child care roles requires a holistic approach addressing both material and socio-relational support needs.     

Knowledge and causal attributions for mental disorders in HIV-positive children and adolescents: results from rural and urban Uganda

Increasing availability of antiretroviral treatment (ART) has led HIV to be considered a chronic disease, shifting attention to focus on quality of life including mental wellbeing. We investigated knowledge and causal attributions for mental disorders in HIV-positive children and adolescents in rural and urban Uganda. This qualitative study was nested in an epidemiological mental health study among HIV-positive children and adolescents aged 5–17 years in rural and urban Uganda. In-depth interviews were conducted with caregivers of HIV-positive children (5–11 years) and adolescents (12–17 years) in HIV care. Interviews were audio recorded with permission from participants and written consent and assent sought before study procedures. Thirty eight participants (19 caregivers, 19 children/adolescents) were interviewed. Age range of caregivers was 28–69 years; majority were female (17). Caregivers had little knowledge on mental disorders ;only 3 related the vignette to a mental problem and attributed it to: improper upbringing, violence, poverty and bereavement. Five adolescents identified vignettes as portraying mental disorders caused by: ill-health of parents, bereavement, child abuse, discrimination, HIV and poverty. Caregivers are not knowledgeable about behavioural and emotional challenges in HIV-positive children/adolescents. Mental health literacy programmes at HIV care clinics are essential to enhance treatment-seeking for mental health.     

Cultural aspects of mental health and mental health service delivery with a focus on Nigeria within a global community

With an endless range of subgroups and individual variations, culture bears upon what all people bring to the clinical setting. Culture could account for health-seeking behaviour, type of services and support system and variations in how people communicate their health concerns. Culture may underlie presentation of sets of symptoms that are peculiar to certain societies – culture-bound syndromes. Culture also influences the meanings that people impart to their illness and also stigma associated with such illnesses. Culture must be viewed from the patients, clinicians and health system dimensions. Changes in mental health service delivery in last few decades have yielded culturally competent mental health services. The aim of this paper was to discuss culture and mental health with a focus on Nigeria and from a global perspective.     

Understanding and management of epilepsy in a rural community in South Africa: An exploratory study

The aim of the study was to explore how people living with epilepsy in an indigenous rural South African community understood and managed their epilepsy. Six people with epilepsy were informants (male = 3, female = 3; age range = 16 to 58 years, unemployed = 5, learner = 1). They completed individual interviews on their meanings of epilepsy and also on their experiences managing the illness. The results indicated that the participants’ understanding of epilepsy is closely linked to their own experiences of the condition, as well as to cultural beliefs about seizure disorder. Moreover, they reported that the unpredictability associated with a seizure generated a greater level of distress to the participants than the fact that they had seizure disorder. The participants reported to rely on family, and both traditional and Western medicine to manage their epilepsy.     

Advocacy processes in mental health: a qualitative study

Advocates perform an important role in representing the rights of mental health consumers, especially since mental health consumers are often marginalized. Little is known about the processes advocates use to assist mental health consumers in navigating the health care system. This study details the manner in which advocates work together with mental health consumers and health professionals through presenting a qualitative synthesis of 60 case records. Four main themes emerged: negotiating on behalf of consumers during meetings with health professionals; liaising between consumers and health professionals outside of meetings; supporting consumer decision making without the involvement of health professionals; and involvement in legal processes. The findings of this study demonstrated that advocates were primarily oriented toward the protection of negative rights, but they also promoted positive rights.     

Listening to the Voices of Children in Early Schooling in the South African Context of HIV/AIDS

This study explored how children in early schooling interpreted their social reality to construct vulnerable childhoods in an HIV/AIDS context. Ten males and ten females between the ages of eight and nine years from low-income families in KwaZulu-Natal participated in the study. In order to raise the voices of the children, a listening framework was created through participatory techniques. Focus group interviews, drawings, story telling and projection techniques were used in the study. The study found that children actively interpreted their social reality through engaging with circumstances that surrounded their lives in an HIV/AIDS context. Child activism is important to HIV/AIDS education.     

School and community participation of in-school teenagers affected by orphanhood in a rural South Africa setting

This study investigated schooling and community participation qualities of teenage learners affected by orphanhood in rural secondary South African setting. Participants were a purposive sample of 30 teenage learners, (female = 60% black = 98%, 12 to 19 years old). Data on their school and community participation were collected using semi-structured individual interviews. The data were thematically analyzed with open-coding. The findings indicated that learners need support for livelihoods, relationship development with extended family or guardians, school attendance, school task engagement and follow through. They experienced material shortages despite state support. From livelihood deprivations and forced opportunities, the learners who had been orphaned enter the working environment earlier than is typical and often do menial jobs.

Children who have been orphaned are those under the age of 18 years who have lost one or both parents from any cause (Jeff & Chris, 2002 Jeff, G., & Chris, D. (2002). Impacts and interventions. South Africa: University of Natal Press. [Google Scholar], UNICEF, 2003). This represents about 18.8% of South African children (3 374 971) and 7.3% of children (24 6373) from the Free State or central province of South Africa alone (Central Statistics South Africa, 2011). According to the World Bank (1998 World Bank. (1998). Confronting AIDS. Washington, DC: World Bank. [Google Scholar]), children affected by orphanhood are less likely to have proper schooling from lack of parenting and the resource deprivation associated with being orphaned. Under guardianship, the host family may reduce a child's attendance at school by labour demands or the inability to pay for schooling (UNICEF, 2003). From these deprivations, learners affected by orphanhood may enter the labour force prematurely, and mostly in the unregulated informal sector (UNICEF, 2012). As a matter of fact, a learner who is orphaned is deprived of childhood from the socio-economic demands on him or her which are developmentally atypical (Ganga & Maphala, 2013).     

Health and well-being among teenage mothers in a rural South African community

This study sought to identify patterns of general health symptoms and coping abilities among school-going teenage mothers in the central region of Limpopo province, South Africa. The participants were 56 teenage mothers and 56 typically developing girls or non-mother peers (age range 16 to 19 years). They attended school ranging from grades 8 to 12. The participants completed the General Health Questionnaire and Coping Strategy Scale. Data were analysed utilising between group t-test comparison statistics. The findings suggest teenage mothers experience fewer somatic symptoms than typical peers. In addition, there was no significant difference between teenage mothers and peers on anxiety, social dysfunction, depression and coping strategies scores. Generally, teenage mothers experienced fewer general health symptoms than non-mother peers.     

Behavioural characteristics of offenders with mental health disorders in a South African prison population

This exploratory study profiled behavioural characteristics of a non-random sample of 91 offenders with mental illness in a South African correctional facility. The sample is directly related to diagnosed cases from the correctional psychiatrist's case load. The most prevalent mental disorders diagnosed amongst the research participants of this sample specific profile were schizophrenia (33%), major depressive (27.5%), bipolar mood (12.1%) and psychotic disorders (11%).     

Vicarious traumatisation experiences among South African Police Service members in a rural setting: An exploratory study

The objective of this study was to explore the vicarious traumatisation experiences of South African Police Service members serving in a rural community. The participants consisted of 17 purposively selected police members (females = 4; age range 27 to 55; average years of police service = 10.6 years). Unstructured face-to-face interviews were conducted on the members’ experiences with trauma events where they were called upon to provide police services. Additionally, field notes, telephone follow-ups, and diaries were used to collect data from the members. The data were analysed using interpretative phenomenological approach guidelines. Findings show the police members to report their outlook on life to change from viewing work-life as routine and impersonal, to viewing it as involved and personal. The police members also reported psychological disorientation and being in a sense of stupor from exposure to traumatic cases. Finally, the police members self-reported empathetic experiences with the survivors as concerned citizen parents.     

An Evaluation of an HIV/AIDS Prevention Program in a Nigerian Setting

The study examined the success of a group based behavioural intervention with Nigerian youths aimed at reducing the risk of contracting and spreading HIV/AIDS and other sexually transmitted illness (STI). Participants were 147 youths (males=75, females=72, age range 5 to 24 years). The study explored the influence of motivational factors (self efficacy), attitudinal factors (perceived personal risk), knowledge (instrumental knowledge of AIDS) and behavioural factors (refusal of high-risk behaviour) in predicting condom use amongst youth participating in a group-based HIV prevention intervention. Findings indicated that the intervention program reliably predicted participants' attitudinal dispositions to high risk heterosexual behaviour. Instrumental knowledge of HIV/AIDS, perceived self-efficacy, perceived personal risk of HIV/AIDS and refusal of risk behaviour were significant predictors of condom use.