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Live your life. Create your destiny.
Empowerment Programme toSupport Children in Child Headed
Households in Resource PoorCommunities in Soshanguve, South
Africa: Phase 1 of an InterventionStudy
J E Ibebuike (D-Tech Nursing Student)
1. BACKGROUND
2. RESEARCH BACKGROUND TO THE PROBLEM
3. OBJECTIVES OF THE STUDY
4. THEORETICAL FRAMEWORK
5. RESEARCH METHODS AND DESIGN
6. TRUSTWORTHINESS
7. ETHICAL CONSIDERATIONS
8. FINDINGS OF THE STUDY
9. JUSTIFICATION OF THE STUDY
10. LIMITATIONS
11. RECOMMENDATIONS
12. CONCLUSION
Faculty of Science: Adelaide Tambo School of Nursing Science
OVERVIEW OF THE PRESENTATION
Faculty of Science: Adelaide Tambo School of Nursing Science
• The Nelson Mandela children’s Fund in their 2001 report noted that SouthAfrica has the fastest growing rate of people living with HIV and AIDS
• This has led to an alarming increase in the number of children orphaned byAIDS and
• The attendant care of the orphaned children by their siblings leading to theterm child headed households (CHHs).
• The child takes on decision making and responsibilities usually carried outby parents, including the provision of care to other children.
1. BACKGROUND
Faculty of Science: Adelaide Tambo School of Nursing Science
Child headed household has been defined as:
= a household which is headed by a person under 18 years old and who is:
• taking care of the household with other younger siblings, as they have lostboth parents to HIV/AIDS or other causes; or
• providing the household income and taking care of the household with otheryounger siblings, whose parents or primary caregivers are chronically ill withHIV/AIDS or with other causes; or
• living alone and taking care of him/herself as no other siblings are present inthe household and as either one of his or her parents are deceased, orwhere the parents cannot be found or are unknown. This third category ofchildren includes street children and child soldiers as noted in some studies.
1. BACKGROUND (cont.)
Faculty of Science: Adelaide Tambo School of Nursing Science
However, a child headed household has also been defined as:
= a household where:
• both parents or alternative adult caregiver are permanently absent and theresponsibility for the day-to-day management of the entire household ispresided by any person who is less than 20 years of age.
For the purpose of this study
• children above 18 years but not exceeding 19 years will be included asa “child”
• The child in this context is a child who has been identified living in achild headed household
1. BACKGROUND (cont.)
Faculty of Science: Adelaide Tambo School of Nursing Science
Types of child headed households (CHHs)
• Unaccompanied CHHs: no adults more than 18 years-old are found
• Accompanied CHHs: households with dependant adults who are notresponsible for the household such as
- ailing parents
- old grandparents
- disabled uncles/aunts
- some other old relatives
1. BACKGROUND (cont.)
Major causes of orphan hood: Leading to the emergence of child headed households
• HIV and AIDS• Armed conflicts• Poverty-driven family disintegration• Others, e.g., natural disasters
Why the study: To develop an empowerment programme to support children in CHHs
in the resource poor communities of Soshanguve Ext 12 and 13• Could be refined, replicated or serve as a baseline for further
intervention studies when completed• Research result will assist health planners in closing the gap to ensure
children in CHHs in resource poor communities are empowered
Faculty of Science: Adelaide Tambo School of Nursing Science
2. RESEARCH BACKGROUND TO THE PROBLEM
The objectives of the study were to:
• identify children in CHHs in the resource poor communities of
Soshanguve
• determine the lived experiences and needs of children in CHHs
• determine the knowledge and perceptions of the resource poor
communities about children in CHHs
Faculty of Science: Adelaide Tambo School of Nursing Science
3. OBJECTIVES OF THE STUDY
6-Step Model for Community Empowerment
Designed to address specific physiological, social, financial, psychological,
spiritual, environmental and physical needs
Intervention Theory
An explanatory theory which combines the characteristics of descriptive and
prescriptive theories
- descriptive theory describes the problem of children in CHHs
- prescriptive theory specifies what needs doing to achieve anoutcome.
Faculty of Science: Adelaide Tambo School of Nursing Science
4. THEORETICAL FRAMEWORK
Faculty of Science: Adelaide Tambo School of Nursing Science
4. THEORETICAL FRAMEWORK (cont.)
Step 1: Gaining entrance into thecommunity
Step 2: Identifying issues of interest orconcern
to the community
Step 3: Prioritizingidentified issues
Step 4: Formulating a strategy to addressa priority issue
Step 5: Developing andimplementing an action plan to
resolveprioritized issues
Step 6: Transitioning to new issues
The 6 steps of the model are:
The nature of the Intervention Theory: involves 2 broad phases
• Phase 1: assisted to guide the conduct of the research in Phase 1
• Phase 2: guided in
- the implementation and evaluation of the effectiveness of thedeveloped empowerment programme in Phase 2
Faculty of Science: Adelaide Tambo School of Nursing Science
4. THEORETICAL FRAMEWORK (cont.)
Faculty of Science: Adelaide Tambo School of Nursing Science
5. RESEARCH METHODS AND DESIGNResearch Methods and
Design
Phase 1
Design Qualitative intervention
Quantitative component for demographic data
Population
Target
Sampling method
Sampling size
Children in CHHs and adults within the resource poor
communities
Purposive sampling method
Saturation of data
Data gathering
Data gathering
method
Data gathering
instrument
In-depth interviews using unstructured interview, focus
group discussion, self-report, field notes and voice
recording
Unstructured interview schedule, field notes and voice
recorder
Data analysis Tesch’s approach
Descriptive statistics
Research outcome Children in CHHs identified, their lived experiences and
needs determined
Summary of researchmethods and design forPhase 1 of the Study
Contextual study– results cannot begeneralized
The study was conducted in SoshanguveExt.12 and 13:
• Soshanguve forms part of the greaterTshwane Metropolitan Municipality.
• It is a semi formal settlement 45km Northof Pretoria.
• The total number of people living in theseextensions is unknown as informal houses areconstantly erected.
• No healthcare facilities available within aradius of 5km
• Resource poor community
• 56% unemployment rate, and
• 75% of the population lived below the internationalpoverty level of $2.
Faculty of Science: Adelaide Tambo School of Nursing Science
5. 1 Context of the Study
C
Ext 12 A
Ext 12 B
Ext 13 B
Ext 13 A
N
N = new site
Informal Settlement
Identification, lived experiences and needs of children in child headedhouseholds in resource poor communities and knowledge and perceptionsof the resource poor communities about these children.
Research design: Qualitative contextual intervention design andQuantitative component for the demographic data
Inclusion criteria:
• Children from 8-19 years of age resident in the child headedhouseholds in Soshanguve Extension 12 and 13
• Community members resident in Soshanguve Extension 12 and 13
• Willingness to participate in the research
Faculty of Science: Adelaide Tambo School of Nursing Science
5.2 Research Methods
Sampling method: Purposive sampling
Sampling size: n• Children from CHHs – saturation of data: (17) n=17• Focus group
Data gathering method: In-depth interviews with the children
Data gathering instrument:
- unstructured interview schedule
- field notes and
- voice recorder
• Period: 2 months
Faculty of Science: Adelaide Tambo School of Nursing Science
5.2 Research Methods (cont.)
Data gathering: In-depth interviews using unstructured interview, focusgroup discussions, self-report, field notes and voice recording
• Formation of a project team: consists of
- the researcher
- community leaders
- advisory committee (consists of some adult members of thecommunities as well as some of the community leaders)
- the language translator, who is a registered community healthnurse working at the mobile clinic (also served as a field worker)
Faculty of Science: Adelaide Tambo School of Nursing Science
5.2 Phase 1 Research Methods (cont.)
Data gathering (cont.):
• Pre-test: was done to test the research instrument and feasibility of thestudy
Faculty of Science: Adelaide Tambo School of Nursing Science
5.2 Research Methods (cont.)
Data analysis:
• Open coding using Tesch’s approach, and• Descriptive statistics for the qualitative component
Faculty of Science: Adelaide Tambo School of Nursing Science
5.2 Research Methods (cont.)
Trustworthiness was ensured through:
• Credibility• Transferability• Dependability• Confirmability• Authenticity
Faculty of Science: Adelaide Tambo School of Nursing Science
6. TRUSTWORTHINESS
Faculty of Science: Adelaide Tambo School of Nursing Science
7. ETHICAL CONSIDERATIONS
• Informed assent/consent from participants
• Permission from the NCoP programme manager
• Numbering of transcribed interviews – anonymity and confidentiality
• No harm intended – emotional discomfort experienced – timeallowed to give support and counselling
• Privacy
• Respondents who meet criteria will be purposively sampled
• Approved by the ethics committee
Faculty of Science: Adelaide Tambo School of Nursing Science
8. FINDINGS OF THE STUDY (NOT RESULTS)
Results will be discussed according to the following:
8.1 General and demographic data:
8.1.1 Gender and age
8.1.2 Cultural group distribution
8.1.3 Education level and source of income
8.1.4 Age of participants in relation to educational level and type of CHHs
8.2 Research findings:
8.2.1 Themes, categories and sub-categories from in-depth interviews fromparticipants from CHHs
8.2.2 Themes, categories and sub-categories from in-depth interviews fromparticipants from focus group discussions
Faculty of Science: Adelaide Tambo School of Nursing Science
8.1 General and demographic data:
8.1.1 Gender and ageGENDER FREQUENCY PERCENTAGE
Male 9 52.9%
Female 8 47.1%
Total 17 100.0%
AGE FREQUENCY PERCENTAGE
8-9 years 4 23.5%
10-11 years 3 17.6%
12-13 years 2 11.8%
14-15 years 2 11.8%
16-17 years 3 17.6%
18-19 years 3 17.6%
Total 30 100.0%
Faculty of Science: Adelaide Tambo School of Nursing Science
8.1 General and demographic data (cont.):
8.1.2 Cultural group distribution
Sepedi8
47%
IsiZulu4
23%
Xitsonga2
12%
Tshivenda2
12%
Sesotho1
6%
Frequency
Sepedi
IsiZulu
Xitsonga
Tshivenda
Sesotho
Faculty of Science: Adelaide Tambo School of Nursing Science
8.1 General and demographic data (cont.):
8.1.3 Education level and source of incomeLevel of education Frequency Results
Grade 1 – 7 12 70.6%
Grade 8 - 10 3 17.6%
Drop out 2 11.8%
Total 17 100.0%
Conclusion:• Majority of participants’ education level were between grade 1 – 7 (primary level)• 17.6% were in secondary level and 11.8% dropped out of school
Source of income Frequency (n=17) Percentage
Grants 9 52.9%
Unspecified 7 41.2%
Menial job 1 5.9%
Total 30 100.0%
Faculty of Science: Adelaide Tambo School of Nursing Science
8.1 General and demographic data (cont.):8.1.4 Age of participants in relation to
educational level and type of CHHsParticipants
number
Age Educational level in grade Type of household
01 11 years 1-7 Accompanied
02 10 years 1-7 Accompanied
03 15 years 1-7 Accompanied
04 9 years 1-7 Unaccompanied
05 19 years Dropped out of school Unaccompanied
06 19 years 8-10 Unaccompanied
07 17 years Dropped out of school Unaccompanied
08 17 years 8-10 Unaccompanied
09 17 years 1-7 Unaccompanied
10 19 years 8-10 Unaccompanied
11 14 years 1-7 Unaccompanied
12 8 years 1-7 Accompanied
13 8 years 1-7 Accompanied
14 12 years 1-7 Unaccompanied
15 14 years 1-7 Unaccompanied
16 10 years 1-7 Accompanied
17 13 years 1-7 Accompanied
Conclusion:• 5 out of the 12 participants in
grades 1-7 were above 12 yearsof age (the expected age for asmooth academic progression inschool) and this may be indicativeof poor progress in school.
• The participants’ distribution withrespect to the type of CHHsshowed that 10 (58.8%) were fromunaccompanied CHHs while 7(41.2%) were from accompaniedCHHs.
Faculty of Science: Adelaide Tambo School of Nursing Science
8.2 Research findings:8.2.1 Themes, categories and sub-categories from in-depth interviews from
participants from CHHsThemes Categories Sub-categoriesKnowledge about existence ofCHHs
Awareness of CHHs Acquainted with CHHs Unaccompanied CHHs Accompanied CHHs
Identification of children of CHHs Ease of identification ofchildren of CHHs
Method of identification ofchildren of CHHs
Reasons for the formation ofCHHs
Parental death Cause of parental deathDeath of a single parent and propertypreservation
Single parentage by motherand mother’s last wishes
Death of a parent and abandonment bythe surviving parent
Death of mother andabandonment by father
Parental preparation Request for a relativeLived experiences of children inCHHs
Personal experiences Emotional disturbance Sadness
Experiences in the community Stigmatization anddiscrimination
Child labour Sexual exploitation Negative influence of friends
Academic experiences Academic performanceAccess to grant Receiving grant
Not receiving grantNeeds of children in CHHs Basic life needs Food, clothes, shoes and
money for subsistenceEducational needs School fees, money for
transport fare to school,scholastic materials andfurthering of education
Health issues Psychological trauma Physical injury
Empowerment Aspirations Empowerment for basic life needs Provision of grants Physical support for basic life
needsEmpowerment for educational needs Physical provision for
educational needs Re-enrolment in school Support for home work
Empowerment for health issues Psychological counsel General household
supervision
Faculty of Science: Adelaide Tambo School of Nursing Science
8.2 Researchfindings (cont.):8.2.2 Themes,categories and sub-categories from in-depth interviewsfrom participantsfrom focus groupdiscussions
Themes Categories Sub-categories
Resource poor
communities’ knowledge
about child headed
households
Awareness of existence of
child headed households
Acquainted with CHHs
Accompanied CHHs
Unaccompanied CHHs
Identification of children of
CHHs
Ease of identification
of children of CHHs
Methods of
identification of
children of CHHs
Reasons for the formation of
CHHs
Death of parents
Alcoholic parents
HIV and AIDS
Parental illness
Parental abandonment
Lack of care and
maltreatment by
relatives
Resource poor
communities’ perceptions
about CHHs
Resource poor communities’
views about child headed
households
Views about
unaccompanied CHHs
Views about education
of children in CHHs
Views about needs of
children in CHHs
Risky behaviours of
children in CHHs
Poverty and child
labour
Resource poor communities’
views on grants for children
in CHHs
Awareness of
government provision
of grants
Awareness of lack of
required documents for
grant
Collection of and
personal use of the
children’s grant by a
third party
Faculty of Science: Adelaide Tambo School of Nursing Science
8.2 Researchfindings (cont.):8.2.2 Themes,categories andsub-categoriesfrom in-depthinterviews fromparticipants fromfocus groupdiscussions (cont.)
Resource poor
communities’ challenges
towards assisting the
CHHs
Resource poor
communities’ support for
children of child headed
households
Collaboration of the
resource poor
communities with NGOs
or government
Areas of resource poor
communities’ support
for the children in CHHs
Obstacles to resource
poor communities’
support for children of
CHHs
Resource poor
communities’
knowledge of
implementation of
government legislations
for child headed
households
Faculty of Science: Adelaide Tambo School of Nursing Science
9. JUSTIFICATION OF THE STUDY
• The study is justified because:
- the purpose and the objectives were accomplished
Faculty of Science: Adelaide Tambo School of Nursing Science
10. LIMITATIONS• Communication:
- participants words when translated to English may not carry theweight intended as in the local language
- probability for amendment is always present during translationsdue to misinterpretation or partial oversight, though this may havebeen unintentional
• Contextual study:
- findings cannot be generalized for Province or country
Faculty of Science: Adelaide Tambo School of Nursing Science
11. RECOMMENDATIONS OF THE STUDY
11.1 Nursing ProfessionProfessional nurses: should be involved in:
Respect and confidentiality to the orphaned children
Faculty of Science: Adelaide Tambo School of Nursing Science
11. RECOMMENDATIONS OF THE STUDY
11.2 Nursing EducationProfessional nurses and student nurses: should be involved in:
professional nurses in school health system should form HIV and AIDSawareness club that can help create positive attitude through drama, quiz,songs
Health professionals:
should encourage and organize peer group clubs called ‘SPEAK-OUT’ whereorphaned children encourage themselves to be strong
Faculty of Science: Adelaide Tambo School of Nursing Science
11. RECOMMENDATIONS OF THE STUDY
11.3 Nursing ResearchTo empower the results to be generalised for the province or countryrespectively:
similar study should be conducted on empowerment programme to supportchild headed households in other resource poor communities in the provinceor provinces
Evidence should be gathered on the actual demographic data of child headedhouseholds in all communities and provinces:
to ensure new CHHs are not missed, and are therefore captured in thedatabase for empowerment programmes, preferably yearly
Faculty of Science: Adelaide Tambo School of Nursing Science
11. RECOMMENDATIONS OF THE STUDY
11.4 Policy MakersProfessional nurses: should be involved in:
Provision of grants for children of parents diagnosed with HIV/AIDS till 18years of age, or
or adopted by the government depending on the financial state of their parents
Support and provision for CHHs by policy makers, non-governmentalorganisations, companies, churches, community members, well-to-doindividuals
Provision of Drop-in Centres and school transport by government
Monitoring and report on school performance at end of every school term
Policy makers should improve more in ensuring that these children in CHHsfurther their education.
- This will result in a reliable, trusted and sustainable future for them
The study provided evidence that:
• Child headed households remain societal issues in our environment
• Though the empowerment programme was not meant as a permanentsolution to the needs of the children, of significance is the fact that it drewthe attention of the communities on the need to support these childrenand assist them to live normal lives within their communities
• It is hoped that the study assists with information in any plan to identifyCHHs in resource poor communities in HIV/AIDS endemic areas.
• The findings showed that the households face serious socioeconomic challenges and aPhase 2 of the study which will develop, implement and evaluate the effectiveness of anempowerment programme to support children in child headed households in the resourcepoor communities is recommended.
Faculty of Science: Adelaide Tambo School of Nursing Science
12. CONCLUSION