Occupational therapy assessment and interventions for young autistic children in South Africa.

Background: Occupational Therapy is among the top interventions for autistic children, hence the need for equitable and effective services in the public and private health and education sectors. Ongoing research into the therapies for autism spectrum disorders in different contexts is also required. Objectives: To explore and describe occupational therapists' assessment and intervention for autistic children in South Africa. Methods: A descriptive qualitative research design using semi-structured interviews to gather data from purposively recruited OTs (n=20). Data were audio-recorded, transcribed and analysed thematically, and compared across three sectors public health, special needs schools and private practice. Results: South African practice across all three sectors was similar to international patterns of informal play-based assessment, sensory processing and Ayres Sensory Integration (ASI®) treatment. Developmental frameworks guided specific approaches. Strong team collaboration was present across sectors, with some transdisciplinary teamwork and co-treatment. Undergraduate and postgraduate training opportunities were, however limited. Conclusions: Occupational therapy assessments had diagnostic value. Informal tools such as developmental checklists were found to have clinical utility, whilst standardised tools were most commonly used to assess sensory processing and visual perception. Recommendations included incorporating ASI® into undergraduate curricula and postgraduate training opportunities with multidisciplinary input to develop ASD professionals in South Africa. It is imperative to advocate for services in under-resourced rural areas and marginalised communities that lack financial and social resources. Occupational therapists need to find new ways of working collaboratively across sectors to ensure effective and comprehensive services in public health and special schools.

Burden of disability in type 2 diabetes mellitus and the moderating effects of physical activity.

The growing diabetic epidemic has created a substantial burden, not only on the people with diabetes but also on society at large. This mini-review discussed the limitations and patterns of disability in type 2 diabetes mellitus and put forward a case for the moderating effects of physical activity (PA) in the management of diabetes. The limitations and impairments associated with diabetes include vascular, neurological, cardiac, and renal impairments. Moreover, individuals participate less in their daily lives and in their instrumental activities of daily living, which negatively impacts the quality of life of individuals with diabetes. This often leads to a loss of quality of life due to disabilities, resulting in an increased rate of disability-adjusted life years among people with type 2 diabetes mellitus. Moreover, there are psychosocial sequelae of diabetes mellitus. This necessitates looking for moderating factors that may reduce the burden of the disease. PA has been shown to be one of the factors that can mitigate these burdens. PA does this in several ways, including through the benefits it confers, such as a reduction of hemoglobin A1c, a reduction of excess fat in the liver and pancreas, and the reduction of cardiovascular risk factors, all of which favorably affect glycemic parameters. Specifically, PA regulates or moderates diabetes disability through two mechanisms: The regulation of glucolipid metabolism disorders and the optimization of body mass index and systemic conditions. Therefore, efforts should be directed at PA uptake through identified strategies. This will not only prevent diabetes or diabetes complications but will reduce its burden.

Occupational choices of school-going adolescents: a study in the Pitseng Area, Leribe District, Lesotho.

INTRODUCTION: Adolescents require opportunities to engage in occupations and need to have the requisite aptitude and agency to choose the occupations they want or need to engage in. Occupations are defined as the everyday activities that people choose to engage in individually or as groups that bring meaning and purpose to their lives. These occupations can be chosen or enforced. There is a paucity of literature around the occupations that adolescents in rural contexts choose and the meaning underlying their choices. This study explored the occupations of school-going adolescents of Pitseng, Lesotho, to gain insight into adolescent behaviour, and the strategies needed to develop sustainable health promotion programs for adolescents in this area. METHODS: A descriptive qualitative research design was used. Purposive sampling was used to recruit 47 adolescents aged between 13 and 15 years from three high schools in Pitseng, Leribe district, Lesotho. Data was collected using focus group interviews after consent was obtained from the parents or caregivers and assent from the adolescents. Data were analysed thematically using Braun and Clarke's method. RESULTS: Three main themes emerged from the study: realities of customary rural life, facilitators of occupational engagement, and wellbeing versus risky behaviour. Participation in daily routine occupations, cultural norming, resource scarcity, school milieu and leisure engagement were subthemes derived under the first theme. The subthemes identified under the theme facilitators of occupational engagement were intrinsic motivation, and vicarious modelling and peer support. The third theme encompassed the conceptualisation of wellbeing and risky behaviour as subthemes. The adolescents were found to engage in risky behaviour to escape the monotony in their daily lives. This could be attributed to them having fewer choices for recreational activities during their free time. Some adolescents were able to improvise and attempted to enjoy their lives with fewer occupational choices. The natural environment, coupled with creativity, facilitated the engagement of adolescents in fun activities. CONCLUSION: The dominant influences relating to the adolescents' occupational choices and participation in activities were the impoverished rural context and the traditional inherited practices. The protracted timeframes for completing basic activities and household responsibilities and the scarcity of resources for leisure led to a restricted range of leisure activities. The traditional cultural context influenced gender-based differences in the manifestation of occupations. Despite the challenges, the adolescents showed resilience, creativity and a strong desire to improve their futures. Moreover, in this culturally steeped environment, the school and the community chief may be the two best entry points for organisations planning to facilitate health promotion programs. They are recognised and sanctioned power bases in rural communities. Recommendations for education, leisure, health promotion and further study were made for Pitseng.

Clinical educator's experiences of the decentralised training platform for Occupational Therapy students in KwaZulu-Natal, South Africa.

Background: In piloting a shift from traditional practice-based placements to decentralised clinical training (DCT), there was a need to explore the factors that influenced the placement as part of monitoring and evaluation. DCT involves placement to clinical sites away from the higher education institution necessitating changes to supervision strategies utilised. Objective: This study explored the experiences of clinical educators supervising occupational therapy students within this new model during a pilot phase of the DCT programme at one institution in South Africa. Method: The study was located in KwaZulu-Natal province and followed an explorative qualitative design with semi-structured interviews and focus groups with purposively sampled clinical educators (n=11). Data were audio-recorded and d thematically analysed. Findings: Two central themes emerged and included the clinical educators' expectations (organisation factors, role and scope of partners in decentralised training and communication) and experiences (perspectives and value of decentralised training). Conclusion: Decentralised training has considerable potential to contribute to authentic student learning. Improved communication between all stakeholders would assist in enhancing the quality of the learning experiences on such platforms. Students need to be more prepared prior to commencing DCT, and there is a need for more rural placements with a primary health care focus.

Challenges and coping strategies of parents of children with autism spectrum disorder in Eswatini.

Background: Research shows that the debilitating effects of autism spectrum disorder (ASD) not only have an impact on the child, but on the parents and caregivers as well. This study aimed to explore the challenges and coping strategies of parents of children with ASD in Eswatini.Methodology: An exploratory, descriptive qualitative study that used purposive sampling to interview parents of children with ASD was utilised. Data were gathered using two focus groups, three dyads, and two semi-structured interviews. There were 18 participants in this study. Data were interpreted by thematic analysis, and considered according to Lazarus and Folkman's Transactional Model of Stress and Coping.Findings: The themes were in alignment with the aim of this study, namely the "challenges of parents of children with ASD" and "coping strategies of parents of children with ASD". Significant personal and societal difficulties, the severity of the symptoms of ASD, and challenges in the health and education systems were subthemes identified under the "challenges of parents" theme. The subthemes that emerged from the "coping strategies" theme were adaptive coping and maladaptive coping. Factors associated with adaptive coping included acceptance of the ASD diagnosis, optimism and faith in God, social support, and celebrating milestones. Maladaptive coping strategies encompassed using corporal punishment, avoidance, social withdrawal, and keeping the child locked in.Conclusion: Recommendations made to mitigate the challenges included strengthening research into ASD, increasing awareness in communities, and training professionals working in the field of ASD.