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Wilkem.Pdf (6.732Mb) Models of care for antiretroviral treatment delivery: A faith -based organization’s response Marisa Wilke MODELS OF CARE FOR ANTIRETROVIRAL TREATMENT DELIVERY: A FAITH-BASED ORGANIZATION’S RESPONSE. by Marisa Wilke M.Cur (University of Johannesburg) Submitted in fulfillment of the requirements for the degree PHILOSOPHIAE DOCTOR In Nursing In the Faculty of Health Sciences, School of Nursing, University of the Free State 14 April 2012 Promoter: Prof Y. Botma, Ph.D. Nursing (School of Nursing) Co-promoter: Prof H.C.J. van Rensburg, D.Phil Sociology (CHSR&D) Co-promoter: Dr R. Stark, Ph.D. Health Services (CRS) Student number: 1998007866 1 DECLARATION I certify that this thesis hereby submitted by me for the Ph.D. (Nursing) degree at the University of the Free State is my independent effort and has not previously been submitted for a degree at another university/faculty. I furthermore waive copyright of this thesis in favor of the University of the Free State. ------------------------------------- 14 April 2012 Marisa Wilke 2 Letter from promoter 3 Letter from editor 4 ACKNOWLEDGEMENTS Through this journey many have encouraged, inspired and supported me. Thank you very much. You were God sent… Some warrant special mention. My heavenly Father who made me willing and able (Praise be to God!) All the patients and staff within the Catholic network for your dedication and courage My familie vir hulle ondersteuning en gebede Dr Ruth Stark for being my mentor and believing in me Prof Yvonne Botma for taking this journey with me and imparting your knowledge (and coffee) so generously Prof Dingie van Rensburg for your comments and insight Sr Alison Munro for leading by example (and all your help with the editing) Riette Nel (Department of Biostatistics) for your patience and assistance with the data analysis The CRS team (especially Marelize Crous, Davor Dakovic, Tansel Vosloo, Tony Linden) for assisting with my work-related tasks when the deadlines were looming and for being my friends My friends Imelda Davidson, Anja Pienaar and Mandie Jacobs for your consistent encouragement and understanding Br Rex Harrison for listening when I needed an ear The Pauline Fathers for your hospitality while I was completing Chapters five and six All the data collectors and data quality assistants: Thank you for being my ears and eyes. A special thank you to Nonhlanhla Maclare. Catholic Relief Services for the support The NRF for the once-off support 5 In loving memory of Wilmirie Nicoleen Grobler (1998-2008) & Willem Jacobus Britz (1934-2007) 6 CONTENTS DECLARATION .............................................................................. 2 Letter from promoter ................................................................ 3 Letter from editor .................................................................... 4 ACKNOWLEDGEMENTS ..................................................................... 5 CONTENTS .................................................................................. 7 LIST OF ACRONYMS ...................................................................... 17 LIST OF TABLES........................................................................... 21 LIST OF FIGURES ......................................................................... 25 LIST OF PHOTOGRAPHS ................................................................. 26 PART I ..................................................................................... 28 CHAPTER 1: HISTORICAL BACKGROUND .............................................. 29 1.1. The early history of the Catholic Church caring for the sick ............ 29 1.1.1. The Early Christian era: 1-500 AD. ..................................... 29 1.1.2. The Early Middle Ages (Dark Ages): 500 – 1000 AD ................... 31 1.1.3. The Late Middle Ages: 1000 - 1500 AD ................................. 32 1.1.4. Renaissance and Reformation. .......................................... 33 1.1.5. Care in Protestant countries ............................................ 35 1.2. South Africa..................................................................... 36 1.2.1. The sea-route to India ................................................... 36 1.3. The beginnings of the Catholic Church in South Africa .................. 39 1.4. Catholic healthcare in South Africa ......................................... 42 1.4.1. Catholic hospitals ......................................................... 44 1.4.2. The period of government support ..................................... 44 1.4.3. Training of nurses ......................................................... 45 1.4.4. Changing times ............................................................ 46 1.4.5. HIV care and support ..................................................... 50 7 1.5. Four HIV projects .............................................................. 52 1.5.1. Centocow Mission, Creighton............................................ 52 1.5.2. Sisters of Mercy, Winterveldt ........................................... 55 1.5.3. Tapologo, Rustenburg .................................................... 56 1.5.4. HIV & AIDS Prevention Group, Bela-Bela .............................. 58 1.5.5. Conclusion ................................................................. 60 CHAPTER 2: INTRODUCTION TO THE STUDY ......................................... 62 2.1. The global epidemic ........................................................... 62 2.1.1. Care of HIV-infected patients ........................................... 63 2.1.2. Antiretroviral treatment ................................................. 64 2.1.3. Universal access ........................................................... 66 2.1.4. South Africa ................................................................ 67 2.1.5. Non-governmental Organizations ....................................... 70 2.1.6. Faith-based Organizations ............................................... 70 2.1.7. The Catholic Church ...................................................... 72 2.2. Problem statement and rationale ........................................... 73 2.3. Aims of the study .............................................................. 75 2.3.1. Objectives ................................................................. 75 2.4. Philosophical approach and research paradigm ........................... 76 2.4.1. The Catholic Church ...................................................... 76 2.4.2. The researcher ............................................................ 78 2.5. Research design ................................................................ 79 2.5.1. Rigor ........................................................................ 80 2.6. Phase I – Preparation .......................................................... 80 2.6.1. Proposal development ................................................... 81 2.6.2. Case selection ............................................................. 81 2.6.3. Ethics approval ............................................................ 81 2.6.4. Ask permission to conduct research.................................... 82 2.6.5. Pilot study ................................................................. 82 8 2.6.6. Preparation to do fieldwork ............................................. 82 2.7. Phase II – Data collection ..................................................... 82 2.7.1. Ethics ....................................................................... 83 2.7.2. Structured interviews .................................................... 83 2.7.3. File audits .................................................................. 84 2.7.4. Semi-structured interviews .............................................. 84 2.7.5. Nominal groups ............................................................ 85 2.8. Phase III – Conclusion .......................................................... 85 2.9. Chapter outline ................................................................ 86 CHAPTER 3: METHODOLOGY............................................................ 87 3.1. Research design ................................................................ 87 3.1.1. Embedded single case design ........................................... 88 3.1.2. Mixed method approach ................................................. 88 3.1.3. Rigor ........................................................................ 89 3.1.3.1. Validity ................................................................... 89 3.1.3.2. Reliability ................................................................ 91 3.1.3.3. Trustworthiness ......................................................... 92 3.2. Phase I – Preparation .......................................................... 95 3.2.1. Proposal development ................................................... 95 3.2.1.1. Case selection (sampling of projects) ............................... 96 3.2.2. Tool refinement .......................................................... 100 3.2.2.1. Tool refinement of the structured interview schedule .......... 100 3.2.2.2. Tool refinement of the file audits .................................. 102 3.2.2.3. Tool refinement of the group technique ........................... 103 3.2.2.4. Tool refinement of the semi-structured interview schedules .. 103 3.2.3. Ethical considerations ................................................... 104 3.2.3.1. Ethics committee approval .........................................
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