guidelines for health care professionals to manage children with foetal alcohol syndrome at health

323 Pages·2017·2.37 MB·English

by  Titus, Antoinette

GUIDELINES FOR HEALTH CARE PROFESSIONALS TO MANAGE
CHILDREN WITH FOETAL ALCOHOL SYNDROME AT HEALTH
FACILITIES IN THE KHOMAS REGION, NAMIBIA

A RESEARCH DISSERTATION SUBMITTED IN FULFILMENT
OF THE REQUIREMENTS FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY IN PUBLIC HEALTH
Of
THE UNIVERSITY OF NAMIBIA
By
Marcus Goraseb
Student number: 201212694
April 2017
Supervisor: Dr H. J. Amukugo (UNAM)
Co-supervisor: Prof D. Hellenberg (UCT)
DECLARATION
I, Marcus Goraseb, hereby declare that this study titled Guidelines for health care
professionals to manage children with foetal alcohol syndrome (FAS) at health facilities
in the Khomas Region, Namibia is a true reflection of my own research and that this
research report or parts thereof have not been submitted for a degree at any other institution
of higher learning. No part of this dissertation may be reproduced, stored in any retrieval
system, or transmitted in any form whether by means of mechanical, electronic,
photocopying, recording, or otherwise without the prior permission of the author, or the
University of Namibia on his behalf.
I, Marcus Goraseb, grant the University of Namibia the right to reproduce this dissertation in
whole or in part in any manner or format, which the university consider appropriate for any
person or institution for study and research purposes; provided that the University of Namibia
shall not waive this right when the entire dissertation has been or is being published in a
manner that is not approved by the university.

……………………………………… ……………………….
Signed Date
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ABSTRACT
In this study, the researcher explored and described the views of health care professionals
who are managing children with foetal alcohol syndrome at public health facilities in the
Khomas Region in Namibia. The purpose of this research project was to develop and evaluate
foetal alcohol syndrome guidelines. This study was qualitative, explorative, descriptive, and
contextual in nature and was conducted in four phases.
Phase 1: This phase focused on a situation analysis. The researcher conducted the situation
analysis to explore and describe experiences of health care professionals who are providing
health care for children with foetal alcohol syndrome at the Katutura State Hospital and the
Windhoek Central Hospital in the Khomas Region. The participants were registered nurses,
enrolled nurses, medical doctors, and social workers. The researcher used in-depth
unstructured interviews to collect data from twelve (n = 12) participants at the Rehoboth
District Hospital for a pilot study and from seventeen (n = 17) participants at the Katutura
Hospital and the Central Hospital respectively. Six (n = 6) focus group discussions were
conducted; two (n = 2) for the pilot study and four at the abovementioned hospitals. Tech’s
methods were employed for the data analysis. Four themes and 12 sub-themes were
identified. The results of the study were used as basis to develop the FAS guidelines for
addressing the challenges experienced by health care professionals.
Phase 2: In this phase, the conceptual framework served as guiding tools to develop the
guidelines. The essential components identified by Dickoff, James, and Wiedenbach (1968)
were used; namely purpose of the activity, and prescription of the activity to the attainment of
the set goal. The guidelines included activities from the survey list of Dickoff et al., (1968).
These elements were: Agent (researcher), recipient (health care professionals), context
(health facilities), dynamics (challenges experienced by the health care professionals in the
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context of managing FAS, procedure (guidelines for health care professionals to facilitate the
management of FAS, and terminus (individual health care professionals’ abilities to manage
FAS competently in accordance of their scopes of practice).
Phase 3: The third phase dealt with the development of the FAS guidelines for the health
care professionals. The researcher utilised the findings from the situation analysis (Phase 1)
and the survey list (Phase 2) of Dickoff et al., (1968) as a reasoning map. The content for the
guidelines were supplemented with the information adopted from the Centre for Diseases
Control (CDC) (2004), and the Canadian guidelines for diagnosis of FAS. The guidelines
comprised six components. The first one focused on the general knowledge for health care
professionals to understand the management of FAS, while the other components specifically
targeted medical doctors, nurses, social workers and psychologist, occupational therapist, as
well as speech therapists. The guidelines structure for each group of health care professionals
comprised the aim, role, and responsibilities; management of FAS; management of the
environment for mother and other family members, as well as strengthening interprofessional
collaboration in terms of the treatment of FAS.
Phase 4: Phase 4 aimed at evaluating the guidelines for the facilitation of the management of
FAS by health professionals in the context of the health care facilities. This was done to
ensure the authenticity, accessibility, and utilisation to enable the maintenance of such
guidelines. This was done in collaboration with various stakeholders who were experts in the
field of each category of health care professionals. The guidelines were evaluated in
accordance with the criteria of Chinn and Kramer (1991) to observe how clear, simple,
general, accessible, and important the guidelines were. That was achieved by conducting a
one-day workshop during which the experts were provided with given guidelines to analyse
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and afforded an opportunity to give their recommendations for improvement of the
guidelines.
During Phase 4 of the study, the guidelines for health care professionals were identified with
the purpose of facilitating the management of children with FAS. Those guidelines were
derived and conceptualised from the challenges that the participants were experiencing in the
context of health care facilities. The guidelines observed the parameters of international
standard for FAS management. The health care professionals would manage the children with
FAS in the context of their respective scopes of practice.
The study recommends the incorporation of the study findings in the curricula for various
health care professionals the augment their essential training growth during in-service
training and continual education interventions. Furthermore, the researcher recommends that
research should be conducted to generate new ideas from the mother, the family, and the
community in general to explore their challenges since this study has narrowly focused on the
needs of health care professionals. This research should be done in various regions. Equally,
this study urges policy makers to make provision for implementing the developed guidelines
that specifically target various health care professionals in the Ministry of Health and Social
Services.
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ACKNOWLEDGEMENTS
I firstly thank the Almighty for giving me the opportunity to conduct this study. The strength
and encouragement are blessings from Him. This study could not have been achieved without
His never-ending blessings. My appreciation to the completion of the study goes to the
following people and institutions:
 Dr H. J. Amukugo for his invaluable guidance, expertise, and tolerance throughout the
study period;
 Professor D. Hellenberg, my co-supervisor, for his timeless advice and contributions.
Your wisdom and encouragement were an inspiration and has kept me going;
 Management and health care professionals at the Katutura State Hospital and the
Windhoek Central Hospital for their support, specifically those health care
professionals who had participated in the study;
 My wife and my daughter who had not failed in their support while I was conducting
this study;
 The University of Namibia for the financial assistance in support of my study, as well
as granting me the opportunity to complete this research project;
 The Ministry of Health and Social Services for allowing me to conduct this study at the
public health facilities;
 The Medical School for granting me the opportunity not only for my professional
growth, but also for contributing to the well-being of the Namibian people;
 My typist, Antoinette Blockstaan, devoted herself with exceptional zeal to complete a
difficult task. Her promptness and accuracy were an inspiration to me; and
 My appreciation goes to Mr Andrew Hills who edited my thesis with dedication and
professionalism.
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DEDICATION
I dedicate this study to:
 The Almighty God for bestowing on me the opportunity and strength to work; through
the challenges during the study;
 My late parents, Eva and Jakobus, who inspired me in my up-bringing;
 My wife, Lischen, and my daughter, Lischen; they were the source of the energy that
kept me going;
 All health care professionals working in the maternity sections of the abovementioned
hospitals; and
 Those mothers who are experiencing the challenges of children born with foetal alcohol
syndrome, Namibia.
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TABLE OF CONTENTS
DECLARATION ....................................................................................................................... ii
ABSTRACT ............................................................................................................................. iii
ACKNOWLEDGEMENTS ...................................................................................................... vi
DEDICATION ......................................................................................................................... vii
ABBREVIATIONS AND ACRONYMS ............................................................................. xxiv

CHAPTER 1
INTRODUCTION AND BACKGROUND OF THE STUDY ............................................. 1
1.1 INTRODUCTION AND RATIONALE OF THE STUDY ............................................. 1
1.2 STATEMENT OF THE PROBLEM................................................................................ 9
1.3 PURPOSE OF THE STUDY ......................................................................................... 11
1.4 OBJECTIVES OF THE STUDY ................................................................................... 11
1.5 SIGNIFICANCE OF THE STUDY ............................................................................... 11
1.6 PARADIGMATIC PERSPECTIVE .............................................................................. 12
1.6.1 Ontological assumptions (the nature of reality) ............................................... 15
1.6.2 Assumptions about epistemology ..................................................................... 16
1.6.3 Methodological assumptions ............................................................................ 18
1.6.4 Axiological assumptions .................................................................................. 19
1.7 THEORETICAL FRAMEWORK AS BASIS FOR GUIDELINE
DEVELOPMENT........................................................................................................... 20
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1.7.1 Practice theory of Dickoff (1968) .................................................................... 21
1.7.2 Guide for development of the practice guidelines process (Kish, 2001) ......... 22
1.8 CONCEPTUAL FRAMEWORK AS BASIS FOR GUIDELINE
DEVELOPMENT........................................................................................................... 25
1.8.1 Centre for Disease Control and Prevention outlines the management
of FAS .............................................................................................................. 26
1.8.2 Canadian guidelines for diagnosis of FAS ....................................................... 26
1.9 RESEARCH METHOD FOR GUIDELINES DEVELOPMENT ................................. 27
1.9.1 Phase 1: Situational analysis ............................................................................ 28
1.9.2 Phase 2: Conceptual framework ....................................................................... 28
1.9.3 Phase 3: Development of the guidelines .......................................................... 30
1.9.4 Phase 4: Evaluation of the guidelines .............................................................. 30
1.10 DEFINITION OF THE CONCEPTS ............................................................................. 31
1.10.1 Guidelines ......................................................................................................... 31
1.10.2 Health professionals ......................................................................................... 32
1.10.3 Management ..................................................................................................... 32
1.10.4 Management of foetal alcohol syndrome ......................................................... 32
1.10.5 Foetal alcohol syndrome .................................................................................. 33
1.10.6 Health facilities ................................................................................................ 34
1.11 CHAPTER OUTLINE.................................................................................................... 34
1.12 SUMMARY ................................................................................................................... 35

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CHAPTER 2
RESEARCH DESIGN AND METHODOLOGY ............................................................... 36
2.1 INTRODUCTION .......................................................................................................... 36
2.2 RESEARCH DESIGN.................................................................................................... 36
2.2.1 Qualitative design ............................................................................................. 37
2.2.2 Exploratory design ........................................................................................... 39
2.2.3 Descriptive design ............................................................................................ 41
2.2.4 Contextual design ............................................................................................. 42
2.3 REASONING STRATEGIES ........................................................................................ 42
2.3.1 Inductive reasoning .......................................................................................... 44
2.3.2 Deductive reasoning ......................................................................................... 45
2.3.3 Inferences ......................................................................................................... 45
2.3.4 Reflection ......................................................................................................... 46
2.3.5 Bracketing ........................................................................................................ 46
2.4 METHODOLOGY ......................................................................................................... 47
2.4.1 Phase 1: Situational analysis ............................................................................ 48
2.4.1.1 Context of the study ...................................................................... 48
2.4.1.2 Population ...................................................................................... 48
2.4.1.3 Sample and sampling method ........................................................ 49
2.4.1.4 Pilot study ...................................................................................... 51
2.4.1.5 Data collection procedure .............................................................. 53
2.4.1.6 Individual interviews ..................................................................... 54
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