the lived experiences of rural-based grandparents raising hiv/aids-orphaned grandchildren in the ...

392 Pages·2017·2.05 MB·English

THE LIVED EXPERIENCES OF RURAL-BASED
GRANDPARENTS RAISING HIV/AIDS-ORPHANED
GRANDCHILDREN IN THE KINGDOM OF SWAZILAND: A
PROPOSED SELF-CARE HEALTH EDUCATION
PROGRAMME

BY

SIFISO I. SITHOLE
THE LIVED EXPERIENCES OF RURAL-BASED GRANDPARENTS
RAISING HIV/AIDS-ORPHANED GRANDCHILDREN IN THE
KINGDOM OF SWAZILAND: A PROPOSED SELF-CARE HEALTH
EDUCATION PROGRAMME

SIFISO I. SITHOLE

A thesis submitted in fulfilment of the
requirements for the degree

Doctor in Philosophy

in the

Faculty of Health Sciences

School of Nursing

at the

University of the Free State

November 2009
Study Promoter : Dr. Lily van Rhyn

i.

STATEMENT BY THE RESEARCHER

“I certify that the dissertation hereby submitted
by me for the PhD degree at the University of the
Free State waive is my independent effort and had
not previously been submitted for a degree at
another university/faculty. I furthermore waive
copyright of the dissertation in favour of the
University of the Free State.”
ii.

DEDICATION

I DEDICATE THIS PIECE OF WORK TO THE MEMORY OF
MY LOVING PARENTS:

THE REVEREND NDABANINGI SITHOLE

&

MRS. ALICE CANAAN SITHOLE

AND ALSO
TO THE MEMORY OF
MY DEAR SIBLINGS:

DINGINDLELA SITHOLE
&
SIKHULULEKILE SITHOLE
&
MPILWENHLE SITHOLE

iii.
ACKNOWLEDGEMENTS
More people than I can possibly document in this space
contributed immensely and wonderfully toward the
development and completion of my doctoral dissertation. I
wish to particularly and sincerely acknowledge the
following:

The Participants: Ngiyabonga kakhulu nine bekunene.

Study Promoter: I am very thankful to Dr. Lily van Rhyn
for the many roles she played in the development of this
research, DANKIE Lily.
Special Faculty: Professor M. Makiwane, Professor Agnes van
Dyk, Mr. Eric Sibanda, Dr. Michael T Masarirambi and Dr.
Winnie N Nhlengethwa.

Faculty of Health Sciences: Mrs. Maureen S Motsa, Dr Eunice
M Mabuza, Dr Murmly D Mathunjwa, Mrs. Oslinah B
Tagutanazvo, Dr Isabella S Ziyane, Ms Siphiwe BP Thwala, Ms
Sakhile KS Masuku, Mr. Alfred Murye, Mr. Jerry DZ Nxumalo
and Mr. Lucky Dlamini.

Library staff at the Faculties of Health Sciences and
Agriculture.

Family: Mr. Tom MD Mtine, Ms Madalitso I. Mtine, Reginald
G. Jr. Barrow, Siphikelelo-Jentimane-Sithole, Alberto
Jentimane, Dr. and Mrs. Mohammed A Kamal, Inkhosikati Make
Joyce-Kruger, Mrs. Betsy Fulton, Thabsile Shongwe, Tony
Kaiser and Berjee Barrow-Kaiser, Samantha Sithole, Jania
Mkunga and Chris Okaro, and Simbai and Chipo Chizendgeni

iv.
THE LIVED EXPERIENCES OF RURAL-BASED
GRANDPARENTS RAISING HIV/AIDS-ORPHANED
GRANDCHILDREN IN THE KINGDOM OF SWAZILAND: A
PROPOSED SELF-CARE HEALTH EDUCATION PROGRAMME

SUMMARY
Since the late 1990s, the Swazi adult population has been
dying from HIV/AIDS related illnesses and leaving behind
children who end up being looked after by older adults, in
particular grandparents in rural areas. Empirical evidence
abounds with findings that indicate that older adulthood is
predominantly characterized by declining health. Owing to
the HIV/AIDS epidemic that has killed many Swazi adults,
most grandparents, especially those in rural areas have
become primary caregivers of HIV/AIDS-orphaned minors.

This research investigated 14 rural-based grandparents
whose ages ranged from 60 through 88 years and looked
after, on a full time basis, grandchildren orphaned through
HIV/AIDS in the lowveld of the Kingdom of Swaziland.
Primarily, the study sought to explore and describe the
lived experiences of rural-based grandparents raising
grandchildren orphaned through HIV/AID. Secondly and based
on the findings, the ultimate purpose of the study was to
formulate a strategy to address the findings thereof.

The study was guided by the four phases of the nursing
process, namely assessment, planning, implementing and
evaluation. While phase one focused on exploring and
describing the day-to-day personal realities of these
rural-based grandparents raising grandchildren orphaned
through HIV/AIDS, phase two described the development of
the conceptual framework that was used to guide the
development of the health education programme. Phase three
focused on the structure and process of the actual
programme. Phase four evaluated the developed programme.
v.
Phase one:
This phase was the phenomenological part of the study and
had a design that was qualitative, exploratory, descriptive
and contextual. As the study was naturalistic, the data
were collected at the homesteads of the participants
through audio taped face-to-face unstructured in-depth
interviews that were guided by the following two open-
ended-questions, ‘‘Ngiccela ungichazele kabanti kutsi
engabe kunjani kunakekela batukulu bako labashiywa batali
babo?“ [“What/How is it like to care for your grandchildren
whose parents died through HIV/AIDS?“] and “Ukhona njani
kumelana netidzingo tonkhe telabatukulu bako?“ [“How do
you manage to look after your grandchildren whose parents
dies through HIV/AIDS?“] An exploratory interview preceded
the main data collection for the purpose of ensuring that
the two questions were clear enough for the participants
to understand and describe their day-to-day encouters with
such children.

Other sources of data were: field notes, health records and
to a lesser extent, photographs that were taken of objects
and relevant scenary but not the participants. The
researcher adhered to the prescribed research standards.

Data analysis started soon after completion of each
interview. The data were analyzed through the method of
Tesch (1990:93). Six major categories were identified: NO
SUPPORT, COMPROMISED HEALTH, RESOURCE AND BASIC NEEDS
CONSTRAINTS, FEELING OVERWHELMED, CONCERNS ABOUT THE FUTURE
OF THE GRANDCHILDREN and SACRIFICING. The majority of the
afore-mentioned identified categories needed interventions
that were collaborative between various stakeholders.
However, the category COMPROMISED HEALTH was found to be an
area that nursing could do something about. Consequently, a
health education programme to empower with self-care rural-
based grandparents raising GOTHA in the

vi.
lowveld was the strategy that was chosen. With the
completion of data analysis phase one had been completed.

Phase two:
This phase marked the post research stage and focused on
the development of the conceptual framework that guided the
development of the proposed health education programme to
empower with self-care rural-based grandparents raising
grandchildren orphaned through HIV/AIDS in the lowveld. Its
structure and process were described.

Phase three:
Phase three was divided into two interrelated parts, namely
phases 3(a) and 3(b). While phase three(a) described the
structure of the proposed health education programme, phase
three(b) focused on describing the process apsect of its
implementing. The implementers of the proposed health
education programme were identified as community health
nurses.

Phase four:
Phase four formed the final phase of the development of
this research and sought to evaluate the programme.
Selected stakeholders were requested for their input on the
developed health education programme. Also discussed in
this phase were the study contributions, limitations and
implications, especially to government and community health
nursing practice, education, management and research.
Recommendations were suggested.

Key words:
lived experiences, rural-based, grandparents, orphan,
HIV/AIDS, Grandchild, health education, programme, self-
care and empowerment
vii.
TABLE OF CONTENTS

CHAPTER ONE
INTRODUCTION AND PROBLEM STATEMENT
1.1 Introduction ……………………………………………………………………………………………………… 1
1.2 Study context …………………………………………………………………………………………………… 2
1.3 Background to the study problem …………………………………………………… 9
1.4 Statement of the problem …………………………………………………………………… 20
1.5 Purpose of the study ……………………………………………………………………………… 21
1.6 Significance of the study ………………………………………………………………… 22
1.7 Clarification of concepts ………………………………………………………………… 23
1.7.1 Adult child …………………………………………………………………………………… 24
1.7.2 HIV/AIDS …………………………………………………………………………………………… 24
1.7.3 Empowerment …………………………………………………………………………………… 25
1.7.4 Grandchild ……………………………………………………………………………………… 25
1.7.5 Grandparent …………………………………………………………………………………… 25
1.7.6 Grandparenting …………………………………………………………………………… 25
1.7.7 Health education programme …………………………………………… 25
1.7.8 Rural-based …………………………………………………………………………………… 26
1.7.9 Lived experiences …………………………………………………………………… 26
1.7.10 Orphan ……………………………………………………………………………………………… 26
1.7.11 Propose …………………………………………………………………………………………… 27
1.7.12 Self-care ……………………………………………………………………………………… 27
1.8 Overview of research design and methods …………………………… 27
1.8.1 Research design ………………………………………………………………………… 28
1.8.1.1 Qualitative ………………………………………………………………… 28
1.8.1.2 Exploratory ………………………………………………………………… 28
1.8.1.3 Descriptive ………………………………………………………………… 29
1.8.1.4 Contextual …………………………………………………………………… 29
1.8.2 Research methods………………………………………………………………………… 29