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Faculty of Science: Adelaide Tambo School of Nursing Science Live your life. Create your destiny. Knowledge Assessment of Caregivers regarding Early Childhood Development in a Resource Poor Community JS Meintjes & Dr. C van Belkum

Faculty of Science: Adelaide Tambo School of Nursing Science OVERVIEW OF THE PRESENTATION BACKGROUND THE RESEARCH PROBLEM RESEARCH QUESTION AIM OF THE STUDY RESEARCH METHODS AND DESIGN VALIDITY AND RELIABILITY ETHICAL CONSIDERATIONS FINDINGS OF THE STUDY (Results) LIMITATION AND RECOMMENDATIONS CONCLUSION

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND • UN Millennium Summit (2000): • The Millennium Development Goals were adopted as a framework for: • reducing poverty • ensuring completion of primary school education. • Countries were encouraged to commit to their children’s future through early childhood development (ECD) programmes.

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) • The South African Government’s plan for ECD (2007) aimed to provide the following services to the young child: • health, • physical, • emotional, • psychosocial, and • cognitive development.

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND(cont) • Period from conception to age 6 years: • = most important influence of any time in the life cycle on • brain development, and • subsequent learning, behaviour and health. • Rapid brain development after birth: • by the age of 6 years: • brain development 90% completed • in size, and • in the functions of the brain.

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) • Schematic presentation: • Brain growth in comparison with – • lymphatic tissues, • general physical growth, and • reproductive organs.

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) • The process of development : • Continuous and cumulative • Proceeds stage by stage in an orderly sequence • Each sub stage: • - influence development of following stage

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) Gross motor development Areas of development Fine motor and visual perception The child Audio and speech development Cognitive development Social and emotional development Physical development

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) • Role of the caregiver in ECD: • Caregiver = a person who takes care of a child, whether related or not, free of charge • Young children are dependent on caregivers for their care and development • Caregiver should be able to recognise if a child has any developmental problems • At birth: every caregiver provided with growth chart for the child • (SA: Road to Health chart) • - provide caregiver with a guideline to: • normal physical growth • neuro-development (include gross motor and speech development) • immunization schedule

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) • Role of the caregiver in ECD (cont): • Caregiver holds the key for: • early intervention if developmental problems occur, through: • early identification • by providing the medical professional with accurate information • The caregiver’s competency to provide care is dependant on: • the macro-social and economic environment of their daily circumstances

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) • The influence of a resource poor community (poverty) on ECD: • Poverty concept clarification: • = the denial of opportunities and choices most basic to human development to lead a long, healthy, creative life and to enjoy a decent standard of living, freedom, dignity, self-esteem and respect from others. • Poverty results in: • compromised child development, • restricted human potential, and • has a cumulative negative impact on ECD. • Young child’s relationship with their caregivers: • extremely vulnerable to the stress associated with poverty.

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND(cont) • Role of the SA Registered Nurse (RN) in ECD: • Nurses are the backbone of the health care system in South Africa. • Since 1980 the role of the nurse has shifted largely: • from supportive care of the sick  community nursing • result: health focus rather than an illness focus. • Currently: RN work across the whole spectrum of child health • - health promotion in primary health care • - nurse specialists in tertiary centers, and • - rehabilitation and care in community settings.

Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND(cont) • Role of the SA Registered Nurse in ECD: • The SA Registered Nurse should: • use every opportunity to monitor development, • timely identify developmental problems, and • intervene appropriate. • Rationale for this statement: • The SA Registered Nurse is the professional (incl. educational and social welfare) with the most frequent opportunity to evaluate the young child. • - How?the childhood immunisation schedule provide regular access to the child.

Faculty of Science: Adelaide Tambo School of Nursing Science 2. THE RESEARCH PROBLEM • Uniqueness of early childhood: • a time of extraordinary development • a time of vulnerability - poverty has a cumulative negative impact on ECD • Researcher has been engaged in the community since 2005 . During this period she came to the following conclusion: • Several children had developmental milestone deficits • Caregivers did not voice any concern regarding this matter • 2008 Community assessment: • 75% of population lived below the international poverty level of 2US$ / day

Faculty of Science: Adelaide Tambo School of Nursing Science 3. RESEARCH QUESTION The research question that was raised: How knowledgeable are caregivers of ECD problems in children younger than 6 years living in Soshanguve Ext.12 and 13?

Faculty of Science: Adelaide Tambo School of Nursing Science 4. AIM OF THE STUDY • The aim of the study was: • to determine caregivers knowledge regarding ECD of children living in a resource poor community. • The objectives were to: • explore caregiver’s previous education regarding the Road to Health chart, • explore caregiver’s knowledge regarding the child’s physical growth and development.

Faculty of Science: Adelaide Tambo School of Nursing Science 5. RESEARCH METHODS AND DESIGN 5.1 Research Strategy The research strategy of this study was: Exploratory Rationale for this research strategy: No information was available on caregivers’ knowledge of ECD of children younger than 6 years living in Soshanguve Ext. 12 and 13

Faculty of Science: Adelaide Tambo School of Nursing Science 5. 2 Context of the Study Informal Settlement Ext 13 B • The study was conducted in Soshanguve Ext.12 and 13: • Soshanguve forms part of the greater Tshwane Metropolitan Municipality. • It is a semi formal settlement 45 km. north of Pretoria. • The total number of people living in these extensions is unknown as informal houses are constantly erected. • 2008 community assessment revealed: • 56% unemployment rate, and • 75% of the population lived below the international poverty level. Ext 13 A Ext 12 A C C N Ext 12 B N = new site

Faculty of Science: Adelaide Tambo School of Nursing Science 5. 2 Context of the Study (cont)

Faculty of Science: Adelaide Tambo School of Nursing Science 5.3 Research Design • Quantitative survey • Population: The population was all caregivers of children younger than 6 years attending the CD NCoP • Sampling method: Consecutive sampling • Sampling size:n=71 • Data gathering method: Structured interview

Faculty of Science: Adelaide Tambo School of Nursing Science 5.3 Research Design (cont) • Inclusion criteria for the population: • Caregiver that was willing to participate • Caregiver of a child younger than 6 years attending the CD NCoP from approval of the study by the Research Ethics Committee until the advised sample size was reached • Informed consent was obtained from the caregiver

Faculty of Science: Adelaide Tambo School of Nursing Science 5.3 Research Design (cont) • Planning for the data gathering: • Before data collection: • Obtained approval from: • The Departmental Research and Innovation Committee (DRIC) • The Higher Degrees Committee of Tshwane University of Technology • The Research Ethics Committee of Tshwane University of Technology • University-based Nursing Education South Africa (UNEDSA) NCoP Programme Manager • Pre-tested the questionnaire • During data collection: • Obtained informed consent from the participant. • Conducted the interview: • in private • only by the researcher. • Interpreter was used when necessary.

Faculty of Science: Adelaide Tambo School of Nursing Science 5.3 Research Design (cont) • Data gathering instrument: • A questionnaire: contained closed-ended questions and one open- ended question. • The Toronto Red Flags Guide on development was utilised to guide with the development of the questionnaire. • Error margin of two months was allowed on all questions regarding ECD, as advised by an occupational therapist. • The data gathering instrument was pre-tested, using the first five caregivers of children younger than 6 years, visiting the CD NCoP after approval of the study by the Ethics Committee.

Faculty of Science: Adelaide Tambo School of Nursing Science 5.3 Research Design (cont) • Data Analysis: • An Excel spread sheet was developed to include each variable identified. • All variables were coded and entered under controlled circumstances limiting interruptions to reduce errors during this phase. • Random check for accuracy was done. • A backup was made of all captured data. • All original data was filed for safe keeping at ATSON (Tshwane University of Technology) for three years.

Faculty of Science: Adelaide Tambo School of Nursing Science 5.3 Research Design (cont) • Data Analysis (cont): • The statistical software package that was used by the statistician to analyze the data was Stata 11. All variables were analyzed descriptively with appropriate statistical methods. • Data gathered by means of the open-ended question was coded during the examination of the data, using a descriptive coding strategy.

Faculty of Science: Adelaide Tambo School of Nursing Science 6. VALIDITY AND RELIABILITY

Faculty of Science: Adelaide Tambo School of Nursing Science 7. ETHICAL CONSIDERATIONS

Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY Findings will be discussed according to the following: 8.1 Demographic data of the caregivers 8.2 Educational level of the caregivers 8.3 Caregivers’ knowledge deficits 8.4 Caregivers’ education regarding the RTH chart 8.5 Caregivers’ social and economic environment 8.6 Most significant role player in ECD problem management as seen by the caregivers

Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) 8.1 Demographic data of the caregivers Marital status Single: 54% Employment status Unemployed: 80% Conclusion: Caregivers’ in age group 25-30 years were in the majority and older than 40 in the minority

FIGURE 4.7 Educational level of the respondent Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) 8.2 Educational level of the caregivers Conclusion: Majority of caregivers were literate

FIGURE 4.7 Educational level of the respondent Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) • 8.3 Caregiver’s knowledge deficits: • Discussion will be presented within the following framework: • gross motor development, • fine motor and visual perception development, • cognitive development, • audio and speech development, and • social and emotional development.

FIGURE 4.7 Educational level of the respondent Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits ongross motor development

FIGURE 4.7 Educational level of the respondent Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on fine motor and visual perception development

FIGURE 4.7 Educational level of the respondent Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on cognitive development

FIGURE 4.7 Educational level of the respondent Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on audioand speech development

FIGURE 4.7 Educational level of the respondent Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on social and emotional development

Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) 8.3 Caregivers’ knowledge deficits Conclusion: Knowledge deficit in all development categories - highest in cognitive, audio and speech development

Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) 8.4 Caregivers education regarding the RTH chart Conclusion: Small majority (54%) of caregivers never received education on the importance and interpretation of the Road to Health chart - RN is the main provider of this knowledge .

Faculty of Science: Adelaide Tambo School of Nursing Science 8. FINDINGS OF THE STUDY (cont) 8.5 Caregivers’ social and economic environment

Faculty of Science: Adelaide Tambo School of Nursing Science 8. RESULTS OF THE STUDY (cont) 8.6 Most significant role player in ECD problems management as seen by the caregivers • Conclusion: • Caregivers’ expect the Registered Nurse to play a significant(63%) role in managing ECD problems.

Faculty of Science: Adelaide Tambo School of Nursing Science 9. LIMITATIONS AND RECOMMENDATIONS 9.1 Limitations Questionnaire was pre tested and rephrased as advised but there were still caregivers that could not understand some of the questions.

Faculty of Science: Adelaide Tambo School of Nursing Science 9. RECOMMENDATIONS OF THE STUDY

Faculty of Science: Adelaide Tambo School of Nursing Science 10. THE STUDY PROVIDED EVIDENCE THAT: • Caregivers’ have a knowledge deficit regarding ECD of children younger than 6 years living in this resource poor community. • Caregivers expect the RN to play a significant role in timely identification and intervention of ECD problems. • These findings will guide: • Intervention Research studies to develop and implement knowledge providing programs to improve caregivers knowledge about ECD

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