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Live your life. Create your destiny. Knowledge Assessment of Caregivers regarding Early Childhood Development in a Resource Poor Community JS Meintjes.

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Presentation on theme: "Live your life. Create your destiny. Knowledge Assessment of Caregivers regarding Early Childhood Development in a Resource Poor Community JS Meintjes."— Presentation transcript:

1 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

2 1.BACKGROUND 2.THE RESEARCH PROBLEM 3.RESEARCH QUESTION 4.AIM OF THE STUDY 5.RESEARCH METHODS AND DESIGN 6.VALIDITY AND RELIABILITY 7.ETHICAL CONSIDERATIONS 8.FINDINGS OF THE STUDY (Results) 9.LIMITATION AND RECOMMENDATIONS 10.CONCLUSION Faculty of Science: Adelaide Tambo School of Nursing Science OVERVIEW OF THE PRESENTATION

3 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

4 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)

5 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. Faculty of Science: Adelaide Tambo School of Nursing Science 1. BACKGROUND (cont) Rapid brain development after birth: → by the age of 6 years: brain development 90% completed in size, and in the functions of the brain.

6 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

7 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)

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

9 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

10 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

11 Faculty of Science: Adelaide Tambo School of Nursing Science 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. 1. BACKGROUND (cont)

12 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)

13 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 1. BACKGROUND (cont)

14 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 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 2. THE RESEARCH PROBLEM

15 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 3. RESEARCH QUESTION

16 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 4. AIM OF THE STUDY

17 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. RESEARCH METHODS AND DESIGN 5.1 Research Strategy

18 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 community assessment revealed: -56% unemployment rate, and -75% of the population lived below the international poverty level. Faculty of Science: Adelaide Tambo School of Nursing Science 5. 2 Context of the Study C Ext 12 A Ext 12 B Ext 13 B Ext 13 A N N = new site C Informal Settlement

19 Faculty of Science: Adelaide Tambo School of Nursing Science 5. 2 Context of the Study (cont) Patient Database: Statistics January ‘10 to March ‘11 (15 mths) NCoP M&WBCDTOTAL BabiesChildren (< 6 years) Totals

20 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

21 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

22 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.

23 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.

24 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.

25 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.

26 Faculty of Science: Adelaide Tambo School of Nursing Science 6. VALIDITY AND RELIABILITY Internal threatsMeasures to prevent/minimize error Research designApproved by the official departments concerned. MeasurementThe questionnaire was pre-tested. Data gathering Data gathered under standardized conditions by the researcher. Using the questionnaire as the basis of the structured interview ensured structural coherence throughout the interviews. Data analysisThe sample size was envisaged to be 71 study subjects by a TUT statistician. The statistical software package that was used by the statistician to analyze the data was Stata 11. External validity The researcher is : an experienced Registered Nurse and M-Tech student at ATSON (TUT), and has been engaged in the community since 2005.

27 Faculty of Science: Adelaide Tambo School of Nursing Science 7. ETHICAL CONSIDERATIONS PrincipleProcedures implemented by the researcher Beneficence No harm was intended. Efforts were made to minimize any emotional discomfort. No physical discomfort was anticipated. Informed consent was obtained from the caregivers. Respect for human dignity Informed consent included the caregivers’ rights to withdraw at any time without penalty or prejudicial treatment. The caregivers were assured that all information obtained was strictly confidential. Justice All personal details of the caregivers were kept confidential and would not be compromised at any stage.

28 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

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

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

31 Faculty of Science: Adelaide Tambo School of Nursing Science FIGURE 4.7 Educational level of the respondent 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.

32 Faculty of Science: Adelaide Tambo School of Nursing Science FIGURE 4.7 Educational level of the respondent 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on gross motor development % Incorrect When should a baby be able to roll over?18.31 When should a baby be able to sit without support?60.56 When should a baby be able to walk without holding on?39.44 Total gross motor development knowledge deficit39.44

33 Faculty of Science: Adelaide Tambo School of Nursing Science FIGURE 4.7 Educational level of the respondent 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on fine motor and visual perception development % Incorrect When should a baby be able to hold something in his/her hand (like a rattle)?39.44 When should a child be able to dress and undress without help?57.75 When should a baby be able to turn a single page of a book?73.24 Total fine motor and visual perception development knowledge deficit56.81

34 Faculty of Science: Adelaide Tambo School of Nursing Science FIGURE 4.7 Educational level of the respondent 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on cognitive development % Incorrect When should a baby search for a hidden object67.61 When should a baby know his/her own name49.3 When should a child begin to sort objects by shapes and colours73.24 Total cognitive development knowledge deficit63.38

35 Faculty of Science: Adelaide Tambo School of Nursing Science FIGURE 4.7 Educational level of the respondent 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on audio and speech development % Incorrect When should a baby respond to "no"?50.7 When should a baby point to body parts when asked?74.65 When should a child speaks clearly enough for strangers to understand?64.79 Total audio and speech development knowledge deficit63.38

36 Faculty of Science: Adelaide Tambo School of Nursing Science FIGURE 4.7 Educational level of the respondent 8. FINDINGS OF THE STUDY (cont) Caregivers’ knowledge deficits on social and emotional development % Incorrect When should a baby smile?21.13 When should a baby laugh out loud in playful situations?28.17 When should a child be toilet trained?83.10 When should a child know his/her gender?67.61 Total social and emotional development knowledge deficit50.0

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

38 Faculty of Science: Adelaide Tambo School of Nursing Science 8.4 Caregivers education regarding the RTH chart 8. FINDINGS OF THE STUDY (cont) 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.

39 Faculty of Science: Adelaide Tambo School of Nursing Science 8.5 Caregivers’ social and economic environment Poverty indicatorSituation of caregiver Female headed households54% of caregivers were single Unemployment80% of caregivers were unemployed Number of children in household 63% had 2 and more children Inadequate nutrition32% had a child that has previously been treated for a underweight problem Unsafe neighbourhoodCrime, alcohol and drug abuse, lack of safe playing areas in the community and insufficient funds to afford pre-school education were the main concerns voiced in the open ended question 8. FINDINGS OF THE STUDY (cont)

40 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 8. RESULTS OF THE STUDY (cont) 8.6 Most significant role player in ECD problems management as seen by the caregivers Responsible role player in managing ECD problems Parent35% Teacher2% Registered Nurse21% Combination of all42%

41 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. LIMITATIONS AND RECOMMENDATIONS 9.1 Limitations

42 Faculty of Science: Adelaide Tambo School of Nursing Science 9. RECOMMENDATIONS OF THE STUDY NURSING PROFESSIONRECOMMENDATIONS NURSING PRACTICE Improve Registered Nurse / Caregiver partnership. Develop programs to provide caregivers with knowledge. NURSING EDUCATION Policy makers should include caregiver’s role in all curriculum development. NURSING RESEARCH Effect of the environment on the caregiver’s knowledge regarding ECD. Reason for knowledge deficit if the majority of caregiver’s were literate. Effect of knowledge providing programs (waiting room education, workshops, outreach programs, etc).

43 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. Faculty of Science: Adelaide Tambo School of Nursing Science 10. THE STUDY PROVIDED EVIDENCE THAT: These findings will guide: -Intervention Research studies to develop and implement knowledge providing programs to improve caregivers knowledge about ECD


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