Presentation 2 - Tshwane University of Technology

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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

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

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

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


s
ubsequent 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.


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


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)

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)

Faculty of Science: Adelaide Tambo School of Nursing Science

1. BACKGROUND
(cont)

R
ole 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)

R
ole 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

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)

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

1.
BACKGROUND

(cont)

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


2
. THE RESEARCH PROBLEM

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

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

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

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.

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

Informal Settlement

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&WB

CD

TOTAL

Babies

Children


(< 6 years)

Totals

1820

885

2705


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

Faculty of Science: Adelaide Tambo School of Nursing Science

5.3 Research Design
(cont)

Inclusion criteria for the population:



C
aregiver that was willing to participate



C
aregiver 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

Internal threats

Measures to prevent/minimize error

Research design

Approved by
the official

departments concerned.


Measurement

The 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 analysis


The 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


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㈰〵2

Faculty of Science: Adelaide Tambo School of Nursing Science

7
. ETHICAL CONSIDERATIONS

Principle

Procedures 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.

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

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


Faculty of Science: Adelaide Tambo School of Nursing Science


8. FINDINGS OF THE STUDY
(cont)

8.1 Demographic data of the caregivers

Faculty of Science: Adelaide Tambo School of Nursing Science

8.2 Educational level of the caregivers

FIGURE 4.7 Educational level of the respondent


0%
20%
40%
60%
80%
Never went to
school
Up to grade 7
Grade 8-10
Grade 11-12
Formal
education
after school
1%

3%

23%

66%

7%

Conclusion:
Majority of caregivers were literate

8. FINDINGS OF THE STUDY
(cont)

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.



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 deficit

39.44

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 deficit

56.81

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 object

67.61

When
should a baby know his/her own name

49.3

When
should a child begin to sort objects by shapes and colours

73.24


Total

cognitive development knowledge deficit

63.38

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 deficit

63.38

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 deficit

50.0


















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)


















Faculty of Science: Adelaide Tambo School of Nursing Science

8.4 Caregivers education regarding the RTH chart

8. FINDINGS OF THE STUDY
(cont)

0%
10%
20%
30%
40%
50%
60%
Friend or family
member
Any other health
worker
RN at the PHC Clinic
RN in the maternity
ward
6%

3%

55%

36%

Conclusion:
S
mall 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

8.5 Caregivers’ social and economic environment

Poverty indicator

Situation of

caregiver

Female headed households

54% of caregivers were single

Unemployment

80%

of caregivers were unemployed

Number of children in
household

63% had 2 and more children

Inadequate nutrition

32% had a child that has previously been treated
for a underweight problem

Unsafe

neighbourhood

Crime, 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)

















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

Parent

35%

Teacher

2%

Registered Nurse

21%

Combination of all

42%



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

Faculty of Science: Adelaide Tambo School of Nursing Science

9
. RECOMMENDATIONS OF THE STUDY

NURSING PROFESSION

RECOMMENDATIONS

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
睥牥w汩瑥牡瑥t



Effect of knowledge providing programs (waiting room
education, workshops, outreach programs, etc).


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