Filling the language gap: the feasibility of communication resources used in the provision of healthcare for HIV/AIDS and tuberculosis in the Eastern Cape, South Africa
- Authors: Von Witt, Nathalia Jane
- Date: 2025-04-02
- Subjects: Communication in community health services South Africa Eastern Cape , Language and languages South Africa Eastern Cape , Multilingualism , Medical care South Africa , Communication in public health , Health literacy
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/478504 , vital:78192 , DOI 10.21504/10962/478504
- Description: South Africa has the largest number of Human Immunodeficiency Virus (HIV)-positive people in the world, the third-highest rate of Tuberculosis (TB) infections, and the second-highest rate of Multi-Drug Resistant TB (MDR-TB) globally, with up to 60% of HIV-positive healthcare users (HCUs) infected with TB as a co-infection. Both HIV/AIDS and TB require strict medicines adherence for disease management or treatment respectively; however, this is often not attained, and as such these statistics also represent lives affected by or lives lost to these diseases. Moreover, in South Africa, up to 80% of healthcare consultations are conducted through a second language. Despite language policies suggesting the contrary, African languages are neglected in healthcare provision in South Africa. This perpetuates inequalities within the South African healthcare system by limiting HCUs understanding of and agency in their own healthcare and maintaining a barrier to more effective treatment. Such language barriers may also result in HCUs defaulting on treatment. Added to this, the fear and mistrust arising from language power dynamics contributes to high rates of avoidance behaviour. This research therefore aimed to (a) explore how healthcare professionals (HCPs) and HCUs communicate when they are not fluent in the same language in care for HIV/AIDS and TB patients; (b) develop practical and feasible strategies that would enable HCPs to address language barriers in their consultations for HIV and TB and (c) to empirically evaluate these strategies in a pilot feasibility trial in the Eastern Cape. The first aim (a) concerning the problem of language barriers in healthcare consultations was addressed through identifying communication barriers experienced by HCPs in South Africa, exploring the strategies used to navigate or alleviate these barriers, creating and implementing communication resources, and analysing the effects of these resources on HCPs’ communication. A selective narrative review was conducted (Chapter 2) to identify the main communication problems experienced by HCPs and HCUs, as well as the main communication strategies and resources used by HCPs to reduce these communication problems. This was further explored by conducting two needs analyses with HCPs (n=31) in South Africa, and specifically in the Eastern Cape, which revealed differing perspectives on health communication and confirmed HCPs’ need for communication resources. For the second aim (b), existing communication resources were reviewed and selected or further developed following a Participatory Action Research approach, and then (c) empirically evaluated in a pilot feasibility trial with six healthcare sites in the Eastern Cape. Both the needs analyses and the pilot feasibility trial were adapted to employ an online or blended approach due to COVID-19-related limitations. The feasibility and acceptability of both the study protocol and the proposed communication resources were evaluated. Three major findings emerged from this research. First, this research echoed existing literature confirming that HCPs do not have the support they need at a structural level. Second, while it was found that there is no one-size-fits-all solution for resources and training to improve HCP-HCU communication, it was noted that the most appropriate resources are those that are flexible, and those that support HCPs’ language learning. HCPs who were already sensitive to communication barriers and were already taking steps to improve their second language (L2) proficiency also took initiative to use the resources in ways other than those suggested in order to best support the communication needs of them and the HCUs they consulted. Third, and linked to the second finding, it was found that communication resources that covered conditions including, but not limited to, HIV and TB were more appropriate. HCPs who used the resources showed a small, although not statistically significant, increase in communication satisfaction, satisfaction with resource support, and trust after using the resources for one month. Although implementation problems were encountered in some settings of the intervention, it was found that this intervention has the potential to be further evaluated in a larger, multi-site randomised controlled trial (RCT). These findings inform recommendations which are made to improve the feasibility of such a study in order to conduct an RCT; to further develop the resources in order to enhance communication between HCPs and HCUs both in HIV and TB consultations and in other fields of healthcare; and to implement a similar intervention at the university level and as Continuing Medical Education. The insights gained into HCPs’ support for language support resources, which resources were used, and particularly how they were used, are significant for taking actionable steps in supporting HCPs’ provision of more equitable healthcare in multilingual South Africa. , Thesis (PhD) -- Faculty of Humanities, Languages and Literatures, 2025
- Full Text:
- Date Issued: 2025-04-02
- Authors: Von Witt, Nathalia Jane
- Date: 2025-04-02
- Subjects: Communication in community health services South Africa Eastern Cape , Language and languages South Africa Eastern Cape , Multilingualism , Medical care South Africa , Communication in public health , Health literacy
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/478504 , vital:78192 , DOI 10.21504/10962/478504
- Description: South Africa has the largest number of Human Immunodeficiency Virus (HIV)-positive people in the world, the third-highest rate of Tuberculosis (TB) infections, and the second-highest rate of Multi-Drug Resistant TB (MDR-TB) globally, with up to 60% of HIV-positive healthcare users (HCUs) infected with TB as a co-infection. Both HIV/AIDS and TB require strict medicines adherence for disease management or treatment respectively; however, this is often not attained, and as such these statistics also represent lives affected by or lives lost to these diseases. Moreover, in South Africa, up to 80% of healthcare consultations are conducted through a second language. Despite language policies suggesting the contrary, African languages are neglected in healthcare provision in South Africa. This perpetuates inequalities within the South African healthcare system by limiting HCUs understanding of and agency in their own healthcare and maintaining a barrier to more effective treatment. Such language barriers may also result in HCUs defaulting on treatment. Added to this, the fear and mistrust arising from language power dynamics contributes to high rates of avoidance behaviour. This research therefore aimed to (a) explore how healthcare professionals (HCPs) and HCUs communicate when they are not fluent in the same language in care for HIV/AIDS and TB patients; (b) develop practical and feasible strategies that would enable HCPs to address language barriers in their consultations for HIV and TB and (c) to empirically evaluate these strategies in a pilot feasibility trial in the Eastern Cape. The first aim (a) concerning the problem of language barriers in healthcare consultations was addressed through identifying communication barriers experienced by HCPs in South Africa, exploring the strategies used to navigate or alleviate these barriers, creating and implementing communication resources, and analysing the effects of these resources on HCPs’ communication. A selective narrative review was conducted (Chapter 2) to identify the main communication problems experienced by HCPs and HCUs, as well as the main communication strategies and resources used by HCPs to reduce these communication problems. This was further explored by conducting two needs analyses with HCPs (n=31) in South Africa, and specifically in the Eastern Cape, which revealed differing perspectives on health communication and confirmed HCPs’ need for communication resources. For the second aim (b), existing communication resources were reviewed and selected or further developed following a Participatory Action Research approach, and then (c) empirically evaluated in a pilot feasibility trial with six healthcare sites in the Eastern Cape. Both the needs analyses and the pilot feasibility trial were adapted to employ an online or blended approach due to COVID-19-related limitations. The feasibility and acceptability of both the study protocol and the proposed communication resources were evaluated. Three major findings emerged from this research. First, this research echoed existing literature confirming that HCPs do not have the support they need at a structural level. Second, while it was found that there is no one-size-fits-all solution for resources and training to improve HCP-HCU communication, it was noted that the most appropriate resources are those that are flexible, and those that support HCPs’ language learning. HCPs who were already sensitive to communication barriers and were already taking steps to improve their second language (L2) proficiency also took initiative to use the resources in ways other than those suggested in order to best support the communication needs of them and the HCUs they consulted. Third, and linked to the second finding, it was found that communication resources that covered conditions including, but not limited to, HIV and TB were more appropriate. HCPs who used the resources showed a small, although not statistically significant, increase in communication satisfaction, satisfaction with resource support, and trust after using the resources for one month. Although implementation problems were encountered in some settings of the intervention, it was found that this intervention has the potential to be further evaluated in a larger, multi-site randomised controlled trial (RCT). These findings inform recommendations which are made to improve the feasibility of such a study in order to conduct an RCT; to further develop the resources in order to enhance communication between HCPs and HCUs both in HIV and TB consultations and in other fields of healthcare; and to implement a similar intervention at the university level and as Continuing Medical Education. The insights gained into HCPs’ support for language support resources, which resources were used, and particularly how they were used, are significant for taking actionable steps in supporting HCPs’ provision of more equitable healthcare in multilingual South Africa. , Thesis (PhD) -- Faculty of Humanities, Languages and Literatures, 2025
- Full Text:
- Date Issued: 2025-04-02
Translanguaging pedagogies and practice for social justice in a multilingual South African previously disadvantaged
- Authors: Mpofu, Tarisai
- Date: 2024-06
- Subjects: Multilingualism
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/11131 , vital:75921
- Description: Over the last two decades, there has been a burgeoning interest in translanguaging as both a theory and a methodology, but a few studies have looked at it as a pedagogy. This has meant that while there is near-consensus on translanguaging’s contribution to knowing, there have been few studies on how it can be implemented systematically in classrooms. This study examines how translanguaging is being practiced at one South African university and makes recommendations on how translanguaging can be implemented systematically for better impact. A mixed method approach was used, meaning that it had both qualitative and quantitative elements. Data for this study were gathered using online questionnaires completed by students and lecturers, interviews with lecturers, and observation. The results show that limited translanguaging was taking place in the classroom, despite both students and staff acknowledging its value to epistemic access. This study calls for intentional and systematic implementation of translanguaging to contribute to socially-just classroom practices. The study proposes the translanguaging matrix model for practice to assist in institutionalising translanguaging through the provision of short learning courses for staff and students on translanguaging, language learning opportunities and clear pedagogical training on when translanguaging must be used in classroom contexts. Key Words: Translanguaging, Language Policy, Social Justice, Multilingalism, Pedagogy , Thesis (D.Ed) -- Faculty of Education, 2024
- Full Text:
- Date Issued: 2024-06
- Authors: Mpofu, Tarisai
- Date: 2024-06
- Subjects: Multilingualism
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/11260/11131 , vital:75921
- Description: Over the last two decades, there has been a burgeoning interest in translanguaging as both a theory and a methodology, but a few studies have looked at it as a pedagogy. This has meant that while there is near-consensus on translanguaging’s contribution to knowing, there have been few studies on how it can be implemented systematically in classrooms. This study examines how translanguaging is being practiced at one South African university and makes recommendations on how translanguaging can be implemented systematically for better impact. A mixed method approach was used, meaning that it had both qualitative and quantitative elements. Data for this study were gathered using online questionnaires completed by students and lecturers, interviews with lecturers, and observation. The results show that limited translanguaging was taking place in the classroom, despite both students and staff acknowledging its value to epistemic access. This study calls for intentional and systematic implementation of translanguaging to contribute to socially-just classroom practices. The study proposes the translanguaging matrix model for practice to assist in institutionalising translanguaging through the provision of short learning courses for staff and students on translanguaging, language learning opportunities and clear pedagogical training on when translanguaging must be used in classroom contexts. Key Words: Translanguaging, Language Policy, Social Justice, Multilingalism, Pedagogy , Thesis (D.Ed) -- Faculty of Education, 2024
- Full Text:
- Date Issued: 2024-06
The views and opinions of Rhodes University lecturers towards isiXhosa as a language of learning and teaching (LOLT) in higher education
- Authors: Nkunzi, Zintle
- Date: 2023-10-13
- Subjects: Multilingualism , Bilingualism , Language and education , Xhosa language , College teachers South Africa Makhanda Attitudes , Code switching (Linguistics)
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/424963 , vital:72197
- Description: This research sought to investigate how African languages function as a communicative tool in a university where English is the medium of instruction. The study's purpose is to provide a systematic review of research that has been carried out on language attitudes towards isiXhosa as a language of learning and teaching (LoLT) in higher education. The study reveals that South African higher education institutions such as Rhodes University mostly use English as the LoLT- a language which for most lecturers is not their first/home language but helps ease communication in a multilingual community. Rhodes University is characterised by multilingualism because the university community is made up of diversity in culture, language, and educational background of the people. Previously explored language attitude studies are based on students’ views and this study investigated RU lecturer views and opinions towards isiXhosa as a LoLT. The study focused on the importance and the need (if any) of isiXhosa in a multilingual higher education institution. The study reveal that language barriers are one of the difficulties, but academic cultural differences seem to play a crucial role that can impact on the learning and teaching outcomes. This can lead to negative experiences and the forming of stereotypical views. These views include how lecturers are and should be trained to teach mathematics, science, and academic studies in African languages. The SA higher education practices and language use (i.e., monolingual language policy) are one of the reasons that the implementation of indigenous languages in education policies in SA is fraught with difficulties due to several factors. Amongst the factors is the fact that indigenous languages are not yet fully developed as academic languages. The study further reveals that lecturers find it difficult to teach mathematical studies in isiXhosa because of lack of terminology in the language for academic purposes particularly at a tertiary level. Furthermore, existing literature highlights the importance of the use of code-switching which is a beneficial practice for lecturers in assisting their students who struggle with English as a LoLT at RU. The lecturer views towards isiXhosa as a LoLT at RU is not only on language barrier but also about the lack of development in the language use in spaces where only English is believed to be the best such as language for academics. The study also reveals an integration of Information Communication Technology in education and how language appears as a barrier. , Thesis (MA) -- Faculty of Humanities, School of Languages and Literatures, 2023
- Full Text:
- Date Issued: 2023-10-13
- Authors: Nkunzi, Zintle
- Date: 2023-10-13
- Subjects: Multilingualism , Bilingualism , Language and education , Xhosa language , College teachers South Africa Makhanda Attitudes , Code switching (Linguistics)
- Language: English
- Type: Academic theses , Master's theses , text
- Identifier: http://hdl.handle.net/10962/424963 , vital:72197
- Description: This research sought to investigate how African languages function as a communicative tool in a university where English is the medium of instruction. The study's purpose is to provide a systematic review of research that has been carried out on language attitudes towards isiXhosa as a language of learning and teaching (LoLT) in higher education. The study reveals that South African higher education institutions such as Rhodes University mostly use English as the LoLT- a language which for most lecturers is not their first/home language but helps ease communication in a multilingual community. Rhodes University is characterised by multilingualism because the university community is made up of diversity in culture, language, and educational background of the people. Previously explored language attitude studies are based on students’ views and this study investigated RU lecturer views and opinions towards isiXhosa as a LoLT. The study focused on the importance and the need (if any) of isiXhosa in a multilingual higher education institution. The study reveal that language barriers are one of the difficulties, but academic cultural differences seem to play a crucial role that can impact on the learning and teaching outcomes. This can lead to negative experiences and the forming of stereotypical views. These views include how lecturers are and should be trained to teach mathematics, science, and academic studies in African languages. The SA higher education practices and language use (i.e., monolingual language policy) are one of the reasons that the implementation of indigenous languages in education policies in SA is fraught with difficulties due to several factors. Amongst the factors is the fact that indigenous languages are not yet fully developed as academic languages. The study further reveals that lecturers find it difficult to teach mathematical studies in isiXhosa because of lack of terminology in the language for academic purposes particularly at a tertiary level. Furthermore, existing literature highlights the importance of the use of code-switching which is a beneficial practice for lecturers in assisting their students who struggle with English as a LoLT at RU. The lecturer views towards isiXhosa as a LoLT at RU is not only on language barrier but also about the lack of development in the language use in spaces where only English is believed to be the best such as language for academics. The study also reveals an integration of Information Communication Technology in education and how language appears as a barrier. , Thesis (MA) -- Faculty of Humanities, School of Languages and Literatures, 2023
- Full Text:
- Date Issued: 2023-10-13
Linguistic minorities in the South African context : the case of Tshivenda
- Authors: Luvhengo, Nkhangweleni
- Date: 2013
- Subjects: Indigenous African languages , Apartheid , Tshivenda , Minority languages , Development , Status , Multilingualism , Sesotho , isiZulu , Perceptions , Linguistic minorities -- Research -- South Africa , Venda language -- Research -- South Africa , Language policy -- Research -- South Africa , Multilingualism -- Research -- South Africa , Linguistic rights -- Research -- South Africa , Language and languages -- Political aspects
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:3558 , http://hdl.handle.net/10962/d1001862
- Description: After many years of the oppressive apartheid government, the new democratic era came into being in 1994. Lot of policy changes came into being, including language policy. This new language policy of the post-apartheid era recognises eleven official languages which include the nine indigenous African languages which were previously recognised as regional languages in the different homelands. The present study investigates the progress of Tshivenda in terms of status and development since it was accorded the official status in South Africa. Literature investigating the status of Tshivenda is generally sparse. This study investigates the status of Tshivenda in South Africa to explore how minority languages which are also recognised as official languages are treated. In most multilingual countries, there are issues which affect the development of minority languages, but the South African situation is interesting in that some of the minority languages are recognised as official languages. This study is a comparative in nature. Firstly, the study compares the level of corpus planning and development in Tshivenda and other indigenous South African languages. Secondly, it compares how people use Tshivenda in a rural area of Lukalo Village where the language is not under pressure from other languages and in Cosmo City, an urban area in Gauteng where Tshivenda speakers come into contact with speakers of more dominant languages such as isiZulu and Sesotho. Language use in different domains like, media, education, government and the home is considered in order to establish how people use languages and the factors which influence their linguistic behaviours. The study also establishes the perceptions and attitudes of the speakers of Tshivenda as a minority and those of the speakers of other languages towards Tshivenda’s role in the different domains such as education and the media. This study was influenced by previous research (Alexander 1989, Webb 2002) which found out that during the apartheid period Tshivenda speakers used to disguise their identity by adopting dominant languages like isiZulu and Sesotho in Johannesburg. Accordingly, the present research wanted to establish how the language policy change in the democratic era has impacted on the confidence of Tshivenda speakers regarding themselves and their language. This study establishes that although Tshivenda is now an official language in post-apartheid South Africa, it still has features of underdevelopment and marginalization that are typically of unofficial minority languages. Translation, lexicographic and terminological work in this language still lags behind that of other indigenous South African languages and there is still a shortage of school textbooks and adult literature in this language. As a result, using the language in education, the media and other controlling domains is still quite challenging, although positive developments such as the teaching of the language at university level can be noted. The Tshivenda speakers generally have a positive attitude towards their language and seem prepared to learn and use it confidently as long its functional value is enhanced, which is currently not happening. As a result, some Tshivenda speakers still regard English as a more worthwhile language to learn at the expense of their language
- Full Text:
- Date Issued: 2013
- Authors: Luvhengo, Nkhangweleni
- Date: 2013
- Subjects: Indigenous African languages , Apartheid , Tshivenda , Minority languages , Development , Status , Multilingualism , Sesotho , isiZulu , Perceptions , Linguistic minorities -- Research -- South Africa , Venda language -- Research -- South Africa , Language policy -- Research -- South Africa , Multilingualism -- Research -- South Africa , Linguistic rights -- Research -- South Africa , Language and languages -- Political aspects
- Language: English
- Type: text , Thesis , Masters , MA
- Identifier: vital:3558 , http://hdl.handle.net/10962/d1001862
- Description: After many years of the oppressive apartheid government, the new democratic era came into being in 1994. Lot of policy changes came into being, including language policy. This new language policy of the post-apartheid era recognises eleven official languages which include the nine indigenous African languages which were previously recognised as regional languages in the different homelands. The present study investigates the progress of Tshivenda in terms of status and development since it was accorded the official status in South Africa. Literature investigating the status of Tshivenda is generally sparse. This study investigates the status of Tshivenda in South Africa to explore how minority languages which are also recognised as official languages are treated. In most multilingual countries, there are issues which affect the development of minority languages, but the South African situation is interesting in that some of the minority languages are recognised as official languages. This study is a comparative in nature. Firstly, the study compares the level of corpus planning and development in Tshivenda and other indigenous South African languages. Secondly, it compares how people use Tshivenda in a rural area of Lukalo Village where the language is not under pressure from other languages and in Cosmo City, an urban area in Gauteng where Tshivenda speakers come into contact with speakers of more dominant languages such as isiZulu and Sesotho. Language use in different domains like, media, education, government and the home is considered in order to establish how people use languages and the factors which influence their linguistic behaviours. The study also establishes the perceptions and attitudes of the speakers of Tshivenda as a minority and those of the speakers of other languages towards Tshivenda’s role in the different domains such as education and the media. This study was influenced by previous research (Alexander 1989, Webb 2002) which found out that during the apartheid period Tshivenda speakers used to disguise their identity by adopting dominant languages like isiZulu and Sesotho in Johannesburg. Accordingly, the present research wanted to establish how the language policy change in the democratic era has impacted on the confidence of Tshivenda speakers regarding themselves and their language. This study establishes that although Tshivenda is now an official language in post-apartheid South Africa, it still has features of underdevelopment and marginalization that are typically of unofficial minority languages. Translation, lexicographic and terminological work in this language still lags behind that of other indigenous South African languages and there is still a shortage of school textbooks and adult literature in this language. As a result, using the language in education, the media and other controlling domains is still quite challenging, although positive developments such as the teaching of the language at university level can be noted. The Tshivenda speakers generally have a positive attitude towards their language and seem prepared to learn and use it confidently as long its functional value is enhanced, which is currently not happening. As a result, some Tshivenda speakers still regard English as a more worthwhile language to learn at the expense of their language
- Full Text:
- Date Issued: 2013
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