Leisure education to leadership: Youth with physical disabilities' experiences in South Africa.

Introduction: Young people with physical disabilities frequently lack opportunities to develop their leadership potential. These include their ability to make decisions and be able to take charge of their leisure programmes. An argument is made that developing leadership skills for youth with physical disabilities can be facilitated by participating in leisure education programmes. Objectives: The objective of this study was to explore youth with physical disabilities' perceptions of how leisure education can be used as a tool to develop their leadership. Method: This study used a descriptive qualitative research design to collect data using the purposive sampling method from 10 youths with physical disabilities aged 18 to 34 years in the Western Cape, South Africa. One-on-one interviews with semi-structured and open-ended questions were used to collect data for this study. Results: The findings of this study include 4 main themes and 11 sub-themes. This study's findings showed that participants' perceptions and experiences were evidence of leisure education being used to build their capacity as leaders within their society. Furthermore, their understanding of how they apply leadership opportunities is an encouraging moment for their development. Conclusion: Leisure education should be considered as a means to promote leadership in youth with physical disabilities in South Africa. Contribution: Knowledge and experience about youth with physical disabilities, their leisure education experiences and skills development during activities.

"We Want to See Youth That Would Be Better People Than Us": A Case Report on Addressing Adolescent Substance Use in Rural South Africa.

Research suggests that substance use, particularly among adolescents may lead to increased illegal activities as well as physical and social health consequences. Around the world, communities, overburdened with adolescent and youth substance use, are finding ways to address this public health threat. Using a case study based on a focus group discussion with nine founding members, this paper reports on the case of Sibanye-a rural community coalition whose mission is to reduce the burden of adolescent substance use on families in rural South Africa. The focus group discussions were audio-recorded, transcribed verbatim, and analyzed using Nvivo 12. This work highlights the power of an engaged collective effort in addressing key community issues, even in rural areas of emerging economies where health and community infrastructure may be limited. The Sibanye coalition taps into its collective wealth of community knowledge to provide social contributions and aesthetics to help adolescents abstain from substance use and sexual risk behaviors. These activities offer adolescents safe places to meet each other, health education, and the ability to structure their free time meaningfully. Engaging community residents, particularly disadvantaged groups, should be central to any local and national strategies for promoting health and well-being.

Leisure education to leadership: Youth with physical disabilities' experiences in South Africa

Introduction: Young people with physical disabilities frequently lack opportunities to develop their leadership potential. These include their ability to make decisions and be able to take charge of their leisure programmes. An argument is made that developing leadership skills for youth with physical disabilities can be facilitated by participating in leisure education programmes. Objectives: The objective of this study was to explore youth with physical disabilities' perceptions of how leisure education can be used as a tool to develop their leadership. Method: This study used a descriptive qualitative research design to collect data using the purposive sampling method from 10 youths with physical disabilities aged 18 to 34 years in the Western Cape, South Africa. One-on-one interviews with semi-structured and open-ended questions were used to collect data for this study. Results: The findings of this study include 4 main themes and 11 sub-themes. This study's findings showed that participants' perceptions and experiences were evidence of leisure education being used to build their capacity as leaders within their society. Furthermore, their understanding of how they apply leadership opportunities is an encouraging moment for their development. Conclusion: Leisure education should be considered as a means to promote leadership in youth with physical disabilities in South Africa. Contribution: Knowledge and experience about youth with physical disabilities, their leisure education experiences and skills development during activities.

Guidelines for leadership development of youth with physical disabilities through leisure education: A Delphi study.

Background: Youth with disabilities benefit by developing a skill set to help resolve any issues during their daily activities, including pursuits that lead to productive livelihoods. Acquiring leadership skills through leisure education programmes may be particularly effective for youth with disabilities to gain confidence in their leadership abilities. Objectives: This study aimed to develop and reach a convergence of opinions on the preferred elements of a leisure education programme to promote leadership development among youth with physical disabilities. Method: In this study, a three-round Delphi methodology was used. In the first round, 16 experts participated; in the second round, 14 experts participated; in the third round, nine participated. The first round of the Delphi method consisted of a qualitative questionnaire with open-ended questions, which assisted in developing guideline statements. The results from the first round informed the second and third rounds of the study. The guidelines were reviewed for consensus in subsequent rounds using a Likert scale format. Results: In the final round (third round) of the Delphi method, the expert panel consisting of nine participants agreed that leadership development for youth with physical disabilities could be promoted by leisure, recreation, sports and activities of daily living. Conclusion: These guidelines are essential in building resilience, empowerment and independence and can be seen as a positive contribution to communities with disabilities and young people with and without disabilities. Contribution: These guidelines would build capacity and resilience among youth and equip them with the skills and abilities to initiate leisure programmes.

Needs ranking: A qualitative study using a participatory approach.

Youth disengagement is a growing concern globally, yet little research has been done to explore participatory approaches that can engage youth as co-creators of community programs that improve their resilience. The primary objective of the study is to report on the results of an innovative participatory approach used in the Eastern and Western Cape provinces, South Africa, to engage vulnerable youth in needs ranking. Data for this paper were collected in three phases. Using information gleaned from the literature review (Phase I), authors compiled a list of core needs on separate cards. In Phase II, youth discussed and ranked each need in terms of importance for their community. In Phase III, youth participated in focus group discussions on the ranked needs as part of a broader discussion on youth risk behaviours. Thematic analysis was used for qualitative data. Needs ranking data were analysed using descriptive statistics. Although expressed priority needs differed amongst communities, combined data revealed the top expressed priorities as further education (priority 1; 85%), skills development (priority 2; 74%) and career development and training (priority 3; 68%). Differences between critical needs as discussed in the literature and those perceived by youth were noted. Focus group data validated the expressed priority needs and highlighted that vulnerable youth felt valued through the needs ranking activity. Involving youth in the assessment of their needs can improve the value of information obtained, which in turn can facilitate better allocation of community resources.

Adolescent Substance Use Behavior Change Through School Intervention Is Improved by Teacher and School Implementation Support Together, Especially for Girls.

An earlier trial of a school-based, preventative intervention, HealthWise South Africa, demonstrated some efficacy in preventing adolescent drinking and smoking in the Western Cape, South Africa. This was followed by the current implementation trial, which examined how implementation support conditions influenced adolescent drinking and smoking behavior change in the HealthWise intervention. The hybridized implementation-effectiveness trial included 34 schools (n = 2175 students) that provided student data at four waves through Grades 8 to 10. Implementation support conditions included a combination of two components (enhanced school environment and teacher consultation), resulting in four conditions: enhanced school environment, teacher consultation, both components, and standard delivery. Using configural frequency analysis, we examined how drinking and smoking behavior change differed across four configurations of intervention support longitudinally and by gender. For baseline non-smokers, results indicated sustained differences in abstention from smoking and smoking initiation between schools that received both support components and schools in the standard delivery condition. These results were primarily driven by girls. For baseline drinkers and smokers in the both components condition, changes in drinking were delayed until Grade 9 and smoking decayed by Grade 10. Results suggest that providing both school and teacher implementation support synergistically facilitates improved intervention outcomes both immediately following intervention and 2 years later across schools with diverse resource levels. Future iterations of HealthWise, and other interventions, may benefit from a multilevel implementation support strategy to improve student outcomes. More research is needed to understand how to improve HealthWise effectiveness among boys.

Support programmes for parents of children with intellectual disabilities: a scoping review protocol.

INTRODUCTION: Evidence shows that parents of children with intellectual disabilities experience high levels of stress, emotional challenges and higher levels of depression. Despite these challenges, support for parents has tended to be peripheral in healthcare services of children. There is a lack of research attention given to support programmes for parents of children with intellectual disabilities despite the importance of parenting for the optimal development of children with intellectual disabilities. METHODS AND ANALYSIS: This review will follow the Joanna Briggs Institute scoping review methods manual. The search for relevant studies will be in Medline (EbscoHost), PsychARTICLES, PubMed, CINHAL, Academic Search Complete and SAePublications. Reference mining of full review studies will be conducted. A three-step search strategy will be used, including the use of information management software to manage the search results and to remove duplications. An independent reviewer will extract data using a data extraction tool. Furthermore, another reviewer will screen the included articles in conjunction with the results of the scoping review. The data extracted will be presented in a tabular format with a narrative summary related to the key findings. ETHICS AND DISSEMINATION: This scoping review has received ethical approval (BM20/4/26). A summary of the findings of the study will be published in a peer-reviewed journal. This scoping review will contribute to a better understanding of the support programmes available to parents of children with intellectual disabilities. This could be the first step in highlighting the gaps and future directions for the development and implementation of support programmes for parents of children with intellectual disabilities. REGISTRATION DETAILS: Marais JE, Wegner L, Mthembu T. Support programs for parents of children with intellectual disabilities: a scoping review [Internet].OSF; 2021. Available from:https://osf.io/en6cs/.

Leisure Boredom, Timing of Sexual Debut, and Co-Occurring Behaviors among South African Adolescents.

Sex during adolescence is normative; however, there are substantial individual differences in the timing and context of sexual debut. Leisure boredom is an underexplored correlate of sexual behavior that is associated with many adolescent health outcomes. We investigated if and how individual differences in leisure boredom may be associated with timing of sexual debut, and whether individuals engage in safe or risky behaviors at debut. Survival analysis, logistic regression, and Poisson regression were applied to eight-wave longitudinal data obtained from 3,088 South African adolescents (baseline Mage = 13.9 years) to examine associations between leisure boredom and cumulative hazard of sexual debut across adolescence, odds of co-occurring sexual behaviors, and incidence rate of co-occurring sexual risk behaviors at debut. Higher levels of leisure boredom were associated with elevated hazard cumulatively across adolescence. Higher levels of leisure boredom were also associated with lower odds of safe sex and higher odds of substance use during sex and transactional sex at sexual debut, but not casual sex or condom non-use at sexual debut. Although odds of singular risk behaviors were lower for girls than for boys, the association between leisure boredom and the number of risk behaviors at sexual debut was stronger for girls than boys. Higher trait leisure boredom was associated with elevated hazard of sexual debut, greater likelihood that risky behaviors accompanied sexual debut, and greater number of co-occurring risky behaviors at sexual debut. Results support leisure boredom as a potential target for preventing sexual risk behavior among South African adolescents.

Rural voices: A social-ecological perspective on factors influencing youth substance use in rural South africa.

BACKGROUND: Youth can be a positive force for development when provided with the knowledge and opportunities they need to thrive, yet they continue to experience insurmountable challenges, such as poverty and absentee fathers, that prompt them to resort to risk behaviours such as substance use. In rural South Africa, women tend to be the breadwinners and more involved with parenting than men. OBJECTIVE: The primary objective of the study was to explore perspectives of rural youth on factors influencing youth participation in substance use. The secondary objective was to obtain the perspectives of adult women on factors influencing substance use among young people. METHODS: The qualitative study, informed by a social-ecological framework, utilised a semi-structured interview protocol in focus group discussions in rural South Africa. Seven focus group discussions, each with between 8 and 15 individuals were conducted with 79 youth. The eighth discussion was with nine adult women. Data were audio recorded and transcribed verbatim, manually coded and further analysed into themes using NVivo 12. FINDINGS: Four themes emerged: hopelessness and lack of motivation, lack of adult role models such as father, lack of built environment for recreational activities and lack of educational opportunities. The social-ecological model provided a useful framework to understand the findings. In line with this model, rural youth in South Africa described a variety of factors that influenced youth substance use and other risk behaviours. These related to the individual, relationships with others, community and societal norms and values factors of the social-ecological model. CONCLUSIONS: The broadening spectrum of substances available to an increasing youth population bulge in Africa suggests a strong threat of social and disease burden due to substance use disorders. Given this threat, this study provides awareness to a multi-systems approach needed to support the rural South African youth.

Boys Are Victims, Too: The Influence of Perpetrators' Age and Gender in Sexual Coercion Against Boys.

Sexual coercion among adolescent boys in South Africa is an underresearched topic despite the frequency of such events. Although quantitative research has illuminated the prevalence of sexual coercion toward boys, it has provided little understanding of the context of sexual coercion for adolescent boys. Given the often severe consequences of sexual coercion, it is important to further understand these experiences to inform prevention efforts. The current study aims to provide a more nuanced understanding of the context of sexual coercion. Data come from the baseline assessment for a translational research evaluation of a school-based intervention. The current study focuses on a subset of early and middle adolescent boys who reported experiencing sexual coercion (n = 223). Analyses examine boys' reports of their perpetrators' characteristics and details about the sexual coercion encounter. Logistic regression is used to examine how coercion tactics used by the perpetrator differs depending on the perpetrator's age and gender. Eighth-grade boys were most likely to report that their perpetrator was a similar-aged female and that perpetrator's age played a particularly important role in what tactics were used. Adult perpetrators were more likely to use physical force, threaten them, harass them electronically, and drink or use drugs at the time. Results provide important insight into boys' experiences of sexual coercion that have implications for both future research and intervention efforts. Although much research is needed on the topic, intervention programs should recognize that both male and female adolescents can be victim and perpetrator.

Supporting South African High School Teachers' Implementation of a Prevention Program via Abridged Consultation: Outcomes and Moderators.

Research is lacking on consultation support for school-based evidence-based programs (EBP) intended to prevent youths' risky behaviors in schools in low-resourced settings like high schools surrounding Cape Town, South Africa. Thus, this study's objective was to examine implementation outcomes and moderators of an abridged consultation condition for supporting teachers in better implementing HealthWise, an EBP for preventing youth risky sexual and substance use behaviors. Twenty-one schools with 33 teachers receiving abridged consultation (i.e., three consultation meetings, text message reminders, lesson plans, and support kits) were compared to 26 schools with 41 teachers that did not receive any consultation. Teachers with abridged consultation self-reported delivering more HealthWise content. Moderation analyses found teachers with lower educational degrees, who received abridged consultation reported more student interest in HealthWise. When there was higher school-level risk, teachers who received abridged consultation marginally self-reported adapting HealthWise more. Findings suggest consultation support that is abridged or a lower dose than is typical can be feasible in such a low-resourced, overburdened setting while still being associated with EBP coverage, student interest, and adaptation. However, moderation findings suggest contextual factors should be considered to match teachers/schools to the implementation support that best suits them.

Parenting Practice, Leisure Experience, and Substance Use Among South African Adolescents.

There is limited understanding of parents' role in positive youth/adolescent development through leisure in developing countries. Using a sample of 6626 8th grade students in South Africa, this study examined the interrelationships among parenting practice, adolescents' leisure experience, and substance use. Results of structural equation modeling showed that parental leisure involvement was associated with less substance use, while parental leisure over-control was associated with greater substance use. The relationship of parental leisure involvement to substance use was mediated by healthy leisure engagement. The relationship of parental leisure over-control to substance use, on the other hand, was mediated by leisure boredom and healthy leisure engagement. The model path coefficients had little variation between genders and socioeconomic groups except that parental leisure over-control had a stronger positive relationship with leisure boredom for males than females. Theoretical and practical implications were discussed.

Profiles of Adolescent Leisure Motivation and Substance Use in the HealthWise South Africa Research Trial: A Person-Centered Approach.

Engaging in intrinsically motivated behaviors, both within and outside of the leisure context, is associated with well-being. However, individuals can be driven by multiple types of motivation simultaneously, and the impact of constellations of leisure motivation is relatively unknown. The current study uses South African adolescents in the HealthWise South Africa efficacy trial (N=2,204; M age =14.0) to identify profiles of leisure motivation, examine the association between profiles and substance use, and evaluate the impact of HealthWise on changes in motivation profiles over time. Results indicate three distinct profiles: high consistent motivation, low consistent motivation, and high intrinsic motivation. Members of the high intrinsic profile had the lowest odds of substance use. Profiles were fairly stable across all time points except for females in a high-training intervention school. Results illustrate the importance of identifying and understanding typologies of leisure motivation and health across time, which can be used to promote positive development in adolescents.

Doing a Leisure Activity because there is Nothing Else to Do: Related Outcomes and Intervention Effects for Adolescents.

This study examined whethera leisure focused intervention, HealthWise, was related to reduced youth polysubstance use and delayed sexual debut via reducing how often youth did leisure activitiesbecause there was nothing else to do. HealthWise was compared to a no-interventioncontrol for 5,610 high school students from 8thto 10thgrade in townships near Cape Town, South Africa. Three specific leisure activities were examined: time spent with friends, playing sports, and going to parks. Among girls, time spent with friends because there was nothing else to do significantly mediated the effect of HealthWise on reducing frequent polysubstance use in the past month. For boys, time spent in parks because there was nothing else to do mediatedthe effect of HealthWise on delayed sexual debut. Results partially supported the HealthWise logic model of impacting risky behaviors via leisure and the value of prevention programs addressing the reasons behind leisure choices.

Occupational therapy students' perspectives of ethics in two countries: South Africa and the United States of America.

OBJECTIVES: Worldwide, health-care students, including occupational therapy students undergo ethics training. Ethics training facilitates students' critical thinking, objective analysis and clinical reasoning skills to promote impartiality and minimize bias in decision-making. The aim of the study was to explore and describe similarities and differences in occupational therapy students' perceptions and experiences of an ethical dilemma. METHODS: The study employed a descriptive qualitative approach. Eighty occupational therapy students from South Africa and the United States of America (USA) participated in the study as part of an online international ethics module. Data were collected from students' written analyses of a case study engaging them in an ethics reasoning process and were analyzed thematically. RESULTS: Three themes emerged: Personal views and biases, ethical approaches, and practical alternatives and implications. Both groups of students from South Africa and the USA approached the case in a similar manner using their knowledge of ethics, principles, and approaches. They also applied the steps of an ethics reasoning process to guide their decision-making. All occupational therapy students from both countries highlighted Ethics of Care as an integral basis for their reasoning. CONCLUSION: There is a need amongst educators to identify, share, and discuss similarities and differences in how health-care practitioners address ethical issues, using the ethics reasoning process as a guide. The international occupational therapy community needs to further the profession's meta-ethical discourse to guide clinical application within a diverse and globally connected workforce.

With a little help from my friends? A longitudinal look at the role of peers versus friends on adolescent alcohol use.

INTRODUCTION: Alcohol is the most commonly used substance by South African adolescents. Social norms play a key role in alcohol use, although distinctions are not always made between descriptive and injunctive norms and peer proximity. Additionally, little research identifies factors attenuating social norms, peer proximity, and alcohol use, such as one's ability to resist peer influence. METHODS: The current study investigates the relationship between adolescent alcohol use in 9th Grade and descriptive peer and injunctive friend norms in 8th grade, the moderating role of resistance to peer influence, and sex differences. Data were from South African students (N = 3592; Mage = 14) participating in the HealthWise South Africa implementation quality trial. RESULTS: Path model results indicated injunctive friend norms, but not peer norms, influenced alcohol use. Resistance to peer influence did not moderate relationships and group comparisons found no sex differences. CONCLUSION: Findings suggest social proximity shapes influences of alcohol use. Despite a differing cultural context, findings were consistent with those from the United States, indicating social proximity is relevant cross-culturally.

Predicting secondary school dropout among South African adolescents: A survival analysis approach.

Education is one of the strongest predictors of health worldwide. In South Africa, school dropout is a crisis where by Grade 12, only 52% of the age appropriate population remain enrolled. Survival analysis was used to identify the risk of dropping out of secondary school for male and female adolescents and examine the influence of substance use and leisure experience predictors while controlling for demographic and known predictors using secondary, longitudinal data. Results indicated being male, not living with one's mother, smoking cigarettes in the past month, and lower levels of leisure-related intrinsic motivation significantly predicted dropout. Results support comprehensive prevention programmes that target risk behaviour and leisure.

Perceived Parental Control, Restructuring Ability, and Leisure Motivation: A Cross-Cultural Comparison.

Leisure is viewed worldwide as an important developmental context for adolescents. As leisure research and programs are shared across nations, it is crucial to examine the cultural equivalence of leisure-related constructs and how they are related. Grounded in self-determination theory, this study explored the influence of perceived parental control and leisure restructuring ability on leisure motivation (amotivation and autonomous motivation) using samples of eighth grade adolescents in the United States and South Africa. Results of multiple-group structural equation modeling showed that the measurement model of the constructs was equivalent across the two samples, but the determinants of leisure motivation differed between the two samples. The findings provide implications for future cross-cultural research in leisure and offer insights on design and adaptation of leisure-based intervention and education programs in different cultural contexts.

Validity and reliability of the South African health promoting schools monitoring questionnaire.

Health promoting schools, as conceptualised by the World Health Organisation, have been developed in many countries to facilitate the health-education link. In 1994, the concept of health promoting schools was introduced in South Africa. In the process of becoming a health promoting school, it is important for schools to monitor and evaluate changes and developments taking place. The Health Promoting Schools (HPS) Monitoring Questionnaire was developed to obtain opinions of students about their school as a health promoting school. It comprises 138 questions in seven sections: socio-demographic information; General health promotion programmes; health related Skills and knowledge; Policies; Environment; Community-school links; and support Services. This paper reports on the reliability and face validity of the HPS Monitoring Questionnaire. Seven experts reviewed the questionnaire and agreed that it has satisfactory face validity. A test-retest reliability study was conducted with 83 students in three high schools in Cape Town, South Africa. The kappa-coefficients demonstrate mostly fair (κ-scores between 0.21 and 0.4) to moderate (κ-scores between 0.41 and 0.6) agreement between test-retest General and Environment items; poor (κ-scores up to 0.2) agreement between Skills and Community test-retest items, fair agreement between Policies items, and for most of the questions focussing on Services a fair agreement was found. The study is a first effort at providing a tool that may be used to monitor and evaluate students' opinions about changes in health promoting schools. Although the HPS Monitoring Questionnaire has face validity, the results of the reliability testing were inconclusive. Further research is warranted.

Girls Just Want to Know Where to Have Fun: Preventing Substance Use Initiation in an Under-Resourced Community in South Africa Through HealthWise.

This study examined how the perception of the availability of leisure opportunities may prevent substance use initiation through HealthWise, a school-based program focused on reducing risky behavior. In this study, we specifically focused on whether HealthWise increased student perceptions of leisure opportunities between 8th grade and 10th grade (N = 5610) in an under-resourced community in South Africa. Path analyses were used to test hypotheses. Given gender differences in substance use patterns, societal norms, and leisure opportunities in under-resourced communities, such as the townships of Cape Town, South Africa, it was especially important to examine associations within each gender. Results suggested that HealthWise directly reduced the likelihood of initiating alcohol and cigarette use and increased the amount of perceived leisure opportunities among girls but not boys. Perceived leisure opportunities mediated the effect of HealthWise on reducing the initiation of alcohol and cigarette use directly, and marijuana use indirectly, among girls but not boys. This is the first study to demonstrate how experimentally targeting leisure through an intervention can increase perceived leisure opportunities and thereby prevent early substance use initiation for a specific population. The importance of considering the context of gender, age, and location is discussed.