Live your life. Create your destiny

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

1. BACKGROUND2. THE RESEARCH PROBLEM3. RESEARCH QUESTION4. AIM OF THE STUDY5. RESEARCH METHODS AND DESIGN6. VALIDITY AND RELIABILITY7. ETHICAL CONSIDERATIONS8. FINDINGS OF THE STUDY (Results)9. LIMITATION AND RECOMMENDATIONS10. CONCLUSION


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.


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.


1. BACKGROUND (cont)

Period from conception to age 6 years:

= most important influence of any time in the life cycle on

• brain development, and

• subsequent learning, behaviour and health.



Rapid brain development after birth: → by the age of 6 years:

brain development 90% completed

• in size, and

• in the functions of the brain.


Schematic presentation:

Brain growth in comparison with –

• lymphatic tissues,

• general physical growth, and

• reproductive organs.


The process of development :

• Continuous and cumulative

• Proceeds stage by stage in an orderly sequence

• Each sub stage:

- influence development of following stage




Areas of development

Social and emotional development

Audio and speech development

Cognitive development

Physical development

Gross motor development

Fine motor and visual perceptionThe child



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


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


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.


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.



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.



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


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?


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.


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


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.


5. 2 Context of the Study C

Ext 12 A

Ext 12 B

Ext 13 B

Ext 13 A

N

N = new site

CInformal

Settlement


5. 2 Context of the Study (cont)

Patient Database: Statistics January ‘10 to March ‘11 (15 mths)

NCoP M&WB CD TOTALBabies 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


5.3 Research Design


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


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.


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.


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.


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.


6. VALIDITY AND RELIABILITYInternal threats Measures to prevent/minimize errorResearch 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 validityThe researcher is :• an experienced Registered Nurse and M-Tech student at ATSON (TUT), and • has been engaged in the community since 2005.


7. ETHICAL CONSIDERATIONSPrinciple Procedures implemented by the researcherBeneficence 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.


8. FINDINGS OF THE STUDYFindings 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 statusSingle: 54%

Employment statusUnemployed: 80%

Conclusion: Caregivers’ in age group 25-30 years were in the majority and older than 40 in the minority


8. FINDINGS OF THE STUDY (cont)8.1 Demographic data of the caregivers

9.86%

22.54%

28.17%22.54%

9.86%7.04%

Age of participating caregivers

15-20 years20-25 years25-30 years30-35 years35-40 years> 40 years


8.2 Educational level of the caregivers

FIGURE 4.7 Educational level of the respondent

0%10%20%30%40%50%60%70%

1% 3%

23%

66%

7%

Conclusion: Majority of caregivers were literate

8. FINDINGS OF THE STUDY (cont)



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.




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




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




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




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




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


0%

10%

20%

30%

40%

50%

60%

70%

Gross motor Fine motor and visual perception

Audio and speech

Cognitive Social and emotional

39%

57%63% 63%

50%

8.3 Caregivers’ knowledge deficits

Conclusion:Knowledge deficit in all development categories - highest in cognitive, audio and speech development



8.4 Caregivers education regarding the RTH chart8. FINDINGS OF THE STUDY (cont)

Friend or family member

Any other health worker

RN at the PHC Clinic RN in the maternity ward

0%

10%

20%

30%

40%

50%

60%

6% 3%

55%

36%

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 .


8.5 Caregivers’ social and economic environmentPoverty indicator Situation of caregiverFemale 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


Conclusion:Caregivers’ expect the Registered Nurse to play a significant(63%) role in managing ECD problems.


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.


9. LIMITATIONS AND RECOMMENDATIONS 9.1 Limitations


9. RECOMMENDATIONS OF THE STUDY

NURSING PROFESSION RECOMMENDATIONSNURSING 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).

• 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.


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

Documents

Live your life. Create your destiny