| Summary: | Thesis (DPhil (Psychology))—University of Stellenbosch, 2009. === ENGLISH ABSTRACT: Extensive research over the past 30 years has shown that reliable, sensitive, responsive and empathic care
of the infant by the mother or mother-substitute in the early months facilitates the development of secure
attachments in infants, and ultimately their healthy development towards competent adulthood and future
relationships with others. This study analyses interviews with 17 mothers selected from an intervention
proven successful by means of a randomized controlled trial. The intervention took place in Khayelitsha, a
peri-urban settlement close to Cape Town, South Africa, and was delivered by previously untrained lay
counsellors to at risk mothers and infants. Supervision and training of the counsellors was provided by the
author. Mothers were purposively selected on the basis of being experienced by counsellors as easy,
difficult to reach, young/immature mothers and HIV-positive mothers, and were interviewed by a
clinically trained interviewer not involved in the project individually and in groups. Counsellors’ process
notes, exploring the impact, relevance and meaning that the intervention had for the recipient mothers, as
well as the supervisor’s notes were also used as data. The findings identify what changes mothers
reported, their experiences of the intervention, cultural issues in the intervention, and mothers’ suggestions
for modifications to the programme. The results are discussed in light of theories of change emerging from
the literature on psychotherapy change research and research on community-based interventions. The
study shows that though results of randomized controlled trials are necessary for policy planning, in-depth
interrogation of the design and process issues at stake in complex community-based studies yield
complementary data which are also important to consider. Finally, the study considers the implications of
this understanding of process for the future dissemination of the training and application of this
programme, as well as policy, research and funding challenges. === AFRIKAANSE OPSOMMING: Wydstrekkende, uitgebreide navorsing van die afgelope 30 jaar toon dat betroubare, sensitiewe,
aandagtige en empatiese sorg vir die peuter deur die moeder of moeder-plaasvervanger, die vorming van
veilige bindings, sowel as die uiteindelike gesonde ontwikkeling van bevoegde volwassenheid en
toekomstige verhoudings met andere fasiliteer. Hierdie studie analiseer onderhoude met 17 moeders,
gekies uit 'n intervensie wat bewys is deur middel van 'n ewekansige kontrole toetsing. Die intervensie het
plaasgevind in Khayelitsha, 'n peri-stedelike nedersetting naby Kaapstad, Suid-Afrika, en is uitgevoer deur
voorheen onopgeleide vrywilliger beraders wat moeders en peuters wat blootgestel is aan risiko bedien.
Supervisie en opleiding van die beraders is deur die outeur voorsien. Moeders is vooraf uitgekies deur die
beraders, volgens die criteria: maklik en moeilik bereikbaar, jong/onvolwasse moeders, en HIV positiewe
status. 'n Klinies opgeleide onderhoudvoerder wat onbetrokke is by die res van die projek het met die
moeders individueel en in groepskonteks onderhoude gevoer. Beraders se prosesnotas wat die impak,
relevansie en betekenis van wat die invervensie vir die moeders ingehou het, sowel as die supervisor se
notas is ook gebruik as data. Die bevindings is bespreek in die lig van veranderingsteorieë wat uit die
literatuur oor psigoterapie veranderingsnavorsing, sowel as navorsing oor gemeenskapsgebaseerde
intervensies vorendag gekom het. Die studie toon dat hoewel bevindings van ewekansige kontrole toetsing
nodig is vir beleidsbeplanning, in-diepte ondersoek van die proses en ontwerp kwessies ter sake in
komplekse gemeenskapsgebaseerde studies komplimentêre data lewer wat ook belangrik is om in ag te
neem. Ten laaste oorweeg die studie die implikasies van hierdie ondersoek van proses vir toekomstige
disseminasie van die opleiding en toepassing van hierdie program, sowel as beleid, navorsing en
befondsings uitdagings.
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