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The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry
Thesis (PhD)--Stellenbosch University, 2025.
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613915093925888 |
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| access_status_str | Open Access |
| author | Hlongwane, Mikateko Nomvula Naomi |
| author2 | Ned, Lieketseng |
| author_browse | Hlongwane, Mikateko Nomvula Naomi Ned, Lieketseng |
| author_facet | Ned, Lieketseng Hlongwane, Mikateko Nomvula Naomi |
| author_sort | Hlongwane, Mikateko Nomvula Naomi |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2025. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/134632 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:43:43.080Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/134632 The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry Hlongwane, Mikateko Nomvula Naomi Ned, Lieketseng Stellenbosch University. Faculty of Medicine and Health Sciences. Centre for Disability & Rehabilitation Studies. Aging -- Social aspects -- South Africa Aging -- Psychological aspects -- South Africa Quality of life -- South Africa Long-term care of the sick -- South Africa Patient-centered health care -- South Africa UCTD Thesis (PhD)--Stellenbosch University, 2025. Hlongwane, M. N. N. 2025. The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district: An institutional ethnography enquiry. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/6eb2afe0-5606-4298-b62d-efe89bde70a4 ENGLISH SUMMARY: Background: Quality of life (QoL) among older people living in long-term care (LTC) facilities is a multidimensional concept shaped not only by individual health status but also by the broader institutional and social environments in which care is delivered. In the Sub-Saharan African context particularly within South Africa’s public LTC sector QoL remains underexplored, with limited attention to how organisational routines, policy texts, and community values intersect to influence older peoples’ everyday experiences. Existing research tends to prioritise biomedical and functional indicators, often overlooking the institutional processes, social relations, and ruling practices that coordinate the conditions under which older people live, receive care, and make meaning of their lives. Methods: This study draws on Institutional Ethnography (IE) as both a theoretical and methodological approach, integrated with Bronfenbrenner’s Ecological Systems Theory, to explore how QoL is socially constructed and institutionally organised in five public LTC facilities in the Tshwane District, South Africa. The research aims to develop a socio- ecological understanding of QoL that centres the everyday experiences of older people while situating these experiences within the broader organisational and policy environments that shape them. An Institutional Ethnography was employed comprising participant observation, In-depth interviews with older people, care workers, and managers, and analysis of institutional texts such as care policies, schedules, and reporting tools. The data were analysed through indexing and mapping processes consistent with IE. Findings: The findings are presented across five research article. The key findings reveal that older people define QoL in terms of autonomy, engaging in meaningful activities, meaningful social relationships, and spiritual fulfilment. However, institutional routines shaped by task-oriented priorities, hierarchical spatial arrangements, and risk-focused accountability systems often restrict older people’s ability to pursue these dimensions of QoL. Care workers face tensions between standardised care expectations and the emotional labour of relational caregiving, while managers highlight systemic challenges including staff shortages and rigid funding protocols. Textual analysis shows that institutional documents prioritise operational efficiency over person-centred care, with limited space for older peoples’ voice or participation in governance. Conclusion: The study concludes that QoL in LTC is shaped by intersecting factors across institutional and policy levels that regulate daily life in ways that often marginalise older people’s own definitions of QoL. Enhancing QoL requires a shift toward relational, person-centred care that reorients institutional priorities to recognise the social, spiritual, and affective dimensions of aging. This includes revising institutional texts to reflect these values, supporting care workers through capacity building and dignified labour practices, and involving both older people and frontline staff in the governance of care. The study contributes methodologically by demonstrating how IE can uncover the social relations embedded in LTC, and practically by offering a framework for improving institutional care that is rooted in the standpoints of older people. These insights are especially relevant for LTC reform in South Africa and other low- and middle-income contexts experiencing demographic transitions and increasing institutionalisation of older people. AFRIKAANSE OPSOMMING: Agtergrond: Lewensgehalte (LWG) onder ouer mense wat in langtermynsorg (LTS)- fasiliteite woon, is ’n veelvlakkige konsep wat nie net deur ’n persoon se gesondheidstoestand bepaal word nie, maar ook deur die breer sosiale en institusionele omgewings waarin sorg gelewer word. In die Sub-Sahara-Afrika-konteks, veral binne Suid-Afrika se openbare LTS-sektor, is LWG nog relatief onderbestudeer. Daar is min aandag aan hoe daaglikse roetines, beleidsdokumente en gemeenskapswaardes met mekaar inwerk en die alledaagse belewenisse van ouer mense beinvloed. Bestaande navorsing fokus meestal op biomediese en funksionele aanwysers, en laat dikwels die institusionele prosesse, sosiale verhoudings en regulasies wat die lewensomstandighede van ouer mense rig, buite rekening. Metodes: Hierdie studie gebruik Institusionele Etnografie (IE) as ’n teoretiese en metodologiese benadering, in kombinasie met Bronfenbrenner se Ekologiese Stelselteorie, om te ondersoek hoe LWG sosiaal gekonstrueer en institusioneel georganiseer word in vyf openbare LTS-fasiliteite in die Tshwane-distrik, Suid-Afrika. Die doel is om ’n sosio-ekologiese begrip van LWG te ontwikkel wat ouer mense se alledaagse ervarings sentraal plaas, en dit terselfdertyd binne die groter beleids- en organisatoriese raamwerk ondersoek wat hul lewens beinvloed. ’n Kwalitatiewe navorsingsontwerp met twee fases is gevolg. Die eerste fase het bestaan uit ’n verkennende oorsig van literatuur om te bepaal hoe LWG oor die algemeen gekonseptualiseer word in LTS-navorsing in Sub-Sahara-Afrika, en watter kennisgapings bestaan. In die tweede fase is IE toegepas deur middel van deelnemende waarneming, in-diepte onderhoude met ouer mense, sorgwerkers en bestuurders, asook analise van institusionele tekste soos sorgbeleide, roosters en verslagdoeningstelsels. Die data is ontleed met behulp van IE-metodes soos indeksering en kartering. Bevindinge: Bevindinge wys dat ouer mense LWG koppel aan outonomie, deelname aan betekenisvolle aktiwiteite, sosiale verbondenheid en geestelike vervulling. Tog word hierdie aspekte dikwels beperk deur roetines wat gefokus is op take, ruimtelike hierargiee en aanspreeklikheidstelsels wat klem le op risiko en nakoming eerder as op persoonlike welstand. Sorgwerkers ervaar ’n spanningslyn tussen gestandaardiseerde verwagtinge en die emosionele arbeid van verhoudingsgebaseerde sorg, terwyl bestuurders strukturele uitdagings soos personeeltekorte en rigiede befondsingsreels uitlig. Analise van dokumente toon dat administratiewe doeltreffendheid dikwels belangriker geag word as persoonsgesentreerde sorg, met min ruimte vir ouer mense se deelname of stem in besluitneming. Gevolgtrekking: Die studie bevind dat LWG in LTS beinvloed word deur verskeie faktore op institusionele en beleidsvlak wat die daaglikse lewe reguleer en dikwels ouer mense se eie sienings van LWG ondermyn. Om LWG te verbeter, is ’n verskuiwing nodig na meer verhoudingsgerigte, persoonsgesentreerde sorg wat die sosiale, emosionele en geestelike dimensies van veroudering erken. Dit sluit in die hersiening van beleidstekste, die ondersteuning van sorgwerkers deur vaardigheidsontwikkeling en billike werksomstandighede, en die betrokkenheid van beide ouer mense en voorlynpersoneel by bestuursprosesse. Hierdie studie dra metodologies by deur aan te toon hoe IE die verborge sosiale verhoudings in LTS aan die lig kan bring, en prakties deur ’n raamwerk te bied wat institusionele sorg kan verbeter vanuit die perspektief van ouer mense. Die insigte is veral relevant vir hervormings in LTS in Suid-Afrika en ander lae- en middelinkomstelande wat tans deur veroudering van hul bevolkings en toenemende institusionalisering gekenmerk word. Doctoral 2025-12-19T09:59:52Z 2025-12-19T09:59:52Z 2025-12 Thesis https://scholar.sun.ac.za/handle/10019.1/134632 en Stellenbosch University xiii, 220 pages : illustrations, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Aging -- Social aspects -- South Africa Aging -- Psychological aspects -- South Africa Quality of life -- South Africa Long-term care of the sick -- South Africa Patient-centered health care -- South Africa UCTD Hlongwane, Mikateko Nomvula Naomi The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry |
| title | The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry |
| title_full | The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry |
| title_fullStr | The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry |
| title_full_unstemmed | The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry |
| title_short | The social relations that construct quality of life of older people living in long-term care government facilities in Tshwane district : an institutional ethnography enquiry |
| title_sort | social relations that construct quality of life of older people living in long term care government facilities in tshwane district an institutional ethnography enquiry |
| topic | Aging -- Social aspects -- South Africa Aging -- Psychological aspects -- South Africa Quality of life -- South Africa Long-term care of the sick -- South Africa Patient-centered health care -- South Africa UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/134632 |
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