Date of Award


Degree Name

Doctor of Philosophy (College of Nursing)

Schools and Centres

Nursing and Midwifery

First Supervisor

Dr Catherine Ward

Second Supervisor

Professor Richard Berlach


Haemophilia is a rare, inherited bleeding disorder found in all races and ethnic groups. Intervention regimens are more complicated in developing countries, such as South Africa, where numerous challenges present impediments to effective health care. This study investigated the value of the Haemophilia Nurses’ Education Program (HNEP) in the South African context where no comparable program of training for haemophilia nurses exists.

The HNEP has been in operation in South Africa for some fifteen years. The researcher, as one of the key instigators of the HNEP, was keen to determine whether the course was delivering the outcomes that had been hoped for. Accordingly, a three part research study was designed to determine the course’s effectiveness. The epistemology utilised was constructionism and the theoretical framework was based on Leininger’s Cultural Care Theory, Watson’s Theory of Human Caring, Knowles’ Theory of Adult Learning, and Kirkpatrick’s four levels of evaluation. To Kirkpatrick’s theory a fifth level was added which considered Return on Investment, identified as important by Phillips. The conceptual design of the research was one of action research which finds its basis on the work of McNiff, Lomax and Whitehead. The methodology chosen was action research and mixed method, and the tools for data collections were surveys, focus group and individual interviews, and document examination.

The study consisted of three parts. The first part revolved around obtaining opinions about the course from the three haemophilia coordinators who resourced all of the South African provinces. The second part gathered data from haemophilia nurses who had previously participated in the HNEP. The third part consisted of forwarding all HNEP materials to experts for comprehensive evaluation. Together, the three parts of the study helped to provide an important overview of the effectiveness of the HNEP and provided valuable ideas and information for inclusion in the next iteration of the HNEP.

Results indicated that in the main, expert nurse educators considered the program to have merit in terms of its design, contextual relevance, and delivery strategies. It was also found that the program was efficacious for training nurses to address the needs of persons with haemophilia. Nurses reported a higher degree of job satisfaction as a result of having completed the program, with many reporting feelings of empowerment and respect, and greater confidence and competence after having completed the HNEP. It was further found that people with haemophilia received better care and education about haemophilia and exhibited improved self-care as a result of their carers having participated in the program.

Although not directly transferable, it was concluded that the program as a subspecialty is likely to have application in other developing countries. Recommendations for the improvement of the HNEP are made.

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