THE INFLUENCE OF CULTURE ON NEUROPSYCHOLOGICAL TESTING IN ZAMBIA

Transcription

1 THE INFLUENCE OF CULTURE ON NEUROPSYCHOLOGICAL TESTING IN ZAMBIA BY MARIA ANNA AKANI A thesis submitted to the University of Zambia in fulfilment of the requirements for the degree of Masters in Science in Clinical Neuropsychology THE UNIVERSITY OF ZAMBIA LUSAKA 2011 i

2 DECLARATION I, Maria Anna Akani, of 2 Middlesex Court, Plot 1044 Makishi Road, Rhodes Park, Lusaka, declare that this thesis represents my original work. This work has not been previously submitted for a degree, diploma or other qualification at this or another University. Date:..... Sign:.. CERTIFICATE OF APPROVAL FORM This dissertation of Maria Anna Akani has been submitted in partial fulfillment of the requirements for the award of the Degree of Masters of Science in Clinical Neuropsychology by the University of Zambia, April, ii

3 Examiner s Signature: Date of Approval: iii

4 ABSTRACT The Influence of Culture on Neuropsychological Testing in Zambia By Maria Anna Akani A research project, the Zambia Neurobehavioural (ZNB) study aimed at developing normative data for a Neuropsychological neurobehavioural test battery was started. The test battery is sensitive to HIV neurocognitive defects and it is hoped that it can be used for clinical practice (for diagnostic and prognostic purposes) and further research in HIV in Zambia. However, none of the test components of the ZNB test battery were developed in Zambia, or indeed Africa. Literature shows that when tests that are developed in one culture are administered in another one, the validity and reliability of the results is compromised because of the influence of cultural differences. The Zambian situation is no different. In my research, I did a phenomenological study seeking to identify and describe the cultural influences on NP testing in Zambia through semi-structured questionnaire administration and in-depth interviews with test-takers and focus group discussion with test-administrators. Five major themes emerged from the results. (1) Use of English as a language of instruction and testing may have given rise to underestimates of the cognitive competence of participants most of whom had limited knowledge of English, and this effect was probably intensified by the use of a type of English that is not quite familiar in Zambia. (2) Use of computer tests in a population that is relatively computer naïve gave rise to distraction, such that much of what was assessed may have been skills and attitudes towards computers per se rather than the cognitive functions the tests were supposed to measure. (3) Use of geometrical forms and graphical representation for the assessment of visual-spatial memory may have given rise to underestimates of the cognitive competence of participants most of whom had limited experience with those media. (4) The emphasis of speed in some of the tests may have given rise to underestimates of the cognitive competence of participants in a culture where people seem to pay more attention to how well something is done rather than how quickly it can be completed. (5) Inclusion of some activities of daily living that were not, in some aspects, culturally relevant, in the questionnaire designed to assess participants level of functioning may have generated misleading results. Based on these findings, it is recommended that tests be adapted to be relevant to the Zambian culture. iv

5 To Pupuzyanji Clifford Sichembe v

6 ACKNOWLEDGEMENTS I wish to acknowledge my primary supervisor, Professor Robert Serpell, who helped me fine tune my initial research concept, guided me, encouraged me to be authentic and tirelessly read through my numerous revisions. My gratitude also goes to my secondary supervisor, Dr Mwanza Banda, who believed in me and encouraged me to pursue this programme in the first instance. Thanks to the NOMA project and the University of Zambia for providing financial and technical support at different stages of my study. I would also like to acknowledge the Ministry of Health for facilitating this research process through their health centres. Thanks to my colleagues Edna Chirwa, Lisa Kalungwana, Lumbuka Kaunda, Norma Kabuba, Gabriel Walubita, Happy Zulu, Mwanza Nakawala and Owen Kabanda from whom I learnt a lot as they also pursued their studies. Many thanks to my parents and siblings for always believing in me against all odds and offering their much needed emotional support. And finally, to my husband, Pupuzyanji Sichembe, who endured this long process and helped with various aspects of the research, thesis presentation and compilation. vi

7 CONTENTS Abbreviations....viii List of Tables..xi Chapter 1.1 Introduction Rationale Statement of the Problem Research Question Objectives Chapter 2 7 Literature Review Chapter Methodology Chapter Results and Thematic Analysis Chapter Discussion Chapter 6 84 Conclusion Recommendations Suggestions for further research References Appendix A Appendix B 93 Appendix C 94 vii

8 ABBREVIATIONS AA AD ADL AQT ANOVA BDI BVMT BVMT-R CA COWAT-FAS COWA-M CTT CVLT ED ELT FGD FAS GVT HCT HDMT HIV HNRC HPT HVLT HVLT-R LM LMM MEAA MMSE NP NLT PAOFI - African Americans - Alzheimer s Disease Activities of daily living - Alzheimer s Quick Test Analysis of variance - Beck Depression Inventory - Brief Visuo-spatial Memory Test - Brief Visuo-spatial Memory Test - Revised - Caucasian Americans - Controlled Oral Word Association Test FAS - Controlled Oral Word Association Maori alternative - Colour Trails Test - California Verbal Learning Test - Ethnically diverse - English Literacy Test - Focus group discussion - same as COWAT-FAS - General Verbal Test - Halstead Category Test - Hiscock Digit Memory Test - Human immuno-deficiency virus - HIV Neurobehavioral Centre - Hand Position Test - Hopkins Verbal Learning Test - Hopkins Verbal Learning Test - Revised - Logical Memory - Logical Memory - Maori alternative - Mono-lingual English-speaking Anglo-Americans - Mini-Mental State Examination - Neuropsychological - Nyanja Literacy Test - Patient s Assessment of Own Functioning Inventory viii

9 PASAT PMT RAVLT TBI TMT TV UCSD UNZA USA Vocab-M VCT WAIS WAIS-R WASI WC WCST WMS WMS-R WRAT YMS ZAT ZNB study - Paced Auditory Serial Addition Test - Panga Munthu Test - Rey s Auditory Verbal Learning Test - Traumatic Brain Injury - Trail Making Test - Television - University of California San Diego - University of Zambia - United States of America - Vocabulary Maori alternative - Voluntary Counselling and Testing - Wechsler Memory Scale - Wechsler Memory Scale Revised - Wechsler Abbreviated Scale of Intelligence - Word-colour - Wisconsin Card Sorting Test - Wechsler Memory Scale - Wechsler Memory Scale Revised - Wide Range Achievement Test - Yoruba Mental Scale - Zambia Achievement Test - Zambia Neurobehavioral study ix

10 LIST OF TABLES Table x