The knowledge, attitude, beliefs and practices of healthy lifestyles among the elderly in Linstead, St. Catherine

In Jamaica, health promotion and education programmes have focused on empowering and facilitating individuals and communities to engage in healthy lifestyle practices to reduce the incidence of non-communicable chronic diseases such as diabetes and hypetension. The elderly receive health education through senior citizens clubs, churches, health services and the mass media. A cross-sectional survey was carried out in Linstead, Saint Catherine among a quota sample of elderly adults (60 years and over) in order to ascertain their knowledge, attitude, beliefs, and practices of healthy lifestyles. Factors examined were their knowledge, self-reported eating habitis, practices, health seeking, and exercise behaviours. Most respondents were knowledgeable about the factors that contribute to a healthy lifestyle including the benefits to be derived from exercise. Ninety-one percent (91) of respondents knew that high fat and salt intake could eventually lead to stroke. Eighty-six percent (86) agreed that exercise reduces stress, and 88 percent knew that smoking was bad for health. Most of the elderly were physically able to engage in some form of exercise or strenuous work that burned calories. The study also revealed some health knowledge deficits, which has implications for health program planning (AU)

Perceptions about mental illness among pre-clinical medical students in Trinidad and Tobago

Perceptions about mental illness among medical practitioners are likely to determine their capacity to recognise, treat appropriately and refer patients who have mental health problems. It is therefore important that training of medical students in psychiatry is undertaken with knowledge of their attitudes to mental health disorders. We determined the perceptions of 108 pre-clinical medical students (69 males, 39 females; mean age 22 years) toward mental illness in Trinidad and Tobago by analysing their responses to a questionnaire based on a case vignette of a young man with a paranoid psychotic illness. 88 percent felt that medical treatment in hospital was the best means of treating the illness and 86 percent suggested that discharge should be conditional on regular visits to a doctor. 89 percent however opposed the patient's marrying into their families and 85 percent to his teaching their children. This was associated significantly with having a personal relationship with someone having a mental illnes (p < 0.03). Surprisingly, 25 percent believed that mental illness could be caused by supernatural forces, particularly females who were almost twice as likely as males to express this belief.(AU)

A behaviour risk factor survey in Jamaica

A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population. 60 percent of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18 percent of the women and 8 percent of the men had never their blood pressure taken. 40 percent of the women had never had a Papanicolaou smear, 29 percent had never had a breast examination and 33 percent said that they were overweight compared with 18 percent of men. Smoking cigarettes and marijuana was more common among men (36 percent) than women (11 percent) as were drinking alcohol (79 percent of men, 41 percent of women) and heavy alcohol use (30 percent of men, 9 percent of women). Injuries requiring medical attention in the previous five years were reported by 40 percent of the men and 15 percent of the women. 34 percent of the men and 12 percent of the women regularly carried a weapon and 18 percent of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10 percent were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54 percent vs 17 percent, p<0.001) or reported ever having a sexually transmitted disease (29 percent vs 9 percent, p<0.001). Younger persons were more sexually active and more likely to use condoms during the most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.(AU)

Using focus groups to evaluate an education program

Two evaluation studies were carried out in 1995 and 1997. The first evaluation assessed tile effectiveness of the Psychiatric Nurse Practitioner's education program and its impact on mental health and psychiatry in Belize. The second study was done to determine if the mental health services were sustained in the country. Interviews and focus groups were used for data collection. In this paper the focus is on the findings from the focus groups. The findings show that the PNP's role performance was adequate, they have made an impact on the mental health services and the services are maintained (Au)

Peer influence and its health implications for adolescents in selected high schools in Jamaica

The aim of this study was to examine the extent to which peer pressure influences the behaviour of adolescents and the implications of such behaviours for health. The study, a cross-sectional one, was conducted at the Clan Carthy and Donald Quarry Comprehensive High Schools with 133 adolescents, and employed a multi-stage sampling process - a combination of random and stratified techniques. Subjects for the sample were selected from one class/stream each from grades 7 - 11, making a total of 5 classes in the study sample. A focus group study, involving 2 groups each of 6 students, was conducted to supplement the quantitative findings. Results showed that male adolescents were more involved in gangs/posses, than females. In relation to drug/substance abuse it was shown that the prevalence for males was much higher than that of females except for the use of inhalants, the majority was encouraged by friends to use ganja and alcohol, males were more likely than females to be influenced or encouraged by their friends to use drugs, and males were 3 times more likely than females to meet with friends to drink alcohol. In relation to sexual behaviour, it was shown that approximately 76 percent of adolescents met with friends to discuss sexual matters 70 percent of the times, and that male adolescents were 11 times more likely than females to be encouraged by friends to have sexual intercourse, 14 times more likely to be encouraged to fondle a girl and 10 times more likely to be encouraged to have more than one lover. In relation to violence it was found that a knife was the most prevalent weapon carried or encouraged to be carried by adolescents; pencils/pens/divider were the most prevalent weapons encouraged to be used in fights at school and males were 3 times more likely than females to fight at school. It was concluded that males were more at risk than females to be influenced by their peers, and it was recommended that Family Life Education programmes in schools be intensified and specifically targetting the male adolescent.(Au)

The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders

BACKGROUND: Recent anthropological studies have documented the importance of understanding the relation of culture to the experience of mental illness. The use of interviews that elicit explanatory models has facilitated such research, but currently available interviews are lengthy and impractical for epidemiological studies. This paper is a preliminary report on the development of a brief instrument to elicit explanatory models for use in field work. METHOD: The development of the SEMI, a short interview to elicit explanatory models is described. The interview explores the subject's cultural background, nature of presenting problem, help-seeking behaviour, interaction with physician/healer and beliefs related to mental illness. RESULTS: The SEMI was employed to study the explanatory models of subjects with common mental disorders among Whites, African-Caribbean and Asians living in London and was also used in Harare, Zimbabwe. Data from its use in four different ethnic groups is presented with the aim of demonstrating its capacity to show up differences in these varied settings. CONCLUSIONS: The simplicity and brevity of the SEMI allow for its use in field studies in different cultures, data can be used to provide variables for use in quantitative analysis and provide qualitative descriptions.(Au)

Sociocultural variations in help-seeking behaviour for everyday symptoms and chronic disorders

In this study, we test the assumption that sociocultural differences in use of health services will occur only below a certain level of illness severity. Data are derived from the Curacao Health Study (N = 2248). Subjects' educational level and degree of proto-professionalisation were used as indicators of their sociocultural background. Differences in the likelihood of seeking professional care for several common health problems were analysed, and were compared with the help seeking behaviour for chronic disorders. As hypothesised, more highly educated and proto-professionalised people were less likely to seek care for everyday symptoms. In addition, proto-professionalisation was accompanied by a greater likelihood of using over the counter medication. Increasing empowerment of patients appeared to lead to increase self care for everyday symptoms. When conditions reached a more serious stage, the difference in help-seeking behaviour disappeared. For most of the chronic conditions studied, the higher educated and more proto-professional treatment as the less advantaged groups. However, there was a difference as to the type of professional consulted for chronic health problems. Proto-professionalised individuals more often received specialist treatment, probably because they were better equipped to persuade GPs to refer. The adverse side of patient empowerment may be increasing consumerism.(AU)

The Jamaican body's role in emotional experience and sense perception: feelings, heart, minds and nerves

When Jamaican speak of feelings, they literally mean feelings: physical sensations. Emotions, which emerge through social interaction, comprise an unmarked subset of feelings. They can affect the mind in ways that are actualized in behavior. Emotions affect other parts of the body as well, in ways that follow from an equilibrium model of health. Non-emotional feelings index bodily disequilibrium rather than causing it. An example of such is seen in nerves: a chronic feeling-complaint that comes about when the nerves, associated with perception and sensation, are weakened, and which entails visual dimness, jumpiness, and joint trouble. Although exacerbated by certain social situations and often used in social commentary and manipulations, nerves is experienced and treated as a physical rather than a socially-based disorder. By studying the bodily dimension of nerves and other feelings we may gain insight into the ways in which the body serves as a source of culture (e.g., nerves culture) as well as into how culture influences bodily experience. We may broaden our understanding of the complex interplay between the bodily and mental dimensions of people's lives.(AU)

Health perceptions and self care response to illness among users of medical alternative health services in St. Andrew, Jamaica

Do persons who utilize the services of the alternative therapist demonstrate a greater self-care response to illness? This cross-sectional study was done to compare the health perceptions and self-care response to minor illness among users of conventional medical care and alternative therapy. Data were collected with a pre-tested, self-administered questionnaire to 99 patients of medical practitioner and 74 of alternative therapists. Results indicated statistically significant differences in some health perceptions such as ways to improve general health and responsibility for personal health. For both groups there were similarities in socio-demographic characteristics and self-care responses to minor illness, such as headaches, constipation, diarrhoea, sinus congestion and colds or flu. Also, results reflected a common practice of self-management of minor illness and an overlap in attendance by patients to both groups of practitioners. Recommendations are made for the public to be guided in its practice of self-management of minor illness and that a regulatory body be set up to govern the practice of alternative therapy in Jamaica. (AU)

Canadian ethnocultural communities facing AIDS: overview and summary of survey results from phase 111

This paper describes the survey results reporting demographic profiles, behaviours, opinions beliefs, attitudes and intentions related to condom use for three Canadian ethnocultural communities (Latin American, English-speaking Caribbean and South Asian) participating in the Ethnocultural Communities facing AIDS Study. Specific recommendations are presented for HIV-prevention programming based on the research results (AU).

An assessment of the health behaviour of chronic disease clients and health centres in St. Georges West, Trinidad

This study was aimed at assessing the health behaviours of clients through their knowledge, perceptions and practices in relation to diet, exercise, weight control and medication and identifying the factors that impact on those behaviours, including the services offered to clients. The questionnaire survey was administered July-August, 1994 to 230 clients who attended chronic disease clinics at the eight health centres in the country of St. George West, Trinidad. Results revealed that the majority of clients were hypertensive, female pensioners of African descent who were obese with a family history of diabetes mellitus, hypertension or heart disease. The health professionals who were in a position to advise clients about lifestyle changes, did not provide them with sufficient knowledge and skills necessary for the adoption of healthy lifestyles. Clients thought it was important to practise the recommended behaviours and recognised a relationship between health behaviour and health status. However, clients failed to practise the desired behaviours due to other reasons such as insufficient financial resources, inadequate social support and lack of motivation. There was an absence of combined clinical and psychosocial management strategy, and clients' illnesses were being managed by drug therapy only, with little client responsibility for their well-being through the use of non-drug methods. The study identified a need for health professionals to be equipped with communication and counselling skills in relation to diet, exercise and weight control for health promotion/health education programmes for clients' families to reduce the risk to family members and also to create a supportive environment for the clients (AU)

Health maintenance needs for perimenopausal women and their partners in a selected population

A survey was conducted among women attending a public gynaecological facility and a private medical facility. Their partners were included wherever possible. The aim was to compare health maintenance needs in the perimenopausal women and their partners (age 40-55) attending a private and a public facility for care. All patients attending both facilities and who were within the age range were invited to enroll. At the public facility 80 females and 27 partners were enrolled whilst at the private facility it was 40 females and 21 partners. It was found approximately one third of the respondents stated that they were unaware of the meanings of menopause and it was noted that, for the majority, menopause was not discussed with either the partner or anyone else. The access to care, especially at the public facility, was affected by long waiting time and lack of adequate transportation. Amongst respondents, both male and female, hypertension was the most common medical problem. Similar proportions of those attending either facility had a total abdominal hysterectomy. This study has identified some factors which affect health maintenance in the stated age group and recommendations are made to address the problem.(AU)

Level of mental impairment in the Jamaican elderly and the issues of screening levels, caregiving, support systems, carepersons, and female burden

Jamaica, although a developing country, has an aging population and is facing the many issues confronting aging. A community-based study using the Folstein minimental screening tool identified 2.3 percent of the over-60 population as severely impaired and 11.8 percent as questionable. The family was identified as the main source of support, and female relatives the main carepersons. Mentally impaired persons were less likely than physically impaired persons not to have a support syustem or careperson needed (AU).

Adolescent health and the adolescent's need for specialised health services and health promotion activities in Kingston

The adolescent period marks the important transition from childhood to adulthood. It is not an easy time for the youngster as he/she undergoes changes that are physical, emotional and social in nature. It is considered by the experts as one of the healthiest time in ones life. This age group however, is involved in much risk taking which is likely to lead to health problems. Whereas services are provided for children and adults, the adolescents do not seem to be any medical group's primary concern. Knowledge of the health problems and needs must be obtained in order to plan specific health programmes and health promotion activities. A sample of 176 adolescents from three high/secondary schools in Kingston was selected and data gathered from them. The findings revealed that 62.8 percent of the boys were aware of their health status while only 49 percent of the girls were aware. The major health problem as perceived by the adolescets are pregnancy and its complications, emotional problems, drug use and violence. The adolescents stated that the responsibility of their health care was their own with only a few stating that parents share the responsibility. The adolescents utilized the private and public facilities but preferred to go to the private doctors because of the privacy that is offered. There was general satisfaction with health care received and they did not identify alternative health care facilities. The adolescents' knowledge of health promotion was very limited with 42.8 percent stating that they did not know what it was. Those who responded thought that it was synonymous with health education or health improvement. The need for more information, education and counselling was seen to be crucial.(AU)

Supernatural beliefs about the causes of disability in three areas in Jamaica - abstract

The purpose of this study was to determine various supernatural beliefs to obtain baseline information before commencing a public education programme. A stratified sample of 300 persons of ages 5, and 12 occupational groups was surveyed in each of three areas, Spanish Town, Linstead/Ewarton and St. Mary, to get rural and urban samples. A total of 898 responses were analysed of which 42 percent were male and 58 percent female. There were proportionately more in the age groups 20 to 40 years (52 percent) and, intentionally, more in the teaching and health care worker categories (115 and 80, respectively). Of the five questions on supernatural beliefs, 46 percent of the whole sample agreed that "God gave us handicapped children to show our charity". An average of 18 percent of persons agreed with statements "A disabled child is a punishment for a sin". "Some cases of disability are still caused by evil spirits" and "if a pregnant women sees a handicapped person, her child will be handicapped". The most significant variables were age and occupation. The youngest and oldest age groups agreed most with the statements and the 30-40-year-age group least. Teachers and professionals disagreed most with the statements (9 percent) and housewives, unemployed and agricultural workers agreed most (37 percent). A mean of 22 percent of health care workers agreed with the statements. If persons with disabilities are to be affected freely in their communities, these attitudes will be a barrier. Since health care workers occupy a strategic position in interfacing with parents of disabled children, their beliefs will also need to be changed. Teachers, who appear to be more enlightened, could be used in schools to correct superstitions passed on by the grandparents to their grandchildren (AU)

A follow-up of second generation Afro-Caribbeans and white British with a first admission diagnosis of schizophrenia: attitudes to mental illness and psychiatric services of patients and relatives

A sample of second generation Afro-Caribbeans and white British with a diagnosis of schizophrenia, and their relatives, were interviewed 5-10 years after first admission. There was no difference between Afro-Caribbeans and whites on measures of satisfaction, conceptualization about illness and attitudes to different types of treatment and management. However black relatives were more likely to attribute causation of illness to substance use and to view services as racist. Most black patients and relatives thought that black day centres would be beneficial. (AU)