Factors influencing adherence to medications in a group of patients with systemic lupus erythematosus in Jamaica.

The objective of this study was to examine the factors influencing adherence to medications in a group of patients with systemic lupus erythematosus (SLE) in Jamaica. A qualitative study was designed using a screening questionnaire and semi-structured interviews. The study was conducted in the rheumatology clinic at the University Hospital of the West Indies, Kingston, Jamaica. 75 patients with SLE including 20 interviewees, who had SLE for at least 1 year participated in the study. The main outcome measures were: (i) level of self-reported adherence in a sample of the clinic attendees and (ii) interviewees explanations of the reasons for taking or not taking drugs as prescribed by their physician. 56% of the 75 study participants reported taking their medications more than 85% of the time. High cost and poor availability of medications were the main reasons for poor adherence, but some patients chose not to take their medications because of side effects, perceived mild severity of their disease and/or a preference to take drugs only when symptomatic. Patients used herbal medicines to counteract side effects of Western medicines, to 'purge the blood' and to manage lupus symptoms when they had no medications. Religious beliefs were used as a coping strategy. Traditional use of herbal medicines is common particularly in patients from rural Jamaica, and may explain the observed use of herbal medicines in those who have emigrated to developed countries. Socio-economic constraints and poor drug availability are particularly important influences on poor adherence in Jamaican patients with SLE. Religious beliefs and use of herbal remedies do not seem to affect adherence adversely but are used when drugs cannot be obtained.

Diabetes mellitus in the Jamaican elderly.

10.2% of 1318 people aged 60 to 97 years old interviewed in a community based survey in Jamaica reported that they had type II diabetes mellitus, and this was confirmed by appropriate blood and urine tests. The disease occurred more frequently in females (12.6%) of 669 interviewed) than in males (7.8% of 649 interviewed), and was detected in an additional 2.96% of the study group who were not aware that they had the disease. Among the group of diabetics, 60.25% also reported that they were hypertensive, 63.1% were taking oral anti-diabetic tablets, and 20.4% reported having the disease for more than 20 years. 89.5% of the entire study group, and 88% of the diabetic population, were functionally independent.