Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study.

INTRODUCTION: Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. METHODS: Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. RESULTS: Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. CONCLUSION: Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.

Pesticides and passion: a qualitative psychological autopsy study of suicide in Guyana.

Background: The suicide rate in Guyana has consistently ranked in the top ten globally, yet there is only limited literature related to the context in which these suicides occur. This study aims to better understand the psychosocial circumstances and characteristics of suicides in Guyana. Methods: This case series study utilised a qualitative psychological autopsy method. One to three informants per deceased person (N = 31) were interviewed regarding the lives of 20 Guyanese who died by suicide (14 M, 6 F, aged 10-74 years). Interpretative Phenomenological Analysis was utilised for the data. Findings: Four superordinate themes were identified: Interpersonal Conflict, Trauma, Health, and Unknown Reasons. Interpersonal conflict included subordinate themes of Domestic Abuse, Marital Separation, and Financial Disputes. Health included subordinate themes of Physical Health and Mental Health. Pesticide poisoning was the method used by Guyanese people whose suicide was triggered primarily by interpersonal conflict. Interpretation: The findings illustrate the complexities of suicide in Guyana and the importance of adopting a biopsychosocial perspective to suicide prevention. Suicide prevention should include mental health and suicide literacy training of medical professionals. It is recommended that the importation of highly toxic pesticides be restricted, and that less toxic substitutes be promoted. Convenience sampling, recall bias, and limited informants are limitations of this study. Future research should focus on suicidal behaviour using larger sample sizes. Funding: This research was supported by an Australian Government Research Training Program Scholarship through Griffith University Australia.

Suicidal behaviour and ideation in Guyana: A systematic literature review.

Background: The suicide rate in Guyana has consistently ranked as one of the highest in the world. This systematic review synthesises and critically analyses the existing literature on suicidal behaviours and ideation in Guyana. Methods: Systematic review with narrative synthesis was conducted following PRISMA guidelines. PubMed, PsychInfo, CINAHL and SCOPUS databases were searched until 31st March 2021. Articles which included the analysis of suicidal behaviour or suicidal ideation using data collected in Guyana were eligible for inclusion. Articles relating to the Jonestown mass murder-suicide event were excluded. This review was pre-registered with PROSPERO [CRD42021247669]. Findings: The search resulted in 318 articles, of which 24 met eligibility for inclusion. The majority were quantitative (n=18), relating to suicide mortality (n=9), and suicide attempt and suicidal ideation (n=9). Additionally, qualitative (n=5) and mixed-method (n=1) papers investigated the experiences of those bereaved by suicide, gatekeepers of suicidality, and adolescent students. Eleven studies were multinational, whilst 13 focused on Guyana. The quality of the publications varied. Interpretation: Despite high annual suicide rates in Guyana, published research is very limited. This review found preliminary evidence for key risk groups; males, female youth, and Indo-Guyanese ethnicity. Pesticide poisoning was identified as the most common method for suicide in Guyana. There is a need for local research investigating the context and narrative of suicide to inform culturally tailored prevention strategies. This study was limited to a narrative synthesis and may be impacted by publication bias. Funding: This research was supported by an Australian Government Research Training Program Scholarship through Griffith University Australia. Registration: Pre-registered in PROSPERO [CRD42021247669].

An evaluation of the usefulness of noncognitive variables as predictors of scores on the national physical therapy licensing examination.

This study employed a correlational design to develop a model to assess the predictive nature of noncognitive variables with regard to the physical therapy licensing examination. Fifty-seven graduates of an accredited physical therapy education program completed the Non-Cognitive Questionnaire-Revised (NCQ-R) and provided their scores from the licensing examination. Regression analysis was used to explore combinations of the eight domains of the NCQ-R as predictors of licensing examination scores. A model combining four of the NCQ-R domains (long-range goals, leadership, community ties, and academic familiarity) was constructed that would account for 21.3% of the variance in licensing examination scores. Some of the NCQ-R domains were related inversely, however, to higher scores on the licensing examination. The authors concluded that although noncognitive variables might be used by admissions committees as indicators of potential future success on the licensing examination, the NCQ-R as it is currently constructed may not be the best tool for measuring noncognitive variables to predict scores on the physical therapy licensing examination. Other health disciplines (e.g., occupational therapy, speech pathology, clinical laboratory science) could consider examining the predictive values of noncognitive variables when making admissions and advising decisions.