Unravelling Delay in Care for Sexually Transmitted Infections-Related Symptoms in a Developing Country Setting (Jamaica).

BACKGROUND: Sexually transmitted infections (STIs) and STI treatment remain a challenge in public health. There is little understanding of related factors influencing health seeking behaviour and delay of care among clinic attendees in Jamaica. AIM: To determine socio-demographic profile of clinic attendees with STI and identify factors associated with delay in seeking care for STI-related symptoms. METHODS: A cross-sectional study was done. 201 adult patients presenting with STI symptoms from four health centres in Kingston and St Andrew were selected. A 24-item interviewer-assisted questionnaire was used to obtain data on socio-demographic characteristics, patients' symptoms and duration, previous STIs, knowledge of complications and seriousness of STIs, and factors influencing decision to seek medical care. RESULTS: Almost 75% delayed seeking care for STIs. Recurrent STIs was identified in 41% of patients. 'Could not find time' was the most commonly reported reason for delay in seeking care (36%). Females were 3.4 times more likely to delay seeking care for STI symptoms than males (OR 3.42, 95% CI: 1.73-6.73). Those with primary level education and below were 5 times more likely to delay seeking care for STI symptoms than those with at least secondary level education (OR 5.05, 95% CI: 1.09-23.46). Participants viewed staff as confidential (68%) and 65% thought health-care workers spent adequate time during consultations. CONCLUSION: Lower education level and the female gender are associated with delay in seeking care for STI-related symptoms. These factors should be considered when developing interventions to reduce delay in care for STI-related symptoms.

Taxi drivers and COVID-19 in Jamaica: Occupationally related income decline and health behaviour.

Income and employment are recognised as social determinants of health. Occupationally related exposures and working conditions impact health behaviours. Taxi drivers have been recognised as an occupationally COVID-19 at-risk group. COVID-19 threatens their lives and livelihoods. This study describes self-reported income changes attributed to the COVID-19 pandemic among taxi drivers. Associations between percentage change in income and reported prevention practices were ascertained. In May 2020, a cross-sectional study was done among 282 taxi drivers in the Kingston and St. Andrew Metropolitan Area in Jamaica. Multi-stage sampling was used to select taxi driver from seven hubs. Data collection utilised a 28-item questionnaire. Self-reported income before and during the COVID-19 pandemic was ascertained and correlations between relative changes in income and COVID-19 prevention practices were assessed. The median pre-COVID-19 monthly income was USD 1,428.57 (IQR = 1,467.26), about USD 51/day. Median monthly income since the COVID-19 outbreak was USD 500 (IQR = 472.37), about USD 18/day, representing a 65% reduction in income. There was a statistically significant association between the relative change in income and the practice of wearing mask while transporting passengers. Generally, as the relative change (decline) in income increased, reported compliance with mask wearing decreased (Spearman's rho = -0.15, p = 0.02). Taxi drivers have experienced marked decline in income due to the COVID-19 pandemic, with implications for health practices and the maintenance of desired health behaviours. Authorities should be cognisant of the economic impact and COVID-related consequences in the taxi industry, as they seek to develop COVID-19 occupationally related prevention and control programmes.

Structured internship in health promotion: an approach used in a middle-income developing country - Jamaica.

Internship programmes have the potential to provide learning and professional experiences, build students' competency and strengthen partnerships between community and training institutions. In this paper, we examine the extent to which a structured internship at The University of the West Indies contributed to experience and competency-building, provided focus and met learners' expectations and satisfaction among a cohort of unpaid health promotion interns. The contribution of placements to the strengthening of health education and promotion competencies and interns' feelings about their experiences are included. Twenty-four (24) internship reports were reviewed using a mix of quantitative and qualitative methods. The majority of interns were Jamaicans (70.8%), 12.5% were from Dominica and the remaining 16.7% represented other nationalities. Health professionals comprised the highest percentage of cohorts (79.2%) and governmental agencies comprised the largest proportion (63%) of internship sites. Activities undertaken were in the areas of planning, implementing and evaluating programmes (71%) and conducting needs assessments (63%). Communication-related activities were reported by 43% of interns. Twenty-one per cent were engaged in lobbying and collaboration with other partners, while 23% established committees to oversee the sustainability of initiatives. While some interns reported negative experiences with supervision at their placement agencies, all valued internship seminars, which they found as a supportive environment in which they were able to share their progress with peers and academics. The opportunity for applying theory to practice and acting as resource persons were reflected as positives. The structured internship approach seems to have merits for building competence and engendering individual satisfaction.

Caregivers of Older Persons in Jamaica: Characteristics, Burden, and Associated Factors.

OBJECTIVE: The objective of this study was to determine and characterize caregiver burden among caregivers of community-dwelling older persons in Jamaica. METHOD: A nationally representative cross-sectional study was done among persons providing noninstitutional care for a single person (≥60 years). The Zarit Burden Interview (ZBI) and a structured questionnaire were administered to 180 caregivers from four geographic health regions. RESULTS: The ZBI scores ranged from 0 to 56 (median = 15). Independently associated factors were relationship to care recipient and age. Children/grandchildren had higher caregiver burden scores than formally employed caregivers (odds ratio = 2.9: 95% confidence interval: [1.02, 8.34]). Compared with caregivers 35 to 44 years, those aged 45 to 65 were almost 5 times more likely to report higher caregiver burden scores. CONCLUSION: Caregiver burden as identified by the ZBI was low. Age (45-65 years) and being the child/grandchild of the care recipient were independently associated with greater caregiver burden. Interventions to address caregiver burden must embrace strategies that recognize that these factors.

Socio-demographic, Health and Functional Status Correlates of Caregiver Burden Among Care Recipients Age 60 Years and Older in Jamaica.

The provision of care to older persons can impose significant burden on those providing care, burdens influenced by care recipient characteristic, caregiver attributes and availability of social support. This paper focuses on identifying relationships between caregiver burden and the socio-demographic, health and functional status attributes of care recipients age 60 years and older in Jamaica. A nationally representative cross-sectional study was done among persons providing non-institutional care for a single person 60 years and older. Data were obtained from a total of 180 caregivers from the four geographic health regions of Jamaica using the Zarit Burden Interview and a 44-question structured questionnaire. Associations between caregiver burden and socio-demographic, health and functional status of care recipients were examined and logistic regression applied to ascertain independent predictors of caregiver burden. The results revealed statistically significant relationships between caregiver burden and care recipients' receipt of conditional cash transfer grants and the ability to toilet independently. In multivariate analysis, ability to toilet remained a significant predictor of caregiver burden-Caregivers who had care recipients who were able to toilet independently were 71% less likely to have mild to severe caregiver burden compared to those who had care recipients that were not able to toilet (OR 0.29; 95% CI 0.14-0.57). Families, health care providers, social workers, state actors and caregivers should take this into account as they develop strategies to mitigate associated caregiver burden.

Zarit burden interview among caregivers of community-dwelling older adults in a caribbean setting (Jamaica): Reliability and factor structure.

The Zarit Burden Interview has been the most popularly used tool for measuring caregiver burden and with the 60 years and over population in Jamaica and developing countries expected to increase, caregiver burden and its assessment assume increased importance. Establishing the reliability and underlying factor structure of instruments such as the ZBI is critical. This study sought to determine the reliability of the Zarit Burden Interview and to assess its underlying factor structure. The ZBI was administered to 180 caregivers of community dwelling older persons in Jamaica in a nationally representative sample across four geographic health regions in 2016. The factor structure was identified using exploratory factor analysis (EFA) with Varimax rotation. Cronbach's alpha was used to assess internal consistency/reliability of the instrument. The internal consistency/reliability of the ZBI instrument was high (Cronbach's α = 0.859) and the corrected item-total correlations ranged from 0.134 to 0.730. The ZBI mean score was found to be 16.92 ± 12.04. EFA produced a six-factor model comprised of 19 items which explained 48.97% of total variance, and was subsequently reduced to four (37.27% of total variance) via the use of parallel analysis and scrutiny of confidence intervals. The four factors identified were 'personal strain', 'social relations disruption', 'resource strain/imbalance' and 'role intensity'. The ZBI-22 tool is a reliable instrument for evaluating caregiver burden among community dwelling older persons in Jamaica. A four factor model has emerged providing greater insights on the underlying constructs of the ZBI, the most widely used caregiver burden assessment tool.

Performance and Receiver Operating Characteristics of the Mini-Mental State Examination Instrument in Detecting Dementia in a Rapidly Aging Developing Country (Jamaica).

OBJECTIVE: To examine the performance of the Mini-Mental State Examination (MMSE) in community-dwelling older persons in a developing country (Jamaica) undergoing rapid population aging. METHODS: An embedded validity study was conducted utilizing participants from a nationally representative sample of 2782 older persons. Standardized MMSE scores were obtained for study participants. A random selection of 170 persons with MMSE scores greater than 20 and 170 persons with scores 20 or less was done. Field staff were trained to apply the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for the diagnosis of dementia. In total, 300 participants (167 participants with MMSE score of 20 or less, 133 participants with scores greater than 20) were assessed and categorized according to dementia status. Performance characteristics of the MMSE tool were determined for study participants and appropriate adjustment and analyses subsequently applied to facilitate extrapolation to the nationally representative sample. RESULTS: The mean MMSE scores for participants with score of 20 and less was 17.1 (standard deviation [SD] = 3.2) and 24.5 (SD = 2.8) for those with scores greater than 20. Dementia was identified in 34 participants. The receiver operating characteristic curve for MMSE scores in relation to dementia diagnosis had an area under the curve value of 0.935 (95% confidence interval, 0.893-0.977). The optimal MMSE cut-point was 18/19 and was consistently so regardless of age category, gender, educational level, and number of chronic illnesses. CONCLUSION: There is merit in using the MMSE examination as a screening tool for dementia in Jamaica. The findings of this study coupled with widespread use and familiarity among practitioners give credence to the MMSE as a reasonable screening tool for dementia in Jamaica-rapidly aging society.

Predictors of Health Service Utilization Among Older Men in Jamaica.

OBJECTIVES: To determine the relative influence of sociodemographic, socioeconomic, psychosocial, and health variables on health service utilization in the last 12 months. METHODS: Data were analyzed for 1,412 men ≥60 years old from a 2012 nationally representative community-based survey in Jamaica. Associations between six health service utilization variables and several explanatory variables were explored. Logistic regression models were used to identify independent predictors of each utilization measure and determine the strengths of associations. RESULTS: More than 75% reported having health visits and blood pressure checks. Blood sugar (69.6%) and cholesterol (63.1%) checks were less common, and having a prostate check (35.1%) was the least utilized service. Adjusted models confirmed that the presence of chronic diseases and health insurance most strongly predicted utilization. A daughter or son as the main source of financial support (vs self) doubled or tripled, respectively, the odds of routine doctors' visits. Compared with primary or lower education, tertiary education doubled [2.37 (1.12, 4.95)] the odds of a blood pressure check. Regular attendance at club/society/religious organizations' meetings increased the odds of having a prostate check by 45%. DISCUSSION: Although need and financial resources most strongly influenced health service utilization, psychosocial variables may be particularly influential for underutilized services.

Participation in Social Activities and the Association with Socio-Demographic and Health-Related Factors among Community-Dwelling Older Adults in Jamaica.

Social participation is critical for maintaining independence and facilitating active ageing. The aim of this paper is to describe participation in social activities among older adults in Jamaica and to identify independently associated socio-demographic and health characteristics. We analysed data from a nationally representative, community-based survey of 2943 persons 60 years and older. Sixty-three percent of older adults attended religious services and 60 % were visited by friends at least once per month in the 12 months preceding the survey. Age was not independently associated with social participation. Persons with post-secondary level education were twice as likely as those with primary education or less, to be visited by friends and to attend meetings of formal organisations. Men, persons not in union, and those with less functional independence had reduced odds of attending meetings of formal organisations. These variables were however not independently associated with having visits with friends. Persons with a positive depression screen were between 42 % and 44 % less likely to be visited by friends. Persons who received an income through livestock/farming were more likely to visit or be visited by friends. The variables independently associated with social participation vary depending on the type of social activity considered. Where possible, health and social interventions should focus on prevention, delay and reversal of risk factors associated with reduced social participation. Social participation programmes should be prioritized and be informed by input from older adults. Future research should include other forms of social interactions and clarify older adults' perceptions of their quality.

Ageing in place: implications of morbidity patterns among older persons--findings from a cross-sectional study in a developing country (Jamaica).

AIM: This paper describes morbidity patterns among older people, relevant health-care resources in a localised population in a developing country (Jamaica) and implications for ageing in place in the community. METHODS: Local morbidity patterns among older people were determined in Jamaica from a 2007 cross-sectional study involving record searches at major hospitals and clinics. Age-specific morbidity distributions were compiled. Data on health-care staff complement were also collected. RESULTS: Non-communicable diseases predominate in older people in Jamaica; 50% of diagnoses related to cardiovascular disorders and diabetes. Staff-to-population ratios were low compared with other international data. CONCLUSION: A high prevalence of non-communicable disease coupled with inadequate staffing threatens the likelihood of ageing in place in the Jamaican community. Secondary prevention efforts and social support services which enhance ageing in place are needed.

Perception of susceptibility to prostate cancer and screening behaviour - insights from a case-control study [abstract]

OBJECTIVE: The aim of this study was to assess the perception of Jamaican men regarding their susceptibility to prostate cancer and to determine how this perception is associated with their decision to attend for screening of this condition. METHODS: A case-control study was conducted among 200 men between the ages of 40 and 75 years attending three health-related clinics in Kingston, Jamaica. A case was defined as any male who had a digital rectal examination or prostate specific antigen (PSA) within the last two years as a check for prostate cancer. Controls were men who did not have any of these screening tests. Factors affecting decision to attend for screening for prostate cancer were assessed through a structured interview. Specifically, participants were asked whether they perceived themselves at risk for prostate cancer. In-depth discussions were done to obtain additional insights about screening. RESULTS: The majority of screeners (70 percent) perceived themselves as being at risk of getting prostate cancer compared to 45 percent of non-screeners. Men who perceived themselves as being at risk were more likely to attend for screening than were men who did not perceive or were unsure about their risk Odds Ratio (OR) (2.85, 95 percent) Confidence Interval (CI) (1.59,3.02). There was no significant association between age and perception of risk (p> 0.05). Men felt that screening for prostate cancer was not given the level of promotion which cancers of women was given. Men who were screened were also likely to have had screening recommended by a physician (un-adjusted OR 44, 95 percent CI 17.9,108. CONCLUSIONS: Consistent with a construct of the health belief model of behaviour change, perception of susceptibility to prostate cancer appears to influence screening behaviour among men in this study. Well-designed cancer screening promotion with due consideration to screening barriers, and physician's advice are likely cues to getting screened. (AU)

Popular music and associated health responses among female adolescents 15-19 years in three parishes of Jamaica

The many health risks faced by adolescents place them high on the list of priorities for family health services. The inculcation of values and sound decision making skills among adolescents are factors which facilitate their resilence. The alleged negative influence of Jamaica's popular dance hall music has been an issue of much public debate. Even as the lyrical content of some dance hall music get more sexually explicit, a sizeable proportion of our population seem to enjoy them. Recognizing the powre of music, this study was undertaken to explore the relationship between music and adolescents' emotions, self-concept and gender perception. The preference for, use and effects of dance hall and other music was analysed among fifty sexually active (cases) and fifty, reportedly, non-sexually active (control) female adolescents in three parishes. It was statistically significant (p<0.05) that sexual activity was associated with the kinds of feelings evoked by music. There was no conclusive evidence however, that exposure to dance hall or other types of music is associated with early sexual involvement, or that they contribute to negative feelings about self, men and women. Soul music was the most valued by both cases and controls and significantly elicited feelings of love, intimancy and loneliness among those who were sexually active. Dance hall music was the preference among adolescents for fun and excitement while reggae music was seen as an instrument for building consciousness and for reflection. Gospel music was more for spirtuality. The words of songs were the major reasons for liking selected songs and this was significantly so for soul music among sexually active and non-sexually active adolescents. Although more detailed research is required, it can be concluded that music is vital to the lives of adolescents and offers scope for use in educational programmes.(Au)

Popular Music and associated health responses among female adolescents 15-19 years in three parishes of Jamaica

The many health risks faced by adolescents place them high on the list of priorities for family health services. The inculcation of values and sound decision making skills among adolescents are factors which facilitate their resilience. The alleged negative influence of Jamaica's popular dance hall music has been an issue of much public debate. Even as the lyrical content of some dance hall music get more sexually explicit, a sizeable proportion of our population seem to enjoy them. Recognising the power of music, this study was undertaken to explore the relationship between music and adolescents' emotion, self-concept and gender perception. The preference for, use and effects of dance hall and other music was analysed among fifty sexually active (cases) and fifty, reportedly, non-sexually active (control) female adolescents in three parishes. It was statistically significant (p<0.05) that sexual activity was associated with the kinds of feelings evoked by mysic. There was no conclusive evidence however, that exposure to dance hall or other types of music is associated with early sexual involvement or that they contribute to negative feelings about self, men and women. Soul music was the most valued by both cases and controls and significantly elicited feelings of love, intimacy and loneliness among those who were sexually active. Dance hall music was the preference among adolescents for fun and excitement while reggae music was seen as an instrument for building consciousness and for reflection. Gospel music was more for spirituality. The words of songs were the major reasons for liking selected songs and this was significantly so for soul music among sexually active and non-sexally active adolescents. Although more detailed research is required, it can be concluded that music is vital to the lives of adolescents and offers scope for use in educational programmes.(AU)