Objectives:To determine the level of adherence and possible barriers to secondary prophylaxis among clients with rheumatic fever in Kingston, Jamaica. Methods: Cross-sectional survey of 39 clients diagnosed with rheumatic fever, receiving penicillin prophylaxis for more than a year using a 22-item self-administered questionnaire on adherence to secondary prophylaxis and knowledge of rheumatic fever. The patients' records were reviewed to determine the number of prophylaxis injections the patients received for the year 2010. Results: The majority of participants (74%) were females and 51% were adults. Only 48.7% had a high level of adherence. The majority (72%) had low knowledge levels regarding their illness, while only 5% had a high knowledge level score. Most clients (70%) strongly agreed that nurses and doctors encouraged them to take their prophylaxis. However, over 60% reported that they travelled long distances and or waited long periods to get their injections. One-third reported that they missed appointments because of fear of injections and having to take time off from work or school. Discussion: Clients attending the health centers studied had limited knowledge about rheumatic fever. Barriers to adherence included fear of the injections, long commutes, and long waiting periods at the facilities studied.

Purpose The purpose of this study was to identify the ways in which urban Jamaican mothers influence their adolescent daughters’ sexual beliefs and behaviors in order to incorporate them into the design of a family-based human immunodeficiency virus (HIV) risk reduction intervention program. Design Focus groups were conducted with 46 14- to 18-year-old adolescent girls and 30 mothers or female guardians of adolescent girls recruited from community-based organizations in and around Kingston and St. Andrew, Jamaica. Separate focus groups were held with mothers and daughters; each included 6 to 10 participants. Focus group sessions were scripted, led by teams that included trained Jamaican and American facilitators and note-takers, and audio-taped to ensure data accuracy. Data were analyzed using qualitative content analysis. Findings Four major maternal influences were identified: mother-daughter relationship quality, mother-daughter sexual communication, monitoring or supervision, and maternal sexual role modeling. Mothers’ and daughters’ reports were consistent; both groups identified positive and negative influences within each category. Conclusions Some maternal influences were positive and health promoting; others were negative and promoted unsafe sexual activity and risk for HIV and other sexually transmitted infections. These influences were incorporated into the design of a culture-specific family-based HIV risk reduction intervention tailored to the needs of urban Jamaican adolescent girls and their mothers. Clinical Relevance In order to be effective, family-based HIV risk reduction interventions should be theory based and tailored to the target audience. The four maternal influences identified in this formative study were incorporated into the subsequent intervention design.

Purpose: Caregivers of patients diagnosed with schizophrenia experience moderate to severe caregiver burden and are at risk for developing mental disorders. This study explores the psychological effects and coping strategies of family caregivers of relatives diagnosed with schizophrenia in the developing world. Methods: This qualitative study used the register of a community mental health clinic at a Jamaican hospital to purposively select and recruit five primary family caregivers of clients diagnosed with schizophrenia (based on the DSM IV). Consenting participants were interviewed using a semi-structured interview guide. Data were analyzed using thematic content analysis. Results: Four of the five caregivers studied were females. Participants were either parents (4) or siblings (1) of the client diagnosed with schizophrenia and aged 42 -57years. Participants experienced feelings of anger, sadness, loss of libido, loss of appetite and depression. They expressed feelings of fear, guilt, stigma and stress related to financial responsibilities in caring for their relatives. Coping mechanisms included social support from family members and their strong faith in God. Conclusion: Participants reported experiencing major psychological distress and ineffective coping. Community based management of individuals with schizophrenia should include strategies to support family caregivers.

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