The Afrocentric view concerning Jamaicans who bleach their skins is that they suffer from self-hate, a result of the lingering psychological scars of slavery. The self-hatred thesis is tested by comparing the self-esteem scores of a small convenience sample of skin bleachers with the scores of a control group. The two groups have almost the same average scores above the median, which indicates that skin bleaching did not occur because of low self-esteem. The preliminary results suggest that there are varied reasons for skin bleaching and there is a range of Black identities as each person constructs his or her identity in a multicultural society.

This article focuses on the sexual attraction motive for skin bleaching in Jamaica. Some captive Africans on plantations in Jamaica altered their complexion. These Africans modeled the British in the colony who bleached their skin to protect the ''superior,'' ''sexy,'' and ideal white skin from the ''impurities'' of interracial sex and the tropical climate. The beauty and sexual attraction accorded to light skin was also evident in skin bleaching newspaper ads in the 1950s. The ads told women that acquiring light complexion through skin bleaching would make them sexually attractive to men. The persistence of colorism and its most blatant expression-skin bleaching-is also evident in contemporary Jamaica as expressed in some dancehall songs which praise skin bleachers, and the explanatory narratives of skin bleachers that bleaching makes them pretty and sexually attractive to potential spouses. Similar themes are reflected in the criticism that the browning Dancehall Queen Carlene was deemed sexually attractive and choreographically talented only because of her brown physicality. Some spouses request that their partner acquire the bleached physicality because they find it sexually attractive similar to many male clients in ''massage parlors'' who only request female sex workers who bleach their skin.

Health literacy is a measure of the patient’s ability to read, comprehend and act on medical instructions. This research article examines health literacy and health-seeking behaviors among elderly men in Jamaica, in order to inform health policy. This is a descriptive cross-sectional study. A 133-item questionnaire was administered to a random sample of 2,000 men, 55 years and older, in St Catherine, Jamaica. In this study, 56.9% of urban and 44.5% of rural residents were health literate. Only 34.0% of participants purchased medications prescribed by the medical doctor and 19.8% were currently smoking. Despite the reported good self-related health status (74.4%) and high cognitive functionality (94.1%) of the older men, only 7.9% sought medical care outside of experiencing illnesses. Thirty-seven percent of rural participants sought medical care when they were ill compared with 31.9% of their urban counterparts. Thirty-four percent of the participants took the medication as prescribed by the medical doctor; 43% self-reported being diagnosed with cancers such as prostate and colorectal in the last 6 months, 9.6% with hypertension, 5.3% with heart disease, 5.3% with benign prostatic hyperplasia, 5.3% with diabetes mellitus, and 3.8% with kidney/bladder problems. Approximately 14% and 24% of the participants indicated that they were unaware of the signs and symptoms of hypertension and diabetes mellitus, respectively. The elderly men displayed low health literacy and poor health-seeking behavior. These findings can be used to guide the formulation of health policies and intervention programs for elderly men in Jamaica.

This article deals with skin bleachers’ representations of skin color and the reasons that inform their representations. A content analysis was done of the reasons the participants give for bleaching their skin. The participants bleach their skin to remove facial blemishes, to make their faces “cool,” as a result of peer influence, to lighten their complexion, to appear beautiful and to attract a partner, to follow a popular fad, and to have the visual stimulus of the bleached skin because it makes them feel good. In Jamaican society, negative representations of dark skin indicate that dark skin is devalued, whereas light skin is valued. The hegemonic representation that elevates light skin over dark skin and guides the behavior of the skin bleachers has its roots in socializing institutions of the larger cultural milieu. The interaction of the government, the church, the education system, the media, formal culture, and popular culture from the colonial period to the present sends repeated messages that light skin is superior to dark skin.

Effective supportive supervision of healthcare services is crucial for improving and maintaining quality of care. However, this process can be challenging in an environment with chronic shortage of qualified human resources, overburdened healthcare providers, multiple roles of district managers, weak supply chains, high donor fragmentation and inefficient allocation of limited financial resources. Operating in this environment, we systematically evaluated an approach developed in Tanzania to strengthen the implementation of routine supportive supervision of primary healthcare providers. The approach included a systematic quality assessment at health facilities using an electronic tool and subsequent result dissemination at council level. Mixed methods were used to compare the new supportive supervision approach with routine supportive supervision. Qualitative data was collected through in-depth interviews in three councils. Observational data and informal communication as well as secondary data complemented the data set. Additionally, an economic costing analysis was carried out in the same councils. Compared to routine supportive supervision, the new approach increased healthcare providers’ knowledge and skills, as well as quality of data collected and acceptance of supportive supervision amongst stakeholders involved. It also ensured better availability of evidence for follow-up actions, including budgeting and planning, and higher stakeholder motivation and ownership of subsequent quality improvement measures. The new approach reduced time and cost spent during supportive supervision. This increased feasibility of supportive supervision and hence the likelihood of its implementation. Thus, the results presented together with previous findings suggested that if used as the standard approach for routine supportive supervision the new approach offers a suitable option to make supportive supervision more efficient and effective and therewith more sustainable. Moreover, the new approach also provides informed guidance to overcome several problems of supportive supervision and healthcare quality assessments in low- and middle income countries.

Background:Studies have shown that women's ability to access contraceptive methods depend on their socio-economic, educational, professional status, and the health and well-being of their families and themselves. Therefore, the embarking of the Governments of the Caribbean on important initiatives relating to gynecological matters is very important and timely.Aims:This study aims to examine the perception, attitude and practice of Jamaican women towards the matter of pelvic examination.Patients and Methods:The current study used an extracted sample of 7,168 women in their reproductive years (15-49 yrs) from a study which was undertaken by the National Family Planning Board in 2002 on Reproductive Health. Data was analyzed using SPSS for Windows, Version 16.0 (SPSS Inc.; Chicago, Ill. USA). Logistic regression was used to analyze factors/variables pertaining to Pelvic examination.Results:The findings revealed that older women are more likely to have done a Pelvic examination compared to younger women (χ2 = 675.29, P < 0.001). Age, number of pregnancies that resulted in miscarriages, number of pregnancies that resulted in induced abortion, age of first sexual intercourse, number of years of schooling, area of residence and socio-economic class are statistically significant factors of Pelvic examinations in Jamaica. Therefore, the model had significant predictive power where (χ2 = 1022.79, P < 0.001).Conclusion:The multidimensional nature of the variables, which emerged in the current study, indicate that a multisectoral approach should be used to address low pelvic and Pap smear examination among Jamaican women.

BackgroundUniversal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision.MethodsMixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements.ResultsThe results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts.ConclusionTogether with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.

BackgroundProgress in health service quality is vital to reach the target of Universal Health Coverage. However, in order to improve quality, it must be measured, and the assessment results must be actionable. We analyzed an electronic tool, which was developed to assess and monitor the quality of primary healthcare in Tanzania in the context of routine supportive supervision. The electronic assessment tool focused on areas in which improvements are most effective in order to suit its purpose of routinely steering improvement measures at local level.MethodsDue to the lack of standards regarding how to best measure quality of care, we used a range of different quantitative and qualitative methods to investigate the appropriateness of the quality assessment tool. The quantitative methods included descriptive statistics, linear regression models, and factor analysis; the qualitative methods in-depth interviews and observations.ResultsQuantitative and qualitative results were overlapping and consistent. Robustness checks confirmed the tool’s ability to assign scores to health facilities and revealed the usefulness of grouping indicators into different quality dimensions. Focusing the quality assessment on processes and structural adequacy of healthcare was an appropriate approach for the assessment’s intended purpose, and a unique key feature of the electronic assessment tool. The findings underpinned the accuracy of the assessment tool to measure and monitor quality of primary healthcare for the purpose of routinely steering improvement measures at local level. This was true for different level and owner categories of primary healthcare facilities in Tanzania.ConclusionThe electronic assessment tool demonstrated a feasible option for routine quality measures of primary healthcare in Tanzania. The findings, combined with the more operational results of companion papers, created a solid foundation for an approach that could lastingly improve services for patients attending primary healthcare. However, the results also revealed that the use of the electronic assessment tool outside its intended purpose, for example for performance-based payment schemes, accreditation and other systematic evaluations of healthcare quality, should be considered carefully because of the risk of bias, adverse effects and corruption.