Davon Van-Veen

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.

The aim of this study was to identify factors associated with commuting stress using symptomatology among tertiary education employees in Georgetown Guyana. A cross sectional survey was conducted among 427 (100 male, 317 female) participants, with a mean age of 29.6(sd=8.7) years. Data about their demographic characteristics, psychosocial measures (perceived stress, coping and resilience), characteristics about their commute (length, mode, and satisfaction with commute infrastructure), and how often they experienced selected symptoms associated with stress on the daily commute was collected using a self administered questionnaire. A commuting stress score was calculated for each participant and this was followed by regression analysis. The results showed that after controlling for resiliency, coping, perception of job, total life stress, income levels and education all of which can contribute to how persons perceive hassles in their lives, the regression model demonstrated that females, persons who used public transportation, persons who have longer commute times and persons who are less satisfied with the commute infrastructure are more likely to report that they experience symptoms associated with stress while engaged in the daily commute compared to males, persons who use private transportation, persons who have shorter commute times and persons who are more satisfied with the commute infrastructure respectively. Once all controlled variables were accounted for, it appears that for this study population, age, where they live and whether or not they actively or passively commuted did not have any meaningful impact on whether they would report if they experienced stress associated symptoms while engaged in the daily commute. he results suggest the need for a multi-pronged approach to address commuting stress, involving individual healthcare, mental-health-centric urban transport design, improved commute infrastructure, and increased employer engagement. Future studies employing qualitative and experimental methods are recommended.