Objective: Psychological and spiritual caregiving gains in cross-cultural missionaries providing invaluable formal, unpaid, full time care at residential facilities in a remote, inner-city island setting were investigated. Method:One hundred and ten (110) Missionary caregivers of over 500 mentally and physically challenged and terminally ill children and adults in residential mission facilities completed a validated 10-item questionnaire, investigating positive aspects of caregiving and spiritual gain.Results: ANOVA on mean frequencies demonstrated significant gains in self-affirmation (p<0.001), outlook on life (p<0.001), and a strengthened relationship with God (p<0.001). Conclusion:Psychological and spiritual gains of missionaries providing vital care at residential facilities highlighted positive aspects of caregiving.Keywords: Positive aspects of caregiving; Missionary; Residential home; Spiritual health; Mental health facilities, they provide full time care for abandoned, terminally ill, physically and mentally disabled, homeless destitute men, women and children. These shelters provide permanent residence for over 500 persons, representing an inestimable economic and social contribution to Jamaica, a developing country. The missionaries (locally known as 'Brothers') conduct all hygiene, nutrition, mobility, toileting, home medical daily living care for all of the residents. It is an intense, unremitting, daily caregiving role.The study aimed to identify positive aspects of caregiving (PAC) and spiritual gains for these cross-cultural missionaries. DesignThis study was a quantitative, descriptive, cross-sectional census of a single group of 110 formal, unpaid missionary caregivers at residential facilities. MethodsEthical approval was obtained from the University of the West Indies Faculty of Medical Sciences Ethics committee prior to administration of the survey. Brothers included in the sample were professed missionaries for at least 3 years, had lived on the island for at least 2 years and were providing full-time care to residents at one of the 6 residential facilities for at least 2 years.Demographic data collected were age, country of birth and number of years working with residents in the homes. The internationally accepted nine-item Positive Aspects of Caregiving (PAC) tool [7] was used in its entirety, with permission. It was previously validated by those authors with an appropriate culturally and ethnically diverse sample. A 10 th item related to spiritual strengthening was included,