Improving the social responsiveness of medical schools: lessons from the Canadian experience.

The recent Canadian experience in promoting social accountability and social responsiveness of medical schools has been one of steady improvement in certain institutions, against a background lacking overall national policy direction. Canada has several distinct advantages in trying to devise means of enhancing social accountability of medical training and health services, including a strong national system of publicly supported and financed health care of high quality, a network of excellent academic medical centers, and well-established accreditation bodies. A review of the literature, complemented by a new survey of Canadian medical schools, confirms that some of the centers, conscious of the need to promote social responsiveness, are developing innovative programs to do so. Future progress toward the goal of social responsiveness of medical schools on a pan-Canadian basis will require a more cohesive approach involving systematic sharing of best practices among academic health centers, effective alliances with other health professionals to promote these objectives, and support by federal and provincial ministries of health. Canadian awareness of an international movement tending to similar objectives would support the efforts of Canadian health professionals engaged in practices of enhanced accountability.

Canadian ethnocultural communities facing AIDS: overview and summary of survey results from phase 111

This paper describes the survey results reporting demographic profiles, behaviours, opinions beliefs, attitudes and intentions related to condom use for three Canadian ethnocultural communities (Latin American, English-speaking Caribbean and South Asian) participating in the Ethnocultural Communities facing AIDS Study. Specific recommendations are presented for HIV-prevention programming based on the research results (AU).

Understanding use of condoms among Canadian ethnocultural communities: methods and main findings of the survey

The aim of this study was to understand the intention to use a condom for each instance of sexual intercourse with a new partner in three of Canada's non-dominant ethnocultural communities: Latin American (N=346), English-speaking Caribbean (N=358), and South Asian (N=355). All respondents were recruited from multiple ethnocultural venues using predetermined sampling frames and quotas for each community. Anonymous questionnaire assessing culturally specific theoretical constructs were completed. This paper presents the methodology and the main findings. The high quality of the results of this study demonstrate the advantage of establishing strong partnerships with members of communities being studied (AU)

Many voices: sociocultural results of the ethnocultural communities facing AIDS study in Canada

This paper presents the results of Phase 11 of the Ethnocultural Communities facing AIDS Study, the sociocultural investigation of factors contributing to risk behaviour associated wih HIV/AIDS in six ethnocultural communities in Canada in three urban sites. In Vancouver, the South Asian and Chinese communities were studied, the Horn of Africa and English-speaking Caribbean communities in Toronto and the Latin American and Arab-speaking communities in Montreal. Results demonstrated that there are common elements across these ethnocultural communities that increase the risk for HIV transmission. HIV/AIDS awareness and prevention in ethnocultural communities must address sociocultural differences, particularly sex role differences between men and women in terms of power within relationships to negotiate for safer sexual practices (AU).

HIV/AIDS in the context of culture: selection of ethnocultural communities for study in Canada.

This article reports on the methodology used to select six ethnocultural communities invited to participate in subsequent phases of the project on HIV/AIDS in the context of culture in Canada. Selection was based on quantitative data on demography, qualitative assessment of ethnocultural cohesion; and quantitative data and qualitative data of exposure to risk for sexually transmitted disease. A principle of partnership insured that the final selection was completed by interaction between the investigators and the National Advisory Committee representing ethnocultural communities in Canada. The six communities asked to participate in Phase II of the study were: in Montreal, the Latin American and the Arabic-speaking communities; in Toronto, the English-speaking Caribbean communities and communities from the Horn of Africa; in Vancouver, the Chinese and the South Asian communities. The results are significant for the future both of research on ethnicity in Canada and of control of HIV and AIDS.

Participatory aspects in the qualitative research design of phase II of the ethnocultural communities facing AIDS study.

This paper describes the steps taken in generating and implementing a qualitative research design for Phase II of the Ethnocultural Communities Facing AIDS Study. Theoretically framed by the macro-level, sociocultural model of health behaviour developed by Kleinman, the methodological procedures are an adaptation of Scrimshaw's Rapid Assessment Procedures (RAP) and a participatory approach involving stakeholders from each ethnocultural community. Qualitative data-on behaviours conducive to HIV transmission in six ethnocultural communities in Canada-were elicited using a combination of key communicator interviews, focus groups, and participant observation techniques. Data were analyzed using systematic content analysis techniques. Inter-rater reliability checks and procedures of triangulation demonstrated the validity of evidence generated. A commitment to research partnership with community persons, and an accountability loop that provided assurances of how the data would be scientifically represented, were critical elements in the process of design construction.

Overview of the Canadian study on the determinants of ethnoculturally specific behaviours related to HIV/AIDS.

Canada's population is composed of heterogenous ethnocultural communities. There is a need for information and educational initiatives on HIV and AIDS directed specifically at these communities. For such interventions to be effective we must determine the existing personal and sociocultural factors related to HIV transmission. There has been little such research in Canada. In this supplement we report on various aspects of a study conducted between May 1992 and December 1994 to determine the factors related to HIV transmission in several ethnocultural communities. This paper describes some innovative aspects of the project: the conceptual framework, the community participatory model, the use of a multi-method research design, and the ongoing communication strategy. The combination of these elements makes the study unique. The value of the study lies not only in the information obtained but also in the model it provides for future research in other settings.

Many voices--sociocultural results of the ethnocultural communities facing AIDS study in Canada.

This paper presents the results of Phase II of the Ethnocultural Communities Facing AIDS Study, the sociocultural investigation of factors contributing to risk behaviour associated with HIV/AIDS in six ethnocultural communities in Canada in three urban sites. In Vancouver, the South Asian and Chinese communities were studied, the Horn of Africa and English-speaking Caribbean communities in Toronto and the Latin American and Arabic-speaking communities in Montreal. Results demonstrated that there are common elements across these ethnocultural communities that increase the risk for HIV transmission. HIV/AIDS awareness and prevention in ethnocultural communities must address sociocultural differences, particularly sex role differences between men and women in terms of power within relationships to negotiate for safer sexual practices.

Understanding use of condoms among Canadian ethnocultural communities: methods and main findings of the survey.

The aim of this study was to understand the intention to use a condom for each instance of sexual intercourse with a new partner in three of Canada's non-dominant ethnocultural communities: Latin American (N = 346), English-speaking Caribbean (N = 358), and South Asian (N = 355). All respondents were recruited from multiple ethnocultural venues using predetermined sampling frames and quotas for each community. Anonymous questionnaires assessing culturally specific theoretical constructs were completed. This paper presents the methodology and the main findings. The high quality of the results of this study demonstrate the advantage of establishing strong partnerships with members of communities being studied.

PIP: During April-May 1994, in Canada, 346 members of the Latin American community aged 18-49, 358 members of the English-speaking Caribbean community aged 16-49, and 355 members of the South Asian community aged 18-45 completed a questionnaire developed by the Research Group on Psychosocial Aspects of Health Behavior at Laval University in Quebec. This study aimed to identify the variables influencing intention to use a condom for each instance of sexual intercourse with a new partner in three nondominant ethnocultural communities. 81% of Latin Americans, 75% of the Caribbeans, and 71% of the South Asians intended to use a condom for each instance of sexual intercourse with a new partner during the next 3 months. Yet, among people who had had sex with a new partner in the last year, only 30% of Latin Americans, 28% of the Caribbeans, and 47% of South Asians always used a condom. Significant predictors of intent to use a condom in each instance of sexual intercourse with a new partner were personal normative belief (a measure of the personal feelings of moral obligation or responsibility to use or refuse to use a condom), perceived behavioral control, and role beliefs (p .0001). For the Latin American community, these three constructs explained 70.7% of the variance (partial R2 = 51.1% for personal normative belief, 10% for role beliefs, and 4.1% for perceived behavioral control). For the English-speaking Caribbean community, they explained 51% of the variance (partial R2 = 35.7% for personal normative belief, 11.9% for perceived behavioral control, and 3.5% for role beliefs). For the South Asian community, they accounted for 76% of the variance (partial R2 = 63.5% for perceived behavioral control, 9.4% for personal normative belief, and 3.1% for role beliefs). These findings serve as a basis for recommendations for the prevention of HIV transmission among the participating ethnocultural communities.

Canadian ethnocultural communities facing AIDS: overview and summary of survey results from phase III.

This paper describes the survey results reporting demographic profiles, behaviours, opinions, beliefs, attitudes, and intentions related to condom use for three Canadian ethnocultural communities (Latin American, English-speaking Caribbean and South Asian) participating in the Ethnocultural Communities Facing AIDS Study. Specific recommendations are presented for HIV-prevention programming based on the research results.

[Predictors of sexual behavior in a group of heterosexual university students at risk for AIDS in Montreal]. / Prédicteurs des comportements sexuels à risque face au SIDA chez un groupe d'étudiants universitaires hétérosexuels de Montréal.

In order to evaluate the predictors of risky sexual behavior and AIDS, 573 male and female college students enrolled in French speaking universities in Montreal answered a questionnaire dealing with their sexual behaviors, from which an index of risks was computed (CASH). The analyses show that the best predictors of the CASH for men are associated to their sexual partner taking the pill, peer attitudes toward sexuality and individual sensation-seeking index. For women the best predictors of risky sexual behaviors are the perception of chances to catch AIDS, use of drugs or alcohol during coital behavior, peer group attitudes, personal sexual attitudes and using the pill as a contraceptive. These results suggest that risky sexual behaviors depend on complex processes associated to lifestyle and personality structures.

HIV: the debate over isolation as a measure of personal control.

In the biomedical ethical debates over HIV/AIDS, the issue of personal control measures, including isolation and detention, should be addressed critically. Taking account of historical experience with epidemics and current legislation, several major policy options are identified, each of which has drawbacks. A sliding scale of personal control measures culminating in limited detention may offer a balance between private responsibility and public health to ensure responsible behaviour. Any measure of personal control must be linked to fully implemented, positive programmes in education and counselling within a coherent strategy for which there is no coercitive substitute.

Occupational health and the family physician part 1: definition and resources.

The field of occupational health is of growing importance to family physicians, yet for many represents a nebulous field. This paper describes the main concepts and shows how a family physician can quickly obtain mastery of the field sufficient for any demands that may be made on his skill in this area. Part 1 names resources in occupational health most useful to family doctors and Part 2, to be published next month, outlines a method of taking an occupational history, and of determining the essential work structure of one's community.

Occupational Health and the Family Physician Part 2: History-taking-How Not to Miss an Occupationally-Related Disease.

In the first part of this article, occupational health was defined as part of the family physician's total care for his or her patient. This part deals with the components of the occupationally related history, the role of stress in the workplace, and knowledge of the work structure in the community.