Lay people's and health care personnel's perceptions of cancer, AIDS, cardiac, and diabetic patients

A caregivers' perspective on social reintegration and stigma of childhood cancer survivors in Kenya

OBJECTIVES

Childhood cancer survivors' social reintegration may be hampered in low and middle-income countries. The nature and extent of social challenges and prejudices that survivors encounter in such settings are largely unknown. This study explores caregivers' perspectives on social reintegration and stigmatization of Kenyan childhood cancer survivors.

METHODS

Caretakers of childhood cancer survivors (<18 years) were interviewed using mixed-methods questionnaires during home or clinic visits between 2021 and 2022. Stigma was assessed with an adjusted Social Impact Scale and risk factors were investigated.

RESULTS

Caretakers of 54 survivors (median age 11 years) were interviewed. Families' income (93%) decreased since start of treatment. Caretakers (44%) often lost their jobs. Financial struggles (88%) were a burden that provoked conflicts within communities (31%). School fees for siblings became unaffordable (52%). Families received negative responses (26%) and were left or avoided (13%) by community members after cancer disclosure. Survivors and families were discriminated against because the child was perceived fragile, and cancer was considered fatal, contagious, or witchcraft. Survivors repeated school levels (58%) and were excluded from school activities (19%) or bullied (13%). Performance limitations of daily activities (p = 0.019), male sex (p = 0.032), solid tumors (p = 0.056) and a short time since treatment completion (p = 0.047) were associated with increased stigma. Caretakers recommended educational programs in schools and communities to raise awareness about cancer treatment and curability.

CONCLUSIONS

Childhood cancer survivors and their families experienced difficulties with re-entry and stigmatization in society. Increasing cancer and survivorship awareness in schools and communities should facilitate social reintegration and prevent stigmatization.

What is the Image of the "Typical Cancer Patient"? The View of Physicians

Former research has identified stigmatizing attitudes toward cancer patients in the general population. Little is known about (implicit) attitudes of physicians toward cancer patients. By using the prototype approach, the study investigated German physicians’ prototypical perceptions of cancer patients. Five hundred nineteen physicians (mean age: 46 years, 47% female) who regularly treat cancer patients participated in the questionnaire study. Participants were asked to state three prototype attributes that describe the “typical cancer patient.” Open format answers were coded on the dimensions favorability (coded with unfavorable, favorable, or neutral) and gender-stereotypicality (coded with masculine stereotypical, feminine stereotypical, or gender-neutral). Of all prototype attributes (N = 1,589), 69.9% were coded as unfavorable and 14.3% as favorable, the remaining attributes were neutral (15.9%). Analysis of gender-stereotypicality revealed that nearly half of the attributes (49.5%) were compatible with the feminine, whereas only 6.5% were compatible with the masculine stereotype. The remaining attributes (44.0%) were gender-neutral. There were no significant associations between prototype favorability or gender-stereotypicality and demographic/professional characteristics of physicians. The prototype approach was successful to identify (implicit) attitudes toward cancer patients and might be more sensitive than social distance scales when investigating stigmatizing attitudes. Physicians described the “typical cancer patient” with predominantly unfavorable and feminine attributes, while favorable attributes were underrepresented and positive masculine attributes were barely mentioned. The finding that the “typical cancer patient” lacks (positive) masculine attributes should be followed up in further research.

Perceptions of IBD within patient and community samples: a systematic review

Objective: Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition that involves a range of debilitating bowel symptoms. Adjustment to living with IBD can be negatively impacted by maladaptive cognitive and behavioural factors (e.g. negative illness representations and repressing emotions). Patient samples also report negative reactions from the general public and such perceptions can further negatively impact people living with IBD. Therefore, we aimed to systematically review literature investigating the illness perceptions, perceived stigmatisation, and negative emotional reactions toward IBD within patient and community samples. We also aimed to review how these factors impact those living with IBD (i.e. adjustment, psychological health). Design: A range of databases (e.g. Psych INFO, PubMed) were searched over two years. One reviewer individually screened titles and abstracts using the specified inclusion criteria, and this process was repeated by a second reviewer. Subsequently, the full text articles were screened and data were extracted for the 82 articles that satisfied the inclusion criteria. Following data extraction, a narrative synthesis was conducted.Results: The review of 82 studies suggested that negative illness perceptions are linked to poorer psychosocial outcomes, that patient samples frequently anticipate stigmatisation, fear relating to bowel accidents was the most common emotion reported, and that the general public direct little enacted stigma towards IBD.Conclusion: For people living with IBD: (i) poorer psychological adjustment was reported by those who held more negative perceptions and reactions toward their illness; and (ii) their concerns regarding public perceptions of IBD warrants further empirical attention. Results emphasise the importance of targeting perceptions, and facilitating education and adaptive responding during treatment.

Awareness and Perception About Cancer Among the Public in Chennai, India

PURPOSE

Cancer-related stigma influences the way people perceive cancer, which renders cancer control-beginning with prevention and proceeding to palliation-a challenging task. This study aimed to assess the current levels of awareness and perceptions about cancer among people with various socioeconomic status and diverse backgrounds in the city of Chennai, India.

PATIENTS AND METHODS

The sample population (N = 2,981; 18 to 88 years of age) was stratified into four groups: patients (n = 510), caregivers (n = 494) consulting at the Cancer Institute (Women Indian Association), college students (n = 978), and general public (n = 999). Fourteen statements related to cancer stigma or myths were identified and categorized by awareness (10 items) or perception (4 items). Responses to those statements were recorded by using a Likert scale (yes, no, and don't know). The data were described by frequency analysis and χ2 test using SPSS Version 13 (SPSS, Chicago, IL).

RESULTS

More than 70% of the study participants were aware that cancer is curable, that cancer is not contagious, and that cancer is not a curse or a death sentence. However, only approximately half believed that surgery or biopsy do not cause cancer to spread to other organs or that radiation therapy does not consist of receiving an electric shock. Higher education, younger age, male sex, personal experience with cancer (either as a patient or caregiver), and high socioeconomic status were the categories of people with increased awareness about cancer.

CONCLUSION

These factors need to be taken into consideration in tailoring information, education, and communication campaigns. Resource allocation for these campaigns is an investment in cancer control.

Stigma Directed toward Chronic Illness is Resistant to Change through Education and Exposure

In the mid-1980s, research reported that people living with HIV were viewed differently on measures of competence, dependence, morbidity, depression, and moral worth from those living with other chronic illnesses. 443 students were surveyed to evaluate present attitudes in comparison to this earlier research. The usefulness of imaginal exposure, i.e., imagining a loved one living with HIV, in reducing stigma toward people with HIV was also investigated. Analysis indicated no difference in the rating of AIDS and cancer patients on measures of competence, depression, and morbidity and patients with heart disease, the latter being rated significantly less competent and more depressed than AIDS or cancer patients. AIDS patients were rated significantly less dependent than cancer and heart disease patients. While these results suggest that stigma associated with an HIV/AIDS diagnosis, in general, may have decreased over the years, ratings of moral worth were still lower for AIDS patients than for patients with cancer and heart disease. Robustness of this specific aspect of stigma may be associated with sexual prejudice. Also, an imagined loved one who lives with HIV was rated significantly more favorably on all 5 composite scales than a generic person living with HIV, suggesting the usefulness of exposure as an intervention for attitude change. Limitations of the research are discussed.

Attitudes toward Cancer

The Cancer Metaphors Test, a measure designed to assess the imagery of cancer, was administered to samples of Nepalese (n = 228) and U.S. (n = 184) graduate students. For both samples, no significant age, gender, or field of study differences were obtained, but Nepalese students scored higher than U.S. students on both Terminal Pessimism and Future Optimism. Within each sample, scores on pessimism were higher than scores on optimism. An analysis of the individual metaphors suggested some differences but also substantial commonality of endorsement.

Counseling the HIV-Infected Client

The emerging empirical and clinical literature on the psychosocial issues of human immunodeficiency virus (HIV) has only begun to guide clinicians in their work with seropositive clients. This article presents a model that provides a conceptual framework for assessing the client's resources as he or she attempts to address the psychosocial issues that may occur as a result of this disease. The model has four components: special characteristics, social supports, situation, and client characteristics. It is hypothesized that these client resources predict or moderate the clients response to HIV infection. Responses to HIV infection are discussed followed by counseling strategies and interventions to address each response or reaction. Case management issues are presented including ethical dilemmas, rethinking clinical goals, the changing boundaries of the therapeutic relationship, transference, and countertransference.

Public perceptions of cancer: a qualitative study of the balance of positive and negative beliefs

OBJECTIVES

Cancer's insidious onset and potentially devastating outcomes have made it one of the most feared diseases of the 20th century. However, advances in early diagnosis and treatment mean that death rates are declining, and there are more than 30 million cancer survivors worldwide. This might be expected to result in more sanguine attitudes to the disease. The present study used a qualitative methodology to provide an in-depth exploration of attitudes to cancer and describes the balance of negative and positive perspectives.

DESIGN

A qualitative study using semistructured interviews with thematic analysis.

SETTING

A university in London, UK.

PARTICIPANTS

30 participants (23-73 years), never themselves diagnosed with cancer.

RESULTS

Accounts of cancer consistently incorporated negative and positive views. In almost all respondents, the first response identified fear, trauma or death. However, this was followed-sometimes within the same sentence-by acknowledgement that improvements in treatment mean that many patients can survive cancer and may even resume a normal life. Some respondents spontaneously reflected on the contradictions, describing their first response as a 'gut feeling' and the second as a more rational appraisal-albeit one they struggled to believe. Others switched perspective without apparent awareness.

CONCLUSIONS

People appear to be 'in two minds' about cancer. A rapid, intuitive sense of dread and imminent death coexists with a deliberative, rational recognition that cancer can be a manageable, or even curable, disease. Recognising cancer's public image could help in the design of effective cancer control messages.

Survivor centrality among breast cancer survivors: implications for well-being

OBJECTIVE

The goal of this research was to examine the extent to which 10-year breast cancer survivors integrated cancer into their self-concept (i.e. survivor centrality), identify predictors of survivor centrality, and determine the relation of survivor centrality to well-being.

METHODS

Breast cancer survivors (n=240) were interviewed 10 years following the initial diagnosis. They completed measures of survivor centrality, illness valence (i.e. positive or negative views of illness), and well-being (positive and negative affect, mental and physical functioning, psychological distress, benefit finding).

RESULTS

There were few predictors of the kinds of women who were more likely to integrate breast cancer into their self-concepts, but survivor centrality was related to engaging in behaviors that suggested survivorship was relevant to women's daily lives, such as becoming involved in breast cancer activities. Survivor centrality was related to three markers of negative psychological well-being: more negative affect, poorer mental functioning, and greater psychological distress. However, in the case of negative affect and psychological distress, this relation was moderated by illness valence, such that survivor centrality was only related to negative psychological well-being when the illness was viewed in less positive terms.

CONCLUSIONS

Women vary in the extent to which they define themselves in terms of the breast cancer experience. Survivor centrality in and of itself is not always indicative of adjustment to disease. When women have a more negative view of being a breast cancer survivor, survivor centrality is more likely to signify potential problems.

Individual- and community-level effects on risk perception in cancer cluster investigations

This article focuses on the relative influence of individual versus community effects on risk perception. The study is grounded in literature examining how individuals manage information and make risk judgments in the context of suspected environmental cancer threats. We focus on three individual-level perspectives: the psychometric model of risk perception, an adaptation of the heuristic-systematic information processing model, and cancer anxiety. We also evaluate five sets of community-level variables that frame cancer cluster investigations: demographic, epidemiologic, sociologic, etiologic, and pathologic. Data were collected through a mail survey of 30 communities in which cancer cluster investigations were being conducted. Response rates averaged 43%, with 1,111 records in the final data set. Through multilevel modeling and other techniques, the results show that the individual-level model developed in previous work remains a robust description of risk perception in these cases. However, the analysis also shows that the community-level measures neither improve the individual-level model nor offer any substantial explanatory power of their own. We provisionally conclude that, within the context of cancer cluster investigations, risk perception is a phenomenon located in a common psychological dimension that is substantially independent of contextual influences. We also suggest that risk communication efforts in this specific context might successfully draw from a common approach informed more by individual than community factors.

Contents of lay illness models dimensions for physical and mental diseases and implications for health professionals

OBJECTIVE

The main aim of this study was to establish the contents of the lay illness models on depression, cancer, hypertension, schizophrenia and influenza in healthy and ill people suffering from these diseases who have/have not coexisted with people with these health alterations.

METHODS

Dimensions of lay illness models for depression, schizophrenia, cancer, hypertension and influenza were assessed in 348 people (62.6% women) aged 13-50 (M=20.72; S.D.=5.96) with different personal experience with the studied diseases.

RESULTS

Lay illness beliefs are usually close to medical knowledge, but in some relevant cases they are very divergent from this. Experience with the disease (to have suffered from it or to have coexisted with an ill relative) seems to have a great influence in the contents of lay illness models.

CONCLUSION

People's representations on illnesses are not complete or correct at all, and this will have, as the Common Sense Model establishes, relevant repercussions on individuals' behaviors in relation to health and illness and on the outcomes of diseases.

PRACTICE IMPLICATIONS

To know the personal illness models for physical and mental health threats of healthy and ill people with different personal experience with the disease has important implications for health professionals' promotion and prevention strategies and clinical (treatment/rehabilitation) actuations.

Cancer anxiety and the perception of risk in alarmed communities

Cancer is a significant public health topic and is frequently a factor in public reactions to environmental hazards. It may be reasonable to suggest that a unique form of health anxiety exists - one specific to cancer. In this article, we explore a measure of cancer anxiety that has applicability to risk perception in the specific context of communities that are alarmed over suspect cancer rates thought to be associated with environmental hazards. A literature search was used to identify survey questions previously used to measure cancer worry, fear, anxiety, etc. A list of 24 items was employed in a mail survey sent to 30 communities in which cancer rates were under investigation (part of a broader study). An analysis of the dataset of 1,111 responses yields two versions of a cancer anxiety scale: one an additive combination of 21 items (alpha= 0.77) and the other a two-factor model consisting of nine- and four-item subscales (alpha= 0.74 and 0.69). The resulting scales are evaluated for their ability to predict perception of risk from the environmental hazards in these cases. Controlling for age, sex, and cancer status, the scales explain between 2% and 10% of risk perception (full R(2) values ranging from 0.17 to 0.24). Given the range of concepts required to model risk perception, we conclude that this measure of cancer anxiety is sufficiently reliable and robust to be recommended for use in circumstances involving hazards associated with cancer. Other uses and further development of the measure are discussed.

What is in a cause? Exploring the relationship between genetic cause and felt stigma

PURPOSE

Concern over stigma as a consequence of genetic testing has grown in response to the recent increase in genetic research and testing resulting from the Human Genome Project. However, whether a genetic or hereditary basis necessarily confers a stigma to a condition remains unexamined.

METHODS

We performed a qualitative interview study with 86 individuals with one of four conditions: deafness or hearing loss, breast cancer, sickle cell disease, and cystic fibrosis. The first two groups were divided approximately between people who ascribed their conditions to a genetic or hereditary cause and those who did not.

RESULTS

Respondents interpreted genetic or hereditary causes and nongenetic causes in a variety of ways. Subjects with breast cancer reported the most consistently negative interpretation of genetic cause. This response concerned future ill health, not an enduring sense of stigma. Deaf and hard of hearing subjects provided the most consistently positive comments about a genetic or hereditary basis to their condition, casting familial hearing loss as a vital component of group and individual identity. Respondents with sickle cell disease and cystic fibrosis offered similar and positive interpretations of the genetic cause of their condition insofar as it meant their conditions were not contagious.

CONCLUSIONS

Although some subjects report feeling stigmatized as a result of their condition, this stigmatization is not uniformly associated with the condition's cause, genetic or otherwise. Instead, stigma emerges from a variety of sources in the context of the lived experience of a particular condition.

Assessing illness representations of breast cancer: a comparison of patients with healthy and benign controls

OBJECTIVE

Illness representations of cancer may comprise inaccurate information, misconceptions, or negative conceptualizations of the disease, which may influence screening behaviors. This study examined the differences between healthy women's and breast cancer patients' representations of breast cancer.

METHODS

The cross-sectional design involved 147 consecutive women free from breast diseases, or with benign breast conditions, and 102 patients with breast cancer recruited from the outpatient breast clinic of a public cancer hospital. Respondents completed a modified version of the Illness Perception Questionnaire (IPQ) that assessed six dimensions of illness representations of breast cancer.

RESULTS

Multiple comparison tests revealed that nonmalignant women's illness representations were characterized by weak beliefs concerning breast cancer curability/controllability, combined with an overestimation of the negative physical, social, and economic consequences of breast cancer. Moreover, these women held stronger beliefs about the role of environmental factors (radiation exposure, diet, and pollution) in breast cancer causation and expressed greater disagreement on the role of chance in the onset and course of the illness.

CONCLUSION

Illness representations of breast cancer appear to play a significant role in determining the unfavorable and exaggerated way in which laywomen perceive breast cancer. This is discussed within the framework of the social construction of the disease, which portrays breast cancer as a fatal and disfiguring disease, and the strong influence lay literature and the media exert on it.

Stigma directed toward chronic illness is resistant to change through education and exposure

In the mid-1980s, research reported that people living with HIV were viewed differently on measures of competence, dependence, morbidity, depression, and moral worth from those living with other chronic illnesses. 443 students were surveyed to evaluate present attitudes in comparison to this earlier research. The usefulness of imaginal exposure, i.e., imagining a loved one living with HIV, in reducing stigma toward people with HIV was also investigated. Analysis indicated no difference in the rating of AIDS and cancer patients on measures of competence, depression, and morbidity and patients with heart disease, the latter being rated significantly less competent and more depressed than AIDS or cancer patients. AIDS patients were rated significantly less dependent than cancer and heart disease patients. While these results suggest that stigma associated with an HIV/AIDS diagnosis, in general, may have decreased over the years, ratings of moral worth were still lower for AIDS patients than for patients with cancer and heart disease. Robustness of this specific aspect of stigma may be associated with sexual prejudice. Also, an imagined loved one who lives with HIV was rated significantly more favorably on all 5 composite scales than a generic person living with HIV, suggesting the usefulness of exposure as an intervention for attitude change. Limitations of the research are discussed.

Evolutionary origins of stigmatization: the functions of social exclusion

A reconceptualization of stigma is presented that changes the emphasis from the devaluation of an individual's identity to the process by which individuals who satisfy certain criteria come to be excluded from various kinds of social interactions. The authors propose that phenomena currently placed under the general rubric of stigma involve a set of distinct psychological systems designed by natural selection to solve specific problems associated with sociality. In particular, the authors suggest that human beings possess cognitive adaptations designed to cause them to avoid poor social exchange partners, join cooperative groups (for purposes of between-group competition and exploitation), and avoid contact with those who are differentially likely to carry communicable pathogens. The evolutionary view contributes to the current conceptualization of stigma by providing an account of the ultimate function of stigmatization and helping to explain its consensual nature.

AIDS attitudes and attitudes toward caring for dying patients

This article reports on a survey of nursing staff working in AIDS residential health care facilities. More than two-thirds of respondents expressed non-punitive attitudes towards AIDS. Certified nursing assistants were more likely to report negative attitudes toward caring for dying patients than registered nurses. In general, respondents who had less punitive AIDS attitudes also reported less negative attitudes toward caring for dying patients. Nursing staff in AIDS residential facilities may benefit from further training that addresses issues involved in working with AIDS patients and caring for dying patients.

AIDS/HIV and university students in Delhi, India: knowledge, beliefs, attitudes and behaviors

Eight hundred eighty-seven students in social work, nursing, and humanities from two major universities in Delhi were compared regarding their knowledge about AIDS/HIV and attitudes toward PWAs and homosexuals. Their scores on the 20-item knowledge test indicate fair degree of knowledge; however, they lacked information in crucial areas of AIDS prevention and human sexual anatomy. Unmarried, female and older students and those in social work and nursing disciplines scored significantly higher on correct answers. Social work students were likely to be more positive in their attitudes toward AIDS victims than those in nursing or humanities. Knowledge was positively related to attitudes and perception of risk. Despite their awareness of personal risks only four in ten used condoms sometimes during intercourse. Educational strategies to increase cognitive and affective understanding of AIDS and its victims are discussed.

Signifying the pandemics: metaphors of AIDS, cancer, and heart disease

This article offers a symbolic analysis of the cultural construction and signification of three of the major "pandemics" of the late 20th century: AIDS, cancer, and heart disease. It is based on unstructured interviews conducted in Israel between 1993-94 with 75 nurses and 40 physicians and between 1993-95 with 60 university students. Two key symbols, "pollution" and "transformation," are shown to constitute AIDS and cancer within a symbolic space that I suggest is "beyond culture," where body boundaries are dissolved and cultural categories are dismantled. Heart disease, in contrast, is metaphorized as a defect in the "body machinery." The article concludes by arguing that heart attack is depicted as the pathology of the Fordist, modernist body, while AIDS/cancer are pathologies of the postmodern body in late capitalism.

The effects of an HIV/AIDS educational programme on the anxiety level of nursing students

Acquired immunodeficiency syndrome (AIDS) is a serious disease that has special concern for the health care provider. AIDS has continued to grow despite control efforts. As the disease infectivity period remains lengthy, and the heterosexual population is affected to a greater degree, the level of anxiety has also risen despite educational endeavours. Many fears and anxieties have been associated with AIDS patients by health care workers. The reduction of stress, perceived risk and discomfort following educational efforts have been supported in past research. Educational programmes will need to be given for current health care workers at all levels as well as nursing students. Future nurses must be prepared to meet this challenge. This study was conducted using a convenience sample of nursing students at a university in western United States. Its purpose was to assess any changes that occurred in state anxiety following an educational presentation. Spielberger's State-Trait Anxiety Inventory was used as the measurement instrument. Some anxiety levels were significantly reduced.

Reliability and validity of AIDS victim blaming scales

Scales were developed to measure the tendencies to blame AIDS victims or the society in which victims live. Data from a sample of 874 students were used to examine the construct validity and reliability of the scales. The list-wise deletion reduced the sample size to the usable sample size of 824. The data showed satisfactory validity and reliability of the scales so they may be used to study attitudes toward those who are suffering from AIDS and related problems.

Perceptions of stigma in women infected with HIV

This qualitative focus group study explored perceptions of stigma in HIV-seropositive women. The sample included 19 HIV-positive women who participated in one of four focus group sessions. Participants were asked to talk about and describe their perceptions of how others think about and respond to them and other HIV-infected individuals. Content analysis was used to code the data and identify participant perceptions. Four themes representing distinctly different perceptions of stigma were identified: distancing, overgeneralizing stereotypes, social discomfort, and pity. The implications of the findings for intervention and future research are discussed.

Experiences of disclosure in women infected with HIV

In this qualitative focus group study, we explored issues of disclosure for women infected with HIV. The sample included 19 women who participated in one of four focus group sessions. Participants talked about and described their experiences sharing information about their HIV infection with others. Content analysis was used to code the data and identify major issues. Participants uniformly expressed concern about disclosing their HIV status because they expected and feared negative responses from others. Descriptions of disclosure revealed an evaluative process involving an analysis of potential risks and benefits. Three themes that represent concerns about disclosure were identified: discrimination, confidentiality, and the context of disclosure. Based on the findings, we concluded that these concerns are important factors influencing disclosure decisions and the use of supportive services and resources. The findings have implications for designing interventions to assist women in coping with the diagnosis of HIV and to promote their quality of life.

Nurses' attitudes about acquired immunodeficiency syndrome care: what research tells us

With the mounting incidence of human immunodeficiency virus infection not projected to peak until a decade into the next century, the question of nurses' willingness to engage in acquired immunodeficiency syndrome (AIDS) care remains important. Published data, however, do not support the frequently cited view that positive attitudes are exceptional. This analysis suggests reasons for misperceptions and also cautions that a continued focus on attitudes may not be useful unless we validate their influence on nursing action in clinical situations. Researchers must ask not only what differentiates the willing from the unwilling but also what alters the extent of nurses' willingness to engage. Even more important may be what influences how nurses engage, that is, what knowledge and skills they need to provide compassionate, effective care. The salience of these questions is especially apparent when we recognize how consistent the finding of positive AIDS-care attitudes has been through the last decade's plethora of studies. Without overlooking negative attitudes about, and some nurses' reluctance to participate in, AIDS care, research at this time should perhaps start with the premise that nurses want to nurse, and then focus on what they need to learn--cognitively, affectively, and technically--to do so competently and comfortably. In other words, the essential question is: What do nurses need to learn?

Culture and the meanings of cancer

This article proposes that the nurse understand culture ideationally in terms of models of reality. A distinction is made between cultural and individual models, and between lay persons' models of sickness and practitioners' models. These are described and discussed in relation to the meanings of cancer. A role for the nurse as a cultural broker, negotiating meanings across the patient-practitioner divide, is outlined. Material taken from the case studies of two cancer patients is used to illustrate how these patients modeled their illness experience and how the nurse might use such information to better enlist patient cooperation in the management and treatment of their illness.

Public reactions towards people with AIDS: an attributional analysis

This article addresses the issue of stigmatization and discrimination towards people with AIDS (PWAs) using Weiner's attributional theory of motivation and emotion. In a field experiment, subjects responded to vignettes describing patients with AIDS, syphilis, lung cancer or tuberculosis. In these vignettes, the onset of the diseases was either described as personally controllable or as uncontrollable. Results show that although attributional variables do account for a significant amount of variance in helping behavior and emotions towards PWAs, other variables such as the incurability of the disease, the risk of infection and associations with (homo)sexuality, may be more useful in explaining reactions to PWAs. Implications for education tailored at the prevention of the stigmatization of PWAs are discussed.

HIV and AIDS: a survey of nurse education in the United Kingdom

A survey conducted throughout the United Kingdom examined the current provision being made to train nurses to care safely and sensitively for patients with HIV and AIDS. Problems relating to intolerance and prejudice are still commonly encountered. The study recommends that HIV and AIDS should be set into a wider context of sexuality, death and infection control rather than singled out for special attention. Nurses, both students and qualified staff, need to gain insight into their own values and prejudices if these are not to inhibit the giving of good quality care. Teaching in this subject area requires special skills and there is concern that nursing is not equipped to deal with it. The involvement of clinical specialists in educating nurses is perceived to have a strongly positive effect, helping to bridge a credibility gap and compensating for the lack of clinical experience amongst the teachers. Providing opportunities for nurses to meet with people whose lives have been profoundly affected by the virus is also a powerful form of learning. There is, however, a great need for support in this stressful area of practice.

Reactions among Dutch youth toward people with AIDS

AIDS education emphasizing personal responsibility toward AIDS-inducing behavior might enhance negative reactions to people with AIDS. This study, based on Weiner's attributional theory of motivation and emotion, addressed this dilemma by reporting data from a sample of 1,018 Dutch secondary school students. Results support the reasoning that emphasizing personal responsibility, and consequently personal controllability, increases negative reactions to people with AIDS. In addition to causal attributions, however, AIDS knowledge and attitudes toward homosexuality also related significantly to reactions to people with AIDS. To prevent negative reactions to people with AIDS, the subject of homosexuality should be dealt with before AIDS education is provided. AIDS education should address the impossibility of HIV infection by daily interactions, and the meaning and consequences of being seropositive.

Nursing Faculty and Students' Attitudes Regarding HIV

A multidisciplinary group of health professional educators examined the faculty and student attitudes related to AIDS in undergraduate and graduate nursing programs and in a dental hygiene program. Results indicated consistent differences in attitudes toward homosexuality and intravenous drug users, AIDS-phobia, AIDS-related work stress, and willingness to work with HIV, homosexual, or intravenous-drug-using patients among faculty, undergraduate, and graduate nursing students, and certificate-level dental hygiene students. Faculty and master's-level nursing students consistently indicated the most positive attitudes and behavioral intentions. A one-year follow-up of a sample of undergraduate students revealed little change in these attitudes or behavioral intentions. Implications of these findings for nursing educators are discussed.

AIDS: fear of contagion among nurses

The current moral panic about HIV/AIDS and the theories of deviance that go with it are not a new phenomenon. People expect nurses to know all about HIV/AIDS, but many experience the same fears and ignorance as the public. Empathy is crucial in the nurse/patient relationship and unfavourable attitudes lead to less than optimal care. There is a need to cultivate non-judgmental attitudes towards the care of people infected with HIV. This requires systematic and sensitive educational programmes. As most patients are nursed at home, it is the responsibility of the Government and educational bodies to strengthen the knowledge base of community nurses. The WHO's global programme on AIDS emphasizes the scope of education and promotes worldwide exchange of information and non-discriminatory policies.

Nurses' Knowledge About and Attitudes Toward Patients With AIDS

With the increasing incidence of AIDS, it is probably inevitable that most nurses working in acute care settings will at some time come in contact with a patient who has AIDS. Nurses must be prepared to give safe, competent, and compassionate care to patients with AIDS. This article reports the results of a survey of registered nurses' knowledge and attitudes related to AIDS and AIDS patients. The respondents displayed moderate scores on the knowledge questions, high scores on transmission and treatment, but low scores on epidemiology and pathophysiology. On the attitude subscales, scores were above three on a five-point scale, indicating a lack of negative attitudes. Recommendations for educational programming are included.

The relationship between knowledge, attitudes and degree of contact with AIDS and HIV

This study examined the relationship between knowledge, attitudes, and degree of contact with AIDS and HIV for three groups of people: nurses, psychology students and design students using a standardized questionnaire. The questionnaire differentiated between the groups on all three dimensions with nurses having most knowledge but least positive attitudes. There was no relationship between knowledge and attitudes for the three groups although contact and knowledge were related for the design students and attitudes and contact were related for the psychology students. For all groups the strongest relationship was between attitudes and contact. The implications of the results for training courses are discussed.