Medical sociology at the start of the new millennium

Perceptions and attitudes of community pharmacists toward professional ethics and ethical dilemmas in the workplace

BACKGROUND

Formal training in pharmacy ethics is relatively new in Croatia, and the professional code of ethics is more than 20 years old. Very little is known about how practicing pharmacists implement ethical considerations and relevant professional guidelines in their work.

OBJECTIVES

This study aimed to provide the first description of the perceptions and attitudes of Croatian community pharmacists toward ethics in pharmacy practice, how often they face certain ethical dilemmas and how they resolve them.

METHODS

A cross-sectional survey of 252 community pharmacists, including community pharmacists and pre-licensing trainees, was conducted in Zagreb, Croatia. This group accounts for 18% of licensed pharmacists in Croatia. The survey questions included four sections: general sociodemographic information, multiple-choice questions, pre-defined ethical scenarios, and ethical scenarios filled in by respondents.

RESULTS

More than half of pharmacists (62.7%) face ethical dilemmas in everyday work. Nearly all (94.4%) are familiar with the current professional code of ethics in Croatia, but only 47.6% think that the code reflects the changes that the pharmacy profession faces today. Most pharmacists (83.3%) solve ethical dilemmas on their own, while nearly the same proportion (75.4%) think that they are not adequately trained to deal with ethical dilemmas. The pre-defined ethical scenarios experienced by the largest proportion of pharmacists are being asked to dispense a drug to someone other than the patient (93.3%), an unnecessary over-the-counter medicine (84.3%), a generic medicine clinically equivalent to the prescribed one (79.4%), or hormonal contraception over the counter (70.4%).

CONCLUSIONS

The results demonstrate a need to improve formal pharmacy ethics education and training in how to assess ethical issues and make appropriate decisions, which implies the need for stronger collaboration between pharmacists and their professional association. Our results also highlight an urgent need to revise and update the Croatian code of ethics for pharmacists.

Social Capital, Local Community Participation and the Construction of Pakistani Identities in England: Implications for Health Inequalities Policies

Emphasis has been placed on the importance of the participation of socially excluded groups in local initiatives to reduce health inequalities in England, in `partnerships' with government. We examine potential obstacles to such participation through a case study of factors shaping local participation by residents of a deprived multi-ethnic area who describe themselves as Pakistani. We draw on three-hour interviews with 26 men and women, aged 15—67 years. Assuming that a sense of common identification is a precondition for participation in local community networks, we examine how the construction of Pakistani identities, within conditions of material and symbolic social exclusion, constrains the likelihood of widespread, representative local participation by Pakistani people in our local area of interest. No matter how significant a category such as `Pakistani' might be in statistical analyses of health inequalities, an epidemiological category of this nature cannot simply be `mapped' onto policy recommendations.

Forming partnerships with parents from a community development perspective: lessons learnt from Sure Start

The aim of this study is to explore some of the issues of service user participation in the planning and delivery of public services from a community development perspective. It draws on an action research evaluation study of a local Sure Start programme, which was introduced into an area without a tradition of community involvement in decisions about local services. The study describes and analyses the challenges of parent participation in the organisation and delivery of the Sure Start programme at an operational and strategic level, using findings from semi-structured interviews, observations and critical conversations with Sure Start parents, staff and members of the Sure Start management board. The main substantive findings are that there was a lack of shared understanding of the nature of parent participation in all its facets and this undermined the efforts of parents and staff in the development of the programme. These findings also raise broader issues about participation, the place of parental partnerships with professionals and ways in which collaboration between the two may be interpreted and evolve.

The development of medical sociology in the post-Soviet society: the case of Lithuania

This article explores the historical development of medical sociology and analyses the social problems that have had impacted the changes of health care institutionalization particularly in Lithuania during the Soviet and post-soviet period. Approaching the interaction between sociology and public health sciences, it is intended to apply the concept of medical sociology and its determinants in the context of health care and education systems. By analyzing the case past of medical sociology in Lithuania, we claim that its prospects should be associated with the study of new challenges in the biomedical sciences. In order to improve the importance of medical sociology in developing democracies we should focus on the questions, for instance, to what extent modern biotechnologies should be applied, how to improve the situation with patients' rights, and how to combine the knowledge of social sciences and biomedicine in order to improve the quality of healthcare services and to ensure better functioning of the healthcare system in particular district.

Developing, integrating, and perpetuating new ways of applying sociology to health, medicine, policy, and everyday life

As a framework for presenting ideas on developing ways to make sociology more applicable, we focus on the recent state of medical sociology research. Data for this paper were generated through a content analysis of a twelve-year period (1993-2004) of the Journal of Health and Social Behavior (JHSB) and Social Science & Medicine (SSM). The analysis aims to determine if the content of JHSB and SSM reflect the breadth of the sub-discipline of medical sociology as well as the stated goals of the journals. The selected issues of JHSB and SSM were coded on the basis of the following attributes: (1) Primary Substantive Topic, (2) Methodology, (3) Data Type and Analytic Technique, and (4) Research and Policy Recommendations. We found that the orientation of JHSB articles was towards generating research and theory that shy away from policy, interdisciplinary approaches, and applied issues. SSM content tends to display more interdisciplinary breadth and variety, but also reflects a dearth of applied recommendations. Our discussion focuses on what JHSB and SSM could be. We present ideas on how the sociological discipline in general-and JHSB and SSM in particular-can help generate and nourish new forms of inquiry that can impact the way research questions are framed. We conclude that such a shift is needed in order to maximize the applicability of social scientific evidence to everyday life, and we share examples situated within a socio-medical context, where there is a particular need for the application of social evidence to practice.

Community group participation:

The lifetime risk of acquiring HIV infection in many rural as well as urban areas of southern Africa is currently as high as two-in-three. For women, much of this risk still accrues rapidly at young ages despite high levels of knowledge about HIV/AIDS. Thus, programmes that are more participatory and address underlying structural and community-level factors appear to be essential. We use cross-sectional data from a large-scale, population-based survey in rural eastern Zimbabwe to describe the relationships between membership of different forms of community group and young women's chances of avoiding HIV. Our results show that participation in local community groups is often positively associated with successful avoidance of HIV, which, in turn, is positively associated with psychosocial determinants of safer behaviour. However, whether or not these relationships hold depends on a range of factors that include how well the group functions, the purpose of the group, and the education level of the individual participant. We identify factors that may influence the social capital value of community groups in relation to HIV prevention at the individual, group, and community levels. Young women with secondary education participate disproportionately in well-functioning community groups and are more likely to avoid HIV when they do participate. Longitudinal studies are needed: (i) to establish whether community group membership supports the development of safer lifestyles or merely has greater appeal to individuals already predisposed towards such lifestyles, and (ii) to pinpoint directions of causality between hypothesised mediating factors. In-depth research is needed on the specific qualities of community groups that enhance their contribution to HIV control. However, our findings suggest that promotion of and organisational development and training among community groups could well be an effective HIV control strategy.

Health, ageing and social differentials: a case study of Soweto, South Africa

This article analyses the relationship between health of people over sixty and a range of social differentials in a specific social context of a relatively deprived community in South Africa. Basic measures of social inequality as well as more sophisticated indicators of social relationships and access to social resources and how they are linked to peoples' perception of their own health are explored. The paper is based on a secondary analysis of data collected in a comprehensive social survey of Soweto conducted in 1997 by a team of researchers based mainly in the Department of Sociology at the University of the Witwatersrand, Johannesburg. The results present an interesting scenario, which, while reaffirming the already established connection between social differentials, social ties and health, also sheds light on a different social context and specific relationships with regard to health.

Self-assessed health--a case study of social differentials in Soweto, South Africa

The study of the relationship between health and social differentials as a focus of research is not new. However, most of the studies originate in the Western-developed world and are thus informed by this specific social and cultural context. The aim of the paper was to analyse the relationship between health and a range of social factors in a specific social context of a relatively deprived community in South Africa. It is based on a secondary analysis of data collected in a comprehensive social survey of Soweto conducted in 1997. A total of 2947 interviews were used for the current analysis. An attempt was made to explore basic measures of social inequality as well as more sophisticated indicators of social relationships and access to "social resources" and how they are linked to people's perception of their own health. The results reveal a clear relationship between health and a range of socio-economic indicators of inequalities. Health is significantly associated with a good "perception about the living environment" and "access to social resources". This paper presents an interesting scenario which -while reaffirming the already established connection between social differentials and health-also sheds light on a different social context and specific relationships with regard to health. It also points towards the ways people try to cope with the psycho-social stressor emanating from their specific context.

Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth

Despite the growing popularity of participatory peer education as an HIV-prevention strategy worldwide, our understandings of the processes underlying its impact on sexual norms are still in their infancy. Starting from the assumption that gender inequalities play a key role in driving the epidemic amongst young people, we outline a framework for conceptualizing the processes underlying successful peer education. We draw on the inter-locking concepts of social identity, empowerment (with particular emphasis on Freire's account of critical consciousness) and social capital. Thereafter we provide a critical case study of a school-based peer education programme in a South African township school, drawing on a longitudinal case study of the programme, and interviews and focus groups with young people in the township. Our research highlights a number of features of the programme itself, as well as the broader context within which it was implemented, which are likely to undermine'the development of the critical thinking and empowerment which we argue are key preconditions for programme success. In relation to the programme itself, these include peer educators' preference for didactic methods and biomedical frameworks, unequal gender dynamics amongst the peer educators, the highly regulated and teacher-driven nature of the school environment and negative learner attitudes to the programme. In relation to the broader context of the programme, we point to factors such as limited opportunities for communication about sex outside of the peer educational setting, poor adult role models of sexual relationships, poverty and unemployment, low levels of social capital and poor community facilities. We discuss the implications of our findings for the design of peer educational activities, and point to a number of broader social and community development initiatives that would maximize the likelihood of programme success.