A survey was conducted during the months of June and July 1976 at the Willow Chest Clinic in Vancouver, British Columbia, using a questionnaire designed to test tuberculosis patients' knowledge on the cause, course, treatment and prevention of tuberculosis, and their attitude towards the patient education process. The questionnaire was administered to 159 new active tuberculosis patients attending the Clinic for follow-up treatment. Approximately half of this population had been hospitalized at Pearson Hospital during their initial treatment phase, while the other half was treated at the Willow Chest Clinic since the diagnosis of the disease. A control population of 162 patients matched by age, sex, education and ethnic origin was selected from patients attending the Clinic for other respiratory diseases. The objective of the study was to compare hospital versus clinic education of tuberculosis patients in Vancouver, since the product and the process of patient education have an important impact on the treatment and control of tuberculosis. The tuberculosis patients knew more about the disease than the non-tuberculosis patients. The Hospitalized patients had consistently and significantly higher scores than the Control group. The Non-Hospitalized patients had statistically higher scores than the Control only in the area of knowledge of treatment of tuberculosis. The patients who had been hospitalized knew more about the disease than patients who were treated on an ambulatory basis since the diagnosis of the disease. Biases such as that resulting from the selection process of the Study and Control groups, the design and administration of the questionnaire could have contributed to the differences in the scores. Age, education and ethnic origin were found to have significant impact on the knowledge of the patients. However, these variables had been adjusted for in the final analysis of the scores. Since the hospital had provided more patient education opportunities than the clinic, the higher scores could be due to the patient education process. Patient education could have increased the knowledge of tuberculosis among the hospitalized patients. The importance of good communication in patient education was reiterated. That these different groups of patients, by virtue of their differences in age, education and ethnic origin, had their unique education needs was evident from the patients' response. Hence different means of communicating disease information in varying amounts would be necessary. The use of non-tuberculosis patients to estimate the level of knowledge of tuberculosis patients prior to their disease has not been completely satisfactory. It is recommended that future patient education programs have mechanisms for evaluation built into their design. This would allow a better assessment of the effectiveness of patient education. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

The aim of this exploratory study has been to discover and analyze some of the basic problems of tuberculous Indian patients, particularly their adjustment to hospitalization. The Indians studied are those of the northwest coast, including the Yukon and the Queen Charlotte Islands. The population studied was in Miller Bay Indian Hospital near Prince Rupert. Primary emphasis was placed on the emotional reactions of the Indian's adjustment to hospitalization and to removal from his familiar environment. Due to the fact that Indian patients show inhibition in communicating their feelings and opinions, it was necessary to use direct observation as the initial technique in gathering data in the first three months of this study. In the fourth month a small sample of staff members and patients were given a semi-structured, non-directive interview. The questions included in the interview schedule covered the following 15 major areas: (1) the patient's attitudes toward life and illness; (2) the patient's acceptance of the diagnosis and understanding of the disease; (3) the patient's acceptance of hospital routine and orders; (4) the patient's response to hygiene measures; (5) the patient's emotional reactions to hospitalization; (6) the influence of visitors response to hygiene measures; (5) the patient's emotional reactions to hospitalization; (6) the influence of visitors on the patient; (7) the patient's trust in the staff; (8) the acceptance of the patient as an equal by the staff; (9) the expression of aggression by the patients and how it is dealt with; (10) the patient's initiation of social activities; (11) the patient's reaction to social activities planned by the staff; (12) the patient's plans regarding his future after discharge; (13) the problem of alcoholism; (14) irregular discharges; (15) the sexual behaviour of the patient. Each of these 15 areas was analyzed in an attempt to arrive at common reactions to hospitalization. / Arts, Faculty of / Psychology, Department of / Graduate

Undetected acute Pulmonary Tuberculosis in the 50,000 refugee immigrants from Southeast Asia to Canada would constitute a serious public health hazard. The 10,000 Southeast Asian refugee immigrants to British Columbia in 1979/80 were rescreened for acute Pulmonary Tuberculosis despite provincial and federal health authorities disagreeing on the need for such rescreening. This thesis demonstrates that the rescreening of the refugee immigrants was warranted by: A) Comparing the rate per 100,000 population with acute Pulmonary Tuberculosis among: 1) The Southeast Asian refugee immigrants arriving in British Columbia in 1979/80 with the rates of acute Pulmonary Tuberculosis per 100,000 population for the three-year period 1976/78 among 2) the general population of British Columbia, 3) the registered native Indian population of British Columbia, 4) the non-refugee Asian immigrant population arriving in British Columbia, and B) Estimating the increased risk of acute Pulmonary Tuberculosis to the general public from the presence of the 10,000 refugee immigrants in British Columbia. Age-specific rates of acute Pulmonary Tuberculosis and the prevalence rates of acute Pulmonary Tuberculosis confirmed bacteriologically were calculated with statistics extracted from the records of the Division of Tuberculosis Control of British Columbia, the Federal Department of Health and Welfare, and the Department of Immigration. Comparison of the age-specific rates demonstrated that acute Pulmonary Tuberculosis occurred 6 times more frequently in the refugee immigrants than in the general population of British Columbia, and 1.25 times more frequently in the refugee Asian immigrants than in the non-refugee Asian immigrants. Comparison of the prevalence rates demonstrated that acute Pulmonary Tuberculosis confirmed bacteriologically occurred 3 times more frequently in the registered native Indian population of British Columbia than in the refugee immigrants to British Columbia. The extra public health risk of acute Pulmonary Tuberculosis from the presence of 10,000 refugee immigrants in British Columbia for one year was estimated to be 730 in 10⁶ for each member of the general population of British Columbia. The rate of acute Pulmonary Tuberculosis occurring in the 10,000 refugee immigrants arriving in British Columbia in 1979-1980 confirmed that the rescreening of the refugee immigrants was warranted. Recommendations were made to centralize the rescreening program within British Columbia so as to minimize the public health hazards of acute Pulmonary Tuberculosis occurring in the Southeast Asian refugee immigrants. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate