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In a study of AIDS activism and communication patterns between people with HIV or AIDS and health care personnel, parallel persuasive processes are described between social or political activism and personal self-advocacy. The analysis of public and private discourse leads to 3 interrelated conclusions about AIDS activist behaviors at the collective and individual levels: (a) greater patient education about the illness and treatment options is encouraged, (b) a more assertive stance toward health care is promoted, and (c) mindful nonadherence is considered. Activists perceived that their self-advocacy behaviors, in turn, impact the physicianpatient interaction. In communicative interactions, education allows patients to challengethe expertise of the physician, assertiveness allows them to confront paternalistic or authoritarian interactional styles, and mindful nonadherence allows them to reject treatment recommendations and offer reasons for doing so. Participants reported that physicians had mixed reactions to their self-advocacy attempts. Dale E. Brashers

Like all organizations, health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. The Hospital Culture Scale (HCS) was designed as a way to assess the unique culture of hospital organizations. The HCS demonstrated high discriminant validity and reliability when applied to all members (patients, nurses, and physicians) of this particular organization. Data provided from different hospital organizations indicated that the HCS could differentiate between a variety of hospitals. Physicians, nurses, and patients were also compared. Although there was agreement between nurses and patients on how scale items are used, there were disagreements when these organizational members were compared to physicians. Differences between hospital members on the overall perception of hospital culture were found. The implications and utility of the HCS are discussed.