Adolescent AIDS Knowledge Scale

Adolescent AIDS Knowledge Scale

GREGORY D. ZIMET,Indiana University School of Medicine

The Adolescent AIDS Knowledge Scale (AAKS) was developed as part of a comprehensive questionnaire to evaluate adolescents’ knowledge, beliefs, and attitudes about acquired immunodeficiency syndrome (AIDS; Zimet et al., 1989). The knowledge scale was developed with two principal issues in mind. First, we wanted to ensure that the scale covered relevant material. To accomplish this goal, item content was derived from a 1988 informational brochure distributed to every household by the

U.S. Government (Centers for Disease Control, 1988). As a result, the scale addresses multiple AIDS-related domains, including modes of transmission, high-risk behaviors, mortality, the existence of a cure, prevention of transmission, and the appearance of persons with AIDS (PWAs).

A second issue considered during scale development was that most existing AIDS knowledge scales confounded knowledge (i.e., awareness of scientific facts about AIDS) with beliefs. It seemed likely that a person might “know” the facts according to experts, but not believe them. In considering the design of AIDS education interventions, it appeared particularly important to assess AIDS aware- ness/knowledge separately from AIDS beliefs. To address this issue, each item on the AAKS was constructed to begin with the phrase “Do most experts say . . .?” A separate but parallel AIDS Beliefs scale was developed to evaluate the extent to which adolescents believed what experts were saying.

Description

The AAKS has 22 items. Each item takes the form of a question (e.g., “Do most experts say you can get AIDS by giving blood?”). Transmission-related items cover true modes of transmission (e.g., sharing needles), low- or no-risk behaviors (e.g., sharing a glass of water), behaviors that increase risk of transmission (e.g., prostitution), and transmission of human immunodeficiency virus (HIV) without clinical AIDS. Two protection items address effective (i.e., condom use) and ineffective (i.e., eating healthy foods) protective behaviors. Finally, single items cover such topics as the mortality associated with AIDS, whether there is a cure for AIDS, and whether it is possible to determine if someone has AIDS by looking at him or her.

Response Mode and Timing

To each question, respondents are asked to circle yesno, or don’t know. Response times vary, but typically the scale requires less than 5 minutes to complete.

Scoring

A correct response receives a score of 1. An incorrect answer or a don’t know response each receives a score of 0. For the following items, no is the correct response: 1, 3, 4, 5, 9, 11, 13, 15, 17, and 19. For the following items, yes is the correct response: 2, 6, 7, 8, 10, 12, 14, 16, 18, 20, 21, and 22. The total score for the scale, which is calculated by summing across items, can range from 0 to 22.

Reliability

An AIDS-knowledge scale such as this one represents multiple content areas, not a single construct. Therefore, standard measures of internal reliability that assess overall internal consistency (e.g., Cronbach’s coefficient alpha or Kuder-Richardson formula 20) are inappropriate (Anastasi, 1982; Zimet, 1992b). A more useful approach involves a specialized form of Spearman-Brown split-half reliability in which items from one half are matched for content with items from the other half (Zimet, 1992b). Given that the AAKS was not designed with this approach to reliability in mind, it is not possible to match all items perfectly (e.g., only one item addresses mortality associated with AIDS). Nonetheless, in a sample of 721 junior and senior high school students, the Spearman-Brown matched-item split- half method resulted in a coefficient of .82, indicating good internal reliability (Zimet, 1992b).

Validity

The content validity of the scale was established through the use of the U.S. government brochure on AIDS to guide item selection (Centers for Disease Control, 1988). Furthermore, in addressing major AIDS-related domains (i.e., HIV transmission, protection, mortality, appearance, etc.), the scale demonstrates good face validity.

Support for the construct validity of the AAKS is demonstrated by expected relationships with other variables. For example, it may be expected that older students have more accurate knowledge about AIDS than younger students. For the AAKS, analysis of variance indicated a linear increase in scores across grade level among 617 7th to 12th graders, F(5, 611) = 8.8, < .0001 (Zimet, DiClemente, et al., 1993).

Another expectation is that greater AIDS knowledge is likely to be negatively correlated to inaccurate beliefs about AIDS. Among 438 junior and senior high school students, increases in scores on the AAKS, in fact, were associated significantly with decreases in inaccurate beliefs about AIDS, = –.65, < .001 (Zimet et al., 1991).

Finally, it is reasonable to expect that more accurate knowledge about AIDS will be negatively related to fears about interacting with PWAs. Among the same 438 students, AAKS scores correlated significantly and negatively with anxiety about interacting with PWAs, = –.28, <.001 (Zimet et al., 1991).

Instructions: Experts on AIDS have talked about the spread and prevention of AIDS. Please circle your answer for each question.

1. Do most experts say there’s a high chance of getting AIDS by kissing someone on the mouth who has AIDS? Yes No Don’t Know
2. Do most experts say AIDS can be spread by sharing a needle with a drug user who has AIDS? Yes No Don’t Know
3. Do most experts say you can get AIDS by giving blood? Yes No Don’t Know
4. Do most experts say there’s a high chance that AIDS can be spread by sharing a glass of water with someone who has AIDS? Yes No Don’t Know
5. Do most experts say there’s a high chance you can get AIDS from a toilet seat? Yes No Don’t Know
6. Do most experts say AIDS can be spread if a man has sex with a woman who has AIDS? Yes No Don’t Know
7. Do most experts say AIDS can be spread if a man has sex with another man who has AIDS? Yes No Don’t Know
8. Do most experts say a pregnant woman with AIDS can give AIDS to her unborn baby? Yes No Don’t Know
9. Do most experts say you can get AIDS by shaking hands with someone who has AIDS?‌ Yes No Don’t Know
10. Do most experts say a woman can get AIDS by having sex with a man who has AIDS? Yes No Don’t Know
11. Do most experts say you can get AIDS when you masturbate by yourself? Yes No Don’t Know
12. Do most experts say using a condom (rubber) can lower your chance of getting AIDS? Yes No Don’t Know
13. Do most experts say that there’s a high chance of getting AIDS if you get a blood transfusion? Yes No Don’t Know
14. Do most experts say that prostitutes have a higher chance of getting AIDS? Yes No Don’t Know
15. Do most experts say that eating healthy foods can keep you from getting AIDS? Yes No Don’t Know
16. Do most experts say that having sex with more than one partner can raise your chance of‌‌ getting AIDS? Yes No Don’t Know
17. Do most experts say that you can always tell if someone has AIDS by looking at them? Yes No Don’t Know
18. Do most experts say that people with AIDS will die from it? Yes No Don’t Know
19. Do most experts say there is a cure for AIDS? Yes No Don’t Know
20. Do most experts say that you can have the AIDS virus without being sick from AIDS? Yes No Don’t Know
21. Do most experts say that you can have the AIDS virus and spread it without being sick from AIDS? Yes No Don’t Know
22. Do most experts say that if a man or woman has sex with someone who shoots up drugs, they raise their chance of getting AIDS? Yes No Don’t Know

Address correspondence to Gregory D. Zimet, Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202; e-mail: [email protected]

References

Anastasi, A. (1982). Psychological testing (5th ed.). New York: Macmillan.

Centers for Disease Control. (1988). Understanding AIDS [An information brochure being mailed to all U.S. households]. Morbidity and Mortality Weekly Report, 37, 261–269.

Zimet, G. D. (1992a). Attitudes of teenagers who know someone with AIDS. Psychological Reports, 70, 1169–1170.

Zimet, G. D. (1992b). Reliability of AIDS knowledge scales: Conceptual issues. AIDS Education and Prevention, 4, 338–344.

Zimet, G. D., Anglin, T. M., Lazebnik, R., Bunch, D., Williams, P., & Krowchuk, D. P. (1989). Adolescents’ knowledge and beliefs about AIDS: Did the government brochure help? American Journal of Diseases of Children, 143, 518–519.

Zimet, G. D., Bunch, D. L., Anglin, T. M., Lazebnik, R., Williams, P., & Krowchuk, D. P. (1992). Relationship of AIDS-related attitudes to sexual behavior changes in adolescents. Journal of Adolescent Health, 13, 493–498.

Zimet, G. D., DiClemente, R. J., Lazebnik, R., Anglin, T. M., Ellick, E. M., & Williams, P. (1993). Changes in adolescents’ knowledge and attitudes about AIDS over the course of the AIDS epidemic. Journal of Adolescent Health, 14, 85–90.

Zimet, G. D., Hillier, S. A., Anglin, T. M., Ellick, E. M., Krowchuk, D. P., & Williams, P. (1991). Knowing someone with AIDS: The impact on adolescents. Journal of Pediatric Psychology, 16, 287–294.

Zimet, G. D., Lazebnik, R., DiClemente, R. J., Anglin, T. M., Williams, P., & Ellick, E. M. (1993). The relationship of Magic Johnson’s announcement of HIV infection to the AIDS attitudes of junior high school students. The Journal of Sex Research, 30, 129–134.