This article was downloaded by: [University of Tennessee, Knoxville] On: 16 April 2015,
At: 10:47 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 3741 Mortimer Street, London W1T 3JH, UK Journal of HIV/AIDS Prevention in Children & Youth Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/whap20 The International AIDS Questionnaire—English Version (IAQE) Cindy Davis PhD a
, Melissa Sloan PhD b
, Samuel Macmaster PhD a
& Leslie Hughes PhD c a
University of Tennessee , Nashville, TN, USA b Drew University , Madison, NJ, USA c University of New South Wales , Sydney, Australia Published online: 04 Oct 2008. To cite this article: Cindy Davis PhD , Melissa Sloan PhD , Samuel Macmaster PhD & Leslie Hughes PhD (2007) The International AIDS Questionnaire—English Version (IAQ E), Journal of HIV/AIDS Prevention in Children & Youth, 7:2, 2942, DOI: 10.1300/ J499v07n02_03 To link to this article: http://dx.doi.org/10.1300/J499v07n02_03 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or
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The International AIDS Questionnaire– English Version (IAQE): Assessing the Validity and Reliability Cindy Davis Melissa Sloan Samuel MacMaster Leslie Hughes ABSTRACT.In order to address HIV infection among college students, a comprehensive measure is needed that can be used with samples from culturally diverse populations. Therefore, this paper assessed the reli ability and validity of an HIV/AIDS questionnaire that measures fours dimensions of HIV/AIDS awareness–factual knowledge, prejudice, per sonal risk, and misconceptions about HIV transmission, and will enable crosscultural research. The International AIDS Questionnaire–Chinese Version (IAQC) was developed and validated by Davis, Tang, Chan, and Noel (1999) for use with Chinese populations. In this study, the va lidity and reliability of the International AIDS Questionnaire–English Version (IQAE) was assessed on a sample of Englishspeaking college students from the United States (N = 200) and Australia (N = 74). The Cindy Davis, PhD, and Samuel MacMaster, PhD, are affiliated with University of Tennessee, Nashville, TN. Melissa Sloan, PhD, is affiliated with Drew University, Madison, NJ. Leslie Hughes, PhD, is affiliated with University of New South Wales, Sydney, Australia. Address correspondence to: Cindy Davis, PhD, University of Tennessee, College of Social Work, 193E Polk Avenue, Nashville, TN 37210 (Email: cdavis3@utk.edu). Journal of HIV/AIDS Prevention in Children & Youth, Vol. 7(2) 2006 Available online at http://jhap.haworthpress.com © 2006 by The Haworth Press, Inc. All rights reserved. doi:10.1300/J499v07n02_03 29
30 HIV/AIDS PREVENTION IN CHILDREN & YOUTH
results of the CFA supported the fourfactor model, and the normative data show patterns similar to previous research. The total IAQE had a high internal consistency (Cronbach’s alpha = 0.88). The Cronbach’s alphas for the subscales were 0.87 (myths), 0.81 (attitudes), 0.66 (personal risk), and 0.40 (facts). A 2week testretest reliability study on a subsample of 32 students revealed a Pearson productmoment correlation coeffi cient of 0.882 (p < 0.001). This instrument provides a valid and reliable comprehensive measure of HIV/AIDS for use with Englishspeaking samples. doi:10.1300/J499v07n02_03 [Article copies available for a fee from The Haworth Document Delivery Service: 1800HAWORTH. Email address: <docdelivery@haworthpress.com> Website: <http://www.HaworthPress.com> © 2006 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. AIDS, HIV, prevention, questionnaire, measures
Today, at least half of all HIV infections in the United States occur among individuals under the age of 25 (CDC, 2002, 2004), and young people between 15 and 24 years of age account for nearly half of all new HIV infections worldwide (UNAIDS, 2004). Although the incidence of HIV/AIDS has been declining, rates of HIV infection among American young adults have not declined proportionately (CDC, 2002; UNAIDS, 2004). Research has shown that patterns of HIV infection differ both crossculturally and by racial and ethnic groups within the United States (Goh, 1993; Leone et al., 2004; St. Lawrence et al., 1995; Yi, 1998;), and worldwide (UNAIDS, 2004). Some racial and ethnic groups are particularly at risk, as certain cultural beliefs may impede safe sex prac tices (e.g., cultural stigma of homosexuality) (Leone et al., 2004), and knowledge about HIV/AIDS differs by geographical region (Grunseit et al., 1995). In addition, the primary modes of HIV transmission differ across cultures (Yi, 1998; Zambrana, Cornelius, Boykin, & Lopez, 2004). Therefore, crosscultural comparisons and assessment is neces sary in order to implement effective prevention programs targeting this worldwide epidemic. College students are particularly vulnerable to HIV infection. Incidents of risky sexual behaviors are prevalent among college stu dents, much of which occurs under the influence of drugs and alcohol (CDC, 2004). A recent study by Hightow et al. (2005) in the Southeastern United States revealed that newly diagnosed HIV infection was found in 37 male college
students and a sexual partner network investigation
Davis et al. 31
linked 21 colleges, 61 students, and 8 partners or students. Historically, prevention of HIV among young people has focused on men who have sex with men (MSM), however young heterosexuals are experiencing much higher rates of infection than ever before (CDC, 2004). Similarly, prevention messages tailored only to MSM may not reflect the current state of sexual behaviors in this country, as a recent study of HIV posi tive African American male college students who have sex with men re ported that 40 percent of the study’s respondents claim to also have sex with heterosexual female students (Leone et al., 2004). Due to these risky sexual behaviors, HIV/AIDS continues to be a significant is sue on American college campuses (CDC, 2004; Hightow, Leone, & MacDonald et al., 2003). Despite such risky behaviors and alarming statistics, many college students are relatively unconcerned about HIV/ AIDS (Ajuluchukwu, Crumey, & Faulk, 1999). The HIV/AIDS epidemic among college students is problematic not only because students are increasingly placing themselves at risk, but also because the number of students living with HIV/AIDS (Gayle, 1990; Le one et al., 2004). In addition to the medical concerns of such students, they often face strong levels of stigmatization. Research on college stu dents has shown that homophobia is a significant factor in the stigmatiza tion of individuals with HIV (Johnson & Baer, 1996; Trezza, 1994). Leiker, Taub, and Gast (1995) found that college students stigmatized ho mosexuals with HIV and injection drug users with HIV to a similar de gree. In a national survey of attitudes towards individuals with AIDS, Herek and Capitanio (1999) found that many people expressed fear about touching the clothing of a person living with AIDS or eating with steril ized utensils used by a person living with AIDS, and these attitudes were associated with misconceptions about persons living with AIDS and sex ual prejudice. They argue that such stigma and ignorance hinders HIV prevention efforts and impinges on the civil rights of persons living with HIV/AIDS. Thus, it is essential for healthy college students not only to understand their risk and
efficacy in safe sex practices that will protect them from HIV/AIDS, but also to be aware of their prejudices and mis conceptions about persons living with HIV/ AIDS. Prejudice, whether stemming from homophobia or ignorance, hinders preventative efforts (Herek & Capitanio, 1999). Negative attitudes towards those living with HIV/AIDS prevents healthy individuals from becoming fully aware of the modes of HIV transmission and by conceptualizing HIV to only exist among members of a population of “others,” they underestimate their own risk of becoming infected with HIV. Accordingly, research of HIV/AIDS knowledge among college students has consistently shown
32 HIV/AIDS PREVENTION IN CHILDREN & YOUTH
that knowledge alone does not predict safe sex practices (CDC, 2004; Gupta & Weiss, 1993; Opt & Loffredo, 2004). In order to address HIV infection among college students, a compre hensive measure is needed that not only assesses knowledge about HIV/ AIDS, but also measures attitudes and prejudices against individuals with HIV/AIDS, knowledge of personal risk factors, and can be used with samples from culturally diverse populations. Furthermore, as the HIV/AIDS epidemic is a global concern, a comprehensive measure of HIV/AIDS awareness should also enable crosscultural compari sons. While several studies have investigated HIV/AIDS knowledge (Lewis, Malow, & Ireland, 1997; Li et al., 2004; Odusanya & Alakija, 2004), or attitudes, (Bruce & Reid, 1998; Bruce & Walker, 2001), there has been little research using multidimensional measures of HIV/AIDS awareness (Paniagua et al., 1994), and we have found no existing multidimensional HIV/AIDS questionnaires that enable crosscultural comparisons in different languages. Therefore, this paper assessed the reliability and validity of an HIV/AIDS questionnaire that measures fours dimensions of HIV/AIDS awareness–factual knowledge, preju dice, personal risk, and misconceptions about HIV transmission, and will enable crosscultural research. The International AIDS Question naire–Chinese Version (IAQC) was developed and validated by Davis et al. (1999) for use with Chinese populations. In this study, the validity and reliability of the International AIDS Questionnaire–English Version (IQAE) was assessed on a sample of EnglishSpeaking college students from the United States and Australia. METHOD Participants and Procedure The IAQE was distributed to several convenience samples of col lege students from three public universities in the southern region of the United States and from a large public university in Australia during so cial science classes. Participation was voluntary, and students were pro vided with time during class to fill out the questionnaire. In addition to the IAQE, the
questionnaire asked for demographic information. A to tal of 281 Englishspeaking students completed the questionnaire (53 males, 221 females, 7 missing). Seven cases with incomplete data were excluded from analysis. The sample included 200 participants from the United States (45 male, 155 female) and 74 participants from Australia
Davis et al. 33
(7 male, 67 female). The 274 cases with complete data were included in the analyses. Participants were, on average, between 21 and 23 years of age (M = 22.4, SD = 3.4). Fiftyone percent of the sample selfidentified as white, 23% as African American, 11% as Australian, and 15% as an other racial/ethnic group. Measures The IAQ was originally developed in English and translated into Chinese by a translator in Hong Kong, and then translated back into English by an independent bilingual researcher. The IAQC was then reviewed by two independent bilingual researchers for face validity. (For further details on the original development and validation of this questionnaire, see Davis et al., 1999.) The IAQE consists of a series of 18 statements which were originally developed to assess four dimensions of HIV/AIDS awareness including myths about the transmission of HIV (7 items), facts about HIV/AIDS (3 items), statements regarding personal HIV risk (3 items), and attitudinal statements about persons in fected with HIV/AIDS (5 items) (Davis et al., 1999). (See Appendix 1) Each statement is rated on a Likert scale ranging from 1 (Strongly dis agree) to 5 (Strongly agree), so that a low score on each item indicates greater awareness. Four of the statements were reverse coded. RESULTS The IAQE was first reviewed by two independent AIDS researchers for face validity. Content validity was established by reviewing other selfconstructed scales used to measure similar concepts, such as, HIV/ AIDS knowledge (Jakobsen & Jostein, 1997; Lewis, Malow, & Ireland, 1997; Li et al., 2004; Odusanya & Alakija, 2004), attitudes (Bruce & Reid, 1998; Bruce & Walker, 2001; Dias, Matos, & Goncalves, 2006), and perceived risk (Barling & Moore, 1990; Moore & Barling, 1991). In order to confirm the 18item fourfactor model found in the IAQC model on an Englishspeaking sample, confirmatory factor analysis (CFA) was performed based on the covariance matrix presented in Ta ble 1.
Overall, the results of the CFA supported the model. The Bentler Bonett Normed Fit Index (NFI) and the Bentler Comparative Fit Index (CFI), measures of the overall portion of explained variance, were above the recommended level of 0.90 (NFI = 0.92 and CFI = 0.95). The
34
Davis et al. 35
BentlerBonett NonNormed Fit Index (NNFI), which adjusts for model complexity, was also high (NNFI = 0.94). The Standardized Root Mean Squared Residual (SRMR), which provides a measure of the discrep ancy between the observed and modelimplied covariances, also indi cated a good fit of the model (SRMR = 0.066). Factor parameter estimates and standard errors for the fourfactor model are presented in Table 2. TABLE 2. Factor Parameter Estimates and Standard Errors for Confirmatory Factor Analysis of IAQE (N = 274) Item Estimate SE Factor 1: Transmission myths HIV can be spread through coughing and sneezing. 0.75 0.05 AIDS can be contracted through sharing cigarettes. 0.67 0.05 HIV/AIDS can be spread through hugging an infected person. 0.64 0.04 HIV can be transmitted through the air. 0.66 0.04 HIV can be spread through swimming pools. 0.65 0.05 HIV can be contracted through toilet seats. 0.64 0.06 Mosquitoes can transmit HIV. 0.39 0.07 Factor 2: Attitudes or prejudices People with HIV should be kept out of school. 0.75 0.04 I would end my friendship if my friend had AIDS. 0.74 0.05 I am willing to do volunteer work with AIDS patients.a 0.40 0.08 If a family member contracts HIV they should move out. 0.71 0.04 People with HIV should stay home or in a hospital. 0.69 0.05 Factor 3: Personal risk ________ are less susceptible of contracting AIDS than are Westerners. 0.43 0.06 AIDS only affects IV drug users, prostitutes, and homosexuals. 0.70 0.05 You can protect yourself against AIDS by being vaccinated for it. 0.73 0.07 Factor 4: Facts Condoms will decrease the risk of HIV transmission.a 0.23 0.07 HIV can be transmitted from mother to baby.a 0.60 0.08 HIV is spread through infected sperm.a 0.40 0.08 Note: IAQ = International AIDS Questionnaire. aItems were reverse scored.
36 HIV/AIDS PREVENTION IN CHILDREN & YOUTH
Normative Data and Psychometric Properties The intercorrelations among the total IAQE scale and the four sub scales and the Cronbach’s alphas for the full IAQE and each subscale are presented in Table 3. As shown, each subscale, with the exception of the facts scale, was strongly correlated with the total IAQE scale (r = 0.764 through 0.898, p < 0.001). The facts subscale was moderately cor related with the total IAQE (r = 0.425, p < 0.001). Each of the subscales were significantly correlated with each other. However, although signifi cant, the correlations between the facts subscale and the other subscales were relatively weak. The total IAQE had a high internal consistency (Cronbach’s alpha = 0.88). The Cronbach’s alphas for the subscales were 0.87 (myths), 0.81 (attitudes), 0.66 (personal risk), and 0.40 (facts). A 2week testretest reliability study on a subsample of 32 students revealed a Pearson productmoment correlation coefficient of 0.882 (p < 0.001). Table 4 presents the means and standard deviations for the total sample and separately by sex of respondent on the total IAQE and on the four subscales. (Note: A lower score indicates greater HIV/AIDS knowledge/awareness and less prejudice against individuals infected with HIV/AIDS.) The mean score for the total IAQE was 31.0 (SD = 10.0). The mean scores for the subscales were as follows: transmission myths (M = 12.0, SD = 4.9), attitudes/prejudices (M = 8.5, SD = 3.7), personal risk (M = 5.1, SD = 2.3), facts (M = 5.3, SD = 1.9). The relative mean scores indicated that this sample scored relatively equally on the total IAQE and on the three subscales. Note, however, this sample had TABLE 3. Intercorrelations, Mean Scores, and Internal Consistency of the IAQE Total Scale and Scale Scores (N = 274) IAQ Total Myths Attitudes Personal Facts Total – Transmission myths 0.898** Attitudes/prejudices 0.823** 0.605** Personal risk 0.764** 0.619** 0.538** Facts 0.425** 0.241** 0.195* 0.231** – Relative mean score 1.72 (0.096) 1.72 (0.12) 1.71 (0.17) 1.72 (0.064) 1.77 (0.03) Cronbach’s alpha 0.88 0.87 0.81 0.66 0.40 Note: *p 0.01, **p 0.001.