Herpes Attitude Scale

Abstract

The Herpes Attitude Scale (HKS), formally introduced in academic literature as the Herpes Knowledge Scale, is a specialized psychometric instrument designed to accurately quantify general knowledge levels regarding genital herpes. Developed by Katherine Bruce and Judith McLaughlin, the scale utilizes a 54-item true-false format, incorporating a “Don’t Know” option to discourage random guessing.

The development process was rigorous, beginning with an initial pool of 64 field-derived statements which were refined through expert review and judged for relevance by a panel of five specialists. An item analysis, conducted on data from 150 undergraduate students, ensured that the final 54 items possessed strong discriminatory power. The HKS covers essential subject areas, including viral cause, symptoms, treatment, contagion, and prevalence, exhibiting high internal consistency with a Cronbach’s alpha of .88.

Keywords

Genital Herpes, Herpes Knowledge Scale, Sexual Health, Knowledge Assessment, Psychology, Reliability, Validity, STI Education, Psychometric Scale

Authors

Katherine Bruce (University of North Carolina at Wilmington), Judith McLaughlin (University of Georgia)

Purpose

The primary purpose of the Herpes Knowledge Scale (HKS) is to provide a standardized, objective measure of an individual’s factual understanding of genital herpes. The scale is structured to assess knowledge across several critical dimensions of the disease, including its etiology (cause), clinical symptoms, available treatments, modes of transmission (contagion), patterns of recurrence, overall prevalence, potential complications, and common myths.

The instrument enables researchers and health educators to reliably distinguish between individuals who possess high levels of accurate knowledge and those who demonstrate significant knowledge deficits. Although initially validated using a population of college students, the scale is adaptable for use in various other populations where assessing herpes knowledge is necessary for educational or intervention purposes.

Construct

The Herpes Knowledge Scale measures the cognitive construct of specific, factual knowledge related to a sexually transmitted infection (STI). This construct is operationalized through 54 items designed to cover the breadth and complexity of information surrounding genital herpes, ensuring that misconceptions are identified alongside correct understanding.

The scale assesses the respondent’s mastery of clinical and epidemiological facts, ranging from the viral nature of the disease and latency periods to the implications for pregnancy and the effectiveness of preventative measures. The underlying goal is to quantify the informational foundation necessary for making responsible decisions regarding sexual health and disease management.

Validity

The validity of the Herpes Knowledge Scale was established primarily through an evaluation of content validity and face validity during the instrument’s development phase. Content validation was crucial to ensure the scale items adequately represented the full domain of knowledge about genital herpes.

A panel of five expert judges was employed to rigorously assess the initial item pool. This panel included diverse specialists: a physician, a registered nurse, two health educators, and a graduate student who had personal experience with herpes. These judges evaluated the relevance, importance, and comprehensiveness of each statement, ultimately agreeing on 57 items for inclusion before the final refinement process (Bruce & McLaughlin, 1986).

Reliability

The reliability of the HKS was assessed by measuring its internal consistency. This assessment involved administering the scale to 148 undergraduate students drawn from psychology and health education courses to determine how consistently the items measured the single construct of herpes knowledge.

The results indicated a high level of reliability, evidenced by a strong Cronbach’s alpha coefficient of .88. This statistical finding confirms that the items within the 54-item scale are highly intercorrelated and function cohesively as a measure of a unified construct, demonstrating the instrument’s stability and precision (Bruce & McLaughlin, 1986; Bruce & Bullins, 1989).

Factor Analysis

While the development literature does not report a formal Factor Analysis (such as Exploratory or Confirmatory), the scale’s construction relied heavily on robust item analysis to ensure high discrimination between respondents. The initial administration to 150 undergraduate students involved calculating item-total correlations.

This process was used to identify statements that could best distinguish between high and low scorers on the scale. Fifty-four items were retained because they exhibited statistically significant item-total correlations (p < .0007). This rigorous item selection process supports the scale’s intended function as a primarily unidimensional measure of knowledge, focused on maximizing discriminatory power.

Instrument

Test Type: Knowledge assessment scale

Format: 54-item true-false test with a “Don’t Know” response option

Language Available: English (Original)

Population Group: General population; primarily validated using college students

Age Group: Late adolescence and young adulthood (College students)

Population Details: The scale was developed and validated using samples of undergraduate students (N=150 for item analysis; N=148 for reliability testing) enrolled in introductory psychology and health education courses.

Test Methodology: The scale is a self-report measure where respondents indicate T (True), F (False), or DK (Don’t Know) for each statement on a separate answer sheet. The total score is calculated by summing the number of correct responses, dividing by 54, and multiplying by 100 to yield a percentage correct (0–100%). The “Don’t Know” response is scored as incorrect. Most respondents complete the scale within 15 minutes.

Keywords

Genital Herpes Assessment, STI Knowledge, Psychometrics, Bruce & McLaughlin, Health Education, Knowledge Deficit, Reliability Coefficient, STD

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Katherine Bruce)

Correspondence Address: Katherine Bruce, Department of Psychology, UNC Wilmington, Wilmington, NC 28403

Permissions & Fee and Test Year

The Herpes Knowledge Scale was developed and published in the mid-1980s, with foundational research appearing in 1986 and 1989. Specific information regarding current licensing, permissions, or associated fees is not provided in the source material. Researchers interested in using the scale should contact the corresponding author, Katherine Bruce, for permission and usage guidelines.

Reference’s

• Bruce, K., & McLaughlin, J. (1986). The development of scales to assess knowledge and attitudes about genital herpes. The Journal of Sex Research, 22, 73–84.
• Bruce, K. E. M., & Bullins, C. G. (1989). Students’ attitudes and knowledge about genital herpes. Journal of Sex Education and Therapy, 15, 257–270.

Items of the Herpes Attitude Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. The length and severity of genital herpes outbreaks vary from person to person.

2. Genital herpes is caused by a virus.

3. Genital herpes was discovered five years ago.

4. Genital herpes recurrences can be triggered by menstruation (in females) or sexual intercourse.

5. Every person who has a primary (first) outbreak of genital herpes will have recurrence within the next year.

6. Genital herpes makes males infertile (sterile).

7. Between recurrences, the genital herpes virus lies dormant (inactive) in the nerve cells.

8. Herpes Type 1 cannot occur on the genitals.

9. A person having recurrences of genital herpes often experiences prodromal (early warning) sensations.

10. Years may pass between genital herpes recurrences.

11. Every sore on the genitals is herpes.

12. Once a genital herpes sore has healed, the person will never develop another herpes sore.

13. A person who gets cold sores on the mouth is immune to genital herpes.

14. Genital herpes usually looks like blisters on the genitals.

15. Prodromal (early warning) sensations of genital herpes recurrences include tingling or itching in the area where the genital herpes sores usually appear.

16. If a person has sexual intercourse with someone who has genital herpes, s/he will definitely get genital herpes too.

17. Several hundred people are expected to catch genital herpes from toilet seats this year.

18. A woman who has genital herpes will become sterile because of the herpes infection.

19. People who wear contact lenses and have oral (mouth) herpes should avoid putting the lenses in their mouths because the herpes infection could spread to their eyes.

20. A person with genital herpes is instructed to keep the sore area clean and dry.

21. Genital herpes leads to death.

22. There is a cure for genital herpes at present.

23. Genital herpes recurrences do not typically become less frequent over time.

24. A person who has genital herpes often has more psychological complications than physical complications.

25. When a person has an active outbreak of genital herpes, it is advisable not to have sexual intercourse.

26. People who have genital herpes can sometimes predict when they will have a recurrence.

27. A woman who has genital herpes should have a Pap smear at least once a year.

28. Genital herpes can be contagious even if the herpes sore has a scab on it.

29. First episodes of genital herpes infection are usually more severe than the recurrences.

30. A person who has genital herpes is immune to oral (mouth) herpes.

31. Between recurrences, the genital herpes virus lies dormant (inactive) near the spinal cord.

32. Stress can often trigger a genital herpes recurrence.

33. Herpes can be fatal to a newborn if s/he contracts the infection.

34. Genital herpes can often be detected by the use of a Pap smear.

35. After a person is exposed to genital herpes, s/he will often show symptoms in 2–20 days.

36. Anxiety can trigger a genital herpes recurrence.

37. Condoms offer 100% protection from catching genital herpes.

38. A genital herpes infection usually leads to syphilis.

39. A woman who had genital herpes must have a Caesarean section if she has a baby.

40. Most people have been exposed to oral herpes at one time or another.

41. A woman with genital herpes can deliver a baby through her vagina if she doesn’t have an active herpes infection at the time of delivery.

42. If both parents have genital herpes, their children will be born with herpes.

43. A woman who has genital herpes can never have a baby.

44. Genital herpes is not contagious.

45. L-lysine is a cure for genital herpes.

46. Genital herpes may be associated with cancer of the cervix.

47. Contraceptive foam has been proven to kill genital herpes in humans.

48. In a primary (first) case of genital herpes, the person may feel like s/he has the flu.

49. Oral herpes is contagious.

50. The best way to treat genital herpes sores is to keep them moist.

51. Acyclovir (also called Zovirax or Valtrex), an anti-viral drug, can cure genital herpes.

52. A person with genital herpes is not contagious during the prodromal (early warning) stage.

53. Genital herpes is not prevalent (common) on college campuses.

54. Oral herpes cannot be transferred to the genitals during oral-genital sex.