Genital Herpes Perceived Severity Scales

Abstract

The Genital Herpes Perceived Severity Scales (GHPSS), developed by Jerrold Mirotznik in 1991, are a multi-dimensional instrument designed to measure attitudes concerning the potential negative consequences of contracting genital herpes. The scales focus specifically on the perceived social and psychological severity of the disease, moving beyond purely medical outcomes. The GHPSS were created to overcome the limitations of prior research, which often relied on unreliable single-item measures and restrictive dichotomous response options.

The conceptualization of the GHPSS is rooted in the Health Belief Model (HBM), which posits that perceived threat, driven largely by perceived severity, motivates preventive health behavior. The instrument comprises three distinct subscales developed de novo—the Fear Scale, the Family Impediment Scale, and the Emotional Response Scale—each assessing a different aspect of perceived non-clinical severity related to infection.

Keywords

Genital Herpes Perceived Severity Scales, GHPSS, Health Belief Model, STD attitudes, perceived severity, Fear Scale, Family Impediment Scale, Emotional Response Scale, psychometric properties, sexual health.

Authors

Jerrold Mirotznik

Purpose

The primary purpose of the GHPSS is to provide a reliable and valid measure of the perceived severity of contracting genital herpes. The scale was developed in response to media speculation during the late 1980s suggesting that sexually active young adults were experiencing heightened anxiety about the virus and dramatically altering their dating behaviors as a result.

Unlike previous measures, which suffered from issues such as vague conceptualization, single-item operationalization, and limited dichotomous response options, the GHPSS offers a rigorous, multi-item approach. By measuring perceived social and psychological consequences, the GHPSS allows researchers to empirically test hypotheses derived from the Health Belief Model concerning the relationship between perceived threat and engagement in preventive health behaviors.

Construct

The core psychological construct measured is the perceived severity of genital herpes. This construct is central to the theoretical framework of the Health Belief Model, which suggests that individuals must perceive a disease as personally threatening (severe) before they take steps to avoid it. The GHPSS operationalizes severity in terms of its non-clinical consequences, including social stigma and psychological distress, rather than just physical symptoms.

The perceived severity construct is subdivided into three components, each measured by a separate scale:

• The Fear Scale: Measures the degree to which respondents characterize herpes and those who contract it in highly negative and stigmatizing terms (7 items, 6-point Likert-type response format).
• The Family Impediment Scale: Assesses the perceived difficulty a single person with herpes would face in achieving major family life-course events (5 items, 6-point Likert-type response format).
• The Emotional Response Scale: Measures potential emotional reactions—such as guilt, fear, or anger—to infection (7 emotions, 4-point Likert-type response format).

Validity

Two primary tests were conducted to establish the construct validity of the GHPSS (Mirotznik, 1991). The first test assessed the convergence of the three subscales, hypothesizing that they would correlate more highly with each other than with measures of unrelated constructs, such as knowledge about genital herpes or preventive behaviors. A principal-components factor analysis confirmed that all three scales loaded strongly onto a single factor (Perceived Severity), providing crucial evidence of construct validity.

The second test examined the scale’s fit within the theoretical predictions of the Health Belief Model, which dictates that increased perceived severity should correlate with increased engagement in preventive health behaviors. Correlations were calculated between the severity scales and a measure of preventive behavior (changes in dating practices) among at-risk respondents. All three scales were significantly associated in the hypothesized direction, albeit modestly so (mean correlations ranged from .17 to .25 for the student subsamples), lending further support to the measure’s construct validity. The modest magnitude of these correlations may have been due to the use of a single-item measure for operationalizing preventive behavior.

Reliability

The internal consistency reliability of the GHPSS was evaluated using Cronbach’s alpha across six subsamples derived from three convenience samples (college students and residents of a therapeutic community). This extensive testing aimed to ensure the consistency of the psychometric properties across varied populations, including both at-risk and not-at-risk individuals.

The results indicated good internal consistency for all three scales:

• Fear Scale: Mean alpha was .80, with a range of .73 to .83.

• Family Impediment Scale: Mean alpha was .77, with a range of .73 to .81.

• Emotional Response Scale: Mean alpha was .77, with a range of .75 to .82.

Overall, the GHPSS demonstrated slightly better reliability within the student subsamples compared to the residents of the therapeutic community, but reliability remained acceptable across all tested groups.

Factor Analysis

A principal-components factor analysis employing varimax rotation was conducted on the initial subsample of at-risk students to determine the underlying structure of the GHPSS. The results confirmed the theoretical model, indicating that the three distinct scales converged to measure a single, overarching construct of perceived severity.

Specifically, all three GHPSS scales exhibited high loadings on one primary factor:

• Fear Scale: .76

• Family Impediment Scale: .75

• Emotional Reaction Scale: .68

Importantly, measures of related but distinct constructs, such as knowledge about genital herpes and preventive behaviors, loaded onto separate factors, supporting the discriminant validity of the perceived severity construct. This consistent factor structure was maintained when the analysis was repeated across the remaining five subsamples.

Instrument

Test Type: Self-report questionnaire measuring attitudes and perceived threat.

Format: Paper-and-pencil format. Uses a mixture of 6-point and 4-point Likert-type response formats (e.g., “strongly disagree” to “strongly agree,” or “not react” to “strongly experience”).

Language Available: English (Original development language).

Population Group: College students, graduate students, and individuals in therapeutic community settings.

Age Group: Young adults.

Population Details: Validation samples included 998 college and graduate students, 178 residents of a therapeutic community for alcohol and drug rehabilitation, and a subsequent sample of 439 college students. Samples were analyzed based on their risk status (single, sexually active vs. not at risk).

Test Methodology: The scales are administered via questionnaire, where respondents can circle their choice or mark it on separate machine-scoreable answer sheets. The total time required for completion of all three scales is approximately 5 minutes.

Keywords

Perceived severity, STD attitudes, psychological consequences, social stigma, psychometrics, Cronbach’s alpha, preventive behaviors, Jerrold Mirotznik, health education.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: [email protected]

Correspondence Address: Jerrold Mirotznik, Office of the Associate Provost, Brooklyn College, 2900 Bedford Avenue, Brooklyn, NY 11210

Permissions & Fee and Test Year

Permissions: Information regarding formal permissions is not explicitly provided in the source material but correspondence should be addressed to the author.

Fee: Not specified.

Test Year: 1991 (Year of publication and validation).

Reference’s

• Aral, S. O., Cates, W., & Jenkins, W. C. (1985). Genital herpes: Does knowledge lead to action? American Journal of Public Health, 75, 69–71.

• Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11, 1–47.

• Mirotznik, J. (1991). Genital herpes: A survey of the attitudes, knowledge, and reported behaviors of college students at-risk for infection. Journal of Psychology and Human Sexuality, 4, 73–99.

• Nunnally, J. C. (1978). Psychometric theory. New York: McGraw-Hill.

• Simkins, L., & Eberhage, M.G. (1984). Attitudes toward AIDS, herpes II, and toxic shock syndrome. Psychological Reports, 55, 779–786.

• Simkins, L., & Kushner, A. (1986). Attitudes toward AIDS, herpes II, and toxic shock syndrome: Two years later. Psychological Reports, 59, 883–891.

Items of the Genital Herpes Perceived Severity Scales

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

Instructions: The following items measure your beliefs about genital herpes. Some of the questions concern your views about others who have contracted the virus and the general consequences of infection. Other questions concern how you would personally react if you contracted the virus. For each item, please circle the response option that best corresponds to your feelings.

Fear Scale

For the following statements please select a number from 1 to 6, 1 meaning that you strongly disagree and 6 that you strongly agree.

1. 1. Genital herpes will ruin your sex life.

   2. Having genital herpes is as bad as having cancer.

   3. No one will want me if I had genital herpes.

   4. Genital herpes is a dirty disease.

   5. I would not trust anybody who has genital herpes.

   6. My opinion of a person would change if I found out he/she had genital herpes.

Even though I would be very understanding of people I knew had genital herpes, I would be tempted to stay away from them.

Family Impediment Scale

How difficult to deal with would each of the following things be for a single person who has genital herpes? Choose a number from 1 to 6, 1 indicating not difficult at all and 6 very difficult.

1. Meeting a boyfriend/girlfriend.

2. Telling a boyfriend or girlfriend that you have genital herpes.

3. Having sex.

4. Getting married.

5. Having children.

Emotional Reaction Scale

People may have different reactions to contracting genital herpes. How would you react? For each emotion listed below indicate if you would: 1. not react with the emotion, 2. mildly feel the emotion, 3. moderately feel the emotion or 4. strongly experience the emotion.

1. 1. 1. Angry.

      2. Punished.

      3. Fearful.‌

      4. Numbed.

      5. Damaged.

      6. That it was expected.

      7. Guilty.