HIV/AIDS Knowledge and Beliefs Scales for Adolescents

Abstract

The HIV/AIDS Knowledge and Beliefs Scales for Adolescents were developed to provide essential measures for evaluating educational and behavioral interventions aimed at increasing accurate knowledge and encouraging the adoption of safer beliefs regarding the prevention of HIV/AIDS. This assessment instrument targets adolescents, a population identified as being at particularly high risk due to their sexual risk behaviors that predispose them to contracting the Human Immunodeficiency Virus (HIV) and other sexually transmitted diseases.

The development process involved rigorous evaluation by two advisory councils composed of domain experts, who assessed a comprehensive pool of items based on content relevance, scientific accuracy, reading level, and clarity. Following initial revisions, the measures were pilot tested with the target population and further refined before being administered to diverse, high-risk adolescent samples, including homeless, gay-identified youth in New York City, and incarcerated delinquents in Virginia.

Keywords

HIV/AIDS, adolescent risk behavior, sexual health, knowledge assessment, beliefs scale, self-efficacy, prevention, psychometrics, Likert-type scale, youth intervention

Authors

Cheryl Koopman, Helen Reid, Elizabeth McGarvey, Adelaida Cruz Castillo

Purpose

The primary purpose of the scales is to quantitatively assess two distinct yet related psychological constructs in adolescents: factual Knowledge of HIV/AIDS and the adoption of Beliefs About Preventing HIV/AIDS. These measures serve as critical tools for researchers and clinicians evaluating the efficacy of educational programs, public health campaigns, and behavioral interventions designed to mitigate high-risk behaviors in vulnerable youth populations.

The instrument was initially validated on two specific high-risk cohorts: homeless and gay-identified adolescents (N=450) and incarcerated delinquent adolescents (N=893). Since its original publication (Koopman et al., 1990), the instrument has demonstrated utility across diverse research settings and populations, including modifications used for screening undergraduate college students and adaptation for use with adult populations in countries such as Kenya, India, and Botswana.

Construct

The scales measure two main psychological domains related to HIV/AIDS prevention:

• HIV/AIDS Knowledge Scale: This component assesses the respondent’s factual understanding of the virus, its transmission, and prevention methods. This is further divided into three empirically derived subscales: Medical/Scientific Knowledge, Myths of HIV Transmission (addressing common misconceptions), and Knowledge of High-Risk and Prevention Behaviors. An optional Safer Alternatives subscale requires comparative judgment on relative risk.

• Beliefs About Preventing HIV/AIDS Scale: This component measures psychosocial factors that influence the adoption of safer sexual practices. The factors derived from this scale align with key concepts often found in health behavior models, specifically focusing on five core subscales: Peer Support for Safe Acts, Expectation to Prevent Pregnancy, Perceived Threat, Self-Control, and Self-Efficacy regarding safe sex practices.

Validity

The content validity of both the Knowledge and Beliefs scales was rigorously established during the initial development phase (Koopman et al., 1990). The process included:

• Expert Review: Two separate advisory councils, comprising experts in HIV/AIDS and adolescent health, reviewed the initial item pool to ensure content validity, accuracy, and clarity appropriate for the target population’s reading level.

• Item Generation: Items were systematically generated to ensure comprehensive coverage across all relevant theoretical domains of knowledge and prevention beliefs.

Furthermore, evidence of construct validity was suggested by the low correlations observed between the Knowledge and Beliefs subscales (ranging from .00 to .19), indicating that the scales measure distinct constructs rather than overlapping significantly. Significant correlations were found between subscales and age (ranging from r = .12 to r = .34), suggesting developmental sensitivity, except for the Expectation to Prevent Pregnancy subscale.

Reliability

Reliability estimates were calculated for both measures across the two primary study populations:

Homeless and Gay-Identified Adolescents (N=450)

• HIV/AIDS Knowledge Scale (45-item True/False): The overall scale demonstrated strong internal consistency (Cronbach’s alpha = .85). Test-retest reliability over one week was also strong (r = .82, p < .0001).

• Knowledge Subscales Internal Consistency: Medical/Scientific Knowledge (alpha = .71), Myths of HIV Transmission (alpha = .72), and Knowledge of High-Risk and Prevention Behaviors (alpha = .68).

• Safer Alternatives Subscale (7 items): Internal consistency was acceptable (alpha = .69), with test-retest reliability reported at r = .40 (p < .01).

• Beliefs About Preventing HIV/AIDS Scale: The overall measure showed moderate test-retest reliability (r = .49, p < .001).

• Beliefs Subscales Internal Consistency: Internal consistencies were generally good to excellent, ranging from marginal to high: Peer Support for Safe Acts (alpha = .61), Expectation to Prevent Pregnancy (alpha = .72), Perceived Threat (alpha = .81), Self-Control (alpha = .82), and Self-Efficacy (alpha = .90).

Incarcerated Adolescents (N=893)

• HIV/AIDS Knowledge Scale (True/False): The overall scale showed strong internal consistency (alpha = .81).

• Beliefs About Preventing HIV/AIDS Scale: The overall scale demonstrated strong internal consistency (alpha = .88).

• Beliefs Subscales Internal Consistency: Internal consistencies ranged from marginal to good: Peer Support for Safe Acts (alpha = .56), Perceived Threat (alpha = .58), Expectation to Prevent Pregnancy (alpha = .60), Self-Control (alpha = .75), and Self-Efficacy (alpha = .79).

Factor Analysis

Factor analysis was performed on the initial item pool to establish the underlying structure of both scales:

HIV/AIDS Knowledge Scale

Of the original 49 items, 45 items were retained and loaded onto three distinct factors:

1. Medical/Scientific Knowledge (23 items)

2. Myths of HIV Transmission (9 items)

3. Knowledge of High-Risk and Prevention Behaviors (13 items)

Beliefs About Preventing HIV/AIDS Scale

A set of 36 Beliefs items loaded onto five corresponding factors, resulting in five subscales:

1. Peer Support for Safe Acts

2. Expectation to Prevent Pregnancy

3. Perceived Threat

4. Self-Control

5. Self-Efficacy

Instrument

Test Type: Psychometric Self-Report Inventory (Knowledge and Beliefs)

Format: Mixed format, including True/False (Knowledge Scale) and a 4-point Likert-type scale (Beliefs Scale)

Language Available: English (Original development)

Population Group: High-risk adolescents and young adults (subsequently adapted for general youth and adult populations)

Age Group: 11 to 19 years old (Primary target); 18 to 24 years old (Adapted use)

Population Details: Homeless youth, gay-identified youth, incarcerated delinquents, and undergraduate college students (in adapted versions). Study samples were ethnically diverse, including African American, Hispanic/Latino, White, and Caucasian participants.

Test Methodology: The Knowledge Scale uses dichotomous scoring (1=correct, 0=incorrect). The Beliefs Scale uses a 4-point Likert scale (1 = Agree Strongly to 4 = Disagree Strongly), requiring 19 items to be reverse scored. Higher scores on the Beliefs scale indicate stronger endorsement of prevention beliefs. Administration time is approximately 35 minutes total (20 minutes for Knowledge, 15 minutes for Beliefs).

Keywords

adolescent psychology, sexual risk, HIV prevention, psychometrics, internal consistency, test-retest reliability, health behavior model, youth assessment, incarcerated youth

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Cheryl Koopman)

Correspondence Address: Cheryl Koopman, Department of Psychiatry and Behavioral Sciences, MC 5718, Stanford University, Stanford, CA 94305-5718

Permissions & Fee and Test Year

The initial development and validation study was published in 1990 (Koopman, Rotheram-Borus, Henderson, Bradley, & Hunter). Information regarding permissions and fees for current usage should be directed to the corresponding author, Cheryl Koopman.

This research was supported by grants from the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse (NIDA).

Reference’s

• Ananth, P., & Koopman, C. (2003). HIV/AIDS knowledge, beliefs, and behavior among women of childbearing age in India. AIDS Education and Prevention, 15, 529–546.

• Canterbury, R. J., Clavet, G. J., McGarvey, E. L., & Koopman, C. (1998). HIV risk-related attitudes and behaviors of incarcerated adolescents: Implications for public school students. High School Journal, 82, 1–10.

• Chang, V. Y., Bendel, T. L., Koopman, C., McGarvey, E. L., & Canterbury, R. J. (2003). Delinquents’ safe sex attitudes: Relationships with demographics, resilience factors, and substance use. Criminal Justice and Behavior, 30, 210–229.

• Greig, F. E., & Koopman, C. (2003). Multilevel analysis of women’s empowerment and HIV prevention: Quantitative survey results from a preliminary study in Botswana. AIDS and Behavior, 7, 195–208.

• Koopman, C., Rotheram-Borus, M. J., Henderson, R., Bradley, J. S., & Hunter, J. (1990). Assessment of knowledge of AIDS and beliefs about AIDS prevention among adolescents. AIDS Education and Prevention, 2, 58–70.

• Otto-Salaj, L. L., Gore-Felton, C., McGarvey, E., & Canterbury, R. J. (2002). Psychiatric functioning and substance use: Factors associated with HIV risk among incarcerated adolescents. Child Psychiatry and Human Development, 33, 91–106.

• Patel, V. L., Gutnik, L. A., Yoskowitz, N. A., O’Sullivan, L. F., & Kaufman, D. R. (2006). Patterns of reasoning and decision making about condom use by urban college students. AIDS Care, 18, 918–930.

• Patel, V. L., Yoskowitz, N. A., & Kaufman, D. R. (2007). Comprehension of sexual situations and its relationship to risky decisions by young adults. AIDS Care, 19, 916–922.

• Volk, J. E. & Koopman, C. (2001). Factors associated with condom use in Kenya: A test of the health belief model. AIDS Education and Prevention, 13, 495–508.

• Whaley, A. L. (1999). Preventing the high-risk behavior of adolescents: Focus on HIV/AIDS transmission, unintended pregnancy, or both? Journal of Adolescent Health, 24, 376–382.

Items of the HIV/AIDS Knowledge and Beliefs Scales for Adolescents

HIV/AIDS Knowledge Scale

Directions: Read each of the following statements and decide whether you think the statement is true or false. If you think the statement is true, mark “T.” If you think the statement is false, mark “F.”

1. AIDS means Acquired Immune Deficiency Syndrome.

2. Most scientists today believe that AIDS is caused by a virus, called HIV (Human Immunodeficiency Virus).

3. Most people who develop AIDS eventually recover.

4. A baby born to a mother with HIV infection can get AIDS.

5. HIV is carried in the blood.

6. Most people who have HIV infection are sick with AIDS.

7. Prostitutes in New York City have a low chance of getting HIV (which can lead to AIDS).

8. HIV (which can lead to AIDS) is carried in men’s cum (semen).

9. The number of men and women infected with HIV will probably be less in the next several years than it is now.

10. AIDS weakens the body’s ability to fight off disease.

11. People have been known to get HIV and develop AIDS from toilet seats.

12. A negative HIV antibody test means that a person probably has AIDS.

13. You can’t get HIV (which can lead to AIDS) if you only have intercourse with one person for the rest of your life.

14. It is a good idea to ask someone about his/her past sexual activities before having sex with them, even though some partners may lie to you.

15. If the HIV test comes out negative, it means that the person has AIDS.

16. People get other diseases because of AIDS.

17. You can die from AIDS.

18. Men have a higher chance of getting AIDS from having sex with a woman than from having sex with a man.

19. Using a condom will lessen the chance of getting AIDS.

20. People who have AIDS get pneumonia more often than the average person.

21. Women are more likely to get AIDS from having sex with a straight (heterosexual) man than with a bisexual man.

22. It is safe to have intercourse without a condom with a person who shoots drugs as long as you don’t shoot drugs.

23. People have been known to get HIV and develop AIDS from a swimming pool used by someone with AIDS.

24. People of any race can get HIV and develop AIDS.

25. People have been known to get HIV and develop AIDS by tongue kissing a person who is infected.

26. Lambskin condoms are better than latex condoms for preventing HIV infection.

27. People usually become very sick with AIDS a few days after being infected with HIV.

28. Getting AIDS depends on whether or not you practice safe sex, not on the group you hang out with.

29. People have been known to get HIV and develop AIDS from insect bites.

30. It is safer not to have sexual intercourse at all than to have sexual intercourse using a condom.

31. You only need one HIV test to come out positive to be sure that you are infected.

32. Pregnant women are safe from getting HIV infection.

33. A vaccine has recently been developed that prevents people from getting HIV infection (which can lead to AIDS).

34. The virus that can lead to AIDS can be passed by an infected person even though that person isn’t sick.

35. If you are really healthy, then exercising daily can prevent getting HIV (which can lead to AIDS).

36. If the person you are now having sex with has been tested and does not have HIV infection, it means that you are not infected.

37. People have been known to get HIV and develop AIDS by eating at a restaurant where a worker has AIDS.

38. When using condoms, it is better to use one with a spermicide like Nonoxynol-9.

39. You can get HIV and eventually AIDS through an open cut or wound.

40. You are safe from AIDS if you have oral sex (with mouth to penis or mouth to vagina) without a condom.

41. If you get a “false positive” result on your HIV antibody test, it means you are infected.

42. Anal (rear end) sex without a condom is one of the safer sexual practices.

43. You can get HIV and eventually AIDS by donating blood.

44. Using drugs like marijuana, alcohol, cocaine, and crack makes it more likely that you may have unsafe sex.

45. You can get HIV (which can lead to AIDS) by getting tested for it.

Safer Alternatives

Directions: For each pair of choices below, show which you think is safer by marking your choice (either A or B) on your answer sheet. If you do not know, take a guess.

Which is safer?

1. A) Giving blood.

   B) Getting a blood transfusion.

2. A) Working in the same office with someone who has AIDS or HIV.

   B) Contact with HIV or the AIDS virus through an open cut or sore.

3. A) Heterosexual vaginal intercourse with a woman who has AIDS.

   B) Anal intercourse with a man who has AIDS.

4. A) Using a needle just used by a person with HIV.

   B) A man having unprotected vaginal intercourse with a woman who has AIDS.

5. A) Having sexual intercourse with a person who shoots drugs.

   B) Spending time in the same house or room with a person who has AIDS.

6. A) Homosexual anal intercourse with someone who has AIDS.

   B) Receiving a blood transfusion.

7. A) Unprotected sexual intercourse with a lesbian.

   B) Unprotected sexual intercourse with a bisexual man.

Beliefs About Preventing HIV/AIDS

Directions: Read each statement carefully. Then show your agreement or disagreement with each statement by marking 1, 2, 3, or 4. Mark:

1. if you agree strongly

2. if you agree somewhat

3. if you disagree somewhat

4. if you disagree strongly

1. I would feel uncomfortable buying condoms.

2. I would be too embarrassed to carry a condom around with me, even if I kept it hidden.

3. It doesn’t bother me if others make fun of me because I believe in having safe sex.

4. If my partner won’t use (or let me use) a condom, I won’t have sex.

5. My friends have changed the way they have sex because of the AIDS epidemic.

6. I will have safe sex even if people make fun of me for it.

7. AIDS is a health scare that I take very seriously.

8. There is a good chance I will get AIDS during the next five years.

9. If I ask to use condoms, it might make my partner not want to have sex with me.

10. A person who gets AIDS has a good chance of being cured.

11. I plan on being very careful about who I have sex with.

12. My friends practice safe sex.

13. I have no control over my sexual urges.

14. My friends feel that it is too much trouble to use condoms.

15. I have a high chance of getting AIDS because of my past history.

16. My partner will know I really care about him/her if I ask to use condoms.

17. I don’t know how to use a condom.

18. AIDS is the scariest disease I know.

19. If I was going to have sex with someone and they made fun of me for wanting to have safe sex, I would probably give in.

20. There is still time for me to protect myself against AIDS.

21. Trying to have safe sex gets in the way of having fun.

22. I feel almost sure that I will get AIDS.

23. I know how to have safe sex.

24. Using condoms would be a sexual “turn-off” for me.

25. I am not doing anything now that is sexually unsafe.

26. In the future I will always be able to practice safe sex.

27. Before I decide to have intercourse, I will make sure we have a condom.

28. Once I get sexually excited, I lose all control over what happens.

29. Most of my friends think that practicing safe sex can lower the spread of AIDS.

30. If I ask to use a condom, it will look like I don’t trust my partner.

31. Carrying condoms with me every day is a habit I can keep.

32. I am too young to take care of a baby right now.

33. Not getting pregnant (or not getting a girl pregnant) is very important to me.

34. I will not bother with birth control when I have intercourse with a member of the opposite sex.

35. In the future, whenever I have sexual intercourse with a member of the opposite sex, I plan to make sure we are using birth control.

36. If I wanted to have sex with a member of the opposite sex, and did not have protection, I would go ahead and have intercourse anyway.