Adolescent AIDS Knowledge Scale

Abstract

The Adolescent AIDS Knowledge Scale (AAKS) is a 22-item psychometric instrument developed by Gregory D. Zimet and colleagues (1989) to measure the factual knowledge of adolescents regarding acquired immunodeficiency syndrome (AIDS). The scale was meticulously constructed to ensure that awareness of scientific facts about AIDS was assessed separately from personal beliefs, a common confounding factor in earlier instruments. Item content was derived from authoritative sources, specifically the 1988 informational brochure distributed by the U.S. Government.

The AAKS covers a broad range of critical domains related to the virus and the disease, including modes of HIV transmission, protective behaviors (both effective and ineffective), high-risk behaviors, mortality associated with AIDS, the possibility of a cure, and misconceptions about the physical appearance of persons with AIDS (PWAs). Respondents answer each question using a forced-choice format: Yes, No, or Don’t Know, typically completing the assessment in less than five minutes.

Keywords

AIDS knowledge, HIV prevention, adolescent health, psychometrics, public health, scale development, health education, knowledge assessment, Gregory D. Zimet.

Authors

Gregory D. Zimet, T. M. Anglin, R. Lazebnik, D. Bunch, P. Williams, D. P. Krowchuk.

Purpose

The primary purpose of the Adolescent AIDS Knowledge Scale (AAKS) is to provide a standardized, factual measure of adolescents’ awareness concerning the scientific aspects of AIDS. The scale was developed as part of a larger, comprehensive questionnaire designed to evaluate adolescents’ knowledge, beliefs, and attitudes toward the disease (Zimet et al., 1989).

A secondary, crucial objective was to develop an instrument that strictly measured objective knowledge, differentiating it sharply from personal acceptance or endorsement of those facts (beliefs). This separation was achieved by framing every question with the phrase, “Do most experts say…?” This design choice is vital for researchers and educators aiming to assess the efficacy of AIDS education interventions by isolating deficiencies in factual awareness from underlying attitudinal barriers.

Construct

The AAKS measures the construct of Factual Scientific Knowledge about AIDS. It is designed specifically to cover relevant material derived from public health information. The scale addresses complex domains related to human immunodeficiency virus (HIV) and AIDS, including:

• Modes of transmission (e.g., sharing needles, sexual contact).
• Low- or no-risk behaviors (e.g., sharing a glass, casual contact).
• Behaviors that increase the risk of transmission (e.g., prostitution).
• Effective protective measures (e.g., condom use) versus ineffective measures (e.g., eating healthy foods).
• Clinical facts concerning mortality, the existence of a cure, and asymptomatic HIV transmission.

Validity

The validity of the AAKS is supported across multiple dimensions, including content, face, and construct validity.

Content Validity and Face Validity: Content validity was established by ensuring that item selection was guided by the 1988 U.S. government informational brochure on AIDS distributed by the Centers for Disease Control (CDC). This grounding in authoritative public health material ensured the scale covered scientifically relevant and current information. The scale also demonstrates good face validity by addressing all major AIDS-related domains relevant to the adolescent population, such as transmission routes, prevention, mortality, and the visibility of the disease.

Construct Validity: Support for construct validity is demonstrated through expected empirical relationships with other variables. For instance, analysis of variance confirmed a statistically significant linear increase in AAKS scores across higher grade levels among 7th to 12th graders (F(5, 611) = 8.8, p < .0001), indicating that older students possess more accurate knowledge, as hypothesized. Furthermore, greater AIDS knowledge (higher AAKS scores) was negatively correlated with inaccurate beliefs about AIDS (r = –.65, p < .001) and negatively related to anxiety about interacting with PWAs (r = –.28, p < .001), confirming theoretical expectations regarding the relationship between knowledge and attitude/fear.

Reliability

Due to the nature of the AAKS as a measure of multiple content areas rather than a single homogeneous construct, standard measures of internal consistency, such as Cronbach’s coefficient alpha or Kuder-Richardson formula 20, are considered inappropriate for this instrument (Anastasi, 1982; Zimet, 1992b).

Instead, the reliability was assessed using a specialized form of the Spearman-Brown split-half reliability method, which requires matching items for content across the split halves. Although the scale was not originally designed for perfect content matching, this method was applied to a sample of 721 junior and senior high school students. The resulting Spearman-Brown matched-item split-half coefficient was .82 (Zimet, 1992b), which is indicative of good internal reliability for a knowledge measure covering diverse topics.

Factor Analysis

The AAKS was developed to cover multiple, comprehensive domains of AIDS knowledge based on authoritative government information, rather than to measure a single latent psychological factor. Given this design, standard factor analysis results are not detailed in the source documentation. The scale functions as a composite measure of competency across distinct content areas.

Instrument

Test Type: Knowledge assessment scale (Objective measurement of factual understanding)

Format: 22-item self-report questionnaire with a three-option response mode (Yes, No, Don’t Know).

Language Available: English (Original version).

Population Group: Adolescents.

Age Group: Typically junior and senior high school students (approximate grades 7 through 12).

Population Details: Developed for use with youth in educational and public health settings to evaluate knowledge acquisition related to AIDS prevention and transmission.

Test Methodology: Each item is constructed as a question beginning with “Do most experts say…?” The scale typically requires less than 5 minutes to complete. Scoring is dichotomous: 1 point is awarded for a correct response, and 0 points are assigned for either an incorrect response or a “don’t know” response. Total scores range from 0 (minimum knowledge) to 22 (maximum knowledge).

Keywords

AAKS, knowledge assessment, HIV/AIDS education, adolescent medicine, psychometric scale, public health intervention, Zimet, reliability, validity.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: [email protected]

Correspondence Address: Gregory D. Zimet, Indiana University School of Medicine, Section of Adolescent Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202.

Permissions & Fee and Test Year

The Adolescent AIDS Knowledge Scale (AAKS) was developed and first published in 1989 (Zimet et al., 1989). Specific information regarding current licensing fees or formal permissions for use is not provided in the original text. Researchers seeking to utilize the scale should contact the primary author for guidance on permissions.

Reference’s

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.

Items of the Adolescent AIDS Knowledge Scale

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

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