Nurses’ Attitudes About HIV/AIDS Scale—Version 2

Abstract

The Nurses’ Attitudes About HIV/AIDS Scale—Version 2 (NAAS-V2) is a revised, 45-item paper-and-pencil instrument developed to measure the attitudes of nursing professionals toward individuals living with HIV/AIDS (PLWHAs). The scale specifically assesses attitudes related to three key vulnerable groups—homosexual men, intravenous drug users, and women with HIV—in addition to professional concerns regarding nursing care and broader societal issues related to the epidemic. Although the instrument is structured into five distinct domains, it is designed to be administered and scored in its entirety to yield a single, comprehensive measure of tolerance and favorable attitudes toward PLWHAs.

Keywords

Nurses’ Attitudes About HIV/AIDS Scale, NAAS, HIV/AIDS, nursing care, professional concerns, intravenous drug abuse, homosexuality, attitude assessment, psychological scale.

Authors

Deborah Bray Preston, Elaine Wilson Young, Patricia Bartholow Koch, Esther M. Forti.

Purpose

The primary purpose of the NAAS-V2 is to provide a standardized tool for assessing nurses’ attitudes concerning the care and social acceptance of people living with HIV/AIDS. This assessment is critical for identifying areas of prejudice, discomfort, or misinformation within the nursing population that may impact patient care quality.

Suggested applications of the NAAS-V2 are multifaceted, serving both research and practical educational needs. These applications include using the scale as a descriptive tool to investigate HIV/AIDS-related attitudes across various nursing populations, describing models of nursing practice behavior related to PLWHAs, and predicting practice outcomes—specifically the adherence to Standard Precautions. Furthermore, the NAAS-V2 is valuable as a needs assessment tool for designing targeted educational programming and as an evaluative tool to measure attitude change resulting from intervention or training.

Construct

The NAAS-V2 is designed to measure the overall favorability and tolerance of nurses’ attitudes toward HIV/AIDS and affected populations. This comprehensive construct is broken down into five distinct, yet interrelated, sub-domains:

• Homosexuality: Attitudes related to homosexual men, comprising 12 items.
• Women with HIV: Attitudes specific to women infected with HIV, comprising 4 items.
• IV Drug Abusers: Attitudes concerning intravenous drug users, comprising 9 items.
• Nursing Care Concerns: Issues related to the practical and emotional challenges of providing care, including fear of contagion, comprising 8 items.
• Social/Professional Issues: Attitudes regarding ethical, legal, and professional responsibilities, such as quarantine, job discrimination, and refusal of care, comprising 12 items.

Validity

While the source content focuses primarily on internal consistency (reliability), the scale was developed based on the original NAAS (1995), which included comprehensive psychometric analysis. The clear delineation of items across five sensitive domains suggests strong content validity, ensuring the scale covers the spectrum of attitudes relevant to nurses regarding HIV/AIDS care and social issues. Users are advised to consult the original 1995 publication for detailed information on construct and criterion validity analyses.

Reliability

The internal consistency of the NAAS-V2 was assessed using Cronbach’s alpha coefficients for the five defined subscales. The reliability coefficients demonstrate generally strong to acceptable internal consistency across the measured domains:

• Homosexuality: α = .95 (Indicating excellent internal consistency).
• Social/Professional Issues: α = .82 (Indicating good internal consistency).
• Nursing Care Concerns: α = .80 (Indicating good internal consistency).
• IV Drug Abusers: α = .75 (Indicating acceptable internal consistency).
• Women with HIV: α = .64 (Indicating marginal internal consistency, suggesting lower coherence among this specific four-item subscale).

These reliability scores, particularly the high alpha for the Homosexuality subscale, support the stability and consistency of the measured constructs within the nursing population.

Factor Analysis

The NAAS-V2 is structured around five conceptual factors (Homosexuality, Women with HIV, IV Drug Abusers, Nursing Care Concerns, and Social/Professional Issues). Although the source advises that the scale should be administered in its entirety and not as a series of stand-alone subscales, the underlying structure implies that these five factors were likely confirmed or derived through exploratory or confirmatory factor analysis during the development of the original 1995 version. The consistent reporting of reliability for these five separate domains supports the presence of a multidimensional factor structure.

Instrument

Test Type: Attitude Assessment Scale

Format: Paper-and-pencil self-report instrument

Language Available: English (Original)

Population Group: Nursing professionals (Registered Nurses, Student Nurses, etc.)

Age Group: Adult (Appropriate for professional healthcare providers)

Population Details: Specifically designed for nurses, but adaptation for other healthcare providers (e.g., health educators, social workers, physicians) is recommended by the authors.

Test Methodology: Respondents use a 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree) to indicate their degree of agreement or disagreement with 45 statements. Completion time is approximately 20 minutes. Total scores range from 45 to 225, where higher scores reflect more tolerant and favorable attitudes toward HIV/AIDS and PLWHAs. Extensive reverse scoring is necessary across all five sub-domains before summation.

Keywords

Psychometrics, attitude measurement, nurse education, Standard Precautions, IV drug users, HIV stigma, scale development, professional ethics.

Authors

Author ORCID Identifier: Not provided in the source material.

Affiliation Email addresses: [email protected] (Deborah Bray Preston)

Correspondence Address: Deborah Bray Preston, Professor Emerita, The Pennsylvania State University, 3296 Shellers Bend, Unit 144, State College, PA 16801.

Permissions & Fee and Test Year

Test Year (Revision): 1997 (Revision of the 1995 NAAS).

Permissions and Fees: Information regarding current usage permissions and associated fees is not provided in the source material. Contact the corresponding author, Deborah Bray Preston, for permission to use the instrument.

Reference’s

• Preston, D. B., Young, E. W., Koch, P. B., & Forti, E. M. (1995). The Nurses’ Attitudes About AIDS Scale (NAAS): Development and psychometric analysis. AIDS Education and Prevention, 7, 443–454.

Items of the Nurses’ Attitudes About HIV/AIDS Scale—Version 2

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

The following are some statements regarding opinions about HIV/AIDS and PWAs. There may be no “right” or “wrong” response. Place the number from the scale that best represents your reaction in the space provided.

1. Strongly Agree 4 Disagree

2. Agree 5 Strongly Disagree

3. Neither Agree nor Disagree

Homosexuality:

1. Homosexual men should be given social equality. 1.              

2. Male homosexuality is obscene and vulgar. 2.              

3. The homosexual civil rights movement is positive for society. 3.              

4. The love between two males is the same as heterosexual love. 4.              

5. Homosexual men are a viable part of our society. 5.              

6. I would be comfortable knowing that my clergy was a homosexual man. 6.              

7. I feel disgusted when I consider the state of sinfulness of male homosexuality. 7.              

8. I feel comfortable when I think that male homosexuality is a natural human occurrence. 8.              

9. I feel confident that homosexual men are just as emotionally healthy as heterosexual men. 9.              

10. I would feel comfortable if I learned that my son’s teacher was a homosexual man. 10.              

11. Male homosexuality should be considered immoral. 11.              

12. I feel revolted when I think of two men engaged in private sexual behaviors with each other. 12.              

Women:

1. Women with HIV ought to have equal access to health care services. 1.              

2. I feel disgusted when I think of an HIV-infected woman. 2.              

3. A woman with HIV deserves what she gets. 3.              

4. I would feel comfortable giving nursing care to an HIV positive woman. 4.              

IV Drug Abusers:

1. The government should provide free syringes to IV drug abusers. 1.              

2. IV drug abusers are victims of society. 2.              

3. I feel disgusted when I consider the immorality of IV drug abuse. 3.              

4. IV drug abusers ought to be locked up. 4.              

5. People who contract HIV through IV drug abuse should not be entitled to free medical care. 5.              

6. People who shoot drugs cannot help themselves. 6.              

7. I feel upset around IV drug abusers. 7.              

8. IV drug abusers are mistreated in our society. 8.              

9. I would feel comfortable giving nursing care to an IV drug abuser. 9.              

Nursing Care Concerns:

1. I feel worried about the possibility of acquiring AIDS from patients. 1.              

2. I am bothered that I might not be able to prevent myself from contracting AIDS. 2.              

3. It is comforting to know that there isn’t much difference in caring for AIDS patients than caring for other

   terminally ill persons. 3.              

4. I have enough information to protect myself against AIDS in my workplace. 4.              

5. I worry about possible casual contact with a person with AIDS. 5.              

6. I am fearful of caring for persons with AIDS because there is no cure. 6.              

7. Nurses need to know the HIV antibody status of patients they are caring for. 7.              

8. I am not bothered about possibly caring for an infant who was born HIV positive. 8.              

Social/Professional Concerns:

1. Nurses who are HIV positive should be prevented from participating in direct patient care. 1.              

2. Persons with AIDS are not dangerous to other people with whom they come in casual contact. 2.              

3. I think the homosexual community has brought the problem of AIDS upon itself. 3.              

4. I feel angry about possibly caring for a person with AIDS who contracted the disease through high-risk

   sexual behaviors. 4.              

5. There is too much money spent on AIDS research. 5.              

6. Persons with AIDS should be quarantined. 6.              

7. Pregnant nurses should be excused from caring for persons with AIDS. 7.              

8. Civil rights laws should be enacted to protect people with AIDS from job and housing discrimination. 8.              

9. Activities that spread AIDS, such as some forms of sexual behaviors, should be outlawed. 9.              

10. It distresses me to think that so many nursing procedures have to be changed or modified as a result of AIDS. 10.              

11. Nurses should be allowed to refuse to care for a person with AIDS. 11.              

12. Public school officials should not be required to accept an AIDS child into classes. 12.