STD Attitude Scale

Abstract

The STD Attitude Scale is a specialized psychometric instrument designed to measure young adults’ comprehensive attitude toward Sexually Transmitted Diseases (STDs). Developed by Yarber, Torabi, and Veenker, the scale is based on the premise that attitude is a multidimensional construct consisting of cognitive (belief), affective (feeling), and conative (intention to act) components. The final instrument comprises 27 items distributed equally across three subscales (9 items each). Utilizing a 5-point Likert-type format, the scale effectively discriminates between individuals holding attitudes that predispose them to high-risk STD behavior and those predisposed to low-risk behavior. Its development, which included rigorous item analysis and jury review across college and secondary student populations, established its utility for researchers and health educators in planning and evaluating STD prevention efforts.

Keywords

STD Attitude Scale, Attitude measurement, Sexual health, Health-risk behavior, Cognitive components, Affective components, Conative components, STD prevention, Adolescent psychology, High-risk behavior.

Authors

William L. Yarber, Mohammad R. Torabi, C. Harold Veenker.

Purpose

The primary purpose of the STD Attitude Scale is to quantify the psychological orientation of young adults concerning Sexually Transmitted Diseases (STDs). By measuring the three distinct components of attitude—belief, feeling, and intention to act—the scale provides a diagnostic tool for understanding the underlying psychological factors that influence individual health-risk behavior.

The scale serves as a critical resource for health educators and researchers. It allows for the objective assessment of current attitudes prior to intervention, facilitates the planning of targeted STD education programs, and enables the determination of specific attitudinal risk correlates within a population. Ultimately, the scale is designed to support efforts aimed at improving or maintaining attitudes conducive to preventive health behavior.

Construct

The STD Attitude Scale measures the psychological construct of attitude, conceptualized as multidimensional (Bagozzi, 1978; Ostrom, 1969). This approach maintains that an individual’s stance toward an object (STDs) is best understood by assessing three distinct components, reflected in the scale’s subscales:

• Belief Subscale (Cognitive): Measures an individual’s perceptions, knowledge, and concepts related to STDs (e.g., prevention methods, consequences).

• Feeling Subscale (Affective): Measures the emotional dimension, assessing expressions of liking or disliking, or comfort/discomfort, related to STDs or associated preventive behaviors.

• Intention to Act Subscale (Conative): Measures the stated likelihood or expression of what the individual intends to do in specific STD-related situations (e.g., seeking treatment, partner notification).

The 27 items were systematically developed based on a table of specifications covering three conceptual areas: the nature of STD, STD prevention, and STD treatment. This rigorous item generation process ensures that the scale captures the full complexity of attitudes relevant to health behavior.

Validity

The validation of the STD Attitude Scale focused on establishing both content and construct evidence.

Content and Face Validity: Strong evidence for content validity exists because the scale items were systematically derived from a table of specifications reflecting key behavioral aspects of STDs and aligning with the preventive health behavior emphasis of school STD curricula (Yarber, 1985). Furthermore, a panel of experts rigorously reviewed and judged the merit of each item, ensuring relevance and appropriateness for the target population.

Construct Validity: Evidence of construct validity was demonstrated through experimental results. When secondary school students exposed to a formal STD curriculum were compared to students receiving no instruction, the students receiving the curriculum showed a measurable, positive improvement in their scores from pretest to posttest (Yarber, 1988). This confirmed that the scale is sensitive to changes in the intended construct (attitude) resulting from targeted educational intervention, aligning with its theoretical purpose.

Reliability

The reliability of the STD Attitude Scale was assessed using both stability (test-retest) and internal consistency measures (Yarber, Torabi, & Veenker, 1988).

Test-Retest Reliability: Measured over a 5- to 7-day period, the stability coefficients were reported as:

• Total Scale: .71

• Belief Subscale: .50

• Feeling Subscale: .57

• Intention to Act Subscale: .63

Internal Consistency: Calculated using Cronbach’s alpha, the coherence of the items within the scale components was found to be:

• Total Scale: .73

• Belief Subscale: .53

• Feeling Subscale: .48

• Intention to Act Subscale: .71

The final 27 items were selected based on highly significant levels of internal consistency and strong discriminating power, ensuring that each item reliably contributes to the overall measurement of the relevant subscale and the total score.

Factor Analysis

The scale development was driven by the theoretical requirement to measure three distinct components of attitude (Cognitive, Affective, Conative). Although a traditional Factor Analysis is not explicitly detailed in the summary, the rigorous item selection process served to empirically validate this structure.

Initial item pools were subjected to statistical analysis based on criteria such as internal consistency and discrimination power across various student populations (college and secondary school). This led to the refinement of the scale from 45 items down to the final 27 items, maintaining a clear division of nine items for each of the three theoretically derived subscales. This process confirms that the final instrument adheres strongly to the hypothesized three-factor model of attitude toward STDs.

Instrument

Test Type: Psychological attitude scale (Summated Rating Scale)

Format: 5-point Likert-type format, ranging from Strongly Agree to Strongly Disagree.

Language Available: English (Original development language).

Population Group: Young adults and adolescents.

Age Group: Secondary school students and college students.

Population Details: Development involved initial administration to 457 college students, followed by 100 high school students, and a large-scale refinement study utilizing 2,980 secondary school students.

Test Methodology: Self-administered questionnaire. Completion time averages 15 minutes. Scoring involves differential weighting for positive and negative items. Higher total or subscale scores indicate an attitude predisposing the respondent toward high-risk STD behavior; lower scores indicate predisposition toward low-risk STD behavior.

Keywords

Psychometrics, Preventive health behavior, Health education, High-risk sexual behavior, Cognitive beliefs, Affective feelings, Behavioral intention, Scale development, Cronbach’s alpha, Test-retest reliability.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (William L. Yarber)

Correspondence Address: William L. Yarber, Department of Applied Health Science, Indiana University, HPER Building, Bloomington, IN 47405.

Permissions & Fee and Test Year

The scale was developed as part of a project supported by U.S. Public Health Service grant award #R30/CCR500638–01, and was also utilized to assess a Centers for Disease Control education program.

Test Year: The final scale development and validation were published in 1988 (Yarber, Torabi, & Veenker).

Permissions: Users seeking to administer the scale should contact the corresponding author, William L. Yarber, for current permissions and usage guidelines.

Reference’s

• Bagozzi, R. P. (1978). The construct validity of the affective, behavioral and cognitive components of attitude by using analysis of covariance of structure. Multivariate Behavior Research, 13, 9–31.

• Kothandapani, V. (1971). A psychological approach to the prediction of contraceptive behavior. Chapel Hill, NC: Carolina Population Center, University of North Carolina.

• Ostrom, T. M. (1969). The relationship between the affective, behavioral and cognitive components of attitude. Journal of Experimental Psychology, 5, 12–30.

• Torabi, M. R., & Veenker, C. H. (1986). An alcohol attitude scale for teen- agers. Journal of School Health, 56, 96–100.

• Yarber, W. L. (1985). STD: A guide for today’s young adults [student and instructor’s manual]. Waldorf, MD: American Alliance Publications.

• Yarber, W. L. (1988). Evaluation of the health behavior approach to school STD education. Journal of Sex Education and Therapy, 14, 33–38.

• Yarber, W. L., Torabi, M. R., & Veenker, C. H. (1988). Development of a three-component sexually transmitted diseases attitude scale. Journal of Sex Education and Therapy, 15, 36–49.

Items of the STD Attitude Scale

Directions: Please read each statement carefully. STD means sexually transmitted diseases, once called venereal diseases. Record your reaction by marking an “X” through the letter which best describes how much you agree or disagree with the idea.

Example: Doing things to prevent getting an STD is the job of each person.

1. How one uses his/her sexuality has nothing to do with STD.

2. It is easy to use the prevention methods that reduce one’s chances of getting an STD.

3. Responsible sex is one of the best ways of reducing the risk of STD.

4. Getting early medical care is the main key to preventing harmful effects of STD.

5. Choosing the right sex partner is important in reducing the risk of getting an STD.

6. A high rate of STD should be a concern for all people.

7. People with an STD have a duty to get their sex partners to medical care.

8. The best way to get a sex partner to STD treatment is to take him/her to the doctor with you.

9. Changing one’s sex habits is necessary once the presence of an STD is known.

10. I would dislike having to follow the medical steps for treating an STD.

11. If I were sexually active, I would feel uneasy doing things before and after sex to prevent getting an STD.

12. If I were sexually active, it would be insulting if a sex partner suggested we use a condom to avoid STD.

13. I dislike talking about STD with my peers.

14. I would be uncertain about going to the doctor unless I was sure I really had an STD.

15. I would feel that I should take my sex partner with me to a clinic if I thought I had an STD.

16. It would be embarrassing to discuss STD with one’s partner if one were sexually active.

17. If I were to have sex, the chance of getting an STD makes me uneasy about having sex with more than one person.

18. I like the idea of sexual abstinence (not having sex) as the best way of avoiding STD.

19. If I had an STD, I would cooperate with public health persons to find the sources of STD.

20. If I had an STD, I would avoid exposing others while I was being treated.

21. I would have regular STD checkups if I were having sex with more than one person.

22. I intend to look for STD signs before deciding to have sex with anyone.

23. I will limit my sex activity to just one partner because of the chances I might get an STD.

24. I will avoid sex contact anytime I think there is even a slight chance of getting an STD.

25. The chance of getting an STD would not stop me from having sex.

26. If I had a chance, I would support community efforts toward controlling STD.

27. I would be willing to work with others to make people aware of STD problems in my town.