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Journal of HIV/AIDS Prevention in Children & Youth
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The International AIDS Questionnaire—English Version (IAQ-E)
Cindy Davis PhD , Melissa Sloan PhD , Samuel Macmaster PhD & Leslie Hughes PhD
a b c a c a b
University of Tennessee, Nashville, TN, USA Drew University, Madison, NJ, USA University of New South Wales, Sydney, Australia
Available online: 04 Oct 2008
To cite this article: Cindy Davis PhD, Melissa Sloan PhD, Samuel Macmaster PhD & Leslie Hughes PhD (2007): The International AIDS Questionnaire—English Version (IAQE), Journal of HIV/AIDS Prevention in Children & Youth, 7:2, 29-42 To link to this article: http://dx.doi.org/10.1300/J499v07n02_03
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Melissa Sloan. College of Social Work. prejudice. In order to address HIV infection among college students. is affiliated with University of New South Wales. Australia. TN. NJ. and misconceptions about HIV transmission. PhD. Leslie Hughes. a comprehensive measure is needed that can be used with samples from culturally diverse populations. PhD. Madison. In this study. All rights reserved. and Samuel MacMaster.Downloaded by [Cranfield University] at 03:46 24 April 2012 The International AIDS Questionnaire– English Version (IAQ-E): Assessing the Validity and Reliability Cindy Davis Melissa Sloan Samuel MacMaster Leslie Hughes ABSTRACT. doi:10. 7(2) 2006 Available online at http://jhap. Vol. Address correspondence to: Cindy Davis. PhD.1300/J499v07n02_03 29 . Journal of HIV/AIDS Prevention in Children & Youth. The International AIDS Questionnaire–Chinese Version (IAQ-C) was developed and validated by Davis.edu). personal risk. this paper assessed the reliability and validity of an HIV/AIDS questionnaire that measures fours dimensions of HIV/AIDS awareness–factual knowledge. Inc. Chan. Sydney. TN 37210 (E-mail: cdavis3@utk. PhD.haworthpress.com © 2006 by The Haworth Press. and Noel (1999) for use with Chinese populations. Therefore. are affiliated with University of Tennessee. the validity and reliability of the International AIDS Questionnaire–English Version (IQA-E) was assessed on a sample of English-speaking college students from the United States (N = 200) and Australia (N = 74). Nashville. University of Tennessee. Tang. Nashville. The Cindy Davis. 193E Polk Avenue. is affiliated with Drew University. PhD. and will enable cross-cultural research.
1998. Boykin. Research has shown that patterns of HIV infection differ both cross-culturally and by racial and ethnic groups within the United States (Goh. prevention. 2004). 2002... A 2-week test-retest reliability study on a sub-sample of 32 students revealed a Pearson product-moment correlation coefficient of 0. and 0. This instrument provides a valid and reliable comprehensive measure of HIV/AIDS for use with English-speaking samples. much of which occurs under the influence of drugs and alcohol (CDC..com> Website: <http://www.com> © 2006 by The Haworth Press. and young people between 15 and 24 years of age account for nearly half of all new HIV infections worldwide (UNAIDS. A recent study by Hightow et al. Inc. cultural stigma of homosexuality) (Leone et al. and knowledge about HIV/AIDS differs by geographical region (Grunseit et al. and worldwide (UNAIDS. the primary modes of HIV transmission differ across cultures (Yi. at least half of all HIV infections in the United States occur among individuals under the age of 25 (CDC. 1995. Incidents of risky sexual behaviors are prevalent among college students. All rights reserved. Lawrence et al. In addition.). Leone et al.. 2004). The total IAQ-E had a high internal consistency (Cronbach’s alpha = 0.] KEYWORDS.g.HaworthPress. Some racial and ethnic groups are particularly at risk. HIV. Although the incidence of HIV/AIDS has been declining..88).40 (facts). 2004. 1995). 0.1300/J499v07n02_03 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. The Cronbach’s alphas for the sub-scales were 0.66 (personal risk). rates of HIV infection among American young adults have not declined proportionately (CDC. 2004). Yi. (2005) in the Southeastern United States revealed that newly diagnosed HIV infection was found in 37 male college students and a sexual partner network investigation .001). 2004).30 HIV/AIDS PREVENTION IN CHILDREN & YOUTH Downloaded by [Cranfield University] at 03:46 24 April 2012 results of the CFA supported the four-factor model. 0. and the normative data show patterns similar to previous research. Therefore. doi:10. 2004). 2002.87 (myths).882 (p < 0. 1993. UNAIDS. College students are particularly vulnerable to HIV infection.81 (attitudes). questionnaire. Zambrana. 2004). 1998. St. & Lopez. E-mail address: <docdelivery@haworthpress. Cornelius. cross-cultural comparisons and assessment is necessary in order to implement effective prevention programs targeting this worldwide epidemic. measures Today. AIDS. as certain cultural beliefs may impede safe sex practices (e. 2004).
Prejudice. many college students are relatively unconcerned about HIV/ AIDS (Ajuluchukwu. however young heterosexuals are experiencing much higher rates of infection than ever before (CDC.” they underestimate their own risk of becoming infected with HIV. Leone et al. Taub. 2004). 2004). Historically. prevention of HIV among young people has focused on men who have sex with men (MSM). they often face strong levels of stigmatization. 31 linked 21 colleges.. Herek and Capitanio (1999) found that many people expressed fear about touching the clothing of a person living with AIDS or eating with sterilized utensils used by a person living with AIDS. Trezza. Negative attitudes towards those living with HIV/AIDS prevents healthy individuals from becoming fully aware of the modes of HIV transmission and by conceptualizing HIV to only exist among members of a population of “others. Leiker. & MacDonald et al. Research on college students has shown that homophobia is a significant factor in the stigmatization of individuals with HIV (Johnson & Baer. as a recent study of HIV positive African American male college students who have sex with men reported that 40 percent of the study’s respondents claim to also have sex with heterosexual female students (Leone et al. & Faulk. research of HIV/AIDS knowledge among college students has consistently shown Downloaded by [Cranfield University] at 03:46 24 April 2012 . Thus. 1999). In addition to the medical concerns of such students. Accordingly. it is essential for healthy college students not only to understand their risk and efficacy in safe sex practices that will protect them from HIV/AIDS. and Gast (1995) found that college students stigmatized homosexuals with HIV and injection drug users with HIV to a similar degree. In a national survey of attitudes towards individuals with AIDS.. They argue that such stigma and ignorance hinders HIV prevention efforts and impinges on the civil rights of persons living with HIV/AIDS. The HIV/AIDS epidemic among college students is problematic not only because students are increasingly placing themselves at risk. 1996. HIV/AIDS continues to be a significant issue on American college campuses (CDC. 2004. Despite such risky behaviors and alarming statistics. 2004). 2003).Davis et al. but also to be aware of their prejudices and misconceptions about persons living with HIV/ AIDS. Crumey. 61 students. and these attitudes were associated with misconceptions about persons living with AIDS and sexual prejudice. Similarly. Leone. 1994). whether stemming from homophobia or ignorance. 1990. and 8 partners or students. but also because the number of students living with HIV/AIDS (Gayle. hinders preventative efforts (Herek & Capitanio. Due to these risky sexual behaviors. 1999). prevention messages tailored only to MSM may not reflect the current state of sexual behaviors in this country.. Hightow.
1997. 1994). Participation was voluntary. Bruce & Walker. and misconceptions about HIV transmission. prejudice.32 HIV/AIDS PREVENTION IN CHILDREN & YOUTH that knowledge alone does not predict safe sex practices (CDC. & Ireland. Furthermore. and will enable cross-cultural research. and can be used with samples from culturally diverse populations. Gupta & Weiss.. 2004. 1993. Seven cases with incomplete data were excluded from analysis. the questionnaire asked for demographic information. 7 missing). While several studies have investigated HIV/AIDS knowledge (Lewis. 155 female) and 74 participants from Australia Downloaded by [Cranfield University] at 03:46 24 April 2012 . there has been little research using multidimensional measures of HIV/AIDS awareness (Paniagua et al. Therefore. a comprehensive measure is needed that not only assesses knowledge about HIV/ AIDS.. 2004. Opt & Loffredo. Malow. and students were provided with time during class to fill out the questionnaire. personal risk. and we have found no existing multidimensional HIV/AIDS questionnaires that enable cross-cultural comparisons in different languages. 2001). In addition to the IAQ-E. Odusanya & Alakija. METHOD Participants and Procedure The IAQ-E was distributed to several convenience samples of college students from three public universities in the southern region of the United States and from a large public university in Australia during social science classes. a comprehensive measure of HIV/AIDS awareness should also enable cross-cultural comparisons. The sample included 200 participants from the United States (45 male. In order to address HIV infection among college students. this paper assessed the reliability and validity of an HIV/AIDS questionnaire that measures fours dimensions of HIV/AIDS awareness–factual knowledge. the validity and reliability of the International AIDS Questionnaire–English Version (IQA-E) was assessed on a sample of English-Speaking college students from the United States and Australia. (1999) for use with Chinese populations. 2004). as the HIV/AIDS epidemic is a global concern. but also measures attitudes and prejudices against individuals with HIV/AIDS. or attitudes. Li et al. (Bruce & Reid. 2004). 221 females. The International AIDS Questionnaire–Chinese Version (IAQ-C) was developed and validated by Davis et al. knowledge of personal risk factors. 1998. A total of 281 English-speaking students completed the questionnaire (53 males. In this study.
Bruce & Walker. and then translated back into English by an independent bilingual researcher. Content validity was established by reviewing other self-constructed scales used to measure similar concepts. attitudes (Bruce & Reid. Dias. so that a low score on each item indicates greater awareness. Four of the statements were reverse coded.92 and CFI = 0. The . Odusanya & Alakija. 2001. 1999. The IAQ-C was then reviewed by two independent bilingual researchers for face validity. and attitudinal statements about persons infected with HIV/AIDS (5 items) (Davis et al. SD = 3. 1997. facts about HIV/AIDS (3 items). see Davis et al. Overall. The 274 cases with complete data were included in the analyses. & Ireland. Measures The IAQ was originally developed in English and translated into Chinese by a translator in Hong Kong. 67 female). 1997. (See Appendix 1) Each statement is rated on a Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). statements regarding personal HIV risk (3 items).. & Goncalves. and perceived risk (Barling & Moore. between 21 and 23 years of age (M = 22.. such as. Li et al. 2004). confirmatory factor analysis (CFA) was performed based on the covariance matrix presented in Table 1.95).90 (NFI = 0. HIV/ AIDS knowledge (Jakobsen & Jostein. Participants were. 11% as Australian. 23% as African American. 1990. the results of the CFA supported the model.) The IAQ-E consists of a series of 18 statements which were originally developed to assess four dimensions of HIV/AIDS awareness including myths about the transmission of HIV (7 items). on average. 2004. 1991).. 1998. measures of the overall portion of explained variance. Moore & Barling. 1999). Lewis. 33 Downloaded by [Cranfield University] at 03:46 24 April 2012 (7 male. and 15% as another racial/ethnic group.4. were above the recommended level of 0. RESULTS The IAQ-E was first reviewed by two independent AIDS researchers for face validity.4).Davis et al. In order to confirm the 18-item four-factor model found in the IAQ-C model on an English-speaking sample. The BentlerBonett Normed Fit Index (NFI) and the Bentler Comparative Fit Index (CFI). Malow. 2006). Matos. Fifty-one percent of the sample self-identified as white. (For further details on the original development and validation of this questionnaire.
19 0.33 0.30 0.71 0.01 0.30 0.16 0.21 0.Downloaded by [Cranfield University] at 03:46 24 April 2012 34 TABLE 1.49 0.29 0.36 0.54 0.12 0.15 0.39 0.13 0.37 0.47 0.12 0.56 1.24 0.05 0.30 0.34 0.08 0.04 0.15 0.64 1.37 0.57 0.91 1 2 3 AIDS1 0.37 AIDS6 0.38 0.36 0.16 0.20 AIDS18 0.36 0.21 0.12 0.39 0.49 0.74 0.16 0.45 0.15 0.11 .25 0.33 0.25 0.11 0.37 0.13 0.37 0.30 0.10 0.08 0. Covariance Matrix of IAQ-E (N = 274) 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 0.01 0.04 0.92 AIDS3 0.51 0.57 0.42 0.37 AIDS13 0.41 0.93 AIDS2 0.41 AIDS15 0.07 0.48 0.14 0.20 0.42 1.38 0.24 0.07 0.63 0.20 AIDS8 0.47 0.18 0.09 0.42 0.31 0.32 0.15 0.19 0.44 AIDS9 0.07 1.26 0.39 AIDS10 0.30 0.15 0.12 0.54 AIDS4 0.13 0.34 0.14 0.40 0.19 0.22 0.46 0.53 0.52 0.40 0.39 0.22 0.41 0.32 0.30 0.31 0.31 0.12 0.33 0.18 0.47 0.15 0.27 0.22 0.40 0.42 0.10 0.84 0.92 0.38 AIDS7 0.48 0.51 0.13 AIDS11 0.28 0.09 0.30 0.03 0.39 AIDS12 0.99 0.18 0.01 1.17 0.45 0.54 0.05 0.44 AIDS5 0.76 0.39 0.18 0.25 1.40 AIDS16 0.07 0.49 0.37 0.12 0.31 0.15 0.20 0.38 0.38 0.10 0.04 0.23 0.58 0.34 0.07 0.27 0.07 0.15 0.48 0.34 0.23 0.22 AIDS14 0.08 0.33 0.15 AIDS17 0.44 0.04 0.31 0.
94).70 0.75 0.65 0. Factor Parameter Estimates and Standard Errors for Confirmatory Factor Analysis of IAQ-E (N = 274) Item Factor 1: Transmission myths HIV can be spread through coughing and sneezing. a Items were reverse scored.60 0.04 0.07 0. HIV can be transmitted through the air.64 0. Factor 4: Facts Condoms will decrease the risk of HIV transmission.71 0. I would end my friendship if my friend had AIDS. which adjusts for model complexity.43 0. HIV can be contracted through toilet seats. Factor parameter estimates and standard errors for the four-factor model are presented in Table 2. I am willing to do volunteer work with AIDS patients.66 0. was also high (NNFI = 0.23 0. also indicated a good fit of the model (SRMR = 0. The Standardized Root Mean Squared Residual (SRMR).04 0. TABLE 2. Estimate SE 0.05 0. and homosexuals.05 0.74 0. 35 Downloaded by [Cranfield University] at 03:46 24 April 2012 Bentler-Bonett Non-Normed Fit Index (NNFI).04 0.73 0.06 0.07 0. AIDS only affects IV drug users.04 0. prostitutes.07 0.39 0. which provides a measure of the discrepancy between the observed and model-implied covariances. AIDS can be contracted through sharing cigarettes.05 0.08 .a Note: IAQ = International AIDS Questionnaire. HIV can be spread through swimming pools.05 0.Davis et al.67 0.08 0. Factor 3: Personal risk ________ are less susceptible of contracting AIDS than are Westerners.066). HIV/AIDS can be spread through hugging an infected person.64 0.05 0.a HIV is spread through infected sperm. a HIV can be transmitted from mother to baby. Mosquitoes can transmit HIV.a If a family member contracts HIV they should move out. People with HIV should stay home or in a hospital.69 0.75 0. Factor 2: Attitudes or prejudices People with HIV should be kept out of school.05 0. You can protect yourself against AIDS by being vaccinated for it.40 0.06 0.40 0.08 0.
898. The total IAQ-E had a high internal consistency (Cronbach’s alpha = 0. Table 4 presents the means and standard deviations for the total sample and separately by sex of respondent on the total IAQ-E and on the four sub-scales. p < 0.9).425** 1.1. Downloaded by [Cranfield University] at 03:46 24 April 2012 Total – 0.538** 0. however. (Note: A lower score indicates greater HIV/AIDS knowledge/awareness and less prejudice against individuals infected with HIV/AIDS. with the exception of the facts scale. SD = 2.764 through 0. attitudes/prejudices (M = 8. The facts sub-scale was moderately correlated with the total IAQ-E (r = 0. this sample had TABLE 3. Note.5. 0.231** 1.3. SD = 1. Mean Scores.9).72 (0.001).81 0.88).241** 1. the correlations between the facts sub-scale and the other sub-scales were relatively weak. **p 0.87 (myths).72 (0. although significant. A 2-week test-retest reliability study on a sub-sample of 32 students revealed a Pearson product-moment correlation coefficient of 0. SD = 3.0.77 (0.882 (p < 0. As shown.0). However.096) 0. Each of the sub-scales were significantly correlated with each other. Intercorrelations.064) 0.03) 0.40 (facts).3).823** 0.898** 0.66 – 1. personal risk (M = 5.17) 0. The relative mean scores indicated that this sample scored relatively equally on the total IAQ-E and on the three sub-scales.001).) The mean score for the total IAQ-E was 31.001). 0.12) 0.195* 1.425.66 (personal risk).72 (0. facts (M = 5.71 (0.619** 0. and Internal Consistency of the IAQ-E Total Scale and Scale Scores (N = 274) IAQ Total Transmission myths Attitudes/prejudices Personal risk Facts Relative mean score Cronbach’s alpha Note: *p 0.88 Myths Attitudes Personal Facts 0.87 0.01. each sub-scale.605** 0.36 HIV/AIDS PREVENTION IN CHILDREN & YOUTH Normative Data and Psychometric Properties The intercorrelations among the total IAQ-E scale and the four subscales and the Cronbach’s alphas for the full IAQ-E and each sub-scale are presented in Table 3. and 0.40 . was strongly correlated with the total IAQ-E scale (r = 0. The mean scores for the sub-scales were as follows: transmission myths (M = 12.001. The Cronbach’s alphas for the sub-scales were 0.764** 0.7).0 (SD = 10.81 (attitudes). p < 0. SD = 4.
1 5. In each case. males showed less HIV/AIDS knowledge and more prejudiced attitudes towards individuals infected with HIV/AIDS than females. Unfortunately.5 5. an epidemic in one geographical area inevitably creates a risk for other areas. a global phenomenon affecting people worldwide.8) (6. the problems associated with HIV are not restricted to the United States.7) (2. *t-test indicates significant difference between means for males and females at p 0.6 7.8) (2.9 5. However. beliefs of popular myths.0 8. Comprehensive assessments of attitudes and knowledge about HIV as well as stigmatizing attitudes are important to guide HIV prevention efforts (Parker & Aggleton.7 (SD) (12.2) (4.2) (1.9) (3.5) (3.1) (2.9) (4. there were significant differences between males and females in their mean scores on the total IAQ-E.5 5. multidimensional measure of HIV/AIDS knowledge and awareness for use with English-speaking college students that can be used for cross-cultural comparisons.3 31.2* 14. but rather. DISCUSSION In order to address HIV/AIDS awareness among young adults.7 11. This paper presents a valid. 2003). Given people’s mobility today.Davis et al. In the comparisons of scale means by sex. understanding of personal risk.9* 5. the least knowledge of HIV/AIDS facts. and on the transmission myths and attitudes/prejudices sub-scales. and prejudice against persons living with HIV/AIDS. it is necessary to assess factual knowledge.3) (1.2 Females (SD) (8. IAQ-E Normative Scores for Total Sample and Separately by Sex Total Sample Males n 200 200 200 200 200 Mean 36.7) (2.8) n 221 221 221 221 221 Downloaded by [Cranfield University] at 03:46 24 April 2012 Mean Total scale Factors Transmission myths Attitudes/ prejudices Personal risk Facts 12.3) n 74 74 74 74 74 Mean 29.0 5.1* 10.0) (4. 37 TABLE 4.9) Note: Cases with missing data on any relevant item were excluded from analysis.0 (SD) (10. very few HIV/AIDS measures allow for cross-cultural comparisons or include data outside one specific .001. particularly young people.
Jakobsen and Jostein. Malow. & Keller. scores on this scale may be more likely to be related to more standardized sex education than to other factors such as peer groups.e.. 2004).. facts) and how HIV is not transmitted (i. The separate dimensions of transmission myths and facts about HIV/AIDS are consistent with previous research on HIV/AIDS (Jakobsen & Jostein. Yi. transmission myths). 1995. 1998. Although the CFA supports the overall model.. Bruce & Reid. the instrument may be beneficial in studies investigating one of the fastest growing at-risk populations. 1998). (1997) conducted a study with adolescents and found two distinct factors associated with HIV knowledge: how HIV is transmitted (i. this is not an issue for our results as the IAQ and sub-scales are able differentiate our sample by sex as expected based on previous research (e. Dias.e.38 HIV/AIDS PREVENTION IN CHILDREN & YOUTH cultural group. Given that the instrument was evaluated on a cross-cultural population of college students. 2006. Jadack. and attitudinal statements about persons infected with HIV/AIDS (5 items). but they are not representative of all English-speaking or Western cultures. Although our sample is drawn from two continents and includes 23% African Americans and 15% who identified as some other minority racial/ethnic group. these results are significant. Odusanya & Alakija. & Goncalves. 1999). 2002). 2000. The results of the CFA for the IAQ-E support the four-factor model of the original IAQ-C (Davis et al. facts about HIV/AIDS (3 items). statements regarding personal HIV risk (3 items). For example. Matos. 1997. Capitanio. However. cultural factors. & Widaman. Li et al.. Despite these limitations. These two cultural areas vary greatly. 2004. Bruce & Walker. & Ireland. Lewis. the inclusion of the dimensions of personal risk and attitudes Downloaded by [Cranfield University] at 03:46 24 April 2012 . While three of the four sub-scales have acceptable alpha levels. the alpha on the Facts sub-scale is relatively lower. Hyde. Also.g. Herek. Although women were over represented in the sample. This international scale provides a unified instrument tapping four dimensions of HIV/AIDS awareness including myths about the transmission of HIV (7 items). and the normative data show patterns similar to previous research (Barling & Moore. 2001. London & Robles. as they provide evidence that the English version of the scale is both valid and reliable and consistent with the Chinese version.. it is limited to college students living in a single southern state in the United States and a single state in Australia. 1990. 1997. These sub-scales provide a multidimensional understanding of knowledge and attitudes associated with HIV/AIDS. this study is not without limitations. It could be inferred that the sub-scale questions measure factual knowledge about HIV/AIDS rather than assess an underlying concept. and stigma.
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6. Condoms will decrease the risk of HIV transmission. 2.42 HIV/AIDS PREVENTION IN CHILDREN & YOUTH APPENDIX 1. HIV can be spread through swimming pools. 17. 16. 18. HIV is spread through infected sperm. and homosexuals. People with HIV should be kept out of school. AIDS can be contracted through sharing cigarettes. prostitutes. HIV can be contracted through toilet seats. 16. HIV can be spread through coughing and sneezing. 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Disagree Don’t Know 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Agree 4 4 4 4 4 4 4 4 4 4 4 4 4 4 Strongly Agree 5 5 5 5 5 5 5 5 5 5 5 5 5 5 Downloaded by [Cranfield University] at 03:46 24 April 2012 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 *Items number reversed scored: 10. 11. AIDS only affects intravenous (IV) drug users. Personal Risk (Items 13-15). HIV can be transmitted through the air. I am willing to do volunteer work with AIDS patients. I would end my friendship if my friend had AIDS. 18 **FACTORS: Transmission Myths (Items 1-7). 8. If a family member contracts HIV he/she should move out. 17. 4. 9. Mosquitoes can transmit HIV. _______ are less susceptible of contracting AIDS than other ethnic groups. 14. 10. 3. . Attitudes: (Items 8-12). HIV/AIDS can be spread through hugging an infected person. 13. HIV can be transmitted from mother to baby. You can protect yourself against AIDS by being vaccinated for it. 12. 15. INTERNATIONAL AIDS QUESTIONNAIRE–ENGLISH VERSION (IAQ-E) Please circle the number that best represents your degree of agreement to each of the items below Strongly Disagree 1. 5. People with HIV should stay home or in a hospital. 7. Facts (Items 16-18).