Using the PRECEDE Model to Determine Junior High School Students' Knowledge, Attitudes, and Beliefs about AIDS
Alteneder, Ruth R., Price, James H., Telljohann, Susan K., Didion, Judy, Locher, Ann, Journal of School Health
Adolescents face a high risk for HIV infection given their sexual behavior, variety of sexual activities in which they engage (intercourse, anal sex, and oral sex), their lack of contraceptive protection, and their drug use behavior. (1,2) They also face increased risk because of their impulsiveness, desire for immediate gratification, and their tendency to perceive themselves as invincible. Because of the long incubation period for development of AIDS (8-12 years), and because better than one in five AIDS cases are diagnosed between ages 20-29, at least one-fifth of AIDS cases probably develop during adolescence. (3)
The earliest study of adolescents' AIDS knowledge was conducted in 1983. (4) A multitude of surveys since then have found significant deficiencies in adolescents' AIDS-related knowledge and beliefs. (5-10) Some studies (11,12) that focused specifically on AIDS knowledge and beliefs of minority adolescents indicated further education about AIDS prevention is necessary to help maximize adolescents' understanding of AIDS.
While several studies have assessed adolescents' knowledge and beliefs of AIDS, fewer studies have assessed the effects of AIDS education programs in schools. Only eight studies that evaluated the effectiveness of AIDS education programs in secondary schools were identified (Table 1). These eight studies all contained evaluation instrument deficiencies. Five did not identify reliability assessments for their instruments, six did not report validity assessments, and none used instruments based on a theoretical behavioral model. (13-20) The evaluation instrument deficiencies bring into question the effectiveness of secondary school AIDS education programs.
Table 1 Effects of School-Based AIDS Education Programs Length Study(Date) N Grade Level Intervention Miller & Downer 114 11th 50 Min. (1988) Johnson et al 1,294 12th 2 x 45 Min. (1988) DiClemente et al 230 Middle school 3 Class Periods (1989) 136 High school 3 Class Periods Brown et al 174 7th 2 x 45 Min. (1989) 139 10th 2 x 45 Min. Huszti et al 284 10th 45 Min. (1989) Ruder et al 358 10th, 11th, 12th 75 Min. (1990) 504 7th 75 Min. Farley et al 186 12th 2 x 45 Min. (1991) Brown et al 1,260 Junior high 4.7 Hours (1991) 1,118 High school 4.7 Hours Study(Date) Outcomes * Miller & Downer 13% increase in knowledge; 19% increase in tolerant (1988) attitudes Johnson et al 9% increase in knowledge (1988) DiClemente et al 14% increase in knowledge (1989) 16% increase in knowledge Brown et al 11% increase in knowledge; 7% increase in tolerant (1989) attitudes; 10% decrease in attitudes toward high-risk behavior; 20% increase in coping with AIDS; 6% increase in knowledge; 10% increase in tolerant attitudes, 20% increase in coping with a friend with AIDS Huszti et al 12%-15% increase in knowledge; 12%-20% increase in (1989) positive attitudes toward patients with AIDS; 2%-15% increase in positive attitudes toward practicing preventive behaviors Ruder et al 6% increase in knowledge (1990) 21% increase in knowledge Farley et al 21% increase in knowledge (16% increase in control (1991) group knowledge) Brown et al 13% increase in knowledge (1991) 8% increase in tolerance toward people with AIDS No change in intention to avoid AIDS-related risk Behaviors ** * Where outcomes are given as a range of scores, this is because results reported were by subgroups of respondents. ** Time span from pretest to posttest was only three weeks.
If the results from these eight studies can be accepted, and the outlier scores are ignored, then one-five-hour AIDS education program may produce a 9% to 20% increase in knowledge about AIDS and a similar gain (8% to 20%) in more tolerant attitudes toward people with AIDS. None of the eight studies measured actual behavior change, but three assessed intentions to avoid AIDS-related risk behavior.
One review of health education literature and AIDS risks claimed that the health belief model, the theory of reasoned action, and the PRECEDE model all make important contributions to explaining the effectiveness of HIV/AIDS education. (21) Yet, no research articles that specifically used the PRECEDE model to assess the effects of a one-hour AIDS education program for junior high school students could be located. Thus, this study developed a valid and reliable instrument based on the PRECEDE model to assess the effects of a one-hour AIDS education program for junior high students. (22) Predisposing, reinforcing, and enabling factors were examined according to grade and gender of the students since these two variables are related to the incidence of HIV risk behavior. (23)
An open-ended, 35-item questionnaire was designed to elicit salient beliefs of adolescents about HIV and AIDS. This method, originated from the model of reasoned action, determined those beliefs most important to the respondents. (24) Questions were designed to elicit responses for major components of the PRECEDE model. Prior to administration, six junior high students reviewed the instrument questions to determine if language might be a problem. None were found. Specific examples of questions to obtain salient beliefs of students based on the PRECEDE model were:
What do you think about people who have AIDS? (Predisposing Factor-Attitudes)
What kind of people get AIDS? (Predisposing Factor-Beliefs)
Where can you get condoms? (Enabling Factor)…
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Publication information: Article title: Using the PRECEDE Model to Determine Junior High School Students' Knowledge, Attitudes, and Beliefs about AIDS. Contributors: Alteneder, Ruth R. - Author, Price, James H. - Author, Telljohann, Susan K. - Author, Didion, Judy - Author, Locher, Ann - Author. Journal title: Journal of School Health. Volume: 62. Issue: 10 Publication date: December 1992. Page number: 464+. © 1999 American School Health Association. COPYRIGHT 1992 Gale Group.
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