PsychologicalReports, 1990, 67, 491-497. @ Psychological Reports 1990
ATTITUDES O F NURSING STUDENTS TOWARD PATIENTS WITH AIDS ' MICHAEL YOUNG
MELINDA M. HENDERSON
Health Science Program, Uniuersiiy of Arkansas
University of Arkansas
DAVID MARX
University of Nebraska, Lincoln Summary.-Nursing students ( N = 124) voluntarily completed a questionnaire designed to measure attitudes towards patients with AIDS. The questionnaire included one of two vignettes, a prejudicial evaluation scale, and the Index of Homophobia. Results indicate that nursing students expressed a significantly more negative attimde toward the homosexual patient with AIDS. Homophobia accounted for a substantial amount of variation in the difference in expressed attitude between heterosexual and homosexual AIDS patients. The researchers recommend that nursing students and other prospective health care workers be provided educational programs dealing with AIDS which include study of homophobia and homosexuality.
With the increasing numbers of patients with Acquired Immune Deficiency Syndrome (AIDS), it is important that nursing schools be aware of the attitudes of graduating nurses who w d be responsible for the care of these persons. Recent estimates indicate that 1.0 million people are infected with HIV in the United States (Center for Disease Control, 1989). Reductions in high-risk sexual practices and leveling HIV seropositivity prevalence among male homosexuals have been reported by several investigators (Becker & Joseph, 1988; Martin, Garcia, & Beatrice, 1989; Siegel, Bauman, Christ, & Krown, 1988). As noted by Kelly and St. Lawrence (1990), however, gay men, along with intravenous drug users and sexual partners of drug users, remain "the groups at most imminent risk . . ." on the AIDS epidemic. Many of the AIDS victims will return to their homes in urban and rural areas to die, which places the burden of caring for the AIDS victim on hospitals that presently do not care for this type of patient (Carroll, 1987). According to Arrindell, Ross, Bndges, Van Houst, Hofman, and Sanderman (1989) no other medical event in history has produced such public and personal fear. AIDS patients have been stigmatized by both the general public and health care workers (Kelly & St. Lawrence, 1988). In fact, Wiley, Heath, and Ackhn (1988) found that more than half of the nursing students in their survey felt that health care workers should be allowed to refuse to treat patients who had tested positive for the human immunodeficiency virus 'Address correspondence to M. Young, Ph.D., Health Science Program, University of Arkansas, Fayetteville, AR 72701.
492
M. YOUNG,ETAL.
(HIV). Negative attitudes among health care workers toward AIDS patients may reflect a fear of contracting the HIV virus from the patient. There is a risk of virus transmission from an inadvertent needle stick. There is also a risk of acquiring AIDS through skin contact with grossly contaminated materials. However, risk to health care workers may be essentially eliminated by scrupulous attention to infection control and needle stick recommendations (Decker & Schaffner, 1986). Negative attitudes concerning AIDS also reflects a prejudice toward its victims. Since nearly three-fourths of AIDS patients are homosexual or bisexual males, negative attitudes may also be a reflection of homophobia (i.e., fear or other negative attitudes, based upon sexual orientation). Dupras, Levy, Samson, and Tessier (1989) found that among a random sample of French Canadians, negative attitudes toward AIDS patients were better predicted by homophobia than by other measures. Poirier (1988) also indicated that for many people AIDS-prevention is linked to the elimination of homosexuality. Homophobia-related AIDS fear may also be in part a f~inction of religious and political conservatism (Bouten, Gallaher, Garhnghouse, Rosenstein, & Young, 1989). The stigmatizing of AIDS patients may be related to fear of the disease, to discomfort or prejudice given the homosexual preference of many of its victims, or to a combination of these factors (Kelly, St. Lawrence, Smith, Hood, & Cook, 1987). Whatever the causes, these need to be identified and remedies developed to improve the perception of AIDS patients among the general public and the quality of nursing care AIDS patients might receive. Previous studies by Kelly and coworkers (Kelly, et al., 1987) have investigated attitudes of different health care workers towards patients with AIDS. In Kelly, et al.'s studies subjects read one of four patient vignettes which were identical in content except the patient was identified as having either AIDS or leukemia and as either homosexual or heterosexual. Subjects then completed survey instruments designed to assess attitudes toward the patient portrayed in the narrative they had received. Comparisons were then made in attitudes expressed toward the different types of patients. This means that the attitudes of subjects in Group 1 toward the homosexual AIDS patient were compared with the attitudes of subjects in Group 2 toward the heterosexual AIDS patient, etc. This is a problem in that the researchers assume that the subjects in different groups have the same attitude toward any given patient. The design of the present study was improved by rotating the vignettes subjects actually read, but asking all subjects to respond to both heterosexual and homosexual situations. The purpose of this study was to identify factors influencing nursing students' attitudes toward patients with AIDS. Of special interest was the relationship of homophobia to expressed attitude.
RNS' ATTITUDES ABOUT AIDS
493
METHOD Subject1 Subjects were 124 nursing students from two different associate degree nursing programs in northern Arkansas. In a classroom setting, students voluntarily completed a questionnaire designed to measure attitudes toward patients with AIDS. All approached students elected to participate. The questionnaire study included one of two vignettes, a prejudicial evaluation scale, and Hudson and Ricketts' (1980) Index of Homophobia. Vignettes.-Each vignette was approximately 200 words long, describing "Dave" as a hard working, young college graduate and the Director of SCAN. The vignettes were identical except in Vignette 1 Dave was described as an homosexual with AIDS and in Vignette 2 Dave was described as an heterosexual who had contracted AIDS from a blood transfusion. Prejudicial evaluation scale. -This is a seven-item scale modeled after Kelly, et al.'s (1987) work, designed to measure attitudes toward the AIDS patient. Subjects indicated their agreement with each statement from "strongly agree" (1) to "strongly disagree" (5). Items were, "Dave": is responsible for his illness, deserves what happened, deserves a lot of pain and suffering, is dangerous to others including family, hospital personnel and other patients, deserves to die, should be quarantined, and deserves to lose his job. Possible scores ranged from a low of 7 (negative attitude) to a high of 35 (positive attitude). is a 25-item scale (Hudson & Index of Homophobia (IOH).-This Ricketts, 1980) with a score range from O to 100. Persons who have very little dread of being in close quarters with homosexuals tend to obtain very low scores. Persons who have considerable dread or discomfort tend to obtain higher scores. Some of the scale items represent positive statements about homosexual people and their social interactions while others are negative statements. Examples of scale items include: "If a member of my sex made an advance toward me, I would feel angry." Response format for the Index is a five-point Likert scale for each of the individual items. The Index is scored by totalling the point value for the 25 items and subtracting 25. Hudson and Ricketts classified respondents in four categories-high grade homophobic 76-100, low homophobic 51-75, low nonhomophobic 26-50, and high nonhomophobic 0-25. Hudson and Ricketts reported an internal consistency reliability of .90. Procedure Questionnaires were distributed to subjects in a regular classroom. Subjects randomly received a questionnaire which included Vignette 1 or 2. Subjects receiving Vignette 1 read it, completed the prejudicial evaluation scale and then completed the scale a second time as they would have done
494
M.
YOUNG.ET AL.
had the patient been heterosexual. Subjects receiving Vignette 2 read it, completed the prejudicial evaluation scale, and then completed the scale a second time as they would have done had the patient been homosexual. All subjects also completed the Index of Homophobia. For analysis, a l l scores for attitudes toward the homosexual patient were grouped together, and all scores £or attitudes toward the heterosexual patient were grouped together regardless of the vignette which the subject read. Data were analyzed using paired t tests, analysis of covariance, and multiple regression.
RESULTS Ninety percent of the students in this sample (n = 111) were women and 10% (n = 13) were men. Sixty-two percent ( n = 80) were currently married, and 38% ((n = 48) were single. The majority reported some religious background-29% Baptist and 52% some other denomination-while 19% indicated that they had no religious affiliation. TABLE I
MEAN SCORESAND STANDARD DEVIATIONS FORA
~
AIDS PATIENTS AND HOMOPHOBIA
Variables
n
Attitudes Toward Homosexual Patient
M
SD
E TOWARD S
Attitudes Toward Heterosexual Patient
M
Homophobia Scale M SD
SD
Semester in School First Second Third Fourth Age Group, yr. 18-24 25-29
30-39 40-49 50-59
Sex Men Women Marital Status Married Not Married Religion Baptist Other None
Table 1 results show the mean attitude toward homosexual and heterosexual patients with AIDS and the mean homophobia scores for respondents,
RNS' ATTITUDES ABOUT AIDS
495
organized by semester in school, age group, sex, marital status, and religion. The mean scores on the homophobia scale show that the students' scores reflect low-grade homophobia in all categories. TABLE 2 COMPARISON OF ATITIWES TOWARD HOMOSEXUAL AND HETEROSEXUAL PATIENTS WITH AIDS (N = 124) Attitude Toward:
M
SD
t*
P
Heterosexual Patients
30.03 25.41 4.74
3.86 5.75 .38
12.66
< ,0001
Homosexual Patients
Difference *t test for paired
data.
Table 2 data indicate a significant difference between the attitude students expressed toward the homosexual patient and the attitude expressed toward the heterosexual patient. As might be expected, the students expressed more negative attitudes toward the homosexual patient. When homophobia, marital status, and GPA were all used to adjust treatment differences (homosexual versus heterosexual patients), these treatments were still marginally significant ( p = .07) as shown in the analysis of covariance. TABLE 3 SUMMARY OF ANALYSIS OF COVARIANCE Source*
Treatment Homophobia Marital Status
GPA Homophobia x Treatment Error
*All factors except
df 1 1 1 1 1 242
SS 61.61 970.25 141.52 55.20 348.97 4.592.26
F
P
3.25 51.13 7.46 2.91 18.39
.073 ,001 ,007 .089 ,001
treatment were covariance.
In Table 4 stepwise multiple regression was used to identify factors which explained the variation in the difference in attitude between homosexual and heterosexual patients. Age, sex, marital status, semester in school, and religion were included as predictor variables. Homophobia accounted for a substantial amount of the variation (22%) in the difference between the expressed attitude toward the heterosexual and homosexual patient with AIDS ( F =37.37, p = .001), i.e., the dependent variable was attitude difference; values were created by subtracting scores for attitude toward homosexual patients from scores for attitude toward heterosexual patients.
M. YOUNG, ETAL. TABLE 4 SUMMARY OF STEPWISE ML~TIPLE REGRESSION EXPLAIN~NG DIFFERENCE IN ATTITUDESTOWARD PATIENTS WITHAIDS Variable Entered Removed Homophobia GPA Sex Sex
R2
df
F
P
59.06 32.54 22.11 32.54
.0001 ,0001 .0001 .0001
(Regression Error) 0.326 0.350 0.356 0.350
11122 21121 31120 21121
The purpose of the study was to identify factors influencing the attitudes of nursing students towards patients with AIDS. Results indicate that ( I ) students expressed significantly more negative attitudes toward the homosexual patient with AIDS than to the heterosexual patient with AIDS and (2) homophobia accounted for a significant amount f; the difference in artitude. These results imply that the negative attitude toward the homosexual AIDS patients is more than simply a fear of the disease but it may in fact be related to discomfort in dealing with homosexuality. Prejudice against and stigmatization of AIDS patients and homosexuals among the general public are important social issues. Such prejudice within the nursing community, however, carries strong implications for quality of patient care. The research that has been conducted with other health care workers (Kelly, et al., 1987) suggests that greater attention should be given to addressing these biases as part of the professional preparation program and/or inservice program (Flaskreud, 1987). Those who develop educational programs for health care workers may wish to consider incorporating comprehensive AIDS education as part of professional training. Bouten, et al. (1989) found among college students that men who knew the most about AIDS were the least fearful and least homophobic. N o such relationship was found for women. Bouten's results suggest that information about AIDS may not be enough. AIDS education could and probably should include study in the areas of homophobia and homosexuality. Young (1988) has provided some insight into how she addresses these topics. Regardless of the format and approach, however, a goal of such educati;n mighi be to help students recognize the worth of all individuals, regardless of sexual orientation. Finally, researchers should examine (1) the effects of attitudes of health-care workers towards AIDS patients on the quality of care patients receive and (2) the effects of educational programs in changing attitudes of health-care workers toward patients with AIDS. - -
RNS' ATTITUDES ABOUT AIDS REFERENCES &DELL, W. A,, ROSS, M. W., BRIDGES,K. R., VAN HOUST, W., HOFMAN,A., & SANDVAN, R. (1989) Fear of AIDS: are there replicable invariant questionnaire dimenslons. Advanced Behavioral Research and Therapy, l l , 69-115. BECKER,M. H., &JOSEPH,J. G. (1988) AIDS and behavioral change to reduce risk: a review. American Journal of Public Health, 78, 394-410. BOUTEN,R. A,, GALLAHER,P. E., GARUNGHOUSE, T. L., ROSENSTEIN, L. D., & YOUNG,R. K. (1989) Demographic variables associated with fear of AIDS and homophobia. Journal of Applied Social Psychology, 19, 885-901. CARROLL,S. M. (1987) Impact of AIDS on hospitals: a challenge for the nurse manager. Nursing Management, 18(9), 82-84. CENTERFOR DISEASECONTROL.(1989) AIDS and human immunodeficiency virus infection in the United States. Morbidity and Mortality Weekly Report, 38, 31. DECKER,D. D., & SCHAFFNER, W. (1986) Risk of AIDS to health care workers. Journal of the American Medical Association, 256, 3264-3265. DUPRAS,A,, LEVY,J., SAMSON,J., & TESSIER,D. (1989) Homophobia and attitudes about AIDS. Psychological Reports, 64, 236-238. FLASKREUD, J. H . (1987) Psychosocial aspects of AIDS. Journal of Psychosocial Nursing, 25(12), 9-16. HUDSON,W., & RICKETTS, W. A. (1980) A strategy for the measurement of homophobia. Journal of Homoseuuality, 5, 357-372. KELLY,J. A,, & ST. LAWRENCE, J. S. (1988) AIDS prevention and treatment: psychology's role in the health crisis. Clinical Psychology Review, 8, 255-284. KELLY, J. A,, & ST. LAWRENCE, J. S. (1990) Risk behavior change m gay men. American Journal of Public Health, 80, 351. KELLY,J. A,, ST. LAWRENCE, J. S., SMITH,S., HOOD,H. V., & COOK,D. J. (1986) Stigmatization of AIDS patients by physicians. American Journal of Public Health, 77, 789-791. KELLY,J. A,, ST. LAWRENCE, J. S., S m , S., HOOD,H. V., & COOK,D. J. (1987) Medical students' attitudes towards AIDS and homosexual patients. Journal of Medical Education, 62, 549-556. MARTIN,J. L., GARCIA,M. A,, & BEATRICE,S. T. (1989) Sexual behavior chan es and HIV antibody in a cohort of New York gay men. American Journal o/ ~ u f l i cHealth, 79, 501-503. POUUER,R. (1988) AIDS and traditions of homophobia. Social Research, 55, 461-475. SIEGEL,K., BAUMAN, L. J., CHRIST, G . H., & KROWN,S. (1988) Patterns of change in sexual behavior among gay men in New York City. Archives of Sexual Behavior, 17, 481-497. WUEY, K., HEATH, L., & ACKLIN,M. (1988) Care of patients: students attitudes. Nursing Outlook, 36, 244-245. YOUNG,E. (1988) Nurses' attitudes toward homosexuality: analysis of change in AIDS workshops. Journal of Continuing Education in Nursing, 19(January/February), 9-12.
Accepted August 20, 1990
ATTITUDES O F NURSING STUDENTS TOWARD PATIENTS WITH AIDS ' MICHAEL YOUNG
MELINDA M. HENDERSON
Health Science Program, Uniuersiiy of Arkansas
University of Arkansas
DAVID MARX
University of Nebraska, Lincoln Summary.-Nursing students ( N = 124) voluntarily completed a questionnaire designed to measure attitudes towards patients with AIDS. The questionnaire included one of two vignettes, a prejudicial evaluation scale, and the Index of Homophobia. Results indicate that nursing students expressed a significantly more negative attimde toward the homosexual patient with AIDS. Homophobia accounted for a substantial amount of variation in the difference in expressed attitude between heterosexual and homosexual AIDS patients. The researchers recommend that nursing students and other prospective health care workers be provided educational programs dealing with AIDS which include study of homophobia and homosexuality.
With the increasing numbers of patients with Acquired Immune Deficiency Syndrome (AIDS), it is important that nursing schools be aware of the attitudes of graduating nurses who w d be responsible for the care of these persons. Recent estimates indicate that 1.0 million people are infected with HIV in the United States (Center for Disease Control, 1989). Reductions in high-risk sexual practices and leveling HIV seropositivity prevalence among male homosexuals have been reported by several investigators (Becker & Joseph, 1988; Martin, Garcia, & Beatrice, 1989; Siegel, Bauman, Christ, & Krown, 1988). As noted by Kelly and St. Lawrence (1990), however, gay men, along with intravenous drug users and sexual partners of drug users, remain "the groups at most imminent risk . . ." on the AIDS epidemic. Many of the AIDS victims will return to their homes in urban and rural areas to die, which places the burden of caring for the AIDS victim on hospitals that presently do not care for this type of patient (Carroll, 1987). According to Arrindell, Ross, Bndges, Van Houst, Hofman, and Sanderman (1989) no other medical event in history has produced such public and personal fear. AIDS patients have been stigmatized by both the general public and health care workers (Kelly & St. Lawrence, 1988). In fact, Wiley, Heath, and Ackhn (1988) found that more than half of the nursing students in their survey felt that health care workers should be allowed to refuse to treat patients who had tested positive for the human immunodeficiency virus 'Address correspondence to M. Young, Ph.D., Health Science Program, University of Arkansas, Fayetteville, AR 72701.
492
M. YOUNG,ETAL.
(HIV). Negative attitudes among health care workers toward AIDS patients may reflect a fear of contracting the HIV virus from the patient. There is a risk of virus transmission from an inadvertent needle stick. There is also a risk of acquiring AIDS through skin contact with grossly contaminated materials. However, risk to health care workers may be essentially eliminated by scrupulous attention to infection control and needle stick recommendations (Decker & Schaffner, 1986). Negative attitudes concerning AIDS also reflects a prejudice toward its victims. Since nearly three-fourths of AIDS patients are homosexual or bisexual males, negative attitudes may also be a reflection of homophobia (i.e., fear or other negative attitudes, based upon sexual orientation). Dupras, Levy, Samson, and Tessier (1989) found that among a random sample of French Canadians, negative attitudes toward AIDS patients were better predicted by homophobia than by other measures. Poirier (1988) also indicated that for many people AIDS-prevention is linked to the elimination of homosexuality. Homophobia-related AIDS fear may also be in part a f~inction of religious and political conservatism (Bouten, Gallaher, Garhnghouse, Rosenstein, & Young, 1989). The stigmatizing of AIDS patients may be related to fear of the disease, to discomfort or prejudice given the homosexual preference of many of its victims, or to a combination of these factors (Kelly, St. Lawrence, Smith, Hood, & Cook, 1987). Whatever the causes, these need to be identified and remedies developed to improve the perception of AIDS patients among the general public and the quality of nursing care AIDS patients might receive. Previous studies by Kelly and coworkers (Kelly, et al., 1987) have investigated attitudes of different health care workers towards patients with AIDS. In Kelly, et al.'s studies subjects read one of four patient vignettes which were identical in content except the patient was identified as having either AIDS or leukemia and as either homosexual or heterosexual. Subjects then completed survey instruments designed to assess attitudes toward the patient portrayed in the narrative they had received. Comparisons were then made in attitudes expressed toward the different types of patients. This means that the attitudes of subjects in Group 1 toward the homosexual AIDS patient were compared with the attitudes of subjects in Group 2 toward the heterosexual AIDS patient, etc. This is a problem in that the researchers assume that the subjects in different groups have the same attitude toward any given patient. The design of the present study was improved by rotating the vignettes subjects actually read, but asking all subjects to respond to both heterosexual and homosexual situations. The purpose of this study was to identify factors influencing nursing students' attitudes toward patients with AIDS. Of special interest was the relationship of homophobia to expressed attitude.
RNS' ATTITUDES ABOUT AIDS
493
METHOD Subject1 Subjects were 124 nursing students from two different associate degree nursing programs in northern Arkansas. In a classroom setting, students voluntarily completed a questionnaire designed to measure attitudes toward patients with AIDS. All approached students elected to participate. The questionnaire study included one of two vignettes, a prejudicial evaluation scale, and Hudson and Ricketts' (1980) Index of Homophobia. Vignettes.-Each vignette was approximately 200 words long, describing "Dave" as a hard working, young college graduate and the Director of SCAN. The vignettes were identical except in Vignette 1 Dave was described as an homosexual with AIDS and in Vignette 2 Dave was described as an heterosexual who had contracted AIDS from a blood transfusion. Prejudicial evaluation scale. -This is a seven-item scale modeled after Kelly, et al.'s (1987) work, designed to measure attitudes toward the AIDS patient. Subjects indicated their agreement with each statement from "strongly agree" (1) to "strongly disagree" (5). Items were, "Dave": is responsible for his illness, deserves what happened, deserves a lot of pain and suffering, is dangerous to others including family, hospital personnel and other patients, deserves to die, should be quarantined, and deserves to lose his job. Possible scores ranged from a low of 7 (negative attitude) to a high of 35 (positive attitude). is a 25-item scale (Hudson & Index of Homophobia (IOH).-This Ricketts, 1980) with a score range from O to 100. Persons who have very little dread of being in close quarters with homosexuals tend to obtain very low scores. Persons who have considerable dread or discomfort tend to obtain higher scores. Some of the scale items represent positive statements about homosexual people and their social interactions while others are negative statements. Examples of scale items include: "If a member of my sex made an advance toward me, I would feel angry." Response format for the Index is a five-point Likert scale for each of the individual items. The Index is scored by totalling the point value for the 25 items and subtracting 25. Hudson and Ricketts classified respondents in four categories-high grade homophobic 76-100, low homophobic 51-75, low nonhomophobic 26-50, and high nonhomophobic 0-25. Hudson and Ricketts reported an internal consistency reliability of .90. Procedure Questionnaires were distributed to subjects in a regular classroom. Subjects randomly received a questionnaire which included Vignette 1 or 2. Subjects receiving Vignette 1 read it, completed the prejudicial evaluation scale and then completed the scale a second time as they would have done
494
M.
YOUNG.ET AL.
had the patient been heterosexual. Subjects receiving Vignette 2 read it, completed the prejudicial evaluation scale, and then completed the scale a second time as they would have done had the patient been homosexual. All subjects also completed the Index of Homophobia. For analysis, a l l scores for attitudes toward the homosexual patient were grouped together, and all scores £or attitudes toward the heterosexual patient were grouped together regardless of the vignette which the subject read. Data were analyzed using paired t tests, analysis of covariance, and multiple regression.
RESULTS Ninety percent of the students in this sample (n = 111) were women and 10% (n = 13) were men. Sixty-two percent ( n = 80) were currently married, and 38% ((n = 48) were single. The majority reported some religious background-29% Baptist and 52% some other denomination-while 19% indicated that they had no religious affiliation. TABLE I
MEAN SCORESAND STANDARD DEVIATIONS FORA
~
AIDS PATIENTS AND HOMOPHOBIA
Variables
n
Attitudes Toward Homosexual Patient
M
SD
E TOWARD S
Attitudes Toward Heterosexual Patient
M
Homophobia Scale M SD
SD
Semester in School First Second Third Fourth Age Group, yr. 18-24 25-29
30-39 40-49 50-59
Sex Men Women Marital Status Married Not Married Religion Baptist Other None
Table 1 results show the mean attitude toward homosexual and heterosexual patients with AIDS and the mean homophobia scores for respondents,
RNS' ATTITUDES ABOUT AIDS
495
organized by semester in school, age group, sex, marital status, and religion. The mean scores on the homophobia scale show that the students' scores reflect low-grade homophobia in all categories. TABLE 2 COMPARISON OF ATITIWES TOWARD HOMOSEXUAL AND HETEROSEXUAL PATIENTS WITH AIDS (N = 124) Attitude Toward:
M
SD
t*
P
Heterosexual Patients
30.03 25.41 4.74
3.86 5.75 .38
12.66
< ,0001
Homosexual Patients
Difference *t test for paired
data.
Table 2 data indicate a significant difference between the attitude students expressed toward the homosexual patient and the attitude expressed toward the heterosexual patient. As might be expected, the students expressed more negative attitudes toward the homosexual patient. When homophobia, marital status, and GPA were all used to adjust treatment differences (homosexual versus heterosexual patients), these treatments were still marginally significant ( p = .07) as shown in the analysis of covariance. TABLE 3 SUMMARY OF ANALYSIS OF COVARIANCE Source*
Treatment Homophobia Marital Status
GPA Homophobia x Treatment Error
*All factors except
df 1 1 1 1 1 242
SS 61.61 970.25 141.52 55.20 348.97 4.592.26
F
P
3.25 51.13 7.46 2.91 18.39
.073 ,001 ,007 .089 ,001
treatment were covariance.
In Table 4 stepwise multiple regression was used to identify factors which explained the variation in the difference in attitude between homosexual and heterosexual patients. Age, sex, marital status, semester in school, and religion were included as predictor variables. Homophobia accounted for a substantial amount of the variation (22%) in the difference between the expressed attitude toward the heterosexual and homosexual patient with AIDS ( F =37.37, p = .001), i.e., the dependent variable was attitude difference; values were created by subtracting scores for attitude toward homosexual patients from scores for attitude toward heterosexual patients.
M. YOUNG, ETAL. TABLE 4 SUMMARY OF STEPWISE ML~TIPLE REGRESSION EXPLAIN~NG DIFFERENCE IN ATTITUDESTOWARD PATIENTS WITHAIDS Variable Entered Removed Homophobia GPA Sex Sex
R2
df
F
P
59.06 32.54 22.11 32.54
.0001 ,0001 .0001 .0001
(Regression Error) 0.326 0.350 0.356 0.350
11122 21121 31120 21121
The purpose of the study was to identify factors influencing the attitudes of nursing students towards patients with AIDS. Results indicate that ( I ) students expressed significantly more negative attitudes toward the homosexual patient with AIDS than to the heterosexual patient with AIDS and (2) homophobia accounted for a significant amount f; the difference in artitude. These results imply that the negative attitude toward the homosexual AIDS patients is more than simply a fear of the disease but it may in fact be related to discomfort in dealing with homosexuality. Prejudice against and stigmatization of AIDS patients and homosexuals among the general public are important social issues. Such prejudice within the nursing community, however, carries strong implications for quality of patient care. The research that has been conducted with other health care workers (Kelly, et al., 1987) suggests that greater attention should be given to addressing these biases as part of the professional preparation program and/or inservice program (Flaskreud, 1987). Those who develop educational programs for health care workers may wish to consider incorporating comprehensive AIDS education as part of professional training. Bouten, et al. (1989) found among college students that men who knew the most about AIDS were the least fearful and least homophobic. N o such relationship was found for women. Bouten's results suggest that information about AIDS may not be enough. AIDS education could and probably should include study in the areas of homophobia and homosexuality. Young (1988) has provided some insight into how she addresses these topics. Regardless of the format and approach, however, a goal of such educati;n mighi be to help students recognize the worth of all individuals, regardless of sexual orientation. Finally, researchers should examine (1) the effects of attitudes of health-care workers towards AIDS patients on the quality of care patients receive and (2) the effects of educational programs in changing attitudes of health-care workers toward patients with AIDS. - -
RNS' ATTITUDES ABOUT AIDS REFERENCES &DELL, W. A,, ROSS, M. W., BRIDGES,K. R., VAN HOUST, W., HOFMAN,A., & SANDVAN, R. (1989) Fear of AIDS: are there replicable invariant questionnaire dimenslons. Advanced Behavioral Research and Therapy, l l , 69-115. BECKER,M. H., &JOSEPH,J. G. (1988) AIDS and behavioral change to reduce risk: a review. American Journal of Public Health, 78, 394-410. BOUTEN,R. A,, GALLAHER,P. E., GARUNGHOUSE, T. L., ROSENSTEIN, L. D., & YOUNG,R. K. (1989) Demographic variables associated with fear of AIDS and homophobia. Journal of Applied Social Psychology, 19, 885-901. CARROLL,S. M. (1987) Impact of AIDS on hospitals: a challenge for the nurse manager. Nursing Management, 18(9), 82-84. CENTERFOR DISEASECONTROL.(1989) AIDS and human immunodeficiency virus infection in the United States. Morbidity and Mortality Weekly Report, 38, 31. DECKER,D. D., & SCHAFFNER, W. (1986) Risk of AIDS to health care workers. Journal of the American Medical Association, 256, 3264-3265. DUPRAS,A,, LEVY,J., SAMSON,J., & TESSIER,D. (1989) Homophobia and attitudes about AIDS. Psychological Reports, 64, 236-238. FLASKREUD, J. H . (1987) Psychosocial aspects of AIDS. Journal of Psychosocial Nursing, 25(12), 9-16. HUDSON,W., & RICKETTS, W. A. (1980) A strategy for the measurement of homophobia. Journal of Homoseuuality, 5, 357-372. KELLY,J. A,, & ST. LAWRENCE, J. S. (1988) AIDS prevention and treatment: psychology's role in the health crisis. Clinical Psychology Review, 8, 255-284. KELLY, J. A,, & ST. LAWRENCE, J. S. (1990) Risk behavior change m gay men. American Journal of Public Health, 80, 351. KELLY,J. A,, ST. LAWRENCE, J. S., SMITH,S., HOOD,H. V., & COOK,D. J. (1986) Stigmatization of AIDS patients by physicians. American Journal of Public Health, 77, 789-791. KELLY,J. A,, ST. LAWRENCE, J. S., S m , S., HOOD,H. V., & COOK,D. J. (1987) Medical students' attitudes towards AIDS and homosexual patients. Journal of Medical Education, 62, 549-556. MARTIN,J. L., GARCIA,M. A,, & BEATRICE,S. T. (1989) Sexual behavior chan es and HIV antibody in a cohort of New York gay men. American Journal o/ ~ u f l i cHealth, 79, 501-503. POUUER,R. (1988) AIDS and traditions of homophobia. Social Research, 55, 461-475. SIEGEL,K., BAUMAN, L. J., CHRIST, G . H., & KROWN,S. (1988) Patterns of change in sexual behavior among gay men in New York City. Archives of Sexual Behavior, 17, 481-497. WUEY, K., HEATH, L., & ACKLIN,M. (1988) Care of patients: students attitudes. Nursing Outlook, 36, 244-245. YOUNG,E. (1988) Nurses' attitudes toward homosexuality: analysis of change in AIDS workshops. Journal of Continuing Education in Nursing, 19(January/February), 9-12.
Accepted August 20, 1990
