This article was downloaded by: [University of Auckland Library] On: 08 October 2014, At: 14:37 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
The effect of a national campaign on attitudes toward AIDS a
b
c
b
M. W. Ross , K. Rigby , B. R. S. Rosser , P. Anagnostou & M. Brown
b
a
National Centre in HIV Social Research, Department of Community Medicine , University of New South Wales , Sydney, Australia b
School of Social Studies , South Australian Institute of Technology , Adelaide, Australia c
Program in Human Sexuality, University of Minnesota , Minneapolis, Minnesota, USA Published online: 25 Sep 2007.
To cite this article: M. W. Ross , K. Rigby , B. R. S. Rosser , P. Anagnostou & M. Brown (1990) The effect of a national campaign on attitudes toward AIDS, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 2:4, 339-346, DOI: 10.1080/09540129008257749 To link to this article: http://dx.doi.org/10.1080/09540129008257749
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 2, NO.4, 1990
339
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
The effect of a national campaign on attitudes toward AIDS M. W. ROSS', K. RIG BY^, B. R. S. ROSSER3, P. ANAGNOSTOU~ 81 M. BROWN^ National Centre in HIV Social Research, Department of Community Medicine, University of New South Wales, Sydney, Australia, School of Social Studies, South Australian Institute of Technology, Adelaide, Australia & Program in Human Sexuality, University of Minnesota, Minneapolis, Minnesota, USA
Abstract Following a national campargn in Australia which had shown no change in level of knowledge about AIDS (using random samples of the population over 16years, before and 5
months afer the campaign), we assessed the change of attitudes towards, and belie4 about AIDS in the same samples. Results indicated that there were changes in beliefs about how much is known about the transmission of HIV, and that people were less concerned about casual transmission. Those respondents reportedly influenced most by the campaign were those with greater fear of diseases and death. We conclude that media campaigns may have a significant efect on am'tudes and beliefs toward AIDS even where there is no effect on level of knowledge, and that the affirudinal changes which may be promoted by such campaigns should also be considered as objectives in campaign design.
Introduction The relationship between knowledge and attitudes in health education is an important one if public education campaigns are to be targeted to provide the maximum effect. One theoretical approach has emphasized the importance of beliefs and attitudes as a determinant of knowledge and behaviour change. Bloom, Krathwohl & Masia (1964), in their taxonomy of educational objectives, note that attitudinal change may precede cognitive change, since willingness to receive information, attention to information, valuing that information, and organization of values may need to occur before there is a set to retain and recall information. On the other hand, knowledge may also alter attitudes. The relationship between attitudes and knowledge of AIDS has seldom been examined in an applied social setting. Ross & Rosser (1989), in a review of the literature, concluded that knowledge about AIDS is generally unrelated to behaviour change without the modification of attitudes and beliefs. They suggest that the first stage of reducing risky behaviours for HIV infection involves provision of information, but that a critical second
Address for correspondence: Dr M. Ross, National Centre in HIV Social Research, 345 Crown Street, Surry
Hills NSW 7.010, Australia
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
340 W.ROSS E T A . stage may involve alteration of attitudes and beliefs. A third stage may include the provision of skills to alter risk where risky behaviours occur in an interpersonal context. Given the potential importance of attitudinal change, we attempted to investigate attitudinal change in a random sample over 11 months, with a major national AIDS (Acquired Immune Deficiency Syndrome) awareness and prevention campaign intervening. The campaign was launched in April 1987 across Australia with a TV commercial featuring the so-called ‘Grim Reaper’ which received considerable public exposure over the next 2 weeks. The feature showed a series of death-like figures (‘Grim Reapers’ with skeletal faces, each carrying scythes) wreaking destruction at bowling alleys with bowls aimed with deadly intent at the ‘pins’ in the form of men, women and children unable to avoid the relentless onslaught. The Austrahan campaign was distinctive in that there was particularly heavy emphasis upon the use of shock tactics to arouse public interest and to shake people out of a supposed state of apathy about AIDS. The campaign drew upon the Morin model (Puckett & Bye, 1987) in formulating a plan for changing behaviour in relation to AIDS. A major tenet of that model is that there must be a belief that AIDS is a personal threat if change was to occur. It was decided that the Australian campaign should begin with a strong message giving an emotional shock to the general community in order to raise awareness and public concern. The message was to be that all members of the community were at risk of AIDS through sexual and drug using behaviours, not only homosexual males. Having created a demand for knowledge about AIDS, the plan was to provide factual information through a wide range of alternative sources. Factual information, using the ‘Grim Reaper’ visuals, and posters and print media advertisements, followed the T V campaign for several months. The rationale underlying the ‘Grim Reaper’ commercial and the subsequent campaign was a simple one: the more fearful the individual, the more likely he or she will be to escape the perceived threat by adopting health-protective behaviours. It has, however, been suggested that the relationship between fear and consequent health-related behaviours may not be straightforward. Whilst at low levels of fear or concern a person may not be motivated to take appropriate actions, when the level of fear is too intense, individuals may in fact behave irrationally or counterproductively. Highly fearful individuals may refuse to expose themselves to additional health information (Levanthal & Watts, 1966) and despair of being able to take effective action (Levanthal & Clearly, 1980). More recently, Sherr (1990) has reported on the UK campaign on AIDS, which used targeted fear messages, and found that fear messages sigmlicantly increased anxiety in low risk individuals and had no impact on those at high risk. Whether the level of fear induced by the ‘Grim Reaper’ would induce appropriate cognitive, attitudinal or behavioural changes was unclear. Sherr noted that willingness to change sexual behaviour did not change, nor did drug-using behaviour in those at high risk, in the UK campaign. In a previous study (Kgby, et al., 1989), we looked at the effect of the ‘Grim Reaper’ campaign on knowledge of AIDS, and found that between baseline and follow-up, there were no significant differences between the two cross-sectional random samples taken before and after the campaign. At an attitudinal level, it was seen as important to determine the long term effects of the campaign, especially in view of the claim (Taylor, 1986) that feararousing messages may produce changes that often do not persist over time. The present study focused primarily upon changes in the Australian community with respect to attitudes toward AIDS in the period between October, 1986 and September, 1987, that is from a time 6 months preceding the campaign until 5 months afterwards. Whilst changes in this period would to some extent have been influenced by other events, for instance, by the growing incidence of the disease itself and its treatment by the media, the
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
EFFECT OF NATIONAL CAMPAIGN ON AIDS Al7TUDE.S
341
‘Grim Reaper’ campaign has been widely regarded as the only significant campaign during this period. Our interest was in whether attitudinal changes had occurred. Baseline data were available from an Australia-wide survey by Ross et ul. (1988) on community knowledge and concern about AIDS carried out in October 1986. A major strength of the study by Ross et d. lay in their use of a carefully developed instrument for testing attitudes toward AIDS in the Australian community. Results from the administration of this test to over 300 South Australians as part of a national study provided a baseline against which subsequent changes could be assessed. We hypothesized that (1) there would be significant changes in attitudes and beliefs about AIDS (particularly those relating to beliefs about contagion, about how much was known about AIDS, and fear of homosexual people) between baseline and follow-up, and (2) that those individuals who reported that the ‘Grim Reaper’ campaign had a personal impact on them would also have significantly different attitudes compared with those who reported no personal impact. Method
The study employed a double cross-section design, with two randomly selected samples of individuals aged 16 years and over residing in the state of South Australia. It was not possible to utilize a longitudinal design since respondents in the initial study had been guaranteed anonymity and there were no identifying details on the protocols which would have enabled re-interview even if it was considered ethically appropriate. The study was approved by the appropriate institutional ethics committee. The interview schedule used in the second part of the study was identical to that employed by Ross et ul. (1988) in the baseline data collection. It included 12 questions on attitudes and beliefs relating to AIDS and related matters. These questions were the highest loading items in the study by Ross (1988) which looked at dimensionality of attitudes toward AIDS in the general community. All items were scored on a five point Likert scale, ranging from ‘strongly agree’ (1) to ‘strongly disagree’ ( 5 ) . These questions are given in Table 1, and covered the domains of beliefs about contagion, homonegative attitudes, belief in the seriousness of AIDS, how much is known about it, and fear of disease of death. These domains of attitudes about AIDS were derived from the study by Ross (1988) on the dimensions of attitudes and beliefs about AIDS. As in the previous study respondents were asked: “How concerned are you about AIDS as a social issue in Australia?” and “How concerned are you about AIDS personally?”. In each case responses were obtained along a 7point rating scale, ranging from ‘not at all’ (1) to ‘extremely concerned’ (7). Following the attitude and knowledge items, and to assess reactions to the ‘Grim Reaper’, respondents were asked first: “DO you recall some months ago an advertisement on television about the Grim Reaper?”. For those who answered ‘yes’, further questions asked (1) whether the respondent thought it was a good way of campaigning against AIDS and (2) whether he or she was influenced by it. Demographic information obtained from the sample included age, sex, marital status and occupation. The follow-up s w e y was conducted by door-knock in Adelaide, South Australia by Social Work students from a major tertiary institution who were trained in the appropriate methodology. The sampling procedure and interviewing technique replacted that given in Ross et al. (1988), which details the methodology for the baseline study of 315 persons. In total 525 respondents over the age of 16 years were interviewed at their homes during September, 1987 for the follow-up study. Not every respondent answered all of the questions, resulting in some minor variations in the numbers available for some’ of the analyses.
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
342 W.ROSS E T A . The demographc composition of the later sample proved to be, in almost all respects, s d a r to that obtained by Ross ef al. (1988) 11 months previously. No significant differences were found using chi square analyses with respect to sex composition or occupational status, employing the Daniel (1983) classification of occupations in Australia. However, the age distributions for the two samples differed: using 12 age categories ( 5 year intervals), x2 = 50.42, d.f. = 11,ptO.001. The follow-up sample had a significantly greater proportion of younger people, their median age being 32 years compared with 36 years in the earlier sample. Subsequent comparisons between the baseline sample and the follow-up sample were made using two age groups identical to those in the first sample (respondents under 38 years, and 38 years and over) to control for this. Data analysis was by analysis of variance, with the time of survey (baseline or followup) and sex as factors, and with age as a covariate which was assessed and corrected for before main effects were calculated. Pearson correlation coefficients were calculated between the 12 attitude items and occupational status for men and women separately, and pointbiserial correlation coefficients between the same items and relationship status (attached or unattached). The results of the correlations between the 12 attitude items and relationship status revealed only one sipficant correlation (-0.22 with item a), and the correlation of the same 12 items with occupational status for males and females separately revealed only two significant correlations for women (0.20 and -0.25 with items 3 and 11 respectively) and one for men (0.23 with item 11). As a result of these few and low correlations, relationship status and occupational status were not included as factors in the analyses of variance, particularly as there was a high proportion of missing data for occupation (where responents were unemployed, retired, students, or involved in home duties). To assess the direction of the effects of age, pearson correlation coefficients were computed for all 12 attitudinal items, as were t-tests between those who indicated that been influenced by the ‘Grim Reaper’ (n= 167) and those who had not (n=326). Alpha level was set at 5% for all analyses.
Results Results are presented in Tables 1 and 2. For four of the 12 items there were significant changes over time (Table 1). These four items related to people with HIV infection being able to mix with other people (change toward agreement), to concern about how little is known about AIDS (change toward disagreement), to belief that little is known about how AIDS spreads (change toward disagreement), and to the belief that minority groups should try to fit into society (change toward disagreement). There were sex differences on nine of the 12 items, with females having consistently more liberal attitudes toward AIDS and related areas than males. In addition, females appeared to be more concerned about how little was known about AIDS and about the extent of the AIDS epidemic. There were only two signhcant Time by Sex interactions: in the item “There is little known about how AIDS spreads”, females changed towards disagreement significantly more than males. In the item, “AIDS is one of the worst epidemics to hit the world this century”, males moved to disagree significantly more than females. The correlational analyses of age with the 12 items revealed that older people were significantly more likely to believe that people with AIDS should not mix socially, that AIDS is very contagious, that homosexuahty is abnormal, that sex should be limited to marriage, that homosexuals are different to heterosexuals in more ways than sexual practices, that the idea of dying is not frightening, that minority groups should try to fit into society, that there
EFFECT OF NATIONAL CAMPAIGN ON AIDS AlTITUDES
343
Table 1. Means for dijkrmces in Crainrdcs between baseline andfollow-up with age as a cooanair Means
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
Male
Time
F values Time x Sex Sex
Age
Item*
Pre
Post
Female Pre Post
I am scared of incurable diseases Homosexuality is abnormal People with the AIDS virus should be allowed to mix with other people People with AIDS should have our pity, not our blame The fact that so little is known about AIDS concerns me Sex should be limited to m i a g e Homosexuals are different to heterosexuals in more ways than just sexual practices The idea of dying frightens me There’s n o h g very contagious about AIDS Minority groups should uy to fit into our society There is little known about how AIDS spreads AIDS is one of the worst epidemics to hit the world this century
2.29
2.30
2.21
2.12
0.21
2.47
0.28
0.01
1.96
2.33
2.44
2.70
3.32
21.8ZC
0.01
65.6ZC
2.91
2.56
2.63
2.35
4.11a
6.85b
0.11
37.76c
2.51
2.28
2.11
2.19
0.34
6.16a
3.33
0.06
1.72
2.06
1.66
1.80
7.4ab
6.1@
1.78
1.68
3.17
3.58
2.80
3.26
2.12
11.53c
0.18
157.72c
2.36
2.48
2.66
2.82
0.06
12.84c
0.11
34.63c
3.15
3.13
3.14
2.87
0.10
2.74
1.53
27.52=
3.89
4.00
4.09
4.19
0.42
4.89a
0.00
5.34a
2.06
2.53
2.28
2.75
17.19c
6.26a
0.01
33.4s
3.10
3.43
2.68
3.46
22.29c
2.05
5.1Ea
22.7F
1.72
2.21
1.77
1.79
3.01
8.23b
6.73b
18.54c
~~
1=Strongly agree; 5 =Strongly disagree a pt 0 . 0 5 p t O . 0 1 p tO.OO 1 Males answering question: pre-campaign 137-138; post campaign 231-233; Females answering question: pre-campaign 164-1 70; post campaign 283
is little known about how AIDS spreads, and that AIDS is one of the worst epidemics h s century. Perceived impact of the ‘Grim Reaper’ was significantly associated with a number of the attitudinal and belief items. These are illustrated in Table 2. Some 93.5% of respondents (n=521) recalled having seen the ‘Grim Reaper’ television commercial 5 months previously. A total of 63.7% of the 493 respondents who made a judgement on the matter thought it was a good way of campaigning against AIDS; 13.4% were unsure; and 22.9% thought it was not. The proportion indicating that they had personally been influenced by the ‘Grim Reaper’ was 33.9%. Finally, the percentage indicating both that not only was it a good way of campaigning against AIDS,but also that they, personally, had been influenced was 28.0%.
344 W.ROSSETAL.
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
Table 2. Mean ( 2SO) LX#mences on artitudinal ium bemeen those influenced and those nor influenced iy Campaign
Itemb
Influenced
Not influenced
I am scared of incurable diseases Homoxxuahty IS abnormal People with the AIDS virus should be allowed to ~II with other people People with AIDS should have our pity, not OUI blame The fact that so httle is known about AIDS concerns me Sex should be hmited to mamage Homosexuals are &fferent to heterosexuals m more ways than just sexual practlces The idea of dying frightens me There’s nothmg very contagious about AIDS Mmonty groups should try to fit into our society There is httle known about how AIDS spreads AIDS is one of the worst epidemcs to hit the world tlus century
1.96%1.19
2.32 2 1.26b
2.65 2 1.50 2.41 z 1.30
2.58 2 1.43 2.39 % 1.27
2.102 1.12
2.292 1.10
1.70 2 0.96
2.01 % 1.07c
3.56 % 1.50
3.41 f 1.54
2.71 -t 1.30
2.67 k 1.27
2.72 z 1.47
3.12-t 1.39b
4.232 1.17
4.09 % 1.22
2.60 2 1.26
2.69 f 1.31
3.28 -t 1.41
3 . 5 5 ~1.33ba
1 . 7 2 1.12 ~
2.09 f 1 .23c
1 =Strongly agree; 5 =Strongly disagree a pt0.05 bp
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
The effect of a national campaign on attitudes toward AIDS a
b
c
b
M. W. Ross , K. Rigby , B. R. S. Rosser , P. Anagnostou & M. Brown
b
a
National Centre in HIV Social Research, Department of Community Medicine , University of New South Wales , Sydney, Australia b
School of Social Studies , South Australian Institute of Technology , Adelaide, Australia c
Program in Human Sexuality, University of Minnesota , Minneapolis, Minnesota, USA Published online: 25 Sep 2007.
To cite this article: M. W. Ross , K. Rigby , B. R. S. Rosser , P. Anagnostou & M. Brown (1990) The effect of a national campaign on attitudes toward AIDS, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 2:4, 339-346, DOI: 10.1080/09540129008257749 To link to this article: http://dx.doi.org/10.1080/09540129008257749
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 2, NO.4, 1990
339
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
The effect of a national campaign on attitudes toward AIDS M. W. ROSS', K. RIG BY^, B. R. S. ROSSER3, P. ANAGNOSTOU~ 81 M. BROWN^ National Centre in HIV Social Research, Department of Community Medicine, University of New South Wales, Sydney, Australia, School of Social Studies, South Australian Institute of Technology, Adelaide, Australia & Program in Human Sexuality, University of Minnesota, Minneapolis, Minnesota, USA
Abstract Following a national campargn in Australia which had shown no change in level of knowledge about AIDS (using random samples of the population over 16years, before and 5
months afer the campaign), we assessed the change of attitudes towards, and belie4 about AIDS in the same samples. Results indicated that there were changes in beliefs about how much is known about the transmission of HIV, and that people were less concerned about casual transmission. Those respondents reportedly influenced most by the campaign were those with greater fear of diseases and death. We conclude that media campaigns may have a significant efect on am'tudes and beliefs toward AIDS even where there is no effect on level of knowledge, and that the affirudinal changes which may be promoted by such campaigns should also be considered as objectives in campaign design.
Introduction The relationship between knowledge and attitudes in health education is an important one if public education campaigns are to be targeted to provide the maximum effect. One theoretical approach has emphasized the importance of beliefs and attitudes as a determinant of knowledge and behaviour change. Bloom, Krathwohl & Masia (1964), in their taxonomy of educational objectives, note that attitudinal change may precede cognitive change, since willingness to receive information, attention to information, valuing that information, and organization of values may need to occur before there is a set to retain and recall information. On the other hand, knowledge may also alter attitudes. The relationship between attitudes and knowledge of AIDS has seldom been examined in an applied social setting. Ross & Rosser (1989), in a review of the literature, concluded that knowledge about AIDS is generally unrelated to behaviour change without the modification of attitudes and beliefs. They suggest that the first stage of reducing risky behaviours for HIV infection involves provision of information, but that a critical second
Address for correspondence: Dr M. Ross, National Centre in HIV Social Research, 345 Crown Street, Surry
Hills NSW 7.010, Australia
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
340 W.ROSS E T A . stage may involve alteration of attitudes and beliefs. A third stage may include the provision of skills to alter risk where risky behaviours occur in an interpersonal context. Given the potential importance of attitudinal change, we attempted to investigate attitudinal change in a random sample over 11 months, with a major national AIDS (Acquired Immune Deficiency Syndrome) awareness and prevention campaign intervening. The campaign was launched in April 1987 across Australia with a TV commercial featuring the so-called ‘Grim Reaper’ which received considerable public exposure over the next 2 weeks. The feature showed a series of death-like figures (‘Grim Reapers’ with skeletal faces, each carrying scythes) wreaking destruction at bowling alleys with bowls aimed with deadly intent at the ‘pins’ in the form of men, women and children unable to avoid the relentless onslaught. The Austrahan campaign was distinctive in that there was particularly heavy emphasis upon the use of shock tactics to arouse public interest and to shake people out of a supposed state of apathy about AIDS. The campaign drew upon the Morin model (Puckett & Bye, 1987) in formulating a plan for changing behaviour in relation to AIDS. A major tenet of that model is that there must be a belief that AIDS is a personal threat if change was to occur. It was decided that the Australian campaign should begin with a strong message giving an emotional shock to the general community in order to raise awareness and public concern. The message was to be that all members of the community were at risk of AIDS through sexual and drug using behaviours, not only homosexual males. Having created a demand for knowledge about AIDS, the plan was to provide factual information through a wide range of alternative sources. Factual information, using the ‘Grim Reaper’ visuals, and posters and print media advertisements, followed the T V campaign for several months. The rationale underlying the ‘Grim Reaper’ commercial and the subsequent campaign was a simple one: the more fearful the individual, the more likely he or she will be to escape the perceived threat by adopting health-protective behaviours. It has, however, been suggested that the relationship between fear and consequent health-related behaviours may not be straightforward. Whilst at low levels of fear or concern a person may not be motivated to take appropriate actions, when the level of fear is too intense, individuals may in fact behave irrationally or counterproductively. Highly fearful individuals may refuse to expose themselves to additional health information (Levanthal & Watts, 1966) and despair of being able to take effective action (Levanthal & Clearly, 1980). More recently, Sherr (1990) has reported on the UK campaign on AIDS, which used targeted fear messages, and found that fear messages sigmlicantly increased anxiety in low risk individuals and had no impact on those at high risk. Whether the level of fear induced by the ‘Grim Reaper’ would induce appropriate cognitive, attitudinal or behavioural changes was unclear. Sherr noted that willingness to change sexual behaviour did not change, nor did drug-using behaviour in those at high risk, in the UK campaign. In a previous study (Kgby, et al., 1989), we looked at the effect of the ‘Grim Reaper’ campaign on knowledge of AIDS, and found that between baseline and follow-up, there were no significant differences between the two cross-sectional random samples taken before and after the campaign. At an attitudinal level, it was seen as important to determine the long term effects of the campaign, especially in view of the claim (Taylor, 1986) that feararousing messages may produce changes that often do not persist over time. The present study focused primarily upon changes in the Australian community with respect to attitudes toward AIDS in the period between October, 1986 and September, 1987, that is from a time 6 months preceding the campaign until 5 months afterwards. Whilst changes in this period would to some extent have been influenced by other events, for instance, by the growing incidence of the disease itself and its treatment by the media, the
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
EFFECT OF NATIONAL CAMPAIGN ON AIDS Al7TUDE.S
341
‘Grim Reaper’ campaign has been widely regarded as the only significant campaign during this period. Our interest was in whether attitudinal changes had occurred. Baseline data were available from an Australia-wide survey by Ross et ul. (1988) on community knowledge and concern about AIDS carried out in October 1986. A major strength of the study by Ross et d. lay in their use of a carefully developed instrument for testing attitudes toward AIDS in the Australian community. Results from the administration of this test to over 300 South Australians as part of a national study provided a baseline against which subsequent changes could be assessed. We hypothesized that (1) there would be significant changes in attitudes and beliefs about AIDS (particularly those relating to beliefs about contagion, about how much was known about AIDS, and fear of homosexual people) between baseline and follow-up, and (2) that those individuals who reported that the ‘Grim Reaper’ campaign had a personal impact on them would also have significantly different attitudes compared with those who reported no personal impact. Method
The study employed a double cross-section design, with two randomly selected samples of individuals aged 16 years and over residing in the state of South Australia. It was not possible to utilize a longitudinal design since respondents in the initial study had been guaranteed anonymity and there were no identifying details on the protocols which would have enabled re-interview even if it was considered ethically appropriate. The study was approved by the appropriate institutional ethics committee. The interview schedule used in the second part of the study was identical to that employed by Ross et ul. (1988) in the baseline data collection. It included 12 questions on attitudes and beliefs relating to AIDS and related matters. These questions were the highest loading items in the study by Ross (1988) which looked at dimensionality of attitudes toward AIDS in the general community. All items were scored on a five point Likert scale, ranging from ‘strongly agree’ (1) to ‘strongly disagree’ ( 5 ) . These questions are given in Table 1, and covered the domains of beliefs about contagion, homonegative attitudes, belief in the seriousness of AIDS, how much is known about it, and fear of disease of death. These domains of attitudes about AIDS were derived from the study by Ross (1988) on the dimensions of attitudes and beliefs about AIDS. As in the previous study respondents were asked: “How concerned are you about AIDS as a social issue in Australia?” and “How concerned are you about AIDS personally?”. In each case responses were obtained along a 7point rating scale, ranging from ‘not at all’ (1) to ‘extremely concerned’ (7). Following the attitude and knowledge items, and to assess reactions to the ‘Grim Reaper’, respondents were asked first: “DO you recall some months ago an advertisement on television about the Grim Reaper?”. For those who answered ‘yes’, further questions asked (1) whether the respondent thought it was a good way of campaigning against AIDS and (2) whether he or she was influenced by it. Demographic information obtained from the sample included age, sex, marital status and occupation. The follow-up s w e y was conducted by door-knock in Adelaide, South Australia by Social Work students from a major tertiary institution who were trained in the appropriate methodology. The sampling procedure and interviewing technique replacted that given in Ross et al. (1988), which details the methodology for the baseline study of 315 persons. In total 525 respondents over the age of 16 years were interviewed at their homes during September, 1987 for the follow-up study. Not every respondent answered all of the questions, resulting in some minor variations in the numbers available for some’ of the analyses.
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
342 W.ROSS E T A . The demographc composition of the later sample proved to be, in almost all respects, s d a r to that obtained by Ross ef al. (1988) 11 months previously. No significant differences were found using chi square analyses with respect to sex composition or occupational status, employing the Daniel (1983) classification of occupations in Australia. However, the age distributions for the two samples differed: using 12 age categories ( 5 year intervals), x2 = 50.42, d.f. = 11,ptO.001. The follow-up sample had a significantly greater proportion of younger people, their median age being 32 years compared with 36 years in the earlier sample. Subsequent comparisons between the baseline sample and the follow-up sample were made using two age groups identical to those in the first sample (respondents under 38 years, and 38 years and over) to control for this. Data analysis was by analysis of variance, with the time of survey (baseline or followup) and sex as factors, and with age as a covariate which was assessed and corrected for before main effects were calculated. Pearson correlation coefficients were calculated between the 12 attitude items and occupational status for men and women separately, and pointbiserial correlation coefficients between the same items and relationship status (attached or unattached). The results of the correlations between the 12 attitude items and relationship status revealed only one sipficant correlation (-0.22 with item a), and the correlation of the same 12 items with occupational status for males and females separately revealed only two significant correlations for women (0.20 and -0.25 with items 3 and 11 respectively) and one for men (0.23 with item 11). As a result of these few and low correlations, relationship status and occupational status were not included as factors in the analyses of variance, particularly as there was a high proportion of missing data for occupation (where responents were unemployed, retired, students, or involved in home duties). To assess the direction of the effects of age, pearson correlation coefficients were computed for all 12 attitudinal items, as were t-tests between those who indicated that been influenced by the ‘Grim Reaper’ (n= 167) and those who had not (n=326). Alpha level was set at 5% for all analyses.
Results Results are presented in Tables 1 and 2. For four of the 12 items there were significant changes over time (Table 1). These four items related to people with HIV infection being able to mix with other people (change toward agreement), to concern about how little is known about AIDS (change toward disagreement), to belief that little is known about how AIDS spreads (change toward disagreement), and to the belief that minority groups should try to fit into society (change toward disagreement). There were sex differences on nine of the 12 items, with females having consistently more liberal attitudes toward AIDS and related areas than males. In addition, females appeared to be more concerned about how little was known about AIDS and about the extent of the AIDS epidemic. There were only two signhcant Time by Sex interactions: in the item “There is little known about how AIDS spreads”, females changed towards disagreement significantly more than males. In the item, “AIDS is one of the worst epidemics to hit the world this century”, males moved to disagree significantly more than females. The correlational analyses of age with the 12 items revealed that older people were significantly more likely to believe that people with AIDS should not mix socially, that AIDS is very contagious, that homosexuahty is abnormal, that sex should be limited to marriage, that homosexuals are different to heterosexuals in more ways than sexual practices, that the idea of dying is not frightening, that minority groups should try to fit into society, that there
EFFECT OF NATIONAL CAMPAIGN ON AIDS AlTITUDES
343
Table 1. Means for dijkrmces in Crainrdcs between baseline andfollow-up with age as a cooanair Means
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
Male
Time
F values Time x Sex Sex
Age
Item*
Pre
Post
Female Pre Post
I am scared of incurable diseases Homosexuality is abnormal People with the AIDS virus should be allowed to mix with other people People with AIDS should have our pity, not our blame The fact that so little is known about AIDS concerns me Sex should be limited to m i a g e Homosexuals are different to heterosexuals in more ways than just sexual practices The idea of dying frightens me There’s n o h g very contagious about AIDS Minority groups should uy to fit into our society There is little known about how AIDS spreads AIDS is one of the worst epidemics to hit the world this century
2.29
2.30
2.21
2.12
0.21
2.47
0.28
0.01
1.96
2.33
2.44
2.70
3.32
21.8ZC
0.01
65.6ZC
2.91
2.56
2.63
2.35
4.11a
6.85b
0.11
37.76c
2.51
2.28
2.11
2.19
0.34
6.16a
3.33
0.06
1.72
2.06
1.66
1.80
7.4ab
6.1@
1.78
1.68
3.17
3.58
2.80
3.26
2.12
11.53c
0.18
157.72c
2.36
2.48
2.66
2.82
0.06
12.84c
0.11
34.63c
3.15
3.13
3.14
2.87
0.10
2.74
1.53
27.52=
3.89
4.00
4.09
4.19
0.42
4.89a
0.00
5.34a
2.06
2.53
2.28
2.75
17.19c
6.26a
0.01
33.4s
3.10
3.43
2.68
3.46
22.29c
2.05
5.1Ea
22.7F
1.72
2.21
1.77
1.79
3.01
8.23b
6.73b
18.54c
~~
1=Strongly agree; 5 =Strongly disagree a pt 0 . 0 5 p t O . 0 1 p tO.OO 1 Males answering question: pre-campaign 137-138; post campaign 231-233; Females answering question: pre-campaign 164-1 70; post campaign 283
is little known about how AIDS spreads, and that AIDS is one of the worst epidemics h s century. Perceived impact of the ‘Grim Reaper’ was significantly associated with a number of the attitudinal and belief items. These are illustrated in Table 2. Some 93.5% of respondents (n=521) recalled having seen the ‘Grim Reaper’ television commercial 5 months previously. A total of 63.7% of the 493 respondents who made a judgement on the matter thought it was a good way of campaigning against AIDS; 13.4% were unsure; and 22.9% thought it was not. The proportion indicating that they had personally been influenced by the ‘Grim Reaper’ was 33.9%. Finally, the percentage indicating both that not only was it a good way of campaigning against AIDS,but also that they, personally, had been influenced was 28.0%.
344 W.ROSSETAL.
Downloaded by [University of Auckland Library] at 14:37 08 October 2014
Table 2. Mean ( 2SO) LX#mences on artitudinal ium bemeen those influenced and those nor influenced iy Campaign
Itemb
Influenced
Not influenced
I am scared of incurable diseases Homoxxuahty IS abnormal People with the AIDS virus should be allowed to ~II with other people People with AIDS should have our pity, not OUI blame The fact that so httle is known about AIDS concerns me Sex should be hmited to mamage Homosexuals are &fferent to heterosexuals m more ways than just sexual practlces The idea of dying frightens me There’s nothmg very contagious about AIDS Mmonty groups should try to fit into our society There is httle known about how AIDS spreads AIDS is one of the worst epidemcs to hit the world tlus century
1.96%1.19
2.32 2 1.26b
2.65 2 1.50 2.41 z 1.30
2.58 2 1.43 2.39 % 1.27
2.102 1.12
2.292 1.10
1.70 2 0.96
2.01 % 1.07c
3.56 % 1.50
3.41 f 1.54
2.71 -t 1.30
2.67 k 1.27
2.72 z 1.47
3.12-t 1.39b
4.232 1.17
4.09 % 1.22
2.60 2 1.26
2.69 f 1.31
3.28 -t 1.41
3 . 5 5 ~1.33ba
1 . 7 2 1.12 ~
2.09 f 1 .23c
1 =Strongly agree; 5 =Strongly disagree a pt0.05 bp
