|Year : 2015 | Volume
| Issue : 1 | Page : 22-27
Under graduate nursing students' knowledge and attitude toward people living with human immunodeficiency virus/acquired immunodeficiency syndrome
Mythili Dharmalingam1, Vijayalakshmi Poreddi1, Sailaxmi Gandhi2, Rama Chandra1
1 College of Nursing, National Institute of Mental Health and Neuro Sciences (Institute of National Importance), Bengaluru, Karnataka, India
2 Department of Nursing, National Institute of Mental Health and Neuro Sciences (Institute of National Importance), Bengaluru, Karnataka, India
|Date of Web Publication||23-Jun-2015|
College of Nursing, National Institute of Mental Health and Neuro Sciences, (INI), Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become one of the significant public health problems in the world. Research regarding HIV/AIDS among nursing professionals is limited from India. Aim: The aim was to assess nursing student's knowledge and attitude toward people living with HIV/AIDS. Methods: A descriptive cross-sectional design was adopted among conveniently selected under graduate nursing students (n = 172) using self-reported questionnaires. Results: The overall mean knowledge (38.05 ± 4.91) and attitude score (51.26 ± 6.2) indicate that majority of the students have good knowledge (77.6%) and moderately favorable attitudes (67.4%) toward HIV/AIDS patients. However, statistically significant differences were observed between age (P < 0.001, P < 0.019) education (P < 0.34, P < 0.01) and experience in taking care of HIV/AIDS patients (P < 0.01, P< 0.01) with knowledge and attitude. Conclusion: Though, a majority of nursing students had adequate knowledge, few students hold discriminatory attitudes toward people with HIV/AIDS. These findings indicate that there is an urgent need to improve the level of knowledge and attitudes among nursing students toward HIV/AIDS as they have a key role in prevention, care and treatment in their future career as nurses.
Keywords: Acquired immunodeficiency syndrome, attitudes, human immunodeficiency virus, India, nursing students
|How to cite this article:|
Dharmalingam M, Poreddi V, Gandhi S, Chandra R. Under graduate nursing students' knowledge and attitude toward people living with human immunodeficiency virus/acquired immunodeficiency syndrome. Int J Adv Med Health Res 2015;2:22-7
|How to cite this URL:|
Dharmalingam M, Poreddi V, Gandhi S, Chandra R. Under graduate nursing students' knowledge and attitude toward people living with human immunodeficiency virus/acquired immunodeficiency syndrome. Int J Adv Med Health Res [serial online] 2015 [cited 2019 Jul 20];2:22-7. Available from: http://www.ijamhrjournal.org/text.asp?2015/2/1/22/159124
| Introduction|| |
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become one of the significant public health problems in the world. AIDS is a fatal illness caused by a retro virus known as the HIV that breaks down body's immune system, leaving the person vulnerable to a host of life-threatening opportunistic infections, neurological disorders, and unusual malignancies.  Further, it affects the mental health and social relationships of carriers and asymptomatic patients.  According to recent estimation, there are 2.08 million people living with HIV (PLHIV) in India. 
Nurses play a major role in the care for HIV/AIDS patients and require current knowledge and skills to ensure that they are able to provide high quality, effective care to PLHIV and AIDS. Further, attitude of health workers in relation to HIV is an important determinant of their willingness to care and the quality of the care they will render to HIV patient. However, previous research identified discriminatory attitudes, misconceptions and lack of HIV knowledge among nurses toward patients with HIV and AIDS.  Unfortunately, negative attitudes about HIV not only prevent health care providers from delivering optimal healthcare but also decreases PLHIV's willingness to access healthcare , and together can perpetuate health inequities among PLHIV. In India, as in many other countries, people with HIV frequently encounter discrimination. A number of studies conducted in India during the past 2 years reported high levels of stigmatization and discrimination against PLHIV/AIDS. ,,, Among the health care professionals, nurses and nursing students are an important component of the health care delivery system. Research indicates lack of knowledge among nursing students. , However, majority of studies have shown that attitudes among nursing students toward people infected with HIV were generally positive.  On the other hand, few of the studies indicate negative attitudes among nursing students toward HIV/AIDS patients.  Further, it is important to understand nursing students' knowledge and attitudes toward PLHIV because the educational preparation of nurses has been known to affect the attitudes and the effectiveness of the care provided to PLHIV.  Thus, the present study was aimed to assess nursing student's knowledge of HIV/AIDS and attitude toward them and their willingness to treat patients living with HIV and AIDS.
| Methods|| |
This was a descriptive study carried out among undergraduate nursing students at a college of nursing in Bangalore, South India from March to April 2014.
The study sample was selected through convenient sampling technique. The study criteria included; nursing students from 2 nd -, 3 rd to 4 th -year of Bachelor of nursing course and those who were willing to participate in the study. Nursing students from 1 st year were excluded since they didn't have enough theoretical and clinical exposure to HIV/AIDS patients. There were 259 students enrolled in to the Bachelor of nursing course, out of them 186 students were eligible to participate in the study. However, 14 questionnaires were subsequently discarded as they were incomplete. Hence, 172 completed questionnaires were analyzed with 92.4% response rate.
The questionnaire had three components; (1) the student sociodemographic questionnaire, (2) the HIV/AIDS knowledge questionnaire and (3) the HIV/AIDS attitude questionnaire.
- The demographic form elicited information on five aspects of the participants' background: Age, religion, family's monthly income, place of residence, and year of their nursing course. Two closed-ended questions were included regarding their experience in caring of HIV/AIDS patients and whether they heard of HIV/AIDS. If yes, source of information about HIV/AIDS disease.
- The HIV/AIDS Knowledge Questionnaire was used to measure students' knowledge regarding HIV/AIDS. This was a previously validated questionnaire developed by Abolfotouh  based on review of the literature. ,, This section consisted of 49 statements that assessed 5 domains; cause of AIDS (5 statements), nature (16 statements), mode of transmission (15 statements), treatment/control (5 statements), and groups at high risk (8 statements). Students were asked to mark the correct answer for each question (yes, no or don't know). On each question, 1 point was awarded for a correct answer and 0 point for an incorrect choice or no response. Total scores for each student therefore ranged from 0 to 49. Students with higher scores had greater HIV/AIDS knowledge and were more willing to take care of people with HIV/AIDS.
- The HIV/AIDS Attitude Questionnaire. ,,, This part consisted of 19 statements to measure nursing students' attitude toward HIV/AIDS in 3 domains namely (a) attitudes toward people living with AIDS (PLWA; 10 statements), (b) attitudes toward care (4 statements), and (c) attitudes toward precautionary measures (5 statements). Attitude toward AIDS was measured on a 4-point Likert-type scale, with 4 indicating strongly agree, and 1 indicating strongly disagree. Higher score indicates better attitudes toward HIV/AIDS patients.
This scale was used for the present study because it is simple to use and has good psychometric properties (α = 0.88).  A pilot study was conducted among 20 students and found that this tool was feasible to administer among Indian Nursing students.
The above said questionnaires were distributed to batches of students separately at various times, in a group setting in common places like the lecture halls. One author (DM) verbally explained the aims and method of the research and how to complete the questionnaires. The willing participants then completed both questionnaires in about 20 min.
After obtaining permission from the administrators of the college, researchers informed the study participants about the purpose of the study's aims and procedures and invited them to participate. After students agreed to participate verbally, the researcher gave them the confidential questionnaire. Data collection tools contained no identifying information and thus individual responses confidential.
The data were analyzed using statistical software and results were presented in narratives and tables. The percentage of respondents with positive responses was calculated for each question. The total for each section was calculated as the average of the percentage of correct responses. The relationship between knowledge, attitude scores, and sociodemographic variables were tested using correlation, t-tests, or a one-way analysis of variance. Statistical significance was assumed at P < 0.05.
| Results|| |
The study sample comprised of women undergraduate nursing students (n = 172) from 2 nd year (42.4%), 3 rd year (41.9%) and 4 th year (15.7%) of Bachelor of Nursing course. The mean age of the participants was 19.37 ± 0.73 (mean [M] ± standard deviation [SD]) and mean income was 1.8 ± 2.31 (M ± SD). Almost all of the participants had heard about HIV/AIDS (99.4%), and 80.2% of the participants agreed that they had come across a person with HIV/AIDS during their clinical postings. Nearly three-fourth (73.8%) of the students reported that mass media (Television, Newspaper, Magazines posters, movies) was the major source of information about HIV/AIDS, followed by nursing teachers (12.7%) [Table 1].
|Table 1: Percentage and frequency distribution of sample characteristics|
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Responses to the knowledge questions showed that students had adequate knowledge related to causes of HIV/AIDS as most of the students answered correctly (4.43 ± 0.70). Concerning the questions related to nature of HIV/AIDS, the mean score (12.3 ± 2.13) indicate that participants had adequate knowledge regarding the nature of HIV/AIDS disease. Unfortunately, nearly more than one-third of the participants opined that "blood donation" swimming in the same place where an infected person swims, being exposed to infected persons who coughs or spits and bite of mosquito can give AIDS. However, the mean score of this domain suggests (11.6 ± 2.46) a moderate level of knowledge regarding the mode of transmission of HIV/AIDS. The mean score for treatment domain of 3.41 ± 1.34 indicate adequate knowledge among the nursing students. Similarly, majority of the students recognized that prostitutes (83.1%), homosexuals (87.2%), and people with multiple sexual partners (90.7%) are the high-risk group to acquire AIDS disease. The mean score (6.25 ± 1.32) also suggests that participants had adequate knowledge in this domain. The overall mean score of the knowledge about HIV/AIDS (38.05 ± 4.91) indicating a good level of knowledge among nursing students [Table 2].
Responses of the participants' attitudes toward HIV/AIDS were diverse [Table 3]. More than two-third of the participants disagreed that "HIV/AIDS is a threat to health workers" (66.8%). However the mean score (27.02 ± 3.21) indicates that nursing students hold moderately favorable attitudes toward patients with HIV/AIDS. Nursing students had favorable attitudes toward care of PLWAS as more number of them agreed that Health workers are duty bound to treat all patients irrespective of their status (62.7%) and "patients with AIDS have the right to receive care as other diseases" (63.95%). The mean score (10.33 ± 2.51) of this domain suggests that participants had favorable attitudes toward care of PLWAS. Whilst, 56.9% of the participants, disagreed, 43% of them agreed that 'AIDS patients should be isolated from other patients. However, the mean score (13.89 ± 2.39) indicate reasonably fair attitudes toward precautionary measures toward PLWAS. Nonetheless, the overall attitudes mean score (51.26 ± 6.32) suggests that nursing students had moderately favorable attitudes toward persons with HIV/AIDS. The Pearson Correlation Coefficient test revealed that a negative relationship existed between attitudes and knowledge (r = −0.862; P < 0.01) toward HIV/AIDS patients.
[Table 4]revealed statistically significant difference between age of the students with the knowledge (P < 0.001) and attitudes (P < 0.019). Older participants had better knowledge and attitudes toward HIV/AIDS patients. Similarly, a significant difference was found between students from 3 rd to 4 th year BSC Nursing and 2 nd year students regarding knowledge (P < 0.034) and attitudes (P < 0.01) toward PLWAS. Students who had come across patients with HIV/AIDS had better knowledge (P < 0.01) and favorable attitudes (P < 0.01) than students who had not provided care to the patients with HIV/AIDS.
|Table 4: Relationship between the mean score of knowledge and attitudes with the student's year of education|
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| Discussion|| |
The present study demonstrated that nursing students had a moderate level of knowledge. However, there were deficiencies in the knowledge about HIV and that misconceptions existed about the spread of HIV. This is consistent with previous reports. , In the present study, nearly three-fourth (73.8%) of the students reported that mass media (television, newspaper, magazines posters, movies) was the major source of information about HIV/AIDS, followed by nursing teachers (12.7%). These findings were in line with previous published studies. ,,,,, These findings suggest that mass media tool has reached to most of the population and may be utilized properly to create awareness about HIV/AIDS.
The mean score of the overall knowledge about HIV/AIDS (38.05 ± 4.91, out 0f 50) indicates a good level of knowledge among nursing students. However, their knowledge about the mode of transmission of HIV/AIDS is limited, and these findings were in consonance with previous research. ,,,,,,,, This indicated huge gaps in the knowledge on the transmission of HIV and on the direct need for training of nursing students in this regards. In line with previous research, , 39% of the students were not aware of "there is no cure for AIDS." Similar findings were observed in a recent study; half of the students did not know that there is at present no cure for this disease condition.  However, the mean percentage of overall knowledge shows that 76.1% of the students had good knowledge about HIV/AIDS. These findings were consistent with earlier studies. ,,
Attitudes of nursing students toward caring for people with HIV/AIDS are of vital importance since they become the future practicing nurses. While majority (67.4%) of the participants were positive, 32.6% of the students had negative attitudes toward HIV/AIDS patients. These findings were consistent with a recent study carried out among nursing students from Saudi.  These findings were inconsistent with the studies that found negative attitudes and unwillingness to care for AIDS patients. ,,, However, more than half of the students agreed that AIDS virus carriers can share a room with noninfected patients', and gloves should not be worn when touching a patient with AIDS. Similar findings were observed in studies from developing countries. , Negative attitudes about HIV among nursing students and health care providers likely contribute to the prevalence of health disparities in PLWH. Thus, it is critical to identify factors linked with positive or negative attitudes toward HIV among nursing students and to rectify them during their training period. Furthermore, studies indicate that negative attitudes toward PLWA can interfere with the quality of nursing care and can cause stress to nurses and patients alike.  Nonetheless, the overall attitudes mean score (51.26 ± 6.32) suggests that nursing students had moderately favorable attitudes toward persons with HIV/AIDS. 
Unlike previous findings,  in the present study a negative relationship existed between attitudes and knowledge (r = −0.862; P < 0.01) toward HIV/AIDS patients. These findings were in agreement with previous study that showed increased scores parallel with student grade (F = 26.925; P = 0.000) and age (Chi-square [K-W] = 35.117; P = 0.000).  Similar to present study findings, earlier studies indicate that students who had previous experience in caring for an AIDS patient had higher scores of knowledge and better attitudes toward HIV/AIDS patients. ,,, In addition, a majority of studies conducted among nursing students and registered nurses showed the gaps in HIV/AIDS knowledge and expressed the need for more education. ,,, Thus, it is recommended that a comprehensive training of the nursing students be done, to promote a good delivery of accurate information on HIV/AIDS to meet the physical and psychological needs of patients with HIV/AIDS.
The present study has certain limitations such as cross-sectional design, convenience sample, women undergraduates and small sample size. Further, the study sample was restricted to one university. Thus, findings of the present study cannot be generalized. Future studies could include a larger, randomized sample from more geographically diverse nursing students and qualitative studies such as focus group discussions could be helpful to understand in depth about this issue.
| Conclusion|| |
Nursing students in the present study had adequate knowledge and favorable attitudes toward caring people with HIV/AIDS. However, a number of misconceptions with discriminatory attitudes among few participants cannot be ignored. These findings were of great concern, because there is an urgent need to improve the level of knowledge and attitudes among nursing students toward HIV/AIDS as they have a key role in prevention, care and treatment in their future career as nurses. Further, continuous educational programs also are needed to improve their knowledge and competence in providing culturally sensitive rights-based approach care to HIV/AIDS patients.
| Acknowledgments|| |
Researchers thank all the nursing students who participated enthusiastically in our study.
| References|| |
Park K. Epidemiology of Communicable Diseases. Park's Textbook of Preventive and Social Medicine. 22 nd
ed. Jabalpur: M/s. Banarasidas Bhanot Publishers; 2013. p. 316-28.
Tavoosi A, Zaferani A, Enzevaei A, Tajik P, Ahmadinezhad Z. Knowledge and attitude towards HIV/AIDS among Iranian students. BMC Public Health 2004;4:17.
NACO. World AIDS Day: India Records Sharp Drop in Number of Cases; 2012. Available from: http://www.ndtv.com/article/india/world-aids-day-india-records-sharp-drop-in-number-of-cases-299730. [Last accessed on 2014 Aug 01].
Delobelle P, Rawlinson JL, Ntuli S, Malatsi I, Decock R, Depoorter AM. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. J Adv Nurs 2009;65:1061-73.
Ding L, Landon BE, Wilson IB, Wong MD, Shapiro MF, Cleary PD. Predictors and consequences of negative physician attitudes toward HIV-infected injection drug users. Arch Intern Med 2005;165:618-23.
Wong MD, Cunningham WE, Shapiro MF, Andersen RM, Cleary PD, Duan N, et al.
Disparities in HIV treatment and physician attitudes about delaying protease inhibitors for nonadherent patients. J Gen Intern Med 2004;19:366-74.
Solomon S, Batavia A, Venkatesh KK, Brown L, Verma P, Cecelia AJ, et al.
A longitudinal quality-of-life study of HIV-infected persons in South India: The case for comprehensive clinical care and support services. AIDS Educ Prev 2009;21:104-12.
Chomat AM, Wilson IB, Wanke CA, Selvakumar A, John KR, Isaac R. Knowledge, beliefs, and health care practices relating to treatment of HIV in Vellore, India. AIDS Patient Care STDS 2009;23:477-84.
Chakrapani V, Newman PA, Shunmugam M, Dubrow R. Prevalence and contexts of inconsistent condom use among heterosexual men and women living with HIV in India: Implications for prevention. AIDS Patient Care STDS 2010;24:49-58.
Subramanian T, Gupte MD, Dorairaj VS, Periannan V, Mathai AK. Psycho-social impact and quality of life of people living with HIV/AIDS in South India. AIDS Care 2009;21:473-81.
Bektas HA, Kulakaç O. Knowledge and attitudes of nursing students toward patients living with HIV/AIDS (PLHIV): A Turkish perspective. AIDS Care 2007;19:888-94.
Tung WC, Ding K, Farmer S. Knowledge, attitudes, and behaviors related to HIV and AIDS among college students in Taiwan. J Assoc Nurses AIDS Care 2008;19:397-408.
Veeramah V, Bruneau B, McNaught A. Exploring knowledge and skills on HIV in student nurses and midwives. Br J Nurs 2008;17:186-91.
Mahat G, Eller LS. HIV/AIDS and universal precautions: Knowledge and attitudes of Nepalese nursing students. J Adv Nurs 2009;65:1907-15.
Abolfotouh MA. The impact of a lecture on AIDS on knowledge, attitudes and beliefs of male school-age adolescents in the Asir Region of southwestern Saudi Arabia. J Community Health 1995;20:271-81.
DiClemente RJ, Zorn J, Temoshok L. Adolescents and AIDS: A survey of knowledge, attitudes and beliefs about AIDS in San Francisco. Am J Public Health 1986;76:1443-5.
Doyle YG, Conroy RM. What Irish schoolchildren know about AIDS. Public Health 1991;105:167-71.
Adebajo SB, Bamgbala AO, Oyediran MA. Attitudes of health care providers to persons living with HIV/AIDS in Lagos State, Nigeria. Afr J Reprod Health 2003;7:103-12.
Abolfotouh MA, Saleh SA, Mahfouz AA, Abolfotouh SM, Fozan HM. Attitudes of Saudi Nursing students on AIDS and predictors of willingness to provide care for patients in central Saudi Arabia. SAGE Open 2013;3:1-11.
Al-Rabeei NA, Dallak AM, Al-Awadi FG. Knowledge, attitude and beliefs towards HIV/AIDS among students of health institutes in Sana'a city. East Mediterr Health J 2012;18:221-6.
Ouzouni C, Nakakis K. HIV/AIDS knowledge, attitudes and behaviours of student nurses. Health Sci J 2012;6:129-50.
Goel KN, Rahul B, Rambha P, Sharma HK, Monika A, Luthra SC. Knowledge and awareness of nursing students about HIV/AIDS. Health Popul Perspect Issues 2010;33:55-60.
Grover N, Prakash A, Singh S, Singh N, Singh P, Nazeer J. Attitude and knowledge of dental students of National Capital Region regarding HIV and AIDS. J Oral Maxillofac Pathol 2014;18:9-13.
Joshi AV, Nikam K, Hungund BR, Viveki RG, Nikam SV, Halappannavar AB, et al
. Knowledge about and attitude towards HIV/AIDS among first year medical students: A cross-sectional study. J Sci Soc 2013;40:155-8.
Bhosale SB, Jadhav SL, Singru SA, Banerjee A. Behavioral surveillance survey regarding human immunodeficiency virus/acquired immunodeficiency syndrome among high school and junior college students. Indian J Dermatol Venereol Leprol 2010;76:33-7.
Taher E, Abdelhai R. Nurses knowledge, perceptions, and attitudes towards HIV/AIDS: Effects of a health education intervention on two nursing groups in Cairo University. Egypt J Public Health Epidemiol 2011;3:144-54.
Achappa B, Soundarya M, Priyansha M, Pranathi M, Deepak M, Unnikrishnan B, et al
. Knowledge, risk perceptions and attitudes of nurses towards HIV in a tertiary care hospital in Mangalore, India. J Clin Diagn Res 2012;6:982-6.
Badahdah AM, Sayem N. HIV-related knowledge and AIDS stigma among college students in Yemen. East Mediterr Health J 2010;16:901-6.
Udgiri R, Yadavannavar MC, Angadi MM, Sharvanan E. Knowledge about HIV/AIDS among first year medical students. Al Ameen J Med Sci 2011;4:280-2.
Azodo C, Umoh A, Ezeja E, Ukpebor M. A survey of HIV-related knowledge and attitude among dental nursing students in South Western Nigeria. Benin J Postgrad Med 2007;9:1-12.
Turhan E, Inandi Y, Inandi T. Risk perception, knowledge and social distance of Turkish high school students about HIV/AIDS. J Public Health (Oxf) 2006;28:137-8.
Oyeyemi A, Oyeyemi B, Bello I. Caring for patients living with AIDS: Knowledge, attitude and global level of comfort. J Adv Nurs 2006;53:196-204.
Tan X, Pan J, Zhou D, Wang C, Xie C. HIV/AIDS knowledge, attitudes and behaviors assessment of Chinese students: A questionnaire study. Int J Environ Res Public Health 2007;4:248-53.
Akin S, Mendi B, Mendi O, Durna Z. Turkish nursing students' knowledge of and attitudes towards patients with HIV/AIDS. J Clin Nurs 2013;22:3361-71.
Platten M, Pham HN, Nguyen HV, Nguyen NT, Le GM. Knowledge of HIV and factors associated with attitudes towards HIV among final-year medical students at Hanoi medical university in Vietnam. BMC Public Health 2014;14:265.
Tyer-Viola LA. Obstetric nurses' attitudes and nursing care intentions regarding care of HIV-positive pregnant women. J Obstet Gynecol Neonatal Nurs 2007;36:398-409.
Eriksson L, Grundin RD. Nursing Students' Knowledge and Attitudes Towards People With HIV/AIDS; 2010.
[Table 1], [Table 2], [Table 3], [Table 4]