Efficacy of HIV Prevention Public Service Announcement Among College Students: A Quasi

Experimental Study

Robert Avina, AA, BS, MPH (c); Kaitlin Brehaut, BS, MPH (c); Abigail Lopez MPH (c); Alexa
Reyes, BS, MPH (c)

Department of Health Science and Human Ecology, California State University, San Bernardino
5500 University Parkway San Bernardino, CA 92407

Key words: HIV prevention, efficacy, public service announcement, knowledge, attitude, college

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 Table of Contents

Abstract....................................................................................................................................... 3

Background................................................................................................................................. 4

Methods ...................................................................................................................................... 5

Results .....................................................................................................................................6-7

Discussion ...............................................................................................................................7-8

References ................................................................................................................................. 9

Appendix ..............................................................................................................................10-17

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 Abstract

Objective: The study’s objective was to measure efficacy of a public service announcement on

Human Immunodeficiency Virus (HIV) prevention knowledge and self-efficacy among college

students.

Methods: Pre- and post- surveys were developed to assess participant knowledge and confidence

levels. A quasi-experimental study was conducted as a pilot test among ten health science

students from three upper division health science undergraduate and graduate courses, at

California State University, San Bernardino (CSUSB). All analyses were conducted in SPSS

version 24 and significance was set at p less than .05.

Results: As a result of the pilot test, 90% of the participants indicated an increase in HIV

knowledge and confidence levels after the intervention. Thus, demonstrating the efficacy of

utilizing public service announcements as a health education prevention tool.

Conclusion: After conducting this pilot study, our findings suggest that further studies should be

implemented to a larger target population in order to increase HIV knowledge and prevention.

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 Background

The Human Immunodeficiency Virus (HIV) has been a major public health concern in

recent years, especially among adolescents living in the United States. It is estimated that 1.2

million adults and adolescents are living with HIV with 50,000 new infections each year (1).

College students are considered to be one of the highest at-risk groups since they are more likely

to contract a sexually transmitted infection and have more sexual partners without using some

form biomedical prevention tool when comparing health behaviors to the adult population (2). In

addition, racial and ethnic minority groups are more susceptible to HIV due to environmental

factors such as, stigma associated with HIV or lack of HIV knowledge. In 2015, the California

Department of Public Health reported a higher incidence rate among ages 18 to 24. In addition,

San Bernardino County has had an increase of HIV newly diagnosed cases in the most recent

years (3).

The purpose of this study was to identify HIV knowledge among California State

University, San Bernardino (CSUSB) college students by providing a pre-test to establish a

baseline of the participants knowledge prior to administering the public service announcement

and zine. The intervention was followed up with a post-test to identify an increase in knowledge

and confidence level. The pilot test study helped evaluate our instruments and materials to

determine efficacy.

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 Methods
Data source

A quasi experiment was conducted among ten students recruited from Health Science

classes at California State University, San Bernardino. A pre- and a post- survey was given to

measure knowledge, practice, and attitude on HIV prevention.

Variables

Demographics of the participants were measured through multiple choice questions

(PREQ24, POSTQ24 through PREQ27, POSTQ27) (Table 1). The first part of knowledge

included PREQ1, POSTQ1 through PREQ6, POSTQ6 and were all multiple choice questions

(Table 2A). The second section of knowledge questions PREQ7, POSTQ7 through PREQ19,

POSTQ19 were measured using True/False/Don’t know (Table 2B). Confidence levels were

measured through four Likert scale questions on PREQ20, POSTQ20 through PREQ23,

POSTQ23 (Table 2C). Lastly, overall impact was measured through one True/False question:

The PSA/ZINE increased my understanding of HIV (POSTQ28) (Table 2C).

Data analyses

The first step in data analyses were descriptives statistics where frequencies were run for

each question category on the pre- and post- test. The next step was a bivariate analysis, which

consisted of multiple tests (McNemar-Bowker, Pearson Chi-square, and Fisher’s exact) to

determine the relationship between two variables. The initial step in the bivariate analyses was to

run a McNemar-Bowker test for each survey question (pre- and post-). If the McNemar-Bowker

test did not provide a p value, then, a Pearson Chi-square was conducted. If the Pearson Chi-

Square indicated that at least one cell was less than five, a Fisher’s exact was run to determine p

value. SPSS version 24 was used for all analyses and significance was set at p less than .05.

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 Results

Descriptive statistics

Table 1 demonstrates the demographic characteristics of the study participants. Ninety

percent of the participants were females while 66.7% reported being Hispanic/Latino.

Bivariate statistics

Table 2C shows the frequencies for the confidence levels and overall impact questions in

the pre- and post- tests. For example, although the p value for PREQ23 and POSTQ23 was

greater than .05, there was still a significant increase in confidence levels before and after the

intervention (30% vs 70%). Similarly, a higher percentage of participants reported strongly agree

to being confident in their knowledge of PrEP in the post-test compared to the pre-test, though it

did not reach significance (10% vs 90%, p> .05). Furthermore, while the p value cannot be

computed for PREQ28 and POSTQ28, 90% of the participants indicated an increase in HIV

knowledge and confidence levels after the intervention.

Survey validation

The peer-validation provided feedback on the sections of demographics and knowledge.

For the demographics section, they reported that PREQ and POSTQ24-27 were well constructed,

however, PREQ25 and POSTQ25 should be changed to current educational level. Peers also

mentioned that PREQ and POSTQ7-11 were too similar to other questions on the survey.

Furthermore, they suggested PREQ and POSTQ14-19 to be written into multiple choice options,

rather than, True/False/Don’t know.

Cronbach’s Alpha (CA) was conducted on all survey questions using a reliability

analysis. Initial CA for PREQ7-12 was .683. After eliminating PREQ10, the CA score increased

to .711. Finally, after deleting PREQ12, the CA score increased to .745. Initial CA for questions

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PREQ20-23 and PREQ28 was .679. After removing PREQ21, the Cronbach’s alpha increased to

.747. Once PREQ20 was removed, Cronbach’s alpha increased to .870.

Discussion

The study’s objective was to measure efficacy of a public service announcement on HIV

prevention based on knowledge and self-efficacy among college students. Statistical analysis

showed a 40% increase in HIV confidence levels, and an 80% increase in PrEP knowledge when

comparing pre-post surveys. As discussed in the results section, 90% (9 out of 10 participants)

indicated an increase in knowledge, while the remaining 10% has had prior knowledge

pertaining to the topic. Based on the participants feedback, the HIV public service announcement

and zine was clear and easy to understand.

The limitations of the study include: a small sample size that was not randomly selected,

did not have equal male to female participants, and participants stemmed from the Health

Science Department. Thus, this study does not accurately represent the entire CSUSB

community. The major strengths of our study was having an increase in HIV knowledge among

the at-risk age group (18-24), establishing a partnership between the Health Science Department

and the Health Center, in addition to pilot testing our instrument at CSUSB for the first time

while having a successful outcome. To further explain the success of the instrument, our

Cronbach Alpha (CA) measured internal consistency of the survey questions to determine if the

questions were compatible in the sequence they were being conducted.

To better represent our CSUSB community further research studies on HIV knowledge

must be conducted using a larger random sample with an equal ratio of males to females, and

including participants from other departments and majors. Based on the success of the PSA and

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zine, the message that was being conveyed can be utilized at other community college or

university campuses to bring HIV awareness and increase HIV prevention and knowledge.

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 References

1. Dennison O, Wu Q, Ickes M. Prevalence of Human Immunodeficiency Virus Testing and

Associated Risk Factors in College Students. J Am Coll Health. 2014 Jul;62(5):309–18.

2. Subbarao NT, Akhilesh A. Knowledge and attitude about sexually transmitted infections
other than HIV among college students. Indian J Sex Transm Dis. 2017 Jan;38(1):10–4.

3. California HIV Surveillance Report - 2015. 2015;14.

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 Appendix

Table 1: Demographics
Question Pre-test, n (%) Post-test, n (%)
PREQ24 POSTQ24
What is your sex?
Male 1 (10.0%) 1 (10.0%)
Female 9 (90.0%) 9 (90.0%)
Prefer not to say 0 (0.0%) 0 (0.0%)
PREQ25 POSTQ25
How many years have you been a student at CSUSB?

0-1 years 2 (20.0%) 2 (20.0%)

2-3 years 4 (40.0%) 4 (40.0%)
4 or more years 4 (40.0%) 4 (40.0%)
PREQ26 POSTQ26
What is your age (in years)
Under 18 0 (0.0%) 0 (0.0%)
18-24 9 (90.0%) 9 (90.0%)
25-39 0 (0.0%) 0 (0.0%)
40+ 1 (10.0%) 1 (10.0%)
PREQ27 POSTQ27
What is your race/ethnicity?
Asian-American 0 (0.0%) 0 (0.0%)
Black/African American 0 (0.0%) 0 (0.0%)
Hispanic/Latino 6 (66.7%) 6 (66.7%)
Non-Hispanic White 2 (22.2%) 2 (22.2%)
American Indian 0 (0.0%) 0 (0.0%)
Two or more 0 (0.0%) 0 (0.0%)
Other 1 (11.1%) 1 (11.1%)

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Table 2A: HIV Knowledge Part 1( Multiple Choice Questions)
Question Pre-test, n (%) Post-test, n
(%)
PREQ1, POSTQ1
What does the acronym HIV stand for?***
Human Immobilization Virus 0(0%) 0 (0%)
Human Immunodeficiency Virus 9(90%) 10 (100%)
Hemoglobin Insufficiency Virus 1(10%) 0(0%)
Don't know 0(0%) 0(0%)
PREQ2, POSTQ2
Which condom does not protect against STIs due to the pores on
the condom?***
Latex 0(0%) 0(0%)
Lambskin 7(70%) 10(100%)
Non Latex 1(10%) 0(0%)
Don't know 2(20%) 0(0%)
PREQ3, POSTQ3
Lambskin condoms are also known as_____.***
Natural skin condoms 5(50%) 8(80%)
Latex condoms 0(0%) 1(10%)
Bearskin condoms 0(0%) 1(1%)
Don't know 5(50%) 0(0%)
PREQ4, POSTQ4
What does HIV do to the body once it is in the bloodstream?***
Attack T-helper cells 9(90%) 10(100%)
Attack red blood cells 1(10%) 0(0%)
Attacks non-ciliated epithelial cells 0(0%) 0(0%)
Don't know 0(0%) 0(0%)
PREQ5, POSTQ5
Which of the following is considered modes of transmission for
HIV?***
Blood, Semen/Precum, Breast Milk, Saliva 0(0%) 0(0%)
Semen/Precum, Nasal Secretions, Breast Milk, Blood 1(10%) 0(0%)
PREQ6, POSTQ6
Which of the following is preventive measure from HIV
transmission?***
Using latex condoms in combination with Pre-Exposure 9(90%) 10(100%)
Prophylaxis (PrEP) when engaging in sexual intercourse
Using lambskin condoms when engaging in sexual intercourse 0(0%) 0(0.0)%
Using only birth control when engaging in sexual intercourse 1(10%) 0(0%)
Don't know 0(0%) 0(0%)
* P is less than or equal to .05
** P is greater than .05
*** P value cannot be computed

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Table 2B: HIV Knowledge Part 2 (True/False)
Question Pre-test, Post-test,
(n%) (n%)
PREQ7, POSTQ7 Pre-Exposure Prophylaxis (PrEP) can prevent HIV if
taken daily.***
True 4 (40.0%) 10 (100.0%)
False 3 (30.0%) 0 (0.0%)
Don’t Know 3 (30.0%) 0 (0.0%)
PREQ8, POSTQ8 Pre-Exposure Prophylaxis (PrEP) can cure HIV if
taken daily.**

True 0 (0.0%) 2 (20.0%)

False 7 (70.0%) 8 (80.0%)
Don’t Know 3 (30.0%) 0 (0.0%)
PREQ9, POSTQ9 Pre-Exposure Prophylaxis (PrEP) is only for people
engaging in same sex partners.***
True 0 (0.0%) 0 (0.0%)
False 8 (80.0%) 10 (100.0%)
Don’t Know 2 (20.0%) 0 (0.0%)
PREQ10, POSTQ10 A HIV positive person can be on Pre-Exposure
Prophylaxis (PrEP).**
True 4 (40.0%) 2 (20.0%)
False 1 (10.0%) 7 (70.0%)
Don’t Know 5 (50.0%) 1 (10.0%)
PREQ11, POSTQ11 Pre-Exposure Prophylaxis (PrEP) is only for people
who are known to be HIV negative.**
True 1 (10.0%) 8 (80.0%)
False 2 (20.0%) 1 (10.0%)
Don’t Know 7 (70.0%) 1 (10.0%)
PREQ12, POSTQ12 A period of time when a person is infected but
shows no signs or symptoms is called the “latency period”.***
True 9 (90.0%) 10 (100.0%)
False 1 (10.0%) 0 (0.0%)
Don’t Know 0 (0.0%) 0 (0.0%)
PREQ13, POSTQ13 Water-based lubricants can reduce friction to
prevent condom breakage.***
True 4 (40%) 10 (100.0%)
False 3 (30%) 0 (0.0%)
Don’t Know 3 (30%) 0 (0.0%)
PREQ14, POSTQ14 A person can get HIV from touching and
kissing.***
True 1 (10%) 0 (0.0%)
False 9 (90%) 10 (100.0%)
Don’t Know 0 (10%) 0 (0.0%)
PREQ15, POSTQ15 A person can get HIV from a toilet seat.***
True 0 (0%) 0 (0%)
False 9 (90%) 10 (100%)
Don’t Know 1 (1%) 0 (0.0%)

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PREQ16, POSTQ16 A person can get HIV from sharing needles.***
True 10 (100%) 10 (100%)
False 0 (0%) 0 (0%)
Don’t Know 0 (0%) 0 (0%)
PREQ17, POSTQ17 Please select True for this question.***
True 10 (100%) 10 (100%)
False 0 (0%) 0 (0%)
Don’t Know 0 (0%) 0 (0%)
PREQ18, POSTQ18 A woman can pass HIV to her baby during
childbirth.***
True 9 (90%) 10 (100%)
False 1 (10%) 0 (0%)
Don’t Know 0 (0%) 0 (0%)
PREQ19, POSTQ19 HIV can ONLY be transmitted sexually.***
True 0 (0%) 1 (10%)
False 10 (100%) 9 (90%)
Don’t Know 0 (0%) 0 (0%)
* P is less than or equal to .05
** P is greater than .05
*** P value cannot be computed

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Table 2C: Descriptive statistics of survey questions-Confidence/Overall Impact
Question Pre-test, n Post-test, n
(%) (%)
PREQ20, POSTQ20
I am confident in my knowledge of HIV.
Strongly agree 1 (10.0%) 4 (40.0%)
Agree 5 (50.0%) 6 (60.0%)
Disagree 4 (40.0) 0 (0.0%)
Strongly disagree 0 (0.0%) 0 (0.0%)
PREQ21, POSTQ21
I am confident in my knowledge of PrEP.
Strongly agree 0 (0.0%) 4 (40.0%)
Agree 1 (10.0%) 5 (50.0%)
Disagree 6 (60.0) 1 (10.0%)
Strongly disagree 3 (30.0%) 0 (0.0%)
PREQ22, POSTQ22
I am confident in my ability to prevent HIV infection.
Strongly agree 5 (50.0%) 6 (60.0%)
Agree 4 (40.0%) 4 (40.0%)
Disagree 1 (10.0%) 0 (0.0%)
Strongly disagree 0 (0.0%) 0 (0.0%)
PREQ23, POSTQ23
I am confident in my ability to distinguish between the high,
low, and no’s of HIV risk.
Strongly agree 3 (30.0%) 7 (70.0%)
Agree 4 (40.0%) 3 (30.0%)
Disagree 3 (30.0%) 0 (0.0%)
Strongly disagree 0 (0.0%) 0 (0.0%)
POSTQ28
The PSA/Zine increased my understanding of HIV.
True - 9 (90.0%)
False - 1 (10.0%)
-- question was not asked in pre- test
* p less than .05
** p greater than .05
*** p value cannot be computed

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 Race/Ethnicity of HIV Prevention Intervention
Other
Participants
11%

Non-Hispanic
White
22%

Hispanic/Latino
67%

Hispanic/Latino Non-Hispanic White Other

Figure 1. Race/Ethnicity

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 Confidence Level in Ability to Distinguish Between the
High, Low, and No's of HIV Risk

7
6
5
4
3
2
1
0
Strongly Agree Agree Disagree Strongly
Disagree

Pre-test Post-test

Figure 2. Pre- and post- test results for participant confidence levels in distinguishing between
the high, low, and no’s of HIV risk

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See attached file labeled Avina_Brehaut_Lopez_Reyes_Data_Dictionary.docx

See attached file labeled _Avina_Brehaut_Lopez_Reyes SPSS HIV Prevention Data.sav

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