International Research Journal of Applied and Basic Sciences

© 2013 Available online at www.irjabs.com

ISSN 2251-838X / Vol, 4 (2): 341-347
Science Explorer Publications

Assessment and Comparison of the Effects of

Lecture and Pamphlet Health Education Methods in
the Fields of AIDS on Knowledge and Attitude of
University Students
Seyede Zahra Ghaemi1*, Parisa Rostambeigi2, Azam Roshandel3
1. Department of Midwifery, Estahban Branch, Islamic Azad University, Estahban, Iran.
2. Department of Midwifery, Estahban Branch, Islamic Azad University, Estahban, Iran.
3. Msc of Mental Health Nursing, Department of Nursing,Zanjan Branch, Islamic Azad
University,Zanjan,Iran.

Corresponding Author email: Z_Ghaemi@iauestahban.ac.ir

ABSTRACT: Prerequisite for behavior modification activities to reduce the spread of AIDS,
especially with regard to the lack of currently available therapies, is an increase in knowledge and
attitudes of at risk groups. The most vulnerable groups against diseases such as AIDS are youths.
To control and reduce the disease risk, after identifying the groups at risk and measuring their
awareness, risk factors and transfer ways should be explained and transparent information on
prevention be offered. This study has been undertaken with the aim of assessing knowledge and
attitudes of students as vulnerable for AIDS, the impact of education and suitable method of
presentation This experimental study has been performed on 2,000 of non medical students of
Estahban Azad University with simple sampling method. Data based on a questionnaire, designed
by the researcher, containing 3 parts of demographic information knowledge (21 items), attitudes (11
items) were collected. In order to gauge students' knowledge and attitude, a pre test was held. Then
subjects were randomized to three groups: education through lectures, pamphlets and non-
intervention group. After 3 weeks a post test to determine the effect of education on students'
knowledge and attitudes was held. Data using statistical SPSS software (version 18) by employing
T-Test, chi square and covariance tests were analyzed The results based on the first test were as
follows: research units subjects' awareness of AIDS, 19% poor, 10% were excellent .89.2% did not
know the disease incubation period time.63.4% did not know that the disease can be transmitted
even in the incubation period.82.7% did not know about the correct way of disease prevention.
92.3% believed that education is necessary.70.2% of students believed that a case with AIDS should
not be allowed to attend classes. The results of the second phase (post -test) in the three groups
contained following changes: mean score of knowledge in teaching group by lecture was: 9.7% poor,
42.4% excellent, the pamphlet group was: 13.9% poor, 36.2% excellent, and in the self-study group
(no intervention): knowledge of 18.9 percent was poor and 11.9% excellent. Knowledge and attitudes
of students after the lecture method in comparison with other groups significantly increased (p
<0.05).Results of a recent study showed that knowledge of students as educated ones and at risk
was low. Since many of the problems of human society is due to ignorance and given the increasing
prevalence of AIDS, training and continuing education programs for at risk groups to improve their
awareness seems necessary

Keywords: Education, AIDS, Attitude, Knowledge

INTRODUCTION

AIDS which is composed of "Acquired", "Immunodeficiency", and "Syndromes" (Shahabi,) is an

acquired immunodeficiency syndrome which is transmitted by Human Immunodeficiency Virus (HIV) (World
Health Organization 2008).Nowadays, AIDS is considered as a major health problem and the most important
challenge of the health system by the political as well as social authorities of and those involved in the world’s
health affairs (Al-Ghanim 2005).HIV is quickly spreading in the world infecting, weakening, and killing people at
the beginning of life (Raisler & Cohn 2005). Based on the report by World Health Organization (W.H.O.) in
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (2), 341-347, 2013

2008, 33.2 million HIV-positive individuals lived around the world up to 2007 and every year, 2.7-3 million
people are added to this measure and 2.1 million individuals die due to AIDS (World Health Organization 2008).
Today, the disease has been present for three decades and is now a world epidemic which threatens the global
community (Mazloomy et al .2005 ).The first HIV-infected cases in Iran were identified among 5 blood
recipients in 1987 (Center for Disease Control (CDC) 2004).Due to adjacency to the northern neighbors, the
eastern part of the continent and the East Mediterranean Region which have the highest rate of infection
spread, Iran has been located in a high-risk geographical status (Akbari & Sedaghat 2007).According to the
statistics published in the first half of 2010, 7.4% of females and 6.92% of males suffering from AIDS were
recognized (Simbar et al.2004, Kolahi & Halaj Zadeh .2007,Mozaffarzadeh & Vahdaninia .2008).Due to the
high sense of curiosity, friends’ pressure, increasing marriage age, lack of sex education, lack of knowledge
and skills, risk of experiencing unsafe sexual relationships, and using drugs, the youth are the most important
vulnerable group around the world (Simbar et al .2004 , Mohammad Nejad et al.2011).The ministry of health
also has alerted about the decreasing age at HIV infection and distribution of psychotropic drugs especially
among the youth and has emphasized the necessity of executing preventive programs for controlling AIDS in
the society (Mohraz & Motamedi .2008, Disease Control Center 2010).
Investigations carried out in different societies have shown the youth’s various knowledge levels
regarding AIDS which is mixed with wrong beliefs as well as socio-cultural factors (Mwambete & Matatura
.2006, Jenkins & Arobalino.2008).Considering the importance of controlling this fatal, communicable disease
and due to the lack of effective treatment facilities or preventive vaccines (Savaser 2003), paying more
attention to the preventive methods seems logical. According to a study conducted in the U.S. in 2008,
prevention from getting infected with AIDS was 28 folds cheaper than treating the patients and a
comprehensive prevention program could prevent millions of individuals from getting infected with the disease
(United Nations 2008).One of the best preventive methods is providing information. In this method, in case the
information is frankly stated and the message is clearly transmitted, both the worry of being at risk and the
stress of spread of rumors as well as superstitions are reduced (Jalali 2004). Thus, since no definite vaccine
and treatment is there for AIDS, the only and most important strategy to defend against the disease is
educating and improving the knowledge level of the society members, particularly the vulnerable groups. Of
course, this aim can only be achieved by determining the individuals’ knowledge level as well as their
educational needs, educational planning, and training the individuals using different methods in order to
increase their knowledge and attitude. Students are in fact the society’s future. Therefore, the present study
aims to investigate the knowledge level of the students as the educated while at risk group of the society,
combine some educational methods and assess the effect of information provision on the subjects’ knowledge
and attitude, and determine the most effective educational method.

METHODS

The present experimental study was conducted on 2000 non-medical students of Estahban Azad
University, Iran. ( N= ).
In this study, two questionnaires were designed for assessing the students’ knowledge and attitude.
The first section of the questionnaire included the demographic information, such as age, sex, number of family
members, and parents’ occupation and level of education. Some questions were also posed regarding the
students’ source of information about AIDS. In order to determine the validity of the questionnaire, content
validity method was used; in a way that first the questionnaire was prepared by studying books as well as
journals in this field and its content validity was assessed by the specialists. In addition, the reliability of the
questionnaire was determined using the test-retest method. In doing so, the questionnaire was distributed
among some students with a 7-day interval, the correlation coefficient between the responses to the two tests
was measured, and the problems were eliminated(R= 0.85).
The knowledge questionnaire which consisted of 21 multiple-choice questions aimed to assess the
students’ knowledge of the epidemiology of AIDS in Iran, the most HIV-infected individuals in Iran, the most
important transmission routes and prevention strategies of AIDS, the factors threatening the society members’
health, tattooing, make up, using shared food or glasses, shaking hands with infected individuals, infection
transmission from the mother to the fetus, using shared syringes, homosexuality, sexual relationships, using
condoms during sexual intercourse, washing hands, doing vaccination, and dental supplies. On the other hand,
the attitude section aimed to investigate the students’ attitude regarding how to treat the HIV-infected
individuals, socio-ethical aspects of AIDS, sitting beside the infected individuals, the right of freely attending the
classes and the society, the right of hiding their disease, the infected individuals’ degree of guiltiness, and their
right of getting married and having children. This section included 16 True/False and Agree/Disagree questions
and the students could also write their opinions for each question if they liked to. At first, a pre-test was run and
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (2), 341-347, 2013

the students were required to complete the questionnaires. After completion of the 2000 questionnaires, the
students were randomly divided into 3 groups. The first group attended 25-member classes for three 1-hour
sessions and was trained by the researchers through lecture, question and answer, power point, and showing
pictures. The second group was provided with 3 pamphlets (1 pamphlet a week) containing educational issues
as well as pictures. Finally, the third group was required to refer to information resources for finding the correct
responses during 3 weeks. Then, the students took the post-test and the questionnaires were coded and
reviewed. Each question in the attitude and knowledge questionnaires received 1 and 2 points, respectively.
Accordingly, knowledge mean scores of below 10, 10-20, 21-30, and 31-42 were considered as weak, average,
good, and excellent, respectively. The subjects’ attitude was also determined by computing the mean scores
out of 100. Finally, the data were entered into the SPSS statistical software (Version 18) and analyzed using t-
test, Chi-square test, and analysis of covariance (ANCOVA). Also, ANOVA was used in order to compare the
data.

Ethical considerations
The study was abided by Helsinki Declaration at all stages and approved by the Ethics Committee of the
university.
RESULTS

Among the study participants, 48.7% were female and 51.3% were male. In addition, 26.7% of the
subjects were in the 21-year-old age group. Besides, 34.2%, 25.5%, 15.3%, and 24.7% of the participants
majored in architecture, civil engineering, surveying, and other majors (geology, mathematics, and agriculture),
respectively. Moreover, the mothers of 39.6% of the participants had diplomas or high school education, while
those of 8.2% were illiterate. On the other hand, the fathers of 44.9% of the participants had above diploma
degrees, while those of 2.1% were illiterate. Furthermore, 43.6%, 52.7%, and 3.7% of the study subjects
mentioned their source of information to be scientific as well as non-scientific journals and books, radio and TV,
and teachers, respectively (Graph 1).
According to Table 4 and the results of the pre-test, 59.7%, 11.3%, 19%, and 10% of the participants
had average, good, weak, and excellent knowledge of AIDS, respectively. In addition, 89.2% of the subjects did
not have any information about the disease’s incubation period and 63.4% did not know that the disease can be
transmitted even in the incubation period. Besides, 82.7% of the students had no idea about the best
prevention method of the disease and 98.5% knew that the disease can be transmitted through shared needles
and syringes. Considering the disease manifestations, 60.2%, 31.2%, 20.6%, and 33.4% of the study subjects
had accurate information about weight loss, continuous profound fatigue, swollen lymph nodes, and skin
manifestations, respectively. Overall, the males’ knowledge scores were higher than those of the females
(21.03(2.72) vs. 19.76(2.43)). The results of the t-test also revealed a significant difference between the
knowledge mean scores based on sex (P<0.05).The study results showed that the highest and the lowest
knowledge mean scores were related to 24-26 year-old and 20 year-old age groups, respectively 24.8±3.3 vs.
18.41±3.7 and no statistically significant relationship was found between the level of knowledge and age.
Considering =0.05, no significant difference was observed between the study subjects’ knowledge mean
scores based on the field of study. On the other hand, a significant relationship was observed between the
subjects’ knowledge mean scores and mother’s level of education. Furthermore, the knowledge mean score of
the subjects who had introduced the mass media as their source of information was higher than that of the
other groups (24.9±2.24). On the other hand, the lowest knowledge mean score was related to those who had
mentioned their teachers to be their source of information (29.02±2.74) and the difference was statistically
significant (P<0.05).Among the participants, 87.3% had a correct attitude that the society was at risk and 92.3%
believed in the necessity to educate the students. Moreover, 88.8% of the students believed that the HIV-
infected individuals should not have children, 70.2% stated that they should not be allowed to attend classes,
and 27.1% believed them to be guilty. Furthermore, 97.8% of the subjects believed that such individuals do not
have the right to hide their disease and it is the other society members’ right to decide about communication
with this group. Overall, the females’ mean score of attitude was higher than that of the males; however, the
difference was not statistically significant (P>0.05). Considering =0.05, no significant difference was observed
between the subjects’ attitude mean scores based on age.
According to the results of the post-test, 34.8%, 13.1%, 9.7%, and 42.4% of the lecture education
subjects had average, good, weak, and excellent knowledge levels, respectively, while these measures were
obtained as 37.6%, 12.3%, 13.9%, and 36.2%, respectively in the pamphlet education group. On the other
hand, 56.2%, 13%, 18.9%, and 11.9% of the control group subjects had average, good, weak, and excellent
knowledge levels, respectively (Table 1 and Graph 2). Table 2 separately shows the mean and Standard
Deviation (SD) of the 3 groups’ AIDS knowledge level before and after the education. As Table 3 depicts,
education was effective in increasing the level of knowledge regarding AIDS. The results of ANCOVA also
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (2), 341-347, 2013

revealed the significant effect of education on increasing the students’ knowledge level (F=153773.7).The
effectiveness of each education methods was assessed using the results of post-hoc test. According to Table
4, both lecture and pamphlet education methods were effective in increasing the level of knowledge. However,
comparison of the two methods showed that the lecture method was more effective in increasing the students’
level of knowledge regarding AIDS compared to the pamphlet method. Moreover, 97.8% of the participants in
the lecture group, 95.3% in the pamphlet group, and 83.9% in the control group had developed a correct
attitude about the society’s being at risk after the education. Furthermore, 23.5%, 33.1%, and 72.9% of the
participants of the lecture, pamphlet, and control group, respectively believed that the HIV-infected students
had the right to attend classes. Also, 9.3%, 15.76%, and 28.4% of the lecture, pamphlet, and control group,
respectively believed that the HIV infected individuals were guilty.
Table 5 separately shows the mean and SD of the 3 groups’ positive attitude toward AIDS before and
after the education. As Table 6 depicts, education was effective in enhancing the positive and logical attitude
toward the HIV patients. The results of ANCOVA also showed the significant effect of education on increasing
the students’ logical attitude toward the HIV patients. The effectiveness of each educational method was
investigated using the results of post-hoc test. According to Table 7, both educational methods were effective in
creating a positive and logical attitude. Nevertheless, comparison of the two methods showed that the lecture
method was more effective in enhancing the students’ positive attitude toward the HIV patients compared to the
pamphlet method.

DISCUSSION

The daily increasing prevalence of AIDS in the Middle East and Iran is undeniable. Up to now, no
treatment has been found for this disease and the only way to defend against it is finding the vulnerable groups
and increasing their knowledge of this fatal but preventable disease (Anderson-Ellstrom 1996).The present
study was conducted on 2000 students of various majors in order to determine their knowledge and attitude
toward AIDS. After investigation of the primary knowledge level, the students were trained and evaluated in
order to determine the effectiveness of health information transmission methods and identify the best method
for transferring health-educational messages.
The results of the current study revealed low knowledge level of the students as a sample of the
society. After passage of 3 decades from the disease presence, the students, as the educated while at risk
group, had a low level of knowledge regarding AIDS; such a way that 59.7% of the participants had an average
knowledge level of the disease, 82.7% had no information about the best prevention method of the disease,
and 70.2% believed that HIV-infected individuals should not be allowed to take part in classes. Ayranci
conducted an epidemiological study in Turkey in 2005 and reported that the participants’ knowledge level was
almost good to good and significantly related to their level of education (Ayranci 2005). Moreover, Buskin
performed a study on Chinese students and showed their average knowledge level regarding AIDS. He also,
reported that 59% of the students were willing to live with the HIV-infected individuals in one society (Buskin et
al .2002). Furthermore, the results of the study conducted by Kigongo on non-medical students in Uganda
showed that the students had a high level of knowledge regarding AIDS, but did not have an appropriate
prevention behavior (Kigongo Sekirime et al .2001).In the study by Mirnejad et al., medical students revealed to
have a low knowledge level (Mirnejad et al.2009). Overall, review of various researches and comparison of the
level of knowledge around the world shows the necessity of education in Iran.
The findings of the present study showed that most of the students had mentioned radio and TV as
their most important sources of information, which is in agreement with the results of the study by Panahandeh
et al (2004). Investigation of the results of several studies conducted in Iran and comparing them with the
findings of the studies performed in the world shows the Iranian youth’s low level of knowledge (Mirnejad et
al.2009, Panahandeh & Taramian 2004, Omidvar 2006, Ghorbani et al.2009). Many problems of human
communities result from ignorance and this supposition is to a great extent true in many life aspects,
particularly health and treatment dimensions (Simbar et al .2006). Moreover, the prevalence of AIDS is
increasing in the Middle East and Iran and our country is exposed to the third wave of AIDS. Thus, considering
the fact that no treatment has been found for this fatal but preventable disease and the only way to defend
against it is finding the vulnerable groups and increasing their knowledge of the prevention methods, training
and continuing education programs are necessary for the vulnerable groups in order to enhance their level of
knowledge. Also, the youth have to be informed about the nature of the disease as well as the danger of high-
risk behaviors and be clearly trained regarding the prevention methods of AIDS (Little et al. 2002). The findings
of the current study showed a significant difference between the levels of knowledge and attitude before and
after the education, which is consistent with the results of the study by Mahmoudifar (2009).
In this study, the students were trained either using pamphlets or through lectures accompanied by
showing pictures, free discussion, and question and answer. The study results showed a significant increase in
Intl. Res. J. Appl. Basic. Sci. Vol., 4 ((2), 341-347,
3 , 2013

the students’ level of knowledge and attitude in both methods (P<0.05);

(P<0.05) however,
owever, the lecture method revealed
to be more effective compared to the pamphlet method (Table 7). Nevertheless, no significant difference was
observed between the control group’s
group’s knowledge and attitude scores in the pre pre- and the post-test
post test (P>0.05).
Thus, using pictures accompanied by verbal, face face-to-face
face education is more effective in transmitting the
message. The study conducted by Klepp in Tanzania also revealed that education regarding AIDS and its
prevention methods w was
as quite effective in the youth’
youth’ss health (Klepp
Klepp et al .1994).
.1994).
Since the aim of education is improving knowledge and knowledge affects the attitude which affects the
behavior (Robinson
(Robinson et al .2000),
.2000), it should create the skill for preventing high high-risk
risk behaviors. Thus, if an
individual knowledge does not improve one
individual’s one’ss skills in dealing with high
high-risk
risk behaviors, it cannot reduce the
spread of the disease (Center
(Center for Disease Control (CDC) 2010 2010). Moreover, teaching how to prevent AIDS and
modifying the society’s negative attitude toward AIDS AIDS as well as its related stigma is the health system’s duty
and of course cannot be achieved without the cooperation of other organs.
Considering the fact this study was conducted on non non-medical
medical students and taking their knowledge
level into account, AIDS should not be covered up in the country anymore and the necessary information about
the disease should be included in the curricula of non non-medical
medical students. Furthermore, according to the findings
of the present and other similar studies, due to the educat educational
ional role of the mass media as well as their
availability for the people and particularly the youth, by improving both quantity and quality of their programs,
radio and TV can play a critical role in enhancing the individuals’ knowledge and consequently ccreating reating a
correct attitude. Nevertheless, due to the cultural atmosphere of the society, the mass media are faced with a
lot of limitations for presenting explicit trainings regarding the transmission routes and prevention methods of
the disease. Therefore
Therefore,, the families should be notified about the sensitivity of the issue and sought for help in
preventing the disease.
CONCLUSION

If prevention is the only way for avoiding the spread of the disease, determining and enhancing the
students’ knowledge and attitude levels can be a step toward designing systematic plans for presenting the
necessary education. The findings of the present study confirmed the necessity of a regular, effective
educational program for improving the youth’s knowledge and attitude toward AIDS. In fact, universities should
be considered as one of the major foci of AIDS reduction strategies and the necessary infor information
mation regarding
the disease should be provided for the students in the universities all over the country. Overall, focusing on the
educational needs of the youth, as one of the vulnerable groups of the society,
society, is of utmost importance.

!"

#
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (2), 341-347, 2013

% & ' ' (

Graph 2. Frequency Distribution of the Study Groups Based on the Level of Knowledge

Table 1. Frequency Distribution of the Study Groups Based on the Level of Knowledge
Knowledge Pre-test Lecture method Pamphlet method Control post-test
level
Weak 19 9.7 13.9 18.9
Average 59.7 34.8 37.6 56.2
Good 11.3 13.1 12.3 13
Excellent 10 42.4 36.2 11.9

Table 2. Mean and SD of the Study Groups’ Knowledge Levels

Pre-test Post-test
Mean SD Mean SD
Control group 21.43 2.45 21.60 2.78
Lecture method 21.03 2.34 36.21 3.01
Pamphlet method 21.19 2.76 28.12 2.98

Table 3. The Effect of Education on the Level of Knowledge

Source of effect SS df MS F Significance level
Pre-test 336310.207 1 336310.207 3363705.000 0.01
Education 30749.228 2 15374.614
Error 199.364 1994 0.100 153773.704 0.01

Table 4. Comparison of the Effect of Different Education Methods on the Level of knowledge
Mean difference Significance level
Lecture and control 14.61 0.01
Pamphlet and control 6.52 0.01
Lecture and pamphlet 8.09 0.01

Table 5. Mean and SD of the Study Groups’ Attitude

Pre-test Post-test
Mean SD Mean SD
Control group 30.12 3.12 30.67 3.05
Lecture method 30.35 3.67 45.12 4.12
Pamphlet method 30.81 3.43 36.41 3.89

Table 6. The Effect of Education on Changing the Attitude

Source of effect SS df MS F Significance level
Pre-test 118612.450 1 118612.450 16466.402 0.01
Education 1101.032 2 550.516
Error 14363.382 1994 7.203 76.426 0.01

$
Intl. Res. J. Appl. Basic. Sci. Vol., 4 (2), 341-347, 2013

Table 7. Comparison of the Effect of Different Education Methods on Changing the Attitude
Mean difference Significance level
Lecture and control 14.35 0.01
Pamphlet and control 5.74 0.01
Lecture and pamphlet 8.69 0.01

ACKNOWLEDGEMENTS

The authors would like to thank the Research Vice-chancellor of Estahban Azad University, the
students, and all the individuals who cooperated in carrying out this research.

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