This cross-sectional study aimed to investigate the effects of two educational methods, lecture and role-playing, on improving the stigmatizing attitudes towards patients as a key factor in controlling and preventing the spread of HIV in the vulnerable population
The present study was conducted as a three-armed educational trial at Isfahan University of Medical Sciences on a marginalized population aged 18–49 living in three regions, Falak od Din, Masur, and Poshteh villages in Khorramabad city in 2019.
The sample size was measured using the formula of multi-arm clinical trial studies and considering the differences of mean attitude scores in the role-playing group (95.4) and the lecture group (98.3) according to a study by Abedian et al. (10), confidence level of 95%, 80% test power, and 10% probability of loss during the study, and it was equal to 110 in the control group and 80 per intervention group (lecture and role playing).
There were three health centers in each of the regions and they were considered as classes; and sampling was performed according to the population covered by each center, the share of age and sex groups, and based on the existing list of individuals in Sib website using the simple random sampling. Then, the individuals were contacted by phone and they were invited to visit the relevant centers to participate in the study after evaluating their inclusion and exclusion criteria. If person were unwilling to participate in the study or was not eligible, another person in the same age and sex group would be randomly selected and contacted by phone. The process continued until samples were completed in all age and sex classes. Inclusion criteria: 18 to 49 years old, Iranian citizenship, resident of Falak od Din, Masur, and Poshteh, at least elementary school education, mental ability to understand education and produce response, no known psychiatric disorders or severe visual and hearing impairments, and written informed consent to participate in the study. They were also excluded from the study if they were unwilling to participate in the study or in the case of their death.
Since it was impossible to blind the individuals in a region, and despite their unawareness, they found out after talking to each other that which group they were in, and thus it was decided to randomly allocate based on the regions to meet the condition of blinding the participants. To this end, the residents of Falak od Din and Poshteh were in the role-playing and lecture groups respectively, and the residents of Masur were in the control group.
We collected data using a standard questionnaire. In a study by Tavakoli (2015), the content and face validity of the questionnaire were evaluated by a qualitative method, and the Cronbach's alpha for internal validity was 0.79 for the attitude section, and 0.773 for knowledge section. The main part of the questionnaire consisted of 18 questions (4 items) about the attitude assessment. The other two parts included 24 questions to assess knowledge and 5 questions about demographic information. The way of answering the stigmatizing attitude was based on the 5-point Likert scale (strongly disagree, disagree, natural, agree, strongly agree); and 14 negative questions were scored from 1 (most positive attitude) to 5 (most negative attitude) and 4 positive questions were reversely scored. Therefore, the range of scores obtained from all attitude questions was from 18 (good attitude) to 90 (stigmatizing attitude) so that the highest score indicated a higher stigmatizing attitude. Therefore, participants with a score above the average (score 54) were classified as those with stigmatizing attitudes towards patients. The way of answering the knowledge section was by yes and no, and a score of 1 was given in case of correct answer to each question and a score of zero in case of incorrect answer. Therefore, the range of scores obtained from the total attitude questions was from 0 to 24 so that the lowest score indicated low knowledge.
The educational content was extracted from the booklet "New approach to HIV education" prepared by the Department of AIDS and Sexually Transmitted Diseases in the Ministry of Health and Medical Education (14). In both educational methods, the content was taught about the biology of HIV, epidemic conditions in the province and Iran, transmission methods, and high- risk behaviors, self- preservation skills, as well as negative thoughts and misconceptions about HIV and its patients. The educational intervention was performed in two groups, "lecture" and "role playing", and an educational pamphlet was prepared and given to the two educational groups. The control group received no intervention.
After explaining the research purpose and giving assurance about the data confidentiality, written informed consent was obtained from them and the self-administered knowledge and attitude questionnaire was completed. Then, the interventions including teaching by lecture and role-playing were performed according to the grouping; and the educational schedule was performed in the health community centers and mosques of the marginalized regions one hour per week for a month. Due to very high possibility of displacement and disappearance of individuals in marginal populations, the interval between the end of educational interventions and reevaluation of individuals was considered to be 2 weeks and the questionnaire was completed again for all individuals in the control group and both intervention groups.
We analyzed the data using SPSS and described them by mean, standard deviation, frequency, and frequency percentage. Also, we utilized the independent two-sample t-test, analysis of variance (ANOVA), and Chi-square test at a significance level of 5% to analyze the data. We also examined the effects of differences in groups before the intervention, confounding variables, and the correlation between knowledge and attitude scores on the research results using the multiple analysis. The significance level was 5% in all analyses.