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W, a COMPARISON of KNOWLEDGE and ATTITUDES BETWEEN * NB /w, A COMPARISON OF KNOWLEDGE AND ATTITUDES BETWEEN DIRECTORS OF ATHLETICS AND HEAD TRAINERS IN THE SOUTHWEST AND SOUTHLAND CONFERENCES REGARDING HIV-TRANSMISSION ISSUES IN ATHLETICS DISSERTATION Presented to the Graduate Council of the University of North Texas in Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY By Harold L. Whiteley, B.S., M.S. Denton, Texas December, 1995 * NB /w, A COMPARISON OF KNOWLEDGE AND ATTITUDES BETWEEN DIRECTORS OF ATHLETICS AND HEAD TRAINERS IN THE SOUTHWEST AND SOUTHLAND CONFERENCES REGARDING HIV-TRANSMISSION ISSUES IN ATHLETICS DISSERTATION Presented to the Graduate Council of the University of North Texas in Partial Fulfillment of the Requirements For the Degree of DOCTOR OF PHILOSOPHY By Harold L. Whiteley, B.S., M.S. Denton, Texas December, 1995 Whiteley, Harold L., A comparison of knowledge and attitudes between directors of athletics and head trainers in the Southwest and Southland conferences regarding HIY-transmission issues in athletics. Doctor of Philosophy (Higher Education), December, 1995, 326 pp., 13 tables, references, 295 titles. The purpose of this study was to investigate and compare knowledge and attitudes of directors of athletics and head trainers in the Southwest (Division 1 A) and the Southland (Division 1AA) Conferences concerning HIV/AIDS issues related to transmission, prevention, and protection within college athletics programs. The results of this qualitative study provided descriptive data from university administrators within the athletics setting who are responsible for providing adequate student athlete health care services from developed and implemented administrative policies that directly or indirectly affect a student athlete's physiological and psychological well-being. Overall, N = 28 represents 82.4% (28 of 34) of accessible participants from the target population within the SWC and SLC. A three-section survey instrument, containing 258 items was used, yielding the following reliability measures: knowledge, r = .83; attitudes, r = .82. The survey collected 7,224 responses during the 1994 fall semester compiling demographic, knowledge, and attitudinal data for qualitative analysis, resulting in demographic and attitudinal profiles for directors and trainers. The attitudinal data collection used a Likert-type format concerning 12 broad-based areas related to HIV transmission, prevention, and protection issues within college athletics. Head trainers had a significantly higher knowledge mean score when compared to the directors at the .05 level regarding the ANOVA, utilizing the Tukey/Kramer method incorporating the Q distribution for small and unequal n group sizes. Directors showed a moderate-to-low knowledge level concerning HIV/AIDS issues compared to the head trainers, who had a moderate-to-high knowledge level. Homogeneity existed between the two groups concerning demographic and attitudinal profile characteristics. However, dissimilar demographics included areas regarding certification status, continuing education activities, community and campus use of resources, and perceived workplace compliance differences. Observed attitudinal differences concerned protection of confidentiality and the perceived severity of HIV/AIDS as a public health dilemma among various subpopulations within the higher education community. 11 Copyright by Harold Lee Whiteley 1995 m TABLE OF CONTENTS Page LIST OF TABLES vi Chapter 1. INTRODUCTION 1 Rationale for the Study Statement of the Problem Purpose of the Study Research Questions Delimitations Definition and Explanation of Terms 2. SYNTHESIS OF RELATED LITERATURE 16 Introduction Historical Perspectives of HIV/AIDS Biotechnical Review of HIV Public Health's Response to HIV/AIDS Sociological Review of HIV Higher Education and HIV/AIDS Intercollegiate Athletics Review of HIV 3. PROCEDURES FOR THE COLLECTION OF DATA 121 Selection of the Methodology Survey Method Research Population Research Instrument Procedures for the Analysis of Data IV 4. ANALYSIS OF DATA 131 Research Questions for the Study Use of a Three-section Survey Instrument Survey Section 1: Demographic Profiles Analysis Survey Section 2: Knowledge Scale Analysis Survey Section 3: Attitude Scale and Profiles Analysis 5. SUMMARY OF THE FINDINGS, CONCLUSIONS, AND RECOMMENDATIONS 190 Summary of the Study Discussion of the Findings Conclusions Implications of the Findings Recommendations for Future Research APPENDIX 231 A. Global Review of HIV/AIDS B. Sample Letter: Review-Panel C. Cover Letter to Survey Instrument D. NATA Support Letter Accompanying Survey E. Survey Instrument REFERENCES 299 LIST OF TABLES Table Page 1 Survey Participants by Athletics Conference and Job Title 132 2 Pictorial of the Study's Survey Instrument 134 3 Demographic Profile for Athletics Directors 135 and Head Trainers (Items 1-6) 4 Demographic Profile for Athletics Directors 136 and Head Trainers (Items 7-9) 5 Demographic Profile for Athletics Directors 138 and Head Trainers (Items 10 - 14) 6 Athletics Directors' and Trainers' Level of Awareness and 141 Their Respective Departments' Compliance With Professional Groups' HIV Transmission Protection Regulations and/or Recommendations, Guidelines and Policies (Items la - 4b) 7 Athletics Directors' and Trainers' Level of Awareness and 143 Their Respective Departments' Compliance With Professional Groups' HIV Transmission Protection Regulations and/or Recommendations, Guidelines, and Policies (Items 5a - 7b) 8 Summary of Knowledge Scale ANOVA for a Significant F Ratio ... 152 9 Data for the Tukey/Kramer (TK) Method Utilizing the 153 Q Distribution 10 Summary ANOVA for Tukey/Kramer (TK) Method 153 VI 11 Summary of the Q Statistic Utilizing the TK Method 154 for Significance 12 HIV and AIDS-Related Knowledge Levels for Trainers 156 and Directors 13 Responsibility for the Delivery of HIV/AIDS Transmission 162 Protection Education Vll CHAPTER I INTRODUCTION TO THE STUDY A Serious Medical Crisis of the 1990s The Human Immunodeficiency Virus (HIV) epidemic is a public health awareness, prevention, and protection problem. Its impact goes well beyond jurisdictional, ethical, moral, and legal barriers. There are no medical cures for HIV and Acquired Immunodeficiency Syndrome (AIDS), with none expected in the foreseeable future. HIV impacts people regardless of their attained educational levels, social, and economic status regardless of their specific race, sex, age, and creed. HIV kills with total indifference and effectiveness among individuals who participate in specific HIV risk behaviors. New AIDS cases due to heterosexual transmission have increased over 100% for males and females from 1989 through 1992 (Novello, Surgeon General 1993). A 1993 CDC study showed HIV infections declining among gay men but rising sharply among blacks, teens, and women. The HIV and AIDS health crisis in the United States "is of immense significance ... and will remain so beyond this millennium" (Vermund, 1993, p. 2817). Adolescents and young adults' HIV transmission guarantees the continuation of the HIV/AIDS epidemic for future generations (American Medical Association [AMA], 1993). Jonsen of the National Research Council (1993), warns that the HIV epidemic is shifting into various minority populations, such as racially and sexually oriented, IV-drug-related, women and respective age groupings that are less politically potent than the gay community. Speaking as Chairman for the National Research Council, Jonsen stated: The disease will become endemic in a way that will allow us in the dominant society not to notice it. We will not turn our eyes to it, because we don't really care about those communities, and that means AIDS now enters the list of other social injustices that we tolerate in society (McCarthy, 1993, page 430). AIDS is considered to be the ultimate communicable disease crisis of the 1990s and into the 21st century (Brown and Pruett, 1990). AIDS has killed over 6 million people worldwide, with nearly 20 million people HIV-infected and the numbers increasing daily at a rate of 5,000 to 10,000 new cases (AMA, 1994). The median time to develop AIDS in HIV-1-infected people is from 7 to 10 years. However, it is still not clear what proportion of those infected will eventually develop severe HIV-1 disease (Cooper, Tindall, & Swanson, 1990). Education is the only known effective prevention and protection health tool to effectively and efficiently combat HIV transmission and AIDS-related illnesses today. Now in the epidemic's second decade of existence HIV and AIDS remain as sports health care related issues, and will continue to impact the higher education sector for the foreseeable future. Leadership Within Intercollegiate Athletics Health Care Intercollegiate athletics administrators and athletic trainers make daily policy and health care service decisions that affect all student athletes. This has a long-range impact on student athletes and sport programs support staff that should be carefully considered. Critical decisions about athlete health care services in higher education should be made with an interactively comprehensive understanding regarding HIV transmission prevention and protection objectives. One example of a complex HIV-related issue concerns a debate whether to exclude HIV-infected athletes from competition in contact sports. In 1995 the legality of excluding HIV-positive athletes from sports competition is uncertain. The Americans With Disabilities Act of 1990 and the Rehabilitation Act of 1973 prohibit unjustified
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