Measurement of the effectiveness of an HIV / AIDS intervention programme on knowledge , attitudes , and behaviour of the South African Polise Service employees

Curationis 32 (4): 4-18 This study investigated if there was any change in the HIV/AIDS knowledge, atti­ tudes, and behaviour of the South African Police Service’s (SAPS) employees of Limpopo province after attending the HIV/AIDS intervention programme. From a population o f (N=108) employees, those who attended the HIV/AIDS awareness workshop participated as experimental group (n=51) while those who attended the suicide prevention and disability workshop as control group (n=57). Random sam­ pling method was used to select the above sample. Both workshops were conducted at various places in Limpopo Province. Pre-tests were administered before the work­ shops while the post-tests were administered after the workshops. The results were analysed using 2 (Group: Experimental versus Control Group) x 2 (Time: Pre-test versus Post-test, a repeated measure) Analyses o f Variances (ANOVA). The findings showed that there was a significant change in HIV/AIDS knowledge after employees have attended the HIV/AIDS awareness workshop. There was however no signifi­ cant change in attitude and ehavior after the HIV/AIDS awareness programme. The study recommends that a one day workshop is not enough to change attitude and ehavior. It also recommends that a follow up in the form o f delayed post-test is required to investigate if the ehavior o f the members who promised to change posi­ tively had actually changed as ehavior changes cannot manifest in a one day work­ shop. This can also serve as a suggestion for further research. C orrespondence address Lily Cherian Tel: (015) 268 2876 E-mail: Cherianl@ul.ac.za Kev words HIV/AIDS, Intervention, A ttitude, Knowledge, Behaviour. 4 Curationis December 2009


Introduction
Background AIDS is a pandemic that is posing ma jo r challenges in the world today (Chinery-Hesse, 2000:1).The Depart ment of Health is tasked with the re sponsibility of coordinating HIV/AIDS strategies to all departments, including non-governm ent institutions (Worldbank, 2001:2).Business institu tions also have the duty to implement HIV/AIDS policy in their workplace.According to Government Communi cation and Information System (GCIS), (2003:2), all sectors of government and other stake holders in civil society should be involved in combating HI V/ AIDS through intervention pro grammes.The problem facing the stakeholders in the HIV/AIDS frater nity is whether the implementation of these intervention programmes serves their purpose (i.e., combating the spread of HIV/AIDS, providing knowl edge necessary to fight the pandemic, changing employees' attitudes towards infected and affected em ployees, changing employees' risky behavior towards sexual behavior, etc).There are also limited studies which investigated the employees' knowledge, attitude, and behavior change all in one study with a proper control group after the introduction of HIV/AIDS intervention programmes.
Problem statement: Strategies for com bating HIV/AIDS within SAPS seem to be taking place.While the objective of these intervention programmes is to combat the spread of HIV/AIDS in the workplace, this objective cannot be achieved if employees' mindset is not changed.A verbal communication with Beukes, the HIV/AIDS Programme Manager in the SAPS in the Limpopo Province, indicated that there was no exact statistics or feedback regarding the HIV/AIDS.
Research questions: Do the interven tions add HIV/AIDS knowledge to the employees in South Africa Police Serv ice?Do they change attitude of the South African employees towards HIV/ AIDS related issues?Do these inter ventions change behaviour towards HIV/AIDS related issues?Would these changes be significantly higher than changes that might occur due to the passage of time?

Purpose of the investigation
Therefore, the purpose of this study is to find out whether HIV/AIDS interven tions programmes change HIV/AIDS knowledge, attitudes, and behavior.

Objectives
To identify whether affective factors (knowledge, attitude, and behaviour) differ significantly among SAPS em ployees who have attended the HIV/ AIDS intervention programme and those who have not?
Earlier studies on HIV/AIDS intervention programme, Knowledge,

Attitudes,and Behaviour
HIV/AIDS intervention programmes The purpose of an intervention pro gramme is to change something in or der to help.Both international and lo cal studies reveal that HIV/AIDS inter vention programmes are aimed at changing the spread and the conse quences of HIV/AIDS.Results from Swanepoel (2005:151) indicated that individuals who have received HIV/ AIDS prevention information are more likely to use protections (condoms) during sexual intercourse, ask their part ners about their HIV status, be tested for HIV themselves, and know where to go for help regarding HIV issues.Swanepoel also concluded that HIV/ AIDS prevention information therefore contributed positively to HIV/AIDS prevention behaviour.The HIV/AIDS intervention pro gramme can help in reducing the un protected sex and HIV/AIDS risk related behaviour among people.Using a Pre vention Marketing Initiative (PMI) in a HIV risk-reduction workshop as an in tervention in controlling the spread of HIV/AIDS in five United States sites (Nashville, Tennessee; Newark, New Jersey; Northern Virginia; Phoenix, Ari zona; and Sacramento, California), Kennedy, Mizuno, Hoffman, Baune, & Strand, (2000:236) found the reduced likelihood of unprotected sex among participants.In terms of risk related behaviour, Sikkem a, W inett, & Lombard, (1995:155) discovered that there were encouraging results regard ing the effectiveness of a behavioural skills training program in increasing knowledge, belief, and skill related to HIV risk behaviour reduction.Kuhn, Steinberg, & M athew s, (1994:163) used classroom based activi ties such as information session on HIV/AIDS, open discussion on HIV/ AIDS, and integration of AIDS con tents as HIV/AIDS awareness pro gramme to 276 students whose age ranged from 12 to 30 years in their study of the effect of an HIV/AIDS pro gramme.A questionnaire which was translated from English to Xhosa was used to investigate the effect of the program on knowledge, attitude, and behaviour.The results also confirmed the relationship between the HIV/AIDS intervention programme and the three affective factors.They showed that the program greatly improved students' knowledge of HIV transmission and prevention; increased level of accept ance of people with AIDS (attitude), and had a small impact on behavioural in tention.
Turner, Garrison, Korpita, Waller, Addy, Hill, & Mohn, (1994:270) maintained that the knowledge, attitude, and be haviour scores for all students in the university were significantly higher than those not enrolled in the seminar aimed at promoting responsible sexual behaviour.Between, pre-and post-in tervention, there was a notable signifi cant increase in knowledge and behav iour score for all students enrolled and not for students who did not enroll.Seven hundred and eighty-six students completed anonymous, self reported questionnaires that focused on sexual behaviour, as well as knowledge, and attitude regarding sexual behaviour.
The HI V/AIDS intervention can bolster the person's intention to change.This is evidenced in the work of MacNair-Semands, Cody & Simono (1997:734) when they investigated the effect of intervention on knowledge, attitude, and behaviour.They found that HIV course on college campus increased condom usage, the ability to discuss safer sex with partners, selection of sexual partners, and learning about HIV/AIDS.The majority of students reported making minor attempts at change prior to the course, and enrolled students made increased and more sig nificant attempts to change in the du ration of the HIV course.
HIV/AIDS intervention programmes can expose the individual to HTV/AIDS information and can encourage discus sion on HIV/AIDS related issues.This was revealed after a six month imple mentation of the Non-Government Or ganisation (NGO) HIV/AIDS educa tional program in primary school chil dren in Tanzania, where pupils from the HIV/AIDS intervention school re ported exposure to AIDS information and discussing HIV/AIDS related is sues significantly more frequently than pupils from the comparison school (Klepp, Ndeki, Seha, Hanna, Lyimo, Msuya, Irema, & Schreiner, 1994:1160).Basen-Engquist (1994:412) also found that students in the Safer Sex Efficacy Workshop (SSE workshop) and those in the lecture on HIV (HIV lecture) im proved more from pre-test to post-test in the intention to use condoms than participants in the unrelated topic -fam ily violence lecture (FV lecture).After two months follow up, participants in the SSE workshop increased their fre quency of condom use from pre-test to post-test more than those in the HIV lecture and FV lecture.

Conceptual framework for the study
HIV/AIDS awareness programme is one of the intervention programme that is widely used to change HIV/AIDS knowledge, attitude, and behaviour as explained in the following subections.(2001:380) defines knowledge as the body of information possessed by a person, or by group of persons or culture.It is the mental components that result from processes, be they in nately given or experientially acquired.Knowledge is the remembering of pre viously learned material, which in volves the recall of wide range of mate rial from specific fact to complete theo ries, and it represents one of the levels of the learning outcome in the cogni tive dom ain (G rinhund & Linn, 1990:506).

HIV/AIDS awareness programmes and knowledge change
Researchers believe that HIV/AIDS in tervention can improve one's knowl edge related to HIV/AIDS.The com ponents of HIV/AIDS awareness pro grammes include exhibitions and thea tre productions on HIV/AIDS and STD themes, campaigns linked to World AIDS Days, National Condom Week, or AIDS Memorial Day (Davies, Sch neider, Rapholo, & Everett, 1998:55).Kuhn et al. (1994:164), in their investi gation of HI V/AIDS program on knowl edge, found that students' level of knowledge about HIV transmission, prevention, and the course of the dis ease improved following the AIDS awareness programme as compared to the neighbouring schools in which no specific HIV/AIDS intervention pro gramme took place.Educational pro grams in the United States do a better job of increasing absolute level of know ledge (W ierson & Bright, 1996:261).This is also shared by Wierson and Bright (1996:262); and MacNair-Semands et al. (1997:735) when they averred that the goals of AIDS educational programs are to in crease knowledge.It was also found that higher AIDS risk knowledge lev els significantly predict more condom use in Zimbabwe, whereas this relation ship was only marginally significant for the U.S. college students (Wierson & Bright, 1996:263).
Jem m ott, Jem m ott, and Fong (1989:1535) reported that the HIV pre vention group scored significantly higher in HIV reduction knowledge than those in the control group.HIV/ AIDS reduction knowledge can also help in reducing risk related to HIV/ AIDS issues.Using 157 inner city Afri can American male adolescents from Philadelphia, Jemmott (1996:138) found that adolescents who received the HIV risk-reduction intervention subse quently had greater AIDS knowledge as compared with the adolescents in the control condition.Instruments used in this research included ques tionnaires which were completed be fore, immediately afterwards and three months after the intervention.Interven tions included videotapes, games, and exercises designed to influence AIDS related knowledge, supportive of safer sex practices.Shapiro, Radeckie, Charchian, and Josephson (1999:24) observed that an HIV/AIDS high-risk individual has a greater knowledge about HIV/AIDS disease and is more likely to have been tested for HIV, and is more self confident.Using 319 col lege students in Orange County, Cali fornia, the researchers found that par ticipants who were concerned about the disease and who had taken an AIDS education class had more knowl edge of HIV/AIDS related issues than those who did not.

Attitude
According to McClintock (1972:108), Social Science is equated with the study of attitude, and that is the core con cept of the study of psychology.Atti tude is a tendency to respond in a par ticular way, in a particular situation to a particular object (Cattel, 1965:444).It is a mental predisposition to act that is expressed by evaluating a particular entity with some degree of favour or disfavour.An individual's attitude usu ally focuses on objects, people, or in stitutions.According to Saal & Knight (1995:61) attitude is a relatively stable affective or evaluative disposition to wards a specific person, situation, or other activities.

HIV/AIDS awareness programme and attitude change
HIV/AIDS awareness programmes that take the form o f educational pro grammes and HIV/AIDS workshops and courses can have an effect on the attitude of individual regarding HIV/ AIDS related issues.Klepp, et al. (1994Klepp, et al. ( :1161) ) found that following the educational program, pupils attending intervention schools reported much more restrictive attitudes towards en gaging in sexual intercourse than at baseline.Kuhn, et al. (1994:164) also, found that attitude of acceptance of people who are HIV positive improved due to HIV awareness programmes.The above findings are also supported by Wilry, Edwards, and Dilworth (1991:411) who found that attitude of the experimental group improved after attending an HIV/AIDS issues course while the control group's attitude about AIDS became more negative.
As indicated by Kuhn, et al. (1994:164), whether students can accept someone with AIDS into their class is an item of attitude towards HIV/AIDS.In their study, they maintained that although negative attitudes persisted following the programme, some students recog nised that HIV could not be spread by being in a classroom with someone with HIV/AIDS, showing how positively HIV/AIDS intervention programme can affect attitude towards infected and affected people.The neighbouring  Leshbari (1994:190) claimed that peo ple who had HIV/AIDS knowledge had positive attitude towards spending time with and taking care of people with AIDS than were less knowledgeable people.The above highlights the in terdependence of the affective factors (e.g.knowledge and attitude) on HIV/ AIDS related issues.

Behaviour
Behaviour derives from the word be have, which is to do things in a par ticular way (Wehmeier, 2000:92) (1976:161), provide many useful con cepts with which to understand the etiology and maintenance of behaviour.Hjelle and Ziegler (1987:10) as such averred that learning becomes the cen tral focus of interest for behaviourist.
HIV/AIDS awareness programme and behaviour change MacNair-Semands, Cody & Simono, (1997:736) maintained that an important aim of HIV course or intervention is not only to help students reduce risk be haviour, but also to help them to main tain safer sex behaviour they may al ready have initiated and making these part of a daily pattern.The goals of the health education intervention are to (a) to provide factual information regard ing STD and AIDS as well as preven tion strategies including abstention and safer sexual techniques; (b) to de sensitize students regarding condoms, (c) to present practice communication skill and assertiveness techniques rela tive to potential sexual situations and relationships (Turner, et al. 1994:267).Davies et al. (1998:61) reiterated that an increase in the number of condoms distributed, occurring together with the They should be educated to take charge of their own life and destiny.

Research design
This study used a quantitative research where one emphasises the quantifica tion of constructs, and believes that the duly way of measuring the proper ties of phenomena is through quanti tative measurement (Babbie & Mouton, 2001:49).The study was a causal-comparative cross-sectional survey where all data were collected at the same time.

Ethical measures
In view of ethical issues, the following received particular attention by the

Questionnaire
The instrument used in this study was a questionnaire called HIV/AIDS Knowledge, Attitude, and Behaviour Questionnaire (see Appendix A).The HIV/AIDS Knowledge, Attitude, and Behaviour Questionnaire (HAKABQ) were adopted, and it consisted of items related to HIV/AIDS knowledge, atti tude, and behaviour.The knowledge and attitude items were adopted from Carey and Schroder's (2002:172-182), HIV Knowledge Questionnaire (HIV-KQ-18).The questionnaire was suitable for low income men and women and was internally consistent, stable, sen sitive to the change resulting from in tervention, and also suitable for low lit erary group.The knowledge and atti tude questionnaire was also adopted by the University of Limpopo, Health Behaviour Research Unit during the Development and Evaluation of an HI V-Risk Programme for the First Entering Students in the university in 2001.The behaviour items on the other hand, were adopted from Wayers (2002:9) HIV/ AIDS Behaviour Questionnaire.The questionnaire was used to assess SAPS members who attended the HIV/AIDS awareness workshops (before and af ter the workshop sessions).

HABAKQ
For content validity, the questionnaire was sent to peer educators, HIV/AIDS

Pilot study
The pilot study was done on all five HIV/AIDS coordinators in the SAPS during their annual meeting.From the pilot study, it was found that items that read 'Traditional medicines are a waste o f time in the HIV/AIDS inter vention ' was categorised under HIV/ AIDS behaviour.It was then put in the HIV/AIDS attitude section, as it seeks the judgement of the participant, and not his/her behaviour.There was an item in the HIV/AIDS knowledge sec tion that read 'a man can contract HIV if he has sex with a man This ques tion was found to be wide and as such anal was added before sex and the items read as follow: ' a man can contract HIV if he has anal sex with a man.'

Variables
This research used two kinds of vari ables, namely independent variables and dependent variables.

Independent variables
Independent variables are variables that the experimenter changes within a defined range.They are the variables that can be manipulated by the experi menter, which the experimenter or in vestigator is interested in its possible effect.In this study the HIV/AIDS awareness workshop is the independ ent variable.

Dependent variables
Dependent variables are variables that measure the influence of the independ ent variable.Behaviour, attitude and behaviour are dependent variables.It was hypothesised that their change depended on the HIV/AIDS interven tion programme, in this case the SAPS' HIV/AIDS awareness workshop.

Data collection
Permission was asked and granted from the provincial SAPS authority to con duct the research in the SAPS.On the date of the workshops (HIV/AIDS awareness, suicide prevention, and dis ability), the coordinators of the work shop gave the researcher/s opportu nity to administer the questionnaire.The researcher/s explained to the par ticipants the purpose of the question naire and all that was required of them.Participants were informed that partici pation was voluntary, and that the re sults would only be used for the study purpose and nothing else.They were also requested to sign consent form before participation.The participants were told about the confidentiality of the process, and that anyone could withdraw from participating at any time if he/she desired.They were told that they would be given the pre-test be fore the workshop, and the post-test after the workshop.The same proce dure was followed at the end of the workshop, when the post-tests were administered.

Statistical analysis
This research study used an Analysis of Variance (ANOVA) to analyse if there were statistically significant changes in knowledge, attitudes, and behaviour before and after members attended the HIV/AIDS awareness, suicide preven tion, and disability workshops.It was also used to analyse if there were sig nificant differences between members who attended HIV/AIDS workshop as a research group, and those who at tended suicide prevention and disabil ity workshops as a control group.

Results and discussion
In order to investigate possible differ ences in HIV/AIDS knowledge, atti tudes, and behaviour on pre-test and post-test between experimental and control groups, ANOVAs were com puted.Each ANOVAhad group (2: ex perimental versus control group) as a between-subjects variable and time (2: pre-test versus post-test) as a within subjects-variable.Separate ANOVAs were computed

HIV/AIDS knowledge and HIV/ AIDS intervention programme
The following null hypothesis was tested: Hoi There will not be a statistically significant change in HI V/AIDS knowl edge after employees have attended HIV/ADS intervention programme.
The 2 (Group: Experimental versus Control) x 2 (Time: Pre-test versus post- "correct" answers for each question NB: Bolded answers are considered the test, a repeated measure) Analysis of Variance (ANOVA) was computed on knowledge scores.There was a signifi cant main effect of time, F (1,105) = 21.73,p= .000.There also was a signifi cant main effect of group, F ( 1,105) = 14.07,p = .000.The experimental group scored higher than the control group, and knowledge scores were signifi cantly higher on the post-test than the pre-test (see Table 2).There also was a significant interaction between time and group, F ( 1,105) = 5.03, p = .027.The null hypothesis was therefore, re jected.

HIV/AIDS attitudes and HIV/AIDS in tervention programme
The following null hypothesis was tested: Ho2 There will not be a statistically significant change in HIV/AIDS atti tudes after employees have attended HIV/ADS intervention pro gramme.
The 2 (Group: Experimental versus Control) x 2 (Time: Pre-test versus post test, a repeated measure) ANOVA was computed on attitude scores.There was not a significant main effect of time, F (1,105) = 2.05,/; = .156.There also was not a significant main effect of group, F (1,105) = 2.24, p = .137.There was not a significant interaction between time and group.F (1,105) = HIV/AIDS behaviour and HIV/AIDS intervention programme The following null hypothesis was tested: Ho3 There will not be a statistically significant change in HIV/AIDS behav iour after employees have attended HIV/ADS intervention programme.
The 2 (Group: Experimental versus Control) x 2 (Time: Pre-test versus post test, a repeated measure) ANOVA was computed on behaviour scores.There was a significant main effect of time, F (1.104) = 62.86,p = .000.Participants got higher behaviour scores on the post-test than the pre-test.There was no significant main effect of group, F (1.104) = 0.51 ,p = .478,and no signifi cant interaction between time and group, F ( l,104) = 0.53,/?= .468.There fore, there was not sufficient evidence that the null hypothesis could be re jected.7able 6 shows Pre-test and post test of HIV/AIDS behaviour scores for experimental and control groups.

Conclusions
Table 8 summarises the findings of the present study with regard to changes in knowledge, attitude, and behaviour.Each of these is discussed in the sec tions that follow.

Knowledge change
It was found that knowledge changed in relation to the actual intervention as indicated by post-test being greater that pre-test.It appeared that the one day HIV/AIDS awareness workshop was effective in changing knowledge and that the experimental groups also had higher scores than the control group.

Attitude change
In the present study, attitude did not change after the HIV/AIDS awareness workshop.Whatever differences there were in attitude initially were the differ ences later, and the workshop appeared to have little to no effect in changing people's attitudes.

Behaviour change
Both the experimental and the control groups said their behaviour had changed after the HIV/AIDS interven tion.This was indicated by the post test being greater than the pre-test.Therefore concluding that the HIV/ AIDS awareness workshop changed the HIV/AIDS behaviour would be im proper.

Recommendations
Government institutions should employ HIV/AIDS intervention programmes in the form of HIV/AIDS awareness work shops, where they educate fellow em ployees on other strategies that were created to change their knowledge to wards the pandemic's related issues.Perhaps it takes much more than a one day workshop to impact people's atti tudes and behaviour.
Prior counseling to senior and admin istrative employees is recommended.
Special skills possessed by the social workers, psychologists, and chaplains, who were presenters of the HIV/AIDS awareness workshops, can be used to change the attitude of employees in order to motivate them and to make the workshop fruitful for them.

Limitations for the study
The researcher did not manage to get responses from some of the targeted workshops.The HIV/AIDS awareness workshop in the Vhembe District did not take place and as such they were not included in this study.The Vhembe District is predominantly Venda speak ing employees.The Venda population is one of the official ethnic groups in the Limpopo Province.The exclusion of this ethnic group may mean that the results of this study's findings may not generalise to all ethnic groups in the South African Police Service of the Limpopo Province.Attitude is not something that devel ops in one day.It is made up of events, views, and judgments that develop over time and as such it is not easy to change it in a one day workshop like the HIV/ AIDS awareness workshop.Attitude can be changed by intervention that last for weeks or months, and the im pact of such intervention would need to be evaluated continuously.The time frame between the pre-test and post test of this study was quite short.
Behaviour change in this study was represented by what the employees did previously and the intention of the par ticipants to change what they had been doing, and not the employees' actual behaviour.The actual behaviour could manifest after weeks, months, or years.It would have been better to give peo ple the very same questionnaire as in the pre-test.Due to time constrains and financial limitations, these follow ups could not materialise.

Suggestions for further research
Intention to do something probably overestimates people's actual behav iour.The research could investigate whether the members were behaving the way they had claimed they in tended to behave by conducting de layed post-tests (i.e., one month after

Not at all Sometimes Always
End of questionnaire.Thanks for your time.

T ablel: Sample distribution
school of which the HIV/AIDS educa tion programmes were not available did not experience the improvement.On the other hand, the use of facilitators who are HIV positive in the workshop can increase the positive attitudes towards people with HIV/AIDS(W alters,  1997:17).Andeki, Klepp, Seha, &

Table 2 : Pre-test and post-test change in knowledge
However,Davies, et al. (1998)men tioned that information alone will not result in any behaviour changes re quired for reducing the risk of HIV transmission.People's skills and con fidence need to develop, so that they can behaviourally protect themselves.

Table 7 : Percentage response on HIV/AIDS behaviour before and after attending HIV/AIDS awareness workshop
BABBIE, E&MOUTON, J 2001: The

Table 8 : Summary of findings
People are likely to contract HIV by deep kissing (putting their tongues in their partners' mouth) if their partners are HIV positive.want to do testing because the person who conducts the testing will make my results known to my colleagues.
1 I use condom during sexNot at all Sometimes Always2 I have done an HIV test in the past year.Not at all Sometimes AlwaysI have many sexual partners.