Sex, Myths, and Adolescents’ Conceptual Understanding of HIV

Sex, Myths, and Adolescents’ Conceptual Understanding of HIV Alla Keselman (ak454@columbia.edu) and Vimla L. Patel (patel@dmi.columbia.edu) Laboratory of Decision Making and Cognition, Department of Medical Informatics, Columbia University 622 West 168 th Street, VC-5, New York, NY, 10032-372 Abstract Research on knowledge organization and how this develops with education and training may provide insight into the alarmingly limited effectiveness of school HIV education curricula. The present study investigates the nature of adolescent knowledge of HIV and its relationship to reasoning. Middle and high school students were interviewed about their understanding of HIV and were also asked to critically examine problem scenarios that contained myths about HIV. The findings suggest that adolescents lack understanding of basic biological concepts around which they could build well- structured schemata of HIV. As a result, their HIV knowledge exists as a collection of disjointed facts, not conducive to effective application for reasoning. The implications for school-based HIV interventions are discussed. Introduction Despite growing awareness about HIV and AIDS, the outbreak of the disease continues unabated. Current assessments of the demographics of AIDS indicate that the disease disproportionately hurts the young, the poor, and urban minorities (CDC, 1999). Schools respond to the problem by producing educational interventions, aimed to teach adolescents about HIV risks and prevention. In particular, the New York City Board of Education mandates its schools to provide six hours of HIV Education annually at every grade level. Unfortunately, in spite of such educational efforts, the statistics remain grim. Evaluations show that many existing interventions, while succeeding in increasing teenagers’ knowledge about HIV and AIDS, do not lead to the decrease in high-risk behaviors (Brown et al., 1992; Langer & Tubman, 1997). These failures lead HIV educators to a conclusion, currently prevalent in HIV education literature, that knowledge about HIV has little bearing on real-life behavior. We believe that in many previous studies, the relationship between knowledge of HIV and its real-life application was obscured by methodological weaknesses of HIV knowledge assessment measures. Typically, these studies assess knowledge as the ability to answer simple factual questions by selecting from true/false or multiple-choice answer options (Siegel et al., 1995). Such measures do not provide any insight into the nature and organization of adolescents’ HIV knowledge which is critical to its applicability. The present study addresses two questions. First, what is the nature of adolescent knowledge about HIV? Second, to what extent do adolescents apply this knowledge when reasoning and evaluating information in the context of HIV? Answering these questions employing cognitive methods could provide important information for improving HIV Education curricula for American schools. Research on expertise has long established that differences between expert and non-expert knowledge extend well beyond the difference in content richness. Studies show that some forms of knowledge organization are more suited for effective application than others. Expert knowledge is coherent and is organized in meaningful patterns around key concepts and ideas (Chi et al., 1981). In contrast, novices frequently organize their knowledge schemata around superficial surface attributes, rather than big ideas (Chi et al., 1982). Compared to novices', experts' knowledge schemata also contain more interrelations among individual concepts and ideas (Chi et al., 1981). As a result, experts have more efficient methods of deciding which chunks of information are essential for solving a particular problem, of retrieving that information efficiently and of applying it correctly. While novice and expert knowledge represent two endpoints of the trajectory, the development of expertise is a long process, which may be conceptualized as a gradual shift from flat and fragmentary to systematic and multi- layered knowledge structures (diSessa, 1993). This process is non-monotonic; often, an increase in knowledge results in a temporary drop in performance, while the new knowledge is being integrated with the existing knowledge (Patel & Groen, 1991). Studies of lay understanding of health and disease provide us with domain-specific information about the kinds of knowledge that lay people use when reasoning about health issues. When reasoning about health, lay adults frequently rely on their intuition, as well as cultural, social and experiential knowledge (Sivaramakrishnan & Patel, 1993). In doing so, they often misattribute disease causality, viewing symptoms or co-factors of diseases as their causes. Lay scientific knowledge of relevant biological concepts is dissociated from experiential and cultural knowledge, fragmented and is often used opportunistically. This results in low internal consistency, self-contradictions, loose ends , factual errors and misconceptions (Patel, Kaufman, & Arocha, 1999).