J Dent Educ. 69(2): 266-269 2005
© 2005 American Dental Education Association
Milieu in Dental School and Practice |
Attitudes of Dental Hygiene Students Toward Individuals with AIDS
Leonard A. Cohen, D.D.S., M.P.H., M.S.;
Elaine Romberg, Ph.D.;
Debra A. Dixon, R.D.H., M.S.;
Edward G. Grace, D.D.S., M.A.
Key words: dental hygiene students, attitudes toward AIDS, attitudes toward homosexuals
Submitted for publication 06/29/04;
accepted 11/03/04
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Abstract
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This study was undertaken to gain a better understanding of dental hygiene students’ attitudes toward AIDS and homosexuals. Each respondent received a 500-word patient case vignette and two scales for recording impressions of the person described in the vignette. There were four vignettes, identical except that the portrayed individual’s illness was identified as either AIDS or leukemia, and sexual preference as either homosexual or heterosexual. No differences in overall ratings on either scale were noted based on the patient’s disease status or sexual preference or the interaction between sexual preferences with disease type. Similarly, neither scale displayed significant differences on any of the individual items based on the patient’s sexual preference. There were, however, significant differences for several individual items on both scales based on the patient’s disease type; students responded more negatively to individuals with AIDS. It appears, therefore, that the hygiene students displayed no bias toward homosexuals and only very minimal bias toward individuals with AIDS.
HIV/AIDS continues to represent a major public health challenge. In the United States, approximately one million individuals suffer from this condition.1 The importance of training dental providers to effectively treat these patients has been widely recognized.2,3 Effective treatment involves not only technical expertise, but also appropriate interpersonal and behavioral aspects of care delivery as well.4,5 As future oral health providers, the attitudes of dental and dental hygiene students toward individuals with AIDS are of particular importance. A number of studies published between 1988 and 1997 involving dental6–11 and dental hygiene students12 documented that students exhibited bias toward individuals with AIDS as well as a more generalized homophobia.13–15 A report published in 2000 found dental students to be free of homophobia as well as to display a diminished level of bias towards individuals with AIDS.16 The present study was undertaken to gain a better understanding of dental hygiene students’ attitudes toward AIDS and homosexuals.
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Methods
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Study methods were identical to an earlier study that investigated whether dental students negatively stigmatize patients with AIDS and/or homosexual lifestyles.16 Dental hygiene students at a northeastern dental school were surveyed. The sample included twenty-two juniors, twenty-two seniors, and nine degree completion students.
Anonymous questionnaires were administered during class. Each respondent received a 500-word patient case vignette and two scales for recording impressions of the person described in the vignette. There were four vignettes, identical except that the portrayed individual’s illness was identified as either AIDS or leukemia, and sexual preference as either homosexual or heterosexual. A complete description of the vignettes has been reported previously.13,17 The particular vignette received by each student was determined randomly. After reading the patient vignette, students completed two scales designed to elicit their attitudes. The items on each of the scales were rated on a five-point Likert scale. The Prejudicial Evaluation Scale (PES) consisted of twelve items developed by Kelly et al.17 that were adopted from prior studies examining interpersonal judgments of victims,18 in addition to anecdotal reports from patients with AIDS that described negative attitudes they had faced. The PES was intended to assess prejudicial attitudes toward the portrayed patient. The Social Interaction Scale (SIS), also developed by Kelly et al.,17 contained seven routine social/conversational interactions that might occur with the individual described in the vignette and measured the respondent’s willingness to interact with him or her.
Responses to both scales were subjected to two-way analyses of variance that examined differences associated with the patient’s disease status (AIDS versus leukemia), sexual preference (heterosexual versus homosexual), and the interaction of sexual preference with disease status. Individual item differences were explored with t tests. In addition, t tests were used to examine differences based on the respondent’s number of years of clinical-related experiences other than their formal dental hygiene training. Chi-square was used to analyze the response rates to the different vignettes. A p<0.05 was considered significant.
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Results
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A total of forty-two usable questionnaires were returned for a response rate of 79.2 percent (42/53). Respondents included forty-one female and one male students. Due to the small number of male students, the responses from the male student were excluded from the analysis. There were no significant differences in response rates for the different vignettes (sexual preference: Chi-square .381, p>0.05; disease status: Chi-square .095, p>0.05). Table 1
presents results of the ANOVA tests and the means and standard deviations for both scales based on the patient’s disease status and sexual preference. No differences in the respondents’ ratings on the PES or SIS as a total scale were noted based on the patient’s disease status or sexual preference or the interaction between sexual preferences with disease type.
Similarly, neither the PES nor the SIS displayed significant differences on any of the individual items based on the patient’s sexual preference. There were, however, significant differences for several individual items on both the PES (Table 2) and the SIS (Table 3) based on the patient’s disease type. On both scales, students responded more negatively to individuals with AIDS as compared to those with leukemia. It is important to note, however, that differences were found in only a few of the individual scale items. Students believed AIDS patients to be more responsible for their illness and to be more dangerous to other people (Table 2). In addition, students reported that they were less likely to attend a party where the patient with AIDS was preparing food and also were less likely to allow their children to visit the home of an individual with AIDS than if the individual had leukemia (Table 3).
The dental hygiene students’ scale scores also were examined for possible association with the number of years of clinical-related experiences students had other than their current dental hygiene education. No significant differences in ratings on the PES or SIS according to number of years in practice were found.
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Discussion
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The findings of this study should be interpreted with caution. Students at only one dental hygiene baccalaureate program were surveyed; therefore, the generalizability of the findings to other hygiene programs may not be valid. These dental hygiene students also have had at least two years of formal education in anatomy, physiology, psychology, and other behavior science courses either at a community college or university prior to completing this survey. Not all dental hygiene programs require these courses prior to entry into their programs. Furthermore, the findings are based on written responses to patient vignettes that may reflect politically correct, socially desirable outcomes on the part of the respondents. The findings concerning attitudes toward homosexuals are consistent with other reports that have found that dental hygiene students did not display a bias toward homosexuals.5,12 In our study, neither the overall scale scores nor any individual items displayed any bias toward homosexuals.
The attitudes of the hygiene students toward individuals with AIDS were slightly more mixed. Although no bias toward individuals with AIDS was reflected in either overall scale score, several individual items did reflect negative attitudes. This finding is consistent with an earlier report that found that dental hygiene students displayed an overt bias toward individuals with AIDS but not toward homosexuals.12 It differs somewhat, however, from a more recent report that found that dental hygiene students did not display an overt bias toward individuals with AIDS or toward homosexuals.5 The two studies, however, used different instruments, so the reports are not directly comparable. The findings from our study describing hygiene student attitudes are generally consistent with a prior report from the same institution that found that dental students exhibited no evidence of homophobia but did display some evidence of bias against individuals with AIDS.16 The difference noted between the findings from the dental school located in Michigan5 and our study may be attributable to the greater prevalence of AIDS in Mary-land19 and, hence, a higher perceived risk of exposure on the part of respondents.
As would be expected, dental hygiene programs have long embraced the responsibility to prepare their students to deal with the AIDS epidemic.20 As is the case with some dentists, practicing dental hygienists have exhibited fears surrounding the treatment of AIDS patients.21,22 Nevertheless, it is encouraging that, overall, oral health care providers’ concerns about treating patients with AIDS appear to be diminishing23 although still linger in some individuals as demonstrated by the results reported here. The dental hygienist is often seen as a first line of defense in the fight against periodontitis and other oral diseases. Hygienists perform oral cancer screenings and gingival assessments, measure periodontal pockets, and inform the dentist of possible findings. Dental hygienists form personal bonds with their patients that can facilitate the disclosure of sensitive information and assist in building trust between a clinician and patient. Therefore, it is critical that dental hygiene students, as future health care providers, develop not only the necessary technical skills but also attitudes that will prepare them to care compassionately for individuals with HIV/AIDS.
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Footnotes
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Dr. Cohen is Professor, Dr. Romberg is Professor, Ms. Dixon is Assistant Professor, and Dr. Grace is Associate Professor—all at the University of Maryland/Baltimore College of Dental Surgery. Direct correspondence and requests for reprints to Dr. Leonard A. Cohen, University of Maryland/Baltimore College of Dental Surgery, Dental School, Department of Health Promotion and Policy, 666 West Baltimore Street, Baltimore, MD 21201; 410-706-7289 phone; 410-706-3028 fax; lac001{at}dental.umaryland.edu.
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Abstract
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