HIV Insight: Systematic Review of Human Immunodeficiency Virus (HIV) Knowledge Measurement Instruments Used on the Arabian Peninsula

In 1984, the Kingdom of Saudi Arabia (KSA) began surveillance for human immunodeficiency virus (HIV) incidence and prevalence. However, no culturally-appropriate standardized questionnaire has been developed to measure HIV prevention knowledge in this population. Evidence exists that married Saudi women are especially at higher risk for infection, but lack knowledge of HIV modes of transmission and underestimate their personal risk of becoming infected. The objective of this paper is to present a critical review of existing HIV knowledge measurement tools developed for the KSA and other Arabian Peninsula populations, and to utilize this review to guide the development of a culturally- and gender-sensitive tool. Studies included were in English reporting results of a quantitative survey instrument as either an interview or self-reported questionnaire with questions about knowledge of HIV or AIDS. Surveys must have been given in English or Arabic, and must have been done in a population in the KSA or the Arabian Peninsula. The following data sources were searched for eligible studies: Google Scholar, Google Web, PubMed, PLoS, WHO publications, UN publications, news, and other peer-reviewed publication databases.

Sixteen articles met criteria, and of these, 10 (63 %) were conducted in a KSA population, and a majority of the articles studied students of primary, secondary, or post-secondary schools (n = 9, 56 %). Five studies included only men, while the other 11 included both sexes.

The KSA’s public health goals should more specifically focus on measuring and improving knowledge in high-risk populations such as married women—an option currently limited by commonly available measurement instruments.

...In summary, 16 papers were reviewed that included HIV knowledge measurement in the KSA or bordering populations. On the positive side, all studies report high response rates, but other features of these reports indicate challenges. First, the absence of a culturally-specific KSA instrument has resulted in the inability to reliably and accurately measure HIV knowledge in KSA populations. Next, studies examined employed a variety of instruments, but they generally did not report reliability and validity studies, so their relative quality could not be compared. Further, gender-specific instruments were not developed, although transmission patterns in the KSA suggest that transmission modes are potentially much more gender-specific than in other countries. Finally, these articles generally reported on low-risk populations in the KSA. The KSA’s public health goals should more specifically focus on measuring and improving knowledge in high-risk populations such as married women—an option currently limited by commonly available measurement instruments.

In fact, it is interesting to observe that those measuring knowledge, attitudes, and behavior surrounding HIV in the KSA seem disconnected from the other researchers in the KSA studying the epidemiology of these conditions. It is recommended that researchers working on the epidemiology of HIV infection in the KSA and those surveying the public seeking to inform an effective response work together to develop culturally-appropriate instruments that measure knowledge pertinent to KSA’s population. Had researchers such as Abolfotouh, Mahfouz, Madani, and Fageeh collaborated, despite their disparate geographic locations, they might have prevented the use of inappropriate questions from the WHO KABP and other US- or European-based questionnaires that include many questions irrelevant to the KSA population.

In the 20 years since the landmark paper in 1995 by Abolfotouh, the evolution towards reliable, valid, and pertinent and gender-specific instruments for measuring HIV knowledge in the KSA population did not take place. Hence, today, little is known about the level of knowledge about HIV prevention in high-risk groups in KSA. KSA-specific instruments measuring knowledge pertinent to the epidemiology of HIV are desperately needed to facilitate the development of an effective public health response capable of accurately reaching at-risk populations...

Full article at: http://goo.gl/Bna5Te

By: Maram T. Alghabashi corresponding author