Health Education Research, Vol. 14, No. 4, 473-484,
August 1999
© 1999 Oxford University Press
Adolescents' knowledge and attitudes concerning HIV infection and HIV-infected persons: how a survey and focus group discussions are suited for researching adolescents' HIV/AIDS knowledge and attitudes
Department of Health Sciences, University of Jyväskylä, PO Box 35, 40351 Jyväskylä and
1 The Family Federation of Finland, The Population Research Institute, PO Box 849, 00101 Helsinki, Finland
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Abstract |
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The purpose of this article is to examine how two different corpora of material are suited for researching the sexuality of youth on the basis of material gathered via a structured questionnaire (N = 1183, response rate 87%) and via eight focus group discussions (FGDs), and to investigate the knowledge and opinions of adolescents at the age of 15 years about HIV infection and HIV-infected persons. Both boys and girls showed a good level of knowledge about HIV infection and AIDS. While their level of knowledge was good, their attitude was that the threat of an HIV infection was not a personal issue. Furthermore, negative attitudes to those having HIV/AIDS became more pronounced the more socially distant the infected person was to the respondent. The FGDs presented a more sceptical view of the attitudes of adolescents than the survey, while the knowledge about HIV infection and AIDS was the same regardless of the research method. In the FGDs, girls discussed the topics more extensively than boys, they used longer sentences, there was spontaneous discussion within the groups and the participants commented on each other's opinions. Boys were often content with short dichotomous responses and the interviewers had to qualify the responses with supplementary questions.
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Introduction |
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From 1982 to 1996, 794 cases of HIV infection were found in Finland—at most, less than 100 HIV cases per year. The number of persons reported having developed AIDS until 1996 was 261, of whom about 186 have died (KTL Statistics, 1997
; WWW, 1998). Epidemiologically speaking, the situation in Finland is, at the moment, good. Although there is ongoing medical research on a vaccine to prevent HIV infection and it is possible to retard the progress of AIDS through medication (Haynes, 1996; Lipsky, 1996), it is still worth while focusing on preventive measures against the HIV infection.
Attitudes involve what people think (cognition), feel (affect) and how they would like to behave toward an attitude object (connotation). Behavior is not only what people would like to do but also what they think they should do, i.e. social norms, habits and the expected consequences of their behavior. An attitude contains beliefs, evaluations and action intentions that may affect behavior (Rosenberg and Hovland, 1960; Triandis, 1971; Uutela, 1985).
Adolescents' attitudes towards HIV infection and HIV-infected persons have been studied in Finland only in graduate theses or with small samples (Hämäläinen and Keinänen-Kiukaanniemi, 1991; Tikkanen and Koskela, 1992). Earlier international studies have found that young people, despite good HIV/AIDS knowledge, underestimate their own risk of becoming infected with HIV. Adolescents believe themselves to be less promiscuous than average (Abrams et al., 1990), and they believe that their and their partners' sexual behavior is responsible (e.g. condom use, HIV testing, knowing the partner, faithful and long relationships). Woodcock et al. (Woodcock et al., 1992) argued that some adolescents did not trust the information in mass media and believed that the risk of infection was exaggerated compared to other risks of life. Besides other reasons, the low incidence of HIV infection among the population also decreased the perceived risk among young people (Frankham and Stronach, 1990; Wight, 1990).
HIV-infected persons arouse conflicting feelings and reactions. Earlier studies have shown that girls have more tolerant attitudes towards HIV-infected persons than boys have (Barnard and McKegany, 1990; Schaalma et al., 1993; Bagnall and Lockerbie, 1996; Currie et al., 1997). The respondents who had tolerant attitudes towards homosexuals also had more tolerant attitudes towards HIV-infected persons (Ross and Rosser, 1988; Schaalma et al., 1993). In addition, the present HIV/AIDS education in schools (Hämäläinen and Keinänen-Kiukaanniemi, 1991; Durant et al., 1992; Svenson et al., 1997) and, in general, good knowledge of HIV/AIDS (Strunin and Hingson, 1987; Wertz et al., 1988; Durant et al., 1992; Ford, 1992; Kindeberg and Christenssen, 1994; Rise and Jacobson, 1995; Currie et al., 1997) have contributed to more widespread tolerant attitudes.
The purpose of this article is to examine how two different corpora of materials are suited for researching the sexuality of adolescents and to describe, with a quantitative and a qualitative corpus of material, the knowledge and opinions of adolescents at the age of 15 years about HIV infection and infected persons. For this article, focus group discussion (FGD) means a discussion in a group, led by a focus group moderator on the basis of a prearranged interview guide.
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Methods |
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The research setting of the HBSC study in 1994
This research concerning the knowledge of HIV/AIDS and opinions of adolescents is part of the international comparative study coordinated by WHO, `A WHO Collaborative Study on Health Behaviour in School-Aged Children'—the so-called HBSC Study (see Wold et al., 1994
). The population for the HBSC study in Finland comprised students in Grades 5, 7 and 9 of comprehensive school (Tynjälä and Törmäkangas, 1995). Students of Grade 7 and 9 in Finland were given a questionnaire on sexuality and HIV/AIDS knowledge. Of these, only the responses of Grade 9 students are examined in this report (43 schools). The sample (N = 1357) was representative of all of Finland. The data was gathered via questionnaires which the students filled in anonymously during a single teaching period. The loss of information in this study consisted of youth absent from school (N = 159) and of rejected responses (N = 15). The final number of respondents was 1183, of whom 547 (49%) were boys and 609 (51%) girls. The response rate of this study was 87%. The mean age of respondents was 15 years and 9 months.
In the HBSC study, the statements used were developed by groups of experts at WHO and used in previous studies (King, 1989; Tikkanen and Koskela, 1992; Currie and Todd, 1993; Bagnall and Lockerbie, 1996). The purpose was to examine the fears and dangers experienced by adolescents about HIV infection and AIDS. For this article, the 10 statements whose themes were also discussed in the FGDs were chosen from among those on the questionnaire.
In a survey conducted in 1994, the knowledge of adolescents about risk behavior was examined using four questions (see Table I). Table I indicates whether a statement is true (T) or false (F) after each statement. Adolescents' opinions about HIV infection and infected persons were described with six statements (see Tables II and III). The statements of the questionnaire are checked through cross-tabulation. Statistical significance between boys and girls has been indicated as follows: *P < 0.05, **P < 0.01 and ***P < 0.001.
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Recruitment of subjects and data collection
In the spring of 1996 our team (Riikka Pötsönen and Susanna Saari) collected the data from FGDs in four localities: Joutseno (the first city selected was Lappeenranta), Puumala, Rauma and Helsinki. We selected the geographical areas and wanted to include youth who came from different backgrounds. The localities where we interviewed adolescents differed from each other by geographical location as well as by degree of urbanization. The results of the interviews cannot be generalized for all of Finland, rather they describe the opinions of the groups in question at that time in their context. We wanted to increase the variety of responses and solicit a maximum of different opinions by selecting dissimilar groups.
The school selected from Lappeenranta declined to participate `because of too many research projects' and consequently we chose a corresponding school in a neighboring town (Joutseno) to replace this school. Of the localities, Puumala (about 3000 inhabitants) represented a sparsely populated area far away from big cities and Joutseno (about 12 000 inhabitants) represented a small provincial town in Eastern Finland. Rauma (about 30 000 inhabitants), located in Western Finland, is a small industrial town. The fourth locality, Helsinki (about 500 000 inhabitants), is the sole city in Finland with a large population.
When recruiting interviewees we first contacted the rector of the selected school. He/she referred us to the teacher whom he/she considered to be responsible for sexual and HIV/AIDS instruction in the school. It was with this contact person that we agreed on further details, how the student groups were to be composed and when we would have the FGDs in that school.
Prior to carrying out a FGD we provided the contact person with supplementary information in writing on the themes and purpose of the FGDs. The contact person distributed notices to the young people arriving for the FGDs before the they were carried out. The final composition of the group was, in the end, the responsibility of the contact person in each school. Our hope was that students in Grade 9 who came voluntarily would be willing to discuss the themes we provided would be chosen for the groups.
We carried out the FGDs during school hours at the schools so that one group of girls and one group of boys from Grade 9 participated from each school. We decided to use single-gender groups on the basis of earlier experience since the functioning of mixed groups can be influenced by attempts by girls and boys to impress the other sex. We knew, on the basis of earlier FGDs, that groups of girls are more open, more verbal and more conversational than groups of boys. On the other hand, boys as well are willing and capable of discussion in groups, especially when the topics are not too personal (Pötsönen and Välimaa, 1995). We had rehearsed ahead of time both conducting a FGD and managing various situations in groups.
Each researcher individually conducted two interviews in different localities. We had agreed in advance on leading the interviews, thematic outline, stimulus questions and other factors that could come up. We made an audio record of all interviews and took notes during each interview situation where we described the atmosphere in the group and our own feelings about the problems in the interview and the effects of the research themes.
The number of adolescents participating in the FDSs varied by group from four to eight persons. A total of 26 girls and 26 boys participated. With each group, the discussions lasted for one lesson (about 45 min). We used in all groups the same semi-structured interview guide. The outline included, among other things, background information about (1) sex and (2) HIV/AIDS education in the school and its scheduling, and (3) information sources for HIV/AIDS and (4) methods and materials of teaching.
The moderator asked, in accordance with the interview guide, stimulating questions on the basis of which the youth carried on their conversation. When needed, the moderator also defined the issue more closely with supplementary questions and asked for explanations.
Data analysis
We recorded all of the FGDs and another person transcribed them word for word. These texts made comparisons between groups possible. In principle, the initial analysis of the FGD began during the interview situation and with the subsequent situational notes. The actual analysis began with reading through the transcribed interviews and listening to the audio records, in order to get a good grasp of all of the data. Then the transcribed corpus of interviews was transferred to the WinMax computer program.
On the basis of the ideas, concepts and thematic entities which arose from the corpus of materials, categories were formed which took shape and evolved even during the analysis. We selected excerpts of conversation from the transcribed raw text under each category. Some excerpts might belong to several categories. We sought to find, on the basis of the conversational excerpts selected from the texts, the common factors and, through them, to make summaries of the themes. The final article consisted of summaries, interpretations and textual excerpts. We also included conflicting opinions. During the research process we attempted to take into account our own preliminary assumptions in, among other things, collecting, classifying and interpreting the corpus of materials (Taylor and Bogdan, 1984).
In this article, we will concentrate on only two thematic areas which emerged in various situations: attitudes towards HIV infection and towards HIV-infected persons. In connection with the results we will present unedited conversational excerpts, how the conversations of the youth progressed in the groups. The explanations in parentheses within the transcripts have been added later.
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Results |
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Adolescents' knowledge about the HIV infection
In the nation-wide survey it was discovered that adolescents' knowledge about preventing HIV infection was good. Almost all (96%) of adolescents responded that HIV infection can be prevented by using a condom and that it is not transmitted by shaking hands. Approximately 90% of adolescents mentioned that the number of sexual partners and the fact that you did not know your sexual partner well enough increased the risk of becoming HIV infected. There were differences in the knowledge of girls and boys only in regard to the number of sexual partners where more girls than boys believed it to be a factor which increases the risk of infection (Table I
). In the FGDs, adolescents stated that the information on HIV/AIDS related themes had concentrated on infection with HIV and preventing it. Intercourse and drug needles were the first modes of infection named. The youth mentioned that it would be good to know your sexual partner and that condoms prevent contagion. Social contacts, e.g. shaking hands and touching, were mentioned as a false mode of infection. Excerpts from the discussion of adolescents on becoming infected:
You shouldn't have sex with someone you don't know. Or then you'll have to use a condom. [Boy]...
Some people think that if you even drink from the same glass you'll get it but it doesn't... But it just can't...
Well, you'll have to say anyway that it (infects) only (via) blood and sperm.
A lot of people think that you can get it when you touch and such. [Girls]
...
You know, you can get them through mucosal contact, pretty rare or then probable anyway... But at least it's no gay disease.
I guess it's the easiest with a one night stand.
Yeah, drunk or something.
That's when you won't be thinking about any contraception. [Boys]
...
I'd be so scared myself about getting it... Although I know that it doesn't happen when you shake hands. [Girl]
Regarding HIV/AIDS knowledge, it appeared that the respondents seemed to have similar knowledge in FGDs as in the survey. The youth seemed to know the modes of infection quite well, e.g. the number of incorrect responses in the survey was low (less than 5%). However, the interviews revealed a certain degree of ambivalence. The youth mentioned during the interviews that other youth had incorrect information—not themselves. Thus they assumed, contrary to the outcome of the survey, that adolescents generally had incorrect information about becoming infected with HIV and that this had come up in earlier discussions among the youth. The interviewees also expressed assumptions in connection with correct information, `You can't be infected by shaking hands, can you?', as if to solicit support for their information from the group or the interviewer.
The attitude of adolescents towards the HIV infection
On the basis of the survey about half of the adolescents (47% of boys and 56% of girls) stated that they were concerned about the possibility of getting AIDS. Approximately one-third of the boys and one-quarter of the girls disagreed. However, adolescents did not feel (about 70% of respondents) that they should avoid sexual relationships because of AIDS. Girls seemed to be more concerned about AIDS than boys (Table II).
The FGDs revealed that adolescents' attitudes towards HIV infection were contradictory. Even though the youth admitted that it was possible for any person having intercourse to get AIDS, becoming HIV infected seemed like a distant risk as far as the youth were concerned. An excerpt from a discussion by girls on the theme of who could contract AIDS:
All people.And it's not so that it's just some people. Sure it's easier for the IV users, drug users and others like that but...
Anybody could get it anyway.
One group of boys doubted the possibility that they could be infected. When they were asked further questions about which group of people might have a problem with becoming infected if not them, the boys discussed as follows:
I suppose all those drug users...And other crazy people...
And gays.
I guess you've got to be careful yourself.
There were some persons in the groups who did not believe there was much of a chance of becoming infected even though boys felt in only one group that the probability of infection clearly was low. Even in this group the boys said that the infection was a problem for everyone but that it was not a current problem for themselves. `I haven't thought about it because I don't have such (relationships) yet...' and `Gays have lots of it'.
Other reasons for perceiving a low probability for HIV infection were a steady relationship and personal caution. Groups of girls carried on discussion for and against as follows:
Somehow it still feels so distant. But you know anyway that it's everywhere and that you can get it. I don't really know.Well, you think anyway that you won't get it yourself. But then you realize that it could happen anyway. It's so distant... You don't think about it at all really.
Yeah, I think that's because it's not been brought up a lot in school. I`ve seen it in some magazines only.
Or in a TV program or so.
...
It's a problem for everybody all right.
There's so much of it in the world anyway that why couldn't you get AIDS yourself.
...
Well, not that way.
Take care, be kind of careful.
And when you have a condom, then it's nothing... Or of course it could be broken.
But it's worth finding out about it a little or like that...
But I think that at this age you worry more about pregnancy than AIDS.
The distinction between relevance for self and relevance for others only surfaced in the group discussions. Adolescents did not feel that the infection was one of their current causes of concern even though they recognized its existence in connection with other groups. Gays came up as a special risk group for HIV infection in two groups of boys. One group of boys had a long discussion about how gays did not have more of a risk of becoming HIV infected than other people.
Adolescents' opinions of HIV-infected persons
Adolescents' opinions of HIV-infected persons were mostly positive and tolerant. Girls were more tolerant in their opinion than boys. However, opinions became more negative the more distant infected persons were felt to be; while approximately three-quarters of adolescents would visit their friend with AIDS or would take care of him, only approximately half of the respondents would allow infected children to go to school with other children or work as teachers. The majority of adolescents stated that they felt compassion towards AIDS patients (63% of boys and 86% of girls) (Table III).
On the basis of FGDs, personal experience of adolescents about HIV-infected persons and AIDS patients were nearly non-existent. The ideas of the youth were mostly based on information from the mass media or the lay referral system since only one person from among 54 reported that she knew a person who was HIV-positive. The lack of personal experience was revealed in the interviews as curtness, generally the youth merely said that they had hardly discussed HIV-infected persons at all. The youth reported that in school, for example, the social and mental problems associated with the HIV infection had not been discussed at all. Rare comments by the youth, however, exhibited misgivings about AIDS patients. The boys discussed the matter in the following manner:
If you hear that someone's got AIDS I guess you'll start avoiding him even if you don't mean it, but anyway...If you hear the word AIDS it's like having a knife at your throat.
This thematic area might be more unfamiliar to the youth than other areas. Especially in groups of boys, the unfamiliarity and difficulty of the theme was manifested as silence and embarrassed laughs. On the other hand, silence might here also indicate disagreement or negative opinions which they did not necessarily wish to reveal during an interview.
Only two groups of girls discussed their attitudes towards those infected with HIV spontaneously, other groups side-stepped the questions with brief comments. In the first group, two girls readily admitted to being somewhat afraid of them. Although the participants knew well that HIV cannot be transmitted while shaking hands, undefined fears concerning the infection were strong. A discussion about meeting an HIV-infected person progressed as follows:
I wouldn't be afraid of shaking hands. I wouldn't go to bed or anything like that. But I could certainly shake hands.I don't know. I might start getting scared when it was time to shake hands.
I'd shake hands all right but I'd feel terribly awkward, like—hello...
I'd go and wash my hands right away afterwards.
I'm sure I wouldn't stay in the same room.
Of course it'd be a bit offensive to that person, but still...
It's not the fault of that person.
In the same school the girls also discussed using HIV-infected persons as teachers and lecturers. One of the girls felt such situations to be oppressive where she would be compelled to be in the same room with an infected person. Other girls were interested to hear what ideas infected persons themselves would possibly have.
The most effective thing would sure be if some guy would come and tell, who would have it (HIV infection) himself...I wouldn't be able to listen. I'd have to get out of that room... I simply couldn't bear to be in the same room.
I'd like to...
... Good to hear all his ideas and so on.
Attitudes towards HIV infection and discussing it was new to the youth interviewed. They did not seem to have such facilities, knowledge or experiences on the basis of which they could carry on a conversation. In not one of the groups of boys did an actual conversation about infected persons develop; the topic was approached with laughter and few words.
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Discussion |
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The results of the survey and FGDs were convergent on the question of measuring knowledge; adolescents were well aware of the facts associated with preventing the HIV infection. However, the FGDs revealed that the possibility of becoming HIV infected was not a current concern for the adolescents although they recognized its existence for other groups. In the questionnaire survey adolescents had fairly tolerant attitudes about HIV-infected persons, yet their opinions became more negative the more distant HIV-infected persons were felt to be. In the survey research adolescents exhibited more tolerant attitudes than in FGDs, which clearly showed their insecurity and conflicting feelings towards becoming HIV infected and HIV-infected persons. Girls were more tolerant about HIV-infected persons than boys.
Regardless of knowledge, adolescents have discounted health risks according to earlier studies (Abrams et al., 1990; Woodcock et al., 1992; Schaalma et al., 1993). The future where the risks have a concrete effect on the life of an individual seems distant to adolescents (Boyle et al., 1989; Koniak-Griffin et al., 1994). In this study as well, everyone knew that AIDS is a dangerous disease but adolescents considered the personal risk of becoming HIV infected to be low. As explanations for the perceived low risk for themselves, adolescents offered condom use, control of one's behavior and knowing one's partner, among other things (Woodcock et al., 1992), and the low incidence of HIV infection in their locality (Wight, 1990).
Adolescents' attitudes towards HIV-infected persons differed, depending on which corpus of material we examined. On the basis of the survey, adolescents had fairly positive and tolerant attitudes towards infected persons (Currie and Todd, 1993; Currie et al., 1997). However, their attitudes became more negative the more distant infected persons were felt to be.
In the FGDs adolescents' attitudes were more prejudiced than in the survey. Discussions concerning this topic were few and the participants often declined to express their own opinion. Expressing personal opinions could be more difficult than ticking a multiple chance questionnaire. The differences in the responses could also have been influenced by the settings where the research was carried out. In setting the survey in a classroom, adolescents might better remember the official HIV/AIDS information and the instruction given at school. Therefore their responses could partially be based on assumptions on how they were supposed to respond in such a setting. In the FGDs, adolescents discussed in groups and then it was the group which regulated the responses and made them more concurring (Koniak-Griffin et al., 1994).
Discussion of the survey research
We attempted to describe the general atmosphere with the survey material; what the usual attitudes of adolescents were towards the themes queried, and whether there were differences between girls and boys. The survey research encompassed the whole of Finland and therefore the results can be generalized to cover all Finnish adolescents aged 15 years.
On the basis of the results, the survey gave a more positive and tolerant impression of adolescent attitudes than the FGDs. One may ask whether it is easier to respond to a questionnaire according to assumed norms which follow conventional tolerance than in an interview situation where the interviewees find themselves face to face with the interviewer. The interviewer always has the option of doubting the veracity of responses, asking for more specific responses and turning imaginary situations into concrete ones.
There was a period of 2 years between the survey and the interviews. Although attitudes change with time the change is usually slow. For example, when the cross-sectional material of the HBCS Study of 1990 and 1994 was compared, the change in HIV/AIDS attitudes was found to be minimal (Pötsönen, 1998).
The questionnaire was based on statements developed in expert groups of WHO and on earlier studies (Currie and Todd, 1993; Currie et al., 1997) where the questions were formulated at the end of the 1980's. Since then, the situation has changed in many respects and, for example, questions examining the beliefs of adolescents from the outside (`Youth of my age should...') have been superseded with more and more personal questions (`I am concerned...').
Discussion of focus groups as a method
Qualitative research has, in the last few decades, strengthened its position within health research. It has been realized that in addition to explaining things, one needs to understand the concepts, beliefs and meanings behind them. Ideally, different research methods and approaches are applied in parallel and complement each other (Brannen, 1992; Dockrell and Joffe, 1992; McEwan et al., 1992; Gilbert, 1993).
FGDs can be used to examine the spectrum of values, norms and meanings revealed in discussions by adolescents. The method is particularly useful for researching the concepts employed by the target group, and their ideas and opinions on the topic under study (Krueger, 1994). The limitation of FGD is that group dynamics can have a more pronounced effect on some individuals than on others and that the participants may attempt to provide `desirable' responses (Basch, 1987). A FGD differs from an individual interview also in the fact that, in addition to the reactions of the leader, all group members influence how the conversation proceeds. Furthermore, one must remember that only such individuals who are capable and willing to express their opinions to others can by studied by the means of a FGD. The outcome of a FGD cannot be generalized but consists of the opinions of a selected group on the topics discussed (Basch, 1987; Bertrand et al., 1992; Hoppe et al., 1994; Krueger, 1994).
The groups employed in this study were chosen from among volunteers. We wanted to create groups which would be as natural as possible for having a discussion since only persons who are capable and willing to express their opinions to others can be studied using FGDs (Basch, 1987). The results of these FGDs cannot be generalized beyond their context, rather they are illustrative of the knowledge and attitudes of the adolescents in these eight groups.
We conducted the interviews on the school premises during school hours and this could have influenced some of the interviews in that the discussion began in a fairly half-hearted manner. On the other hand, the questionnaires were also completed in classrooms, and a part of the research themes were related to sex and HIV/AIDS education in school. We also considered our own role as interviewers during the research. As outsiders not known to the adolescents we did not know the background of the youth but, on the other hand, it might have been more difficult for the adolescents to open up to an acquaintance than to us, strangers.
One of the shortcomings of carrying out the FGDs was that we interviewed the groups alone. It would have been easier to conduct the interviews if both researchers could have attended all interviews in person. Then one researcher could have concentrated on leading the interviews while the other one observed the atmosphere and interpersonal interaction of the FGD. We attempted to share later the atmosphere we experienced in the groups as comprehensively as possible through situational notes and discussions.
Some of the results of the FGDs were based on discussions in one or two groups and the opinions which emerged constituted a minority in comparison to the interviews of other groups. By bringing up these divergent opinions we wished to describe the total spectrum of variation in opinion. The weight of these divergent opinions was enhanced by the fact that unusually experienced and liberal minded youth participated in these groups, which is, in general, common in studies related to sexuality (Holland et al., 1993; Kontula and Haavio-Mannila, 1995). Since the discussions of these adolescents participating in the FGDs revealed hidden prejudices and negative attitudes, one must wonder what these would be among average adolescents.
Gender-related differences
In the survey, the attitudes of girls towards HIV-infected persons were more tolerant than those of boys (Clift and Stears, 1988; Currie and Todd, 1993; Rise and Jacobson, 1995; Bagnall and Lockerbie, 1996; Currie et al., 1997). In FGD situations, boys did not participate or did not want to discuss HIV-infected persons hardly at all while girls discussed them in two groups. In these two groups the girls knew very well that HIV was not transmitted through social contact. Yet they had an ambivalent attitude towards possible situations where they come into contact with a HIV-infected person (Bagnall and Lockerbie, 1996). The youth recognized that, in imaginary situations, they feared possibly becoming infected with HIV by shaking hands, for example.
The atmosphere varied from group to group in the interview situations. There were clear differences between groups of boys and groups of girls conversational culture, as we had expected. Girls discussed their themes at greater length than boys; their sentences were longer, spontaneous discussion ensued inside the groups and the participants commented on each other's opinions. The discursive knowledge and skills of girls, which are required for participating in a discussion, were possibly superior to those of boys (Tanz, 1987). The discussions by girls were characterized by cooperation (Tannen, 1990). In addition, the girls seemed to be better informed than boys—possibly because of their sexual maturation. It could be seen that they had thought about and discussed matters related to the HIV/AIDS themes before.
There was a feeling in some groups of boys that the participants did not have sufficient knowledge and experience which would have enabled a discussion, and, consequently, the discussion did not really proceed to a fruitful stage. The conversational culture of boys does not normally include chatting about one's feelings and experiences in a group but rather involves discussing activity and hobbies (Mayall, 1996). The boys were often content with short dichotomous responses and the interviewers were required to qualify the content of the responses with supplementary questions. On the other hand, the boys' silence could be a protest against the theme of the interview; they did not want to discuss it or they did not want to disclose their ignorance to the interviewers (Holland et al., 1993). In some of the groups the boys commented on the questions with `everybody knows that', for example, and failed to provide a response. It would have been interesting to compare, in this situation, what discussions a male interviewer would have been able to solicit.
FGDs mainly provide information on the collective opinions of the group (Basch, 1987; Krueger, 1994; Koniak-Griffin et al., 1994) and most of the interviewed groups indeed were relatively unanimous in their opinions. Disagreement also surfaced in some groups of girls and one group of boys. The participants justified their opinions against others and did not at any stage join in with the general opinion along with others. Especially in groups of girls it seemed to be acceptable to disagree. The girls did not seem to be intimidated by group pressure but held firmly to their own opinion.
In the FGDs, the attitudes and beliefs of the youth varied somewhat according to locality and gender. There were no differences in discussions about knowledge between localities or gender. On an average, boys from small localities did not feel the infection to be as personal as those in other groups. Their attitudes towards infected persons were also more negative than those in other groups. The opinions of girls were convergent regardless of locality.
Implication for sex education and research
Presently, the medical information and health promoting activities related to the HIV infection and AIDS in Finland are objective and up to date. The educational effort directed towards adolescents is being conducted by many organizations and institutions, of which the school is one of the best due to its accessibility. The majority of the youth interviewed felt that the instruction concerning HIV infection and AIDS in schools was limited and fragmentary. The principal content of the instruction was the means of contagion: how it is transmitted and how it is not transmitted. HIV-infected persons and the consequences of AIDS had not been given much attention in class. Instruction which influences attitudes and behavior should consist of more than giving out information. The most important problems for HIV/AIDS instruction were the teacher's central position and the scarcity of classroom time allotted for the instruction (Kontula, 1997). The youth felt that the classes were too rushed, progress was so fast that there was no time for discussion.
According to the results, the FGD appears to be fairly well suited for studying 15 year olds, in particular, discussions in groups of girls were rewarding and the research material rich in content. With boys of equal age it could be useful to combine FGDs with parallel individual interviews as well. In the future, qualitative research methods could be utilized in health education, particularly for studying meanings and concepts, for it could be observed, on the basis of this research among others, that studying opinions and attitudes with a structured methods only provides a limited picture of the total phenomenon. If the planning of sexual and HIV/AIDS instruction in schools rests solely on such knowledge, for example, it is possible to rely on an overly optimistic view, and the instruction will become increasingly limited in content.
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Acknowledgments |
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This research was supported by funds from the Finnish Ministry of Social and Health Affairs.
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References |
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Received on January 15, 1998; accepted on September 9, 1998
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