1. Development of the Black Christians’ HIV/AIDS Survey‐
Revised : A scale to assess Black Christians’ motivational
factors for HIV/AIDS ministry participation
Kimberly M. Coleman, MPH, PhD, CHES
Georgia Southern University
Kathleen J. Welshimer, PhD, MSPH
Southern Illinois University Carbondale
American Public Health Association 136th Annual Meeting
San Diego, CA
Tuesday, October 28, 2008

2. Presenter Disclosures
Kimberly M. Coleman
(1) The following personal financial relationships with
commercial interests relevant to this presentation
existed during the past 12 months:
No relationships to disclose

3. The Scientific “Dilemma”
“We in the research community know that it is
possible to change HIV risk‐associated behavior
among African Americans. What we need is
empirical evidence that tells us what types of
intervention strategies will bring about the
greatest changes…”
Jemmott, Jemmott, & Hutchinson (2001)

4. The Scientific “Dilemma”
“We in the research community know that it is
possible to change HIV risk‐associated behavior
among African Americans. What we need is
empirical evidence that tells us what types of
intervention strategies will bring about the
greatest changes…”
Jemmott, Jemmott, & Hutchinson (2001)

5. HIV/AIDS & The Black Church
Thousands of Black churches
(the institution) are addressing
HIV/AIDS epidemic in a variety
of ways
“Kim, why aren’t Black
congregants and
congregations more active in
a problem that is devastating
many U.S. communities?”
Question posed by a friend living with
AIDS

6. The Problem
• Several survey instruments exist
which assess HIV/AIDS‐related KABs
• No surveys were found that assess the
factors which motivate persons to
participate in HIV/AIDS church‐based
programs (as LHWs)

7. Survey Development
The development of a conceptual framework is
imperative and should recognize and
synthesize experiences, observations, and
relevant research literature for study (Babbie,
1990)
The BCHAS‐R is an updated version of a survey
Assessing HIV/AIDS‐related knowledge, attitudes,
and behaviors of African‐American Christian adults
(Coleman, 2004)

8. Survey Development
Additional items were based on major themes
found in the literature review and were directly
incorporated or modified based on existing
survey instruments
National Survey of Americans on HIV/AIDS (Kaiser Family
Foundation, 2001)
National Survey of American Life (UMICH‐ISR, 2001)
Intrinsic Religious Motivation Scale (Hoge, 1972)
The Meharry Questionnaire: The Measurement of Attitudes
Toward AIDS‐Related Issues (Ernst, Francis, Perkins, Britton‐
Williams, & Kang, 1991)

9. Perceived Threat
“…perceptions of susceptibility and severity
(threat) [are] associated largely with an
intention to take action…”
Rosenstock, Strecher, & Becker, 1994, p. 13

10. Divine Causation
“As early as 1985, conservative and
fundamentalist clergy had publicly stated
that somehow AIDS was the ‘wrath of God’
visited on male homosexuals and because
of their sinful lifestyles.”
Beckley & Koch, 2002, p. 29

11. Normative Attitudes
“A person’s subjective norm with respect to a
given behavior is a function of the person’s
normative beliefs that specific salient
referents (either individual or groups) think
that he or she should or should not perform
the behavior and the person’s motivation to
comply with those individuals or groups.”
Fishbein, Middlestadt, & Hitchcock, 1994, pp. 67‐68

12. Perceived Efficacy
“Among the mechanisms of self‐influence,
none is more focal or pervading than belief
of personal efficacy… Whatever other
factors may operate as motivators, they are
rooted in the core belief that one has the
power to produce desired results.”
Bandura, 2000, p. 2

13. Religious Motivational Orientation
Intrinsic
People spend time in religious thought and meditation,
interpret their secular experiences in terms of their
religious beliefs, and essentially live their religion in their
various dealings in life (Allport & Ross, 1967).
Extrinsic
People turn to religion for the sense of security, solace,
sociability that church membership provides and to
establish themselves in the community (Allport & Ross,
1967).

14. Religious Motivational Orientation

15. Conceptual Framework
Intrinsic
Normative Religious
attitudes about Motivation
personal action
in
i HIV/AIDS
ministry
Background Individual
Factors Participation in
HIV/AIDS
- Gender Perceived Ministry
- Age threat of
HIV/AIDS
- Education
- Personal Perceived
Relationships with efficacy
HIV+ People
-Pastor’s/Church Beliefs about
Leadership’s Focus divine
on HIV/AIDS causation of Congregational
- Denomination HIV/AIDS Participation in
HIV/AIDS
Ministry
Normative
attitudes about Extrinsic
congregational Religious
action in Motivation
HIV/AIDS
ministry

16. The Black Christians’ HIV/AIDS Survey –
Revised (BCHAS‐R)
7 Subscales, 99 items
• Perceived Threat (HBM)
• Divine Causation (AT)
• Normative Attitudes Regarding Personal Action (TPB)
• Normative Attitudes Regarding Congregational Action
(TPB)
• Perceived Efficacy [Self Efficacy & Congregational Efficacy]
(SCT)
• Religious Motivational Orientation (Allport & Ross,1967;
Hoge, 1972)
• Ministry Participation (Individual & Congregational)

17. Data Analysis
Validity:
Expert panel review
Pilot testing
Reliability:
Cronbach alpha (total instrument & per subscale)
Statistical Analyses (p < 0.05)
Descriptive statistics
t‐tests
Spearman’s rho correlations
ANOVA

18. Reliability
A reliable survey instrument is consistent,
dependable, and stable (Kerlinger, 1973) and
“relatively free from measurement error”
(McDermott & Sarvela, 1999, p. 132).
Internal‐consistency reliability calculates the
average correlation among items in an
instrument, measuring “the degree to which
the items ‘hang together’” (McDermott &
Sarvela, 1999, p. 139).

19. Validity
A survey instrument’s suitability, significance,
and value of the inferences made from its scores
(McDermott & Sarvela, 1999).
A valid survey instrument accurately measures
what it was designed to measure.
Content validity assessed by expert panel
review & pilot test participant feedback.

20. Expert Panel Review
Survey instrument was reviewed by six experts
Expertise in health ministry, health education, HIV
prevention/advocacy, & community organization
Asked to provide feedback on each item
Suitability, intelligibility, & sufficiency to collect
necessary information
Process for deletion of items

21. Expert Panel Review
Recommendations for additions/clarifications
Distinction made between HIV/AIDS as punishment
by God & HIV/AIDS being allowed by God
God has allowed HIV/AIDS to affect (or infect):
a) homosexuals (people who have sex with members of the same sex).
b) people who use illegal drugs (such as cocaine and heroin).
c) people who have sex before marriage.
d) people who have extramarital affairs.
Demographic options were added
Types of ministerial activities were clarified

22. Pilot Test
Convenience sample – Western Kentucky
22 members of the same congregation
Incentives: a light meal & $10 Wall‐Mart gift card
Participants assessed survey:
Item clarity
Appropriateness
Level of intrusiveness
Personal applicability
Comprehension difficulty
Security
Survey length
Suggestions for item additions and/or omissions

23. Pilot Test
Mean time to complete survey = 27 minutes
All pilot participants indicated that the
BCHAS‐R items were clear, comprehensible,
appropriate, and believed that their identities
would be protected and the questions were
not unnecessarily intrusive
The Flesch‐Kincaid Grade Level = 7.0
Several suggestions/comments for additional
items made; none incorporated

24. Reliability Coefficients of the BCHAS‐R
PILOT (n=22)*
TOTAL INSTRUMENT (α) .956
Subscales:
Perceived Threat .769
Divine Causation .855
Normative Attitudes re. Personal Action .930
Normative Attitudes re. Congregational Action .911
Perceived Self‐Efficacy .968
Perceived Congregational Efficacy .969
Religious Motivation .958
Participation in HIV/AIDS Ministry .711 (.822+)
‐‐ Individual .940
‐‐ Congregational .896

25. Sample
African‐American Christian adults in metro
Washington, DC [n = 375 (N=3460)]
Participating churches (75% African‐American
membership) :
1 Baptist
2 Methodist (AME & AME Zion)
1 Roman Catholic
2 Holiness/Pentecostal

26. Demographic Profile
79% of participants were female
Mean age of study participants = 53.58 years
Nearly 54% of participants had a college
education
78% of participants had personal relationships
with persons who were currently HIV positive or
living with AIDS
60% of participants indicated that they had
taken an HIV antibody test

27. Reliability Coefficients of the BCHAS‐R
STUDY (n=375)**
TOTAL INSTRUMENT (α) .937
Subscales:
Perceived Threat .571
Divine Causation .859
Normative Attitudes re. Personal Action .931
Normative Attitudes re. Congregational Action .960
Perceived Self‐Efficacy .958
Perceived Congregational Efficacy .952
Religious Motivation .961
Participation in HIV/AIDS Ministry .666+
‐‐ Individual .892
‐‐ Congregational .924

28. Significant Factors – Individual Ministry
Participation
Personal Relationships with HIV‐positive
Persons (p<0.001)
Congregational Affiliation (p<0.05)
Beliefs of Divine Causation (p<0.05)
Normative Attitudes Regarding Personal
Action in HIV/AIDS Ministry (p<0.001)
Perceived Self‐Efficacy (p<0.001)

29. Significant Factors – Congregational
Ministry Participation
Congregational Affiliation (p<0.001)
Perceived Threat of HIV/AIDS (p<0.05)
Normative Attitudes Regarding Congregational
Action in HIV/AIDS Ministry (p<0.001)

30. Recommendations for Future Research
Further revisions of the BCHAS‐R to resolve
unanswered questions and/or increase instrument
reliability and validity.
Additional items: nature of relationships with persons who
are HIV positive or living with AIDS; occupations of
participants.
Edit items from the National Survey of American Life
(UMICH‐ISR, 2001) to make them similar to BCHAS‐R
format.
Incorporate or develop an assessment instrument on
religious motivational orientation for African‐American
Christian populations (culturally sensitive, reliable, &
valid).

31. Recommendations for Practice
The use of the BCHAS‐R to assess
congregants’ HIV/AIDS ministry efforts and
attitudes regarding congregational
programming.
Provide skills training based on areas of
highest efficacy.

32. Acknowledgements
SIUC Dissertation Committee Members
Data Collection Assistants
Hani M. Samawi, Ph.D. (Biostatistician,
JPHCOPH)
Rev. Clinton W. Austin, D.Min. & Rev. James A.
Turner, Jr., M.Div.
The Participating Pastors & Congregants

33. Contact Information
Kimberly M. Coleman, MPH, PhD, CHES
Georgia Southern University
College of Health & Human Sciences
&
Jiann‐Ping Hsu College of Public Health
kcoleman@georgiasouthern.edu
912‐478‐7666