Changing dentists’ knowledge, attitudes, and behaviors relating to AIDS: a controlled educational intervention

A R T I C L E S

The efficacy o f an educational intervention designed to im prove dentists’ knowledge, attitudes, an d behaviors abou t acquired im m une deficiency syndrom e (AIDS) w as tested. The intervention h ad three com ponents: com puterized feedback com parin g p a rticip a n ts’ ow n knowledge, attitudes, and behaviors w ith those of fellow p a rticip a n ts an d w ith an ideal; periodic bulletins; an d telephone conference calls w ith experts. T he group receiving the educational package h ad better scores than a control group on outcom es o f w illingness to treat persons w ith AIDS; identification of hum an im m unodeficiency virus lesions; kn ow ledge of AIDS; and com pleteness o f both intraoral an d extraoral exam inations. It w as concluded th at intervention is one approach to increasing den tists’ positive response to the AID S epidem ic.

Changing dentists’ knowledge, attitudes, and behaviors relating to AIDS: a controlled educational intervention Barbara Gerbert, PhD Bryan M agu ire V icto r Badner, DMD, M PH D eb orah G reen sp an , BDS

J o h n G reen sp a n , BDS, PhD , FRC P ath D o n n a Barnes, MA R ich ard C arlto n , M PH

c q u ire d im m u n e deficiency syn­ drom e (AIDS) poses s ig n ific a n t . c h a lle n g e s in m a n y a re a s of dental practice. D entists need inform ation on p atien t care, staff interactions, infec­ tio n c o n tro l, a n d m o re to h e lp th e m u nderstand these issues and to assist them in educating their coworkers and patients. A lth o u g h th e re is a g re a t d e a l of in fo rm ation available for dentists about th e h u m a n im m u n o d e fic ie n c y v iru s (H IV ) in fectio n , m ost dentists still are n o t p re p a re d to re sp o n d p o sitiv e ly to the AIDS crisis.1,2 W hether this lack of im pact is the result of the form at in w hich the in fo rm a tio n has been presen ted or of a failure to address attitu d in al barriers, p re v io u s r e s e a r c h 1 su g g e sts th e re are se rio u s d e fic its in d e n tis ts ’ re sp o n se s to edu cational m aterials and program s. In 1986, a ra n d o m sam p le survey was taken of dentists in C alifornia. T h e results disclosed th a t d en tists’ know ledge, a tti­ tudes, an d behaviors w ith regard to AIDS an d H IV infection are less than optim al, an d th a t dentists need to become m ore inform ed about AIDS and its im plications

for dental p rac tice .1,2 M ajor b arriers to c a rin g for p e o p le w ith H IV in fe c tio n in c lu d e d fear o f tr a n s m is s io n to th e dentist, perception of problem s w ith staff, fear of lo sin g o th e r p a tie n ts, an d self­ perceived lack of the ap p ro p riate skills. A tch iso n an d c o llea g u es3 also n o ted a lack of know ledge ab o u t the oral m an ­ ifestatio n s of H IV in fectio n a n d AIDS am ong dentists in the Los Angeles area. A m isconception of some dentists is that by excluding know n AIDS p atients they w ill keep th eir practice free from HIV in fe c tio n . T h is h as led som e d e n tists to “d u m p ” people w ith AIDS from their practice.4 It is speculated, however, that u p to 2 m illio n p eo p le in the U n ite d S tates m ay be infected w ith H IV , an d th a t 80% of th ese in d iv id u a ls m ay be in f e c tio u s .5 M e a n w h ile , o n ly a sm a ll n um ber (10%) of these infected individuals may know their ow n H IV status.6 T h u s, even if it were eth ica lly accep tab le, it is not practically possible to com pletely exclude H IV -positive patients from dental operatories. Because inform ation provided to den­

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tis ts h as n o t h a d s u f f ic ie n t im p a c t, e d u c a tio n a l in te rv e n tio n s w ere needed. P re v io u s r e p o r ts 7 s u g g e ste d th a t it is possible to change h ealth professionals’ attitu d e s a n d b eh a v io r to w ard p a tie n ts w ith AIDS. For exam ple, in one ho sp ital in w h ich staff m em bers h ad refused to care for AIDS p atien ts, an ed u c atio n al p ro g ram w as in tro d u c ed th a t served to correct m isconceptions an d allay anxiety ab o u t co n tractin g the disease.7 T h e re fo re , a n e d u c a tio n a l p ro g ra m ab o u t AIDS was d esigned a n d targeted to dentists. It was tested in a controlled e x p e r im e n ta l stu d y . T h e im m e d ia te o b jectiv es of th e in te r v e n tio n w ere to im prove d en tists’ know ledge ab o u t H IV infection (its epidem iology, basic science, a n d c lin ic a l im p lic a tio n s); to in crease th e ir k n o w le d g e a b o u t th e o r a l m a n ­ ifestatio n s of H IV in fec tio n a n d AIDS so th a t su c h m a n if e s ta tio n s c o u ld be detected; to im p ro v e th e ir p erfo rm an ce d u rin g intra- an d extraoral exam ination p ro ced u res; a n d to increase th e ir w ill­ in g n e s s to tre a t p e rs o n s w ith H IV infection. T h e educational interventions JADA, Vol. 116, Jun e 1988 ■ 851

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used were based on ad u lt-learn in g tech­ n iq u e s th a t h a d p ro v e d effec tiv e in c h a n g in g h e a lth p ro fe ssio n a ls’ k n o w l­ edge, attitu d e s, a n d behav io rs.8,9 T hese interventions consisted of: com puterized feedback c o m p a rin g p a r tic ip a n ts ’ ow n know ledge, attitudes, an d behaviors w ith th o se of fellow p a r tic ip a n ts a n d w ith th e id eal; p e rio d ic b u lle tin s ; a n d tele­ p h o n e c o n fe re n c e c a lls w ith e x p e rts. M e d ica l e d u c a to rs re c o m m e n d these techniques because they include a feed­ b ack c o m p o n e n t a n d in c o rp o r a te resp ected le a d e rsh ip (m ed ical experts) in to the in te rv en tio n .10 T h e fe e d b ack c o m p o n e n t c a n be a pow erful tool for m otivating behavioral change. Feedback, alo n g w ith conference calls, served to in d iv id u alize an d focus the ed u cation. T h e m ethods were espe­ cially suited to the content of the m aterial b e c a u s e in f o r m a tio n a b o u t AID S is constantly being updated.

Methods and materials Subjects O f 700 dentists in San Francisco invited to p articip ate in an AIDS education study, 107 (15%) signed consent forms; com pleted pretests were received from 102 of these. T h ir ty - s ix p a r tic ip a n ts w ere assig n ed to receive an e d u c a tio n a l in te rv e n tio n c o m p o s e d of th re e m e th o d s a n d th e rem a in in g 66 served as a control group, rec eiv in g n o in te rv e n tio n . At posttest, 35 dentists rem ained in the experim ental g ro u p an d 64 in the control group. T he m ean age of the p a rtic ip a n ts was 41.4 years. M ale p a rtic ip a n ts m ade u p 91% of the study. G eneral dentists com posed 95% of th e s tu d y , a n d th e re m a in d e r practiced a variety of specialties.

m u ltip le -c h o ic e item s ad d re ssin g basic a n d c lin ic a l science a n d ep id em io lo g y of H IV in fectio n . T h e item s were fo r­ m u la te d in c o n s u lta tio n w ith p u b lic h e a lth sources a n d le a d in g o ra l AID S researchers. 2. H IV -associated lesions (know ledge scale). E ight oral lesions associated w ith H IV infections were described. Subjects were asked to m atch the descrip tio n to the nam e of the lesion. T h e score was calculated as the total num ber of correctly m atched lesions. 3. A ttitudes in d ic atin g w illingness to tre a t A ID S /H IV p a tie n ts ( a tt itu d in a l scale). Eleven item s on a six-point L ikert scale represented the do m ain of barriers to c a r in g for p e rso n s w ith A ID S a n d H IV in fec tio n .1,2 T h e item s represented fears ab o u t tran sm issio n from patien ts, lo s in g o th e r p a tie n ts , u p s e ttin g staff, a n d lack of sk ills to a d e q u a te ly tre a t people w ith H IV infection. Subjects were asked to agree o r disagree w ith the attitu d e expressed in the item. T h e possible range of scores was 11 to 66. T h e h ig h e r the score, the m ore positive were the attitudes. S ubjects re sp o n d in g to few er th a n six of the item s received m issing values on this scale. T h e a ttitu d e scale w as c o n ­ stru c te d u s in g th e C r o n b a c h ’s a lp h a . E leven a ttitu d e item s h a d an in te r n a l reliability of alp h a = .86 and a h om oge­ neity ratio of 0.37. 4. In tra o ra l ex a m in a tio n (b eh av io ral outcom e). Subjects were given a list of 14 possible elem ents of an in tra o ra l e x a m in a tio n (for ex am p le, e x a m in in g the lateral borders of the tongue, exam ­ in in g th e g in g iv a ) a n d asked w h e th e r they perform ed each procedure “alw ays” (score = 2); “ som etim es” (score = 1); or “ never” (score = 0). T h e possible range of scores was from 0 to 28.

Outcomes A q u e s tio n n a ire , ad a p te d a n d u p d ated from previous w ork,1,2 was used to collect in fo rm atio n from participants at baseline. D en tists w ere then ran d o m ly assigned, u sin g a com puter-generated list, to either an ex perim ental or a control group. T h e q u e s tio n n a ire w as a g a in a d m in iste re d at posttest, 6 m onths later. Item s on the q u estio n n aire were placed, a priori, into th e k n o w le d g e scales (n u m b e rs 1 an d 2), one attitu d in al scale (num ber 3), and tw o b e h a v io r a l o u tc o m e v a ria b le s (num bers 4 an d 5). 1. FIIV inform ation (knowledge scale). T h is scale consisted of the total num ber of c o rre c tly c h o s e n a n sw e rs to 21 852 ■ JADA, Vol. 116, June 1988

G eneral know ledge questions T h e re w ere 21 q u e stio n s a b o u t H IV in fe c tio n a n d AIDS. T h e m a x im u m p o ssib le score w as 21. N one o f o u r respondents go t a perfect score. —T h e average score was 14 (of 21 ). —Y our score w as 15. As you can see, your score was better th a n average. We c o m p lim e n t yo u fo r y o u r level o f u n d e r ­ s ta n d i n g r e g a r d in g th is c r u c ia l m a tte r. By stu d y in g the b ulletin s we are sen d in g you over th e s u m m e r, y ou c a n le a rn even m o re a b o u t this vitally im p o rtan t subject.

F ig 1 ■ E x c e rp t o f su rv e y fe e d b a c k to o n e p a rtic ip a n t.

5. E x trao ral e x a m in a tio n (behavioral outcom e). Subjects were asked w h eth er th ey c a rrie d o u t e ig h t elem e n ts of an ex trao ral (head an d neck) ex a m in a tio n “alw ays,” “ som etim es,” or “never” ; the to tal score, ra n g in g from 0 to 16, was calculated as described for the in trao ral ex am in atio n scale. Intervention

O u r ed u c atio n al in te rv en tio n consisted of three co m p o n en ts cond u cted d u rin g a 6-m onth perio d in 1987. T h e firs t c o m p o n e n t in v o lv e d tw o e ig h t-p a g e b u lle tin s m a ile d to p a r tic ­ ipants a t 2 -m onth intervals. T hese were w ritten especially for the project, tak in g in to ac co u n t the needs revealed by the subjects’ pretest q u estio n n aire data. T h e m ost recent research findings ab o u t AIDS an d H IV were included in feature article form at. C o n ten t included epidem iology, basic science, clin ical science, an d oral m a n if e s ta tio n s of H IV in f e c tio n a n d AIDS. Psychosocial an d legal issues were presented. Case exam ples were provided, w ith teaching p oints highlighted. T h e second com ponent involved each d e n tist receiving a d etailed an aly sis of h is o r h er p erfo rm an ce on th e p rete st q u e s tio n n a ir e . T h e feed b ack fo rm in c lu d e d in f o r m a tio n o n th e th re e scales—H IV in fo rm a tio n , H IV lesions, a n d w illin g n ess to tre a t—an d item -byitem feedback o n each d e n tis t’s in tra and extraoral exam inations. Each in d i­ vid u al’s three scale scores were com pared w ith the m ean of all p articip an ts in the study. T h e feedback also com plim ented dentists w hen they excelled on a variable an d p o in ted o u t where im provem ent was needed. An excerpt from one p a rtic ip a n t’s fe e d b a c k — s h o w in g H IV in f o r m a tio n o n ly —is presented in Figure 1. T h e th ird c o m p o n e n t in v o lv ed each dentist p articip a tin g in a conference call w ith five o r six other dentists and AIDS experts from the U niversity of C alifornia at San Francisco. T h e form at of the call included a brief review of in fo rm atio n from the b u lle tin s a n d am p le tim e for p articip a n ts’ questions, an d answers from the experts. D iscussion am o n g the p a r­ ticipants was also encouraged. T h e calls lasted approxim ately 1 hour. T h e co n ten t an d style of presentation of th e th re e c o m p o n e n ts of th e in te r ­ vention were designed to increase k n o w l­ edge (general an d lesion), increase intraan d ex tra o ra l ex a m in a tio n procedures, a n d re d u c e b a rrie rs to ca re, th e re b y

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in creasin g scores on the w illingness to treat scale.

Results

Table 1

■ Pretest and posttest means and standard deviations of dentists on the outcome variables. C o n tro l g ro u p

T h e pretest an d posttest m eans for both th e e x p e r im e n ta l a n d c o n tro l g r o u p s were ex am ined to determ ine w here the scores fell a lo n g the ran g e of possible scores and to test for differences at pretest betw een the e x p e rim e n ta l a n d co n tro l groups. Next, the efficacy of ou r in te r­ vention was tested by assessing differences in m ean pretest to posttest change scores betw een th e e x p e rim e n ta l a n d co n tro l groups. T h e m a in h ypothesis was th a t the educational intervention w ould cause the experim ental group to show a greater im p ro v e m e n t fro m p re te st to p o stte st than the control g ro u p on the variables o f in te r e s t— H IV in f o r m a tio n , H IV lesions, w illingness to treat patients w ith H IV in fe c tio n , in tr a o ra l e x a m in a tio n , an d extraoral exam ination. T o test this, scores were calcu lated rep resen tin g the degree of c h a n g e for each v a ria b le by su b tractin g pretest from posttest scores. Independent ¿-tests were perform ed (using separate variance m odel) for differences betw een the e x p e rim e n ta l a n d co n tro l g ro u p means. T a b le 1 show s th e m ean scores an d sta n d a rd d e v ia tio n s of each g ro u p for each of th e five o u tc o m e v a ria b le s at p re te s t a n d p o s tte s t. T h e n u m b e r of su b je c ts is s lig h tly d iffe re n t for each variable because some of the participants returned incom plete questionnaires. T he d ifferen ces b etw e en e x p e rim e n ta l an d ' c o n tro l g r o u p s a t p re te s t w ere n o t significant (P > .05). Review of pretest scores indicated the need for im provem ent on all five outcom e v a ria b le s . T h e d e n tis ts ’ p re e x is tin g know ledge of AIDS was m oderate, w ith a b o u t tw o th ird s of th e q u e s tio n s a n ­ sw ered c o rre c tly in ea ch case (H IV in f o rm a tio n a n d H IV le sio n s). T h e w illingness to treat score was ju st above the m id p oint of the scale (38.5), reflecting d e n tists’ am bivalence tow ard the issue. T h e r e w as a n a p p r e c ia b le c o n tra s t betw een the scores o n in tra o ra l ex am ­ in a tio n , w here m ost dentists perform ed the procedures som etim es or always, and the e x tra o ra l e x a m in a tio n , w h ere the procedures were less thorough (averaging 7.0-9.2 o ut of 16). T h e m easure of greatest interest was the difference between the change scores for the experim ental and control groups. T h e m ean c h a n g e scores are listed in T ab le 2, alo n g w ith results of S tudent

H IV in fo rm atio n R an g e (0-21) n = 64,35* H IV lesions R ange (0-8) n = 59,35 W illingness to treat R an g e (11-77) n = 63,35 In trao ral ex am in atio n R ange (0-28) n = 62,35 E xtraoral ex am in atio n R ange (0-16) n = 59,32

Pretest Posttest

14.1 15.1

Pretest Posttest

5.6 5.1

Pretest Posttest

E xperim ental g ro u p 14.3 16.9

(2.1) (2.0)

(1.9) (1-6)

5.1 6.4

(2.0) (1-5)

40.5 43.7

(10.0) (10.5)

43.6 50.1

(10.1) (9.3)

Pretest Posttest

23.4 23.4

(4.2) (3.4)

22.4 24.7

(4.3) (4.9)

Pretest Posttest

9.2 10.0

(3.4) (3.6)

7.0 10.3

(3.8) (3.9)

(2.4)f (2.2)

* n = number of subjects responding to question. t Numbers in parentheses represent standard deviations.

Table 2

■

Mean change from pretest with t- tests for differences between groups.

HIV in fo rm ation H IV lesions W illingness to treat In trao ral e x am in atio n E xtraoral e x am in atio n

C ontrol g ro u p

E xperim ental g ro u p

t

P*

1.0 -0.5 3.1 0.0 0.8

2.6 1.3 6.7 2.3 2.4

3.37 3.94 2.32 2.60 2.63

< .0 0 2 < .0 0 1 < .024 < .0 1 3 < .0 1 2

* All differences are significant (P < .05).

¿-tests fo r d iffe ren ce s betw een e x p e ri­ m ental an d control groups. U sing P < .05 as a sta n d a rd , th e re w as a s ig n ific a n t differen ce betw een th e tw o g ro u p s on each variable, in d icatin g the effectiveness of the intervention. We also used analysis of covariance to assess posttest differences betw een th e e x p e rim e n ta l an d co n tro l groups, u sing the pretest as a covariate. T h e r e s u lts fro m th is a n a ly s is w ere essentially the same as those of the i-tests.

Discussion R esults of th is 6 -m o n th study indicate th a t d e n tis ts c a n c h a n g e to re s p o n d appropriately to the AIDS epidem ic. O ur three-m ethod intervention was successful in e ffe c tin g a s ig n if ic a n t c h a n g e in know ledge, attitudes, an d certain behav­ iors. At posttest, d en tists in the ex p er­ im ental g ro u p had significantly higher scores on five o u tco m e v ariab les—HIV in fo rm a tio n , H IV lesions, w illin g n ess to tre a t, in tr a o r a l e x a m in a tio n , an d extraoral exam ination. These results are encouraging; im p o r­ ta n t changes can be m ade by a d m in is­ tering proved educational m ethods that acknow ledge d en tists’ fears and concerns

w hile addressing know ledge an d behav­ io ral deficits. Even in th is h ig h ly m o ­ tiv a te d s a m p le o f v o lu n te e r d e n tis ts , h o w ev e r, sc o re s o n a ll fiv e o u tc o m e s indicated room for fu rth er im provem ent. Mean scores were n ot at the u p p er end of the ran g e for any outcom e, an d few in dividual p articip a n ts had perfect scores on any outcom e variable. T h e p a rtic ip a n ts w h o co m p leted the stu d y r e p r e s e n t o n ly 14% of d e n tis ts in v ited in to th e study. V olunteers m ay represent dentists in San Francisco w ho are interested in in fo rm atio n ab o u t HIV infection an d w ant to learn ab o u t AIDS. T h e h ig h reten tio n rate in the 6-m onth stu d y (97%) in d ic a te s th e co m m itm e n t to th e p ro je c t of p a r tic ip a n ts in b o th th e e x p e rim e n ta l a n d c o n tro l g ro u p s. T h is self-selection bias may have affected o u r study results in tw o ways. First, the e x te n t of th e in te rv e n tio n ’s effect may have been m oderated by dentists in the control g ro u p seeking in fo rm atio n in d e­ p e n d e n tly d u r in g th e stu d y an d , th u s, c h a n g in g o n th e ir o w n . In fac t, th e change in scores in T ab le 2 show that dentists in the control g ro u p did im prove in three of five outcom e variables d u rin g th e stu d y . T h e se c o n d effect o f th e

G erbert-O thers : C H A N G IN G A T T IT U D E S R E L A T IN G T O AIDS ■ 853

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v o lu n teer bias is th a t we c a n n o t easily g e n e ra liz e th e re su lts of th is stu d y to the oth er 86% of dentists in San Francisco. F u rth erm o re, dentists in San Francisco m ay n o t be representative of other dentists in the U nited States. T herefore, although th e re su lts a re fav o rab le, th e need for further educational research is acknow l­ edged to d eterm in e w h eth e r o u r in te r­ ven tio n te ch n iq u es are su itab le for use w ith all dentists. M oreover, it m u st be tested w hether all three techniques are vital to the success of the intervention. C onference calls in p articu lar are costly an d labor intensive. A 1987 review " of the co n tin u in g ed u ­ c a tio n lit e r a tu r e d isc lo se d a lack of c lin ic a l tria ls assessing the efficacy of c o n tin u in g dental education. More exper­ im e n ts a n d e d u c a tio n of th is type are n eed ed . F u r th e r re se a rc h is necessary to d e te rm in e w h eth e r the in te rv e n tio n techniques used in this study are suitable for use w ith all dentists. T h e role an d im age of dentists as part of the h ealth care team are being tested by th e A ID S c risis. F o r d e n tis tr y to

2. G erbert, B.; B adner, V.; a n d M aguire, B. AIDS a n d d e n ta l p ra c tic e. J P u b lic H e a lth D ent, to be published. 3. A tchinson, K.; D olan, T .; a n d Meetz, H . Have ----------------- jm A ------------------ d e n tis ts a s s im ila te d in f o r m a tio n a b o u t A ID S? J D ent E duc 51(11 ):668-672, 1987. 4. R a b e r, P .E . A ID S: P re v e n t its s p re a d , tre a t T h is research w as su p p o rte d in p art by the AIDS its victim s. D ent T o d ay 4(8): 1, 21, 1985. C lin ic a l R e s e a rc h c e n te r a t th e U n iv e rs ity of 5. L e B a ro n , R. U n k n o w in g e x p o su re to AIDS: C alifornia, San Francisco. d e n ta l p e rs o n n e l o n th e fro n t lin e . JC D A 13:2829, 1985. Dr. G erbert is assistant professor and chair, division 6. A m erican A ssociation of P u b lic H ealth D entistry of b ehavioral science, d ep artm e n t of d e ntal p u b lic Ad H o c C o m m itte e o n In fe c tio u s D iseases. T h e h e a lth a n d h y g ien e, S c h o o l of D e n tistry , D-1012, control of transm issible diseases in dental practice: U niversity of C alifornia, San Francisco 94143-0754. a p o s itio n p a p e r of the A m erican A sso c ia tio n of Mr. M aguire is graduate student, h ealth psychology P u b lic H e a lt h D e n tis try . J P u b lic H e a lth D e n t p ro g ram , U n iv ersity of C alifo rn ia , San Francisco. 46(1): 13-22, 1986. Dr. B a d n e r is a s s is ta n t p ro fe s so r, d e p a r tm e n t of 7. Steinbrook, R., a n d others. Perspective: ethical d entistry, A lbert E instein School of M edicine, New dilem m as in c a rin g fo r p a tie n ts w ith the acquired York. Dr. D eb o rah G re e n sp a n is associate c linical im m u n o d e fic ie n c y s y n d ro m e . A n n I n te r n M ed p ro fe s so r o f o ra l m e d ic in e ; Dr. J o h n G re e n sp a n 103(5):787-790, 1985. is p ro fe s so r a n d c h a ir , d iv is io n of o ra l b io lo g y , 8. G u llio n , D.S.; A dam son, T .E .; an d W atts, M.S. d e p a r tm e n t o f s to m a to lo g y , S c h o o l of D e n tistry , T h e effect o n a n in d iv id u a l p ra c tic e b a se d CM E U niversity of C alifornia, San Francisco. Ms. Barnes p ro g r a m o n p h y s ic ia n p e rfo rm a n c e a n d p a tie n t an d Mr. C arlto n are research associates, departm ent outcom es. W est J M ed 138 (4):582-586, 1983. of d e n ta l p u b lic h e a lth a n d h y g ie n e , S c h o o l of 9. A dam son, T .E ., an d G u llio n , D.S. Sm all g ro u p D entistry, U n iv ersity of C alifo rn ia, San Francisco. te a c h in g v ia te le p h o n e in c o n tin u in g m e d ic a l Address requests for re p rin ts to Dr. G erbert. education. M obius 2 (4): 13-19, 1982. 10. Sanazaro, P.J. CM E can im prove p a tie n t care (editorial). West J Med 138(4):560-561, 1983. 1. G erbert, B. AIDS a n d infection control in dental 11. Bader, J. A review of evaluations of effectiveness practice: d e n tists’ know ledge, attitudes, and behaviors. in c o n tin u in g d e n ta l e d u c a tio n . M o b iu s 7(3):39JAD A 114(3):S11-314, 1987. 48, 1987.

m aintain or increase in stature, a p ro ac­ tive, positive response to AIDS is essential.

Self-Assessment Questions 1. A ccording to the authors, dentists sh o u ld be able to: a) diagnose oral m anifestations of H IV /A ID S b) treat individuals w ith AIDS c) use in fe c tio n c o n tro l w ith all patients d) co n d u ct a th o ro u g h intra- and extraoral ex am ination e) all of the above

2. T h e in terv en tio n to change den­ tists’ know ledge, attitudes, and behav­ iors rela tin g to AIDS included: a) lecture, sm all gro u p discussion,

854 ■ JADA, Vol. 116, June 1988

bulletins b) lecture, bu lletin s, com puterized feedback, office visit from expert c) le c tu re , co n fe re n ce ca lls, selfassessment exam inations d) b u lle tin s , c o m p u te riz e d fee d ­ back, conference calls e) sm all g ro u p d isc u ssio n , study clubs, lecture

4. At posttest, dentists w ho had re­ ceived th e in te r v e n tio n knew m o re a b o u t AIDS an d were m ore w illin g to treat persons w ith AIDS th an the control group. T ru e or false?

3. After receiving this interv en tio n ,

5. D e n tis ts in C a lif o r n ia le a rn e d m ore about AIDS th an other dentists in the U nited States. T ru e or false?

p a r tic ip a n ts h a d p e rfe c t sco res on scales of k n o w led g e, a ttitu d e s, an d behaviors. T ru e or false?

8c

A nsw ers are fo u n d in th e P eo p le M eetings section.