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Article Excerpt
Despite some success in behaviorally focused HIV prevention, the pandemic continues to spread and a vaccine for HIV infection is many years away (Anonymous, 2001; Centers for Disease Control and Prevention, 2007; Girard, Osmanov, & Kieny, 2006). Advances in medical treatments have dramatically changed the course of HIV infection to a chronic disease requiring lifetime management. With the advent of protease inhibitors and non-nucleoside reverse transcriptase inhibitors in 1996, combination treatment of antiretrovirals to suppress HIV viral replication and improve immune function became available. The treatment is termed highly active antiretroviral therapy (HAART), and commonly known as the treatment cocktail and enhanced the longevity of persons living with HIV/AIDS (PLWHA). Between 1990 and 2003, the number of PLWHA in the US increased 519.1% and the annual number of AIDS-related deaths in the US decreased approximately 75.2% (Centers for Disease Control and Prevention, 2003; Karon, Fleming, Steketee, & DeCock, 2001; National Center for Health Statistics, 2002; Vittinghoff, Scheer, O'Malley, Colfax, Holmberg, & Buchbinder, 1999).
In 2007, there were nearly 1 million PLWHA in the US, of which 97% were between the working ages of 20 to 64 years (CDC, 2007). Because of HAART and the increased longevity of PLWHA, the number of PLWHA seeking employment has increased (Brooks & Klosinski, 1999; Fesko, 2001; Glenn, Ford, Moore, & Hollar, 2003; Hergenrather, Rhodes, & Clark, 2004; 2005; Hergenrather, Rhodes, & McDaniel, 2005; Hunt, Jaques, Niles, & Wierlis, 2003; Kalichman et al., 2000; Massagli, Weissman, Seage, & Epstein, 1994; McReynolds, 2001).
During the past two decades, the Americans with Disabilities Act (ADA) of 1990 has enhanced opportunities for persons with disabilities to participate in society. The ADA reflects Congressional intent to prohibit discrimination against persons with disabilities. Under the ADA, PLWHA that meet defined disability criteria are eligible for specific services, including job placement, through public vocational rehabilitation services (Americans with Disabilities Act, section 3: Definitions, 1990; McCarthy, 1998). Research suggests that successful job placement services for persons with disabilities, including those with HIV/AIDS, is influenced by the attitude of public rehabilitation placement professionals (e.g., job placement specialists, rehabilitation counselors, employment specialists) employed by state and federal vocational rehabilitation agencies to place individuals with disabilities into jobs (All, Fried, Ritcher, Shaw, & Roberto, 1997; Hergenrather et al., 2005; Mullins, Roessler, Schriner, Brown, & Bellini, 1997). Attitudes of public rehabilitation placement professionals toward persons with disabilities (i.e., consumers) have been correlated with the consumer's self-concept, consumer's self-efficacy, and consumer's level of job-seeking skills (All, Fried, Ritcher, Shaw, & Roberto, 1997; Millington, Asner, Linkowski, & Der-Stepanian, 1996). Although federal legislation addresses the placement for persons with disabilities, there is limited knowledge of the influences on rehabilitation placement professionals to place PLWHA into jobs from an emic or insider perspective. Successful placement of PLWHA may be enhanced by exploring and understanding the salient beliefs of public rehabilitation placement professionals toward the behavior of placing consumers with HIV/AIDS.
The Theory of Planned Behavior (TPB) suggests that a person's behavior is a function of his or her beliefs toward performing a specific behavior (Ajzen, 2001; Ajzen, 1988). The TPB is a widely applied social cognitive behavioral theory utilized to elicit and identify beliefs and develop interventions to enhance behaviors that include: HIV prevention among adolescents in the UK (Sutton, McVey, & Glanz, 1999), the effect of organization-based self esteem (Hsu & Kuo, 2003), research dissemination among addictions counselors (Breslin, Li, Tupker, & Sdao-Jarvie, 2001), the placement of consumers with a disability of substance abuse (Hergenrather & Rhodes, 2006), technology training adaptation in the workplace (Morris & Venkatesh, 2000), enrollment in distance education courses (Becker & Gibson, 1998), and the influences of intrinsic motivation on behavior (Chatzisarantis, Hagger, Smith, & Luke, 2006).
Theory of Planned Behavior
Theory of Planned Behavior (TPB) posits that one's behavior is a function of his or her intention to perform a particular behavior (Ajzen, 1985, 1988, 2001; Ajzen & Fishbein, 1980; Ajzen & Madden, 1986). Intention is correlated with actual behavior and predicted by the determinants of attitude, subjective norm, and perceived behavioral control (see Figure 1). Each determinant consists of a set of beliefs elicited from persons most likely to perform that behavior, and an evaluation of each elicited belief.
Furthermore, attitude is defined as the individual's overall evaluation of the consequences or outcomes of performing a specific behavior. Attitude is comprised of: (a) behavioral beliefs identifying the likely outcomes of performing the behavior (e.g., "Placement of a person with HIV/AIDS would increase his or her self-esteem.") and (b) a corresponding outcome evaluation item, assessing each behavioral belief as good or bad (e.g., "Would increasing the self-esteem of a person with HIV/AIDS be good or bad?").
Subjective norm is defined as the social pressures felt toward performing, or not performing, the specific behavior. Subjective norm is comprised of: (a) normative beliefs identifying those important referents perceived as likely to support, or not support, the individual in performing the behavior (e.g., "The PLWHA's Infectious Disease Physician thinks I should not provide placement for the consumer.") and (b) a corresponding motivation to comply item, evaluating the individual's likelihood to comply with each important referent (e.g., "How likely am I to comply with the opinion of the consumer's Infectious Disease Physician ?")
Perceived behavioral control is defined as the individual's perception of the extent to which the behavior is easy or difficult to perform. Perceived behavioral control is comprised of two components: (a) control beliefs, identifying an individual's perception of the likely resources for, and impediments to, performing the behavior (e.g., "A barrier to placement of a person with HIV/AIDS is his or her noncompliance with prescribed medical treatment.") and (b) a corresponding perceived power item evaluating the individual's level of ease/difficulty to access each resource and/or overcome each impediment (e.g. "How much control do I have to ensure a person with HIV/AIDS is complying with prescribed medical treatment?").
According to the TPB, behavioral change is the result of the change in behavioral beliefs, normative beliefs, and control beliefs; which impact the outcome evaluations, motivation to comply, and perceived power of persons performing the behavior addressed. When applying the TPB, a two stage data collection process is suggested (Ajzen & Fishbein, 1980; Ajzen and Madden, 1986). In the first stage, the behavior being studied is identified, and the behavioral beliefs, normative beliefs, and control beliefs toward the behavior are elicited from persons most likely to perform (e.g., public rehabilitation professionals) that specific behavior (e.g., placing a consumer w HIV/AIDS into a job). The elicited beliefs then are categorized into three determinants: behavioral, normative, and control. Modal beliefs are identified as those beliefs, with the highest frequencies, that represent the majority of the elicited beliefs for each determinant (Ajzen & Fishbein, 1980). This study addresses the first stage of the data collection process as defined by TPB. The second stage of the data collection process would address the development of a quantitative instrument, from the modal beliefs, in which the modal belief of each determinant is evaluated on a Likert scale. In this study, the TPB was applied to elicit the behavioral beliefs, normative beliefs, and control beliefs of public rehabilitation placement professionals to explore factors that influence the placement of consumers with HIV/AIDS. The following three research questions were explored:
1. Do public rehabilitation placement professionals identify likely placement outcomes for persons with HIV/AIDS?
2. Do public rehabilitation placement professionals identify specific referents who influence the placement of consumers with HIV/AIDS?
3. Do public rehabilitation placement professional identify specific resources for, or impediments to, the placement of consumers with HIV/AIDS?
This analysis is especially important because the application of behavioral theory...
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