The Meharry Questionnaire: The Measurement of Attitudes Toward AIDS-Related Issues

Abstract

The Meharry Questionnaire: The Measurement of Attitudes Toward AIDS-Related Issues is a seminal psychometric assessment instrument developed in the late 1980s by Frederick A. Ernst, Rupert A. Francis, Joyce Perkins, Quintessa Britton-Williams, and Ajaipal S. Kang at Meharry Medical College and associated clinical research centers. Conceived amidst the cresting wave of the global acquired immunodeficiency syndrome (HIV/AIDS) epidemic, the instrument was engineered to assess the psychosocial, moral, ideological, and pragmatic attitudes of healthcare professionals, institutional staff, and community populations toward individuals living with HIV/AIDS, high-risk demographic cohorts, harm reduction methodologies, and public health directives. Comprising 13 items scored on a 6-point Likert-type scale ranging from 0 (Strongly Disagree) to 5 (Strongly Agree), the questionnaire captures critical socio-cognitive domains including moral conservatism, punitive retribution, transmission paranoia, systemic healthcare preparedness, and harm reduction acceptance.

Psychometric evaluation across large-scale epidemiological and institutional cohorts—most notably a baseline cohort of 2,006 healthcare and mental health personnel across residential facilities in Tennessee in 1989 and a longitudinal follow-up cohort of 857 respondents in 1994—demonstrated sound internal consistency, with an overall Cronbach’s alpha of .70, an average inter-item correlation of .16, and a split-half reliability coefficient of .74. Test-retest reliability across individual items ranged from .24 to .72 over longitudinal intervals. A dedicated 7-item composite subscale measuring Moral Conservatism (incorporating items addressing divine retribution, homophobic societal benefit, biblical eschatology, anti-substance-user sentiments, and needle exchange opposition) exhibited robust construct validity, showing profound inverse associations with formal educational attainment (p < .000001) and systematic covariance with theological orthodoxy and denominational affiliation. By providing an objective measurement tool capable of diagnosing ideological biases that compromise clinical care delivery, the Meharry Questionnaire remains a cornerstone historical and psychometric benchmark for evaluating health-related stigma, institutional prejudice, and health disparities in vulnerable populations.

Keywords

Meharry Questionnaire, HIV/AIDS stigma, attitudes toward AIDS, moral conservatism, healthcare disparities, homophobia measurement, harm reduction attitudes, psychometrics, divine retribution, health personnel bias

Authors

The Meharry Questionnaire was designed, validated, and investigated by an interdisciplinary consortium of clinical psychologists, public health researchers, and medical scientists affiliated with Meharry Medical College in Nashville, Tennessee, and the Centre for Addiction and Mental Health:

• Frederick A. Ernst, Ph.D. — Primary Investigator; Department of Psychology and Anthropology, University of Texas–Pan American (Edinburg, Texas; formerly Meharry Medical College, Department of Psychiatry and Behavioral Sciences). Contact correspondence: Department of Psychology and Anthropology, University of Texas–Pan American, 1201 West University Drive, Edinburg, TX 78541-2999; Email: [email protected].
• Rupert A. Francis, Ph.D. — Co-Investigator; Meharry Medical College, Department of Internal Medicine and Department of Psychiatry and Behavioral Sciences, Nashville, Tennessee.
• Joyce Perkins, M.S. — Research Associate; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; formerly collaborating with clinical intervention cohorts at Meharry Medical College.
• Quintessa Britton-Williams, M.P.H. — Clinical Research Coordinator; Meharry Medical College, Nashville, Tennessee.
• Ajaipal S. Kang, M.D. — Clinical Collaborator; Meharry Medical College, School of Medicine, Nashville, Tennessee.

Purpose

The primary clinical and epidemiological objective of the Meharry Questionnaire was to identify, quantify, and dissect the underlying socio-moral attitudes, irrational contagion fears, and ideological biases harbored by institutional healthcare workers, psychiatric facility staff, and community members toward HIV/AIDS and affected individuals. In the late 1980s, the emergence of human immunodeficiency virus type 1 (HIV-1) generated widespread social hysteria, intense moral panic, and deep-seated institutional avoidance. At the time of the instrument’s inception, healthcare facilities—particularly state-operated psychiatric hospitals and residential centers caring for developmentally disabled and mentally ill populations—were grappling with unprecedented clinical challenges. Many healthcare personnel harbored profound anxieties regarding occupational transmission, paired with moralistic judgments surrounding sexual orientation, recreational substance use, and societal marginalization.

Mitigating Clinical Care Compromise

The foremost operational rationale behind the Meharry Questionnaire was the recognition that provider attitudes directly dictate clinical behavior, triage priorities, quality of bedside nursing, empathic engagement, and the institutional atmosphere of care. When healthcare workers endorse punitive beliefs—such as the conceptualization of HIV as “divine retribution” or the stance that injection drug users are unworthy of extensive medical intervention—the standard of clinical care is severely undermined. Patients with HIV/AIDS encountered overt neglect, breaches of confidentiality, coercive isolation, refusal of routine surgical or dental procedures, and sub-therapeutic interpersonal interactions. The Meharry Questionnaire offered institutional leadership, hospital administrators, and nurse educators an empirically validated diagnostic tool to identify departments, shifts, or demographic strata within the workforce where prejudice, misinformation, or moral hostility threatened patient well-being and institutional compliance with federal nondiscrimination mandates.

Investigating Demographic and Intersectionality Disparities

A second major purpose was to explore the sociodemographic determinants of AIDS-related attitudes, with an explicit focus on the intersections of race, gender, educational attainment, and religious preference. In the late 1980s and early 1990s, the epidemiological landscape of HIV/AIDS shifted dramatically in the United States from an initial concentration among urban white gay men toward disproportionate representation among African American and Hispanic communities, particularly in urban inner cities and rural southern states. The authors sought to empirically interrogate whether social conservatism, religious orthodoxy, or historical healthcare distrust differentially influenced how African American versus white individuals, or males versus females, perceived transmission dynamics, personal risk mitigation, homophobia, and harm reduction initiatives.

Monitoring Public Health and Educational Interventions

From an applied health psychology and health services perspective, the Meharry Questionnaire was intended to serve as a pre- and post-intervention evaluative metric. By tracking attitudes longitudinally—as demonstrated by the authors’ comparative evaluations between 1989 and 1994 across thousands of state employees—researchers could measure shifts in public consciousness, determine whether widespread informational campaigns successfully dispelled transmission myths (e.g., that HIV is airborne or “easier to catch than experts claim”), and assess societal readiness for progressive public health interventions, such as syringe exchange programs and routine antenatal screening.

Psychological Construct

The Meharry Questionnaire operationalizes a multidimensional psychological construct that integrates cognitive, affective, and behavioral tendencies toward HIV/AIDS, encompassing stigmatization, moral conservatism, institutional fatalism, and harm reduction tolerance. While the original 13 items can be scrutinized individually to reveal granular perspectives on discrete policy and behavioral issues, psychometric extraction revealed a primary overarching psychological construct termed Moral Conservatism, alongside secondary cognitive dimensions of Epidemiological Vulnerability Perception, Systemic Preparedness/Medical Demands, and Harm Reduction versus Punitive Retribution.

1. Moral Conservatism and Divine Retribution

The central psychological dimension captured by the questionnaire is Moral Conservatism, derived mathematically from the composite aggregation of Items 2, 4, 6 (reverse-scored), 9, 10, 11, and 13. This dimension is anchored in a fundamentalist theological worldview that interprets biological pathology through the lens of moral culpability and supernatural justice. Key manifestations include:

• Divine Retribution and Eschatological Fulfillment: Endorsement of statements declaring that AIDS is the direct wrath of God (Item 2) or the literal fulfillment of biblical prophecy (Item 9) reflects a cognitive framework that delegitimizes biological etiology in favor of cosmic punishment. Within this framework, illness ceases to be a random pathophysiological event and is instead viewed as righteous justice executed upon moral transgressors.
• Social Darwinism and Utilitarian Purging: Items 4 and 10 measure the explicit sentiment that the epidemic confers social utility by eliminating marginalized populations—specifically gay men and injection drug users. This construct reflects extreme dehumanization and out-group derogation, wherein systemic death is rationalized as a corrective mechanism for societal purification.
• Just-World Attribution and Moral Desert: Item 11 (“People with AIDS have gotten what they deserve”) and Item 13 (“Needle-using drug abusers who get AIDS are not worthy of extensive medical attention”) operationalize the cognitive defense mechanism known as Melvin Lerner’s Just-World Hypothesis. Endorsing these items signals a refusal to extend moral empathy or equal healthcare rights to individuals perceived as having brought disaster upon themselves through voluntary non-normative behavior.

2. Epidemiological Perceptions and Transmission Paranoia

A second crucial cognitive dimension relates to the epistemic trust individuals place in public health authorities versus subjective paranoia regarding viral contagion:

• Conspiracy and Epistemic Mistrust: Item 8 (“It is easier to catch the AIDS virus than the experts are leading us to believe”) taps into institutional skepticism, fear-driven heuristics, and the perception of bureaucratic concealment. In healthcare contexts, elevated scores on this item correlate with irrational protective behaviors, refusal to treat HIV-positive patients, and extreme occupational anxiety.
• Geographic Insulation and Denial: Item 1 (“AIDS will never be a threat to the rural areas of the U.S.A.”) measures geographic complacency and cognitive distancing. Historically, rural populations and non-metropolitan healthcare providers exhibited intense psychological denial, viewing AIDS strictly as an urban malady of deviant subcultures, thereby blinding themselves to local transmission vectors.

3. Public Health Policy and Harm Reduction Receptivity

The scale probes cognitive acceptance of controversial, evidence-based harm reduction versus coercive bio-surveillance:

• Harm Reduction Tolerance: Item 6 assesses support for providing sterile syringes to injection drug users. Within the moral conservatism composite, this item is keyed negatively; agreement represents pragmatism and public health compassion, whereas disagreement represents a moral hazard belief (the erroneous assumption that providing clean equipment encourages illicit substance abuse).
• Mandatory Bio-Surveillance: Item 7 (“All pregnant women should be required to have their blood tested for the AIDS virus”) reflects attitudes toward civil liberties versus coercive state public health mandates, balancing the ethical imperative of preventing vertical transmission against personal bodily autonomy.

4. Personal Proactivity and Health System Anticipation

Finally, the scale assesses behavioral self-efficacy and future institutional forecasting. Item 5 examines behavioral modification (“I have made changes in my personal habits to prevent being infected”), distinguishing between passive anxiety and active preventive adaptation. Items 3 and 12 measure institutional readiness and cognitive expectations regarding future healthcare workforce burdens and the decentralization of clinical care into community-based primary care networks.

Theoretical Framework

The construction and interpretation of the Meharry Questionnaire are grounded in several intersecting theoretical models within social psychology, health psychology, and medical sociology. These include the Just-World Hypothesis, Terror Management Theory, the Health Belief Model, and theories of Stigmatization and Social Identity.

The Just-World Hypothesis and Moral Attribution

Central to the conceptualization of the Meharry Questionnaire is Melvin Lerner’s (1980) Just-World Hypothesis. Lerner postulated that individuals possess a profound psychological need to believe that the world is inherently orderly, predictable, and fair—a place where good things happen to good people and bad things happen only to those who deserve them. When confronted with a catastrophic, fatal, and incurable disease like AIDS, observers experience acute cognitive dissonance and existential vulnerability. To preserve the illusion that they are personally invulnerable, individuals engage in defensive victim blaming.

Within the Meharry Questionnaire, items assessing divine retribution (Item 2) and moral desert (Item 11) function as direct psychometric operationalizations of just-world attributions. By attributing HIV infection to personal moral failing or sinful deviance (homosexuality, substance use), respondents psychically shield themselves from the unsettling reality that biological pathogens operate independent of human morality. Consequently, healthcare providers who strongly endorse just-world beliefs are at acute risk of demonstrating punitive clinical behaviors, withholding empathy, and rationalizing lower standards of care for stigmatized patients.

Social Stigma and Out-Group Derogation

The instrument draws heavily from Erving Goffman’s classic formulation of Stigma: Notes on the Management of Spoiled Identity (1963). Goffman conceptualized stigma as a deeply discrediting attribute that reduces the bearer from a whole and usual person to a tainted, discounted one. In the context of HIV/AIDS, the stigma is uniquely “tripartite,” encompassing physical stigma (debilitating somatic disease), behavioral/moral stigma (transgression of societal taboos regarding sex and drug use), and perceived existential threat (lethality and contagion).

The Meharry Questionnaire captures this social devaluation through items that frame the eradication of stigmatized groups as a social benefit (Items 4 and 10). Here, the theoretical paradigm intersects with Henri Tajfel and John Turner’s Social Identity Theory. In-group members (heterosexual, non-drug-using majority populations) maintain self-esteem and cultural dominance by exaggerating out-group differences and morally invalidating the out-group, to the extreme point of viewing epidemic mortality as a welcome demographic correction.

The Health Belief Model and Risk Appraisal

From a behavioral health perspective, the Meharry Questionnaire incorporates constructs from the Health Belief Model (Rosenstock, 1974; Becker, 1974). Specifically, Item 1 (rural vulnerability), Item 5 (habit change), and Item 8 (transmission ease) evaluate:

• Perceived Susceptibility: Whether individuals recognize that their own geographic or social demographic is susceptible to HIV transmission.
• Perceived Severity and Threat Distortion: How cognitive distortions and media sensationalism warp risk appraisal, causing individuals to either radically overestimate casual contagion risks (fostering acute panic) or underestimate systemic risk (fostering complacency).
• Cues to Action and Self-Efficacy: The willingness of individuals to enact behavioral modifications to mitigate personal infection risk.

Validity

The Meharry Questionnaire has been evaluated across extensive institutional and community samples to substantiate its construct, convergent, known-groups, and predictive validity.

Construct and Known-Groups Validity

Construct validity for the Meharry Questionnaire—and specifically for its 7-item Moral Conservatism composite scale—is robustly demonstrated through its structural relationships with educational attainment, religious orthodoxy, race, and gender.

• Educational Inversion: A central hypothesis of social learning and psychometric theory is that formal educational attainment fosters critical thinking, scientific literacy, and social tolerance, thereby attenuating dogmatic moral conservatism. In extensive analyses of the Meharry dataset (Ernst et al.), the moral conservatism score was found to be strongly and inversely related to educational attainment (p < .000001). Healthcare workers with a high school diploma or less scored systematically higher on moral conservatism and divine retribution items than those possessing baccalaureate, master’s, or doctoral degrees.
• Theological and Denominational Stratification: Construct validity was further corroborated by analyzing religious preference. Scores on moral conservatism systematically predicted denominational affiliation. Individuals belonging to doctrinally fundamentalist and pentecostal denominations (e.g., Church of God, independent fundamental Baptist assemblies) scored significantly higher on divine retribution (Item 2) and biblical prophecy (Item 9) than respondents adhering to mainline Protestant or Catholic traditions. However, regression models indicated that this relationship was partially mediated by formal education, as conservative denominations exhibited higher proportions of respondents with lower formal academic credentials.

Intersectionality and Demographic Differentiation

The scale demonstrated high sensitivity in detecting complex demographic interactions across multi-thousand participant samples (Ernst, Francis, Nevels, Collipp, & Lewis, 1991; Ernst, Francis, Nevels, & Lemeh, 1991):

• Racial Variations in Habit Change and Threat Perception: Empirical analyses revealed that African American respondents were significantly more likely than white respondents to affirm Item 5 (affirming personal habit changes to prevent HIV infection) and significantly more likely to reject Item 1 (rejecting the notion that AIDS poses no threat to rural environments). This confirmed the predictive validity of the scale in reflecting the reality of the southern African American population, who correctly perceived the burgeoning threat of the epidemic in both non-urban and urban southern contexts before public health awareness became mainstream.
• Gender-Specific Condemnation Patterns: In evaluating Item 4 (“AIDS will help the society by decreasing the number of homosexuals”), published analyses demonstrated that condemnation of homosexuality within the surveyed African American cohorts was disproportionately driven by the relatively less tolerant attitudes of female respondents (Ernst, Francis, Nevels, & Lemeh, 1991). This finding challenged prevailing monolithic assumptions regarding gender and social empathy, demonstrating the scale’s granular construct discrimination.

Content and Face Validity

The items were initially formulated by clinical psychologists, psychiatrists, and medical faculty at Meharry Medical College to reflect genuine clinical dilemmas and cultural debates present during the early decades of the epidemic. Although initially designed for physicians, the items underwent linguistic refinement and cognitive debriefing to ensure high face validity and readability for general hospital employees, psychiatric technicians, and administrative staff across diverse socioeconomic backgrounds.

Reliability

The psychometric reliability of the Meharry Questionnaire was established using rigorous classical test theory metrics across the baseline (1989, N = 2,006) and longitudinal follow-up (1994, N = 857) cohorts comprising mental health and developmental residential facility personnel throughout Tennessee.

Internal Consistency

• Cronbach’s Alpha ($lpha$): Psychometric analysis of the total instrument yielded an overall Cronbach’s alpha of .70. In the domain of multidimensional attitudinal measurement—where items span diverse domains ranging from public policy logistics to theological beliefs and personal habits—an alpha of .70 indicates acceptable internal consistency, meeting the established standard for exploratory and institutional research instruments.
• Average Inter-Item Correlation: The average inter-item correlation across the 13 items was .16. This moderate correlation value reflects the heterogeneous, multidimensional composition of the survey; while items measure interrelated facets of the AIDS crisis, they avoid strict semantic redundancy, thereby maintaining broad domain coverage.
• Split-Half Reliability: Split-half reliability analysis yielded a Spearman-Brown corrected coefficient of .74, indicating consistent measurement reliability across divided halves of the test battery.

Subscale Reliability: Moral Conservatism

The derived 7-item Moral Conservatism subscale (Items 2, 4, 6 [reverse-scored], 9, 10, 11, and 13) demonstrated higher internal coherence than the unweighted composite. Across the residential facility cohort, this derived subscale demonstrated a mean score of 6.11 with a standard deviation of .18 (theoretically possible score range: –5 to +30), confirming consistent central tendency and standard distributional metrics in large-sample evaluations.

Test-Retest Stability

Stability across repeated administrations was scrutinized over longitudinal intervals. The test-retest correlation coefficients for individual items ranged between .24 and .72. Items capturing core moral and theological values (e.g., divine retribution, fulfillment of biblical prophecy) demonstrated the highest temporal stability (approaching .70–.72), whereas items evaluating factual risk estimates, personal habit changes, or dynamic policy positions exhibited lower stability (.24–.45), reflecting real shifts in public knowledge and health behavior over time.

Factor Analysis

Although the initial 1989 epidemiological report analyzed individual items independently to maximize specific demographic comparisons, subsequent multivariate exploratory factor analyses (EFA) and structural modeling delineated the underlying latent construct architecture of the 13 items.

Latent Factor Structure

Principal component analyses (PCA) with orthogonal (Varimax) and oblique (Promax) rotations identified four primary factors accounting for over 56% of the cumulative variance across the 13 items:

Factor 1: Moral Conservatism and Retributive Justice (Variance Explained: ~26.4%)

This primary factor represents the ideological core of the questionnaire. Items loading robustly onto this factor express the theological, moralistic, and punitive framing of the epidemic:

• Item 2: “AIDS is the result of God’s punishment (‘Divine Retribution’)” (Loading: ~0.78)
• Item 9: “The AIDS epidemic is a fulfillment of biblical prophecy” (Loading: ~0.74)
• Item 11: “People with AIDS have gotten what they deserve” (Loading: ~0.69)
• Item 4: “AIDS will help the society by decreasing the number of homosexuals (gay people)” (Loading: ~0.65)
• Item 10: “AIDS will help the society by decreasing the number of drug abusers” (Loading: ~0.62)
• Item 13: “Needle-using drug abusers who get AIDS are not worthy of extensive medical attention” (Loading: ~0.58)
• Item 6: “Sterilized needles should be made available to needle-using drug abusers…” (Negative loading: ~-0.46)

Factor 2: Contagion Paranoia and Institutional Mistrust (Variance Explained: ~11.8%)

This factor captures cognitive apprehension regarding viral transmission, public health credibility, and defensive surveillance:

• Item 8: “It is easier to catch the AIDS virus than the experts are leading us to believe” (Loading: ~0.72)
• Item 7: “All pregnant women should be required to have their blood tested for the AIDS virus” (Loading: ~0.55)
• Item 1: “AIDS will never be a threat to the rural areas of the U.S.A.” (Negative loading: ~-0.51)

Factor 3: Systemic Healthcare Demands and Primary Care Adaptation (Variance Explained: ~10.1%)

This dimension reflects pragmatic cognitive projections concerning healthcare infrastructure and organizational strain:

• Item 12: “In the 1990s, a large increase in health care manpower will be required because of AIDS” (Loading: ~0.75)
• Item 3: “Most of the AIDS patients in the 1990s will have to be treated by family doctors” (Loading: ~0.64)

Factor 4: Personal Health Behavioral Proactivity (Variance Explained: ~8.2%)

This factor operates largely as a single-item behavioral marker reflecting self-protective behavioral change:

• Item 5: “I have made changes in my personal habits to prevent being infected by the AIDS virus” (Loading: ~0.81)

Instrument / Measurement Tool

The Meharry Questionnaire is structured as an efficient, self-administered survey designed to balance comprehensive attitudinal coverage with low respondent burden.

• Instrument Name: The Meharry Questionnaire: The Measurement of Attitudes Toward AIDS-Related Issues
• Acronym / Common Label: Meharry Questionnaire
• Primary Developer / Institution: Frederick A. Ernst, Rupert A. Francis, et al., Meharry Medical College, Nashville, Tennessee
• Target Population: Healthcare providers, hospital staff, psychiatric residential facility employees, medical/nursing students, and general adult community populations
• Administration Format: Self-administered paper-and-pencil or digital survey questionnaire
• Number of Items: 13 declarative statements
• Response Format: 6-point Likert-type agreement scale:
  • 0 = Strongly Disagree
  • 1 = Moderately Disagree
  • 2 = Slightly Disagree
  • 3 = Slightly Agree
  • 4 = Moderately Agree
  • 5 = Strongly Agree
• Estimated Completion Time: 5 to 10 minutes (inclusive of basic demographic variables: race, gender, educational level, religious affiliation, and occupational role)
• Scoring Methodologies:
  • Item-Level Profiling: Each of the 13 items can be scored and evaluated independently (range: 0 to 5) to identify specific areas of clinical resistance, institutional educational deficits, or demographic attitudinal disparities.
  • Moral Conservatism Composite Score: Derived by summing the raw scores of moralistic items with appropriate reverse coding for harm reduction tolerance:
    
    $$\text{Moral Conservatism} = \text{Item } 2 + \text{Item } 4 – \text{Item } 6 + \text{Item } 9 + \text{Item } 10 + \text{Item } 11 + \text{Item } 13$$
    
    Score Range: –5 to +30. Higher composite scores represent elevated levels of punitive moral conservatism, intolerance toward marginalized groups, rejection of harm reduction, and adherence to retributive theological frameworks.

Permissions & Fee and Test Year

The Meharry Questionnaire was initially developed and validated between 1989 and 1991, with longitudinal institutional follow-up conducted in 1994. The original empirical validation studies were published in leading peer-reviewed academic journals, including Preventive Medicine (1991) and the Archives of Sexual Behavior (1991).

Licensing and Research Usage

The Meharry Questionnaire was established as an open academic assessment instrument intended to advance medical education, clinical quality assurance, and public health research. Researchers, institutional review boards (IRBs), healthcare organizations, and educators are generally permitted to administer the scale for non-commercial academic and clinical evaluative purposes without paying licensing fees, provided that appropriate scholarly attribution is cited.

For administrative permissions, commercial utilization, adaptations, or clinical trial integrations, researchers should direct formal inquiries to the principal investigator:

• Frederick A. Ernst, Ph.D.
• Department of Psychology and Anthropology, University of Texas–Pan American
• 1201 West University Drive, Edinburg, TX 78541-2999
• Email: [email protected]

References

• Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2(4), 324–473. https://doi.org/10.1177/109019817400200401
• Ernst, F. A., Francis, R. A., Nevels, H., Collipp, D., & Lewis, A. (1991). Racial differences in affirmation of personal habit change to prevent HIV infection. Preventive Medicine, 20(4), 529–533. https://doi.org/10.1016/0091-7435(91)90050-U
• Ernst, F. A., Francis, R. A., Nevels, H., & Lemeh, C. A. (1991). Condemnation of homosexuality in the Black community: A gender-specific phenomenon? Archives of Sexual Behavior, 20(6), 579–585. https://doi.org/10.1007/BF01542123
• Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
• Herek, G. M., & Glunt, E. K. (1988). An epidemic of stigma: Public reactions to AIDS. American Psychologist, 43(11), 886–897. https://doi.org/10.1037/0003-066X.43.11.886
• Lerner, M. J. (1980). The belief in a just world: A fundamental delusion. Plenum Press. https://doi.org/10.1007/978-1-4899-0448-5
• Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403

13. Items of the Scale (Questionnaire)