Study area
The study employed a face-to-face interview-based cross-sectional survey. Data was collected from slum areas of Dhaka city in Bangladesh, between October and November 2023.
Sample size
The sample size was calculated using the following equation:
|
\(n=\frac{{z}^{2}pq}{{d}^{2}}; n=\frac{{1.96}^{2}\times 0.5\times \left(1-0.5\right)}{{0.05}^{2}}=384.16\approx 384\) |
Here, n = number of samples z = 1.96 (95% confidence level) p = prevalence estimate (50% or 0.5), no previous study found q = (1-p) d = Precession of the prevalence estimate (10% of 0.05) |
Anticipating a prevalence estimate (p) of 50% in the current study, we aimed for a sample size of 424 people, accounting for a 10% non-response rate. Our sample size surpassed this initial estimate. Yet, 453 individuals were enlisted to bolster the study’s robustness.
Study design, participants, and procedure
The study employed a cross-sectional survey design with face-to-face interviews using questionnaires conducted between October and November 2023. Participants were recruited through a non-probability sampling (convenience sampling) technique. Participants spent around 15–20 min completing the interviews. Initially, 490 participants participated in the surveys. After excluding incomplete responses, the final analysis encompassed 453 surveys. Missing responses occurred randomly, and justification will be provided during the revise and data entry phase. Data collection involved a paper-based semi-structured questionnaire in Bangla, the native language of the participants, conducted house-to-house. Given the sensitivity of HIV/AIDS, trained research assistants conducted the data collection, ensuring strict confidentiality.
A preliminary trial involving 30 participants from the target population was conducted to assess the questionnaire’s acceptability and transparency. Subsequent to the pilot testing, minor adjustments were made to the questionnaire. Data from this trial were not included in the final analysis. The initial page of the questionnaire included an informed consent statement outlining the study’s objectives, procedures, and the participant’s right to refuse participation. Prior to the survey commencement, participants were requested to give informed consent by confirming their voluntary and spontaneous willingness to participate in the study. The participant inclusion criteria comprised: i) adults aged 18 or above residing in urban slums for at least one year, ii) proficiency in Bengali language (ability to talk), iii) willingness to participate in the study, iv) being married and sexually active (as most questions were related to sexual activity), and v) residency in Bangladesh as Bangladeshi citizens. Individuals below 18 years and those unwilling to participate were excluded during the interview.
Measures
Socio-demographic measures
Socio-demographic data were collected through inquiries covering various aspects: age, education level (categorized as illiterate, primary, secondary, or higher secondary and above), occupation (including housewife, day laborer, rickshaw puller, employee, unemployed, or other), monthly family income (grouped into less than 10,000 Bangladeshi Taka [BDT], 1000BDT to 20,000 BDT, or more than 20,000 BDT), history of sexually transmitted diseases (STDs) (yes/no), presence of STDs among family members (yes/no), willingness of family members to discuss STDs/HIV, acquaintance with HIV patients (yes/no), smoking and alcohol consumption habits (yes/no), daily physical exercise routine (yes/no), body mass index (BMI) classification based on measured height and weight (underweight/normal/overweight/obese), daily sleeping duration (classified as less than 7 h, 7 to 9 h, or more than 9 h), and daily social media usage time (categorized as less than 2 h, 2 to 5 h, or more than 5 h) [23]. The full study was conducted using a blinded questionnaire (see Additional file 1 for details).
Knowledge, attitudes, and practices measures
In this study, we employed a set of 33 questions, comprising 11 items each for knowledge, attitudes, and prevention practices related to HIV/AIDS. These questions were adapted from previous validated studies [24,25,26]. The skewness and kurtosis of the total scores for all measures fell within the acceptable range of ± 2, a methodology consistent with validated Knowledge, Attitudes, and Practices (KAP) studies [23, 27].
Participants were presented with a set of eleven questions addressing knowledge about HIV/AIDS and its health effects, each offering three response options: yes, no, or don’t know (e.g., “Is HIV/AIDS a preventable disease?, Can HIV/AIDS spread by coughing & sneezing?” (See details in Fig. 1). During the analysis, responses affirming with “yes” were designated the code “1,” while responses of “no” and “don’t know” were assigned the code “0.” The cumulative score was computed by adding the scores of all items, ranging from 0 to 11, where a higher score indicated a higher level of knowledge [27]. Additionally, the study documented the origins from which participants acquired knowledge about HIV/AIDS. The reliability of the knowledge items was assessed using Cronbach’s Alpha, resulting in a calculated value of 0.88 indicates that there is a high internal consistency [28].
Knowledge regarding HIV/AIDS
To assess attitudes regarding HIV/AIDS, eleven questions were utilized, employing a three-point Likert scale (e.g., 1 = disagree, 2 = neutral, 3 = agree). Illustrative queries included statements such as: I feel comfortable discussing HIV/AIDS and related topics with healthcare providers, I trust that regular screening is an effective way to detect HIV/AIDS early. “ (see details in Fig. 2). The overall score, obtained by adding up individual item scores, ranged from 11 to 33, with a higher score reflecting a more positive attitude [27]. The Cronbach’s Alpha for attitude items was computed at 0.82 indicates that there is a high internal consistency [28], and negative statements were reverse-coded.
Attitudes regarding HIV/AIDS
To assess the participants’ practices, eleven questions were posed, such as “How often do you perform self-examinations to check for any abnormal changes in your body including reproductive health?, How often do you engage in practices that can reduce the risk of HIV/AIDS (e.g., limiting sexual partners, using protection, not sharing needles, etc.)?, How frequently do you use protection (e.g., condoms) during unsafe sexual intercourse to reduce the risk of HIV/AIDS??” (see details in Fig. 3). Participants used a three-point scale (indicating “never,” “sometimes,” or “always”). In the analysis, “never” was coded as “1,” “sometimes” as “2,” and “always” as “3.” The total score, ranging from 11 to 33, reflected adherence to practices, with a higher score indicating a higher level of adherence [27]. The Cronbach’s Alpha value for the practice items, calculated as 0.79, demonstrates a high level of internal consistency [28].
Prevention practices regarding HIV/AIDS
Statistical analysis
The analysis involved multiple statistical tools, including Microsoft Excel 2021, SPSS version 26.0 (Chicago, IL, USA), and STATA version 15.0. Microsoft Excel facilitated data cleaning, coding, and sorting, after which the Excel file was imported into SPSS for calculating descriptive statistics like frequencies, percentages, means, and standard deviations. Bivariate and multivariable linear regression analyses, using the total scores of knowledge, attitudes, and practices measures, were conducted in STATA. All analyses adhered to a significance level of p < 0.05.
Ethics approval and consent to participate
The research protocol underwent review and approval by the Biosafety, Biosecurity, and Ethical Clearance Committee at Jahangirnagar University, Savar, Dhaka-1342, Bangladesh [Ref. No: BBEC, JU/M 2023/9–72]. The study procedures strictly adhered to human research guidelines, including the Helsinki Declaration. Informed written consent was procured from every participant, outlining the study’s procedures, objectives, and confidentiality of their information. Informed written consent was taken from participants, and local guardians of the illiterate participants. Data collection was anonymous, and numerical codes were used for analysis.
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