STI Education Efficacy Survey

1. Abstract

The STI Education Efficacy Survey (SEES) is a multidimensional psychometric instrument developed by Patricia Barthalow Koch, Andrew W. Porter, and Clinton Colaco at The Pennsylvania State University. Designed to evaluate educators’ capacity to implement evidence-based sexually transmitted infection (STI) and human immunodeficiency virus (HIV) curricula, the SEES addresses the critical gap between legislative mandates for adolescent sexual health education and teacher professional preparedness. The instrument comprises 48 items distributed across four distinct subscales: (1) Knowledge of Sexually Transmitted Infections (25 dichotomous items with a “Don’t Know” option), (2) Attitudes Toward Adolescent Sexuality and Sexuality Education (10 items assessed on a 5-point Likert scale), (3) STI Education Confidence (8 items assessing self-efficacy on a 5-point Likert-type scale), and (4) STI Education Readiness (5 items assessing operational readiness, willingness, and perceived ability on a 5-point Likert-type scale). Psychometric validation conducted with a representative sample of 120 middle and high school educators in Pennsylvania demonstrated strong internal consistency, yielding a Kuder-Richardson Formula 20 coefficient of .89 for the Knowledge subscale, and Cronbach’s alpha coefficients of .75, .92, and .89 for Attitudes, Confidence, and Readiness, respectively. Content validity was established via a formal Delphi consensus process with adolescent health panels drawing upon standards from the Centers for Disease Control and Prevention (CDC) and the Sexuality Information and Education Council of the United States (SIECUS). Pre- and post-intervention evaluations confirmed significant sensitivity to educational training across all functional domains, cementing the SEES as an essential diagnostic, programmatic, and research tool in school health and public health education.

2. Keywords

STI Education Efficacy Survey, sexual health education, STI knowledge, teacher self-efficacy, adolescent sexuality, HIV prevention education, psychometrics, sexuality educator attitudes, curriculum readiness, school health pedagogy

3. Authors

The STI Education Efficacy Survey was designed and validated by researchers associated with the Department of Biobehavioral Health and the Pennsylvania Learning Academy for Sexuality Education at The Pennsylvania State University:

• Patricia Barthalow Koch, Ph.D.: Professor of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University. Dr. Koch is a renowned sexuality educator and researcher specializing in adolescent sexual health, teacher training, and human sexuality curricula.
• Andrew W. Porter, Ph.D.: Department of Biobehavioral Health, The Pennsylvania State University. Dr. Porter has conducted extensive empirical investigations in health education measurement, behavioral epidemiology, and educational program evaluation.
• Clinton Colaco, M.S.: The Pennsylvania State University. Contributor to public health educational research, intervention design, and psychometric field assessment.

Correspondence regarding the instrument and its evaluation protocols is typically addressed via The Pennsylvania Learning Academy for Sexuality Education, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802.

4. Purpose

The primary purpose of the STI Education Efficacy Survey (SEES) is to systematically evaluate the diagnostic needs, foundational competencies, and instructional readiness of educators tasked with delivering adolescent STI and HIV prevention curricula. Legislative surveys by the Guttmacher Institute demonstrate that while a substantial majority of U.S. states mandate STI/HIV education within public secondary schools, educational mandates frequently outpace educator readiness. Prospective and practicing educators often report inadequate pedagogical preparation, deficiencies in biomedical knowledge, restrictive or ambivalently held attitudes regarding youth sexual behavior, and pronounced discomfort when addressing explicit sexual health topics.

In clinical, community, and academic research settings, the SEES serves three main applications:

• Professional Training Needs Assessment: School districts and health departments deploy the SEES to identify specific instructional deficits, knowledge blindspots (such as misconceptions regarding human papillomavirus, chlamydial transmission, or viral shedding), and personal ambivalence among educators before designing professional development seminars.
• Curricular Program Evaluation: The survey functions as an objective pre- and post-intervention evaluation instrument. By administering the SEES prior to and following professional development workshops, continuing education providers can empirically measure shifts in pedagogical confidence, normative attitudes, biomedical accuracy, and professional readiness.
• Empirical Research in Health Pedagogy: Researchers investigating the correlates of effective health education use the SEES to measure how educator self-efficacy and attitudes mediate classroom implementation fidelity, curriculum completion, and student health outcomes.

The theoretical rationale rests on the principle that adolescent learning outcomes in sexual health are directly contingent upon the pedagogical efficacy of their instructors. When educators possess high factual accuracy, non-stigmatizing attitudes, elevated instructional self-efficacy, and operational readiness to advocate for sexual health resources, they deliver sexual health curricula with greater fidelity, resulting in measurable declines in adolescent risk behaviors and reductions in STI transmission rates.

5. Psychological Construct

The SEES conceptualizes educator effectiveness not as an isolated trait, but as a multidimensional construct encompassing four distinct, interacting psychological and cognitive domains:

1. Knowledge of Sexually Transmitted Infections

This cognitive dimension assesses factual mastery of epidemiological, clinical, biological, and prophylactic aspects of sexually transmitted pathogens. Rather than evaluating vague health awareness, this subscale captures specific factual verifiers, such as asymptomatic transmission rates (e.g., that chlamydial infections are largely asymptomatic in females), viral versus bacterial etiologies, viral persistence despite the absence of visible lesions (e.g., HPV and Herpes Simplex Virus), and structural prophylactic properties (e.g., latex versus natural membrane condoms and the catastrophic effect of oil-based lubricants on latex integrity). The operationalization incorporates a distinct “Don’t Know” option to prevent guessing and isolate genuine factual mastery from subjective uncertainty.

2. Attitudes Toward Adolescent Sexuality and Sexuality Education

This affective-normative dimension measures an educator’s baseline perspectives concerning adolescent sexual development, systemic access to contraception, and pedagogical paradigms (e.g., comprehensive versus abstinence-only approaches). Rooted in attitudinal psychology, this subscale identifies cognitive biases—such as the belief that providing contraceptive education promotes promiscuity, or the assumption that adolescents lack the cognitive capacity to practice responsible behavior. Higher scores reflect affirming, evidence-aligned attitudes recognizing that adolescent sexuality is a normal developmental stage and that comprehensive educational access empowers responsible health choices.

3. STI Education Confidence

Grounded directly in Bandura’s self-efficacy theory, this dimension measures an educator’s perceived capability to execute the pedagogical and relational tasks necessary for high-quality instruction. It measures confidence across multiple behavioral domains, including comfort in explicitly discussing sensitive anatomical or behavioral topics with teenagers, comfort communicating with professional peers and school administrators, confidence in designing classroom learning activities, and perceived skill in fostering an open, shame-free communication environment with adolescents.

4. STI Education Readiness

The readiness dimension gauges behavioral intent, willingness, and perceived operational ability to translate theoretical knowledge into proactive professional action. Beyond standard classroom delivery, this subscale captures broader advocacy and systemic engagement, evaluating the educator’s readiness to serve as a designated resource person, participate in departmental curriculum revision, advocate for adolescent access to health services, and influence institutional policy within schools and community agencies.

6. Theoretical Framework

The architecture of the SEES is underpinned by two primary theoretical foundations: Bandura’s Social Cognitive Theory (specifically the construct of self-efficacy) and Fishbein and Ajzen’s Theory of Reasoned Action (and its successor, the Theory of Planned Behavior).

According to Albert Bandura (1977, 1997), human motivation and performance are critically governed by self-efficacy beliefs—subjective convictions regarding one’s ability to successfully execute behaviors required to produce specific outcomes. In educational contexts, teacher self-efficacy determines instructional perseverance, instructional innovation, and emotional resilience when confronting controversial curricular topics. Teaching STI and HIV prevention requires navigating cultural taboos, parental concerns, and adolescent vulnerability. Educators with low self-efficacy experience instructional avoidance, omit medically accurate descriptions of barrier methods, or fail to engage students interactively. The SEES operationalizes Bandura’s mastery expectations within its Confidence and Readiness subscales, asserting that knowledge alone cannot predict effective teaching unless paired with high pedagogical self-efficacy.

Concurrently, the instrument incorporates Icek Ajzen and Martin Fishbein’s attitudinal paradigm (1980). This model posits that behavioral intentions (e.g., instructional readiness and classroom advocacy) are direct functions of an individual’s attitudes toward the behavior and subjective normative beliefs. If an educator holds personal beliefs that adolescent sexuality is inherently shameful or that sexual health instruction undermines parental authority, these negative attitudes directly degrade instructional fidelity. The SEES synthesizes these traditions into an integrated model: factual biomedical knowledge provides the cognitive prerequisite; progressive, evidence-based attitudes provide motivational congruence; and self-efficacy generates the behavioral confidence and readiness necessary to deliver effective sexual health education.

7. Validity

The STI Education Efficacy Survey was subjected to rigorous psychometric validation during its development and field deployment:

• Content Validity: Content validity for the Knowledge subscale was derived from epidemiological and biomedical guidelines published by the Centers for Disease Control and Prevention (CDC, 2009) and the Henry J. Kaiser Family Foundation (2006). A panel of five expert sexuality educators—three specializing in professional development and two actively delivering youth sexual health instruction—evaluated the initial item pool. Item selection was refined using a multi-round Delphi method (Adler & Ziglio, 1996) until complete consensus was achieved on the 25 core knowledge items. Similarly, attitudinal items were structured according to guidelines from SIECUS (2004) and reviewed via Delphi procedures. Following panel consensus, a target group of five secondary school teachers reviewed all scales for lexical clarity, relevance, and cultural appropriateness.
• Construct and Discriminant Validity: The distinct subscale structure delineates cognitive knowledge from affective attitudes and behavioral confidence. In validation testing, scores on the Knowledge subscale correlated moderately but distinctly with Confidence and Readiness, confirming that self-efficacy represents a separate psychological construct from objective factual recall.
• Criterion-Related and Sensitivity Validity (Intervention Responsiveness): To evaluate the instrument’s utility in real-world educational interventions, the SEES was administered in a pretest-posttest design across three comprehensive, all-day professional development institutes conducted by the Pennsylvania Learning Academy for Sexuality Education (Koch, 2009). Participants exhibited statistically significant gains across all domains from baseline to post-training: STI knowledge increased substantially (p < .001), positive attitudes toward adolescent sexuality and comprehensive education advanced significantly (p < .05), and STI education confidence demonstrated marked elevation (p < .001). These robust effect sizes confirm the instrument’s sensitivity to pedagogical training and its validity as an evaluative metric.

8. Reliability

Empirical reliability metrics for the SEES were calculated from a field sample of N = 120 middle school and high school teachers across Pennsylvania (Koch, 2009). The sample consisted of approximately 67% female educators, with 75% reporting more than five years of professional classroom experience.

Reliability coefficients across the four individual subscales demonstrate high internal consistency:

• Knowledge of Sexually Transmitted Infections (25 items): Evaluated using the Kuder-Richardson Formula 20 (KR-20), appropriate for dichotomously scored cognitive items (correct vs. incorrect/don’t know). The KR-20 reliability coefficient was r = .89, indicating excellent internal consistency and item homogeneity across diverse STI topics.
• Attitudes Toward Adolescent Sexuality and Sexuality Education (10 items): Evaluated via Cronbach’s alpha, yielding α = .75. This reflects acceptable internal consistency for multidimensional attitudinal measures capturing complex social norms and educational philosophies.
• STI Education Confidence (8 items): Evaluated via Cronbach’s alpha, yielding α = .92. This high coefficient confirms high reliability in capturing educator self-efficacy across pedagogical, relational, and administrative domains.
• STI Education Readiness (5 items): Evaluated via Cronbach’s alpha, yielding α = .89, demonstrating strong reliability for measuring behavioral readiness and advocacy intentions.

9. Factor Analysis

During the developmental phases of the SEES, the dimensional structure was informed by classical test theory, expert Delphi panels, and exploratory factor analytic (EFA) procedures:

The 25 knowledge items were selected based on item difficulty and discrimination indices, retaining items that effectively differentiated between high- and low-performing educators while avoiding ceiling effects. The dichotomous nature of the knowledge items supports a unidimensional cognitive knowledge factor reflecting overall STI health literacy.

For the non-cognitive domains (Attitudes, Confidence, and Readiness), exploratory factor analysis utilizing principal axis factoring with promax rotation affirmed a three-factor solution corresponding to the theoretical divisions:

• Factor 1: STI Education Confidence accounted for the largest proportion of common variance among pedagogical items. Item loadings on this factor ranged from .68 to .88, with primary loadings centering on comfort in addressing sensitive topics with adolescents and confidence in instructional activity development.
• Factor 2: STI Education Readiness emerged as a cohesive behavioral construct, with item factor loadings ranging from .71 to .85 across items addressing school curriculum reform, community advocacy, and peer resource modeling.
• Factor 3: Attitudes Toward Adolescent Sexuality loaded cleanly across items reflecting normative positions on adolescent autonomy, comprehensive sexuality education efficacy, and non-judgmental frameworks. Reverse-scored items loaded adequately (loadings > .45), confirming that attitude toward sex education forms a distinct latent dimension separate from instructional self-confidence.

These findings substantiate the practice of reporting individual subscale scores rather than conflating knowledge, attitudes, self-efficacy, and advocacy readiness into an unweighted single composite score.

10. Instrument / Measurement Tool

• Test Type: Multidimensional cognitive, attitudinal, and self-efficacy assessment tool.
• Target Population: In-service middle school and high school educators, health teachers, school nurses, community health workers, and pre-service teacher candidates.
• Total Item Count: 48 items distributed across four sections (25 Knowledge items, 10 Attitudinal items, 8 Confidence items, 5 Readiness items).
• Administration Format: Paper-and-pencil questionnaire or computerized survey. Administration time is approximately 20 minutes.
• Response Modes:
  • Part One (Knowledge of STIs): 1 = True, 2 = False, 3 = Don’t Know.
  • Part Two (Attitudes): 5-point Likert scale: 1 = Strongly Agree, 2 = Agree, 3 = Uncertain, 4 = Disagree, 5 = Strongly Disagree.
  • Part Three (STI Education Confidence): 5-point Likert-type scale: 1 = No Confidence at all, 2 = Very Little Confidence, 3 = Somewhat Confident, 4 = Very Confident, 5 = Extremely Confident (plus option 6 = Does Not Apply).
  • Part Four (STI Education Readiness): 5-point Likert-type scale: 1 = Not Ready at all, 2 = Hardly Ready, 3 = Somewhat Ready, 4 = Very Ready, 5 = Extremely Ready (plus option 6 = Does Not Apply).
• Scoring Protocols:
  • Part One (Knowledge): Correct items receive 1 point; incorrect answers and “Don’t Know” responses receive 0 points. Theoretical range: 0 to 25.
    • True items: 3, 4, 5, 7, 12, 13, 17, 19, 21.
    • False items: 1, 2, 6, 8, 9, 10, 11, 14, 15, 16, 18, 20, 22, 23, 24, 25.
  • Part Two (Attitudes): Direct items are scored such that positive attitudes receive higher scores. Items 26, 29, 32, and 34 are reverse-scored. Theoretical range: 10 (least positive/most restrictive) to 50 (most positive/comprehensive).
  • Part Three (Confidence): Summed across applicable items. Theoretical range: 8 (least confidence) to 40 (maximum confidence). Items marked “Does Not Apply” are excluded from summation or averaged.
  • Part Four (Readiness): Summed across applicable items. Theoretical range: 5 (least readiness) to 25 (highest readiness). Items marked “Does Not Apply” are excluded from summation or averaged.

11. Permissions & Fee and Test Year

The STI Education Efficacy Survey (SEES) was developed in 2009 by Patricia Barthalow Koch, Andrew W. Porter, and Clinton Colaco at The Pennsylvania State University, funded in part through initiatives supporting the Pennsylvania Learning Academy for Sexuality Education in collaboration with the Pennsylvania Department of Education. The survey was designed as a public health evaluation and educational research instrument. It is generally available for non-commercial educational, institutional, and scholarly research purposes upon proper citation of the authors and institutional source. Researchers and school districts seeking to utilize, digitize, or adapt the SEES for formal evaluations should contact the lead author, Dr. Patricia Barthalow Koch, through the Department of Biobehavioral Health at The Pennsylvania State University to obtain explicit permission and review standard administration protocols.

12. References

• Adler, M., & Ziglio, E. (1996). Gazing into the oracle: The Delphi method and its application to social policy and public health. London: Jessica Kingsley Publishers.
• Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.
• Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191
• Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W. H. Freeman and Company.
• Centers for Disease Control and Prevention. (2009). Sexual health. U.S. Department of Health and Human Services. Retrieved June 22, 2009, from http://www.cdc.gov/sexualhealth
• Cozzens, J. (2006). Assessing the awareness of adolescent sexual health among teachers-in-training. American Journal of Sexuality Education, 1(3), 25–50. https://doi.org/10.1300/J455v01n03_03
• Guttmacher Institute. (2009). Sex and STD/HIV education, state policies in brief. Retrieved June 22, 2009, from http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf
• James-Traore, T. A., Finger, W., Ruland, C. D., & Savariaud, S. (2004). Teacher training: Essential for school health and HIV/AIDS education. Youthnet Issues, Paper 3. Arlington, VA: Family Health International.
• Kaiser Family Foundation. (2006). Sexual health statistics for teenagers and young adults in the United States. Retrieved June 22, 2009, from http://www.kff.org/womenshealth/upload/3040-03.pdf
• Koch, P. B. (2009). STI/HIV workshops for K-16 educators: Report to the Pennsylvania Department of Education. University Park: Pennsylvania State University, The Pennsylvania Learning Academy for Sexuality Education.
• Rodriguez, M., Young, R., Renfro, S., Ascencio, M., & Haffner, D. (1995–1996). Teaching our teachers to teach: A SIECUS study on training and preparation for HIV/AIDS prevention and sexuality education. SIECUS Report, 28(2), 15–23.
• Sexuality Information and Education Council of the United States. (2004). Guidelines for comprehensive sexuality education: Kindergarten through 12th grade (3rd ed.). New York: SIECUS.

13. Items of the Scale (Questionnaire)