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Order Number 9306615
An instrument for evaluating w om ens health knowledge
Butler, Susan Orange, Ed.D.

The University of Tennessee, 1992
Copyright 1993 by Butler, Susan Orange. All rights reserved.
UMI
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AN INSTRUMENT FOR EVALUATING
WOMEN'S HEALTH KNOWLEDGE
A Dissertation
Presented for the
Doctor of Education
Degree
The University of Tennessee, Knoxville
Susan Orange Butler
August 1992
To the Graduate Council:
I am submitting herewith a dissertation written by Susan 0.

Butler entitled "An Instrument for Evaluating Women's Health
Knowledge." I have examined the final copy of this
dissertation for form and content and recommend that it be
accepted in partial fulfillment of the requirements for the
degree of Doctor of Education, with a major in Health
Education.
Robert H . Kirk
Major Professor
We have read this dissertation

and recommend its^acceptance:
Accepted for the Council:
Associate Vice Chancellor and

Dean of The Graduate School
DEDICATION
This dissertation is dedicated to all women, to become
empowered through increased knowledge about their own
health.
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ACKNOWLEDGMENTS
Grateful acknowledgment Is extended to the many women
who agreed to participate in my study. Without their
commitment to my success and their support for the
progression of women in education, this study would not
have been possible.
Appreciation is extended to the twenty-three experts
from across the country who took time and effort to
evaluate my work.
Appreciation is extended to my doctoral committee for
their assistance, patience, and for the excellent training
and education I received: to Dr. Robert Kirk, committee
chair, who shared his knowledge and wisdom from many years
in the field, to Dr. James Neutens, who enhanced my
understanding of research, and to Dr. Jean Skinner, who
increased my awareness of nutrition issues.
Special acknowledgment is extended to committee member
Dr. June Gorski, who, from the first time I met her, was an
inspiration and role model for me, by her professional
assertiveness, enthusiasm, knowledge of the field, and
concern for students.
Appreciation is extended to my employer, Dr. Paul
Benson, Vice President for Student Affairs at Kennesaw
State College, for his support and cooperation.
iv
Appreciation is extended to Dr. Keith Tudor at
Kennesaw State College, School of Business, who assisted me
with statistical inquiries, and to Dr. Donald Dessart at
the University of Tennessee, College of Education, who made
the understanding of advanced statistics possible.
Much appreciation is extended to Cole Printing &
Thesis Service, who handled all the typing, guideline
requirements, binding, and deliveries.
I am grateful to my parents, Mac and Hazel Orange, who
raised six children in a loving and supportive environment,
where the importance of a college education was always
stressed. They spent many hours stuffing and organizing
envelopes for the study.
Sincere gratitude to my husband, Skip, who supported
my decision to reach my highest goal, even though it meant
interruptions in our time together and his acceptance of
complete responsibility for the home and pets. I
appreciate his willingness to provide help when I needed it
and his own commitment to my goal.
ABSTRACT
This study constructed a valid and reliable instrument
for evaluating women's health knowledge. Content validity
for the instrument was, in part, established by writing ten
behavioral objectives relating to ten women's health
knowledge conceptual areas. Content validity was also
established through a textbook and syllabi review, and
recommendations from experts in the field of women's
health. A table of specifications was developed and used
as a guideline to generate preliminary multiple-choice test
items. After review and evaluation from the jurors, 125
test items which met the requirements of the table of
specifications were used for the preliminary test, which
was reviewed by the jurors. Using the juror's comments,
suggestions, and recommended additional test items, the
preliminary instrument was revised and administered to a
representative sample of twenty-two women from a women's
organization. Data were subjected to item analysis,
including difficulty and discrimination indexes. A final
knowledge test of 85 test items was developed based upon
the results of the item analysis.
The final test was administered to 617 women from
women's organizations and women's health classes from
across the country. Because only five women's health
classes were obtained for the study, the study results can
vi
only be generaiizable for women in women's organizations.
The data were subjected to item analysis and reliability.
Reliability analysis included the Kuder-Richardson Formula
21 and the split-half test for reliability. Reliability
coefficients of .67 and 1.00 were produced by the Kuder-
Richardson Formula 21 and split-half, respectively,
indicating the test is reliable for evaluating women's
health knowledge of postsecondary women in women's
organizations.
vii
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TABLE OF CONTENTS
CHAPTER PAGE
I. INTRODUCTION ........................................ 1
Statement of the P r o b l e m ........... 5

Research Questions ............................... 5
Delimitations ................................... 6
Limitation ........................................ 6
Assumptions ..................................... 6
Need for the S t u d y ................................ 7
Definitions of Terms .......................... 20
II. REVIEW OF THE L I T E R A T U R E ........................... 25
Introduction ................................... 25
Theoretical Framework ........................ 25
Literature Related in Content ............... 29
Literature Related in Methodology ........... 39
Literature Related Specifically to
Women's Health Courses ...................... 45
S u m m a r y .......................................... 56
III. METHODS AND P R O C E D U R E S ............................. 59
Introduction ................................... 59
Study P o p u l a t i o n ................................. 59
Instrumentation ............................... 64
Jury Selection and U s e ........................... 66
Development of Original Draft of the
I n s t r u m e n t ...................................... 67
Item D e v e l o p m e n t ................................. 70
Pilot Test A n a l y s i s ............................. 71
S u m m a r y .......................................... 79
IV. FINAL TEST A N A L Y S I S ............................... 81
Introduction ................................... 81
Descriptive Statistics ........................ 83
S p e e d e d n e s s ...................................... 85
Item Analysis and R e v i s i o n s .................... 85
Item D i s c r i m i n a t i o n ............................. 85
Item D i f f i c u l t y ................................. 88
R e l i a b i l i t y ...................................... 89
Percentile Ranks and Norms .................... 92
S u m m a r y ........................ 95
viii
CHAPTER PA G E
V. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS ... 97
S u m m a r y ...........................................97
C o n c l u s i o n s ...................................... 99
Recommendations ................................ 103
VI. THE STUDY IN R E T R O S P E C T .......................... 105
B I B L I O G R A P H Y ................. ........................... 115
A P P E N D I X E S ................................................ 122
A. STUDY POPULATION FOR FINAL T E S T ................123

B. FINAL TEST FOR S T U D Y ...........................126
C. FREQUENCY DISTRIBUTIONS AND ACCOMPANYING BAR
GRAPHS FOR WOMEN'S HEALTH COURSE TOPICS ......... 143
D. POSSIBLE CONCEPTUAL AREAS FOR WOMEN'S HEALTH . . 148
E. EXPERT PANEL OF JURORS AND POSTCARD SAMPLES . . . 150
F. COVER LETTER FOR JURORS, BACKGROUND
INFORMATION SHEET, AND JUROR RESPONSE
F O R M .............................................155
G. COVER LETTER TO JURORS, RESPONSE FORM RESULTS,
PRELIMINARY TABLE OF SPECIFICATIONS, AND
EVALUATION FORM FOR TEST I T E M S ................ 161
H. REVISED TEST SENT TO J U R O R S .................... 192
I. PRELIMINARY TEST FOR PILOTING PURPOSES ......... 217
J. RANK ORDER OF SCORES FOR PRELIMINARY TEST . . . . 240
K. MEASURES OF CENTRAL TENDENCY AND VARIANCE
FOR PRELIMINARY T E S T ........................... 242
L. ITEM ANALYSIS CHART FOR THE PRELIMINARY TEST . . 244
M. NUMBER OF RESPONSES FOR ITEM ALTERNATIVES
FOR PRELIMINARY T E S T ........................... 250
N. FREQUENCY AND RANKS OF SCORES FOR FINAL TEST . . 255
O. MEASURES OF CENTRAL TENDENCY AND VARIANCE
FOR FINAL T E S T ..................................257
P. ITEM ANALYSIS CHART FOR THE FINAL T E S T ....... 259
Q. NUMBER OF RESPONSES FOR ITEM ALTERNATIVES
FOR FINAL T E S T ................................. . . 2 6 3
R. WOMEN'S HEALTH RESOURCES ........................ 266
V I T A .......................................................281
ix
LIST OF TABLES
TABLE PAGE
1. Taxonomy of Educational Objectives/

Cognitive Domain ................................. 26
2. Preliminary Table of Specifications for

Women's Health Knowledge Test Determined
by Panel of E x p e r t s ............................ 69
3. Pilot Test General Summary of Statistical

A n a l y s i s ......................................... 76
4. Pilot Test Summary of Item Analysis Chart . . . 77
5. Final Test Table of Specifications ..... 82
6. Final Test Summary of Item Analysis Chart . . . 86
7. Final Test General Summary of Statistical

A n a l y s i s ......................................... 87
8. Final Test Percentile Ranks and T-scores ... 94
LIST OF FIGURES
FIGURE PAGE
1. States Containing Study Population ............. 61
2. Frequency Distribution of the Final Test . . . . 84
xi
CHAPTER I
INTRODUCTION
A heightened interest and awareness of women's health

%
originated from the combination of activism for patients'
rights, the 1960s anti-Vietnam war movement, the community
health movement, and the women's liberation movement
(Marieskind, 1980). The National Organization for Women,
founded in 1966 by Betty Friedan, was also responsible for
focusing on the rights of women in terms of equal rights,
equal respect, and women's health issues. The issue of
abortion law reform following the Supreme Court decision on
the case of Roe v. Wade in 1973 led to consciousness-
raising groups, which were important to the women's
liberation movement. These groups questioned traditional
social roles assigned to males and females and the
institutions that determined these roles. They saw the
medical care system as "supporting, under the guise of
science, societal sexism through its disruption of women's
physical and mental capabilities and its emphasis on
women's reproductive organs" (Marieskind, 1980). The
issues raised by women's groups in the 1970s included
equitable access to health care, the quality of health
care, and the need to end class and sex biases in the
health system (Marieskind, 1980). Marieskind (1980) stated
that the women's health movement that exists today is a
women's movement because discrimination against women is
derived from their "womaness" and their ability to bear
children. She also states that these differences have been
used "particularly in capitalist societies, to build social
structures and supportive ideologies based on the concepts
of female frailty, inferiority, and submissiveness, and of
women's lesser rights to economic rewards and more limited
abilities to earn them" (Marieskind, 1980).
The knowledge base about women's health could be
enhanced by more research in women's health. The General
Accounting Office (GAO) in 1991 released a report, National
Institutes of Health: Problems in Implementing Policy on
Women in Study Populations, that stated a 1985 Report of
the Public Health Service Task Force on Women's Health
Issues recommended increased research on health problems
affecting women. The National Institutes of Health (NIH)
at that time were supposed to implement a policy to ensure
that women were included in study populations unless it
would be scientifically inappropriate to do so. NIH had
funded some projects that studied only men, even though the
diseases being researched affect both men and women, and
according to NIH, the underrepresentation of women in such
studies "has resulted in significant gaps in knowledge."
According to the GAO report, NIH had taken little action to
implement this policy (GAO, 1990). Ruzek (1986) stated
that the research on women's health issues prior to the
late 1960s was done mostly by men, or by women who were
trained in male dominated and male oriented academic and
clinical fields. Many issues related to women's health
were ignored, trivialized, or simply not considered (Ruzek,
1986).
In 1991, a congressional caucus on women's health
issues was created in Congresswoman Pat Schroeder's office
in Washington, D.C. The caucus believed that more research
funding should be spent in the areas of women's health,
such as breast cancer and women and AIDS. In early 1992,
the National Institutes of Health, under the direction of
Bernadine Healy, M.D., undertook the "Women's Health
Initiative," the largest research study on women's health
ever, that is continuing to investigate lifestyle and risk
factors among thousands of women, and the safety of
estrogen replacement therapy.
The general health status of women has been misleading
because of the medicalization of women. Medicalization
means three things: 1) making normal daily living
processes and aging processes a disease state, 2) creating
a disease that is not there, and 3) lacking interest in
medical research in needed areas of women's health that
will replace dangerous drug therapy and surgery (Boston
Women's Health Collective, 1984). Hammond (1986) stated
that drugs and surgery seem to be automatic answers to
women's health problems when research is needed into how to
prevent diseases. Life expectancy in the United States is
now 78.3 years for women and 71.3 for men (Department of
Health & Human Services, 1989). The life expectancy of
women is longer than men in the U.S. due to the following
as stated by Lewis (1985): 1) women have better immune
resistance and female hormones offer a certain protection,
2) women are exposed to less hazardous environmental
hazards such as carcinogens, asbestos, and other toxic
substances, 3) women have better health habits, and 4) men
more so than women have the "Type A Personality" that has
been linked to heart disease.
Gilda Radner, a popular television and movie
entertainer who died in 1989 from ovarian cancer, did not
know that because some of her female relatives died of this
disease, she should have been regularly screened for early
detection. Gilda is just one example of the thousands of
women who die yearly because of their lack of knowledge
concerning women's health. Numerous studies have revealed
a lack of knowledge among college-educated women about
their own health and bodies. Koff, Rierdan, and Stubbs
(1990) found that college women were not very knowledgeable
about menstruation, ovulation, and menopause. The authors
suggested the need to address the topic of menstrual
education for adult women with respect to both basic
knowledge of the menstrual cycle and expectations for
associated physical and behavioral changes (Koff et al.,
1990). Breintenstein (1988)/ stated that there is now a
widespread recognition among health educators that greater
attention must be focused on issues related to women's
health (Breintenstein/ 1988). Reagan (1981) stated that
women's health is not a bandwagon issue/ but is a vital
concern. Its highest goal is health education (Reagan,
1981).
Statement of the Problem
The purpose of this study was to develop a
comprehensive/ valid, and reliable women's health knowledge
test that would assess the level of knowledge about women's
health.
Research Questions
The study addressed the following research questions:
1. What are the major objectives of a women's health
instruction program?
2. What should be the contents of a women's health
knowledge test?
3. Can a valid and reliable women's health knowledge test
be developed?
Delimitations
The researcher set certain delimitations for the study
in order for the research to be conducted properly and for
certain criteria to be met. The following delimitation was
the only one set by the researcher:
1. The population was delimited to women's organizations
and women's health classes.
Limitation
The study contained a major limitation. Only college-
educated women were used.
Assumptions
Certain assumptions were made. The assumptions were:
1. Answers to the knowledge test items were honest and
answered as accurately as possible by study
participants.
2 Terminology in the test was understood by study
participants.
3. Women's health knowledge can be measured.
4. The test is best suited for postsecondary women
associated with intact groups.
Need for the Study
There have been fragmented efforts to gain information
on the knowledge level of women about women's health, both
in a college setting and community setting. They were
limited in scope in terms of topics covered. Review of the
literature found researchers developing health knowledge
tests for their own individual studies about particular
topics, such as breast cancer, menopause, reproductive
organs, nutrition, and anatomy. A comprehensive women's
health knowledge test could not be found by this
researcher. According to Charles Fast, author of the "Fast
Health Knowledge Test," there is also a lack of
standardized health knowledge tests in the field of health
education (personal letter to researcher, December 22,
1990).
There is a lack of knowledge among women about women's
health. There are many women's health issues that need to
be included in a women's health knowledge test and
instruction program. Those twelve issues follow:
1. In the document, Healthy People 2000, there are
public health education objectives that relate specifically
to women's health. Even though not all women are pregnant,
those of child-bearing ages are being targeted by the
objective, "increase to at least 90 percent the proportion
of women ages 15 through 44 who know that alcohol, smoking,
and other drug use during pregnancy post risks to the
fetus" (U.S. Department of HHS, 1990). The 1985 baseline
for this objective includes 62 percent knew of Fetal
Alcohol Syndrome, 88 percent knew that heavy drinking
causes birth defects, and 75 percent knew that smoking
causes miscarriages; baseline data for other drugs were
unavailable. The basis for this objective includes the
common knowledge of the connection between drinking alcohol
during pregnancy and particular syndromes of birth defects.
There is new evidence linking the use of other drugs during
pregnancy with harmful effects to the fetus. The document
states that it is necessary to create a heightened
awareness among the general public regarding the risks
associated with the use of alcohol and other drugs during
pregnancy (U.S. Department of HHS, 1990).
2. Physicians commonly dismiss symptoms of heart
disease in women. Lewis stated that there is a saying
among women that "if a woman goes to the doctor, she gets a
Valium, while a man gets a work-up" (1985). It is a
misconception that heart attacks only occur in overweight,
overstressed men. Heart disease kills one out of two
Americans each year, including one out of two women, and
heart disease is the leading cause of death among women
(American Heart Association, 1990). After menopause, the
incidence of heart disease in women equals that in men. A
1991 research study at the Harvard Medical School found
that out of more than 83,000 cases, doctors were about ten
times more likely to recommend angiography after a positive
stress test for a man than for a woman (Ayanian & Epstein,
1991). Data from 112 American and Canadian hospitals
showed that a woman was not likely to receive equal
treatment for suspected heart disease until she actually
had a heart attack (Steingart et al., 1991). As more and
more women enter the job market, it was expected that the
high stress and fast pace would raise women's risk of heart
attack to the level of their male counterpart (American
Heart Association, 1990). The truth is that women working
outside the home have the same rates of heart disease as
women who do not, except for clerical workers. It was
found by the Framingham Heart Study that women in clerical
positions have twice the heart attack rate of homemakers.
The study associated a lack of control the women had in
their lives, and found that women who were at greatest risk
of heart attack were more likely to show suppressed
hostility and hold jobs without much chance for advancement
(American Heart Association, 1990). There is a need to
make women aware of these facts and offer suggestions for
stress management.
3. Even though Americans eat more calories per day
than people of any other country in the world, low daily
calcium intake is widespread among American women. Both
men and women lose bone density, but it is more prevalent
in women than in men after age fifty (Hamilton, Whitney,
and Sizer, 1988). Osteoporosis is common among older white
women, but low calcium intake is only one factor associated
with the disease. Also associated is heredity, hormones,
alcohol abuse, lack of exercise, and prolonged use of
prescription drugs (Hamilton, Whitney, and Sizer, 1988). A
high protein diet and overconsumption of soft drinks leads
to leaching of calcium from bone. The 1990 Recommended
Dietary Allowance (RDA) for calcium for women ages 18-24 is
1200 mg., which requires an intake of the equivalent of
four cups of milk a day. Women need to be informed of
complete information about osteoporosis, associated
factors, and alternative calcium sources.
4. The number of AIDS (acquired immune deficiency
syndrome) cases is increasing among women more than any
other target population in the world. It was once believed
that AIDS is a "gay" disease. In 1985, for every 64 men
with AIDS, only 1 woman had AIDS. In 1991, that ratio
narrowed to 12 to 1 (Centers for Disease Control, 1990).
It is a misconception among women that they are protected
by oral contraceptives. The only form of protection
available against the virus that causes AIDS is the latex
condom. Women need to be informed of their risks for AIDS.
5. Leidig (1992) stated that violence against women
is of epidemic proportions in this country. McCann,
Sackheim, and Abrahamson (1988) reported that 24 percent of
10
women report at least one life experience that meets the
legal definition of rape (McCann/ Sackhein, & Abrahamson,
1988). Leidig (1992) stated that acts against women extend
from brief, annoying contacts, such as street hassling, to
brutal incidents of incest, battering, and rape. Leidig
also added to the list demeaning media portrayals of women,
sexist jokes, verbal slurs, and the daily reminders women
receive of their lesser status in the workplace (male
bosses, female secretaries) (Leidig, 1992). To date, one
out of every four women in the country is raped each year.
There is a misconception that rape occurs in a dark city
alley, when in fact, 70 to 90 percent of rape victims know
their assailant (Santa Monica Rape Treatment Center, 1990).
Research shows that 50 percent of all rapists had been
drinking alcohol (Santa Monica Rape Crisis Center, 1990).
Known as "acquaintance rape," many of these rapes could be
prevented if women knew more about the signs and symptoms
of a potential rapist or rape situation.
6. Hysterectomies (removal of the uterus) and
oophorectomies (removal of the ovaries) are quite common
surgical operations today performed on older women.
According to the Boston Women's Health Collective (BWHC),
of all adult women today, 62 percent will have had either
of these operations by the time they are seventy years old.
Hammond (1986) stated that hysterectomies are still being
performed by surgeons as a solution to menopausal
11
discomfort although studies have found that 40 percent of
these operations are not needed (Hammond, 1986). BWHC
stated that these operations are advised by some physicians
as soon as reproductive ability have ceased as if there
were no other possible functional use for these organs.
Some physicians claim these operations will help prevent
cancer, but ironically, the increased of estrogen
replacement therapy (ERT) may have partially caused the
increased rate of endometrial cancer (BWHC, 1984). The
National Women's Health Network (1989) stated that research
has indicated that women under the age of 44 years, who
have their uteruses removed, face a significantly increased
risk of developing heart disease later on, for poorly
understood reasons. Also, the organization states that
oophorectomy in premenopausal women usually results in
immediate, severe signs of menopause. Women need to be
aware of when hysterectomies are medically necessary and
when they are not.
7. Women are administered drugs more often than men
(BWHC, 1984). Being administered drugs more often does not
necessarily mean that sickness is present more often.
Psychotherapy and medication is commonly used to treat mood
disorders such as depression, but these medications need to
be carefully monitored by one physician (Kahn and Holt,
1987). BWHC (1984) stated that there may be a physical
reason for mood swings or depression, including
12
combinations of medications prescribed by different
physicians. BWHC also stated that physicians may refer a
woman to psychotherapy because they learned in medical
training that many problems of a woman are "all in her
head" (BWHC, 1984). Kahn and Holt (1987) stated that some
women who feel unable to cope with daily stresses
associated with midlife and hormonal changes, go to their
physicians with complaints of mood swings, irritability,
and fatigue. These women ask for estrogen, and many
physicians prescribe estrogen without investigating the
real cause, either physical or mental. Before drugs are
administered, physicians should investigate physical causes
of emotional complaints first, and women should become more
aware of the over-prescription of drugs to women.
8. Hammond (1986) stated that research into
osteoporosis has not improved much in the past ten years.
The U.S. Department of Health & Human Services has as one
of its health objectives by the year 2000 to increase at
least 90 percent the proportion of postmenopausal women at
high risk for osteoporosis who have been counseled about
the benefits and risks of estrogen replacement therapy
(DHHS, 1989). This objective reflects the involvement of
the federal government in the use of a drug for women.
Again, the answer to a health problem in women is being
answered with drug therapy. Osteoporosis is seen primarily
as a woman's problem because it does not affect men until a
13
much later age, usually past their life expectancy (D.
Benardot, chair and associate professor, Nutrition and
Dietetics Department, Georgia State University, personal
communication, June 27, 1990). Graber and Barber (1975)
stated that estrogen helps prevent osteoporosis by
diminishing the calcium lost through the kidney. What they
object to is the way estrogen is being presented in the
literature: "lack of estrogen causes osteoporosis, give
estrogen to prevent it, give estrogen to cure it." Nelson
(1990) reported that estrogen has been found to stabilize
bone loss in postmenopausal women, but the side effects
include hot flashes and a resumption of menstruation. It
is common knowledge in the health field that regular
weight-bearing exercise and the right quantity of calcium
and vitamin D intake throughout a woman's life will help
prevent osteoporosis.
9. Older women are stereotypically seen by the
medical community as being constantly sick, depressed, and
experiencing what they call diseases: menopause and old
age. Hammond (1986) stated that menopausal and
postmenopausal women are seen by the medical community as
having severe health problems with this naturally occurring
phenomenon. In reality, only 20 percent of women suffer
the discomforts of menopause severe enough to be brought to
the attention of a physician. When discomfort is reported,
it usually results in a pathological diagnosis requiring
14
hormonal treatment, tranquilizers, or surgery. Menopause
is a normal and natural occurrence in a woman's life and is
part of the aging process that can not be stopped. As a
woman passes through and beyond the menopausal process,
there may be some problems with changes in the menstrual
cycle, hot flashes, and vaginal changes such as a decrease
of moisture and elasticity. These problems are due to the
lack of estrogen production that accompanies menopause. A
woman's body continues to produce estrogen in the fatty
tissues of the body and in the adrenal glands. The ovaries
also continue to produce small amounts of estrogen for ten
years or longer after periods stop (BWHC, 1984). Menopause
is seen by physicians as a deficiency disease and is
treated as such. Graber and Barber (1975) stated that some
gynecologists have suggested that estrogen should be given
from the onset of menopause until death to reverse this
abnormality and to help women remain young, healthy, and
sexually attractive. One cause of concern with the use of
estrogen is the suspected relationship between estrogen and
endometrial cancer (Wilson, Garrison, & Castelli, 1985).
This possible relationship was first suggested in 1922
(Hammond & Ory, 1988). Five studies between 1975 and 1976
found that estrogen was associated with a five- to fifteen-
times' increased risk of endometrial cancer, especially
among women who have taken estrogen for more than a year
(BWHC, 1984). Since then, the NIH reported that the claims
15
made about estrogen were either inflated or incorrect. In
1979, the Food and Drug Administration (FDA) required all
estrogen products to contain ah insert describing their
risks. It lists only two possible benefits: relief from
hot flashes and from vaginal dryness (BWHC, 1984). The
National Women's Health Network (1989) stated that although
the FDA in 1984 stated that estrogen does not cause breast
cancer, a number of research studies have found that women
who used estrogens after menopause were one and a half to
two times as likely to get breast cancer. More research on
estrogen replacement therapy is needed and women should
become more aware of possible side effects of such therapy.
10. Female cancers are on the rise in this country,
especially breast cancer. According to the American Cancer
Society, the incidence of breast cancer among women
increased from one in eleven in 1983 to one in nine in
1991. There are still many unanswered questions about what
causes breast cancer. It has been suspected that the use
of estrogen may increase the risk for breast cancer
(Olsson, Ranstam, Baldetorp, Ewers, Ferno, Killander, and
Sigurdsson, 1991). Olsson et al. (1991) found that among
175 premenopausal breast cancer patients, extended use of
oral contraceptive use before twenty years of age was
significantly associated with higher breast tumor cell
growth and lower survival rates. In 1982, the pill was
used by 56.5 percent of ever-married contracepting women,
16
ages 15-24 years (U.S. Department of Health & Human
Services, 1988). The study of breast cancer and oral
contraceptives is especially pressing since a vast majority
of American women use oral contraceptives (NWHN, 1991).
The National Women's Health Network has as a goal to
raise public awareness about breast cancer, specifically
the vast number of woman affected by the disease. The
organization recommends more research into the cause of
breast cancer, especially the relationship between oral
contraceptives and breast cancer. It also recommends
increased research on ovarian cancer and the possible cause
and effect relationship between the Human Papillano Virus
(HPV) and cervical cancer (NWHN, 1991).
Women who have a history of ovarian cancer in their
families should be regularly screened for this disease.
The best screening is a regular pelvic exam. There is also
a blood test called CA125 which can detect ovarian cancer
at a later stage (Garen-Fazio, 1991).
The National Women's Health Network believes research
is necessary to help reduce cancer statistics on women's
health.
11. Women need to question the advice given to them
by their physicians. According to Reynard (1973), the
following lines appeared in a 1978 gynecology textbook:
"If like all human beings, he (the gynecologist) is made in
the image of the Almighty, and if he is kind, then his
17
kindness and concern for his patient may provide her with a
glimpse of God's image."
Reynard (1973) stated that the "burgeoning
disenchantment with gynecologists and the deepening
sentiment that gynecology does not exist to serve the needs
of women have given rise to a women's health movement,
whose objectives include arming women with the information
and personal familiarity with their internal anatomy needed
to create medically aware consumers." She also stated that
it was not until the 1960s, when Ralph Nader and Betty
Friedan appeared, that women began to look at the doctor-
patient relationship in a very new way. Nader believed
that people have the right to know what they are paying
for, and Friedan believed that women should have more of a
say about what happens to their bodies (Reynard, 1973).
Wolfe (1991) stated that doctors "all too often look
at natural biological processes such as menstruation,
pregnancy, and lactation as treatable illnesses." His
findings include a) ten million women have been prescribed
drugs that stop breast-milk production despite federal Food
and Drug Administration statements that these drugs should
not be used for this reason, b) of the 13 million women
taking birth control pills, more than 100,000 are getting
pills that are too strong, c) an estimated one in three
women will have a hysterectomy be age 60, yet more than a
quarter of these operations are medically unnecessary, and
18
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d) Accutane, a drug for acne, was prescribed to 600,000
women, causing sever birth defects in hundreds of children
(Wolfe, 1991).
In 1988, the Food and Drug Administration's General
and Plastic Surgical Devices Panel recommended that the FDA
prepare educational materials for potential consumers of
silicone breast implants. Consumers on the panel included
the National Women's Health Network and the Boston's
Women's Health Collective. The brochures were drafted, but
as of August 1991, have not been published because of the
objections by the American Society for Plastic and
Reconstructive Surgery, who does not want the names and
addresses of consumer groups to be listed in printed
materials (NWHN, 1991). Women need to become more
intelligent health care consumers.
12. In most high school health classes the human body
is studied without regard to health issues and diseases
peculiar to women. There is also a lack of women's health
classes on college campuses. An informal and random
telephone survey to the 35 health education departments
listed in the November/December 1991 issue of Health
Education yielded only six classes. On two occasions, the
researcher was referred to Nursing and Women's Studies
departments. Three of the six departments only taught
women's health occasionally, because of a lack of funding
and faculty to teach.
19
A women's health knowledge test, through the
development of a table of specifications, can provide the
framework for conceptual areas to be covered in a women's
health instruction course.
Definitions of Terms
Below are definitions of terms used in the study:
1. Content Validity: Measures the degree to which the
concepts under study are accurately represented by the
particular items on an instrument (Green & Lewis,
1986) .
2. Criterion-referenced Testing: A measured proficiency
of defined groups on specified tasks and not on
comparison of performance with that of others or with
norms (Lien, 1980).
3. Speededness: A characteristic of a test that enables
an examinee to earn a higher if he/she were given more
time (Stanley, 1971). The speededness of the test
developed for this study was evaluated.
4. Reliability: Examines the intercorrelations or
covariance of all the individual items making up a
test. Also, the consistency, stability and
dependability of a set of measurements. Reliability
is usually expressed in the form of a coefficient that
20
ranges from 0 to 1. The closer to 1, the more
reliable the instrument (Green & Lewis, 1986).
5. Item Analysis: The process of evaluating single test
items by any of several methods. It usually involves
determining the difficulty value and the
discriminating power of the item and often its
correlation with some criterion (Lien, 1980). The
test items on the knowledge test developed for this
study were analyzed for both difficulty and
discrimination. Testing standards were used to
determine if the items needed to be deleted from the
test or retained.
6. Item Difficulty: The difficulty of a test item,
measured by the percentage of participants taking a
test who answer each item correctly (Lien, 1980). The
larger the percent of study participants who answered
a test item correctly, the easier the item was. If a
certain percentage of the participants answered a test
item correctly, the item was too easy. If too few of
the participants answered a test item correctly, the
item was too difficult.
7. Item Discrimination: The discriminating power of a
test item. Such a test item discriminates between
those participants who know the information and those
who do not. Discrimination is measured by the
difference of the number of correct responses between
upper and lower groups in a sample (Lien, 1980). If a
21
test item on the knowledge test contained an
acceptable discrimination value that met testing
standards, then the item was answered correctly most
often by those participants who possessed more
knowledge about women's health. If a test item was
answered correctly most often by those participants
who possessed less knowledge about women's health, the
item contained poor documentation.
8. Knowledge Test: Knowledge is defined as an
acquaintance with facts or the range of information,
awareness, or understanding of facts (Webster's New
World Dictionary, Second College Edition, 1970). The
written knowledge test developed for the study
assessed the knowledge level of members of women's
organizations and women's health classes about women's
health. The higher the score on the test, the greater
the knowledge level about women's health.
9. Purposive Sampling: The researcher employs discretion
to select the participants who best meet the purposes
of a study (Rubinson & Neutens, 1987). A group of
women from a local women's organization was chosen for
the piloting of the test developed for the study.
10. Nonprobability Convenience Sampling: The probability
that a participant will be chosen for a study is
unknown, with the result that a claim for
representativeness of the population cannot be made.
The researcher's ability to generalize findings beyond
22
the actual sample if greatly limited (Rubinson &
Neutens, 1987). Convenience sampling is the captive-
audience approach to sampling. It involves selecting
the closest and most convenient participants (Rubinson
& Neutens, 1987). The knowledge test developed for
this study was mailed to women's organizations who
agreed to participate. The researcher did not know
how many tests would be returned. The organizations
were convenient for the researcher because addresses
were available for a major mailing.
11. Test Validity: The degree to which the concepts under
study are accurately represented by the particular
items on a test (Green & Lewis, 1986). Such validity
is best evidenced by a comparison of the test content
with courses of study, instructional materials, and
statements of instructional goals (Lien, 1980).
12. Women's Health: Health has been defined by the World
Health Organization as possessing an optimum level of
mental and physical well-being, not merely the absence
of disease or infirmity (World Health Organization,
1974). Women's health pertains to health issues that
are peculiar to women, such as the issues determined
by the study's panel of experts, which included:
health status of women,

patient/physician relationship,
normal female physiology,
causation and prevention of female diseases and
illnesses,
emotional and mental health,
safety and security,
23
gynecological procedures and female surgeries,
health services for women,
contributions by women to the medical and health
care fields, and
assertiveness and self-expression among women.
13. Women's Health Instruction Program: A health
education course that presents information on general
and basic topics pertaining to women's health and
women as consumers in the nation's health care system.
It presents information on health problems such as
female diseases, and on concerns such as domestic
violence, and techniques for prevention, maintenance
and/or correction (Course syllabus, University of
Tennessee, Department of Health, Leisure, & Safety,
1990). A college course is a type of instruction
program in terms of evaluation that is usually
conducted throughout the course for credit hours.
14. Women's Health Knowledge: Knowledge is defined as an
acquaintance with facts or the range of information,
awareness, or understanding of facts (Webster's New
World Dictionary, Second College Edition, 1970).
Women's health knowledge involves possessing knowledge
of women's health topics presented in the knowledge
test. The greater the number of test items answered
correctly by a participant, the greater the level of
knowledge the participant possessed about women's
health.
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CHAPTER II
REVIEW OF THE LITERATURE
Introduction
Since women's health is a relatively new concept in
the field of health, a review of the literature produced a
relatively small amount of information in terms of
knowledge testing. The literature revealed little evidence
of a comprehensive women's health knowledge test. The
small amount of knowledge evaluations found were components
of entire testing instruments that measured knowledge,
beliefs, and attitudes of particular topics, such as breast
cancer and menopause. The review of the literature
consists of 1) theoretical framework, 2) literature related
to content, 3) literature related to methodology, and
4) literature related to women's health courses.
Theoretical Framework
The theoretical framework used for writing the Women's
Health Knowledge Test included employment of the Taxonomy
of Educational Objectives developed by Benjamin S. Bloom.
The taxonomy can be found in the handbook, The Cognitive
Domain (Bloom, 1956) (see Table 1). The taxonomy was
25
developed to provide precision in educational thought.
There was confusion at one time among educators concerning
educational objectives. There was difficulty in
identifying, classifying, and formulating such objectives
(Wesley & Wronski, 1973).
Table 1
Taxonomy of Educational Objectives, Cognitive Domain

(Benjamin S. Bloom, 1956)
1. Knowledge Including knowledge of specifics,

knowledge of ways and means of
dealing with specifics, and
knowledge of universals and
abstractions.
2. Comprehension Including translation,

interpretation, and extrapolation.
3. Application Including implications of applied

knowledge.
4. Analysis Including analysis of elements,

relationships, and organizational
principles.
5. Synthesis Including production of a unique

communication, production of a
proposed set of operations, and
derivation of a set of abstract
relationships.
6. Evaluation Including judgements in terms of

internal evidence and external
criteria.
26
Bloom's work revolutionized the process of lesson
planning for teachers and the taxonomy became the standard
for describing objectives and the process of achieving them
(Sprinthall & Sprinthall, 1974). The taxonomy provides a
system for classifying educational objectives according to
a hierarchy of thought processes. The taxonomy consists of
six classifications of educational objectives: knowledge,
comprehension, application, analysis, synthesis, and
evaluation (Bloom, 1956). A sequence of questions may be
developed concerning any topic, which requires thinking on
various levels (Merwin, Schneider, & Stephens, 1974).
Bloom was a member of an expert committee at the
University of Chicago that created the three major domains
of educational objectives: cognitive, affective, and
psychomotor. Bloom was the leader of the team that
formulated cognitive objectives (Wesley & Wronski, 1973).
The Women's Health Knowledge Test was written for the
cognitive domain and the items were written to meet the
knowledge classification of Bloom's Taxonomy.
The theoretical framework for the study also included
using the conceptual model to health education first
introduced through the School Health Education Study
(SHES). The School Health Education Study was initiated in
1961 by the Bronfman Foundation and carried out in 1967.
The study provided a conceptual design for curriculum
development in health education.
27
The first phase began in 1961 with a national survey
of health instruction in U.S. elementary and secondary
schools that revealed a need for young people to acquire
new levels of health knowledge. There was also
misinformation in need of correction. The second phase
involved the development of a comprehensive curriculum
covering the full range of health topics. It was a
comprehensive treatment of health or a conceptual structure
of health which represented an effort to apply learning
theory to curriculum planning (SHES, 1968).
The publication/ Health Education: a Conceptual
Approach to Curriculum Design (1968) stated that the SHES
model was characteristic of the cognitive theory of
learning/ where health is the comprehensive/ unified
concept at the apex of the hierarchy developed for the
conceptual model for health and health education (SHES,
1968).
The Women's Health Knowledge Test was comprehensive in
nature and in developing the test, ten conceptual areas
were also developed for the cognitive domain of Bloom's
Taxonomy of Educational Objectives. Each conceptual area
pertaining to women's health became the basis for each
behavioral objective of the test.
28
Literature Related in Content
Marieskind (1980) stated that the lack of knowledge of
anatomy and gynecological care has been verified. Reynard
(1973) tested women at a self-help clinic for their
knowledge of basic anatomy and simple gynecological
procedures. Using 100 women, the mean score on the test
was 3.34, out of a possible 8.
Marieskind (1975), in an identification survey of 100
female college students, 30 percent could identify the
uterus, 20 percent could identify the vagina, 10 percent
could identify the fallopian tubes, and .5 percent could
identify the cervix.
Koff, Rierdan, and Stubbs (1990) tested the knowledge
of college women concerning menstruation, ovulation, and
menopause. The study hypothesized that 1) women would be
relatively uninformed about the menstrual cycle, but more
informed about menstruation than about ovulation or
menopause, and 2) negatively valued changes would be
described more frequently than positively valued ones. The
results were that basic knowledge about the menstrual
cycle, even among well-educated women, is at times
incorrect, generally incomplete, and negatively biased.
The authors suggested a more comprehensive approach to
menstrual education that spoke both to the biology of the
29
menstrual cycle and to norms and variability of associated
physical and behavioral changes.
The study was conducted on college women to serve as a
reference group to compare other groups who would have less
opportunity to become knowledgeable about the menstrual
cycle. Since the results for the college population
validated the hypotheses, less privileged groups would have
even less knowledge and more extensive biases (Koff et al.,
1990). The eighty college women were recruited from
introductory and intermediate level psychology courses, who
responded to a questionnaire consisting of sixteen open-
ended questions about menstruation, ovulation, and
menopause. Over 30 percent were unable to provide a
definition of menstruation and acceptable information about
the biology of ovulation. Concerning menopause, 96 percent
correctly defined the occurrence, but 27 percent believed
it to be an enduring event, which was not defined. The
roles of estrogen and progesterone were poorly understood,
even though these are widely discussed in popular magazines
(Koff et a l . , 1990).
The authors believed that misinformation about the
menstrual cycle had serious implications for women's lives,
which kept them from understanding their bodies and their
reproductive lives (Koff et al., 1990). They stated, "Lack
of knowledge can place women at risk for unwanted pregnancy
and sexually transmitted diseases, result in
30
misunderstanding and mistreatment of menstrual disorders,
and can prevent effective communication with other women
and with health care providers" (Koff et al., 1990).
Riggs and Noland (1983) studied the relationship
between awareness, knowledge, and perceived risk for toxic
shock syndrome (TSS) in relation to health behavior. The
researchers used a sample of 306 female college students
between the ages of 17 and 49, with the largest
representation from the 20 to 22 year age category. The
students were enrolled in health and physical education
courses at a large urban university. The instrument used
was an 18-item questionnaire developed by the first author,
which included five knowledge items, two items related to
menstrual hygiene practices, three items concerning self-
assessment of risk for TSS, four demographic items, and
four items related to TSS awareness. It was found that two
of the five knowledge items and the item relating to
perceived knowledge were related significantly to various
health behaviors. Actual knowledge was related to changing
menstrual products due to concern for TSS and 21 percent of
the students in the sample did change their health behavior
as a result of concern for TSS (Riggs et al., 1983). This
researcher wants to make note that toxic shock syndrome
since 1983 has been rarely reported. The height of the
problem existed between 1980 and 1983, and the authors of
the preceding study stated that TSS received a significant
31
amount of media attention during the summer and fall of
1980 (Riggs et al., 1983).
Clark (1985) utilized a health knowledge test for
women in a nonschool setting through a women's health fair
on a large military base. There was a significant
difference between pretest and posttest scores for
knowledge and a majority of respondents indicated their
intent to change (not an actual change in behavior) from
health-damaging to health promoting behaviors (Clark,
1985). The health fair included booths on topics such as
iron-deficiency anemia, hypertension, hearing and vision
conservation, smoking, self breast examination, dental
hygiene, child abuse, automobile safety, obesity, alcohol
abuse, and Pap smears. The fair was attended by 275 young
women on active duty, who were eighteen years of age, with
a minimum of a high school education. Both the pretest and
posttest questionnaires were designed to examine
participants' knowledge of various promotive and preventive
aspects of health (Clark, 1985). Only 98 of the 275
participants completed both a pretest and a posttest. The
instrument contained 24 items, with 14 related to knowledge
of healthful behaviors and ten related to current health
behavior. Examples of knowledge questions included
questions about a cause of anemia, smoking while pregnant,
breast self-examination, and automobile safety for
children.
32
Rahn and Sabry (1984) investigated the nutrition
knowledge of a sample of urban women by utilizing a
nutrition knowledge test developed by the researchers. The
sample consisted of 210 urban women, through a stratified
random sampling with systematic selection. The median age
was 41 years and the median number of years of schooling
was twelve. The data were collected by personal interview
and the instrument used was a 20-item multiple-choice
questionnaire to test nutrition knowledge. The test items
pertained to the nutrition topics: micronutrients, diet
and heart disease, energy concept, and dietary fat.
Results of a multiple linear regression analysis found that
the level of nutrition knowledge was positively correlated
with the women's level of education and socioeconomic
status (Rahn & Sabry, 1984).
Some of the technical terms in this knowledge test had
to be changed to adjust the readability of the items. For
example, there was 31 percent nonresponse of the item which
included the nutrition term linoleic acid, and women wrote
that they had not heard of this term. This term was
included in public awareness materials developed by a
community agency. There was also a lack of knowledge about
dietary fat and the authors suggest the relationship
between diet and cardiovascular disease has yet to be
effectively communicated to the public (Rahn and Sabry,
1984).
33
Brailey (1986) administered a health knowledge test to
women in the workplace in determining the effects of group
and individual teaching by nurses regarding women's
knowledge, beliefs, and practices of breast self-
examination (BSE). The sample consisted of 154 women
employees by convenience over a two-month period, who had
received breast self-examination teaching at the workplace
for at least two years. Five nurses were chosen randomly
from a staff of eleven nurses employed by the firm. A 34-
item questionnaire was designed to measure the
predisposing, enabling, and reinforcing factors related to
BSE, and the frequency of practicing BSE. The design was
based on the theoretical model, PRECEDE (predisposing,
enabling, and reinforcing causes in educational diagnosis
and evaluation) model for health education planning
developed by Green, Kreuter, Deeds, and Partridge in 1980.
Predisposing factors (health knowledge) occur prior to BSE
and provide rationale or contribute to the motivation for
the behavior (Brailey, 1986). The predisposing factor was
measured by four questions regarding prevalence of breast
cancer, incidence of malignant and benign tumors, and age
of greater susceptibility to breast cancer. These four
questions were developed by Stillman, who also conducted a
study on BSE (Stillman, 1977). A pretest found that there
was a lack of knowledge regarding the prevalence of breast
cancer, and health knowledge scores found no significant
34
change after teaching in any of the different modes of
teaching. For example, less than 25 percent of the women
knew that only 15 percent of breast lumps "turn out to be
breast cancer" and only 22 percent of the sample chose
correctly the statement that 1 in 9 women will develop
breast cancer (Brailey, 1986).
Trotta (1980) used knowledge questions as part of her
investigation into how frequently and thoroughly women
practice BSE, how they learn about BSE, and what influences
their compliance. The convenience sample consisted of 446
women employees of a large insurance company and the
questionnaires were distributed through interoffice mail.
The median age was 36 years with a range of 18 to 64.
Ninety-two percent of the sample were Caucasian and 7
percent were black. Ninety-eight percent had graduated
from high school, and 35 percent of those women had a
college degree. A large majority (84 percent) were
employed in clerical or semi-professional positions. The
questionnaire consisted of 50 questions grouped in five
major categories: compliance behaviors, conditions of
learning BSE, health beliefs, knowledge about breast
cancer, and demographic characteristics. The author stated
that public education programs aim to increase people's
knowledge about a particular disease and possible health
actions in an attempt to improve health behavior. The
knowledge questions used by Trotta were the same ones used
35
by Brailey that were developed by Stillman. The study
found that women with a high knowledge score tended to
practice the most thoroughly. Age and religion did not
contribute significantly, but it was found that older women
and Catholics practiced less thoroughly (Trotta, 1980).
A nutrition knowledge test was used by Byrd-
Bredbenner, O'Connell, Shannon, and Eddy (1984) in
determining the effectiveness of a nutrition curriculum
guide developed for a public school system in Pennsylvania
and Ohio. The knowledge test was administered, as a
pretest and a posttest, to an experimental group, which
used the nutrition curriculum guide, and to two control
groups at the secondary school level. The tests consisted
of 52 multiple-choice items for the junior high students
and 56 items for the senior high students. The questions
were related to athletic diets, weight control, and
reliable nutrition information. For both grade levels, the
knowledge score increased in the experimental group (Byrd-
Bredbenner et al., 1984).
Baseline data for the public awareness objective of
increasing to at least 90 percent the proportion of women
ages 15 through 44 who know that alcohol, smoking, and
other drug use during pregnancy post risks to the fetus,
found in Healthy People 2000, was provided by the National
Health Interview Survey, conducted by the National Center
36
for Health Statistics (NCHS). The survey found that 62
percent knew of Fetal Alcohol Syndrome, 88 percent knew
that heavy drinking causes birth defects, and 75 percent
knew that smoking causes miscarriages in 1985. Baseline
data for other drugs were unavailable.
There are vital statistics that differ between the
races that may be influenced by women's health knowledge.
In 1988, the percent of black women using public family
planning clinics was much higher than the percent of white
women using such clinics (53 percent vs. 32 percent).
According to NCHS (1990), explaining the greater reliance
of black women than white women on clinics is complex and
is an appropriate subject for further research.
Interestingly, NCHS also found that black women were less
likely to be using contraception than white women (57
percent vs. 62 percent), and the methods most used by black
women were the two most effective female methods female
sterilization and the pill (NCHS, 1990). The death rate
from breast cancer are similar for white and black women,
23.0 and 25.8 per 100,000 resident population respectively
(U.S. Dept, of HHS, 1988).
As determined by the Hispanic Health and Nutrition
Examination Survey, 1982-84, and the second National Health
and Nutrition Examination Survey, the incidence of iron
deficiency in women between the ages of 30 and 50, are much
more prevalent in Mexican-American women (13 percent).
37
Black women, ages 40-49 also have a high incidence of iron
deficiency (14 percent). These statistics are significantly
higher than those for white women, between the ages of 30
to 50 (7 percent) (U.S. Dept, of HHS and Agriculture,
1989).
The document, Healthy People 2000 states: "Attainment
of the year 2000 national health objectives relies
substantially on improvements in health education
strategies and enhanced access to and utilization of
clinical preventive services" (U. S. Department of Health &
Human Services, 1990). Clinical preventive services are
those services that are delivered in a health care setting
such as immunizations, screening for early detection of
disease, and patient education. The Department of Health &
Human Services uses the Green, Kreuter, Deeds, and
Partridge (1980) definition of health education, meaning
any combination of learning experiences designed to
predispose, enable, and reinforce voluntary adaptations of
individual or collective behavior conducive to health.
Green et al. (1980) stated that the defining
characteristic of health education is the voluntary
participation of the consumer in determining his or her own
health practices. Organized health education programs are
based on the desire to intervene in such a way as to
maintain positive health behavior or to interrupt a
38
behavioral pattern that is linked to increased risks for
illness, injury, disability, or death (Green et al., 1980).
Literature Related in Methodology
A study very similar to the present study was
conducted by Hashim (1988) in his dissertation at Indiana
University. The purpose of his study was to construct a
valid and reliable instrument to measure health knowledge
of male freshmen college students in Saudi Arabia. He
stated that contents of the instrument were derived from
the information contained in required health science
textbooks. He constructed the test by developing a table
of specifications and constructing test items with the
assistance of a panel of experts, developing a preliminary
test, administering and analyzing the preliminary, and
developing and analyzing the final test. The results of
his statistical analysis found that the test possessed
internal consistency. Reliability coefficients were
determined with the split-half method corrected by the
Spearman-Brown formula and with the alpha method. Norms in
the form of percentile ranks and T-scores were also
developed (Hashim, 1988).
Torabi (1989) constructed a valid and reliable cancer
prevention knowledge test for college students. Through a
literature review and through consulting a panel of experts
39
in the cancer field and cancer education, he developed a
table of specifications and used it as a guideline for
writing multiple-choice items. Sixty items meeting the
requirements for the table of specifications, were chosen
for the preliminary test and reviewed by his jurors. The
preliminary test was administered and analyzed, and revised
to produce a test containing thirty items. The final test
was administered to a representative sample and analyzed
for reliability using the split-half method and Cronbach
alpha. The test was found to be reliable and valid for
studying college student's knowledge about cancer
prevention (Torabi, 1989).
Marieskind (1975) studied three different intact
groups of women in terms of women's health knowledge, in
terms of anatomy identification, definition of
gynecological procedures, appropriate frequency of
performing certain procedures, and contraceptive
contraindications. The groups studied consisted of women
found in three different types of health care clinics: 1)
traditional facility (physician-staffed), 2) paramedic
facility (physician-trained paramedics), and 3) self-help
facility (feminist facility). Knowledge level increased in
the women who visited the self-help facility. The mean age
of the women in each group was comparable (24, 21, and 25
years, respectively). The educational level of women in
40
the self-help facility was almost two years higher than the
other two (14.82 vs. 13.60 and 13.64 years in the other two
facilities) (Marieskind, 1980).
Oaks, Warren, and Harsha (1987) developed a knowledge
questionnaire to determine the cardiovascular health
knowledge of children and school personnel in Louisiana
public schools. The Louisiana Association of Health,
Physical Education, Recreation and Dance, through the Jump
Rope for Heart Research Committee, funded a study to
evaluate the status of comprehensive school health in the
state. Endorsed by the state Department of Education and
the National Research and Demonstration Center-
Arteriosclerosis (NRDC-A) and the Louisiana State Medical
Center, cardiovascular knowledge tests developed by the
NRDC-A were included so data for cardiovascular health
education could be collected in addition to data on
comprehensive school health. The sample consisted of 100
matched schools serving fourth, sixth, and 12th grades.
The total number of subjects include 458 fourth graders,
228 sixth graders, and 318 12th graders. Twenty-nine
principals and 26 teachers also completed the tests (Oaks
et al., 1987). The Statistical Package for the Social
Sciences (SPSS) was used to provide information on the
collected frequency data. It was found that cardiovascular
health knowledge of both professionals and students was
low, with several correlations between knowledge and
41
educational or administrative practices. The study also
made recommendations for improvements in school health
education programs (Oaks et al., 1987). Since the data
were parametric in this particular study, the parametric
Pearson Product-Moment technique was used to determine if a
significant relationship existed between the cardiovascular
health knowledge scores of the teachers, administrators,
fourth graders, sixth graders, and 12th graders. There
were no significant correlations found (Oaks et al., 1987).
Shea and Basch (1990) conducted a review of five major
community-based cardiovascular disease prevention programs.
The researchers hypothesized that community intervention
will reduce the prevalence of cardiovascular disease risk
factors and consequently reduce cardiovascular disease
incidence, morbidity, and mortality. The community-based
Minnesota Heart Health Program is related to the present
study in terms of implementation of health education and
theory base. The program relates to the present study by
the involvement of community leaders and organizations,
which comprised a community advisory board. The program
also included adult education classes for worksites,
churches, clubs, and other organizations. The Heart Health
Program also initiated changes in the social environment
such as labeling of grocery shelves and restaurant menus to
identify healthier alternatives (Shea & Basch, 1990).
42
A study conducted by Douglas and Douglas (1984)
analyzed nutrition knowledge and food practices of high
school athletes. The authors stated that what athletes
know about nutrition continues to be an issue in the field
of nutrition education and that problems of erroneous
nutrition knowledge and food faddism have been observed in
special interest and age groups (Douglas & Douglas, 1984).
The sample consisted of 943 male and female athletes from
ten high schools from a public school system in
Connecticut. A questionnaire was personally administered
to the subjects. The 80-item questionnaire consisted of
three parts: Part I included questions pertaining to
sports, Part II included questions pertaining to food
practices, and Part III included questions pertaining to
conceptual and factual information on nutrition. Part III
was a composite of several validated questionnaires. There
were 15 true-false statements dealing with common
misconceptions about food and nutrition. Using SPSS, mean
scores of nutrition knowledge and food practices by sport
and sex were tabulated. The female athletes had
significantly higher nutrition knowledge scores than the
male athletes, but there was a weak correlation between
knowledge and nutrition practices. It was also found that
cross-country runners and track-and-field participants
scored significantly higher on nutrition knowledge than the
athletes from other sports (Douglas & Douglas, 1984).
43
Stillman (1977) conducted research on women's health
beliefs about breast cancer and breast self-examination
(BSE). Stillman developed valid and reliable knowledge
questions about breast cancer, as well as attitude
questions. Some of Stillman's knowledge questions were
used in the present study. Those questions were also used
in earlier studies mentioned in the review of the
literature (Trotta, 1980 and Brailey, 1986).
The convenience sample consisted of 122 members of
specific women's organizations in a community of
approximately 4,000 women, according to a 1970 census.
Five different organizations were visited within a three
week period. The sampling of women's organizations was
considered representative of the community. Participants
were asked to complete a questionnaire during a regularly
scheduled meeting. The ages ranged from 20 to 59, 62
percent of the sample in the 30 to 39 year old range. The
questionnaire consisted of five sections: Section I
consisted of questions pertaining to factual knowledge
about breast cancer, Section II consisted of a Likert-type
scale with an agree-disagree continuum, Section III and IV
consisted of measuring the practice of BSE, and Section V
consisted of demographic data believed to have relevance to
the practice of BSE. The data was analyzed using
descriptive statistics.
44
Stillman found that only 12 percent answered correctly
the question concerning the prevalence of breast cancer in
this country. The majority overestimated the prevalence of
breast cancer. One area of misconception existed
concerning the effect of oral contraceptives on breast
cancer. Twenty-two percent believed there was an increased
risk of breast cancer while taking oral contraceptives.
This study was conducted in 1977/ and at that time,
researchers believed taking an oral contraceptive was not a
risk factor for breast cancer. Only between 20 and 30
percent of the women believed that being married with no
children or being single or postmenopausal were
contributing factors for breast cancer. A majority of the
women did know that most breast lumps discovered are not
malignant/ and that the chances of developing breast cancer
increases after the 30th birthday. When comparing the
different groups, the Jewish organization had the highest
mean score of all the groups on all five sections ofthe
questionnaire. The only other religious group surveyed was
a Catholic organization, who had the lowest score ofall
the groups (Stillman, 1977).
Literature Related Specifically to Women's Health Courses
The concept of women's health is sometimes followed by
the term, "movement," because the study of women's health
45
in this country started out as a movement a movement of
self-care.
Reagan (1981) stated that the terms that illustrate
preventive health concepts include self-awareness, or
personal control, which she claimed are definitions of
health education. But those terms also describe the
women's health movement (Reagan, 1981).
Self-help courses, or "body courses," were first
offered in the community (Ruzek, 1986). In the book,
Seizing Our Bodies, by Claudia Dreifus, there is a story
about a mother of six children who was arrested in 1972 for
"practicing medicine," and for the crime of illegal
unlicensed insertion of yogurt into a woman's vagina
(Dreifus, 1977). Reagan (1981) reported that what the
woman was trying to do was bring self-care and health
instruction to women who were told they were "hysterical
mothers, hypochondriacs, and old ladies whom doctors must
manage" as quoted from the book, Why Would a Girl go into
Medicine, by Margaret Campbell (Campbell, 1973).
In the 1990s, this researcher has found that community
women's health classes are limited to efforts by nonprofit
organizations and hospitals pertaining to certain diseases
and illnesses, such as breast cancer, depression, stress
management, disease support groups, and so on. Any review
of community course schedules and local newspaper listings
can attest to these topics.
46
Reagan (1981) stated that the women's health movement
is underlined by the belief that women are not docile,
dependent clients, but rather, interested, activated,
competent participants in their own health. It has taken
prevention, diagnosis, and therapy out of the exclusive
hands of predominantly male controlled, capitalistic
system. Also, she stated that without the ability or
perceived right to question and obtain satisfactory
answers, women are guinea pigs to a system that rewards
physicians for performing unnecessary surgery, over
prescribing drugs, and arbitrarily using hormone therapies
(Reagan, 1981).
According to Reagan (1981), like women's self-help
groups, university courses in women's health should be
planned to help women regain some control over their bodies
through an understanding of how the health care system
works for and against women. Courses should include
application of self-awareness skills, self-help, prevention
and maintenance, and knowledge of the language, politics,
and economics of women's health. The highest goal of self-
help is health education. Without health education that
provides women with knowledge, skills and raised
consciousness, the woman is reduced to consumer of health
care which perpetuates many unnecessary services (Reagan,
1981).
47
Marieskind (1980) found some women's health classes in
universities. She stated that the most radical of these
was the pelvic teaching program conducted at various
medical schools in Boston by the Cambridge Women's
Community Health Center (Marieskind, 1980). Rosser (1986)
found that out of 149 university/college health education
departments surveyed across the country, twelve of the
departments that did not offer a women's health course,
indicated that it was taught in another department, such as
Nursing, Sociology, or Women's Studies. In the survey,
39.6 percent indicated that they offered a women's health
course and 5.4 percent were seriously considering offering
such a course. Therefore, women's health courses can be
found in a variety of departments on college campuses:
Women's Studies, Nursing, Sociology, Biology, and a few in
Health Education and Physical Education (Rosser, 1986).
Clarke, Olesen, Ruzek, and Anderson (1986) stated that
curriculum development in women's health has undergone a
transformation over the past twenty years, based on the
availability of teaching resources. During the early
1970s, resources were few and conceptually limited. They
ranged from being called "over-heated and under-cited"
early feminist political treatises emerging from the
consumer-oriented women's health movement to quantitative
studies of reproductive ad other epidemiological issues to
48
problematic medical and psychiatric specialty literature
(Clarke et al., 1986).
In 1983, Olesen, Ruzek, and Lewin at the University of
California, San Francisco, in the department of Social and
Behavioral Sciences, developed a grant proposal for a major
nationwide curriculum development project in women's health
which gained the support of the Fund for the Improvement of
Post-Secondary Education (FIPSE) of the Department of
Education. The grant emphasized the training of faculty to
develop curricula in women's health, preparing researchers
to enter the field of women's health, and preparing
curricula materials that would extend women's health
education into previously underdeveloped areas such as the
health issues of minority women (Clarke et al., 1986).
Ruzek (1986) stated that in contrast to purely bio-
medically oriented "health and hygiene" or obstetrics,
gynecology, and maternal health courses, women's health
studies courses tend to incorporate the view that women's
health must be viewed in a broad sociocultural framework.
Women's experience of health and illness is conceptualized
as having social, political, economic, psychological, and
cultural dimensions. Health is more than the absence of
disease of the functioning of organ-systems (Ruzek, 1986).
Ruzek (1986) also stated that of particular importance
is the emphasis placed on understanding women's own
subjective experience of health and health care by allowing
49
women to speak about these matters in their own voices.
She suggested that these themes shift the attention to
women's own voices and differentiate women's health studies
from traditional perspectives (Ruzek/ 1986).
This is clearly illustrated by contrasting the tone
and content of the Boston Women's Health Collective's Our
Bodies, Ourselves, with any textbook used in high school or
college health and hygiene courses in the 1950s and 1960s
(Ruzek, 1986). When discussing contraceptives, a
conventional clinically oriented health course would
provide information on the various types available, the
"failure rates," and how they are "correctly used." In
comparison, a women's health class would focus not only on
how to use contraceptives, but also on how women feel when
they use them and what problems they have with health
providers or sexual partners (Ruzek, 1986).
Ruzek (1986) claimed that there was a shift in
definitions of who had the legitimate right to define what
was important, what was safe, and what was dangerous. In
the late 1960s and early 1970s, only certain "properly
certified experts," i.e. obstetrician-gynecologists, were
defined as having expertise in women's health. In the
1980s, lay groups, nurses, midwives, health educators,
social scientists, and others were viewed by the public as
having legitimate knowledge (Ruzek, 1986). That trend
continues through the 1990s, including consumer groups such
50
as Public Citizen, the National Women's Health Network, the
Breast Cancer Coalition, the Institute for Research on
Women and Gender, the Melpomene Institute, the National
Council for Research on Women, and a women's health
committee of the Association for the Advancement of Health
Education.
On college campuses, the first type of course offered
resembled the self-help curses offered in the community.
They were difficult to track, since they were often taught
at the margins of college campuses by temporary, part-time
faculty in women's studies programs or under the
sponsorship of a faculty member who was afraid to teach
such a course on campus. Some were student-taught (Ruzek,
1986). Ruzek (1986) stated that there are three major
types of women's health courses offered on college
campuses.
Early women's health courses focused on reproductive
health and relied on literature produced in the lay
feminist world, such as the early edition of Our Bodies,
Ourselves (1976) and Ehrenreich and English's pamphlet,
Witches, Midwives, and Nurses (1972) and Complaints and
Disorders (1973). These materials constituted the "core
curriculum" (Ruzek, 1986). One of the earliest syllabi of
this nature was developed by Adele Clarke (1986) at the
University of California at San Francisco (UCSF) for the
Women's Studies program. Clarke's course was composed of
51
R ep ro d u ced with p erm ission of the copyright ow ner. Further reproduction prohibited w ithout perm ission.
personal experience, politics, and the mechanics of moving
body parts. In addition to the "core curriculum," Clarke
used materials produced by physicians, scientists, health
writers, and others who explained not only how the body
worked, but who wrote from sociocultural, behavioral, and
political perspectives (Ruzek, 1986).
The second major type of course emerged from the
social and behavioral sciences. Such courses focus on
feminist research and scholarship which addresses women's
subjective experiences of health, using qualitative
research methods, sex differences in health status, and
health service utilization, relying on demographic and
qualitative data, sociopolitical, economic, and historical
analyses of health and illness (Ruzek, 1986).
The third major type of course is a biologically or
clinically oriented course which emerged in the basic
sciences and health professions training schools such as
nursing, medicine, and public health. Ruzek (1986) felt
that the courses offered in health professions training
schools are the least well-aligned with the women's studies
program (Ruzek, 1986).
One curricular resource is the University of
California, San Francisco (UCSF), syllabi called Women,
Health and Healing: Fourteen Courses (1986). It includes
all of the graduate courses developed and integrated by the
faculty of the Women, Health and Healing Program in the
52
Department of Social and Behavioral Sciences at UCSF. They
are directed at students of sociology/ anthropology,
psychology, social work, public health, nursing, and
women's studies. In part, they include courses in women's
health and health education (Clarke, 1986).
Other women's health syllabi can be found in Sue
Rosser's book, Teaching Science and Health from a Feminist
Perspective: A Practical Guide (1986). Rosser sent out
over 400 surveys to determine how many and where women's
health courses were across the country. She found three
classifications of courses: those offered for 1) only
women's studies credit, 2) only for credit in a department
other than women's studies, and 3) cross-listed with
w o m e n s studies and another department. Women's health
courses were often found in women's studies, nursing,
biology, sociology, zoology, history, anthropology,
history, public health, and health education. Reviewing
syllabi of women's health studies, the courses were multi
disciplinary, including topics from the disciplines
mentioned above (Ruzek, 1986).
A frequency distribution (see Appendix A) was done by
the researcher for topics listed among fourteen women's
health syllabi from Rosser's book and one syllabus obtained
from an instructor at another state college. Fourteen out
of the 31 listed were chosen because they were more health
education oriented than the others.
53
Major topic areas from these fifteen syllabi included
the following:
Life Stages
a. pregnancy care
b. menstrual cycle
c. aging and menopause
d. child alternatives
e. motherhood and postpartum depression
f . historical perspectives of childbirth
Physical Concerns of Women
a. anatomy and reproductive cycle
b. reproductive rights
c. osteoporosis and aging
d. contraceptives
e. cancers of women
f . gynecological problems and diseases
g- infertility
h. women and exercise, and sports
i. gynecological procedures
j- STDs
k. lifestyle and wellness
1. health status of women
m. prescription drugs
n. nutritional concerns
0. heart disease and women
P- disabled women issues
Mental and Emotional Concerns of Women
a. mental health issues
b. stress and stress management
c . substance and alcohol abuse
d. depression
e. eating disorders
f . sexuality
g- nervous system
h. self-esteem
i . assertiveness
j- selfhood and politics of appearance
Social Concerns of Women
a. women's health movement
b. clinics and self-help groups
c. women and health care system
d. violence against women
e. rape and date rape
f . theoretical perspectives on women's health care
g- doctor-patient relationship/rnedical education
h. domestic abuse
i. women in medicine
j. feminist approach to women's health
k. women and career/employment
1. Lesbian lifestyle
54
m. occupational health hazards
n. politics of health services
0. future of health and medical care
p. alternative health care
q. women and legislation
r. feminization of poverty
s. ageism
t. women as consumers
u. dating, cohabitation, and marriage
A curriculum outline developed by Reagan, found in the
May/June 1981 issue of Health Education, was written for an
introductory course in women's health (Reagan, 1981). Such
a course included the following major topic areas:
1. historical perspectives
2. economics of women's health
3. terminology
4. hysterectomies
5. breast cancer
6. hormone therapy
7. patient/physician relationships
8. birthing
9. women's health occupations
Breitenstein (1987) developed a unit plan on women's
health issues for a secondary level health education class.
She selected ten topics of current interest. The unit plan
was to be incorporated into a comprehensive and sequential
health curriculum:
Lesson 1: Who is healthier, women or men?

Lesson 2: Women, fitness, and body image
Lesson 3: Menstrual health
Lesson 4: Early detection of breast and genital
cancers
Lesson 5: Women as victims of violence
55
Lesson 6: Women and substance abuse
Lesson 7: Women and occupational health
Lesson 8: Adolescent pregnancy
Lesson 9: Healthy childbearing
Lesson 10: Women and aging
Ruzek (1986) felt that it was important to emphasize
how the dynamics of race and class interact with gender to
produce health, illness, and responses to health status
among different groups of women. By the end of a women's
health course, participants should, when talking about
women, be able to conceptualize whether or not they are
referring to "all" women or to specific groups of women
under specific conditions (Ruzek, 1986).
Summary
The review of the literature revealed the theoretical
framework for this study. The review also revealed the
limited amount of research completed in the area of women's
health knowledge. There were similarities between past
studies and the present study completed by the researcher.
In relation to content, the women's health knowledge test
developed by this researcher covers topics found in the
literature, in addition to topics recommended by an expert
panel of jurors. In relation to methodology, this
researcher followed the same procedures found in the
literature, including the researcher being responsible for
56
administering the questionnaire, collecting the data, and
analyzing the data.
Based on the findings of the studies reviewed,
recommendations were made for health instruction for women.
For example, Koff et al. (1990) suggested the need to
address the topic of menstrual education for adult women
with respect to both basic knowledge of the menstrual cycle
and expectations for associated physical and behavioral
changes. Findings by Clark (1985) suggested that health
fairs are effective means of promoting positive health
behaviors, since the level of knowledge displayed by
respondents on the postprogram questionnaire was
significantly greater than see on the pretest. Brailey
(1986) found that with both group and individual teaching
in the workplace, the practice of breast self-examination
increased, but knowledge did not increase with either
teaching format. This study suggested finding other
teaching strategies.
Stillman (1977) made the suggestion that her study be
replicated on a sample with different demographic
characteristics to further evaluate the efficacy of the
instrument used, and determine whether groups with
different characteristics vary on beliefs, knowledge, and
behavior.
Reagan (1981) stated that health education can do for
women what it does best for all. It can help people feel
57
good about their ability to be themselves, to feel normal
and distinctive, to have a sense of self that allows for
positive decision-making and self-actualized behavior
(Reagan, 1981). A review of the literature revealed a
radical beginning for women's health instruction programs.
This researcher discovered a variety of women's health
college course syllabi, but all contained commonalities, in
terms of topics covered. There is a shortage of such
courses on college campuses, and community classes are
limited to efforts by nonprofit organizations and hospitals
pertaining to specific diseases, illnesses, or conditions
such as pregnancy.
58
CHAPTER III
METHODS AND PROCEDURES
Introduction
The literature revealed little knowledge about women's
health instruction among college-educated women and the
need for the development women's health knowledge test.
This research is designed to develop a comprehensive/ valid
and reliable women's health knowledge test. This chapter
explains the procedures employed to develop the instrument.
The methodology presented in this chapter includes the
study population/ instrumentation/ jury selection and use,
development of original draft of the instrument, item
development, and pilot test analysis.
Study Population
The sampling for the final edition of the test
consisted of nonprobability convenience sampling using
women from intact groups: women's organizations and
women's health classes from colleges and universities. The
study population consisted of 617 women, from 24 states,
representing a cross-section of the country (see
Appendix A). Because of a limited number of women's health
59
classes available, only three classes participated in the
study. The women's organizations used consisted of the
League of Women Voters (LWV) and the American Association
of University Women (AAUW) from across the country. The
following map (Figure 1) illustrates which states contained
participants for the study. A total of 1511 final tests
were mailed out: 150 to classes, 834 to AAUW branches, and
527 to LWV offices. A total of 724 answer sheets were
returned, and 617 were usable. The others were either
incomplete or contained missing responses. The response
rate was 48 percent.
Below is a general definition of each group that
participated:
1) League of Women Voters
According to membership literature, there are
approximately 100,000 members in the organization
nationwide. The racial background and the socioeconomic
status of the members vary. Meetings are usually held in
public places, such as a library or government building.
Smaller neighborhood meetings are held in members' homes.
The organization is a nonpartisan political organization
that encourages citizens to plan an informed and active
role in government. At the local, state, and national
levels, the League works to influence public policy through
education and advocacy. On occasion at monthly meetings,
presentations on general health issues are made. There is
60
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was four (District of Columbia) and the maximum
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Figure 1. states containing study population.
61
also a health care committee in the organization, which
monitors general health issues and women's health issues.
2) American Association of University Women
According to membership literature, there are
approximately 135,000 women in the organization nationwide.
The racial background and the socioeconomic status of the
members vary. Current membership requires a college degree
from an accredited college or university. Occupations of
the members include college professors, public school
teachers, business women, office managers, medical
personnel, homemakers, and retirees from the various fields
mentioned. The organization works toward the advancement
of women in education and in the work force by raising
money for educational scholarships and career and college
placement services. The organization also monitors state
legislatures while they are in session, representing
national policies of AAUW. Meetings are usually held in a
public place, such as a library, restaurant, or hotel. On
occasion at monthly meetings, presentations on general
health issues are presented. There is no type of health
committee in the organization, but the legislative
committee often monitors women's health issues.
3) Women's Health Classes
The women's health classes used were found in college
and universities across the country. Some were located
through the book, Teaching Science and Health from a
62
Feminist Perspective: A Practical Guide, by Sue Rosser
(1986), which lists the location of women's health classes.
The researcher also located classes by contacting health
education department across the country listed in the 1991
Directory of Institutions offering Specialization in
Undergraduate and Graduate Professional Preparations
Programs in School, Community, and Public Health Education/
compiled by the Association for the Advancement of Health
Education. Other classes were located through existing
knowledge of the researcher. Women's health classes were
found in a variety of college and university departments,
including health education, sociology, women's studies,
nursing, history, and biology. The researcher chose
classes that were mainly health related.
A sample from the above groups of women was used for
the study. The total study population consisted of 617
women, from 24 states. A total of 599 participants
completed the demographic survey forms. The ages of the
women in the study population ranged from eighteen to
ninety-two years of age. The mean, mode, and median ages
were 52, 67, and 53 respectively. The mean, mode, and
median ages of the college sample were 21, 19, and 20,
respectively. The racial background of the sample
consisted of 96.72 percent white, 2.40 percent Afro-
American, and .88 percent other. A total of 68 percent of
the participants were married and 76 percent had children.
63
A total of 82 percent of the participants had a four-year
college degree from accredited colleges or universities. A
total of 62 percent of the participants considered their
state of health to be excellent, while 36 percent and 2
percent considered their state of health as average and
poor, respectively. A total of 119 participants out of the
572 women from women's organizations had ever taken a
women's health course.
Each group of women received a cover letter, the
appropriate number of final tests and scan-tron answer
sheets, and a stamped, self-addressed envelope (see
Appendix B ) .
Instrumentation
The instrument was based on criterion-referenced
testing, where proficiency was based on specific cognitive
learning objectives in ten major conceptual areas of
women's health. Lien (1980) stated that criterion-
referenced testing emphasizes the measured proficiency of
defined groups on specific tasks and not on comparison of
performance with that of others or with norms (Lien, 1980).
Cronbach (1971) stated that criterion-related validation
compares test scores with an external variable (criterion)
considered to provide a direct measure of the behavior in
question (Cronbach, 1971).
64
These conceptual areas would be contained in a general
women's health instruction program. The program would
contain fifty contact hours of general women's health
instruction, either in an undergraduate level college
setting or in a community organizational setting. For a
college setting, this program would be credited five
quarter hours or three semester hours. In an
organizational setting, the hours would have to be modified
to accommodate the schedule of the organization.
In developing the conceptual areas, the researcher
first reviewed a widely used text for women's health
classes, The New Our Bodies, Ourselves, by the Boston
Women's Health Book Collective (1984). The researcher
also reviewed fifteen women's health class syllabi from
colleges and universities from a cross-section of the
country. Thirteen syllabi were found in the book, Teaching
Science and Health from a Feminist Prospective, by Sue
Rosser (1986). The researcher also obtained two syllabi
from two women's health instructors. A frequency
distribution was compiled on a list of conceptual areas
that were cited (see Appendix C ) . The list of possible
conceptual areas are cited in Appendix D.
The above fifty-four topics were studied, reviewed,
combined, and compiled into ten major women's health
knowledge conceptual areas. The ten conceptual statements
65
were then submitted to the study's panel of experts for
consideration.
Jury Selection and Use
Since the instrument was to be used nationwide, a panel
of experts was selected consisting of twenty-two
specialists in the field of women's health from across the
country (see Appendix E). The jurors were recruited from
the fields of higher education (health education, nursing,
women's studies, psychology, and physiology), medicine,
research, mental health, public health, and dietetics.
The specialists were located through three methods: 1)
a listing of women's health classes and instructors, found
in the book, Teaching Science and Health from a Feminist
Perspective, by Sue Rosser (1986), 2) referral from already
recruited members of the panel, and 3) existing knowledge
of experts by the researcher.
Experts who met the following criteria were selected
for the panel: Each juror must 1) work in the area of
women's health, 2) have expertise in the area of women's
health, and 3) be interested in the study and be willing to
assist by spending the necessary time (approximately three
hours) needed to complete the job.
The jurors' major responsibilities included: 1) rating
and weighing the conceptual areas in women's health that
66
should be used for the table of specifications for the
test, and 2) evaluating the test items to be included on
the instrument.
Development of Original Draft of the Instrument
Green and Lewis (1986) stated that validity represents
the extent to which an instrument adequately measures the
concepts under study (Green & Lewis, 1986). Cronbach
(1971) stated that content validity demonstrates how well
the content of the test samples the subject material about
which conclusions are to be drawn (Cronbach, 1971).
Content validity for the instrument was, in part,
established by writing ten behavioral objectives relating
to the ten women's health knowledge areas; by reviewing the
text, The New Our Bodies, Ourselves; and studying the
women's health class syllabi. The objectives were then
submitted to the study's panel of experts for evaluation.
Each juror received a cover letter, background
information explaining the purpose of the study, a rating
and weighing response form for the ten behavioral
objectives, and a stamped, self-addressed envelope (see
Appendix F ).
Each objective was first evaluated on the basis of how
essential each was and should be used for developing
questions for the study's knowledge test. Essentiality was
67
determined by a rating system. Rating, in terms of how
essential the objective was, was done by using the
following scale:
1 - the objective is essential and should be included
2 - the objective is acceptable and should be included
3 - the objective is unacceptable and should not be
included
Each behavioral objective was next evaluated on the
basis of what percentage of the knowledge test should be
devoted to each. The jurors determined the percentage that
should be devoted to each objective by weighing each, with
all ten totalling 100 percent.
Weighing is defined as the amount of emphasis that
should be placed on a particular objective and consequently
the number of test items that would be devoted to it on a
test.
From the objectives listed reflecting ten major
conceptual areas in women's health, a table of
specifications was developed by compiling a frequency
distribution of the ratings and by computing the means of
the weightings of the ten areas (see Table 2). The
frequency distribution of the ratings reflected a consensus
by the panel to include all conceptual areas submitted,
with recommended revisions.
68
Table 2
Preliminary Table of Specifications for Women's Health Knowledge Test
Determined by Panel of Experts
Percent of
Objective Items
1. Identify the current health status and 17%

health needs of women in the U.S.,
recognizing the unique health care needs of
women through their entire life cycle from
birth to old age, and recognizing the
differences between women.
2. Explain the ideal relationship between a 7%
woman and her physician, and factors to
consider when selecting a physician for
general and gynecological care.
3. Identify normal female physiology. 10%
4. Explain causation and prevention of disease 10%
and illness, and health issues peculiar to
women.
5. Demonstrate healthy skills for coping with 10%
different emotional and mental health
problems among women.
6. Explain how violence against women, 6%
domestic violence, date rape, and sexual
harassment are all harmful to women's
health.
7. Explain gynecological procedures 11%
implemented during regular exams, female
surgeries, and the "medicalization" of
natural occurrences in women's lives.
8. Describe traditional and alternative forms 17%
of health services available to women, and
describe how women's health can be
affected by poverty, a lack of health
insurance, and a lack of research in
women's health.
9. Identify contributions by women in the 5%
medical and health care fields, including
professional, non-traditional, and
familial caregiving contributions.
10. Describe skills for women in attaining 7%
occupational health and in assertiveness
and self-expression in all areas of life
open to women, including education, career,
motherhood, relationships, friendships, and
sexuality.
Total 100%
69
Item Development
The researcher used the table of specifications to
write test items for the instrument. Before sending the
draft test items to the expert panel of jurors, the
researcher evaluated each item on the basis of how well
each provided a learning opportunity for the study
participant. For example, if an item provided useful and
helpful information related to women's health, it was
submitted. The researcher wrote the test so that upon its
completion, study participants would have gained at least
minimum knowledge about women's health.
The researcher wrote a total of 125 draft test items.
Beneath each item written, the researcher documented a
common source where the content of the item could be found.
The items were sent to the panel of experts for evaluation.
Each juror received a cover letter, the results from the
rating and weighing response forms completed earlier by the
panel, the recommended table of specifications, and an
evaluation form for the 125 test items (see Appendix G ) .
Each juror was asked to evaluate each test item by
using a scale of 1-3. The legend follows:
1 - the test item is essential as related to the
objective and should be included.
2 - the test item is acceptable and should be included,
with the recommended change.
70
3 - the test item is unacceptable and should not be
included.
A space for comments was also provided after each test
item for evaluative remarks. Those test items determined
to be unacceptable by any juror(s) were deleted. Those
items determined to be essential by all the jurors were
retained. Certain test items were revised based on an
analysis of the recommendations made by the jurors. Jurors
also recommended five additional test items, which
increased the number of preliminary test items to 130. A
revised test was then sent to each juror for further
comments (see Appendix H ) . The preliminary test contained
130 test items (see Appendix I).
Pilot Test Analysis
The test was piloted using a pilot group of twenty-two
members from the Atlanta Branch, American Association of
University Women (AAUW). Volunteers for the preliminary
test were recruited at a monthly meeting of the
organization. After a short presentation about the
project, a sign-up sheet was circulated among the group.
Each participant received, via the mail, a participant
letter, the preliminary instrument, and an answer sheet
(see Appendix I ).
71
The ages of the pilot sample ranged from 28 to 77 years
of age. The mean, median, and mode age of the group was
forty-one. The racial background of the group consisted of
twenty-one Caucasians and one African-American. All of the
members were graduates of various fields from accredited
colleges and universities. To keep the test administration
anonymous, the researcher told the pilot participants that
they would have to contact the researcher via telephone for
their scores. The tests were retained by the researcher.
The pilot tests were scored and analyzed by the
researcher. The maximum possible raw score on the test was
130. The speededness of the preliminary test was 100
percent, where all participants completed their tests.
Scoring and item analysis was accomplished by using the
National Computer Systems' Sentry 3000 Scanner Program at
the Kennesaw State College computer lab in Marietta,
Georgia.
Sample statistics were used for the data analysis. The
Crunch Version Four Statistical Package was used for the
frequency distribution analyses, which included the sample
statistics rank order listing, measures of central tendency
(mean, median, and mode), variability (standard deviation,
range, and variance), and standard error of the mean.
The mean and median scores for the preliminary test
were 78.73 and 80, respectively. There was a tie for the
mode, with three observations at the scores 88, 80, 73, and
72
63. The range was 56. The variance was 173.54 and the
standard deviation was 13.17, and the standard error of the
mean was 2.81. The rank order of scores for the pilot test
is listed in Appendix J and the measures of central
tendency and variability are listed in Appendix K.
An item analysis was conducted. Item analysis is
defined as an evaluation of the strengths and weaknesses of
a test and is based on the hypothesis that the total test
is or is not good depending upon the worth of individual
items (Lien, 1980). The item analysis consisted of
determination of discrimination and difficulty. These
procedures determined what differences existed between the
upper 27 percent and lower 27 percent of participants who
took the test.
Lien (1980) stated that discrimination is the
difference between the number of correct responses between
the upper and lower groups. Raw scores from the top and
lower third of the study population became the upper and
lower groups. The number of participants who responded
correctly to each question is then counted. Discrimination
is determined by using the formula (Lien, 1980):
D = U - L
D = index of discrimination
U = number of participants in upper group who
successfully answered the item
73
L = number of participants in lower group who
successfully answered the item
Lien (1980) stated that the index of discrimination
describes the discrimination power of each item, and that a
good test item will differentiate between the good and poor
participants on the test. He described the following
standard for use in noting discrimination (Lien, 1980):
Above .41 to 1.00 = good discriminator
.20 to .40 = fair
.00 to .19 = poor
-.01 to -1.00 = unsatisfactory
Lien (1980) stated that a good instrument should have
50 percent of the items exceeding .40, less than 40 percent
should have values between .40 and .20, less than 10%
between .20 and 0, and none should have negative values.
Negative values indicate more participants in the lower
group answered an item correctly than in the upper group
(Lien, 1980).
Tinkelman (1971) stated that the difficulty of a test
item is commonly defined as the percentage of participants
answering that particular item correctly. If 32 percent of
the participants answer an item correctly, the item is said
to have a difficulty index of 32 percent, or .32. The
difficulty index may vary from zero for an item answered
correctly by no participants to 1.00 for an item answered
correctly by all participants (Tinkelman, 1971).
74
Lien (1980) stated that most test items should be in
the 30-70 percent range so that most participants can have
a good opportunity to answer the question (Lien, 1980).
Table 3 lists the general summary of statistical
analyses for the pilot test and the summary of the item
analysis is listed in Table 4. The complete item analysis
can be found in Appendix L and the number of responses to
each test item alternative can be found in Appendix M.
In terms of discrimination, on the pilot test, a total
of 28, or 22 percent, of the items exceeded the
discrimination value of .40. A total of 68, or 52 percent
of the items had discrimination values between .40 and .20
A total of 28, or 22 percent, of the items had
discrimination values between .20 and 0. Four percent of
the items had negative values. All items with a negative
value were deleted. A total of 96, or 74 percent, of the
test items had at least a satisfactory discrimination.
In terms of difficulty, on the preliminary test, a
total of 73, or 56 percent of test items had an acceptable
level of difficulty, in the 30 to 70 percent range. A
total of 41, or 32 percent, were found to be too easy. A
total of 16, or 12 percent, were found to be too difficult
Five of the acceptable items had to be deleted due to
negative discrimination values.
A total of 54, or 42 percent, of the test items had
both at least a satisfactory discrimination together with
75
Table 3
Pilot Test
General Summary of Statistical Analysis
1. Number of participants taking test 22

2. Number of test items 130
3. Mean 78.73
4. Median 80
5. Mode 88, 80, 73, 63
6. Range 56
7. Standard Deviation 13.17
8. Variance 173.54
9. Standard Error 2.81
10. Percentage of items with at least a
satisfactory index of discrimination
(+.20 to +1.00) 74
11. Percentage of items with an acceptable

level of difficulty (30 to 70%) 56
12. Average level of discrimination for test + .29
13. Average level of difficulty for test 60.67
76
Table 4
Pilot Test
Summary of Item Analysis Chart
Amount Percentage
Discrimination
Very good (+.41 to +1.00) 28 22
Satisfactory (+.20 to +.40) 68 52
Low (.00 to +.19) 28 22
Unsatisfactory (-.01 to -1.00) __6 _4
Totals 130 100
Satisfactory and above 96 74
Difficulty
Too easy (over 70%) 41 32
Too difficult (below 30%) 16 12
Acceptable (30 to 70%) 73 56
Totals 130 100
Combination Discrimination and Difficulty

Items with both at least a satisfactory
discrimination and acceptable difficulty 54 42
Average level of discrimination for test + .29
Average level of difficulty for test 60.67
Items Rejected
Unsatisfactory 4
Too easy 19
Too difficult 9
Low discrimination 17
Accommodate table of specifications __5
Total number rejected fromm pilot test 45*
*Some items were rejected for two reasons.
77
an acceptable difficulty level. The preliminary test
contained an average discrimination value of .29 and an
average level of difficulty of 60.67.
Twenty-two of the 41 test items with a difficulty level
over .70 were retained and six of the 16 test items with a
difficulty level below .30 were retained to keep the number
of test items needed to accommodate the percentage devoted
to each behavioral objective determined by the expert panel
of jurors. Nine of the 28 test items with low
discrimination were retained unrevised to meet the standard
of 10 percent of test items with low discrimination and to
accommodate the table of specifications.
Criteria for selecting test items to be included on the
final test consisted of retaining as many items as possible
that adhered to standards for discrimination and
difficulty. After completing the item analysis, a total of
45 test items had to be deleted. Tinkelman (1971) stated
that the proper number of items to include in a test
depends on three factors: 1) the relative weights assigned
to the various part of the test must be assured, 2) the
item numbers must be sufficient to achieve the minimum
standards of reliability, and 3) both of these factors must
be achieved within a reasonable and practical limitation of
testing time (Tinkelman, 1971).
For reliability, for any given level of
intercorrelation, the longer the test, the more reliable it
78
will be. Tinkelman (1971) suggested that if a test is
designed for group survey purposes, a reliability of .75 is
sufficient. Also, he stated that the usual multiple-choice
question may take forty-five to sixty seconds to answer
(Tinkelman, 1971). The researcher came to a compromise
with the first two factors, and developed a test that could
safely be completed in a college class period of fifty
minutes or an organizational meeting period of one hour. A
total of 85 test items were included in the final test (see
Appendix B ) .
A total of 52, or 61 percent, of the items selected for
the final test had at least a satisfactory level of
discrimination together with an acceptable level of
difficulty. A total of 76, or 90 percent, of the items had
at least a satisfactory discrimination value. A total of
57, or 67 percent, of the items had an acceptable
difficulty value. The average discrimination level of the
items compiled for the final test was .38 and the average
level of difficulty was 60.70.
Summary
The methodology described in this chapter was employed
in developing an instrument to measure the knowledge level
of postsecondary women about women's health. The
instrument was based on criterion-referenced testing, where
79
proficiency was based on specific cognitive learning
objectives in ten major conceptual areas of women's health.
Content validity was established by compiling a list of
conceptual areas covered in a widely used text and from
fifteen women's health syllabi. A table of specifications
was then developed, with the assistance from an expert
panel of jurors recruited for the study. The panel rated
and weighted the conceptual areas and evaluated the test
items for inclusion in the instrument. A total of 130
initial test items were developed and accepted by the
panel of experts to be used for the preliminary test.
After item analysis, a final edition of the instrument was
developed, which included 85 test items.
80
CHAPTER IV
FINAL TEST ANALYSIS
Introduction
Based on the results of the preliminary test, the
table of specifications for the final test was developed
(see Table 5). The total number of test items resulted in
85, to meet the percentages recommended by the panel of
experts. This chapter explains the results of the data
analyses completed on the final edition of the women's
health knowledge test.
The final tests were scored and analyzed by the
researcher. The maximum possible raw score on the test was
85. The higher the score out of 85, the greater the level
of women's health knowledge by the participant. Scoring
and item analysis was accomplished by using the National
Computer Systems' Sentry 3000 Scanner Program at the
Kennesaw State College computer lab in Marietta, Georgia.
Sample statistics were used for the data analysis.
The Crunch Version Four Statistical Package was used for
the frequency distribution analyses, which included
frequency and rank order listing, measures of central
tendency (mean, median, and mode), variability (standard
deviation, range, and variance), and standard error of the
81
Table S
Final Teat
Table of Specifications
Percent
of
Content Area Items Number
1. Identify the current health status and health needs of 17% 14

women in the U.S., recognizing the unique health care
needs of women through their entire life cycle from birth
to old age, and recognizing the differences between women.
2. Explain the ideal relationship between a woman and her 7% 6

physician, and factors to consider when selecting a
physician for general and gynecological care.
3. Identify normal female physiology. 10% 9
4. Explain causation and prevention of disease and illness, 10% 9

and health iBSueB peculiar to women.
5. Demonstrate healthy skills for coping with different 10% 9

emotional and mental health problems among women.
6. Explain how violence against women, domestic violence, 6% 5

date rape, and sexual harassment are all harmful to
women's health.
7. Explain gynecological procedures Implemented during 11% 9

regular exams, female surgeries, and the "medicallzatlon"
of natural occurrences in women's lives.
8. Describe traditional and alternative forms of health 17% 14

services available to women, and describe how women's
health can be affected by poverty, a lack of health
Insurance, and a lack of research in women's health.
9. Identify contributions by women in the medical and health 5% 4

care fields, including professional, non-traditional, and
familial caregivlng contributions.
10. Describe Bkills for women in attaining occupational health 7% 6

and in assertiveness and self-expression in all areas of
life open to women, Including education, career,
motherhood, relationships, friendships, and sexuality.
Total 100% 85
82
mean. A reliability coefficient was completed manually,
using the Kuder Richardson Formula 21 and split-half tests
for reliability.
Descriptive Statistics
The scores of the final test approximated a normal
distribution where 68.26 percent, or roughly two-thirds, of
the scores fall between plus and minus one sigma and
95.44 percent of the scores fall between plus or minus two
sigmas (see Figure 2). For the final test, a total of 489
scores (79 percent) fell within one standard deviation of
the mean, 612 scores (99 percent) fell within two standard
deviations of the mean, and 617 fell within three. The
mean, median, and mode for the final test were 53, 54, and
56 respectively. The range, variance, and standard
deviation were 58, 63.62, and 7.8, respectively. The
standard error of the mean was .32. The minimum score was
17 and the maximum score was 75. The frequency and rank of
scores for the final test are presented in Appendix N and
the measures of central tendency and variability are
presented in Appendix 0.
83
200
150
Number o f
Participants
100
50
T 1 i 1------ 1------ 1------ 1------ 1------ 1------ 1------ 1------ 1------ 1------ 1------ r
10 20 30 40 50 60 70 80
Scores on final test
Figure 2. Frequency distribution of the final test.
84
Speededness
The speededness of the final test consisted of seven
teen out of the total study population being incomplete. A
speeded test is one where participants would earn higher
scores if they were given more time. The average time to
take the final test was between thirty and forty-five m i n
utes, which allowed approximately two minutes for each test
item. Many participants commented that the test was very
difficult, but most participants completed the test within
thirty to forty-five minutes. The seventeen incomplete
tests were deleted from the sample.
Item Analysis and Revisions
An item analysis was conducted on the final test,
which included discrimination, difficulty, and reliability.
The summary of the item analysis for the final test is
presented in Table 6 and the general summary of statistical
analyses is presented in Table 7.
Item Discrimination
In terms of item discrimination, on the final test, a
total of 15, or 18 percent, of the items exceeded the
discrimination value of .40. A total of 34, or 40 percent,
85
Table 6
Final Test
Summary of Item Analysis Chart
Amount Percentage
Discrimination
Very good (+.41 to +1.00) 15 18
Satisfactory (+.20 to +.40) 34 40
Low (.00 to +.19) 31 37
Unsatisfactory (-.01 to -1.00) __5 __5
Totals 85 100
Satisfactory and above 49 58
Difficulty
Too easy (over 70%) 36 42
Too difficult (below 30%) 11 13
Acceptable (30 to 70%) 38 45
Totals 85 100
Combination Discrimination and Difficulty

Items with both at least a satisfactory
discrimination and acceptable difficulty 26 31
Average level of discrimination for test + .24
Average level of difficulty for test 62.38
Items Rejected
Negative discrimination 5
Too easy 5
Too difficult 4
Low discrimination 9
Accommodate table of specifications _2
Total number rejected from final test 15*
*Some itemB were rejected for two reasons.
86
Table 7
Final Test
General Summary of Statistical Analysis
1. Number of participants taking test 617

2. Number of test items 85
3. Mean 53
4. Median 54
5. Mode 56
6. Range 58
7. Standard Deviation 7.8
8. Variance 61.48
9. Standard Error of the Mean .32
10. Kuder Richardson Formula 21 Reliability Coefficient .67
11. Split-half Reliability Coefficient 1.00
12. Standard error of measurement .58
13. Percentage of items with at least a satisfactory
index of discrimination (+.20 to +1.00) 58
14. Percentage of items with an acceptable level
of difficulty (30 to 70%) 45
15. Average level of discrimination for test + .24
16. Average level of difficulty for test 62.38
87
of the items had discrimination values between .40 and .20.
A total of 31, or 37 percent, of the items had
discrimination values between .20 and 0. All five items
with a negative value were deleted. A total of 49, or
58 percent, of the test items had at least a satisfactory
discrimination.
The final test contained an average discrimination
value of .24, which is satisfactory. Twenty-four of the
thirty-one test items with low discrimination were retained
to meet the necessary number of items needed dictated by
the table of specifications.
Item Difficulty
In terms of item difficulty, on the final test, a
total of 38, or 45 percent of test items had an acceptable
level of difficulty, in the 30 to 70 percent range. A
total of 36, or 42 percent, were found to be too easy. A
total of 11, or 13 percent, were found to be too difficult.
Two of the acceptable items had to be deleted due to
negative discrimination values.
A total of 26, or 38 percent, of the test items had
both at least a satisfactory discrimination together with
an acceptable difficulty level.
The final test contained an average level of
difficulty of 62.38 percent, which is acceptable. Thirty
88
of the 36 test items with a difficulty level over .70 were
retained and six of the eleven test items with a difficulty
level below .30 were retained to meet the necessary number
of items needed dictated by the table of specifications.
The item analysis chart for the final test can be found in
Appendix P. The number of responses to each test item
alternative can be found is Appendix Q.
Reliability
Green and Lewis (1986) stated that internal
consistency reliability examines the intercorrelations of
all the individual items making up an instrument. It is an
indication of the extent to which each item of the
instrument relates to the other items. The higher the
intercorrelation among items, the greater the instrument's
internal consistency reliability.
Total reliability of an instrument is expressed as a
coefficient of reliability that ranges from 0 to 1. The
closer the coefficient is to 1, the more reliable the
instrument (Green & Lewis, 1986). A satisfactory level of
reliability ranges from .50 to .95 (Bostrom & Kahn, 1991).
Hopkins and Glass (1978) stated that the greater the
variance of a sample, the greater the values of the
reliability (Hopkins & Glass, 1978). The following is the
89
standard for interpreting a coefficient of correlation
(Lien, 1980):
+ .70 to + 1.00 high to very high
t .40 to i .70 average to fairly high
.20 to .40 present, but low
i .00 to i .20 negligible or low
The final test was evaluated for reliability by using
the Kuder Richardson Formula 21 test for reliability and
the split-half test for reliability. For the wide study
population under investigation, the Kuder Richardson
Formula 21 test resulted in a reliability coefficient of
.67, which is considered to be average to fairly high. The
split-half test resulted in a reliability coefficient of
1.00, which is considered to be very high.
Reliability is affected by the standard error of
measurement. Lien (1980) stated that while reliability
indicates freedom from error, the standard error of
measurement estimates the amount of error which does exist.
It is used to indicate how a participant's obtained score
differs from her true score (Lien, 1980). Hopkins and
Glass (1978) stated that measurement error can greatly
reduce the value of the observed reliability. The greater
the error, the lower the obtained reliability (Hopkins &
Glass, 1978). The standard error of measurement for the
final test was .58.
90
Using a table of random numbers, a random sample of
fifty participants was used for calculating reliability.
Kuder Richardson Formula 21 estimates the reliability of a
test from information about the individual test items from
a single administration, such as the mean score, standard
deviation, and the number of items on a test. The formula
was introduced in 1937 by G. Kuder and M. Richardson by
using the variance-covariance structure of the test items
from a single administration to compute a reliability
coefficient (Kuder & Richardson, 1937). Two of these
structures, based on their formulas 20 and 21, are widely
used today in lieu of test-retest or split-half methods.
The formula for the Kuder Richardson Formula 21 is cited as
(Kuder & Richardson, 1937):
r = 1 - MOC-M
K x SD2
K = Number of test items
M = Mean of test scores
SD = Standard deviation for test
Green and Lewis (1986) stated that the split-half test
for reliability estimates reliability as the magnitude of
the correlation of scores between two halves of an
instrument (Green & Lewis, 1986). According to Lien
(1980), after the test is administered, it is scored in two
parts: first, the odd-numbered items are scored to obtain
a total score for that half, then the even-number items are
91
scored to obtain a total score for that half. A
correlation is run between the two scores (Lien# 1980).
The method used to determine the coefficient of correlation
was the Pearson r, or Product-Moment r. The formula for
Pearson's correlation is cited as (Rubinson & Neutens,
1987):
r = N(Ex) (Ey )
________________________ ________________________
JnEx2 - (EX)2 nEy2 - (EY)2
N = number of cases
E = sum of
X = score of even-numbered items
Y = score of odd-numbered items
The coefficient of reliability obtained is for one-
half of the test and must be converted to the total
reliability by a conversion formula. The Spearman-Brown
Formula of Conversion is cited as (Lien, 1980):
i = 2 x x f -1-/2 ^ e test
1 + r of 1/2 the test
Percentile Ranks and Norms
Lien (1980) stated that a raw score could be converted
to a percentile rank. A percentile rank, or percentile
score, indicates the particular relative position of a
score in the entire study population. For example, the
92
fiftieth percentile is the median. The fiftieth percentile
score of the final test was 54.
To give the raw scores meaning and to assist future
administration of the test, norms in the form of percentile
ranks and T-scores were developed, based on the normal
probability curve (see Table 8). Angoff (1971) stated that
W.A. McCall in 1939 was principally associated with
normalized standard scores. McCall proposed that when
members of a group are tested, a distribution is formed of
their scores, and mid-percentile ranks are attached to
their scores, which are transformed to normal deviate
scores corresponding to those percentile ranks, but with a
preassigned mean of 50 and standard deviation of 10
(Angoff, 1971). Percentile ranks were obtained by using
the formula as cited (Lien, 1980):
PR = 100 -
(N)
100 = constant
R = Rank of scores
50 = constant
N = Number of scores
The formula for calculated T-scores requires using the
z-score formula as cited (Lien, 1980):
93
Table 8
Final Teat
Percentile Ranks and T-scoreB
Raw Score Percentile Rank T-acore
75 99.76 78
70 99.51 72
69 99.19 71
68 98.87 69
67 97.81 68
66 96.60 67
65 95.46 65
64 93.76 64
63 91.73 63
62 89.38 62
61 86.47 60
60 82.90 59
59 78.44 58
58 72.85 56
57 67.99 55
56 62.64 54
55 56.40 53
54 50.73 51
53 46.27 50
52 39.79 49
51 34.93 47
50 30.23 46
49 26.82 45
48 23.26 44
47 19.77 42
46 17.42 41
45 15.32 40
44 12.64 38
43 10.29 37
42 8.35 36
41 6.97 35
40 6.16 33
39 5.19 32
38 4.54 31
37 3.89 29
36 3.16 28
35 2.43 27
34 1.78 26
33 1.54 24
32 1.38 23
31 1.13 22
30 .81 21
27 .49 17
26 .24 15
17 .08 4
94
X = raw score
M = mean
SD = standard deviation
Lien (1980) stated that T-scores are directly related to z-
scores. Using the z-score formula, calculating T-scores
consists of doing the following computation:
T = lOz + 50
Summary
Based on the results of the preliminary test, a valid
and reliable test was developed. A total of 85 test items
were retained to meet the Table of Specifications. The
final test was analyzed for frequency distribution,
measures of central tendency, variability, standard error
of the mean, and reliability. Reliability was analyzed
using Kuder Richardson Formula 21 and split-half tests for
reliability. The scores of the final test almost
represented a normal probability curve, where 68.26 of the
scores fell between plus and minus one sigma. The mean,
median, and mode for the final test were 53, 54, and 56
respectively. The Kuder Richardson reliability coefficient
was .67 and the split-half reliability coefficient was
1. 00.
95
Item analysis revealed an average discrimination value
of .24, which is satisfactory and an average level of
difficulty of 62.38, which is acceptable. Percentile ranks
and T-scores were developed to give the raw scores meaning
and to assist with future administration of the test.
96
CHAPTER V
SUMMARY, CONCLUSIONS,. AND RECOMMENDATIONS
Summary
The purpose of this study was to develop a
comprehensive, valid, and reliable women's health knowledge
test. The test is best suited to assess the women's health
knowledge level of postsecondary women.
In conducting a study to develop a women's health
knowledge test, a review of the literature revealed a
paucity of information of women's health knowledge among
postsecondary education level women. The search for
women's health classes to administer the final test to
revealed a lack of women's health classes on college
campuses across the country.
The instrument developed was based on criterion-
referenced testing, where proficiency on the test was based
on specific cognitive learning objectives in ten major
conceptual areas of women's health.
Content validity was accomplished by compiling a list
of topics and items from a widely used women's health text
and from fifteen women's health syllabi. A table of
specifications was developed, with the assistance of an
97
expert panel of twenty-three jurors from the field of
women's health throughout the United States.
The jurors evaluated the test items by rating them in
terms of essentiality to the test:
1. essential and should be included
2. acceptable and should be included, with the
recommended changes
3. unacceptable and should not be included
The test was piloted, using twenty-two women from a
women's organization. The answer sheets were scored by the
researcher. Item analysis, which included discrimination
and difficulty, was conducted to determine which items to
retain and delete, attempting to keep all items that met
test construction standards. After completing the item
analysis, a total of forty-five test items had to be
deleted. It was determined by the researcher that the
deleted items were unsalvageable and determined that 85
test items were a sufficient number for a test that could
be completed in forty to forty-five minutes.
The final test was administered to 1511 women in
fifty-two women's organizations and women's health classes
in twenty-four states across the country. A total of 724
answer sheets were returned, for a response rate of
48 percent. A total of 617 answer sheets were usable. Out
of 85 questions, the mean, median, and mode of the scores
were 53 (62 percent), 54 (64 percent), and 56 (66 percent)
98
respectively. The range, variance, and standard deviation
was 53, 63.62, and 7.8, respectively. The standard error
of the mean was .32. The minimum score was 17 (20 percent)
and the maximum score was 75 (88 percent).
Item analysis was also conducted on the items of the
final test. The final test contained an average
discriminating value of .24, which is satisfactory, and an
average level of difficulty of 62.38, which is acceptable.
A random sample of fifty scores was used to determine
reliability. The final test was evaluated for reliability
by using the Kuder Richardson Formula 21 test for
reliability and the split-half test for reliability. The
Kuder Richardson Formula 21 test produced a reliability
coefficient of .67, which is considered to be average to
fairly high for the wide population under investigation.
The split-half test produced a reliability coefficient of
1.00, which is considered to be very high.
For future administration of the test and to give the
final scores meaning, percentile ranks and T-scores were
developed for the final test.
Conclusions
In developing a women's health knowledge test, three
basic research questions surfaced. The following
99
conclusions are based on the findings related specifically
to the investigative research questions.
1. What are the major objectives of a women's health
instruction program? The objectives for a women's health
instruction program should be based on the same ten
conceptual areas found in the table of specifications
developed for the women's health knowledge test.
Objectives for any instruction program should be based on
what is to be evaluated after participants complete the
program. At the end of a women's health instruction
program, participants should be able to:
a. Identify the current health status and health
needs of women in the U.S., recognizing the
unique health care needs of women through their
entire life cycle from birth to old age, and
recognizing the differences between women.
b. Explain the ideal relationship between a woman
and her physician, and factors to consider when
selecting a physician for general and
gynecological care.
c. Identify normal female physiology.
d. Explain causation and prevention of disease and
illness, and health issues peculiar to women.
e. Demonstrate healthy skills for coping with
different emotional and mental health problems
among women.
100
f. Explain how violence against women, domestic
violence, date rape, and sexual harassment are
all harmful to women's health.
g. Explain gynecological procedures implemented
during regular exams, female surgeries, and the
"medicalization" of natural occurrences in
women's lives.
h. Describe traditional and alternative forms of
health services available to women, and describe
how women's health can be affected by poverty, a
lack of health insurance, and a lack of research
in women's health.
i. Identify contributions by women in the medical
and health care fields, including professional,
nontraditional, and familial care giving
contributions.
j. Describe skills for women in attaining
occupational health and in assertiveness and
self-expression in all areas of life open to
women, including education, career, motherhood,
relationships, friendships, and sexuality.
Conclusion I: The major objectives of a women's health
instruction program were identified.
2. What should be the contents of a women's health
knowledge test? With the assistance of an expert panel of
jurors, a table of specifications and accompanying
101
weightings were developed for the test. A weighting is the
amount of emphasis that should be placed on a particular
objective and consequently the number of test items that
should be devoted to it on a test. The table contained ten
conceptual areas related to women's health to be used as
objectives. The contents of a women's health knowledge
test should derive from the following table of
specifications:
Topic Percentage of Items

1. Health status of women 17%
2. Patient/physician relationship 7%
3. Normal female physiology 10%
4. Causation and prevention of disease
and illness 10%
5. Emotional and mental health 10%
6. Safety and security 6%
7. Gynecological procedures and surgeries 11%
8. Health services for women 17%
9. Contributions by women to medical and
health care field 5%
10. Occupational health and assertiveness
and self-expression among women 7%
Conclusion II: The contents of a women's health knowledge
test were decided.
3. Can a valid and reliable test be developed? The
content validity of the knowledge test was accomplished.
With the assistance of an expert panel of jurors, the
researcher developed a table of specifications for the
test. The table contained ten conceptual areas of w o m e n s
health, derived from a text review and a review of women's
health syllabi from across the country. Reliability of the
final test was determined by using the Kuder Richardson
102
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout perm ission.
Formula 21 and split-half tests for reliability, with a
random sample of fifty answer sheets from the study
population. The Kuder Richardson Formula 21 test produced
a reliability coefficient of .67 for a wide population,
which is considered to be average to fairly high, and the
split-half test produced a reliability coefficient of 1.00,
which is considered to be very high.
Conclusion III: The test is valid and reliable for
postsecondary education level women found in intact gro u p s .
Recommendations
1. The test needs to be administered solely to
female college students in women's health classes. Because
of a lack of classes available, the test was mostly
administered to older women in the community. Traditional
college-aged women (ages 18 to 24) were not well
represented in the study. Such an endeavor may produce
different data results.
2. The test should be used in a postsecondary
women's health instruction program as an evaluative tool,
either as a pretest or a posttest.
3. The test should be revised on a regular basis as
new health information arises, as medical and health
advances are made available, and as the health status of
women changes.
103
4. An investigation into the use of the test with
minority women should be undertaken.
5. The test should be revised and utilized as an
evaluative tool for nonpostsecondary education level women.
104
CHAPTER VI
THE STUDY IN RETROSPECT
The country is seeing a resurgence of self-help and
self-care groups, and health classes that were once popular
during the early seventies. Today, women who are
interested in retaining their rights to health and their
basic human rights, have had to call out the cavalry older
women who remember fighting for those rights, such as
Gloria Steinem. By the mid 1980s, women in America were
just beginning to realize the gains achieved by the
pioneers of the women's rights movement during the 1960s
and 1970s, such as gains in pay, in the number of political
offices held, in equality as head of their households, in
the number of corporate president positions, and in
general, respect for our work, career choices, and
opinions. The apex of the movement came when a female ran
for vice president in 1984. The standards for women were
high.
With the nineties approaching in the late eighties,
the "backlash" occurred. Women started wearing their
undergarments on the outside. Undergarments became fashion
items for one female singing artist and for most women in
music videos. Fashion magazines and department store
displays began featuring undergarments as regular clothing.
105
Female undergarments are usually associated with sex;
therefore, fashionable women were dressing as objects of
sexual desire, not as respectable and credible human
beings.
The term "backlash," was coined in 1992 by Susan
Faludi, author of the book Backlash. The "backlash"
involves certain men in society who own all sources of the
media in the country, including television, movies,
newspapers, magazines, and radio, that shape (not reflect)
societal standards for how women should look, act, talk,
think, and live. The respect women gained is
deteriorating. Today's female standards are becoming more
and more degrading and hazardous to women's health. As
this study has found and as the literature has shown, there
is a lack of knowledge among women about their own health.
They are also poor health care consumers. Women are
starving themselves to death, inserting and injecting
foreign and dangerous substances into their bodies,
agreeing to unnecessary surgeries, spraying perfume in
unnecessary areas of their bodies, and having cosmetic
surgeries to meet the standards presented to them in the
male-dominated media.
Because of the radical nature of some of the self-care
groups today, they are most often found in community
centered women's health clinics. There is an increasing
interest in self-abortions. Roe v. Wade, which in 1973,
106
guaranteed safe and legal abortions for w o men, Is now
threatened with a reversal. The nature of women's health
courses on college campuses remain unchanged from the late
seventies. But I feel some may start addressing the
backlash that has occurred.
Conducting this study brought me in contact with women
who were interested in retaining their health and basic
human rights. The investigator received overwhelming
support from 99 percent of the women contacted, either
personally, on the telephone, or through the mail. The
experts recruited were very willing to help me. Women in
the organizations contacted expressed sincere interest in
the study and wishes for my success. Only a few
organizations reported no time to participate, and only a
few of the experts contacted were nonsupportive.
This study provoked much discussion in women's
organizations across the country. Some of the organization
presidents commented to the researcher that the test
stimulated their interest in women's health. Presentations
on women's health were conducted at their monthly meetings
as a result of taking the test.
This study also provoked debate on the facts. Some
women expressed their opinion on different aspects of
women's health. Examples included comments for and against
the Equal Rights Amendment, abortion, and women in the
medical field. One group sent "right to life" literature
107
and wrote that it was credible literature based on
research. Review of the material revealed no research
citations.
A major strength of the study consists of developing a
comprehensive/ valid and reliable women's health knowledge
test, available for use by postsecondary women in either
college or community settings.
One strength of the study included an awareness of a
lack of knowledge about women's health among postsecondary
women. More women's health instruction programs are needed
in college and community settings across the country to
counter this lack of knowledge. Health education in
secondary schools are usually taught by physical education
instructors, who are not properly trained or certified as
health education specialists. Because of this phenomenon,
the amount of women's health taught in high schools is
close to zero. I have witnessed very limited health
education being taught in high school health and physical
education classes. With more and more young people going
to college, women's health should be introduced at the
freshman level in more colleges.
Another strength of the study included an awareness of
a lack of women's health classes in health education
departments on college campuses across the country. The
researcher found many of the classes on college campuses in
either nursing or women's studies departments. This
108
researcher believes that a women's health instruction
program on college campuses should be mainstreamed into the
health education curriculum and also offered in the
community in a comprehensive manner. After presenting
information on the study at the 1992 Southern District,
American Association of Health, Physical Education,
Recreation, & Dance Convention in Atlanta, Georgia, several
professors spoke to the investigator and inquired about the
information presented so that they could implement a
women's health class in their college health and physical
education departments. An updated women's health textbook
for college classes also needs to be written. The table of
specifications developed for this study could be used for
the basis of the text.
More men should be exposed to information about
women's health and college classes should be receptive to
male students. With crucial women's health information,
husbands, male friends and relatives, and other significant
males could more effectively care for female loved ones in
time of need or emergency, such as childbirth. As men
increase their knowledge about women's health, they will be
better equipped to handle and understand certain situations
concerning women's health. They may also better understand
themselves.
The study also produced conceptual areas to be covered
in a women's health instruction program. By following the
109
table of specifications developed, the contents of women's
health instruction programs across the country may be more
consistent and uniform to ensure coverage of all the
aspects of women's health.
One last strength of the study included identification
of resources in women's health. The collection includes
newsletters, books, articles, advocacy and research groups,
women's health organizations, and educational pamphlets and
brochures produced by nonprofit agencies. The list
produced does not claim to be inclusive of all possible
resources, but is an attempt to assist instructors of
women's health to identify and locate written material and
research and advocacy groups related to women's health.
Such resources may be helpful for instructors who are
planning a women's health instruction program in their
organization or at their college or university.
A weakness of the study was the difficulty in writing
questions that pertained to sensitive and controversial
topics in women's health, such as abortion, sexuality, and
the Equal Rights Amendment. To develop questions that
cover all aspects from the table of specifications for a
women's health instruction program, that can be completed
in about forty minutes, was also difficult.
An evaluation of women's health knowledge facilitates
needs assessment pertaining to women's health. Before any
health instruction program can be conducted with any group,
110
a health educator usually develops and Implements a needs
assessment tool, which dictates what conceptual areas will
be included for that specific group.
When a needs assessment is conducted on a large group
from across the country, a health instruction program can
then be standardized to insure uniformity and consistency
in terms of instruction. Conversely, the education needs
in one area of the country may differ from another area.
The women's health knowledge test was written to
provide a learning opportunity for women. The test items
were written in such a manner that they provided helpful
and practical information about women's health. This type
of test facilitated an increased knowledge level and
awareness about w o m e n s health issues. An increase in
knowledge level and awareness provides the following
benefits for women:
1. Becoming more knowledgeable about one's own
health and how to take care of it. Life-saving and
preventive measures such as practicing breast self-
examination, having at least an annual Pap smear, consuming
adequate amounts of calcium, and getting adequate exercise
are important to women's health. There are test items on
the women's health knowledge test that address these areas.
2. Taking control of one's health and accepting more
responsibility for it. As knowledge about women's health
is increased, women can learn to take control over measures
111
that pertain to health, such as care for less serious
health problems. For example, instead of visiting a
physician for painful menstrual periods, some women may be
able to control the problem themselves by adhering to an
exercise program on a regular basis, or by making dietary
changes such as reducing salt and sugar consumption during
menstruation. Also, when a woman knows she has a vaginal
yeast infection, she can buy an over-the-counter product
that was once only available through a prescription.
3. Knowing when to seek professional help. Women
taking control of personal health includes knowing at what
point professional help is necessary, such as a medical
doctor or a mental health professional. The medical
profession plays a very important part in women's health,
not only for preventive measures such as annual exams, but
also for necessary treatment and therapy. For example,
early diagnosis of cervical dysplasia can be successfully
treated. Also, correct diagnosis of a sexually transmitted
disease is crucial to the appropriate and successful
treatment.
4. Becoming an assertive and knowledgeable consumer
of health care. Being knowledgeable about their own body,
as well as women's health, assists physicians in making a
diagnosis of any illness or disease. As a patient, being
able to communicate the type of pain that may be present
and the location or organ that is affected, and being able
112
to specifically explain the problem is crucial to finding
the cause of the problem.
It is advantageous for patients to do research
concerning their illness or disease. They can then make a
more intelligent decision as to the best treatment for
their specific medical history and lifestyle. They can
also more intelligently ask and answer questions in
conference with physicians.
Patients usually have many questions when they are
told they have a certain illness or disease. It is
advantageous for patients to be assertive and persistent to
get all their questions answered that will help eliminate
fears, concerns/ and indecisions pertaining to treatment.
Patients should always feel free to ask questions about any
recommended treatment by their physicians. As an
intelligent health care consumer/ it is imperative to have
a physician who will listen and answer all questions and
concerns/ and who will give patients information regarding
all possible medical alternatives to any condition or
illness.
Intelligent health care consumers also seek a second
opinion before making decisions about illness and disease
treatment. To avoid unnecessary surgery, they will always
investigate the safety and necessity of any recommended
treatment before agreeing to it. Intelligent health care
consumers will investigate the safety and necessity of any
113
prescription and over-the-counter product before using it
and will not succumb their bodies to the latest perfect
female image dictated by the media.
The benefits of having an increased knowledge level
about women's health are the same as having a high level of
wellness: accepting responsibility for one's own health,
learning to practice disease prevention, taking control of
health problems, knowing when to seek professional help,
and being an intelligent health care consumer.
The need for a national health care system, which
provides health care for all Americans, is finally being
discussed by politicians, physicians, nurses, special
interest groups, the media, and the general public.
Slowly, protective and preventive health measures are
becoming more available to everyone. For example, the 1992
Georgia legislature passed a bill to require insurance
coverage for mammograms. With rising insurance and health
care costs, and no national health care program, it is
imperative that women gain more knowledge about women's
health, so that they can make responsible decisions for
their health and maintain a maximum level of health and
wellness.
114
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R ep ro d u ced with p erm ission of th e copyright ow ner. Further reproduction prohibited w ithout perm ission.
Trotta, P. (1980). Breast self-examination: Factors
influencing compliance. Oncology Nursing Forum, .7(3)/
13-17.
U.S. Department of Health and Human Services, Public Health

Service. (1989). Health United States 1988.
Washington, D . C . : author.
U.S. Department of Health and Human Services; U.S.

Department of Agriculture. (September 1989)).
Nutrition Monitoring in the United States. Washington,
D.C.: author.
U.S. Department of Health and Human Services, National

Center for Health Statistics. (1990). Contraceptive
use in the United States, 1973-88. Advance D a t a ,
March 20, number 182.
U.S. Department of Health and Human Services, National

Center for Health Statistics. (1990). Use of family
planning services in the United States, 1982 and 1988.
Advance Data, April 11, Number 184.
U.S. Department of Health and Human Services, Public Health

Service. (1990). Healthy People 2 0 0 0 . Washington,
D.C.: author.
Wesley, E. & Wronski, S. (1973). Teaching Secondary

Social Studies in a World Society. Lexington,
Massachusetts: D.C. Heath and Company.
Wilson, P.; Garrison, R. & Castelli, W. (1985).

Postmenopausal estrogen use, cigarette smoking, and
cardiovascular morbidity in women over 50: The
Framingham Study. New England Journal of Medicine,
3 1 3 , 1038-1043.
Wolfe, S. (1991). Women's Health A l e r t . Reading,

Massachusetts: Addison-Wesley Publishing Company,
Inc.
121
I
APPENDIXES
APPENDIX A
STUDY POPULATION FOR FINAL TEST
"Study Population
L ocation N um ber o f P articip an ts
LWV, Little Rock, Arkansas 5
LWV, Denver, Colorado 11

LWV, Hamden, Connecticut 20
LWV, Washington, D.C. 4
LWV, Tallahassee, Florida 5
AAUW, Atlanta, Georgia 15

LWV, Atlanta, Georgia 39
LWV, Chicago, Illinois 4

LWV, Des Moines, Iowa 13
LWV, Cape Elizabeth, Maine 2

LWV, York, Maine 13
LWV, St. Louis, Missouri 9
WHC, University o f Minnesota 36
LWV, Omaha, Nebraska 8

WHC, University o f Nebraska 2
AAUW, Corrales, New Mexico 10
LWV, Socorro, New M exico 12
LWV, Albany, New York 10
AAUW, Dickinson, North Dakota 10
AAUW, Altus, Oklahoma 20

AAUW, Duncan, Oklahoma 21
AAUW, Durant, Oklahoma 13
AAUW, Edmond, Oklahoma 20
AAUW, El Reno, Oklahoma 8
AAUW, Wewoka, Oklahoma 7
LWV, Salem, Oregon 14
LWV, Clemson, South Carolina 19

LWV, Sioux Falls, South Dakota 6
124
WHC, University o f Tennessee, Chattanooga 7
LWV, Austin, Texas 7
LWV, Dallas, Texas 9
AAUW , Alexandria, Virginia 16

AAUW , Arlington, Virginia 12
AAUW , Bedford, Virginia 5
AAUW , Burke, Virginia 6
AAUW, Chesapeake, Virginia 11
AAUW , Falls Church, Virginia 10
AAUW , Fairfax, Virginia 14
AAUW, Great Falls, Virginia 18
AAUW , Hampton, Virginia 9
AAUW , Marion, Virginia 12
AAUW, McGaheysville, Virginia 11
AAUW , Norfolk, Virginia 19
AAUW , Waynesboro, Virginia 9
AAUW , Winchester, Virginia 8
AAUW , Woodridge, Virginia 6
AAUW , Yorktown, Virginia 16
LWV, South Charleston, West Virginia 8

AAUW , Casper, Wyoming 8
AAUW, Cody, Wyoming 19
AAUW , Laramie, Wyoming 9
AAUW , Powell, Wyoming 12
T o ta l 617
* AAUW = American Association o f University Women

LWV = League of Women Voters
WHC = Womens Health Class
125
APPENDIX B
FINAL TEST FOR STUDY
SUSAN O. BUTLER
3400 CHASTAIN CROSSING
MARIETTA.GEORGIA 30066
(4041427-5528
D ecem ber 15, 1991
Ms. Linda Polk, President

LWV o f Arkansas
2020 W. Third Street
Room 501
Little Rock, AR 72205-4466
Dear Linda:
Thank you again for agreeing to distribute my Womens Health

Knowledge Test to your organization. I have sent you the
following:
1. 100 WHKT test booklets

2. 100 scan-tron answer sheets
3. stamped, self-addressed envelope
As a reminder, the Women's Health Knowledge Test I have

developed is for my work toward a doctorate degree in health
education from the University o f Tennessee, Knoxville.
The participant letter attached to each test booklet will give you
test directions and background information about the test.
Please return all test booklets and scan-tron answer sheets to me

in the enclosed stamped, self-addressed envelope by .
After I score the tests, I w ill send you a list o f test scores for
your organization that w ill be identifiable only by the
participant number found on each scan-tron answer sheet.
If you have any questions or need clarification on anything,

please call me. Thanks again!
Susan Butler
127
SUSAN O. BUTLER
(404)427-5528
Jan u ary 15, 1991
Janet Alexander
Associate Professor
SUNY
Department o f Nursing
P.O. Box 141
Peru, N ew York 12901
Dear Janet:
Thank you again for agreeing to distribute my Women's Health

Knowledge Test to your class. I have sent you the following:
1. 40 WHKT test booklets

2. 40 scan-tron answer sheets
3. stamped, self-addressed envelope
As a reminder, the Women's Health Knowledge Test I have

developed is for my work toward a doctorate degree in health
education from the University o f Tennessee, Knoxville.
The participant letter attached to each test booklet will give you
test directions and background information about the test.
Please return all test booklets and scan-tron answer sheets to me

in the enclosed stamped, self-addressed envelope by
February 28.
After I score the tests, I will send you a list o f test scores for
your class that w ill be identifiable only by the participant
number found on each scan-tron answer sheet.
If you have any questions or need clarification on anything,

please call me. Thanks again!
Susan Butler
128
Susan O. Butler
3400 Chastain Crossing
Marietta, Georgia 30066
(404) 427-5528
Women's Health Knowledge Test
C o p y r i g h t , 1992
Dear Participant:
For my doctoral dissertation in health education, I am developing a women's

health knowledge test. The test is being administered to students in women's
health classes and to members o f women's organizations across the country.
The test contains knowledge questions about anatomy, physical problems and
diseases, emotional health, and societal health issues concerning women. There
are no questions about your personal attitudes, beliefs, or behaviors.
It w ill require about thirty to forty-five minutes for you to complete the
Women's Health Knowledge Test. Please take a few moments to also complete
the demographic survey form found on the last page. Y o u r p a r tic ip a tio n in
th is stu d y is c o m p le te ly v o lu n ta r y and a n o n y m o u s.
Please do not pu t your name on the answer sheet and do not w rite on the test.
Use a pencil to mark your responses on the answer sheet that is provided. There
is only one answer per question. Select the answer you think is best. If you want
to learn your score on the test, make note o f your participant number that
appears on the answer sheet, and your score can later be retrieved.
In the field o f health education, a valid and reliable women's health knowledge
test is greatly needed. Validity o f this test has been established by an expert panel
o f jurors who work in the area o f w om ens health. The topics covered in the test
were also determined by these jurors. Your participation in this study w ill assist
in establishing reliability o f this test. Thank you for contributing time to my
dissertation and to women's health.
Sincerely,
Susan Butler
doctoral candidate, health education
University o f Tennessee, Knoxville
Research at the University o f Tennessee, Knoxville which involves human participants is conducted under the supervision
o f the Institutional Review Board. Questions regarding this research should be addressed to: Dr. Robert 11. Pursley,
Coordinator; Human Subjects Research; Department o f H ealth, Leisure, & Safety; 1914 Andy Holt Avenue; Knoxville, Tn.
. 37996-2700; (615) 974-5041 or Edith M. Szathm ary, C oordintor o f Com pliances; R esearch A dm inistration; 404 Andy
H olt T ow er; K noxville, Tn. 37996-0140 (615) 974-3466.
129
copyright, 1992 by Susan Butler
Please select the best choice for each item and mark the
appropriate item number on the answer sheet.
DO NOT WRITE ON THE TEST.
Objective fl - Health status of women:
1. The incidence of diabetes is more prevalent among women who:

a. are hypertensive
b. are obese and sedentary
c. exercise regularly
d. take oral contraceptives
2. Regular moderate exercise three or four times a week, not to
fatigue, is beneficial to a pregnant woman. When should such
exercise be sharply reduced?
a. four weeks prior to delivery
b. two months prior to delivery
c. three months prior to delivery
d. after the first trimester
3. Which of the following is responsible for contraceptive failure
among American women?
a. user error by either partner
b. faulty devices
c. lack of directions
d. poor selection of method
4. Which of the following is the leading cause of death for all
women, ages 18 to 24?
a. automobile accidents
b. breast cancer
c. leukemia
d. suicide
5. When in a woman's life is the incidence of heart disease most
prevalent?
a. before age fifty
b. between 50-55 years of age
c. between 40-45 years of age
d. after menopause
6. Black women have higher incidence rates than white women in all
of the following areas EXCEPT:
a. AIDS
b. maternal mortality
c. breast cancer
d. high blood pressure
7. Which of the following is the best source of calcium?
a. salmon
b. tomato
c. wheat bread
d. orange juice
130
8. For a healthy baby, how many pounds should a woman gain during
pregnancy?
a. 10 to 15 pounds
b. 20 to 25 pounds
c. 22 to 32 pounds
d. 32 to 42 pounds
9. Most lumps found in or around the breast are usually diagnosed
as which of the following?
a. caffeine-induced
b. fibrocystic disease
c. non-cancerous
d. cancerous
10. It is especially important for both women without children and
lesbian women to include in their annual gynecological exam a
screening for which of the following health problems?
a. dysmenorrhea
b. endometriosis
c. osteoporosis
d. cervical cancer
11. According to the National Health Interview Survey, which of the
following age groups of women is at greatest risk of cervical
cancer mortality and is the least likely to have been screened?
a. older
b. adolescent
c. young adult
d. adult
12. Thegeneral health status of Americans has improved in the last
century, due to which of the following?
a. betterhealth care
b. public health measures such as immunizations
c. more physicians
d. new technology
13. Which of the following is one of the three leading causes of
death for women, ages 20 to 35?
a. diabetes
b. leukemia
c. suicide
d. motor vehicle accidents
14. Which of the following is the best source of iron?
a. spinach
b. raisins
c. soybeans
d. milk
Objective #2 - Patient/physician relationship;
15. To insure that a physician is aware of all questions a woman may

have, it is beBt that she do which of the following?
a. call the physician after the office visit
b. write a list of questions to bring to the officevisit
c. bring a friend along to the office visit
d. stay at the physician's office until all questions have
been answered
131
16. To receive the best medical treatment and advice from a
physician, it is important for a woman to do which of the
following?
a. offer information that relates to her medical history
b. offer information that relates only to the reason for her
office visit
c. withhold information that she may think will be judged
d. keep quietly at the exam and allow the physician to make a
diagnosis and ask the questions
17. Which of the following is the physician's main responsibility to
a patient?
a. provide health education for patients during office visits
b. monitor health status of patients between physicals
c. notify patients of latest medical research
d. diagnose and treat disease that is causing symptoms in
patients
18. What is the definition of "advocacy" in relation to health care
for women?
a. joining a self-help group
b. having a friend or family member along during a visit to a
physician
c. informing patients of their alternatives for medical
treatment
d. locating a physician through a physician referral service
19. A potential patient should ask all of the following questions
when rating potential physicians EXCEPT:
a. Is the physician willing to consult with you on the
telephone?
b. With the receptionist, are you provided privacy in
responding to personal questions?
c. Does the physician have a degree from a prestigious
medical school?
d. Does the physician explain why a particular drug is
prescribed?
20. What is the main principle of medical quackery?
a. quick therapy and cure
b. therapy based on scientifically unproven remedies
c. therapy based on scientifically proven remedies
d. therapy based on herbal and natural remedies
Objective #3 - Normal female physiology;
21. The ovaries are the female reproductive organs that produce
which of the following?
a. germ cells (eggs)
b. menstrual flow
c. amniotic fluid
d. follicle-stimulating hormone
22. Which of the following is the best method of cleansing for the
vagina:
a. douching
b. vaginal deodorants
c. normal vaginal secretions
d. deodorant soap
132
23. What is a normal reaction of the breasts three to four days
prior to the onset of the menstrual period?
a. little or no reaction
b. swelling and tenderness
c. firmer due to change in hormone levels
d. loss of elasticity
24. The entire female reproductive cycle is regulated by which of
the following?
a. menstrual cycle
b. female hormones
c. ovulation
d. endometrial lining
25. At what point in the monthly reproductive cycle can a woman most
likely become pregnant?
a. just after menstrual phase
b. just before menstrual phase
c. within one day of ovulation
d. four days after ovulation
26. Which of the following is known as Mittelschmerz, a common
occurence in women during ovulation each month?
a. headache
b. sharp pain in the abdomen
c. water retention throughout the body
d. lethargy or a great lack of energy
27. When does the menstrual phase of the female monthly reproductive
cycle occur?
a. the first day of the cycle
b. around the sixth day of the cycle
c. immediately after ovulation
d. immediately before ovulation
28. Which of the following is the least percent body fat a woman
should have to be considered a healthy amount?
a. 5 percent
b. 13 percent
c. 18 percent
d. 20 percent
29. Which of the following best explains why menopause occurs?
a. estrogen production ceases
b. fallopian tubes can no longer sustain mature ovum
c. degeneration of the aging ovaries
d. degeneration of the aging uterus
Objective #4 - Cauaation and prevention of disease and illnesB;
30. Unusual pain in the lower abdomen that increases prior to or

during menstruation is the major symptom of which of the
following conditions?
a. cystitis
b. vaginitis
c. endometriosis
d. Premenstrual Syndrome (PMS)
133
31. A common side effect of using an IUD is the increase in risk of
a. cystitis
b. pelvic infection
c. cervical cancer
d. endometrosis
32. Until menopause, the best time to do breast-self examination
(BSE) is:
a. during your period
b. after each period
c. every day
d. every month
33. Which of the following risk factors have been linked with an
increase in breast cancer?
a. low-fat diet
b. high-fat diet
c. high-protein diet
d. high intake of caffeine
34. Drinking at least two quarts of fluid each day, using unscented
toilet paper, and urinating at least every three hours can help
prevent which of the following conditions?
a. cystitis
b. vaginitis
c. gonnorhea
d. syphilis
35. Which of the following is one of the most common and serious
problem found in infants with Fetal Alcohol Syndrome (FAS)?
a. mental retardation
b. cardiac defects
c. delayed maturation
d. hyperactivity
36. All of the following are benefits of exercise such as cycling
and swimming EXCEPT:
a. lowers risk of developingheart disease
b. helps maintain weight
c. assists treatment of osteo andrheumatoid arthritis
d. assists treatment of osteoporosis
37. Uterine bleeding is a major symptom for which of the following
types of cancer?
a. cervical
b. endometrial
c. bladder
d. ovarian
38. All of the following may contribute to loss in bone density in
women EXCEPT:
a. excessive exercise
b. high protein diet
c. weight bearing exercise
d. frequent dieting
134
Objective #5 - Emotional and mental health:
39. Which of the following is symptomatic of a woman suffering from

manic-depression?
a. extreme depression, thensuicidal
b. excessive well-being, then depression
c. extreme irritability
d. continuous depression
40. A woman who has anorexia nervosa is at great risk for which of
the following?
a. hypertension
b. overeating
c. cardiac arreBt
d. diabetes
41. All of the following are common symptoms of anxiety EXCEPT:
a. reclusion
b. mental tension
c. high blood pressure
d. inability to concentrate
42. Advice from health experts for sleeping problems usually include
all of the following EXCEPT:
a. taking sleeping pills
b. retiring for bed later
c. avoiding caffeine before bedtime
d. implementing a nighttime routine
43. Which of the following is the best and healthiest way to relieve
a mild case of depression?
a. calcium
b. exercise
c. sunshine
d. vitamin B
44. Which characteristic below relates to the woman who is at
greatest risk for commiting suicide?
a. living in the inner city
b. being married
c. being over forty years of age
d. being between twenty and thirty-five years of age
45. Which of the following coping strategies for stress is the most
healthful?
a. exercise
b. avoidance of stressor
c. sleeping aid
d. discussion
46. All of the following are common symptoms of anorexia nervosa
EXCEPT:
a. resistance to eating
b. eating binges
c. amenorrhea
d. hyperactivity
135
47. Which of the following occupations has the highest level of
job-related stress?
a. retail clerk
b. cashier
c. public school teacher
d. secretary
Objective #6 - Safety and Security;
48. All of the following are true statements about rape EXCEPT:
a. usually occurs between acquaintances
b. rape is usually a planned act
c. appearance of rapist is non-distinguishable
d. rapists only choose strangers as their victims
49. According to crisis treatment experts, the safest course of
action for a woman who is a continual victim of domestic
violence is to:
a. call a close friend
b. call the police
c. go to a women1s shelter
d. confront the abuser
50. All of the following are examples of sexual harassment EXCEPT:
a. telling sexual jokes
b. displaying sexually suggestive visuals
c. blocking a person's walking path
d. continually smiling atsomeone
51. All of the following problem areas usually precipitate domestic
violence toward a woman EXCEPT:
a. economic stress
b. woman's jealousy
c. man's jealousy
d. man's alcohol or drug problem
52. A common personality trait of a date rapist primarily includes:
a. a quiet personality
b. being in total control of date plans
c. showing off muscular strength
d. immature personality
Objective #7 - Gynecological procedures and female surgeries;
53. Certification of mammography facilities by the American College

of Radiology is for quality standards in all of the following
areas EXCEPT:
a. dose
b. image quality
c. equipment
d. proximity to hospital
54. The PAP smear is a procedure done by a gynecologist for the
diagnosis of:
a. cystitis
b. ovarian cancer
c. cervical cancer
d. endometriosis
136
55. A hysterectomy is a surgical procedure which removes the:
a. ovaries
b. fallopian tubes
c. cervix
d. uterus
56. Among women's health experts, a major concern about women talcing
any type of estrogen replacement therapy (ERT) includes the
increased risk of which of the following:
a. osteoporosis
b. endometrial cancer
c. obesity
d. heart disease
57. What is the safest and easiest way for a woman to deliver a
child?
a. lying down on back
b. lying down on side
c. squatting
d. standing
58. Which of the following is a common, surgical procedure for
invasive cervical cancer?
a. oophorectomy
b. hysterectomy
c. cryosurgery
d. conization
59. Conization is a gynecological procedure that is useful for the
removal of:
a. a breast lump
b. abnormal cervical cells
c. endometrial scar tissue
d. genital warts
60. Dilation and Curettage (D&C) is a gynecological procedure that
is useful for all of the following purposes EXCEPT:
a. uterine malignancy
b. evaluation of infertility r
c. destruction of cancer cells
d. removal of polyps
61. The breast cancer screening procedure that can determine whether
a lump is a benign cyst or a malignant tumor is called:
a. ultrasound
b. mammography
c. chest X-ray
d. breaBt self-examination
Objective #8 - Health services for women & factors affecting women's

health:
62. A major focus of a birthing unit in a hospital is on which of

the following?
a. reduce the cost of pregnancy, labor, and delivery
b. replace the traditional obstetrician
c. provide a more homelike environment
d. provide services for low income pregnant women
137
63. All of the following are techniques used in holistic medicine
EXCEPT:
a. diet improvement
b. exercise
c. drug therapy
d. positive mental imagery
64. The Equal Rights Amendment (ERA) would have guaranteed which of
the following:
a. equal pay for equal work
b. coed restrooms
c. loss of child custody
d. national health insurance for women
65. Women's health centers should approach women's health with which
of the following perspectives?
a. treatment
b. wellness
c. pharmacological
d. non-intervention
66. All of the following factors below contribute to an easier
degree of adjustment after divorce for women EXCEPT:
a. full-time job
b. higher educational level
c. availability of welfare
d. social support system
67. Compared to single or divorced women, out-of-pocket medical
expenses for married women are usually:
a. higher
b. lower
c. same
d. can not be compared
68. All of the following statements about abortion are true EXCEPT:
a. abortion is legal.
b. abortion was made legal by a constitutional amendment
c. abortion was made legal by the court case Roe v. Wade in
1973
d. the health risks from an abortion are lower than risks
from giving birth
69. The General Accounting Office found that women have been
purposely excluded from which of the following by the National
Institutes of Health?
a. employment
b. research
c. education
d. executive positions
70. All of the following statements about medical insurance coverage

is usually true EXCEPT:
a. companies assume the husband is a primary wage earner
b. companies gear around the notion that wife and children
are dependents
c. when a marriage ends through death or divorce, benefits do
not cease
d. companies may nbt cover preventive health services, such
as mammography
138
71. All of the following statements about poverty are true EXCEPT:
a. medical attention is usually delayed until a health
problem reaches emergency room status
b. poor people are often used in teaching hospitals as guinea
pigs for new treatments
c. poor people use free medical care often
d. the working poor usually do not have healthinsurance
72. Which of the following agegroups ofwomen usually has little or
no health insurance?
a. less than six years
b. 19 to 24 years
c. 25 to 54 years
d. 65 and over
73. Which occupation below is most likely ignored by group health
insurance coverage?
a. hotel maid
b. corporate secretary
c. dental assistant
d. supermarket cashier
74. A higher rate of poor health among uninsured women is related to
a. more health problems
b. lack of employment
c. lack of hospitals
d. lack of Medicaid coverage
75. Which situation below may automatically cause a woman to lose
health insurance coverage?
a. marriage
b. spousal death
c. major illness
d. spousal unemployment
Objective 9 - Contributions by women to medical and health care
field:
t
76. The caregiver of elderly parents is usually which of the
following?
a. daughter
b. son
c. nurse
d. close relative
77. All of the following are purposes of the American Nurses
Association EXCEPT:
a. monitor health care legislation
b. provide standards for nursing practices
c. provide a code of ethics
d. set wages for nurses
78. The proportion of women enrolled in medical schools since 1900
has:
a. decreased
b. increased substantially
c. increased slightly
d. stabilized
139
79. All of the following strategies by nurses can reduce nursing
sex-role stereotyping EXCEPT:
a. supporting nurse colleagues
b. collaborating with colleagues on projects
c. confronting colleagues who seek datesfrom male physicians
d. confronting colleagues who participate inthe
"doctor-nurse" game
Objective 110 - Assertiveness and self-expression among women;
80. Which of the following behaviorB is representative of

assertiveness while speaking?
a. direct eye contact
b. eyes looking down
c. twirling hair
d. shifting feet
81. Which of the following is the most common reason for a reduction
in intimacy between a husband and wife during middle adulthood,
ages 30 to 40?
a. sexual dysfunction
b. fear of pregnancy
c. lack of interest in sex
d. involvement in careers and family
82. Which of the following is the premise of assertiveness training?
a. being able to act aggressively
b. leaving any situation that is stressful
c. standing up for one's ownrights
d. believing in aggressiveness
83. Assertive sexuality involves all of the following behaviors
EXCEPT:
a. self-responsibility for protection against disease and/or
pregnancy
b. having the partner be responsible for protection against
disease and/or pregnancy
c. saying no to a partner when necessary
d. speaking with partner about sexuality
84. Assertiveness training teaches women to do all of the following
EXCEPT:
a. express their likes and dislikes
b. say no without feeling guilty
c. accept compliments comfortably
d. deter compliments by others
85. Which of the following is a major reason why women who enter
nontraditional occupations face physical job-related hazards?
a. they cannot cope with a male-dominated environment
b. they are not accepted in such an environment
c. they were not considered during design of the work
environment
d. they are not as strong or as task oriented as men
This concludes the testing portion of the test.
Please complete the demographic survey form
found on the bach of thiB page.

Copyright, 1992
All rights reserved and no part may be reproduced in any form
without prior authorization by the author.
140
Demographic Survey Form
Please answer the following questions and return this form along with your
answer sheet:
How long did it take you to take this test?____________
Organization/College:__________________ City & State:______________
Race:_____________ Birthdate:_______________
Last grade completed:__________
Have you ever taken a college-level women's health course? Yes No _
Do you have a bachelor's degree from an accredited college? Y es No
If yes, degree and major:_____________________________
Do you have a degree from a vocational/technical college? Y es No _
If yes, degree and major:______________________________
Occupation:____________________
If retired, what was your occupation before retirement?_______________
Religious affiliation:__________________
Marital status:_______________________
Do you have children? Y es N o____
If yes, how many children do you have?______
What is your state of health? Excellent Average Poor____
Thank you again for your cooperation. -Susan Butler

Copyright, 1992
without prior written authorization by the author.
141
Final Test Key
1. b 21. a 41. a 61. a 81. d
2. a 22. c 42. a 62. c 82. c
3. a 23. b 43. b 63. c 83. b
4. a 24. b 44. d 64. a 84. d
5. d 25. c 45. a 65. b 85. c
6. c 26. b 46. b 66. c
7. a 27. a 41. d 67. b
8. c 28. b 48. d 68. b
9. c 29. c 49. c 69. b
10. b 30. c 50. d 70. c
11. a 31. b 51. b 71. c
12. b 32. b 52. b 72. b
13. c 33. b 53. d 73. a

f
14. c 34. a 54. c 74. b
15. b 35. a 55. d 75. b
16. a 36. d 56. b 76. a
17. d 37. b 57. c 77. d
18. c 38. c 58. b 78. b
19. c 39. b 59. b 79. c
20. a 40. c 60. c 80. a
142
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout p erm ission
APPENDIX C
FREQUENCY DISTRIBUTIONS AND ACCOMPANYING BAR GRAPHS
FOR WOMEN'S HEALTH COURSE TOPICS
LIFE ST AG E S
N 1 5 .0
u
m 13.5_
b
1 2 .0_
e
r 10.S_ l.'.'.V .'i.'.'j
0 9 .0 * .*.
f XXX- .*:
7 -5. XXX. y
.-XX.
XXX *
S 6 .0_
XXX XXX m
y 4.5_ MX
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a XXX
b
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0.0
MX-
i '*.**.
Sk
preg/care m e n /c y c le aging/meno child altarn m o th e r/p o s t hist, persp.
Topics ..
Bar graph of frequency distribution of womens health topics found

in fifteen women's health course syllabi.
144
PH YSI CA L C O N C E R N S O F WOMEN
15.0,
13.5_
1 2 . 0.
10.5,
9 -.
7.5.
6 .0. m
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m.
4.5. >Vy;Vv
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1.5.
m W.
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anat/rapro r a p r o righ ts ostao/aging contra gy n prob
Top ics
PH YSI CA L C O N C E R N S O F WOMEN
15.0.
13.5.
1 2 .0.
10.5.
9.0.
7.5.
6 .0.
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0. 0
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'..ij*.1
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1
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P H Y S I C A L C O N C E R N S O F W OME N
15.0
13.5
12.0
10.5
9.0
7.5
6.0
4.6
3.0
pres drugs n u tr i ti o n hsartdis.

Topics
Bar ^raph of frequency distribution of women's health topics found

145
MENTAL & EMOTIONAL C O N C E R N S O F WOMEN
N 1 5 .0
u
m 1 3.5_
b
1 2 .0_
e
r 10.5_
o 9.0_
f 7.5_ ?77771
M f
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y
vvvvV.t 1
v.-v;*v,
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*.*..<
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-.vy.-.-v.
^V.W
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mental stress substance dbpression eat dis. sex ua lity

Topics
MENTAL & EMOTIONAL C O N C E R N S O F WOMEN

1 5 .0
1 3 .5
12. 0
1 0 .5
7 .5
6.0
3 .0
0.0
nerv s y s a s s e r t. appearance
Topics

in fifteen womens health course syllabi.
146
S O C IA L C O N C E R N S O F W O K E N
ts o
1) s
ti.o .
10.1
c lin ic *
T o p ic *
IS.O
4.1
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d o c col. w o m /m s d liin . ip p .
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c o n su m e!* d a t i n g , e tc .
T o p ic s

147
APPENDIX D
POSSIBLE CONCEPTUAL AREAS FOR WOMEN'S HEALTH
Possible conceptual areas for women's healih
found in women's health syllabi
ageism nutritional concerns

aging and menopause occupational health hazards
alternative health care osteoporosis and other aging problems
anatomy and reproductive cycle politics o f health services
assertiveness postpartum depression
cancers o f women pregnancy and prenatal care
childbirth alternatives prescription drugs
clinics & self-help groups rape and date rape
contraceptives reproductive rights
dating, cohabitation, marriage self-esteem
depression selfhood and politics o f appearance
disabled women issues sexuality
doctor/patient relationship STDs
and medical education stress and stress management
domestic violence substance and alcohol abuse
eating disorders the nervous system
feminist approach to women's theoretical perspectives on women's
health health care
feminization o f poverty violence against women
future o f health & medical care women and exercise/sports
gynecological surgeries women and legislation
gynecological problems & diseases women as consumers
health status o f women women and the health care system
heart disease and women woitien and career/employment
historical perpectives o f pregnancy women in medicine
and childbirth women's health movement
infertility
Lesbian lifestyle
lifestyle and wellness
menstruation & menstrual cycle
mental health issues
motherhood and parenting
149
APPENDIX E
EXPERT PANEL OF JURORS AND POSTCARD SAMPLES
List of jurors for knowledge test
1. Janet Alexander, R.N.

Associate Professor
SUNY
Dept, of Nursing
P.O. Box 141
Peru, New York 12901
2. Ruth Barnard, R.N.

Associate Professor
School of Nursing
University of Michigan
Ann Arbor, Michigan 48109
3. Linda Bernhard, R.N.

Assistant Professor
Ohio State University
Department of Nursing & Women's. Studies
1585 Neil Avenue
Columbus, Ohio 43210
4. Donna Breitenstein, Ph.D.

Coordinator of Health Education
Appalachian State University
Department of Health Education, P.E., & Leisure
Studies
Boone, North Carolina 28608
5. Cheryl Jennings-Sauer, M.A., R.D., L.D.

1509 Oxford
Austin, Texas 78704
6. Georgia Keeney, Ed.D.

Associate Professor
University of Minnesota
Department of Health, P.E., & Recreation
10 University Drive
110 Sports & Health Center
Duluth, Minnesota 55812-2495
7. Elissa Koff, Ph.D.

Associate Professor
Wellesley College
Department of Psychology
Wellesley, Massachusetts 02181-8201
8. Barbara Levy, M.D.

726 Broadway
Suite 305
Seattle, Washington 98122
151
9. Charlotte MacLeod, Ph.D.
Associate Professor
University of Minnesota
Duluth School of Medicine
610 N. 27th Avenue West
Duluth, Minnesota 55812
10. Leslie McBride, Ph.D., Chair

Portland State University
School of Health Studies
Portland, Oregon 97207
11. Judith McLaughlin, Ph.D.

Associate Professor
University of Georgia
Department of Health Promotion & Behavior
219 Stegman Hall
Athens, Georgia 30602
12. Velma Pressly, R.N., Ph.D.

Assistant Professor
University of Tennessee
Department of Health, Leisure, Safety
1914 Andy Holt Avenue
Knoxville, Tennessee 37996-2700
13. Sandra Quinn, Research Associate

Minority Health Research Lab
University of Maryland
Department of Health Education
1958 Dundee Road
College Park, Maryland 20742
t
14. Patty Reagan, Ph.D.
Associate Professor
University of Utah
Women's Studies Program
189 1st Avenue, #83
Salt Lake City, Utah 81403
15. Vanice Roberts, R.N., Ph.D.

Associate Professor
Kennesaw State College
Department of Nursing
P.O. Box 444
16. Sue Rosser, Ph.D., Director

University of South Carolina
Dept, of Family & Preventive Medicine
1710 College Street
Columbia, South Carolina 29208
152
17. Jodie Shield, R.D.
Senior Partner
J.M. & Associates
670 Shallow Cove
Lake Zurich, Illinois 60047
18. Becky Smith, Ph.D.,

Executive Director
Association for the Advancement of Health Education
1900 Association Drive
Reston, Virginia 22091
19. Elizabeth Street, M.D.

643 Campbell Hill Street N.W.
20. Patricia Wallin, R.D.

President, Tennessee Dietetic Association
6300 Baum Drive
Suite C
Knoxville, Tennessee 37919
21. Diane Weber

University of Massachusetts at Boston
Harbor Campus
Boston, Massachusetts 02125
22. Susan Woods, M.D.

Congressional Science Fellow
Congressional Caucus for Women's Issues
2471 Rayburn House Office Building
Washington, D.C. 20515
153
Name of.Juror: '(/ v\OSS*-(k
* ik&r'ltf
Please check the statement below that applies
to you and return postcard separately to:..me
by August 1. Thank you.
)> / I agree to serve as a juror for an

evaluation instrument being developed by
Susan Butler, for her dissertation in
health education from the University of
Tennessee-
I can not serve as a juror at this time.
Name of Juror:
Please check the statement below that applies

to you and return postcard separately to me
by August 1. Thank you. Susan Butler
I agree to serve as a member of a panel

of jurors for an evaluation instrument
being developed by Susan Butler, for her
dissertation in health education from
U.T., Knoxville.'
I am not able to serve as a member of a
panel of jurors for' Susan Butler at this
time.
Name of Juror: 3*.

Title: !><? &!&&&>-
Please check the statement below that applies to

you and return to r.ie by August 1. Thank you.
I agree to serve as a juror for an

evaluation instrument being developed by
Susan Butler, for her dissertation'in
'health education from U.T.
I can not serve as & juror at this time.

I/
154
APPENDIX F
COVER LETTER FOR JURORS, BACKGROUND INFORMATION SHEET,
AND JUROR RESPONSE FORM
SUSAN O. BUTLER
3400CHASTAINCROSSING
MARIETTA.GEORGIA30066
(404)427-5528
July 16,1991
Leslie McBride, Chair

School of Health Studies
Portland State University
Portland, Oregon 97207
Dear Leslie:
Thank you for agreeing to be on my panel o f jurors for the evaluation instrument
I am developing concerning womens health. Please complete and return the
enclosed postcard, which serves as written documentation that you have either
agreed or declined to serve as a juror. I have also enclosed a background
information sheet on my study.
Your participation is essential to the development o f an evaluation instrument.

As a member o f my panel, you have been asked to perform the following tasks:
1) complete a response form on test objectives that should be used for the
development o f test items.
2) validate and evaluate test items to be included on a women's health knowledge
test.
f
The response form is enclosed with directions. For your convenience, a stamped,
self-addressed envelope has been provided for you to return the form. Please
return by August 1.
I am very excited about your contribution to my study. Thank you for your
support and assistance.
Sincerely,
Susan Butler
Enclosures
156
Development o f a women's health knowledge test
Background Information
I am a doctoral candidate in health education at the University o f Tennessee,

Knoxville. My dissertation, "Development of a Women's Health Knowledge
Test," involves the process o f developing a comprehensive, valid, and reliable
women's health knowledge test for college-educated women. In the developing
stages, my 100-item multiple choice test must be validated by an expert panel o f
jurors and piloted on one group o f women. The expert panel o f jurors w ill
evaluate test objectives that should be the basis for test items and evaluate and
validate test items for the instrument.
The test w ill first be administered to a pilot group o f women. A complete test
analysis will be conducted on the pilot administration, including item difficulty,
item discriminiation, readability, and reliability. After the appropriate revisions
are made, the test w ill then be administered to the study population.
The study population consists o f college-educated women from a cross-section o f

the country, found in women's organizations and women's health college classes.
After the test is administered to the study participants, it w ill again be analyzed
and revised accordingly. The results o f the study w ill be used to determine if the
"Women's Health Knowledge Test" is a valid, reliable, and objective evaluation
instrument. If so, the study will also provide a standardized, valid and reliable
women's health knowledge instrument that can be administered to college-
educated women across the country, found in women's organizations, businesses,
companies, churches, hospitals, and so on, and in women's health college classes.
Susan Butler, University of Tennessee

Health Education dissertation project
(404) 423-6394 (W) 427-5528 (H)
157
Women's General Health Knowledge Test
Panel of Jurors Response Form
Name of Juror:________________________
Directions:
Below are test objectives, which represent ten conceptual areas for a women's general health
knowledge test. The objectives were determined by a frequency distribution of topics listed among
fifteen women's health course syllabi from colleges and universities across the country. Based on
your evaluation of the following objectives, I will be able to develop a table of specifications for
the construction o f test items.
Please evaluate the test objectives by doing the following:
1) Rate each objective using the numerical scale 1 - 3, based on the following
criteria:
1 - The objective is essential and should be included.
2 - The objective is acceptable and should be included.
3 - The objective is unacceptable should not be included.
For example, if you believe objective number one is essential to a women's health knowledge test,
place a "1" next to that objective on the appropriate line.
(see example)
2) W eight each objective by percentage. Weight is defined as how much emphasis would be
placed on a particular objective and consequently the number of test items that would be devoted to
it on a test. Decide how many test items you think should be devoted to each objective and convert
that number to a percentage, with all ten objectives totalling 100%. If you must add or delete
objectives, please incorporate your weightings into
the existing list.
For example, if you think 10 test items should be devoted to objective number one, place "10%"
next to that objective on the appropriate line.
(see example)
If you have any questions, please call me at either (404) 423-6394 or

(404) 427-5528. Return the response form in the enclosed stamped, self-addressed envelope
by August 1. Thank you for your time and assistance.
Example;.
Rale..l..-.3 Percent Weight
1 10% Identify the current health status and....
1 40% Identify normal female physiology and...
1 30% Describe skills for coping with emotional...
2 20% Identify historical and current perceptions...

Total 100%
158
Rating.
Rating Legend: 1-Essential 2-Acceptable 3-Unacceptable

Rate 1-3
Upon completion of women's health instruction, each participant will be able to:
Identify the current health status and health needs of women in the U .S., recognizing the
unique health care needs, biological, psychological, sociological, and cultural responses of
the female through the life cycle.
Comments:
Explain the historical perspective on the structural, ideological, and cultural factors that
shape the relationship between women and the health care system, and identify
interrelationship of past and current attitudes, values, and practices related to women's
health and health care.
Comments:
Identify normal female physiology and gynecological procedures, and explain disease and
illness causation and prevention pertaining to women.
Comments:
Describe skills for coping with emotional and mental health problems common among
women, and for self-expression and assertiveness.
Comments:
Identify historical and current perceptions by society of women in terms of politics of

appearance and ability, and how women were and are now treated and abused.
Comments:
Explain the nature of consequences of female surgeries, and the professionalization of

medicine, contraception, gynecology, obstetrics, and female surgery.
Comments:
List traditional and alternative forms of health services for women and controversial health
issues affecting women.
Comments:
Identify current and historical contributions of women to the art of healing and health care.
Comments:
Develop a rationale for making decisions about participation or non-participation in

motherhood, parenthood, employment, and career.
Comments:
Explain the effectiveness of strategies by feminists to change practices of overt and

covert discrimination in women's health, and examine how politics, poverty, race,
unemployment, and age critically affect the development of health care policies, as well as
the provision of health care services to women.
Comments:
159
Weighting
Please make sure that the weighting of the ten objectives total 100%.
Percent Weight
Upon completion of women's health instruction, each participate will be able to:
Identify the current health status and health needs of women in the U.S., recognizing the
unique health care needs, biological, psychological, sociological, and cultural responses of
the female through the life cycle.
Comments:
Explain the historical perspective on the structural, ideological, and cultural factors that
shape the relationship between women and the health care system, and identify
interrelationship of past and current attitudes, values, and practices related to women's
health and health care.
Comments:
Identify normal female physiology and gynecological procedures, and explain disease and
illness causation and prevention pertaining to women.
Comments:
Describe skills for coping with emotional and mental health problems common among
women, and for self-expression and assertiveness.
Comments:
Identify historical and current perceptions by society of women in terms of politics of

appearance and ability, and how women were and are now treated and abused.
Comments:
Explain the nature of consequences of female surgeries, and the professionalization of

medicine, contraception, gynecology, obstetrics, and female surgery.
Comments:
List traditional and alternative forms o f health services for women and controversial health
issues affecting women.
Comments:
Identify current and historical contributions of women to the art of healing and health care.
Comments:
Develop a rationale for making decisions about participation or non-participation in

motherhood, parenthood, employment, and career.
Comments:
Explain the effectiveness of strategies by feminists to change practices of overt and

covert discrimination in women's health, and examine how politics, poverty, race,
unemployment, and age critically affect the development of health care policies, as well as
the provision o f health care services to women.
100% Total Percent
Comments:
160
APPENDIX G
COVER LETTER TO JURORS, RESPONSE FORM RESULTS,
PRELIMINARY TABLE OF SPECIFICATIONS, AND
EVALUATION FORM FOR TEST ITEMS
Susan Rutter
S e p t e m b e r ? , 1991
Dr. Patty Reagan

Associate Professor
University o f Utah
189 1st. Avenue, #83
Salt Lake City, Utah 81403
Dear Patty:
Thank you for your evaluation and recommendations on the juror response form
1 sent you. I have enclosed the following:
1. Results o f the response form completed by the panel o f jurors.

2. Table o f Specifications based on a frequency distribution o f ratings and an
average o f the weightings by each juror for the ten test objectives written.
3. Directions for evaluating test items.
4. Test items.
The conceptual areas in the Table o f Specifications have also been revised, based
on recommendations by the panel. The revised test objectives still reflect ten
conceptual areas o f women's health instruction.
Your last responsibility as a juror is to evaluate the test items to be included on a

women's health knowledge test. For your convenience, a stamped self-addressed
envelope has be provided for you. Please return by Friday, October 11, 1991.
I appreciate you taking time out o f your busy schedule to help me with my
dissertation and to become involved in a worthy study that w ill lead to the
perpetuation o f women's health instruction programs across the country.
Sincerely,
162
R esp o n se Form R esu lts
R atin g W e ig h tin g A v e r a g e in P ercen t

i 2 3
1. 20 1 0 17
0jU* 12 8 0 7
3. 18 3 0 20
4. 13 8 0 10
5. 8 11 1 6
6. 13 5 1 11
7. 15 6 0 10
8. 6 12 0A* 5
9. 8 7 4 7
10. 12 5 2 7
Results:
All but one o f the objectives were believed to be essential. Objective number
eight was believed to be acceptable. The lowest weighting was given to the
objective number eight (5%). The highest weighting was give to number three
(20%). See Table o f Recommendations for recommended revisions.
163
ConceptHalArea Percentage
1 . I d e n tif y th e c u r r e n t h e a lth s ta tu s a n d h e a lth n e e d s o f 17 %

w o m e n i n t h e U .S ., r e c o g n i z i n g t h e u n i q u e h e a l t h c a r e n e e d s
o f w o m e n th r o u g h th e ir e n tir e life c y c le f r o m b ir th to o ld a g e ,
a n d r e c o g n iz in g th e d iffe re n c e s b e tw e e n w o m e n .
2 . E x p la in th e id e a l re la tio n s h ip b e tw e e n a w o m a n a n d h e r 7%
p h y s ic ia n , a n d fa c to rs to c o n s id e r w h e n s e le c tin g a p h y s ic ia n
f o r g e n e ra l a n d g y n e c o lo g ic a l c a re .
3. I d e n tif y n o rm a l fe m a le p h y s io lo g y . 10%
4 . E x p la in c a u s a tio n a n d p re v e n tio n o f d is e a s e a n d illn e s s , 10%

a n d h e a lth is s u e s p e rta in in g to w o m e n .
5 . D e m o n s tra te h e a lth y s k ills fo r c o p in g w ith d if f e r e n t e m o tio n a l 10%

a n d m e n ta l h e a lth p ro b le m s a m o n g w o m e n .
6 . E x p la in h o w v io le n c e a g a in s t w o m e n , d o m e s tic v io le n c e , 6%
d a t e r a p e , a n d s e x u a l h a r a s s m e n t a r e a l l h a r m f u l t o w o m e n 's h e a l t h .
7 . E x p la in g y n e c o lo g ic a l p ro c e d u re s im p le m e n te d d u r in g r e g u la r 11 %
e x a m s , fe m a le s u rg e rie s , a n d th e " m e d ic a liz a tio n " o f n a tu r a l
o c c u r r e n c e s i n w o m e n 's l i v e s .
8 . D e s c rib e tra d itio n a l a n d a lte rn a tiv e f o r m s o f h e a lth s e r v ic e s 17%

a v a i l a b l e t o w o m e n , a n d d e s c r i b e h o w w o m e n 's h e a l t h c a n b e
a f f e c te d b y p o v e r ty , a la c k o f h e a lth in s u ra n c e , a n d a la c k o f
r e s e a r c h i n w o m e n 's h e a l t h .
9 . Id e n tify c o n trib u tio n s b y w o m e n to th e m e d ic a l a n d h e a lth c a re 5%

f ie ld s , in c lu d in g p ro fe s s io n a l, n o n -tra d itio n a l, a n d
fa m ilia l c a re g iv in g c o n trib u tio n s .
1 0 . D e s c r ib e s k ills f o r w o m e n in a s s e rtiv e n e s s a n d s e lf - e x p re s s io n 7%
in a l l a r e a s o f l i f e o p e n to w o m e n , i n c l u d i n g e d u c a t i o n , c a r e e r ,
m o th e rh o o d , re la tio n s h ip s , frie n d s h ip s , a n d s e x u a lity .
R e c o m m e n d a tio n s b v th e p a n e l o f e x p e r ts :
A m a j o r i t y o f t h e p a n e l b e l i e v e d a l l c o n c e p t u a l a r e a s s h o u l d b e i n c l u d e d o n a W o m e n 's H e a l t h
K n o w le d g e T e s t, b u t s h o u ld b e c o n fin e d to h e a lth -re la te d a re a s . T h e o b je c tiv e s w e re a ls o w ritte n
m o re c le a r ly . O b je c tiv e 3 w a s d iv id e d in to tw o s e p a ra te o b je c tiv e s , 3 a n d 4 , w ith 1 0 % f o r e a c h
n e w o b je c tiv e . O b je c tiv e 1 0 w a s in c o r p o r a te d in to o b je c tiv e 7 , w ith a n e w p e rc e n ta g e o f 1 7 % .
O b je c tiv e s 8 a n d 9 b e c a m e o b je c tiv e s 9 a n d 1 0 re s p e c tiv e ly .
164
Juror Evaluation Form
Directions
Below arc 126 test items pertaining to general women's health. The items were developed in
response to your ratings and weightings o f test objectives representing ten conceptual areas. These
objectives were used for the table of specifications.
To assist you with the evaluation, a corresponding instruction program may contain any number of
contact hours of general womens health instruction, either in an undergraduate college setting or in
an organizational setting such as the American Association of University Women (AAUW) and the
League of Women Voters. For a college setting, the hours would be credited five quarter hours or
three semester hours. For the organizational settings, the hours may have to be modified to
accommodate the schedule of the organization.
Please evaluate the test items by doing the following:
Rate each item using the numerical scale 1 - 3, based on the following criteria:
1 The test item is essential as related to the objective and should be included
2 - The test item is acceptable and should be included, with the recommended change
3 - The test item is unacceptable and should not be included
For example, if you think a test item is essential, place a "1" next to that test item. If you think a
test item is acceptable with a recommended change, place a "2" next to that test item, and make a
recommendation in the space below the item, (see examples)
After you have completed your evaluation of the items presented to you, please advise me
concerning any gaps which appear anywhere in this preliminary document.
Examples:
Rate 1 - 3
1 The Recommended Dietary Allowance (RDA) for calcium in women, ages 19 to 24 ...
a. 800
b. 1000
c. 1200
d. 1400
Comments:
2 When selecting a physician, the most important criteria ...

a. medical board certified and post-graduate residency
b. non-judgemental
c. open with all medical information on any given subject
d. conveniently located
Comments: Change the word...
165
Name of Juror__________________
Rating
1-Fssential 2-AcceptabIe with Change 3-lJnacceptable
(Please notice the dates listed under most items.)
Objective#!:
The incidence of breast cancer among women in the U.S. is 1 in:

a. 9
b. 12
c. 15
d. 18
Source: Heallhv.Pe.ople 2000. Health Objectives for the Nation.
Comments:
The Recommended Dietary Allowance (RDA) for calcium in women, ages 19 to 24 is

milligrams.
a. 800
b. 1000
c. 1200
d. 1400
Source; Recommended Dietary Allowances. National Research Press, 1989.
Comments:
Of the following, which is the most common health problem among women, age 65 and
over:
a. high blood pressure
b. osteoporosis
c. Altzheimers Disease
d. arthritis
Source: Verbrugge, L.M. Growing Old in America. 1985.
Comments:
During pregnancy, a woman should gain pounds:

a. 10-15
b. 20-25
c. 30-35
d. 40-45
Source: Healthy People 2000
Comments:
166
The leading cause of death among women, age 35 to 50 is:
a. breast cancer
b. lung cancer
c. suicide
d. colon cancer
Source: Health Risk Appraisal, Carter Center o f Emory University
Comments:
Common societal stereotyping of menopausal women include being:

a. helpless and sick
b. unattractive to men
c. unproductive to society
d. all o f the above
Source: Payne, B. & Whittington, F. "Older Women: an examination of popular stereotypes and
research evidence," Social Problems. 23, 488-504, 1976.
Comments:
Prenatal care should begin:

a. before conception
b. beginning of first trimester
c. end of first trimester
d. fifth month
Source: Our Bodies. Ourselves. 1984
Comments:
Heart disease in women is more prevalent:

a. before age fifty
b. during pregnancy
c. after menopause
d. between 40-45 years of age
Source: Lemer, D.J. & Kannel, W.B. "Patterns o f coronary heart disease morbidity and mortality
in the sexes: a 26-year follow up of the Framingham population."
American Heart Journal. 111(2), 383-390, 1986.
Comments:
For a working pregnant woman who works 8 hours a day, which of the following has been
shown to be unsafe:
a. walking
b. reaching overhead for items
c. working with a video display terminal (VDT)
d. working outside
Source: Womens Health test, Dr. Velma Pressly, Univ. o f Tenn.
Comments:
167
Which of the following best describes menopause:
a. end of all menstmal periods
b. pause of menstrual period during pregnancy
c. disappearance o f hot flashes
d. end of each monthly period
Source: Koff, E.; Rierdan, J.& Stubbs, M. "Conceptions and misconceptions of the menstrual
cycle." Women and .Health., 16(3/4), 119-135,1990.
Comments:
Major improvements in the health status of Americans is due to improvements in:

a. better health care
c. more physicians
d. new technology
Source: Our Bodies. Ourselves. 1984.
Comments:
The largest increase in the number of AIDS cases in the last two years have been among:
a. homosexual men
b. bisexual men
c. heterosexual women
d. heterosexual men
Source: Health. United States. U.S. Dept, of Health & Human Services, 1988.
Comments:
The most preventable disease in the U.S. is:

a. lung cancer
b. heart disease
c. breast cancer
d. stroke
Source: ILSJSwgeon General's. Report, 1989.
Comments:
Because an estimated 84% of pregnancies among young people under age twenty were
unintended, teaching about___________has proven to have the greatest impact on lowering the
percentage.
a. responsible sex
b. contraceptives
c. biology
d. abstinence
Source: Health & Society class, U.T., 1990.
Comments:
168
The birth control pill should not be used by a woman who has a personal history of:
a. blood clots
b. high blood pressure
c. diabetes
d. both a and b
Source: Wolfe, S. Womens Health Alert. 1991.
Comments:
In 1988, American women reported that 56% of their pregnancies in the last five years had
been unintended, with contraceptive failure mainly due to:
a. user error
b. faulty devices
Source: Healthy People 2000. 1991.
Comments:
Which of the following is NOT a benefit of breastfeeding an infant:

a. human milk contains the ideal balance of nutrients, enzymes and immunity substances.
b. breastfeeding provides a time of intense maternal-infant interaction.
c. breastfeeding can still be done by mothers who used such drugs as cocaine or marijuana.
d. breastfeeding helps to facilitate the physical return for the mother to prepregnancy state.
Comments:
Which of the following is NOT a health status indicator that the Year 2000 Health
Objectives for the Nation has developed to assist communities in assessing their general health
status:
a. proportion of the population uninsured for medical care
b. proportion of women receiving a PAP smear '
c. proportion of the population without access to primary medical care
d. proportion of the population who have access to drinking water
Source: Morbidity & Mortality Weekly Report. Volume 40, #27,1991.
Comments:
Education efforts are greatly needed with__________ , since contraceptive failure rates are
highest among:
a. unmarried, nonwhite women
b. unmarried, white women
c. unmarried, white adolescents
d. married, nonwhite women
Source: Healthy People 2000. 1991
Comments:
169
Pregnant women with diabetes have:
a. increased pregnancy complications
b. babies with a threefold higher frequency of birth defects
c. no pregnancy risks
d. both a and b
Comments:
According to the National Health Interview Survey___________women are at greatest risk

of cervical cancer modality and are the least likely to have been screened.
a. older
b. adolescent
c. young adult
d. adult
Comments:
Objective #2:
When selecting a physician, the most important criteria is:

a. medical board certified
b. non-judgemental
c. convenient location
d. providing all available medical information
Source: Womens Health test, Dr. Velma Pressly, Univ. o f Tenn.
Comments:
In building a relationship with a physician, it is important to practice being:

a. assertive
b. inquisitive
c. aggressive
d. quiet
Comments:
The best way to locate a physician is through:

a. physician referral service
b. telephone book
c. word of mouth
d. medical society
Source: Women's Health class. University of Tennessee, 1990.
Comments:
170
It is best to see a physician who has:
a. many patients
b. few patients
c. many nurses
d. time to spend with each patient
Source: Women's Health class, University of Tennessee, 1990.
Comments:
To insure that a physician answers all questions a patient may have, it is best that he/she:
b. write a list of questions to bring to the office visit
d. stay at the physician's office until all questions have been answered
Source: Ardell, D. & Langdon, J. Wellness: The Body. Mind, and Spirit. 1989.
Comments:
To receive the best medical treatment and advice, it is important for a patient to:
a. give the physician a complete medical history
b. tell the physician everything that relates only an ailment
c. keep quiet and allow the physician determine the ailment
d. have the physician ask the questions
Comments:
A consumer should NOT avoid the physician who:

a. does not practice self-care
b. acts incompetent
c. works many, long hours
d. works with three other physicians
Comments:
When given a medical diagnosis of any type, it is always best to:

a. trust your physician
b. seek a second opinion
c. ask to be referred to another physician
d. try to diagnose the problem yourself
Comments:
To maximize the relationship between a physician and a patient, it is the patient's

responsiblity to:
a. keep appointments
b. take prescribed medication
c. report any problem or side-effect from medication
d. call for results of tests
Source: Women's Health Class, U.T., 1990.
Comments:
171
Objective #3:
The ovaries are the female reproductive organs that produce:

b. female sex hormones
c. menstrual flow
d. both a and b
Comments:
Which of the following is method of cleansing for the vagina:

a. douching
d. deodorant soap
Comments:
The uterus is the female reproductive organ that:

a. produces the germ cells (eggs)
b. nourishes the embryo and fetus during pregnancy
c. stores the germ cells (eggs)
d. produces female sex hormones
Source: Taber's Cyclopedic Medical Dictionary. 1989.
Comments:
Which of the following best describes menstruation:

a. passage of a mature egg through the fallopian tubes
b. discharge o f ovaries
c. elimination of reproductive wastes
d. elimination of the uteral lining built up to feed a fertilized egg
Source; Koff, E.; Rierdan, J. & Stubbs, M. "Conceptions and misconceptions of the menstrual
cycle". Women and Health. 16(3/4), 119-135, 1990.
Comments:
An ectopic pregnancy, which involves the egg developing outside the uterus, can be
deiected by:
a. amniocentesis
b. ultrasound
c. X-ray
d. pelvic exam
Comments:
172
It is important for a pregnant woman to eat nutritious food, since the___________is
responsible for supplying nourishment for the fetus before birth.
a. placenta
b. uterus
c. amniotic fluid
d. womb
Source: Taber's Cyclopedic Medical Dictionary. 1989.
Comments:
A woman must have at least percent body fat and weigh at least 105 pounds,
generally, to menstruate and be able to carry out other reproductive functions.
a. 5
b. 13
c. 20
d. 25
Source: Williams, M. Lifetime Fitness and Wellness: A Personal Choice. 1989.
Comments:
The entire reproductive cycle is regulated by:

a. menstrual cycle
b. hormones and chemical messengers
c. ovulation
Source: Our Bodies" Ourselves. 1984.
Comments:
Normally, menstruation and ovulation will continue until the age o f_____ , and only twenty
percent of women suffer any menopausal problems.
a. 40 or 41
b. 48 or 49
c. 55 or 56
d. 60 or 61
Comments:
A woman who decides not to have children will:

a. continue to menstruate
b. have earlier menopause
c. have less menstrual cramps
d. have worse menstrual cramps
Comments:
Day one of the menstrual cycle consists of:

a. ovulation
b. first day of menstrual period
c. end of menstrual period
d. development of a mature egg
Comments:
173
A woman is most likely to get pregnant:
a. just after menstrual period
b. just before menstrual period
Source: Our Bodies, Ourselves, 1984.
Comments:
Objective #4:
Which of the following statements about women and any type of cancer is TRUE:
a. It is best to wait until a cancer creates noticeable symptoms
b. Heredity is not a major risk factor
c. Heredity is a major risk
d. Not all women are susceptible to cancer o f the reproductive system
Source: American Cancer Society
Comments:
Which of the following can cigarette smoking by a pregnant woman possibly produce in an
infant:
a. low birth weight
b. stillborn
c. lower developmental rate
d. all of the above
Source: American Cancer Society
Comments:
If a woman takes birth control pills for protection against pregnancy, she is also protected
against:
a. AIDS
b. herpes
c. vaginitis
d. none of the above
Source: American Red Cross
Comments:
Amenorrhea is defined as:

a. painful menstruation
b. absence of menstruation
c. abnormally frequent menstruation
d. scanty menstrual flow
Source: Qur Bodies. Ourselves. 1984.
Comments:
174
The best time to do self-breast examination (BSE) is:
b. halfway between one period and the next
c. everyday
d. once a year
Source: Clark, M. "The health fair: An effective approach to health promotion?"
Public .HfcalthJfrirsing, 2(1), 33-42,1980.
Comments:
Out of the following, which is a cause of vaginitis:

a. stress
b. lowered resistance
c. antibiotics
d. all of the above
Source: Qur Bodies. Ourselves, 1984
Comments:
One of the most common and serious problems found in infants with Fetal Alcohol
Syndrome (FAS) is:
b. cardiac defects
d. hyperactivity
Source: Womens Health test, Dr. Velma Pressly, Univ. of Tenn.
Comments:
Anemia is usually due to:

a. not drinking enough milk
b. not eating enough iron-rich foods
c. exercising too much
d. not getting enough sleep
Source: Clark, M. "The health fair: An effective approach to health promotion?"
Public Health Nursing. 2(1), 33-42, 1980.
Comments:
The inability to concentrate, irritability, water retention, food cravings, and mood swings
are common symptoms of:
a. pregnancy
b. PMS
c. post partum depression
d. anxiety attack
Comments:
175
Babies bora to mothers who take crack-cocaine during pregnancy may:
a. suffer from a stroke
b. be severely brain damaged
c. have congenital heart disease
d. all of the above
Source: Metropolitan Atlanta Council on Alcohol and Drugs (MACAD)
Comments:
Loss o f bone density produces softening and fragility of bone tissue and deformity, and
increases the risks for fractures. This condition is known as:
a. osteomalacia
b. arthritis
c. osteoporosis
d. aging
Comments:
Which of the following risk factors have been linked with an increase in breast cancer:
a. low-fat diet
b. high-fat diet
c. cigarette smoking
d. intake of caffeine
Source: National Women's Health Network
Comments:
A mild case of cystitis may be successfiilly treated by all of the following EXCEPT:
a. drinking lots of fluids every day
b. avoiding caffeine products
c. eating sweet foods
d. drinking vitamin C sources
Comments:
Endometriosis may be indicated by which of the following symptoms:

a. no symptoms
b. pelvic pain around menstruation
c. excessive or irregular menstrual flow
d. all of the above
Source: Qur.fiQd.ie.$J3.ursplvgs, 1984.
C o m m e n ts :
176
QMtdhreJg;
Which of the following is a common stressor among women today in the U.S.:
a. anxiety in the workplace
b. trying to successfully achieve motherhood, career, home management, and wifery
c. lack of education
d. all of the above
Source: Our Bodes. Ourselves. 1984.
Comments:
Which of the following is a FALSE statement about post-partum depression:

a. symptoms are experienced by 50-70% of new mothers and the symptoms range from mild to
severe.
b. emotional, physical, and psychological demands of pregnancy and delivery are contributing
factors
c. since the symptoms are alike, women can be stereotyped
d. about 15% of women experiencing post-partum depression have long lasting symptoms of
depression
Source: Womens Health test, Dr. Velma Pressly, Univ. of Tenn.
Comments:
Characteristic of the anorexic woman include all of the following EXCEPT:

a. hatred toward food
b. distorted self-image
c. poor self-image
d. perfectionism
Comments:
A bulimic woman is at risk for which of the following?

a. personality changes
b. cardiac arrest
c. damage to throat tissue and teeth
d. all of the above
Comments:
A major cause of eating disorders include:

a. attempting to achieve appearance perpetuated by the media
b. emotional or psychological illness
c. feelings of low self-esteem
d. all of the above
Comments:
177
Even at recommended doses, tranquilizers such ass Valium, Xanax, and Prozac can cause:
a. no side effects
b. daytime sedation
c. memory loss
d. both b and c
Source: Wolfe, S. Women's Health Alert. 1991.
Comments:
Which of the following has been found to be a natural and healthy way to relieve a mild case
of depression:
a. calcium
b. exercise
c. sunshine
d. vitamin B
Comments: .
Which of the following are characteristics of depression:

a. negative feelings toward self
b. crying spells
c. indecisive
Source: Our Bodes. Ourselves. 1984
Comments:
Sleeping problems can best be treated by all of the following EXCEPT:

a. sleeping pills
b. going to bed later
c. avoiding caffeie before bedtime
Comments:
A person may be manic-depressive if he/she is experiencing:

a. panic attacks
b. a series of psychotic depression or excessive well-being
c. extreme depression
d. suicidal tendencies
C o m m e n ts :
178
Psychologists have use psychotherapy to treat different types o f mental diseases. This type
of therapy is a:
a. therapy for psychosis
b. treatment for mental diseases through prescribed drugs
c. method of treating nervous disorders by mental means rather than physical
d. drug that affects behavior
Source: TaberkCyctopedic MedicalPictionary, 1989.
Comments:
Objective #6:
Rape is an act of:

a. violence
b. sex
c. lust
d. hate
Comments:
Which of the following is an example o f domestic violence:

a. locking out a household member
b. refusing to help with a sick or injured household member
c. abandonment in a dangerous place
d. all of the above
Comments:
A common personality trait of a date rapist includes:

Source: Muehlenhard, C. & Linton, M. "Date rape and sexual aggression in dating situations:
Incidence and risk factors." Journal of Counseling Psychology. 34. 196-196, 1987.
Comments:
Which o f the following is a FALSE statement about rape:

a. rape is an act o f violence
c. rapists are non-distinguishable from non-rapists in terms of appearance
Comments:
179
Which of the following is an example of sexual harassment:
c. blocking a person's path
d. all of the above
Source: Georgia Board of Resents Employee Handbook, 1991.
Comments:
Which of the following is NOT an example of sexual harassment:

a. turning work or classroom discussion to sexual topics
b. standing close to a person
c. continually smiling at someone
d. making sexual comments about a person's clothing, anatomy, or looks
Source: Geargiia.Poard. of Regenis.EmplQyee Handbook, 1991.
Comments:
The best course of action for a woman who is a victim of domestic violence is to:
b. call the police
c. leave and go to a women's shelter
Comments:
Which o f the following is a FALSE statement about rape:

a. unmarried and low-income women are the most frequent victims of rape
b. women between 12 and 34 are particularly vulnerable
c. reported offenders are usually strangers
d. reported offenders are usually acquaintances
Comments:
Guilt, fear, shame, and anger are emotions felt by a victim of violence as part of:
a. blaming society
b. blaming the victim
c. blaming the attacker
d. threat of harassment
Comments:
The value o f a friend for a victim of rape is to:

a. be there for the victim
b. tell her what she should have done
c. report the crime
d. get details from the victim
Source: Santa Monica Rape Crisis Treatment Center video, ''Campus Rape."
Comments:
180
Objective #7:
A hysterectomy is a surgical procedure which removes:

a. uterus and ovaries
b. ovaries and fallopian tubes
c. fallopian tubes
d. uterus
Source: Our Bodies,.Ourselves, 1984.
Comments:
The PAP smear is a procedure done by a gynecologist for the diagnosis of:
a. cystitis
b. ovarian cancer
c. cervical cancer
d. endometriosis
Comments:
Which of the following has estrogen replacement therapy (ERTi been prescribed for:
a. menopause
b. hysterectomy
c. prevention of osteoporosis
d. all of the above
Comments:
For which of the following reasons is a hysterectomy necessary:

a. cancer
b. emergency such as trauma or hemorrhage
c. uterine prolapse
d. both b and c
Comments:
All of the following are included in the definition of "medicalization" EXCEPT:

a. providing needed medical treatment for a disease
b. making normal daily living processes and aging processes a disease state
c. creating a disease that is not there
d. lacking interest in medical research in needed areas of women's health
Comments:
181
Certification of mammography facilities have been instituted by the American College of
Radiology that requires the facility to meet quality standards in all of the following areas EXCEPT:
a. dose
b. image quality
c. equipment
Comments:
Laparoscopy is a gynecological procedure that involves the laparoscope, which is useful as

a
a. scraping device used while doing a PAP smear
b. lighted tubelike instrument to make a diagnosis
c. device for removing fibroids
d. microscope for detection of cancer cells
Comments:
Dilation and Curettage (D&C) is a gynecological procedure that is useful for:

a. scraping some of the uterine lining to make a diagnosis
b. enlarging the vagina for placement o f the speculum
c. removing a tissue sample from the opening of the cervix
d. destroying cancer cells of the cervix
Comments:
Conization is a procedure that is useful for the removal of:

a. a breast lump
c. endometrial scare tissue
d. genital warts
Comments:
An acceptable reading for hemoglobin, which is often used to determine iron deficiency, is
or greater for women, age 18 and over.
a. 6
b. 8
c. 10
d. 12
Source: Grant, A. & DeHoog, S. Nutritional Assessment and Support. 1985.
Comments:
182
This childbirth position is the safest way to deliver a child, which also decreases the need
for an episiotomy and the length of labor:
c. sitting or squatting
d. standing
Comments:
________________ is the most frequently performed and unnecessary obstetric operation in the
U.S., that enlarges the opening through which the baby will pass:
a. amniotomy
b. epidural
c. Cesarean section
d. episiotomy
Comments:
More so than twenty years ago, this obstetrical operation has become more commonly
performed, for liability reasons:
a. Cesarean dellivery
b. hysterectomy
c. episiotomy
d. epidural
Source: Qgr Bodies,, Ourselves, 1984.
Comments:
Qhiediyje-tffr
According to the National Womens Health Network, there is a lack o f __________research

today:
a. heart disease
b. lung cancer
c. breast cancer
d. STDs
Source: National Women's Health Network, Network News. March/April/May, 1991.
Comments:
Compared to other industrialized nations, the U.S. has a higher rate of:
a. measles
b. infant mortality
c. TB
d. pneumonia
Source: Healthy Peonle 2000. 1991.
Comments:
183
The Equal Rights Admendment (ERA) would guaranteed which of the following:
b. coed restrooms
Source: National Organization for Women
Comments:
With eighty percent of the poor people in the U.S. being women and children,
it is best that the federal government create:
a. more physicians
b. national health care
c. jobs for these people
d. mandated health education in the schools
Source: National Women's Health Network
Comments:
The likelihood of a woman being hospitalized is dependent, to a high degree, on:

a. health status
b. age
c. choice
d. accessibility to medical care
Source: Women's Health test, Dr. Velma Pressly, Univ. of Tenn.
Comments:
A major focus of midwifery is to:

c. provide a satisfying, family centered childbirth in q comfortable environment
Source: Women's Health test, Dr. Velma Pressly, Univ. o f Tenn.
Comments:
A divorced female parent can face many obstacles in U.S. society today, including:
a. alienation in all aspects of life
b. prejudice and discrimination in many areas
c. lowered socio-economic status
Source: Women's Health test, Dr. Velma Pressly, Univ. o f Tenn.
Comments:
184
Which of the following statements about abortion in the U.S. is FALSE:
a. abortion was made legal by a constitutional amendment
b. abortion is legal
c. abortion was made legal by the court case Roe v. Wade in 1972
d. the health risks from an abortion are lower than risks from giving birth
Comments:
The Women's Health Movement has fostered the growth o f all of the following EXCEPT:
a. health education
b. rape counseling
c. abortion and contraceptive counseling
d. referral to female gynecologists
Source: Marieskind, H. Women in the Health System. 1980.
Comments: .
The Women's Health Movement started in the early 1970s in the form of
groups.
a. self-help
b. female physician
c. social
d. support
Comments:
Which of the following skills are obstetricians/gynecologists NOT trained to do:

a. diagnose and treat diseases of the reproductive organs
b. manage childbirth complications
c. act as sexual counselors
d. perform gynecological surgery
Comments:
This type of practitioner treats people al all ages and for most common problems, and is
becoming less of a chosen area o f medicine for medical students:
a. family practitioner
b. physician specialist
c. internist
d. primary care physician
Comments:
185
All of the following are problems associated with alternative methods of medical care
EXCEPT:
a. lack of interest
b. limited availability
c. lack of social and political awareness
d. lack of standards
Comments:
As proof that medicine is not a science and is sometimes based on untested assumptions,
discovered health risks have been associated with all of the following EXCEPT:
a. Daikon IUD
b. birth control pills
c. DES
d. aspirin
Source: QuLB.WliCS^Qu^slves, 1984.
Comments:
Which of the following is a natural and safe way to help prevent osteoporosis and joint
problems, that are characteristic of older women;
a. weight-bearing exercise
b. estrogen replacement therapy (ERT)
c. calcium supplements
d. yoga
Source: Qur Bodies. Ourselves, 1984.
Comments:
Since 65% of black and Hispanic households are headed by women, it is most important for
these women to have a:
a. job
b. social security check
c. financial retirement plan
d. home
Comments:
Which of the following is the key to breaking the vicious cycle of poverty:
a. public assistance
b. education
c. job
d. insurance coverage
Source: Health & Society class, U.T. 1990.
Comments:
186
Which of the following statements concerning insurance coverage is FALSE:
b. companies gear around the notion that wife and children are dependents
c. when a marriage ends through death or divorce, benefits do not cease
d. in some communities, single women cannot get coverage for reproductive health in areas such
as contraception and childbirth
Comments:
The General Accounting Office recently found that women have been purposely excluded
from__________ by the National Institutes of Health.
a. employment
b. research
c. education
Source: General Accounting Office. National Institutes of Health: Problems in Implementing
Policv_Qn_Women in Study Populations. 1990.
Comments:
Which of the following statements about being poor is FALSE:

a. medical attention is usually delayed until a health problem reaches emergency room status
b. poor people are often used in teaching hospitals as guinea pigs for new treatments
d. there are"working poor people who work, but do not have insurance coverage from
employers
Source: Women's Health class, Univ. of Tennessee, 1990.
Comments:
Homelessness is indicated if a person:

a. lives on the streets
b. lives in a shelter
c. does not own or rent a home/apartment
d. does not have a job
Comments:
Objective #9:
In the last decade, the proportion of women enrolled in medical schools have:
a. decreased
d. stabilized
Source: Health. United States. U.S. Dept, of Health and Human Services, 1988.
Comments:
187
In the nineteenth century, childbirth was performed almost exclusively in the home by:
a. physicians
b. family members
c. midwives
d. nurses
Comments:
___________ percent of health care workers are women.

a. 25
b. 50
c. 60
d. 85
Comments:
Which of the following is NOT an issue pertaining to women in the health care field:
a. unequal pay
b. unequal advancement oppportunities
c. competition with other women
d. hours not conducive to combining spouse/parent/employment roles
Comments:
The caregiver of elderly parents is usually a:

a. daughter
b. son
c. nurse
d. close relative
Source: J. Hendricks & C. Hendricks. Aging in Mass Society: Mvths and Realities. 1986.
Comments:
Even though such workers help people make changes often necessary for preventing
illness, all of the following health care workers are usually inaccessible to patients without a
doctor's order EXCEPT:
a. physical therapists
b. social workers
c. nutritionists
d. nurses
Comments:
188
Since the first woman graduated from a regular medical college in 1849, female physicians
have seen improvements in:
a. pay
b. accessibility to medical colleges
c. decrease in sexism
d. competent perception by male colleagues
Comments:
Objective.ffiQ:
Which of the following characteristics is representative of assertiveness:

a. direct eye contact when speaking
b. eyes looking down while speaking
c. twirling hair while speaking
d. shifting feet while speaking
Source: Diane Wilkerson, Counselor, Kennesaw State College, Assertiveness Seminar
Comments:
Women who enter untraditional and physically demanding occupations face problems and
hazards because women:
a. cannot cope with a male-dominated environment
b. are not accepted in such an environment
c. were not considered when the physical environment in the jobs were designed for men
d. are not as strong or as task oriented as men
Source: Women's Health test, Dr. Velma Pressly, Univ. of Tenn.
Comments:
Motherhood in the United States is:

a. inevitable
b. expected
c. a choice
d. forced
Source: Our Bodies, Ourselves, 1984.
Comments:
Compulsory heterosexuality is defined as all of the following EXCEPT:

a. a woman feeling desperate when not with a man
b. causing a woman to jump into a relationship with a man who is simply available
c. feeling unsafe anywhere without a man
d. fearing lesbianism
Comments:
189
Developing "personal power" means being all of the following EXCEPT:
a. self-reliant and independent
b. assertive and self-confident
c. able to earn a living
d. having and keeping a partner who has these qualities
Comments:
A major reason wives lose sexual desire consists of:

a. a lack of interest in sex
b. fatigue and tiredness
c. an affair
d. feeling unattractive
Comments:
To prevent a couple from growing apart, it is most important to have:

a. family outings
b. dates
c. frequent sex
d. continuous dialogue
Comments:
When a couple marries, they usually:

a. retain their single friends
b. close in on themselves
c. make new friends
d. become active in the community
Comments:
190
Dear Ju ro r:
1. Can you identify any weaknesses in the instrument that needs to be revised?
2. Do you have suggestions for additional items or changes to the present instrument as a whole?
3. Do you think that the instmment is valid for the purpose intended?
Thank you again for your assistance and support. -Susan
191
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout p erm ission .
APPENDIX H
REV ISED TEST SENT TO JURORS
SUSAN O. BUTLER
(404)427-5526
O cto b er 26, 1991
To: Jurors for W om en's H ealth K n o w le d g e T est ^

From: Susan B utler, doctoral candidate, U n iv ersity o f T en n essee
Re: T est rev isio n s $
I w ant to thank all o f y o u for you r im portant con trib u tion toward m y d issertation
and the d ev elo p m en t o f a w om en's health k n o w le d g e test. I appreciate your input
such as con stru ctive criticism , com p lim en ts, su g g estio n s, ed itin g, and ad vice. I
h ave taken all o f this inform ation and h ave m ad e the appropriate revision s.
P lease se e the en clo sed sum m ary o f the re v isio n s m ade and the revised test item s.
For you r inform ation , I h ave a lso e n c lo se d the list o f jurors assistin g m e w ith m y
dissertation.
Thank you for taking tim e out o f your b u sy sch ed u le to read through m y w ork. I
w ill be very happy to return the favor i f I can ev e r h elp you w ith anything.
If you h ave further com m en ts or con cern s, p le a se co n ta ct me.
193
Form B
Please select the best choice for each item and mark the appropriate
Item number on the scan-tron form. Do not write on the test.
Objective #1 - Health status of women:
1. ______Which of the following is the leading cause of death for all women, ages 18 to 24?
b. breast cancer
c. leukemia
d. suicide
Source: Vital & Health Statistics of the National Center for Health Statistics, 1991.
(for both sexes)
Health Risk Appraisal, Carter Center of Emory University, 1991.
2. Which of the following is one o f the three leading causes of death for women,
ages 20 to 35?
a. diabetes
b. leukemia
c. suicide
Source: Health Risk Appraisal, Carter Center of Emory University, 1991.
Vital & Health Statistics, 1991.
3 . ____ Which of the following is the most common health problem among women,
ages 65 and over?
b. osteoporosis
d. arthritis
Source: Verbrugge, L.M. Growing Old in America. 1985.
4._____ Black women have higher incidence rates than white women in all of the following
areas EXCEPT:
a. AIDS
c. breast cancer
Source: Public Health Service, Dept, of Health & Human Services, Healthy People 2 0 0 0 .1991.
National Cancer Institute, Dept, of Cancer Prevention and Control, 1991.
5. Incidence of which of the following in women increase dramatically after the age
o f fifty?
a. homicide
b. leukemia
c. motor vehicle accidents
d. breast cancer
Source: National Cancer Institute, Dept, of Cancer Prevention and Control, 1991.
194
6. Which of the following is the best source of calcium?
a. salmon
b. tomato
c. wheat bread
d. orange juice
Source: Latest Recommended Dietary Allowances. National Research Press, 10th edition, 1989.
7. Which of the following is the best source of iron?

a. spinach
b. raisins
c. soybeans
d. milk
Source: Griffith-Kenney, J. Contemporary Women's Health. 1986.
8. For a healthy baby, how many pounds should a woman gain during pregnancy?
a. 10 to IS pounds
b. 20 to 25 pounds
c. 22 to 32 pounds
d. 32 to 42 pounds
Source: Recommendation from The American College of Obstetricians and Gynecologists.
Bobak, I .; Jensen, M. & Zalar, M. Maternal & Gynecologic Care. 1989.
9 . _____ Pregnant women with diabetes have which of the following?

a. increased blood pressure
b. no pregnancy risks
c. a higher than average frequency of babies bom with birth defects
d. babies weighing less than the average baby
Source: Bobak, I.; Jensen, M .;& Zolar,M . Maternity & Gynecologic Care. 1989.
Public Health Service, Dept, of HHS, Healthy People 2000. 1991.
10. _____ When in a woman's life is the incidence of heart disease most prevalent?
a. before age fifty
d. after menopause
Source: Lerner, D.J. & Kannel, W.B. "Patterns o f coronary heart disease morbidity and mortality
in the sexes: a 26-year follow up of the Framingham population." American Heart Journal.
111(2), 383-390, 1986.
Health Risk Appraisal, Carter Center of Emory University, 1991.
11. Regular moderate exercise three or four times a week, not to fatigue, is beneficial to a
pregnant woman. When should such exercise be sharply reduced?
b. two months prior to delivery
Source: Present recommendation by The American College of Obstetricians and Gynecologists.
Bobak, I.; Jensen, M. & Zalar, M. Maternity & Gynecologic Care. 1989.
195
12. Major improvements in the health status of Americans are due to improvements in
c. more physicians
d. new technology
13. Which of the following is the major transmission route for the AIDS virus among
women?
a. intravenous drug use
b. bisexual male partner
c. bisexual female partner
d. blood transfusion
Source: Centers for Disease Control. HIV/AIDS Prevention Newsletter. 2(1). April 1991.
14. Which of the following is responsible for contraceptive failure among American
women?
b. faulty devices
Source: Public Health Service, Dept, o f HHS, Healthy People 2000. 1991.
15. According to the National Health Interview Survey, which o f the following age groups
of women is at greatest risk of cervical cancer mortality and is the least likely to have been
screened?
a. older
b. adolescent
c. young adult
d. adult
Source: Public Health Service, Dept, of HHS, Healthy People 2000. 1991.
16. Why are women the principal residents of nursing homes?

a. there are few alternatives
b. their families do not care about them
c. they are sicker than men
d. they live longer than men
Source: Griffith-Kenney, J. Contemporary Womens Health. 1986.

a. are hypertensive
196
18. Both women without children and lesbian women should include in their annual
gynecological exam a check for which of the following health problems?
a. dysmenorrhea
b. endometriosis
c. osteoporosis
d. cervical cancer
19. Most lumps found in or around the breast are usually diagnosed as which of the
following?
a. caffeine-induced
c. non-cancerous
d. cancerous
Source: Information on breast cancer, American Cancer Society, 1991.
Objective #2 - Patient/phvsician relationship:
20. What is the definition of "advocacy" in relation to health care for women?
a. joining a self-belp group
b. having a friend or family member along during a visit to a physician
c. informing patients of their alternatives for medical treatment
21. To insure that a physician is aware of all questions a woman may have, it is best that
she do which of the following?
22. To receive the best medical treatment and advice from a physician, it is important for a
woman to do which of the following?
b. offer information that relates only to the reason for her office visit
d. keep quiet, at the exam and allow the physician to make a diagnosis and ask the questions
197
23. A woman should seek a physician who has all o f the following characteristics
EXCEPT:
a. a healthy lifestyle
b. networks with other physicians
c. allows time for questions from the patient
d. an overload of people in the waiting room
24. To improve decision making by a woman concerning her health, it

is important for her to do which of the following?
a. try to self-diagnose health problems
b. call a number of physicians for advice
c. learn more about her body to assist physician
d. avoid traditional health care professionals
25. As a patient in a hospital for elective surgery, you have the right to which of the
following?
a. to decide on which room you will stay in
b. to decide who will be your nurse
c. to be fully informed of all medical procedures
d. to decide when you will leave the hospital
Source: Edlin, G. & Golanty, E. Health & Wellness: A Holistic Approach. 1988.
26. Which of the following is the physician's main responsibility to a patient?

b. monitor health status of patients between physicals
c. notify patients of latest medical research
d. diagnose and treat disease that is causing symptoms in patients
Source: Edlin, G. & Golanty, E. Health &_Wellness;, A Holistic Approach. 1988.
27. What is the main principle of medical quackery?

Source: Edlin, G. & Golanty, E. Health & Wellness: A Holistic Approach. 1988.
28. A potential patient should ask all of the following questions when rating potential
physicians EXCEPT:
a. Is the physician willing to consult with you on the telephone?
b. With the receptionist, are you provided privacy in responding to personal questions?
c. Does the physician have a degree from a prestigious medical school?
d. Does the physician explain why a particular drug is prescribed?
Source: Mullen, K.; Gold, R.; Belcastro, P. & McDermott, R. Connections for Health. 1986.
198
Objective # 3 Normal female physiology:
2 9 . _____ W h i c h o f t h e f o l l o w i n g i s t h e b e s t m e t h o d o f c l e a n s i n g f o r t h e v a g i n a :
a . d o u c h in g
b . v a g in a l d e o d o ra n ts
c . n o rm a l v a g in a l s e c re tio n s
d . d e o d o ra n t so ap
S o u rc e : E d lin , G . & G o la n ty , E . H e a lth & W e lln e s s : A H o lis tic A p p ro a c h . 1 9 8 8 .
30. W h ic h o f th e fo llo w in g is th e le a s t p e r c e n t b o d y fa t a w o m a n s h o u ld h a v e to b e
c o n s id e r e d a h e a lth y a m o u n t?
a. 5 p e rc e n t
b. 1 3 p e r c e n t
c. 18 p e rc e n t
d . 2 0 p e rc e n t
S o u rc e : W illia m s , M . L ife tim e F itn e s s a n d W e lln e s s : A P e rs o n a l C h o ic e . 1 9 8 9 .
31. T h e e n tire fe m a le re p ro d u c tiv e c y c le is re g u la te d b y w h ic h o f th e fo llo w in g ?

a . m e n s tru a l c y c le
b. f e m a l e s e x h o r m o n e s
c . o v u la tio n
d . e n d o m e tria l lin in g
S o u rc e : T o r to r a ,G . In tro d u c tio n to th e H u m a n B o d y . 1 9 9 1 .
32. When does the menstrual phase o f the female monthly reproductive cycle occur?
Source: Tortora, G. Introduction to the Human Body. 1991.
33. At what point in the monthly reproductive cycle can a woman most likely become
pregnant?
Source: Bobak, I.; Jensen, M. & Zalar, M. Maternity & Gynecologic Care. 1989.
34. Even though a woman's heart is smaller than a man's heart, how much can a woman
improve her cardiovascular fitness in comparison to a man?
a. the same percentage
b. the same level
c. only half the level
d. only two-thirds the level
199
35. Which of the following major muscle groups in a woman's body is the strongest?
a. forearm
b. upper arm muscles
c. quadriceps or thigh muscles
d. calf muscles of leg
36. The ovaries are the female reproductive organs that produce which of the following?
b. menstrual flow
c. amniotic fluid
37. Which of the following best explains why menopause occurs?

d. degeneration of the aging uterus
38. What is a normal reaction of the breasts three to four days prior to the onset of the
menstrual period?
d. loss o f elasticity
39. Which of the following is known as Mittelschmerz, a common occurence in women

during ovulation each month?
a. headache
b. dull pain in the abdomen
Source: Mullen, K.; Gold, R.; Belcastro, P. & McDermott, R. Connections for Health. 1986.
40. Common occurences in women who experience menopausal characteristics include all
of the following EXCEPT:
a. hot flashes
b. loss of appetite
c. dryness of vagina
d. profuse sweating
Tortora, G. Introduction to the Human Body. 1991.
200
Objective #4 - Causation and prevention of disease and illness:
41. Cigarette smoking by a pregnant woman can possibly produce all of the following in an
infant EXCEPT:
a. low birth weight
b. high birth weight
c. mental retardation
d. stillborn
Source: Vital & Health Statistics of the National Center for Health Statistics, #202, June 18,1991.
42. Oral contraceptives provide protection against which of the following?

a. AIDS
b. herpes
c. vaginitis
d. pregnancy
Source: Recommendations by the American Red Cross and the American College Health
Association, 1991.
43. Common side effects of oral contraceptives include all of the following EXCEPT:
a. weight gain
b. emotional changes
c. difficulty in conceiving
d. breast tenderness
S o u r c e : G r i f f i t h - K e n n e y , J . C o n t e m p o r a r y W o m e n 's H e a l t h . 1 9 8 6 .
44. With a male partner, which of the following contraceptive methods is best for a
woman who has a history of heart disease, smoking, and pelvic inflammatory disease?
a. oral contraceptive
b. condom
c. diaphragm
d. IUD
Source: Fogel, C. Sexual Health Promotion. 1990.
45. Which of the following alterations in the menstrual cycle is the major cause of
women's absence from work or school?
a. amenorrhea
b. dysmenorrhea
c. hypermenorrhea
d. menorrhagia
Source: Fogel, C. & Lauver, D. Sexual Health Promotion. 1990.
201
46. Which of the following health problems related to the menstrual cycle is common
among female athletes who overtrain?
a. dysmennorhea
b. amenorrhea
c. premenstrual syndrome
d. hypermenorrbea
Mullen, K.; Gold, R.; Belcastro, P. & McDermott, R. Connections for Health. 1986.
Williams, M. Lifetime Fitness and Wellness: A Personal Choice. 1989.
47. Until menopause, the best time to do breast-self examination (BSE) is:
c. everyday
d. every month
48. Candidiasis, trichomoniasis, and gardnerella are all types of which of the following
conditions?
a. vaginitis
b. syphilis
c. endometrosis
d. cystitis
Source: Fogel, C. Sexual Health Promotion. 1990.
49. Which of the following is one of the most common and serious problem found in
infants with Fetal Alcohol Syndrome (FAS)?
b. cardiac defects
d. hyperactivity
50. All of the following may contribute to loss in bone density in women EXCEPT:
d. frequent dieting
202
51. Uterine bleeding is a major symptom for which of the following types of cancer?
a. cervical
b. endometrial
c. bladder
d. ovarian
Source: Recommendations from the American Cancer Society, 1991.
52. Breast tenderness, water retention, irritability, depression, and tiredness are all
common symptoms of which of the following conditions?
a. menopause
b. PMS
d. anxiety attack
53. Which of the following risk factors have been linked with an increase in breast cancer?
a. low-fat diet
b. high-fat diet
Source: Vant, P.; van Leer, E.; Rietdijk, A.; Kok, F.; Schauten, E.; Hermus, R. & Sturman, S.
Combination of dietary factors in relation to breast cancer occurrence.
International Journal of Cancer. 42(5), 649-53, 1991.
54. Drinking at least two quarts of fluid each day, using unscented toilet paper, and
urinating at least every three hours can help prevent which of the following conditions?
a. cystitis
b. vaginitis
c. gonnorhea
d. syphilis
55. Unusual pain in the lower abdomen that increases prior to or during menstruation is
the major symptom of which of the following conditions?
a. cystitis
b. vaginitis
c. endometriosis
d. PMS
56. Varicose veins are common in women who do which of the following all day long?
a. yard work
b. sit or stand
c. walk
d. move or lift objects
203
57. To help prevent toxic shock syndrome (TSS), it is best to do which of the following
when using a tampon during menstruation?
a. use a deodorant type
b. use a non-deodorant type
c. change tampons often
d. avoid those with an applicator
58. Symptoms of toxic shock syndrome (TSS) include all of the following EXCEPT:
a. high fever
b. sore throat
c. rash
d. reduction in body temperature
59. Which of the following, if done on a regular basis, generally lessens menstrual cramps
and the need for medication?
a. resting
b. exercising
c. sitting
d. sleeping
60. A c o m m o n s id e e ffe c t o f u s in g a n IU D is th e in c re a s e in ris k o f w h ic h o f th e

fo llo w in g ?
a . c y s titis
b. p e l v i c i n f e c t i o n
c. c e r v i c a l c a n c e r
d . e n d o m e tro s is
S o u r c e : G r i f f i t h - K e n n e y , J. C o n t e m p o r a r y W o m e n 's H e a l t h . 1986.
R e c o m m e n d a t i o n s f r o m t h e A m e r i c a n C o l l e g e H e a l t h A s s o c i a t i o n , 1991.
61 . C ig a r e tte s m o k in g h a s b e e n s h o w n to in c re a s e th e r is k o f w h ic h ty p e o f c a n c e r?
a. b r e a s t
b . c e rv ic a l
c . u te rin e
d . o v a ria n
S o u r c e : N a t i o n a l C a n c e r I n s t i t u t e , D e p t , o f C a n c e r P r e v e n t i o n a n d C o n t r o l , 1991.
G r i f f i t h - K e n n e y , J. C o n t e m p o r a r y W o m e n 's H e a l t h . 1986.
T o r t o r a , G . I n t r o d u c t i o n t o t h e H u m a n B o d y . 1991.
R e c o m m e n d a t i o n s f r o m t h e A m e r i c a n C a n c e r S o c i e t y , 1991.
204
62. Which of the following i6 considered a high risk factor for endometrial (uterine)
cancer?
a. cigarette smoking
b. use of oral contraceptives
c. progesterone therapy for any length of time
d. estrogen therapy for more than two years
National Cancer Institute. What you need to know about cancer of the uterus. 1988.
63. All of the following are risk factors for cervical cancer EXCEPT:
a. frequent sex with many male partners
b. poor genital hygiene
c. unusual vaginal discharge between periods
d. being between twenty and thirty years o f age
64. Ovarian cancer and cancers of the bowel, breast, and uterus all have which of the
following factors in common?
a. obesity
b. cigarette smoking
c. high fat diet
65. All of following are measures for the treatment of fibrocystic disease EXCEPT:
a. wearing support bra
b. restricting the intake of sodium
c. restricting the intake of fat
d. abstaining from caffeine.
Tabers Cyclopedic Medical Dictionary. 1989.
66. All of the following are benefits of exercise such as cycling and swimming EXCEPT:
a. lowers risk of developing heart disease
c. assists treatment of osteo and rheumatoid arthritis
67. Family medical history is an important risk factor for all o f the following diseases
EXCEPT:
a. all cancers
c. diabetes
d. nutritional anemia
Source: Recommendations of the March of Dimes, 1991.
205
Objective #5 - Emotional and mental health:
68. Which of the following occupations has the highest level of job-related stress?
a. retail clerk
b. cashier
d. secretary
Source: Recommendations of National Institute for Occupational Safety and Health, 1985.
69. Common health problems related to stress among women include all of the following
EXCEPT:
a. raigrane headaches
b. back pain
c. gray hair
d. peptic ulcers
Source: Griffith-Kenney, J. Contemporv Women's Health. 1986.
70. Which of the following coping strategies for stress is the most healthful?
a. exercise
c. sleeping aid
d. discussion
71. The most common cause of depression is:

a. malnutrition
b. a loss
c. stressor(s)
d. heredity
72. A woman who has anorexia nervosa is at great risk for which of the following?
a. hypertension
b. overeating
c. cardiac arrest
d. diabetes
73. All of the following are common symptoms of anorexia nervosa EXCEPT:
b. eating binges
c. amenorrhea
d. hyperactivity
206
74. At recommended doses, which of the following is the most commonly reported side
effect o f tranquilizer pills?
a. anxiety
b. daytime sedation
c. insomnia
d. depression
Nursing91 Books. Drug Handbook. 1991.
75. Which of the following is the best and healthiest way to rellieve a mild case of
depression?
a. calcium
b. exercise
c. sunshine
d. vitamin B
Source: Griffith-Kenney, J. Contemporary Women's Health. 1986
Tortora, G. Introduction.to.the Human Body, 1991.
Williams, M. Lifetime Fitness and Wellness: A Personal Choice. 1989.
76. Advice from health experts for sleeping problems usually include all of the following
EXCEPT:
77. Which of the following is symptomatic of a woman suffering from manic-depression?

a. extreme depression, then suicidal
78. Which characteristic below relates to the woman who is at greatest risk for commiting
suicide?
b. being married
Health Risk Appraisal, Carter Center at Emory University, 1991.
207
79. All of the following arc common symptoms of anxiety EXCEPT:
a. reclusion
b. mental tension
Objective #6 - Safety and Security:
80. Where do most rapes occur?

a. dark alley
b. victim's car
c. victim's place o f employment
d. victim's or rapist's home
81. All of the following problem areas may precipitate domestic violence EXCEPT:
a. economic stress
b. woman's jealousy
c. man's jealousy
82. A common personality trait of a date rapist primarily includes:

Source: Muehlenhard, C. & Linton, M. "Date rape and sexual aggression in dating situations:
Incidence and risk factors." Journal of Counseling Psychology. 34, 1987.
83. AH of the following are true statements about rape EXCEPT:

b. rape is usuaUy a planned act
84. AH of the foUowing are examples of sexual harassment EXCEPT:

b. displaying sexuaUy suggestive visuals
d. continually smiling at someone
Source: Legal definition of sexual harassment, Georgia Board of Regents Employee Handbook.
1991.
208
85 . _____ According to crisis treatment experts, the safest course of action for a woman who is a
continual victim of domestic violence is to:
b. call the police
c. go to a women's shelter
Source: Santa Monica Rape Crisis Treatment Center, 1990.
86 . Which of the following characteristics is common among victims of domestic

violence?
a. addicted to drugs or alcohol
b. unemployed and always at home
c. aggressive behavior toward spouse
d. dependence on spouse for financial and emotional support
87. The value of a friend for a victim of rape is to:

c. report the crime
Source: Santa Monica Rape Crisis Treatment Center video, "Campus Rape," 1990.
Objective #7 - Gynecological procedures and female surgeries:
88. A hysterectomy is a surgical procedure which removes the:

a. ovaries
b. fallopian tubes
c. cervix
d. uterus
Source: Tabers Cyclopedic Medical Dictionary. 1989.
89. The PAP smear is a procedure done by a gynecologist for the diagnosis of:
a. cystitis
b. ovarian cancer
c. cervical cancer
d. endometriosis
209
90. The breast cancer screening procedure that can determine whether a Jump is a benign
cyst or a malignant tumor is called:
a. ultrasound
b. mammography
c. chest X-ray
d. breast self-examination
91. The CA-125 blood test provides screening for what type of cancer?
a. breast
b. uterine
c. ovarian
d. colorectal
Source: Fazio-Garen, S. Learning from families, Harvard Health Letter. October 1991.
92. A major concern about estrogen replacement therapy (ERT) is in relation to the
increased risk of:
a. osteoporosis
c. obesity
d. heart disease
93. Certification of mammography facilities by the American College of Radiology is for

quality standards in all of the following areas EXCEPT:
a. dose
b. image quality
c. equipment
Source: Public Health Service, Dept, o f Health & Human Services, Healthy People 2000. 1991.
94. Dilation and Curettage (D&C) is a gynecological procedure that is useful for all of the
following purposes EXCEPT:
b. evaluation of infertility
95. Conization is a gynecological procedure that is useful for the removal of:
a. a breast lump
d. genital warts
210
96. In diagnosing iron deficiency, which of the following is the most acceptable reading
for hemoglobin in adult women?
a. 6gm
b. 8gm
c. 10 gm
d. 12 gm
Source: Grant, A. & DeHoog, S. Nutritional Assessment and Support. 1985.
97. What is the safest and easiest way for a woman to deliver a child?
c. squatting
d. standing
98. Indications for a cesarean delivery include all of the following EXCEPT:
a. unacceptable weight determined by an obstetrician
b. active maternal gonorrhea
c. premature breech position
d. pregnancy-induced hypertension
99. Abrupt surgical menopause occurs in premenopausal women who have which of the
following female surgeries:
a. hysterectomy
b. salpingectomy
c. oophorectomy
d. tubal ligation
100. Which of the following is a common surgical procedure for invasive cervical cancer?
a. oophorectomy
b. hysterectomy
c. cryosurgery
d. conization
Objective #8 - Health services for women & factors affecting women's health:
101. The Equal Rights Admendment (ERA) would guaranteed which of the following:
b. coed restrooms
Source: National Organization for Women
211
102. The likelihood of a woman receiving any necessary hospitalization is dependent, to a
high degree, on which of the following?
a. health status
b. age
c. choice
d. access to hospital
103. A major focus of a birthing unit in a hospital is on which of the following?

105. All of the following statements about insurance coverage is usually true EXCEPT:
d. companies may not cover preventive health services, such as mammography
Source: Conrad, P. & Kern, R. The Sociology of Health and Illness. 1990.
106. The General Accounting Office found that women have been purposely excluded
from which of the following by the National Institutes of Health?
a. employment
b. research
c. education
Source: General Accounting Office. National Institutes of Health: Problems in Implementing
Policy on Women in Study Populations. 1990.
107. All of the following statements about poverty are true EXCEPT:
d. the working poor usually do not have health insurance
Source: Conrad, P. & Kern, R. The Sociology o f Health and Illness. 1990.
212
108. All o f the following are techniques used in holistic medicine EXCEPT:
a. diet improvement
b. exercise
c. drag therapy
Source: Edlin, G. & Golanty, E. Health & Wellness. 1988.
109. Women's health centers should approach women's health with which of the
following perspectives?
a. treatment
b. wellness
c. pharmacological
d. non-intervention
110. Research has shown that all o f the following factors below contribute to a higher
degree of adjustment for women after divorce EXCEPT:
a. full-time job
c. availability of welfare
111. Which occupation below is most likely ignored by group health insurance coverage?
a. hotel maid
c. dental assistant
112. A higher rate of poor health among uninsured women is related to which of the
following?
Source: Conrad, P. & Kern, R. TJie_Sociologv of Health and Illness. 1990.
113. Which of the following age groups of women usually has little or no health
insurance?
b. 19 to 24 years
c. 25 to 54 years
d. 65 and over
213
114. How does out-of-pocket medical expenses for married women usually compare to
those for divorced women?
a. higher
b. lower
c. same
115. Which situation below may automatically cause a woman to lose health insurance
coverage?
a. marriage
b. spousal death
c. major illness
Objective *9 - Contributions by women to medical and health care field:
116. The proportion of women enrolled in medical schools since 1900 has:
a. decreased
d. stabilized
Source: Health. United States. U.S. Dept, of Health and Human Services, 1988.
117. _____ In the nineteenth century, childbirth was performed almost exclusively in the home
by:
a. physicians
b. family members
c. midwives
d. nurses
118. _____ At least which percentage of health care workers are women?
a. 25
b. 50
c. 60
d. 75
119. The caregiver of elderly parents is usually which of the following?

a. daughter
b. son
c. nurse
d. close relative
Source: J. Hendricks & C. Hendricks. Aging in Mass Society: Mvths and Realities. 1986.
214
120. All of the following arc purposes o f the American Nurses Association EXCEPT:
c. provide a code o f ethics
121. Which of the following health field occupations usually has a career ladder?
a. registered nurse
b. licensed practical nurse
c. physician
d. physician's assistant
Source: Conrad, P. & Kern, R. The Sociology o f Health and Illness. 1990.
122. All of the following strategies by nurses can reduce nursing sex-role stereotyping
EXCEPT:
c. confronting colleagues who seek dates from male physicians
d. confronting colleagues who participate in the "doctor-nurse" game
Objective #10- Assertiveness and self-expression among women:
123. Which of the following behaviors is representative of assertiveness while speaking?

c. twirling hair
d. shifting feet
Source: Sizer, F. & Whitney, E. Life Choice: Health Concepts & Strategies. 1988.
124. Why do some women who enter nontraditional occupations sometimes face problems
and hazards?
c. they were not considered during design of the work environment
125. Which of the following is the most common reason for a reduction in intimacy
between a husband and wife during middle adulthood, ages 30 to 40?
a . s e x u a l d y s fu n c tio n
215
126. For a working woman with children and a husband, all o f the following issues
usually cause stress EXCEPT:
a. role overload
b. timing of career and children
c. lack of encouragement from husband
d. lack of encouragement from employer

c. standing up for one's own rights
128. Assertiveness training teaches women to do all of the following EXCEPT:

129. Assertive sexuality involves all of the following behaviors EXCEPT:

a. self-responsibility for protection against disease and/or pregnancy
b. having the partner be responsible for protection against disease and/or pregnancy
Source: Travis, J. & Ryan, R. Wellness WortftwK. 1988.
130. Possessing which of the following means possessing the attainment of self-
actualization?
a. love
b. safety
c. self-esteem
d. acceptance by others
Source: Maslow, A. Motivation and Personality. 1954.
Maslow, A. Toward a Psychology of Being. 1968.
This concludes the testing portion of the test. Please complete the demographic form found on
next page.
216
APPENDIX I
PRELIMINARY TEST FOR PIL O T IN G PURPOSES
SU SA N O. BUTLER
340 0 CHASTAIN C R O S S I N G
MARIETTA. G E O R G I A 3 0 0 6 6
<404)427-5528
W om en's H ealth K n o w led g e T est

Copyrighted, 1991
Dear Participant:
For my doctoral dissertation in health education, I am developing a women's

health knowledge test. The test is being administered to students in women's
health classes and to members o f women's organizations across the country.
The test contains knowledge questions about anatomy, reproductive health,
physical problems and diseases, emotional health, and social issues concerning
women. There are no questions about your personal attitudes, beliefs, or
behaviors.
It w ill require about thirty to forty minutes for you to complete the Women's
Health Knowledge Test. Please take a few moments to also complete the
demographic survey form found on the last page. Y o u r p a r tic ip a tio n in th is
stu d y is c o m p le te ly v o lu n ta r y a n d a n o n y m o u s.
Please do not p u t you r name on the answ er sheet and do not w rite on the test.
Use a pencil to mark your responses on the answer sheet that is provided. There
is only one answer per question. Select the answer you think is best. If you want
to learn your score on the test, make note o f your participant number that
appears on the answer sheet, and your score can later be retrieved. A list of
scores will be sent to your course instructor/organization president.
In the field o f health education, a valid and reliable women's health knowledge
test is greatly needed. Validity o f this test has been established by an expert panel
o f jurors from a cross-section o f the country, who work in the area o f women's
health. The topics covered in the test were also determined by these jurors.
Your participation in this study will assist in establishing reliability o f this test.
Thank you for contributing time to my dissertation and to women's health.
usan Butler
doctoral candidate, health education
University o f Tennessee, Knoxville
Research at the U niversity o f Tennessee, K noxville which involves hum an participants is conducted under the supervision
o f the Institutional Review Board. Questions regarding this research should be addressed to: Dr. Robert H. Pursley,
Coordinator, Human Subjects Research; Departm ent o f Health, L eisure, & Safety; 1914 Andy Holt Avenue; Knoxville, Tn.
37996-2700; (615) 974-5041 o r Edith M . Szalhm ary, C oordintor o f Com pliances; R esearch A dm inistration; 404 Andy
Holt T ow er; K noxville, T n. 37996-0140 (615) 974-3466.
218
copyrighted, 1991 by Susan Butler
Please select the best choice for each item and mark the appropriate
item number on the scan-tron form. Do not write on the test.
QfriertiraJJLrJfleaith statusof.woroen:
1. _____ Which of the following is the leading cause of death for all women, ages 18 to 24?
b. breast cancer
c. leukemia
d. suicide
2 . ______ Which of the following is one of the three leading causes of death for women,
ages 20 to 35?
a. diabetes
b. leukemia
c. suicide
3 . _____ Which of the following is the most common health problem among women,
ages 65 and over?
b. osteoporosis
d. arthritis
4 . _____ Black women have higher incidence rates than white women in all of the following
areas EXCEPT:
a. AIDS
c. breast cancer
5. Incidence of which of the following in women increase dramatically after the age
of fifty?
a. homicide
b. leukemia
c. motor vehicle accidents
d. breast cancer
6. _____Which of the following is the best source of calcium?

a. salmon
b. tomato
c. wheat bread
d. orange juice
219
7. _____Which of the following is the best source of iron?
a. spinach
b. raisins
c. soybeans
d. milk
8. For a healthy baby, how many pounds should a woman gain during pregnancy?
a. 10 to IS pounds
b. 20 to 25 pounds
c. 22 to 32 pounds
d. 32 to 42 pounds
9. _____Pregnant women with diabetes have which o f the following?

a. increased blood pressure
b. no pregnancy risks
c. a higher than average frequency of babies bom with birth defects
d. babies weighing less than the average baby
10. _____When in a woman's life is the incidence of heart disease most prevalent?
a. before age fifty
d. after menopause
11. _____Regular moderate exercise three or four times a week, not to fatigue, is beneficial to
pregnant woman. When should such exercise be sharply reduced?
b. two months prior to deliveiy
12. _____ Major improvements in the health status of Americans are due to improvements in
c. more physicians
d. new technology
13. Which of the following is the major transmission route for the AIDS virus among
women?
a. intravenous drug use
b. bisexual male partner
c. bisexual female partner
d. blood transfusion
14. _____ Which of the following is responsible for contraceptive failure among American
women?
b. faulty devices
220
15. _____According to the National Health Interview Survey, which o f the following age groups
of women is at greatest risk of cervical cancer mortality and is the least likely to have been
screened?
a. older
b. adolescent
c. young adult
d. adult
16. _____ Why are women the principal residents of nursing homes?
a. there are few alternatives
b. their families do not care about them
c. they are sicker than men
d. they live longer than men

a. are hypertensive
18. Both women without children and lesbian women should include in their annual
gynecological exam a check for which of the following health problems?
a. dysmenorrhea
b. endometriosis
c. osteoporosis
d. cervical cancer
19. Most lumps found in or around the breast are usually diagnosed as which of the
following?
a. caffeine-induced
c. non-cancerous
d. cancerous
Objective #2 - Patient/phvsician relationship:
20 . _____What is the definition of "advocacy" in relation to health care for women?

a. joining a self-help group
b. having a friend or family member along during a visit to a physician
c. informing patients of their alternatives for medical treatment
21 . _____To insure that a physician is aware of all questions a woman may have, it is best that
she do which of the following?
221
22 . _____ To receive the best medical treatment and advice from a physician, it is important for a
woman to do which of the following?
b. offer information that relates only to the reason for her office visit
d. keep quietly at the exam and allow the physician to make a diagnosis and ask the questions
23 . A woman should seek a physician who has all o f the following characteristics below
EXCEPT:
a. a healthy lifestyles
b. networks with other physicians
c. allows time for questions from the patient
d. an overload of people in the waiting room
24 . To improve decision making by a woman concerning her health, it

is important for her to do which of the following?
a. try to self-diagnose health problems
b. call a number o f physicians for advice
c. learn more about her body to assist physician
d. avoid traditional health care professionals
25 . As a patient in a hospital for elective surgery, you have the right to which of the
following?
a. to decide on which room you will stay in
b. to decide who will be your nurse
c. to be fully informed of all medical procedures
d. to decide when you will leave the hospital
26 . Which of the following is the physicians main responsibility to a patient?

b. monitor health status o f patients between physicals
c. notify patients o f latest medical research
d. diagnose and treat disease that is causing symptoms in patients
27 . What is the main principle o f medical quackery?

28 . A potential patient should ask all of the following questions when rating potential
physicians EXCEPT:
a. Is the physician willing to consult with you on the telephone?
b. With the receptionist, are you provided privacy in responding to personal questions?
c. Does the physician have a degree from a prestigious medical school?
d. Does the physician explain why a particular drug is prescribed?
222
Objective #3 Normal female physiology:
29 . _____ Which of the following is the best method of cleansing for the vagina:
a. douching
d. deodorant soap
30 . _____ Which of the following is the least percent body fat a woman should have to be
considered a healthy amount?
a. 5 percent
b. 13 percent
c. 18 percent
d. 20 percent
31 . _____ The entire female reproductive cycle is regulated by which of the following?
a. menstrua] cycle
b. female sex hormones
c. ovulation
32 . _____ When does the menstrual phase of the female monthly reproductive cycle occur?
33 . _____ At what point in the monthly reproductive cycle can a woman most likely become
pregnant?
34 . _____ Even though a woman's heart is smaller than a man's heart, how much can a woman
improve her cardiovascular fitness in comparison to a man?
a. the same percentage
b. the same level
c. only half the level
d. only two-thirds the level
35 . _____ Which of the following major muscle groups in a woman's body is the strongest?
a. forearm
b. upper arm muscles
c. quadriceps or thigh muscles
d. calf muscles o f leg
36 . _____ The ovaries are the female reproductive organs that produce which of the following?
b. menstrual flow
c. amniotic fluid
223
37 . Which of the following best explains why menopause occurs?
d. degeneration o f the aging uterus
38 . What is a normal reaction of the breasts three to four days prior to the onset of the
menstrual period?
d. loss of elasticity
39 . _____ Which of the following is known as Mittelschmerz, a common occurence in women

during ovulation each month?
a. headache
b. dull pain in the abdomen
40 . Common occurences in women who experience menopausal characteristics include all

of the following EXCEPT:
a. hot flashes
b. loss of appetite
c. dryness o f vagina
d. profuse sweating
Objective #4 - C ausation a n d prevention o f disease and illness;
41 . Cigarette smoking by a pregnant woman can possibly produce all of the following in an
infant EXCEPT:
a. low birth weight
b. high birth weight
c. mental retardation
d. stillborn
42. ______ Oral contraceptives provide protection against which of the following?
a. AIDS
b. herpes
c. vaginitis
d. pregnancy
43. Common side effects of oral contraceptives include all of the following EXCEPT:
a. weight gain
b. emotional changes
c. difficulty in conceiving
d. breast tenderness
224
44 . With a male partner, which of the following contraceptive methods is best for a
woman who has a history o f heart disease, smoking, and pelvic inflammatory disease?
a. oral contraceptive
b. condom
c. diaphragm
d. IUD
45 . Which of the following alterations in the menstrual cycle is the major cause of
women's absence from work or school?
a. amenorrhea
b. dysmenorrhea
c. hypermenorrhea
d. menorrhagia
46 . Which of the following health problems related to the menstrual cycle is common
among female athletes who overtrain?
a. dysmennorhea
b. amenorrhea
c. premenstrual syndrome
d. hypermenorrhea
47 . Until menopause, the best time to do breast-self examination (BSE) is:

c. everyday
d. every month
48 . Candidiasis, trichomoniasis, and gardnerella are all types of which of the following
conditions?
a. vaginitis
b. syphilis
c. endometrosis
d. cystitis
49 . Which o f the following is one o f the most common and serious problem found in
infants with Fetal Alcohol Syndrome (FAS)?
b. cardiac defects
d. hyperactivity
50 . All of the following may contribute to loss in bone density in women EXCEPT:
d. frequent dieting
51 . Uterine bleeding is a major symptom for which of the following types of cancer?
a. cervical
b. endometrial
c. bladder
d. ovarian
225
52 . _____ Breast tenderness, water retention, irritability, depression, and tiredness are all
common symptoms of which of the following conditions?
a. menopause
b. PMS
d. anxiety attack
53 . _____ Which of the following risk factors have been linked with an increase in breast cancer?
a. low-fat diet
b. high-fat diet
54 . Drinking at least two quatts of fluid each day, using unscented toilet paper, and
urinating at least every three hours can help prevent which of the following conditions?
a. cystitis
b. vaginitis
c. gonnorhea
d. syphilis
55 . Unusual pain in the lower abdomen that increases prior to or during menstruation is
the major symptom of which of the following conditions?
a. cystitis
b. vaginitis
c. endometriosis
d. PMS
56. Varicose veins are common in women who do which of the following all day long?
a. yard work
b. sit or stand
c. walk
d. move or lift objects
57. To help prevent toxic shock syndrome (TSS), it is best to do which of the following
when using a tampon during menstruation?
a. use a deodorant type
b. use a non-deodorant type
c. change tampons often
d. avoid those with an applicator
58 . Symptoms of toxic shock syndrome (TSS) include all of the following EXCEPT:
a. high fever
b. sore throat
c. rash
d. reduction in body temperature
59 . Which o f the following, if done on a regular basis, generally lessens menstrual cramps
and the need for medication?
a. resting
b. exercising
c. sitting
d. sleeping
226
60. A common side effect of using an IUD is the increase in risk of which of the
following?
a. cystitis
b. pelvic infection
c. cervical cancer
d. endometrosis
61. Cigarette smoking has been shown to increase the risk of which type of cancer?
a. breast
b. cervical
c. uterine
d. ovarian
62. Which of the following is considered a high risk factor for endometrial(uterine)
cancer?
a. cigarette smoking
b. use of oral contraceptives
c. progesterone therapy for any length of time
63. All of the following are risk factors for cervical cancer EXCEPT:
a. frequent sex with many male partners
b. poor genital hygiene
c. unusual vaginal discharge between periods
d. being between twenty and thirty years o f age
64. Ovarian cancer and cancers of the bowel, breast, and uterus all have which of the
following factors in common?
a. obesity
b. cigarette smoking
c. high fat diet
65 . All of following are measures for the treatment of fibrocystic disease EXCEPT:
a. wearing support bra
b. restricting the intake of sodium
c. restricting the intake of fat
d. abstaining from caffeine.
66. All of the following are benefits of exercise such as cycling and swimming EXCEPT:
a. lowers risk of developing heart disease
c. assists treatment o f osteo and rheumatoid arthritis
67. Family medical history is an important risk factor for all of the following diseases
EXCEPT:
a. all cancers
c. diabetes
d. nutritional anemia
227
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout p erm ission .
QhkcUvc#5- Emotional and mental health;
68 . _____ Which of the following occupations has the highest level of job-related stress?
a. retail clerk
b. cashier
d. secretary
69 . Common health problems related to stress among women include all of the following
EXCEPT:
a. migrane headaches
b. back pain
c. gray hair
d. peptic ulcers
70 . Which of the following coping strategies for stress is the most healthful?
a. exercise
c. sleeping aid
d. discussion
71 . The most common cause o f depression is:

a. malnutrition
b. a loss
c. stressorfs)
d. heredity
72 . _____ A woman who has anorexia nervosa is at great risk for which o f the following?
a. hypertension
b. overeating
c. cardiac arrest
d. diabetes
73 . _____ All of the following are common symptoms of anorexia nervosa EXCEPT:
b. eating binges
c. amenorrhea
d. hyperactivity
74 . _____ At recommended doses, which of the following is the most commonly reported side
effect of tranquilizer pills?
a. anxiety
b. daytime sedation
c. insomnia
d. depression
75 . _____Which of the following is the best and healthiest way to rellieve a mild case of
depression?
a. calcium
b. exercise
c. sunshine
d. vitamin B
228
76 . _____ Advice from health experts for sleeping problems usually include all of the following
EXCEPT:
77 . _____ Which o f the following is symptomatic of a woman suffering from manic-depression?

a. extreme depression, then suicidal
78 . _____ Which characteristic below relates to the woman who is at greatest risk forcommiting
suicide?
b. being married
79 . All of the following are common symptoms of anxiety EXCEPT:

a. reclusion
b. mental tension
Objective #6 - Safety and Security;
80. ____ Where do most rapes occur?

a. dark alley
b. victim's car
c. victim's place of employment
d. victim's or rapist's home
81. All of the following problem areas may precipitate domestic violence EXCEPT:
a. economic stress
b. woman's jealousy
c. man's jealousy
82. _____A common personality trait of a date rapist primarily includes:

229
83 . _____ All of the following are true statements about rape EXCEPT:
84 . _____ All of the following are examples of sexual harassment EXCEPT:

d. continually smiling at someone
85 . _____ According to crisis treatment experts, the safest course of action for a woman who is a
continual victim of domestic violence is to:
b. call the police
c. go to a women's shelter
86 . _____ Which of the following characteristics is common among victims of domestic

violence?
a. addicted to drugs or alcohol
b. unemployed and always at home
c. aggressive behavior toward spouse
d. dependence on spouse for financial and emotional support
87 . The value of a friend for a victim of rape is to:

c. report the crime
Objective #7_- Gynecological procedures and female surgeries:
88. ____ A hysterectomy is a surgical procedure which removes the:

a. ovaries
b. fallopian tubes
c. cervix
d. uterus
89. ____ The PAP smear is a procedure done by a gynecologist for the diagnosis of:
a. cystitis
b. ovarian cancer
c. cervical cancer
d. endometriosis
230
90 . The breast cancer screening procedure that can determine whether a lump is a benign
cyst or a malignant tumor is called:
a. ultrasound
b. mammography
c. chest X-ray
d. breast self-examination
91 . The CA-125 blood test provides screening for what type of cancer?
a. breast
b. uterine
c. ovarian
d. colorectal
92 . _____ A major concern about estrogen replacement therapy (ERT) is in relation to the
increased risk of:
a. osteoporosis
c. obesity
d. heart disease
93 . _____ Certification of mammography facilities by the American College of Radiology is for

quality standards in all of the following areas EXCEPT:
a. dose
b. image quality
c. equipment
94 . _____ Dilation and Curettage (D&C) is a gynecological procedure that is useful for all of the
following purposes EXCEPT:
b. evaluation of infertility
95 . _____Conization is a gynecological procedure that is useful for the removal of:

a. a breast lump
d. genital warts
96 . ______ In diagnosing iron deficiency, which of the following is the most acceptable reading
for hemoglobin in adult women?
a. 6gm
b. 8gm
c. 10 gm
d. 12 gm
97 . _____What is the safest and easiest way for a woman to deliver a child?
c. squatting
d. standing
231
98. _____Indications for a cesarean delivery include all of the following EXCEPT:
a. unacceptable weight determined by an obstetrician
b. active maternal gonorrhea
c. premature breech position
d. pregnancy-induced hypertension
99. Abrupt surgical menopause occurs in premenopausal women who have which of the
following female surgeries:
a. hysterectomy
b. salpingectomy
c. oophorectomy
d. tubal ligation
100. Which of the following is a common surgical procedure for invasive cervical cancer?
a. oophorectomy
b. hysterectomy
c. cryosurgery
d. conization
Objective #8 - Jfealtfa services for women & factors affecting women's health;
101. _____ The Equal Rights Admendment (ERA) would guaranteed which of the following:
b. coed restrooms
c. loss o f child custody
102. _____ The likelihood of a woman receiving any necessary hospitalization is dependent, to a
high degree, on which of the following?
a. health status
b. age
c. choice
d. access to hospital
103. _____ A major focus of a birthing unit in a hospital is on which of the following?
a. reduce the cost o f pregnancy, labor, and delivery
105. All of the following statements about insurance coverage is usually true EXCEPT:
d. companies may not cover preventive health services, such as mammography
232
106. _____The General Accounting Office found that women have been purposely excluded
from which o f the following by the National Institutes of Health?
a. employment
b. research
c. education
107. _____All of the following statements about poverty are true EXCEPT:
d. the working poor usually do not have health insurance
108. All o f the following are techniques used in holistic medicine EXCEPT:
a. diet improvement
b. exercise
c. drug therapy
109. Women's health centers should approach women's health with which o f the
following perspectives?
a. treatment
b. wellness
c. pharmacological
d. non-intervention
110. Research has shown that all o f the following factors below contribute to a higher
degree of adjustment for women after divorce EXCEPT:
a. full-time job
c. availability o f welfare
111. Which occupation below is most likely ignored by group health insurance coverage?
a. hotel maid
c. dental assistant
112. A higher rate o f poor health among uninsured women is related to which of the
following?
113. Which of the following aige groups of women usually has little or no health
insurance?
b. 19 to 24 years
c. 25 to 54 years
d. 65 and over
233
114._____How does out-of-pocket medical expenses for married women usually compare to
those for divorced women?
a. higher
b. lower
c. same
115 . Which situation below may automatically cause a woman to lose health insurance
coverage?
a. marriage
b. spousal death
c. major illness
Objective #9 - Contributions bv women to medical and health care field:
116 . ____ The proportion o f women enrolled in medical schools since 1900 has:
a. decreased
d. stabilized
117. ____ In the nineteenth century, childbirth was performed almost exclusively in the home
by:
a. physicians
b. family members
c. midwives
d. nurses
118. _____At least which percentage of health care workers are women?
a. 25
b. 50
c. 60
d. 75
119. ____________The caregiver of elderly parents is usually which of the following?

a. daughter
b. son
c. nurse
d. close relative
120 . ______All o f the following are purposes o f the American Nurses Association EXCEPT:
c. provide a code of ethics
234
121. Which,of the following health field occupations usually has a career ladder?
a. registered nurse
b. licensed practical nurse
c. physician
d. physician's assistant
122. All of the following strategies by nurses can reduce nursing sex-role stereotyping
EXCEPT:
c. confronting colleagues who seek dates from male physicians
d. confronting colleagues who participate in the "doctor-nurse" game
Objective #10 - Assertiveness and self-expression among women:
123 . _____Which of the following behaviors is representative of assertiveness while speaking?

c. twirling hair
d. shifting feet
124. _____Why do some women who enter nontraditional occupations sometimes face problems
and hazards?
c. they were not considered during design of the woik environment
125. _____ Which of the following is the most common reason for a reduction in intimacy
between a husband and wife during middle adulthood, ages 30 to 40?
a. sexual dysfunction
126 . F o r a w o rk in g w o m a n w ith c h ild re n a n d a h u s b a n d , a ll o f th e fo llo w in g is s u e s

usually cause stress EXCEPT:
a . r o le o v e rlo a d
b. timing of career and children
c. lack of encouragement from husband
d. lack of encouragement from employer

c. standing up for one's own rights
235
128. Assertiveness training teaches women to do all of the following EXCEPT:
129. Assertive sexuality involves all of the following behaviors EXCEPT:

a. self-responsibility for protection against disease and/or pregnancy
b. having the partner be responsible for protection against disease and/or pregnancy
130 . Possessing which o f the following means possessing the attainment of self-
actualization?
a. love
b. safety
c. self-esteem
d. acceptance by others
This concludes the testing portion of the test. Please complete the demographic
survey form found on the next page.
Womens Health Knowledge Test

Copyrighted, 1991
without prior authorization by the author.
236
Demographic Survey Form
Please answer the following questions and return this form along with your
answer sheet:
Organization/College:__________________City & State:______________
Race:______________________ Birthdate:______
Last grade completed:__________
Have you ever taken a college-level women's health course? Y es No _
Do you have a bachelor's degree from an accredited college? Y es No
If yes, degree and major:_____________________________
Do you have a degree from a vocational/technical college? Y es N o_
If yes, degree and major:______________________________
Occupation:____________________
If retired, what was your occupation before retirement?_______________
Religious affiliation:__________________
Marital status:_______________________
Do you have children? Y es N o ____
If yes, how many children do you have?______
What is your state of health? Excellent Average Poor____
Thank you again for your cooperation. -Susan Butler
Copyrighted, 1991
without prior written authorization by the author.
237
Test Key
1. a 21. b 41. b 61. a
2. c 22. a 42. d 62. d
3. d 23. d 43. c 63. d
4. c 24. c 44. b 64. a
5. d 25. c 45. b 65. b
6. a 26. d 46. b 66. d
7. c 27. a 47. b 67. d
8. c 28. c 48. a 68. d
9. c 29. c 49. a 69. c
10. d 30. b 50. c 70. a
11. a 31. b 51. b 71. b
12. b 32. a 52. b 72. c
13. a 33. c 53. b 73. b
14. a 34. a 54. a 74. b
15: a 35. c 55. c 75. b
16. a 36. a 56. b 76. a
17. b 37. c 57. c 77. b
18. b 38. b 58. d 78. d
19. c 39. b 59. b 79. a
20. c 40. b 60. b 80. d
238
WHKT Key, Cont.
81. b 101. a 121. c
82. b 102. d 122. c
83. d 103. c 123. a
84. d 104. b 124. c
85. c 105. c 125. d
86. d 106. b 126. c
87. a 107. c 127. c
88. d 108. c 128. d
89. c 109. b 129. b
90. a 110. c 130. c
91. c 111. a
92. b 112. b
93. d 113. b
94. c 114. b
95. b 115. b
96. d 116. b
97. c 117. c
98. c 118. d
99. c 119. a
100. b 120. d
239
APPENDIX J
RANK ORDER OF SCORES FOR PRELIMINARY TEST
Rank Order of Scores for Preliminary Test
Raw Score Percentage Grade Rank Order
99 76 1
98 75 2
94 72 3
91 70 4
88 68 5 .5
88 68 5 .5
87 67 7
86 66 8
84 65 9
82 63 10
80 62 11.5
80 62 11.5
78 60 13
74 57 14
73 56 15.5
73 56 15.5
72 55 17
70 54 18
66 51 19
63 48 20.5
63 48 20.5
43 33 22
241
APPENDIX K
MEASURES OF CENTRAL TENDENCY AND
VARIANCE FOR PRELIMINARY TEST
Preliminary Test
Measures of Central Tendency and Variability
Score Frequency Cumulative Frequency
99 1 1
98 1 2
94 1 3
91 1 4
88 6
87 1 7
86 1 8
84 1 9
82 1 10
80 12
78 1 13
74 1 14
73 16
72 1 17
70 1 18
66 1 19
63 2 21
43 1 22
1732 22
N = 22
Mean (X) = -S u m of-X = = 78.73
N 22
Median = point of distribution where 50% of scores are
above and below = 80
Mode = scores that occurs most often = 88,80,73,63

Measures of Variability
(Range, Standard Deviation, and Variance)
Range = high score minus low score = 56

Standard Deviation = 13.17
Variance = 173.54
243
APPENDIX L
ITEM A N A LY SIS CHART FOR THE PRELIMINARY TEST
Itan Analysis chart for Pilot Teat
Remarks for Remarks for Reasons for

Item Index of Discrimination Index of Difficulty Rejection
Humber Discrimination (A) Difficulty (B) (C)
1 0.2 s 77.3 E
2 0.2 3 4.5 D
3 0.2 0 36.4 A u
4 0.6 V 63.6 A
5 0 L 100 E E
6 0.4 S 54.5 A
7 0 L 0 D
8 0 L 36.4 A
9 0.4 U 18.2 D U
10 0.2 S 68.2 A
11 0.2 S 81.8 E
12 0.2 S 27.3 D
13 0.2 U 59.1 A u
14 0 L 81.8 E
15 0.2 S 27.3 A
16 0 L 0 D D
17 0 L 90.9 E
18 0.2 S 31.8 A
19 0 L 36.4 A
4
20 0.4 S 68.2 A
21 0.2 S 90.9 E
22 0.2 S 90.9 E
23 0 L 95.5 E L,E
24 0.2 S 95.5 E E
25 0 L 95.5 E L,E
26 0.2 S 86.4 E
27 0.2 S 9.1 D
28 0.2 S 68.2 A
29 0.6 V 81.8 E
30 0.4 s 40.9 A
31 0.4 s 77.3 A
32 0.4 8 40.9 A
245
Item Analysis Chart for Pilot Tost

Number Discrimination (A) Difficulty (B) (C)
33 0.2 S 72.7 A
34 0 L 77.3 A L
35 0 L 81.8 E L,E
36 0.2 S 95.5 E
37 0.2 S 13.6 D
38 0.4 s 81.8 E
39 0.6 V 50 A
40 0.4 s 90.9 E E
41 0.2 s 90.9 E T,E
42 0 L 100 E E
43 0.2 S 50 A LD,T
44 0.2 3 86.4 E LD,E
45 0 L 50 A LD
46 0.4 3 72.7 A T
47 1 V 59.1 A
48 0.2 3 81.8 E LD/E
49 0.2 3 54.5 A
50 0.8 V 31.8 A
51 0.6 V 36.4 A

52 0.2 3 95.5 E ID/E
53 0.6 V 59.1 A
54 0.4 3 59.1 A
55 0.4 3 72.7 A
56 0.4 3 86.4 E E
57 0.2 3 90.9 E ID,E
58 0 54.5 A ID
59 0.4 3 90.9 E E
60 0.6 V 72.7 A
61 0.2 S 50 A T
62 0.4 S 27.3 D D
63 0.4 S 59.1 A T
64 0 L 0 D LD,D
246
Item Analysia chart for Pilot Teat

65 0 L 13.6 D LD,D
66 0.6 V 40.9 A
67 0.2 s 95.5 E E
68 0.2 s 27.3 A
69 0 L 95.5 E LD.E
70 0.4 s 54.5 A LD
71 0 L 31.8 A
72 0.4 S 77.3 A
73 0.6 V 45.5 A
74 0 I 50 A ID
75 1 V 63.6 A
76 0.6 V 72.7 A
77 0.4 s 81.8 E
78 0.2 s 59.1 A
79 0.2 s 72.7 A
80 0.4 s 90.9 E E
81 0.4 s 54.5 A
82 0.4 s 31.8 A
83 0.6 V 81.8 E
t
84 0.2 s 72.7 A
85 0.4 s 77.3 A
86 0 L 81.8 E LD.E
87 0.4 S 86.4 E E
88 0.8 V 68.2 A
89 0.8 V 81.8 E
90 0.6 V 18.2 D
91 0 L 31.8 A ID
92 0.4 S 59.1 A
93 0.4 S 90.9 E
94 0.2 s 31.8 A
95 0.4 s 40.9 A
96 0.4 s 18.2 D D
2 47
Itan Analysis Chart for Pilot Test
RemarkB for Remarks for Reasons for

97 0.6 V 59.1 A
9B 0.2 a 18.2 D D
99 0.2 a 13.6 D D
100 0.2 a 54.5 A
101 0.5 V 77.3 A
102 0.15 u 54.5 A U
103 0 L 95.5 E
104 0.3 S 63.6 A
105 0.55 V 59.1 A
106 0.75 V 53.6 A
107 0.1 L 50 A
108 0.25 S 90.9 E
109 0.05 L 77.3 A
110 0.3 S 77.3 A
111 0.15 L 45.5 A
112 0.35 S 36.4 A
113 0.3 S 50 A
114 0.5 V 77.3 A
115 0.8 V 31.8 A

4
116 0.3 s 72.7 A
117 0.05 L 77.3 A LD
118 0.2 S 18.2 D D
119 0.25 S 90.9 G
120 0.5 V 90.9 E
121 0.15 L 27.3 A LD
122 0.55 V 40.9 A
123 0.25 s 95.5 E
124 0.4 s 27.3 A
125 0.5 V 86.4 E
126 0.2 s 9.1 D D
127 0.75 V 86.4 E
128 0.5 V 77.3 A
248
Item Analysis Chart for Pilot Test

129 0.5 V 81.8 E
130 0.05 L 77.3 A LD
(A) (B) (C)

I Low A Accceptable D Too difficult
S * Satisfactory D Difficult E Too eaBy
U = Unsatisfactory E = EaBy LD = Low discrimination
V = Very good T = Accommodate table of
specifications
U * Unsatisfactory
249
APPENDIX M
NUMBER OF RESPONSES FOR ITEM ALTERNATIVES
FOR PRELIMINARY TEST
group
PAGE NO. 1
APVANCgP ANAfcVSIS-
------------------------------------ RESPONSES----------------------------------------
QUESTION DISCS PERCENT
NUMBER 2/3/A/5 VALUE CORRECT
------- Bh n* A----- B e B------- E N o rte -'------------------
1. 0 [ 17] 1 0 4 0 0 0.17 77.3

1------- 0------- 1 1- [ -t ] H ---- 9------- 0 OriO ttr-
3. 2 4 7 1 [ 6] 0 0 -0.13 36.4
4. 0 3 3 [ 14] 2 0 0 0.67 63.6
r. 0-------0------ 0 O' [ 27]----- 0-------0----- W O t f l i w -
6. 0 [ 12] 1 3 6 0 0 0.30 56.5

r.---1 tt s fol o o o crroo <w-
5. 2 3 9 ( 8] 0 0 0 0.10 36.6
9. 2 9 2 ( 4] S 0 0. -0.17 18.2
to : ----- o tr ;------1' "[ i s ] 11 o ori7 r r -
11. 1 ( 18] 2 0 1 0 0 0.30 81.8

TT.------ (T------ 8 ' [ "6] 0 ------ 8----- 0------ 0--------0 3 7 ----2 7 3
13. 1 (1 2 ] 8 0 1 0 0 0.10 54.5
14. 1 [ 18] 1 0 2 0 0 0.17 81.8
153------ 0 ( 6]----- 1-------- a------- 1----- 0------ 0------- 0 3 0 ----- 2773
16. 1 ( 0] 0 0 21 0 0 0.00 0.0

17. ' I----- 1 ( 19]----- 0----- " I ----- 0------- 0 ~ 0 133----- 8674
18. 1 0 ( 7] 0 Uv.-:'.' 0 0 . 0.23 31.8
19. 3 1 11 [ 7] 0 : 0 . . 0 0.20 31.8
20:------- 1------- 1------- 5 11 ( 15]" " ' " "0------ 0 0----- 0747----- 6872
21. 1 0 [ 20] 0 1 0 0 0.17 90.9

227-------3 [ 19 1 0------ 0 - 0 " - - 0 ; 0----- 0 3 0 ------ 8 8 7 1 -
23. 0 1 .. ...0 . 0 211 0 0 0.00 95.5
24. 1 0; 1. ( 2 0 ] 0 0 0 0.33 90.9
25:-------0--------0----- 0"""( "2fl------- 1----- 0------- 0------- 07OT----9 5 3 ~
26. 1 2 0 0 [ 19] 0 0 0.33 86.6

277------- 1 f 2 j 19------ 0 0------- 0------ 0----- 0 3 0 ------ 971
23. 1 1 5 [ 14] 1 0 0 0.47 63.6
29. 1 1 0 ( 18 ) 2 0 0 0.33 81.8
30:------- 0------- 3 " [ 9]------ 8------- 0-------0------- 0----- W J- 4 W ~
31. 1 3 ( 16] 2 0 0 0 0.67 72.7

: ( ] "- 5------ :2 'T 0 o- 0:10 - 4 0 :9 -
33. 1 2 1 ( 151 3 " 0 0 0.33 68.2
34. 1 ( 16] 4 0 1 0 0 0.13 72.7
35."" " 2------- 0------ 0 [ 17) - 3 ------ 0 - fr-----Br30 Thi~
36. 2 ( 20] 0 0 0 0 0 0.33 90.9

37:------ 2------ 16--------1 { - -3j---- 0------- 0------ 0------- 0r23---- B t6 -
38. 2 0 ( 18] 2 0 0 0 0.33 81.8
39. 3 0 ( 1 1]; 8 0 . 0 : 0 0.63 50.0
251
group
PAGE NO. J..
ADVANCEP' AHALY3I5
Afl: ----- 3------- -0 h ? )----- Q----- 0 - 0 - ----- 0 1 W 0 ----- 8 < r t-

41. 2 Q (1 8 ] 2 0 0 0 0.50 81.8
42. 2 0 0 0 [ 20] 0 0 0.33 90.9
-Sft------ 2-------- 3----- 4" " '[ 9)'" 4 ------ 0------0------- tW 3---- 4 ftT "
44. 2 1 [ 18] 1 0 0 0 0.33 31.8
-4 ft------ 3-------- 2- 1 - 1 0 ]------ 4----- 5 "----- 0 - 0 M O ----- 4 f t t "

46. 2 4 [1 5 ] 0 1 0 0 0.63 68.2
47. 3 0 [ 12] 0 7 0 0 0.83 54.5
- t f t ------ 2 {-13]------- 3------- 0------- 1 0---- 0 MO 7 ft? -
49. 1 [ 12] 3 3 3 0 0 0.30 54.5
-5 ft 1------- 3.........1... ( " 7 ] ------ 3------ 0 - 0 0.63 31.8"

51. 3 6 (8 ] 1 4 0 0 0.80 36.4
52. 3 0 [ 18] 1 0 0 0 0.67 81.8
-5ft------ 1-------- 0 [- 13 ]------0------ 3------- 0---- 0------- 0 * 3 ---- 5 9 r t-
54. 3 [ 13] 6 0 0 0 0 0.30 59.1
-5ft------ 1---------1----- 0- [ 16]------- 4------- 0---- 0------- 0r30---- T ftft-

56. 0 0 [ 19] 0 3 0 0 0.17 86.4
57. 3 0 0 [1 7 ] .2 0 0 0.83 77.3
-5 ft------ 3-------- 1------- 6-----2 H o)-------- 0------ 0 orto ---- 4 5 * -
59. 4 1 [ 17] 0 0 0 0 0.83 77.3
-6 ft------ 2------- 0 " [ 15}----- 4--------1 0------0------- M 3 ---- 6 f tf t-

61. 4 [ 10] 2- . 5 1 0 0 0.07 45.5
62. 3 9 2 3 [ .5 ] 0 0 0.27 22.7
-6ft------ 1-------- 2------- 5-----2' [-12 ]-------- 0------ 0 =0*3---- 5 M ~
64. 1 [ 0] 4 17 0 0 0 0.00 0.0
6ft------ 3------- 14 [ - 2 ] ------ 2------- 1------- 6---- 0------- ft2 0 ----- W -

66. 2 0 2 9 [ 9] 0 Q 0.27 40.9
67. 2 0 0 0 [20] 0 0 0.33 90.9
6ft------ 3------- 0----- 0-------- 14 {-- ; ]------0---- 0------- ft? 3 ---- 2 ft7 ~
69. 2 0 0 [ 20] 0 0 0 0.33 90.9
-7ft------ 3 [-12]------- 2------ 3------ f t------- 0---- ft------- ft5 0 ---- 5 4 * -

71. 2 0 [ 6] 12 2 0 0 0.20 27.3
72. 1 1 1 [ 17): 2 0 0 0.30 77.3
-7ft------ 3------- 1 [ - 3 ] ----- 3 7------- 0------ 0------- M O ---- 3 6 * -
74 . 3 2 [ 11] 0 6 0 0 0.27 50.0
75. " . " I t 14] 4 ; ....1 '.- ----- 0------ 0 ftOO 63*-
76. 2 [15] 2 1 .2 0 0 0.67 68.2
7 7 . - 1 0 [18] 1 2 0 0 0.33 81.8
7ft-------3------- 3----- a--------- 5 H t ) ------0---- 0------- 0 * 3 ---- 5 0 * -
79. 1 [ 15] 0 5 1 0 0 0.50 68.2
-6ft-------1-------- 1------0--------- 0 H 0 ] ----- 0---- 0------- 0 * 3 ---- 9fcft

81. 4 7 [11] 0 0 0 0 0.43 50.0
82. 2 0 [ 7] 0 13 0 0 0.23 31.8
252
group
PAGE NO. 3
ADVANCEO"ANALYSIS'
8S r "t 1------- 1 [ 1 8 ] " - * 5 6 ----- 8 h *

84. 0 5 [15] 0 0.27 68.2
85. 1 [ 17] 2 0 0.50 77.3
-1ST -o t-H rt- -6 we- -fti-
87. 3 [ 18] 1 0 0 0 0.50
-38r - 1 (- 15)------ft- -W7-- 68t2-

89. 2 0 1 [ 18] t 0 0 0.67 81.8
90. 3 [ 31 16 0 0 0 0 0.60 13.6
-Ofc-------- 4------- 1----- - { " 71------- 8------- 0------ 6------0:93----- 3 tr0 -
92. 3 4 [ 11] 1 3 0.80 50.0
-5 3 :------- 1------- 1------- 0------- 0 H O ] ----- 6-------6----- 0r33----- 9 0 *

94. 2 7 6 [ 7] 0 0 0 0.23 31.8
95. 3 1 [ 9] 1 8 0 0 0.43 40.9
- 9 f t------ 4------- 0------- 4------10 " [ 4 ] 0------ 0----- 0:23' '" "1 8 .2
97. 2 7 0 [ 13] 0 0 0 0.30 59.1
"98:------- 1------- tr~ J E s i------ 6------- 0------ 0----- 9:40----- r t r t

99. 2 14 . 2 .[ 3] 1 Q 0 . 0.03 13.6
100. I l l 12] 4 4 0 0 : 0.10 54.5
Number of Sheets Processed: 22
.......... .. rib -------- Percent---------

. . Scores Scores
1 ~ nbAHI" ' :" "57.2 ' 57 . 2

STANDARD DEVIATION: 14.1 14.1
HIGHEST GRADE : 77 77
LOWEST GRADE------ T ~ -------"-2 2 " ' " : -----
RANGE OF SCORES : ' 55. 55
253
:jrw \
PACE NO. 1
:- --------- ADVANCEO ANALYSIS"-----
----- ------------RKIW SK -----------------

OUESTION ------------------------------------------- DISCR PERCENT
NW1BER 2/3 /4 /5 VALUE . CORRECT
. Blank A- - - B- - - E D Harka- - - - - - - -
1. 4 [ 16] 1 1 0 0 0 0.67 72.7

h-------- 1----- 1---------9----- f t - (12]------ 0------ 0----- 8:6?------ 54r6 -
3. 0 0 1 [21] 0 0 0 0.00 05.5
4. 2 0 [ 13) 2 5 0 0 0.47 50.1
5;-------- 0----- 1--------- 0 ( 13]----- 5-------- 0----- 0----- 0 t47------ 5 M ~
6. 1 0 [1 3 ] 1 7 0 0 1.00 50.1
t -------1------- 0------- H f l ---- 1------- 0---- -6 -6:0?- 50r0~
8. 0 0 0 [ 20] ..'. 2 0 . 0 0.33 . 00.9
9, 1 2 [16] 0 -3 0 0 0.47 72.7
10:-------- 1----- 0-------3 [ 16] 2 0 0 ------ M l ------ 7 2 r7 -
11. 1 [ 10] 0 5 6 0 0 0.07 45.5

It 1--- 2 [8]-- -1--- 9 0 0 0:68 -- 3674-
13. 0 1 [ 11] 4 6 . 0 0 0.47 50.0
14. 1 2 [ 17] If; 1 ' 0 0 0.67 77.3
I t --------0-----1 [--- 7]-----0----- 14 -fl------0----- OrW
16. 1 0 [ 16] 5 0 0 0 0.13 72.7

- 1 7 . - - 1------ 0 4 ' [ 17] - O ' 0. . 0 ; - 0.13 : 7 7 :3 "
18. 3 2. 3: 10 t * ] ;V 1 0 , 1; 0 0 .2 0 :: 18.2
10.. . 2 [ 19]- 0...: ... 0 ;. V O . v V O " 0 . 6 7 ' ' " 86.4
20: ' 1------- 0 l ' '(- 20) '0 " " " ; O'" " ' 0.67------ 90^
21. 2 10 3 [ 6] 1 0 0 0.07 27.3

22;--- S-- 0- 2 [ 8]' 9':-.'.0 '. 0 0 .8 0 -- 3 6 :6 -
23. 2 [20] 0 0 0 0 0 ^ . 3 3 : 90.9
24. 1 2 13 [ 6 ] 0 0 0 0.40 27.3
25:------- 1----- 1------- 1----- 0 ["13]""'--- 0------- 1----- (W7 SM -
26. 1 1 11 [ 2] 7 0 0 0.20 9.1

27;-------- 1-----0 3 " [ 18]----- 0------ 0-------- 0--- MO----- 8
28. .3 0 2 0 [17] 0 0 0.6 7 .. 77.3
29. 1 1 [ 17] 1 2. 0 O' 1.00 ; 77.3
30:--------- !----- 2------- 0 [ 16]----- 3 "" 0 ' 0------ 0713------ Ttf~
r-77 " NlffltW 'Qf SOWtr fTBCgSStd!' '22"
254
APPENDIX N
FREQUENCY AND RANKS OF SCORES FOR FINAL TEST
Frequency and Rank Order of Scores for Final Test
Percentage Cumulative
Raw Score Grade Frequency Frequency Rank Ore
75 88 1 1 1
70 82 2 3 2.5
69 81 2 5 4.5
68 80 2 7 6.5
67 79 11 18 13
66 78 4 22 20.5
65 76 10 32 27.5
64 75 11 43 38
63 74 14 57 50.5
62 73 15 72 65
61 72 21 93 83
60 71 24 117 105.5
59 69 32 149 133.5
58 68 37 186 168
57 67 23 209 198
56 66 43 252 231
55 65 34 286 269.5
54 64 36 322 304.5
53 62 37 359 332
52 61 25 384 372
51 60 35 419 402
50 59 23 442 431
49 58 19 461 452
48 56 25 486 474
47 55 18 504 495.5
46 54 11 515 510
45 53 15 530 523
44 52 18 548 539.5
43 51 11 559 554
42 49 13 572 566
41 48 4 576 574.5
40 47 6 582 579.5
39 46 6 , 588 585.5
38 45 2 590 589.5
37 44 6 596 593.5
36 42 3 599 598
35 41 6 605 602.5
34 40 2 607 606.5
33 39 1 608 608
32 38 1 609 609
31 36 2 611 610.5
30 35 2 613 612.5
27 32 2 615 614.5
26 31 1 616 616
17 20 1 617 617
256
APPENDIX 0
MEASURES OF CENTRAL TENDENCY
AND VARIANCE FOR FINAL TEST
Final Test
Measures of Central Tendency

(Mean, Median and Mode)
N = 617
Mean (X)
_ Sum of X 32715 _ ^
N err _ 5 3
Median = point of distribution where 50% of scores are
above and below = 54
Mode = score that occurs most often = 56
Measures of Variability
(Range, Standard Deviation, and Variance)
Range = high score minus low score = 5 8
Standard Deviation = 7.8
Variance = 61.48
258
APPENDIX P
ITEM ANALYSIS CHART FOR THE FINAL TEST
Item Analysis Chart for Final Test
Remarks for RemarkB for Reasons for

1 0.11 L 87.8 E LD, E
2 0.22 S 85.3 E
3 0.19 L 80.6 E
4 0.29 S 71.2 E
5 0.37 S 80.2 E
6 0.41 V 65 A
7 0.35 s 62.2 A
e 0.14 L 24.8 D
9 0.09 L 46.8 A
10 0.06 L 15.2 D
11 0.23 S 37.8 A
12 0.33 S 41 A
13 0.08 L 21.6 D
14 -0.02 U 8.4 D N
15 0.12 L 92.5 E
16 0.09 L 95.5 E
17 0.06 L 80.2 E
18 0.2 S 74.7 E
19 0.26 S 65.5 A
20 -0.05 u 24.5 ' D N
21 0.1 L 96.9 E LD, E
22 0.47 V 76.7 E
23 0.05 L 89.3 E
24 0.64 V 53.3 A
25 0.28 s 65.3 A
26 0.4 V 56.1 A
27 0.5 V 52.5 A
28 0.1 L 53.2 A
29 0.04 L 11 D LD, D
30 0.51 V 53 A
31 0.44 V 72.6 E
32 0.57 V 52.2 A
260
Item Analysis Chart for Final Tost

item Index of Discrimination Index of Difficulty Rejection
33 0.32 S 69.4 A
34 0.39 S 58.3 A
35 0.32 s 62.2 A
36 0.08 L 44.9 A LD, T
37 0.3 S 30.1 D D, T
38 0.5 V 37.1 A
39 0.52 V 75.4 E
40 0.36 s 78 E
41 -0.06 u 48.6 A N
42 0.27 s 82.3 E
43 0.23 8 79.6 E
44 0.15 L 50.2 A
45 0.22 S 59.3 A
46 0.21 S 36.8 A
47 0.09 L 13.8 D LD, D
48 0.22 S 76.2 E
49 0.14 L 91.1 E
50 0.22 S 80.9 E
51 0.44 V 61.6 A
52 -0.01 u 43.9 ' A K
53 0.37 s 86.9 E
54 0.17 L 91.9 E LD, E
55 0.3 s 83.1 E
56 0.11 L 59 A
57 0.46 V 64.8 A
58 0.12 L 57.9 A
59 0.32 S 57.4 A
60 0.18 L 25.1 D
61 0.15 L 20.4 D LD, D
62 0.16 L 89.8 E
63 0.28 S 91.4 E
64 0.18 I 87.7 E LD, E
261
Item Analysis chart for Final Test

65 0.32 s 87.2 E
66 0.28 s 67.9 A
67 0.43 V 55.8 A
68 0.54 V 68.9 A
69 0.49 V 50.2 A
70 0.35 s 71.8 E
71 0.33 s 38.2 A
72 0.27 s 66 A
73 0.08 L 66.5 A
74 -0.05 U 38.2 A N
75 0.1 L 29 D
76 0.22 S 90.4 E
77 0.39 S 76 E
78 0.22 S 73.9 E
79 0.16 L 42.3 A
80 0.09 L 97.6 E LD, E
81 0.18 L 88.5 E
82 0.29 S 88 E
83 0.23 S 87.4 E
84 0.16 L 94.3 ' E
85 0.19 L 35.8 A
(A) (B) (C)

L = Low A = Accceptable D = Too difficult
S = Satisfactory D = Difficult E = Too easy
U Unsatisfactory E Easy LD Low discrimination
V = Very good T Accommodate table of
specifications
N Negative discrimination
262
APPENDIX Q
NUMBER OF RESPONSES FOR ITEM ALTERNATIVES
FOR FINAL TEST
final test
PA GE N O . .1
ADVANCED A N A L Y S IS
RESPO N SES
Q U E S T IO N --------------------------------------------------------------------
IMBER 2 /3 /4 /
R 1ank. A R c 0 E Mark
t. 2 62 [542] 3 3 0 0
2. 4 C3261 50 21 16 0 0
3. 7 [497) IS 27 67 I 0
4. 0 f4391 56 11 111 0 0
5. 0 14 82 24 [495] *v 0
6. 1 55 33 [401] 75 1 1
7. o T334 ] 41 1 93 0 I
g. o 102 349 [153] 11 0 0
9. 0 13 291 [299] 24 0 0
10. 1 30 [ 94] 17 473 1 I
11. 2 [233] 46 256. 30 0 0

12. 2 176 [253] 5 131 0 0
13. 0 50 46 [133] 387 1 0
.1.4. 1 323 .223 [ 52] 13 a 0
IS.'" 1 7 [571] 4 33 0 I
16. 0 [589] 15 2 11 0 0
17. 0 84 34 3 [495] 1 0
18. 0 82 43 [4617 31- - ... Q 0
19. 1 53 144 [404] 15 0 0
?M. . 1 [151] 425 12 27 0 1
21., . 1- [598] 7 0 11 0 0
22.- 0 120. 5 [473] 19 0 0
23. 0 . 34- - [551] 31 1. 0 0
24. 0 81 [329] 205 2 0 0
25. .0 22 34 [403] 155 1 0
i .. ... .. .
26. 3 !- :i7 [346] 196 55 0 0
27.. 3 [324] 136 na 36 0 0
23. 1 99- [3287 121 68 0- 0
29. 1 510 32 [ 68] ' 6 0 0
30. 3 33 34 [327] 220 0 0
31. .4 17 [448] 98 49 1 0
32. 2 26 [322] 49 217 0 1
33. 1 ' 7 [4287- 17- - 164- 0 0
34. 2 [360] 246 5 4 0 0
35. 1 [384] 50 113 69 0 0
36. 1 30 62 247 [277] 0 0

37. 3 268 [186] 34 126 0 0
33 2 67 227 [229] 92 0 0
39. 3 67 [465] 13 69 0 0
264
final nest
PAGE NO. 2
ADVANCED ANALYSIS
40. 2 58 48 [481] 28 0 0
'H . I [300] 34 261 20 o 1
4 2. 1 [508] 70 11 27 0 0
47. 0 9 [491] too 17 0 0
46. 0 183 25 99 [310] 0 0
45. I [3661 35 16 149 0 0
2 57 [227] 118 212 1 0
0 35 41 455 [ 351 0 1
r n 17 65 65 r470l 0 o
I1. t 3 37 (562 ] 14 it 0
~ i'~ . l a y 102 [499] 0 0

si 3 204 [330] 6 22 o 0
.O>
i yt 68 [271] 62 253 n 0
ST. .3 38 23 16 [536] I 0
S6. 1 5 33 [567] 11 0 0
55. 1 81. 13 8 [513] 1 0

S6. o 102 [364] 17 132 0 0
57. 0 206 10 [400] 1 0 0
sa. 2 30 [357] 122 106 0 0
59. 7 52 [354] 87 116 1 0
60. 2 179 233 [155] 43 0 0

61. 4 [1261 476 9 o 0 0
62'. 1 62 5 [554] 15 0 0
63. 0 11 13 [564] 29 0 0
66. 4 [541] 12 25 35 0 a
65. 2 68 [538] 13 16 0 0
66. 0 35 112 [4191- 50 0 1
67. 0 79 " [364] 65 129 0 0
68. 2 11 [425] . 28 149 0 2
- 69. 0 . 12 [310] 15- 280 0 0
70. 0 15: 18 [643] 161 . 0 0

71. 1 25 286 [2361 71 -0 0
72. 1 58 [407] 61 90 0 0
73. 1 [410] 10 66 130 0 0
76^ 1 155 [236] 14 208 1 2
75. 1 11 [1791 60 366 0 0

r fT . 1 [5581 - 6 22 30 0 0
77. : 1 110 9 28 [469] 0 0
78. 1 26 [456] 120 16 0 a
,79, 2 .38 - 61- [261] 255 ... 0 0
' 30. 1 [602] 7 5- 2 .0 0

: 31- 0 23 23 - 25 [546] 0 0
32. 0 26 28 [563] 19 0 1
83. 0 23 [5391 25 25 0 0
; 84. 2 4 16 15 [5821 0 0
' 35. 6 37 334 [221] 19 0 0
Number- of Sheets Processed: 617
265
APPENDIX R
WOMEN'S HEALTH RESOURCES
Women's Health Resources1
Organizations:
1. National Women's Health Network (also has a newsletter)

1325 G Street, N.W.
(202) 347-1140 (see NWHN listing of resources)
2. Melpomene Institute
1010 University Avenue
St. Paul, Minnesota 55104
3. American Association of University Women (also has a magazine)
1111 Sixteenth Street, N.W.
(202) 785-7745
4. The League of Women Voters (also has a magazine)
1730 M Street, N.W.
(202) 429-1965
5. Institute for Research on Women & Gender (also has a newsletter)
Stanford University
Serra House
Stanford, California 94305-8640
(415) 723-1994 (see Institute listing of resources)
6. National Council for Research on Women (also has a newsletter)
The Sara Delano Roosevelt Memorial House
47-49 East 65th Street
New York, New York 10021
(212) 570-5001
7. Women, Health and Healing Program
Dept, of Social and Behavioral Sciences
N-631-Y
University of California
San Francisco, California 94143-0612 '
8. Center for Research on Women
Memphis State University
Memphis, Tennessee 38152
9. Women's Resource Center
Aguedilla Regional College
University of Peurto Rico
Box 160
Ramey, Peurto Rico 00604
This handout was compiled from different sources by

Susan Butler, Univ. of Tennessee doctoral candidate, Dept,
of Health, Leisure, & Safety, February 1992. I do not
claim to list the latest and all possible resources in
women's health. Nor do I necessarily hold the same views
and beliefs as these resources. Please add others as you
discover them,
267
10. Minority Women's Program
Wellesley College Center for Research on Women
Wellesley, Mass. 02181
11. Association for the Advancement of Health Education (also has a
journal)
1900 Association Drive
Reston, Virginia 22091
(703) 476-3437
12. Hysterectomy Educational Resources and Services (also has a
newsletter)
422 Bryn Mawr Avenue
Bala Cynwyd, PA 19004
(215) 667-7757
13. Planned Parenthood Federation of America, Inc.
Atlanta: 100 Edgewood Avenue, N.E.
Suite 1604
Atlanta, Georgia 30303
(404) 688-9300
Books:
1. The New Our Bodies, Ourselves (1984). The Boston Women's Health
Collective. Simon & Schuster, New York.
2. Contemporary Women's Health (1986). Griffith-Kenny, Janet.
Addison-Wesley Publishing Company.
3. For Her Own Good (1985). Ehrenreich, Barbara et all. Anchor
Books, New York.
4. Women's Health Alert (1991). Wolfe, Sidney. Public Citizen
Health Research Group.
5. Teaching Science and Health from a Feminist Prospective; A
Practical Guide (1986). Rosser, Sue. Pergamon Press: New
York.
6. Women in the Health System (1980). Marieskind, H. C.V. Mosby
Company, St. Louis, Missouri.
7. Teaching Materials on Women, Health and Healing (1986). Edited
by Adele Clark, Virginia Olesen, Sheryl Ruzek and Patricia
Anderson. Women, Health and Healing Program, University of
California, San Francisco.
8. Biology of Women (1980). Sloane, Ethel. John Wiley & Sons, New
York.
9. Women & Health: The Politics of Sex in Medicine (1983). Fee,
Elizabeth. Baywood Publishing Company, Farmingdale, New York.
10. Straight Talk, No Nonsense Guide to Woman Care (1984). American
Medical Association.
268
11. "Special Health Concerns of Ethnic Minority Women," Commissioned
Paper, Women's Health; Report of the Public Health Service Task
Force on Women's Health Issues (1985). Manley, A.; Lin-fu, J.;
Miranda, M.; Noonan, A.; Parker, T. Volume II, Public Health
Service: U.S. Dept, of Health & Human Services, pp. 37-47.
Listings of organizations and available literature:
1. American Cancer Society, your local unit

Facts on Ovarian Cancer
Facts on Breast Cancer
Facts on Cervical Cancer
2. National Cancer Institute
U.S. Dept, of Health & Human Services
Public Health Service
National Institutes of Health
(301) 496-4000
What you need to know about cancer of the cervix
What you need to know about ovarian cancer
What you need to know about cancer of the uterus
What you need to know about breast cancer
3. National Women's Health Network
1325 G Street, N.W.
(202) 347-1140
Women, AIDS, and public health policies
Childbearing policies within a national health program:
An evolving consensus for new directions
Turning things around: A women's occupational &
environmental health resource guide
Research to improve women's health : An agenda for equity
Abortion then and now: creative responses to restricted
access
Taking hormones and women's health: Choices, riskB, and
benefits
Hearts, bones, hot flashes & hormones
The diet your doctor won't give you
(see attached order form for more Materials from NWHN)
4. National Council for Research on Women
The Sara Delano Roosevelt Memorial House
47-49 East 65th Street
New York, New York 10021
(212) 570-5001
(see attached order form)
5. Center for Women Policy Studies
2000 P Street, N.W.
Suite 508
(202) 872-1770
Policy Paper: Violence Against Women
(contact the Publications Dept, for other materials)
269
KEY ORGANIZATIONS AND RESOURCES IN WOMEN. HEALTH AND HEALING
The following list is focused on organizations, and

resources which address women's health issues from more
scholarly than activist perspectives. The Boston Women's
Health Book Collective's THE NEW OUR BODIES, OURSELVES
(Simon and Schuster, 1984) offers excellent listings of
activist groups focused on a wide range of issues. Many of
the following organizations have newsletters or other
publications which would be of curricular assistance. For
faculty attempting to develop resources in women's health,
we strongly recommend that you send a form letter to each of
these groups requesting a list of current publications.
Such materials can be invaluable for both student research
projects and faculty curriculum development.
Alan Guttmacher Institute

515 Madison Avenue
New York, NY 10022
[publications on family planning topics]
Boston Women's Health Collective

P.O. Box 192
Somerville, MA 02144
Disabled Women's International

c/o Janne Sander, Knudsen,
Gadekaervej 28, 2.th, 2500
Valby, Copenhagen
Denmark
International Childbirth Education Association

P.O. Box 20048
Minneapolis, MN 55420
Health Research Group

2000 P St., N.W. [#2]
International Confederation of Midwives

57 Lower Belgrave St.
London, England
Mari Spehar Health Education Project

P.O. Box 545
Fayetteville, AR 72701
National Abortion Rights Action League

825 15th St., N.W.
From Teaching Materials on Women. Health & Healing.

Edited by A. Clarke, V. Olesen, S. Ruzek, & P. Anderson^
Women, Health & Healing Program, University of California,
San Francisco, 1986.
270
National Center for Education in Maternal and Child Health
3520 Prospect St., N.W.
(202) 625-8400
National Health law Program

2639 LaCienega Blvd.
Los Angeles, CA 90034
National Midwives Association

Women's Legislative Service
324 C St., S.E.
National Organization of Adolescent Pregnancy and Parenting

820 Davis St.
Evanston, IL 60201
National Organization for Women

425 13th St., N.W.
National Perinatal Association

1311A Dolly Madison Blvd.
McLean, VA 22101
National Women's Health.Network

224 7th St., S.E.
[offers a wide variety of publications in women's health]
Project on the Status and Education of Women

Association of American Colleges
1818 R St., N.W.
Washington, D.C, 20009
[offers listings of minority women's organizations and
programs and of centers of research on women as well as
special focus materials, e.g. sexual harassment on campus]
Religious Coalition for Abortion Rights

100 Maryland Avenue, N.E.
Sex Information and Education Council of the U.S. (SIECUS)

84 Fifth Ave. Suite 403
New York, NY 10011
From Teaching Materials on Women. Health & Healing.
271
Society for Menstrual Cycle Research
c/o Dr. Barbara Sommer
Department of Psychology
University of California, Davis
Davis, CA 95616
Women and Health Roundtable

Federation of Organizations for Professional Women
2000 P St., N.W. Suite 403
Women's Equity Action League

Educational and Legal Defense Fund
733 15th St., N.W. Suite 200
Women's Legislative Service

324 C St., S.E.
Women's Occupational Health Resource Center

Columbia University
School of Public Health
60 Haven Ave. [Bl[
New York, NY 10032
From Teaching Materials on Women. Health & Healing
272
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout perm ission
JOURNALS IN WOMEN. HEALTH AND HEALING
All of the following journals publish materials in women,

health and healing and several specialize in women's health
topics. Faculty should request that those most pertinent be
acquired by your university library.
FEMINIST ISSUES
Transaction, Inc., Dept. 8200
Rutgers The State University
New Brunswick, NJ 08903
FEMINIST STUDIES
C/O Women's Studies Program
University of Maryland
College Park, MD 20742
FEMINIST TEACHER
Ballantine 442
Indiana University
Bloomington, IN 47405
FRONTIERS
University of Colorado
Boulder, CO 80309
GENDER AND SOCIETY

Sage Publications
275 South Beverly Drive
Beverly Hills, CA 90212
. HEALTH CARE FOR WOMEN INTERNATIONAL .

Hemisphere Publishing Corp.
1010 Vermont Ave., N.W.
RADICAL TEACHER
P.O. Box 102, Kendall Square Post Office
Cambridge, MA 02142
SAGE: A SCHOLARLY JOURNAL ON BLACK WOMEN

P.O. BOX 42741
Atlanta, GA 30311-0741
SCIENCE FOR THE PEOPLE

897 Main St.
Cambridge, MA 02139
From Teaching Materials on Women, Health & Healing.
273
Hartsock, Nancy. 1990. "Foucault on Power: A Theory for Women?" Pp. 157-175 in Linda J.
Nicholson (ed.) Feminism/Postmodernism. New York: Routledge.
Hurtado, Aida. 1989. "Relating to Privilege: Seduction and Rejection in the Subordination of
White Women and Women o f Color." Signs 14(41):833-855.
Lengermann, Patricia Madoo and Jill Niebmgge-Brantley. 1983. "Contemporary Feminist

Theory." Pp. 400-443 in George Ritzer (ed.) Contemporary Sociological Theory. New
York: Knopf.
Mascia-Lees, Frances E., Patricia Sharpe, and Colleen Ballerino Cohen. 1989. "The
Postmodernist Turn in Anthropology: Cautions from a Feminist Perspective." Signs
15(l):7-33.
Nicholson, Linda J. 1990. "Introduction." Pp. 1-17 in her (ed.) Feminism/Postmodernism. New
York: Routledge.
Olesen, Virginia and Ellen Lewin. 1985. "Women, Health, & Healing: A Theoretical
Introduction. Pp. 1-24 in Olesen & Lewin (eds.) Women, Health, and Healing: Toward
a N ew Perspective. New York: Tavistock.
Petchesky, Rosalind Pollack. 1990 [1984]. "Preface to the 1990 Edition." Pp. ix-xxxi in her
Abortion and W omans Choice: The State, Sexuality, and Reproductive Freedom.
Boston: Northeastern University Press.
Petchesky, Rosalind Pollack. 1985. "Abortion in the 1980s: Feminist Morality and Women's
Health." Pp. 139-173 in Ellen Lewin and Virginia Olesen (eds.) Women, Health, and
Healing: Toward a N ew Perspective. New York: Tavistock.
Rodin, Judith and Jeannette R. Ickovics. 1990. "Women's Health: Review and Research
Agenda as We Approach the 21st Century." American Psychologist 45(9): 1018-1034.
Rothman, Barbara Katz. 1989. Recreating Motherhood: Ideology and Technology in a

Patriarchal Society. New York: W.W. Norton & Company. Pp. 17-81,240-260.
Rubin, Gayle. 1990. "The Traffic in Women: Notes on the Pplitical Economy o f Sex." Pp. 74-
113 in Karen Hansen and Bene Phillipson (eds.) Women, Class, and the Feminist
Imagination. Temple University Press.
Ruzek, Sheryl. 1986. "Feminist Visions o f Health: An International Perspective." Pp. 184-207
in Juliet Mitchell and Ann Oakley (eds.) What Is Feminism? A Re-Examination. New
York: Pantheon Books.
Smith, Dorothy. 1987. The Everyday World as Problematic. Northeastern University Press.
Pp. 1-104.
Stacey, Margaret. 1981. "The Division o f Labour Revisited or Overcoming the Two Adams."
Pp. 172-204 in P. Abrams and R. Deem (eds.) Practice and Progress: British Sociology
1950-1980. Allen and Unwin.
Stanworth, Michelle. 1987. "Introduction" and "Reproductive Technologies and the

Deconstruction o f Motherhood." Pp. 1-35 in her (ed.) Reproductive Technologies:
Gender, M otherhood and Medicine. Minneapolis: University o f Minnesota.
276
Todd, Alexandra Dundas. 1989. Intimate Adversaries: Cultural Conflict Between Doctors and
Women Patients. Philadelphia: University o f Pennsylvania Press. Ch. 5-6.
West, Candace and Don Zimmerman. 1991. "Doing Gender." Pp. 13-37 in Judith Lorber and
Susan Farrell (eds.) The Social Construction o f Gender. Newbury Park, CA: Sage.
Zimmerman, Mary K. 1987. "The Women's Health Movement: A Critique o f Medical

Enterprise and the Position o f Women." Pp. 442-473 in Beth B. Hess and Myra Marx
Ferree (eds.) Analyzing Gender: A Handbook o f Social Science Research. Newbury
Park: Sage.
277
Sources for Further Information
Books, Booklets, Pamphlets
A gainst O ur W ill-M e n , W om en a n d R ape by Susan Brownmiller. The
landmark book that raised America's consciousness about rape. 541 pages.
$4.95. 1976. Bantam Books, New York.
A voiding R ape on a n d o ff C am pus by Carol Pritchard, rape referral counselor

at Glassboro State College in Glassboro, New Jersey. Sixty-page booklet
examining realities of acquaintance rape and stranger rape for college students.
$3.95 plus $1 postage/handling; bulk prices available. 1987. State College
Publishing Co., P.O. Box 209, Wenonah, NJ 08090-9990.
D a te R ape! A pamphlet for teens; includes guidelines for girls and boys. 50
pamphlets for $11; discounts for larger quantities available. Network Pub
lications, P.O. Box 1830, Santa Cruz, CA 95061-1830. (For all Network
Publications material, add 15% postage and handling; CA residents add 6%
sales tax. $10.00 minimum order.)
"F riends" R aping F riends: C o u ld I t H appen to You? by Julie K. Ehrhart and

Bernice R. Sandier. Date rape informational pamphlet aimed at college
students. Contains prevention advice for women and men. 8 pages. $2; bulk
prices available. PSEW/AAC, 1818 R S t, N.W ., Washington, DC 20009.
H er W its A bout H er-S elf-D efen se Success Stories b y W om en edited by Denise

Caignon and Gail Groves. Fifty-four women* tell how they effectively fought
off rapists. Includes information on womens self-defense programs in the
United States and Canada. 303 pages. $9.95. 1987. Harper & Row, New
York.
R ecovering fro m R ape by Linda E. Ledray, director o f the Minneapolis Sexual

Assault Resource Service. A handbook for rape survivors and the people who
love them. Includes directory o f more than 275 rape-crisis centers nationwide.
258 pages. 1986. $9.95. Henry Holt and Co., New York.
R ecovery, H ow to Survive Sexual A ssau lt f o r W omen, M en, T eenagers, an d

T heir F riends a n d F am ilies by Helen Benedict Guide to physical, emotional,
and social healing from rape. 293 pages. 1985. $15.95. Doubleday, New
York.
Safe, Strong an d Streetw ise~T he T eenagers G uide to Preventing Sexual

A ssault by Helen Benedict. Sexual assault prevention for adolescents and
teens. 192 pages. 1986. $14.95. Little, Brown & Co., Boston.
278
NATIONAL WOMEN'S HEALTH NETWORK
WOMENS HEALTH INFORMATION SERVICE
DIRECTORY OF TOPICS
The Wrmens Health Information Service of the National Women's Health Network is a clearinghouse for women's
lifetime wellness. Ifyou need information on any of these topics please feel free to write us.
' A $5.00 charge per topic, to cover photocopying and postage, is requested. Topics include:
Abortion Interstitial Cystitis

AIDS Lesbian Health Issues
Breast Cancer Mammography
Cervical Cancer/ftp Smears Menopause ERT/HRT
Cesarean Childbirth National Health Plan
Contraceptives ($5.00 each): New Reproductive Technology
Cervical Cap Occupational/Environmental Health
Diaphragm Osteoporosis
Intrauterine Device (IUD) Ovarian Cysts
New Methods Pelvic Inflammatory Disease (PID)
Norplant Postpartum Depression
Pill Pregnancy/Childbirth
Spermicide Premenstrual Syndrome (PMS)
Sponge RU486
Depo-Provera Sexually Dansmitted Diseases (STDs)
Depression Sterilizatioa:
Diethytstilbestrol (DES) Teen Pregnancy
Endometriosis Toxic Shock Syndrome (TSS)
Epstein-Barr Virus Urinary ttact Infections (UTIs)
Fibroids Women and Alcohol
Fibrocystic Disease Women and Disabilities 4
Home Pregnancy Tests Women and Smoking
Hysterectomy Wglnitis"
Infertility 'feast Infections
Please send me i
.v s l, iUnvr* . ..
Name_
Address. . City 77_ .State. .Zip Code.
Iam lam notam em berhutw ouldliletobe-.' -

Enclosed is my $25 membership fee. .
Please allow four to six weeks fair delivery. The National Women's Health Network is a non-profit organization that
survives through the generosity of its friends and members. Please be generous to support our work. Thank you.
Enclosedis__________ -j,., P4.;
Please make your check payable to: National Womens Health Network, 1325 G Street, N.W., Washington, DC 20005.
The only national pubHc-lntorest organization devoted solely to women and health
1325 G Street, N.W. Washington, D.C. *20005 *(202) 347-1140
279
ORDER FORM
TITLE DESCRIPTION PRICE QUANTITY TOTAL

ORDERED COST
Directoryo f Womaii MaBa, 1991-92 pre-publication

special till 10/31/91 $25.00
OpportunitiesforResearch
and Study, 1991-92 each $10.00
A Womens WaSng List DbtcUuy each $20.00
Women in Academe (paper) Use this form $15.00
Women in Acadane(hardcover) Order from Russell Sage
Foundation 212/750-6037 $29.95
A Women's Tftrfrrarfhardcavcr) Use this form $20.00
A Womens 7ftes0iii(paper) Order from Harper & Row
1-800638-3030 $16.95
MonanrnmngMtnony
Womens StuSes, 1991-92 each $6.00
International Centersfor
Research on Women each $10.00
Trmsfcrmingthe KnowledgeBase
(inquire about bulk rates) each $5.00
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SUBTOTAL:
LESS 20% MEMBER CENTER/AFFILIATE DISCOUNT:
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(add$2.00forfustpublicationand$1.00foreach
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(annual subscription) organizations $100.00
TOTAL ENCLOSED:
Orders must be prepaid o r charged. Make checks out to the National Council for Research on Women from
U.S. banks or drafts on U.S. banks only (no foreign currency) and send to NCRW at 47-49 East 65th Street,
New York, NY 10021. O r charge your order ($15 minimum) to:
VISA MasterCard Card number
Expiration date__________ Signature_
Name
address
city state zip phone number
280
VITA
Susan Orange Butler was born In Marietta, Georgia, on
November 24, 1952. She attended elementary schools in the
Smyrna, Georgia area and graduated from F. T. Wills High
School, Smyrna, in June 1970. She received the degree of
Associate Science in Secondary Education from Kennesaw
State College, Marietta, in 1974; the degree of Bachelor of
Science in Education in Social Science from the University
of Georgia, Athens, in 1976; and the degree of Master of
Education in Health and Physical Education from Georgia
State University, Atlanta, in 1980. In the fall of 1988,
she entered the University of Tennessee, Knoxville, and in
August 1992 received the degree of Doctor of Education in
Health Education. She became a Certified Health Education
Specialist in 1991.
Susan has worked as a public and ^chool health
educator since 1981 for organizations and agencies such as
a county health department under the Georgia Department of
Human Resources; the Metropolitan Atlanta YMCA; the
American Cancer Society; the Georgia Lung Association;
county, community, and private school systems; and Kennesaw
State College. She is presently a member of the
Administrative Faculty as the Coordinator of Wellness
Services at Kennesaw State College in Marietta, Georgia.

i
281
Susan has been married to Daryl Butler since 1975 and
resides in Marietta, Georgia.
282

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INFORMATION TO USERS

The quality of this reproduction is dependent upon the quality of the

Oversize materials (e.g., maps, drawings, charts) are reproduced by

Photographs included in the original manuscript have been reproduced

University Microfilms International

An instrument for evaluating w om ens health knowledge

Butler, Susan Orange, Ed.D.

Copyright 1993 by Butler, Susan Orange. All rights reserved.

WOMEN'S HEALTH KNOWLEDGE

Presented for the

The University of Tennessee, Knoxville

Susan Orange Butler

I am submitting herewith a dissertation written by Susan 0.

We have read this dissertation

Accepted for the Council:

Associate Vice Chancellor and

This dissertation is dedicated to all women, to become

empowered through increased knowledge about their own

Grateful acknowledgment Is extended to the many women

who agreed to participate in my study. Without their

commitment to my success and their support for the

progression of women in education, this study would not

have been possible.

Appreciation is extended to the twenty-three experts

from across the country who took time and effort to

Appreciation is extended to my doctoral committee for

their assistance, patience, and for the excellent training

and education I received: to Dr. Robert Kirk, committee

in the field, to Dr. James Neutens, who enhanced my

understanding of research, and to Dr. Jean Skinner, who

increased my awareness of nutrition issues.

Special acknowledgment is extended to committee member

inspiration and role model for me, by her professional

assertiveness, enthusiasm, knowledge of the field, and

concern for students.

Appreciation is extended to my employer, Dr. Paul

Benson, Vice President for Student Affairs at Kennesaw

State College, for his support and cooperation.

Kennesaw State College, School of Business, who assisted me

with statistical inquiries, and to Dr. Donald Dessart at

the University of Tennessee, College of Education, who made

the understanding of advanced statistics possible.

Much appreciation is extended to Cole Printing &

Thesis Service, who handled all the typing, guideline

requirements, binding, and deliveries.

I am grateful to my parents, Mac and Hazel Orange, who

raised six children in a loving and supportive environment,

where the importance of a college education was always

stressed. They spent many hours stuffing and organizing

envelopes for the study.

Sincere gratitude to my husband, Skip, who supported

my decision to reach my highest goal, even though it meant

interruptions in our time together and his acceptance of

complete responsibility for the home and pets. I

appreciate his willingness to provide help when I needed it

and his own commitment to my goal.

This study constructed a valid and reliable instrument

for evaluating women's health knowledge. Content validity

for the instrument was, in part, established by writing ten

behavioral objectives relating to ten women's health

knowledge conceptual areas. Content validity was also

established through a textbook and syllabi review, and

recommendations from experts in the field of women's