Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information–motivation–behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.     

Application of an Integrated Behavioral Model to Predict Condom Use: A Prospective Study Among High HIV Risk Groups1

An integrated theoretical model using constructs from multiple behavioral models was applied to understand and predict condom use among a sample of injecting drug users, commercial sex workers, men who have sex with men, and multipartnered heterosexuals. Elicitation interviews were conducted to develop a questionnaire to measure model constructs that may be predictive of condom use for sex with vaginal, anal, and oral regular and casual partners. A prospective survey design was used, with 993 participants interviewed at Time 1, and 686 returning for Time 2 interviews 3 months later. Regression analyses were conducted using Time 1 measures to predict intention and Time 2 behavior. Strong support was found for a model that includes attitude, social norm, and facilitators/constraints as predictors of behavior, with multiple correlations in the 0.20 to 0.40 range. Findings also indicate perceived control and facilitators/constraints are distinct constructs and both, along with attitude and social norm, contribute to explaining behavioral intention. Implications for intervention development are discussed.     

HIV-protection through condom use: Testing the theory of planned behaviour in a community sample of heterosexual men in a high-income country

Given the increasing importance of heterosexual HIV-transmission in Europe and Switzerland, the present study tested the theory of planned behaviour (TPB) in a prospective study on the HIV-protection behaviour in a community sample of heterosexual men. The study focused on condom use in sexual encounters with new partners. Participants were 982 Swiss men between the ages of 25 and 65 who were surveyed using standardised questionnaires in two computer-assisted telephone interviews that took place in autumn 2002 and spring 2003. The TPB was able to predict condom use in sexual encounters with new and casual partners. In accordance with the theory, condom use was predicted by intention. Perceived behavioural control and attitude were significant predictors of intention, whereas subjective norm was not. Thus, in line with other studies, the present study highlighted the somewhat limited explanatory power of the theory. Further theoretical and empirical work is needed to develop extensions to the theory.     

Social-cognitive predictors of intention to vaccinate against the human papillomavirus in college-age women

This study examined social-cognitive predictors of college-age women's intentions to obtain the human papillomavirus (HPV) vaccine using the Health Belief Model (HBM) and Theory of Planned Behavior (TBP) as theoretical guides. Questionnaire data were collected from 143 women at a Midwestern university. Among the HBM variables, perceived susceptibility to HPV, perceived benefits of the vaccine, and self-efficacy to obtain the vaccine were significant predictors. Among the TPB variables, positive attitudes toward the vaccine and beliefs that important others would support vaccination predicted intentions. A model with all HBM and TPB variables explained nearly 60% of the variance in intentions. Comparison of the theories suggests that the TPB is a better predictor of intentions than the HBM. Results suggest that targeting personal beliefs about the vaccine, and increasing acceptance for the vaccine among social network members, may increase vaccination intentions among college-age women.     

Condom use in steady and casual sexual relationships: Planning, preparation and willingness to take risks among adolescents

Condom use within steady and casual sexual relationships was examined among 14-16 year old Dutch adolescents from secondary school (N?=?140). It was hypothesised that among adolescents sex and subsequently condom use with casual sex partners is less likely to be considered in advance, more context-dependent and less habitual; whereas the opposite is true for steady relationships. Therefore, preparatory behaviours (buying and carrying condoms and communicating about condom use) were expected to mediate the intention-behaviour relation in the context of steady relationships, but not in the context of casual sex. Results confirmed that condom use with steady sex partners was explained by preparatory behaviours, habits, and to some extent, behavioural willingness, and that preparatory behaviours mediated the intention-behaviour relationship. Condom use with casual sex partners was predicted by risk willingness and intentions, without any mediation by preparatory behaviours. The results indicate that it is essential to increase awareness among adolescents that unexpected sexual situations may occur and to train them to take preparatory actions.     

Bringing up condom use and using condoms with new sexual partners: Intentional or habitual?

Abstract

A prospective study of 94 Dutch adults who have casual sexual partners examined whether two important aspects of safe sex, namely bringing up condom use (BCU) and actual condom use (ACU) are intentional or habitual. For each of these aspects, a model based on the Theory of Planned Behaviour (TPB: Ajzen, 1991) was pitted against a similar model that was extended with a path from past to later BCU and ACU, respectively. The results suggest that bringing up the issue of condom use was equally predicted by intentions and past BCU. However, among people with casual partners, using condoms - and more importantly not using condoms - was especially predicted by past ACU, suggesting a strong habitual component. These results are discussed in terms of their implications for safe sex education and the use of theories in safe sex promotion campaigns.     

Condom Use by Low-Income African American and Hispanic Youth With a Weil-Known Partner: Integrating the Health Belief Model,Theory of Reasoned Action,and the Construct Accessibility Model1

This study used multiple group structural equation modeling (SEM) to evaluate gender and ethnic differences in a theoretical model of condom use with a well known partner. The sample consisted of urban, low income, African American and Hispanic males and females. The theoretical model incorporated concepts from the Health Belief Model (HBM), Theory of Reasoned Action (TRA), and Construct Accessibility Model (CAM). A new theoretical concept, condom predisposition, emerged from SEM as a predictor of condom use in all four gender-ethnic groups. This concept combines elements of the TRA (attitude, partner norm) and CAM (accessibility of condom related constructs). Statistically reliable differences were found in the theoretical models for each group. For example, talking about AIDS was positively related to a predisposition to use condoms for African American males and both Hispanic males and females. In contrast, for African American females, it was their concern about AIDS that was positively related to this predisposition. These results underscore the importance of investigating gender differences within ethnic groups, and benefits of integrating different theoretical perspectives.     

Having Casual Sex: Additive and Interactive Effects of Alcohol and Condom Availability on the Determinants of Intentions

The impact of alcohol, condom availability, and gender on intentions to engage in casual sex and its antecedents was investigated. Students ( N = 384) who were or were not intoxicated with alcohol completed measures based on the theory of planned behavior (TPB) in relation to having casual sex in a scenario. The scenario described sex between 2 individuals not in a relationship and manipulated the consumption of alcohol of the sexual partners and availability of condoms. The data were supportive of the TPB: Intentions were predictable from attitudes, subjective norms, and perceived behavioral control (PBC). Results also support the inclusion of measures of past behavior and anticipated affective reactions, but not self-identity or moral norms as predictors of intentions. Alcohol in the scenario and condom availability increased intentions to have sex. There were also several interaction effects. Implications for using the TPB to understand sexual behaviors under the influence of alcohol are discussed.     

Using the Theory of Planned Behavior to Predict Intention to Use Condoms Among Male and Female Injecting Drug Users

This study tested the utility of the theory of planned behavior (TPB) for understanding and predicting condom use intentions among male and female injecting drug users (IDUs). Interviews were conducted with 405 male and 315 female sexually active IDUs. Participants indicated their intentions to use condoms with main and nonmain sexual partners as well as attitudes, social norms, partner norms, and perceived behavioral control relevant to condom use with each partner type. The TPB accounted for 36 to 48% of the variance in intentions to use condoms. Intentions were related to attitudes, regardless of partner type. Partner norms were related to intentions to use condoms with main partners (men and women) and nonmain partners (men only). Social norms did not predict intentions, regardless of partner type. Perceived behavioral control was related to intentions to use condoms with main partners (men and women) and nonmain partners (women only). The findings are interpreted in light of the roles of cooperation, intimacy, and concern about self-protection.     

School-based,randomised controlled trial of an evidence-based condom promotion leaflet

A condom use promotion leaflet was designed for use with older teenagers in schools. The text targeted a series of cognitive and behavioural antecedents of condom use identified in the literature. Given previous evidence that motivational incentives can enhance the effectiveness of health promotion leaflets, the leaflet was presented in conjunction with a quiz and prize draw. Students were randomly assigned to either the intervention condition or a (no leaflet or incentive) control condition. Measures were taken immediately, pre-intervention and 4 weeks later from 404 students. The 20-min intervention successfully promoted six of the eight measured cognitions, namely (1) attitude towards using condoms with a new partner (2) attitude towards using condoms with a steady partner (3) normative beliefs in relation to preparatory actions (4) self-efficacy in relation to both preparatory actions and (5) condom use (6) intention to use condoms, as well as three measured preparatory actions, that is, purchasing condoms, carrying condoms and discussing condom use. The intervention did not increase condom use with steady or new partners but power to test intervention impact on condom use was curtailed.     

Safer Sex Behavior: The Role of Attitudes, Norms, and Control Factors

A study was undertaken to assess the utility of revisions to the theories of reasoned action/planned behavior in the context of HIV-preventive behaviors. Revisions to the models incorporated the addition of group norm (behavioral norm and group attitude) to the nonnative component of the reasoned action model and the distinction among three aspects (self-efficacy, perceived behavioral control, and planning) of the control component of the theory of planned behavior. Respondents were 211 sexually experienced heterosexual undergraduates. The study employed a longitudinal design, with the proposed predictors of performing the behaviors under consideration (using a condom every time you have sexual intercourse during the next month and discussing whether to use a condom with any new partners during the next month) assessed prior to the measures of reported behavior. Consistent with expectations, group norm emerged as a distinctive predictor (in addition to attitude and subjective norm) of intentions to practice both safer sex behaviors. The data also revealed some support for the distinction among the different measures of control. The results of the study suggest that the normative component of the theories of reasoned action and planned behavior should be revised to incorporate more subtle influences of the referent group and that tests of theory of planned behavior should distinguish among the different aspects of behavioral control.     

Predictors of Condom Use in Mexican Migrant Laborers

The purpose of this study was to explore predictors of condom use with occasional sex partners and regular sex partners, as well as carrying condoms in a new high-risk group for HIV infection, Mexican migrant laborers. This study extends previous findings by (1) exploring additional predictors not previously examined, (2) utilizing a large sample of male and female Mexican migrant laborers, (3) carefully controlling for the effects of various demographic and lifestyle variables related to condom use, and (4) assessing the interactive effects of gender on predictors of condom use. Snowball sampling was used to survey 501 adult Mexican migrant laborers. Results revealed that condom use with occasional sex partners was predicted by carrying condoms and condom self-efficacy and that women were more likely to use condoms with occasional partners when both men and women knew someone with HIV/AIDS. Condom use with regular sex partners was predicted by procondom social norms, less negative attitudes toward condoms, not knowing someone with HIV/AIDS, and condom self-efficacy. Carrying condoms was predicted by procondom social norms, less negative attitudes toward condoms, condom self-efficacy, worry about contracting HIV/AIDS, and women were more likely than men to carry condoms when both men and women were married. Understanding these findings, future research directions, and implications for condom promotion strategies with Mexican migrant laborers are discussed.     

Health beliefs and promotion of HIV-preventive intentions among teenagers: a Scottish perspective.

Beliefs concerning the spread of the human immunodeficiency virus (HIV) and preventive behaviors were examined in a sample of 351 sexually active Scottish teenagers. A postal questionnaire, including measures of variables specified by the health belief model (HBM) and preventive intentions, was employed. The relation between HBM measures and reported endorsement of HIV-preventive intentions was investigated. Results indicated that, in general, respondents intended to use condoms with new sexual partners. The majority also intended to carry condoms if they thought they might have sex with a new partner and to ask potential partners about their previous sexual history. Multiple-regression analyses showed that measures of health beliefs, gender, age, sexual experience, and previous condom use accounted for 17.8% to 24.3% of the variance in reported preventive intentions. Perceived barriers to preventive behaviors were found to be important predictors. However, the overall pattern of results raised questions concerning the adequacy of the HBM as a model of the determinants of HIV-preventive intentions, and the need for an extended model is discussed. Separate analyses were conducted for men and women and for 16- and 18-year-olds, and the implications for modeling intention formation in these subgroups are considered. The relevance of these findings to HIV-preventive campaigns is also discussed.     

The 90's: gender differences in AIDS-related sexual concerns and behaviors,condom use and subjective condom experiences

To evaluate gender differences in the subjective experience and use of condoms, 193 heterosexual patrons at 13 bars in New York City were interviewed on site in 1991. Most respondents were single, middle class, and White; their ages ranged from 18 to 51 years. The data analysis was restricted to the 155 men and women who had at least 1 new partner in the 3 years preceding the survey. Respondents worried most about acquired immunodeficiency syndrome (AIDS) when engaging in sex with a new partner. 86% indicated concern about AIDS had affected their sexual behavior, most often by increasing their condom use and decreasing casual sex. 91% of women and 79% of men said that condoms give them greater peace of mind. Women worried more than men about AIDS when they had a new sexual partner and were more likely to limit their number of partners, work harder on an existing sexual relationship, give up casual sex, or give up sex with new partners. Men's subjective condom experiences were related to their penile functioning (erection and ejaculation) and the threat of loss of sexual pleasure. Multiple regression equations revealed that, among men, condom use with new partners was associated with worrying about AIDS and younger age; among women, peace of mind was a positive predictor. With casual partners, more partners led to increased condom use among women and worrying about AIDS was a predictor for men; peace of mind was predictive for both genders. 53% of men compared to 21% of women expected to meet a new sexual partner at the bar where they were interviewed, and 36% of men and 19% of women were carrying condoms with them.     

Blurring Emotional Safety With Physical Safety in AIDS and STD Risk Estimations: The Casual/Regular Partner Distinction1

Research on the sexual behavior of young adults has documented a casual/regular partner distinction in terms of condom use and perceived risk of contracting sexually transmitted diseases (STDs). How this population distinguishes between the 2 partner types has not been known, making it impossible to assess the rationality of this strategy. In the present study, college students' conceptions of casual vs. regular partners were explored and used to create 3 sexual partner scenarios: casual, regular with insufficient risk information (regular emotionally safe), and regular with sufficient risk information (regular objectively safe). Participants rated the target partner in terms of emotional safety, AIDS/STD risk, and likelihood of condom use. Results showed participants to be blurring emotional with physical safety; i. e., employing an emotionally based strategy in rating perceived risk.     

Perceived sexual self-control and condom use with primary and casual sex partners: age and relationship agreement differences in a Portuguese sample

Abstract

Objective: Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e. non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM).

Design: Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; M_age = 42.24, SD?=?9.65, range: 23–76 years). All individuals were in a romantic relationship (M_length = 13.47 years, SD?=?9.39).

Measures: Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months) and relationship agreement.

Results: Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (>49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age.

Conclusion: Our findings can inform evidence-based strategies to promote consistent condom use as an effective behaviour to prevent sexually transmitted infections, especially among older and NCNM individuals.     

Intentions to Use the Female Condom Among African American Adults1

The present study tested whether the theory of reasoned action (TRA) and self‐efficacy for female condom use predicted intentions to use the female condom among African American adults. Participants were 137 men and women, 18 to 35 years of age, who were recruited from a community‐based organization. Results indicate that: (a) the TRA model has predictive utility for women's but not for men's intentions to use the female condom with both main and casual sex partners, and (b) the TRA model was a better predictor of intentions to use the female condom with main than with casual partners. Implications for female condom‐use promotion are discussed.     

Today I'll use a condom, but who knows about tomorrow: a daily process study of variability in predictors of condom use

OBJECTIVE: Most models of health behavior change applied to condom use behavior have focused on individual differences in theoretical constructs to explain condom use or nonuse, while ignoring the possibility that day-to-day within-person changes in these constructs may contribute to understanding behavior. The goal of the present study was to investigate day-to-day variability in condom use attitudes, self-efficacy, and behavioral intentions and assess the utility of this variability in predicting the likelihood of condom use each day. DESIGN: A 30-day Web-based structured daily diary was used to collect daily reports of sexual behaviors and data on theoretical predictors of condom use behavior from sexually active college students (N = 116). MAIN OUTCOME MEASURES: The authors investigated whether condom use attitudes, self-efficacy, and behavioral intentions vary day to day; whether this within-person variability predicts condom use behavior; and whether negative affective states explain this variability. RESULTS AND CONCLUSIONS: Within-person variability was found for each of the constructs. Within-person day-to-day changes in behavioral intentions and attitudes predicted the instances in which an individual used a condom and daily negative affect partially explained within-person day-to-day changes in behavioral intentions and self-efficacy. Implications for models of health behavior change and for behavior change interventions are discussed.     

Understanding AIDS preventive behavior with casual and primary partners in homosexual men: The theory of planned behavior and the information-motivation-behavioral-skills model

Abstract

This study examined whether components from the Information-Motivation-Behavioral-Skills Model, in particular information, added explanatory power to factors derived from the Theory of Planned Behavior with respect to predicting AIDS-preventive behaviors among gay men. Participants were recruited from a longstanding cohort study in Amsterdam. Multivariate regression analyses showed that concepts from the Theory of Planned Behavior could account adequately for intentions to use condoms with casual as well as with steady partners. Actual behavior was best predicted by past behavior. In addition, structural equation modeling demonstrated that the causal paths as posited by Theory of Planned Behavior had a good fit to the data. From the presented findings implications for preventive interventions can be drawn. Specifically, interventions to increase condom use with casual partners need to focus at improving perceived behavioral control regarding this behavior, for instance through skills training. Interventions aimed at safer sex within steady relationships should take into account that the HIV-status of the individual and his partner plays an important role in the occurrence of unprotected anal sex in a romantic dyad.     

Theory of planned behaviour and parasuicide: An exploratory study

Recent evidence suggests that parasuicide (deliberate self-harm) should be considered in terms of ‘normal’ rather than ‘abnormal’ behaviour. This study aimed to address this assertion by applying a social cognition model, for the first time, to parasuicidal behaviour. An extended theory of planned behaviour (TPB) model was tested on 55 individuals drawn from hospital and non-hospital populations. Thirty-eight percent of the sample (n=21) reported a history of deliberate self-harm. Findings supported the utility of the TPB: attitudes, subjective norm, self-efficacy, moral norm and anticipated affect discriminated significantly between those with and without a history of parasuicide. The extended TPB explained more than 50% of the variance associated with intentions to deliberately self-harm. These findings have considerable theoretical and practical implications for intervention. Future research should investigate the utility of the TPB employed within a prospective framework.