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.     

Effects of a School‐Based Life Skills and HIV‐Prevention Program for Adolescents in Mexican High Schools1

A school‐based life skills and sexuality education HIV/AIDS program for adolescents was evaluated in Toluca, Mexico, through a quasi‐experimental pre–post design with 1,566 cases, divided over a control group and an experimental group. Based on a previously tested path model, 3 levels of variables were included as a guide for the contents of the program: personal variables (self‐knowledge, self‐efficacy regarding condom use, and decision making), intervening variables (subjective norms about, knowledge about HIV/AIDS, and attitudes toward condoms), and outcome variables (communication on sexuality and intentions to use condoms). Evaluation was conducted following these categories. Significant increases in all of these variables recognized as precursors of safer sex were found in the experimental group.     

A six-month follow-up of adolescents' sexual risk-taking,HIV/AIDS knowledge,and attitudes to condoms

A follow-up study was conducted to investigate change in sexual behaviour, knowledge about HIV/AIDS transmission, and attitudes to condoms over a 6-month period in a sample of late-adolescent students. The study also obtained subjective reports of HIV/AIDS-relevant change. Overall there was a decrease in sexual risk-taking behaviour with casual partners but no change occurred in sexual behaviour with regular partners, knowledge about HIV/AIDS, attitude towards condoms, or intention to use a condom on next sexual encounter. Examination of individual data revealed that, for some adolescents where behavioural change had occurred, this was in the direction of less safe sex. There were few self-reports of change in sexual behaviour, intention to take precautions against HIV/AIDS, or concern about HIV/AIDS over the preceding 6 months. Subjective reports of behaviour change did not correspond with reports of actual behaviour. Low rates of behaviour change are attributed to the failure of adolescents to personalize the threat of AIDS and to their trust in the safety of sex with a regular partner as well as to the lack of relevance of HIV/AIDS education campaigns to this group.     

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.     

The Theory of Reasoned Action and the Role of External Factors on Heterosexual Men's Monogamy and Condom Use1

Although the majority of prevention efforts have focused on women, reduction of heterosexual transmission of STDs also requires interventions for men, necessitating understanding of men's safer sex decision making. In a random sample of 486 heterosexually active men, the theory of reasoned action (TRA) was used to predict intentions to use condoms with casual partners, as well as 2 steady‐partner safer sex behaviors: mutual monogamy and condom use. The basic TRA model fit the data well. Expanded models identified the mediated (via attitudes, social norms, and self‐efficacy) and, for some, direct effects on intentions and behavior of selected intrapersonal, interpersonal, and sociocultural variables. Results suggest that the role of external variables might vary depending on the behaviors in question.     

Differential effects of mood on information processing: evidence from the theories of reasoned action and planned behaviour

The theories of reasoned action and planned behaviour continue to receive considerable research attention, despite criticisms of their ‘asocial’ conceptualisation and the rational decision‐making approach. Two studies were designed to assess the impact of induced mood on condom use (Study 1) and food choice (Study 2). Both studies provided support for application of the theory of reasoned action to health‐related behaviour, and for differential effects of mood on information processing. Study 1 provided support for problem‐focus theory, with attitudes (but not subjective norm) predicting intention in the negative mood condition. The opposite pattern of findings held for the positive mood condition (i.e. only subjective norm predicted intention). The results of Study 2 provided further support for the problem‐focus approach and for the inclusion of self‐identity in the theory of planned behaviour. The findings are discussed with implications for future work on mood and behavioural decision making. Copyright © 1999 John Wiley & Sons, Ltd.     

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.     

Application of the Theory of Planned Behavior to Adolescents’ Condom Use: A Panel Study1

The authors report a longitudinal study of factors determining use of condoms with new sexual partners in a representative sample of 650 German youth. Measures derived from the theory of planned behavior (Ajzen, 1985) were obtained in 2 waves separated by 1 year. Consistent with the theory, intentions to use condoms could be predicted from attitudes, subjective norms, and perceived behavioral control with respect to this behavior; and actual condom use was strongly related to intentions and perceptions of control assessed in Wave 2. Due to changes in beliefs and attitudes over time, only about 10% of the variance in reported condom use was accounted for by intentions and perceived control assessed 1 year earlier. Reported condom use was found to exert a direct effect on later intentions, unmediated by their hypothesized antecedents. Theoretical and practical implications of these findings are discussed.     

The effects of safer-sex stories on college students' attitudes toward condoms

Social learning theory predicts that reading non-erotic stories involving condom use will be as effective as reading erotic stories with condom use in producing positive attitudes toward condoms. Werner's orthogenetic principle, however, predicts that reading erotic condom stories will be most effective because of the link created between sexual arousal and cognitive information about condoms. 168 male and 149 female undergraduates enrolled in Introductory Psychology at a small, private, southern university participated in a study to test the validity of these two theories. The students read one of the following types of stories: erotic with condom placement described, erotic without condom use, or non-erotic with a model for discussing condoms. The men and women who read the non-erotic stories were most positive about condoms and reported the strongest intentions to use condoms in the future. These findings suggest that erotica is not necessary to produce positive attitudes toward condoms.     

Self-conscious emotions and self-regulation in the promotion of condom use

Two prospective studies examined the self-regulatory role of anticipated negative self-conscious emotions (ANSCE) in the theory of planned behavior. In Study 1, 147 undergraduates reported condom attitudes, perceived norms, self-efficacy, ANSCE (shame and guilt) should they not use condoms, and intentions to use condoms during the coming 6 weeks. At a 6-week follow-up, ANSCE predicted condom use intentions and behavior and partially mediated the effect of attitudes and norms on both. Study 2 experimentally tested the social nature of self-consciousness in ANSCE; 61 female undergraduates read a scenario priming the private-self or social-self or were assigned to a no-scenario control. They reported condom attitudes, perceived control, ANSCE, condom use intentions, and a 6-week follow-up. ANSCE again predicted condom use intentions. A test of moderated mediation indicated that ANSCE influenced condom intentions more in the social-self condition than in the control condition. Implications of these findings are discussed.     

Adolescents' self-efficacy to communicate about sex: its role in condom attitudes, commitment, and use

This study examined whether and how self-efficacy to communicate with parents and peers about sex relate to sexually experienced adolescent males' and females' (N= 144, 112) condom attitudes, intentions, and use. Results showed that males who reported greater self-efficacy to communicate with parents used condoms more frequently; and both males and females who can communicate with peers used condoms more frequently. Self-efficacy to communicate with peers was related to more positive condom attitudes, which in turn were associated with greater condom commitment and use. Greater ability to communicate with parents was also related to greater condom commitment and use among males. These results suggest the importance of designing interventions that give adolescents the skills they need to feel efficacious in their ability to communicate about sex and contraception.     

Predictors of Teens' Attitudes Toward Condoms: Gender Differences in the Effects of Norms

Using data collected from a telephone survey of adolescents aged 15 to 19, we studied predictors of condom attitudes. Analyses were conducted on a sample of 348 sexually active teens. Multiple regression revealed that holding other variables constant being females, African American, perceiving that more of their friends were using condoms (i. e., perceived normative behavior). and stronger perceived normative pressure were significantly associated with favorable condom attitudes. Furthermore, significant interaction effects pointed to gender differences in the association between two types of norms and attitudes toward condoms. Perceived normative behavior had a greater effect on the attitudes of female adolescents. Perceived normative pressure had a greater effect on the attitudes of male adolescents.     

Addressing the cross‐country applicability of the theory of planned behaviour (TPB): A structured review of multi‐country TPB studies

The theories of reasoned action and planned behaviour (TRA/TPB) have received substantial research interest from consumer behaviourists. One important area of interest that has not been adequately researched concerns the impact of national culture on the TRA/TPB components and interrelationships. To date, no systematic assessment of the impact of culture on the TRA/TPB model relationships has been undertaken. In order to understand the potential impact of culture on the TRA/TPB model relationships, a structured review of TRA/TPB studies is undertaken. Studies that have quantitatively applied the TRA/TPB across at least two countries within a consumption domain since 2000 are reviewed. The authors propose that two of Hofstede's cultural dimensions, individualism and power distance, may moderate the TRA/TPB relationships. The review highlights that the impact of subjective norm on intention varies most across countries, with the relationship between intention and both attitude and perceived behavioural control operating more similarly across country samples. Further, a systematic assessment of variation in the TRA/TPB model relationships via multilevel modelling shows that only the subjective norm–intention relationship varies across the countries studied. The relationship between subjective norm and intention is found to be influenced by power distance, with a stronger relationship evident in high power distance cultures. This review is the first of its kind and is of significance in addressing the emic versus etic nature of the TRA/TPB. Importantly, the article outlines relevant avenues and recommendations for future cross‐national research utilizing the TRA/TPB. Copyright © 2015 John Wiley & Sons, Ltd.     

Identifying Precursors of Safer‐Sex Practices in Mexican Adolescents With and Without Sexual Experience: An Exploratory Model1

Theoretical variables were examined for their empirical relevance as precursors of safer‐sex behavior in 2,011 Mexican adolescents, most of whom were not sexually experienced. Using structural equation modeling, a good fit was found for a path model with (a) partner communication and intention to use condoms as outcome variables; (b) self‐esteem, self‐efficacy, and decision making as antecedent variables; and (c) perceived norms about sexual practices, attitudes toward condom use, and knowledge of HIV as mediating variables. A good fit also was found for a slightly elaborated model involving condom use as outcome variable that was fitted in a subsample with 319 adolescents who reported sexual experience. Gender differences are discussed, as well as implications for intervention programs promoting safer‐sex behaviors.     

The fallacy of intimacy: sexual risk behaviour and beliefs about trust and condom use among men who have sex with men in South Africa

The objective of this study is to assess (1) whether beliefs about trust and condom use affect sexual risk behaviour, and (2) if beliefs about trust and condom use impact sexual risk behaviour directly or if this relationship is mediated by other determinants. The Information-Motivation-Behavioural Skills model was used as a framework for the mediation analysis. A diverse cohort of three hundred 18-40 year old men who have sex with men (MSM) residing in Pretoria, South Africa, were recruited and surveyed for this project. Findings indicate that men who report a high frequency of past unprotected anal intercourse are more likely to believe that it is not necessary to use condoms with a trusted or steady partner regardless of their current partnership status. This fallacy of intimacy appears to affect sexual risk behaviour through intentions and attitudes regarding safer sex practices. Based on these findings, we recommend that more attention be given in gaining a better understanding of how beliefs about trust and condom use are formed and how they can be changed among MSM in South Africa.     

Predicting intention to use condoms in homosexual men: an application and extension of the theory of reasoned action

A questionnaire based upon the Theory of Reasoned Action was developed and tested to identify predictors of intention to use condoms. Behavioral intentions, attitudes and subjective normative beliefs, behavioral norms, and age of HIV-positive status were included on the questionnaire. Internal consistency of the four components was high, with Cronbach's alpha coefficients of 0.76-0.87. Qualitative data were collected over 2 months from 194 homosexual men who participated in Sydney's homosexual community. Participants aged 17-64 years of mean age 29.5 attended individual interviews or small focus groups to discuss their views concerning condom use. 15% reported having tested HIV-positive, 59% tested negative, and 26% reported not knowing their HIV serostatus. According to logistic modeling, the significant predictors of intentions to use a condom were attitudes and behavioral norms, while HIV antibody positive status and age directly influence behavioral intentions to use a condom. About 50% of men over age 25 years intended to use a condom, irrespective of HIV status. Overall, 59% of men aged 25 years and younger intended to use a condom; 22% of HIV-positive men and 63% of HIV-negative men.     

The relationship between attitude,assertiveness and condom use

Abstract

This study investigated the relationships between attitudes, assertiveness and intention to use and actual use of condoms as a means of preventing infection from sexually transmitted disease. Both homosexual (n = 83) and heterosexual men (n = 128) participated in the survey. It was found that the homosexual men held more favourable attitudes, and reported greater intended and actdal condom use than the heterosexual men. Intention to use condoms was positively related to favourable attitudes, which were related to condom-specific assertiveness for both groups. For the heterosexual men only, general social assertiveness was negatively related to attitudes toward condoms. It was concluded that condom use was reassuringly frequent among homosexual men, but not for heterosexual men. Efforts to increase condom use among the latter will need to take into account negative attitudes and, in particular, the possible perception of condom use as an effeminate behaviour.     

‘Sluts’ or ‘Sleazy Little Animals’?: Young People's Difficulties with Carrying and Using Condoms

Qualitative data from a Western Australian study of sexual behaviour in young people were used to describe difficulties experienced in carrying and using condoms. Both men and women were concerned for their sexual reputation if they carried condoms, although this was more of a problem for the women than the men. However, these fears were not matched by the attitudes of the opposite gender: in general, there was less negativity about condom-carrying than was feared. Many of those who described using condoms had experienced condom failure and other difficulties, and it appeared that they were unfamiliar with the correct way to use condoms. It is suggested that many of these barriers to condom use can be removed with appropriate education and information strategies.     

Women,men, and condoms: attitudes and experiences of heterosexual college students

Little is known concerning gender and ethnic differences in attitudes about condoms or about the impact of attitudes on condom use. College students ( N = 393) rated many features of condoms. Overall, students were mildly positive about condoms, believing they offer effective protection but detract from sexual sensation. Both past condom use and future intentions to use condoms were higher among students with more favorable global attitudes toward condoms and more favorable specific beliefs about the interpersonal dynamics of condom use. Future intentions to use condoms were also associated with greater worry about sexually transmitted diseases and fewer previous sexual partners. Women were more favorable toward condoms than men. Gender differences also emerged in the predictors of condom use. Implications for assessing condom attitudes and for increasing condom use among young heterosexuals are discussed.     

Determinants of Condom Use Among High-Risk Heterosexual Adults: A Test of the Theory of Reasoned Action1

The research presents tests of traditional and augmented versions of Fishbein and Ajzen's Theory of Reasoned Action (TRA), applied to condom use among adult clients of a sexually transmitted disease clinic. In a longitudinal survey, predictor variables suggested by Ajzen and Fishbein (1980), plus gender and condom use self-efficacy, were measured at Time 1. Condom use at Time 2, 3 months later, was regressed onto these variables. The traditional TRA worked well to predict condom use intentions and behavior. Support was also found for inclusion of gender and self-efficacy in the prediction of intention to use condoms, but not behavior. Implications for interventions to increase condom use among those at high risk for AIDS and other STDs are discussed.