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.     

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.     

Predicting Undergraduate Condom Use with the Fishbein and Ajzen and the Triandis Attitude-Behavior Models: Implications for Public Health Interventions1

The present study used two social-psychological theories of attitude-behavior relationships to investigate condom use by college undergraduates. One purpose of the present research is to provide information for public health practitioners to better design theory-based interventions to reduce the incidence of STD's by increasing the use of condoms. Another purpose is to compare the relative usefulness of two attitude-behavior models in predicting condom use. The Fishbein and Ajzen theory of reasoned action (Ajzen, 1988; Fishbein & Ajzen. 1980) was compared with a version of Triandis' theory of attitude-behavior relations (Triandis, 1977). Of major interest was whether variables in this version of the Triandis model increased the explanatory power of the Fishbein and Ajzen model in the prediction of condom use intention and behavior. In addition, specific outcome beliefs and normative beliefs held by subjects were used to predict condom use. One hundred and ninety college undergraduates were given a questionnaire designed to measure the components of the two models. Three months after completing the questionnaire, subjects were contacted by phone to record the subject's frequency of condom use (if the subject reported having had intercourse) during the 3-month period between initial assessment and follow-up. In the prediction of intention to use a condom, results indicate that one variable from the Triandis model, personal normative beliefs, increases the explanatory power offered by the expectancy value and normative belief components of the Fishbein and Ajzen model. In the prediction of reported condom use during the 3-month follow-up period, two variables from the Triandis model—perceived susceptibility and AIDS fear—significantly increased the predictive power of the Fishbein and Ajzen model. Based on these results, the authors propose an alternative model to explain undergraduate condom use. The implications of these findings for public health interventions to encourage the use of condoms is discussed.     

Generalizing Behavioral Findings Across Times,Samples, and Measures: A Study of Condom Use1

Data from a Knowledge, Attitude, Belief, and Practices (KABP) Survey, administered to a sample of residents of Saint Vincent and the Grenadines, were used to replicate a previous study (Fishbein, Trafimow, Francis, et al., 1995) that investigated the relative importance, as predictors of condom use, of selected theoretical variables from the theory of reasoned action (Fishbein & Ajzen, 1975), and the theory of planned behavior (Ajzen & Madden, 1986). Besides addressing generalization problems, the study tested a more internally valid formulation of the role of past behavior that supported the argument that past condom use is better viewed as a predictor of current intention than as a criterion variable. Perhaps more important, the influence of past behavior was found to be partially mediated by its effect on attitudes and norms.     

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.     

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.     

Gender Differences in a Comparison of Two Tested Etiological Models of Cigarette Smoking Among Elementary School Students1

The theory of reasoned action (TRA), theory of planned behavior (TPB), and a revised TPB were evaluated using manifest variable structural equation modeling among 4^th‐ through 6^th‐grade students for effectiveness in predicting lifetime cigarette use. TRA was an adequate model for female students, but not male students. TPB resulted in improved model fit over TRA for both male and female students, and a revised TPB model improved fit marginally among female students. Tests for differences across gender indicated that the relationship between intention to use and lifetime cigarette use was stronger among female compared to male students. The results indicate that the TPB is an effective model for predicting lifetime cigarette use among late elementary‐school‐aged children.     

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.     

Sexually Explicit Media and Sexual Risk Behavior in a Sample of Men Who Have Sex with Men in Norway

The aim of this study was to explore the association between the consumption of sexually explicit media (SEM) depicting condom and non-condom use and HIV/STI-related sexual risk behavior among men who have sex with men (MSM) in Norway. We also explored whether the association between SEM consumption and STI-related sexual risk behavior is mediated by men’s sexual self-esteem and/or condom use self-efficacy. A cross-sectional online survey study was carried out in Norway in 2012. The final sample comprised 529 MSM in Norway. There was a bivariate association between the use of SEM picturing condom use and less STI-related sexual risk behavior. Further, the association between SEM consumption and sexual risk behavior was mediated by condom use self-efficacy. However, SEM did not influence sexual risk behavior via sexual self-esteem. The results offer important cross-cultural validation of recent comparative data from the US and may be used to promote HIV/STI prevention, in the sense that the actors in SEM may serve as role models in managing condom use in sexual contexts.     

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.     

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.     

A Longitudinal Application of the Theory of Reasoned Action to Women's Career Behavior1

Based on the theory of reasoned action (TRA; Fishbein & Ajzen, 1975), we hypothesized that young women's career intentions would be predicted by their gender-role attitudes and perceptions of their boyfriends' and parents' career-related preferences for them. Career intention was expected to predict future career behavior. The model was tested using longitudinal data from 105 women studied in 1973 and followed up 14 years later in 1987. Data were analyzed using structural equation modeling. Results supported the TRA: women's gender-role attitudes and their perceptions of important others' preferences predicted their career intentions, which predicted career behavior 14 years later. Implications for the study of women's careers and the longitudinal application of the TRA are discussed.     

Predicting Contraceptive Behavior Among University Men: The Role of Emotions and Behavioral Intentions1

This research employed two theories to predict contraceptive behavior (condom use) among university men. The sexual behavior sequence (Byrne, 1977, 1983) hypothesizes that erotophobia-erotophilia (negative to positive emotional response to sexuality) will generalize and mediate avoidance or approach of contraception. The theory of reasoned action (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975) hypothesizes that condom use behavior (B) is a function of behavioral intentions (BI) to perform this act; BI is hypothesized to be a function of attitudes towards the act (Aact) and relevant subjective norms (SN), and Aact and SN in turn have hypothesized basic determinants (). In addition, the theory of reasoned action holds that variables external to this model (i.e., erotophobia-erotophilia) may only affect behavior indirectly, by affecting the model's components. To test these assumptions, 145 undergraduate males completed measures of erotophobia-erotophilia and BI, Aact, SN, and and with respect to condom use in the coming month; a one month follow-up measure of B was also obtained. Results confirmed each of the hypothesized relationships and showed that for subjects who had sex during the month under study (N= 44), erotophobia-erotophilia and behavioral intentions were related to condom use (r= .33, r= .44, p < .05). Moreover, in contrast to the assumption of the theory of reasoned action, erotophobia-erotophilia and intentions independently predicted condom use; the linear combination of these factors predicted condom use significantly better (R= .57, p < .001) than either factor taken singly. Conceptual and applied implications of these findings are discussed.     

The relationship between psychosocial factors and condom use among African-American adolescents

The present investigation explored the relationship between psychosocial factors and condom use by African-American adolescents. Two hundred twenty-nine males, aged 14 to 19 years, responded to a health behavior survey that gathered information on demographics, HIV knowledge, perceived certainty of future condom use, present and past use of condoms, and intention to use condoms in the next six months. Several psychological variables, including sexual self-efficacy and self-esteem, were also measured. It was found that the majority of participants were sexually active by age 13, had four or more lifetime sexual partners, and were using condoms regularly. Multiple linear regression analysis indicated that sexual self-efficacy predicted perceived certainty of condom use. In addition, self-esteem and sexual self-efficacy predicted intention to use condoms. These findings highlight the need to develop HIV prevention curricula for African-American male adolescents that not only emphasize the potential risks associated with having multiple sexual partners, but also include components to enhance self-worth and sexual self-efficacy.     

Factors affecting behaviors that address HIV risk among senior secondary school pupils in South Africa.

The purpose of this study was to identify factors affecting HIV risk reduction among senior secondary school pupils in South Africa. The sample included 460 Grade 12, Secondary School pupils whose ages ranged from 16 to 30 years (M = 19.7 yr., SD = 2.5) and who were chosen at random from the total Grade 12 population throughout one region in the Northern Province of South Africa. Measures were of sexual behavior and condom use, knowledge about correct condom use, intention of condom use, behavioral norms, attitudes, normative beliefs, and subjective norms about condoms, HIV/AIDS vulnerability (likelihood to get it) and severity of the illness in the country, and condom use self-efficacy. Bivariate analysis gave positive significant relations among normative beliefs, subjective norms, and attitudes towards condom use as well as HIV/AIDS vulnerability and HIV risk behavior. Regression analysis indicated that for boys, younger age at first vaginal intercourse, less intention for condom use, and HIV/AIDS vulnerability were predictive for HIV/AIDS risk behavior and explained 39% of the variance. It is suggested that these predictors should be included in intervention programs for HIV prevention.     

Barriers to Condom Use and Safer Sex Talk among College Dating Couples

Using an open-ended questionnaire response format, this study examined self-generated barriers to condom use and safer sex talk among 119 heterosexual college dating couples at the University of New Mexico (total N=238). Data were collected from both members of these dyads. Reasons for abstaining from intercourse were also elicited. Several general response categories emerged including no perceived risk; spontaneity; deliberate choice; negative attitudes; and a lack of perceived self-efficacy for enacting condom use and safer sex discussion. Explanations for abstinence included religious/moral prohibitions; lack of readiness for intercourse; and a fear of being emotionally hurt. Few differences emerged across gender, ethnicity (Caucasian vs Hispanic), and prior sexual experience (participant had intercourse prior to current relationship vs did not). Selected reasons for not using a condom and/or discussing safer sex (e.g. partner is monogamous) were cross-validated with the self-reported behavior of the respondent's dating partner. In general, participants reasons for perceived non-risk were not supported by their partner's reported behavior. Implications of these findings for sexual risk reduction programs include: establishing realistic goals for safer sex behavior and talk within committed relationships, acknowledging the impact of passion on safer sex, and addressing knowledge gaps in risk perception.     

Condom use among high-risk adolescents: testing the influence of alcohol use on the relationship of cognitive correlates of behavior.

The goal of this study was the exploration of distal effects of alcohol use on condom use. Criminally involved adolescents completed an initial measure of attitudes, beliefs, and prior behavior. Of the 300 who completed the initial measurement, 267 (89%) completed a behavioral assessment 6 months later. Analyses validated a theoretical model of condom use intentions and indicated that intentions and attitudes measured at baseline were significant predictors of condom use behavior 6 months later. Neither alcohol use nor alcohol problems moderated relationships among model variables or the influence of intentions and attitudes on behavior. The findings do not support a distal role for alcohol use in altering the cognitive correlates of condom use intentions and behavior among high-risk adolescents.     

Predicting the Performance of Dental Hygiene Behaviors: An Examination of the Fishbein and Ajzen Model and Self-Efficacy Expectations1

This study examined the value of the Fishbein and Ajzen model of behavioral intentions and Bandura's concept of self-efficacy expectations as prospective predictors of the dental hygiene behaviors of young adults. All participants (73 males and 58 females) completed self-report measures of the predictor variables and 60% of that group (N = 77) then recorded brushing and flossing behaviors over a four-week period. The Fishbein and Ajzen model accounted for a significant proportion of the variance in intentions to brush (R²= .32) and intentions to floss (R²= .30). Intentions were in turn related to self-monitoring records of brushing and flossing frequency (rs= .52 and .61). Introducing self-efficacy expectations into the Fishbein and Ajzen model failed to improve the prediction of brushing and flossing frequency. However, self-efficacy was predictive of behavioral intentions, adding significantly to the variance accounted for by the attitudinal and subjective norm components of the Fishbein and Ajzen model. These data suggest that self-efficacy expectations are important in understanding protective health behaviors and that the inclusion of a self-efficacy component in the Fishbein and Ajzen model deserves consideration.     

Does Past Condom Use Moderate the Future Condom Use Intention-Behavior Relationship? Results from a Ghanaian Sample

Behavioral intention is an important predictor of actual behavior. Yet, people often fail to act on their intentions. This study used panel data to examine whether intention interacts with past behavior in determining future behavior. Young people in the Eastern Region of Ghana (N = 956, 495 = female, 461 = male) completed a structured self-administered questionnaire, assessing intentions to use condoms and past condom use behavior at Time 1, and future condom use behavior at Time 2. Hierarchical multiple regression analyses indicated that intentions to use condoms and past condom use behavior accounted for a significant proportion of the variance in future condom use behavior. In addition, past condom use moderated the future condom use intention–behavior relationship. These results demonstrate the usefulness of considering young people's past experiences with condoms in informing the design of condom use skills training. In other words, a condom use skills training intervention that uses the pedagogical approach of starting from the “known” to the “unknown” might benefit young Ghanaians.