A Comparison of Health Behavior Constructs: Social Psychological Predictors of AIDS-Preventive Behavioral Intentions

The present study focused on predicting AIDS-preventive behavioral intentions (i. e., intentions to discuss AIDS-related information and to use condoms) from constructs taken from the health belief model, the theory of reasoned action/planned behavior, and social cognitive theory. Questionnaire data were collected from 124 undergraduates using scales from previously published work as well as some new measures designed for this study. Perceived behavioral control, perceived risk, attitudes, self-efficacy, subjective norms, negative expected outcomes, and perceived severity of HIV infection were correlated with at least one intention measure; but regression analyses showed that perceived behavioral control was the strongest independent predictor of condom use intentions and of intentions to discuss AIDS information with a partner. Implications for theory and application are discussed.     

Predicting Zimbabwean women's ability to tell their partners to use condoms.

The effectiveness of AIDS education may depend on the development of models that predict and explain HIV prevention behavior. In this study, the aim was to test Fishbein and Ajzen's theory of reasoned action model in predicting women's capacity to tell their partner to use condoms. The basic theory pertains to the relationship of 1) attitude toward behavior and 2) the subjective norms to behavior; further refinements reflect factors such as 3) perceived behavioral control or self-efficacy, 4) and perceived barriers. A sample was drawn of 123 female first-year teacher trainees in Harare, Zimbabwe, in late 1990; a self-administered questionnaire was distributed and returned. 72% of the respondents were sexually experienced. The mean age of the entire sample was 24 years. The results of the multiple linear regression indicated that the model was able to predict were F(2,74)=32.81, p.0001. 47% of the variance was explained by this Fishbein model. Attitude toward behavior was significantly associated with the intention to tell one's partner to use condoms (beta = .60, p .05). Subjective norms were not significant (beta = .15, p .05). Perceived behavioral control and perceived barriers were also not significantly associated with the intention to tell one's partner to use condoms. A caveat was that the subjective norm was measured by only one item, and an improved conceptualization and measurement of this construct might have changed the relationship. The suggestion is that health educators should address women's underlying beliefs and attitudes about the benefits of telling their partners to use condoms. Future prospective studies will better delineate the relationship between attitude and behavior.     

Predicting Nutrition Behavior: The Utilization of a Social Psychological Model of Health Behavior

In a prospective study, two nutrition behaviors, meat and sodium consumption, were examined utilizing a social psychological model of health behavior suggested by Wallston and Wallston. The model conceptually integrates elements from the Health Belief Model, Fishbein's attitude-behavior model, and Triandis' theory of social behavior. According to the model, behavior is a function of behavioral intent, habit, and facilitating conditions. Behavioral intent is a function of affect, perceived consequences, and social and personal norms. In this study, the model explained a significant proportion of the variance for each self-reported nutrition behavior and behavioral intent. Hierarchical regression analyses indicated that all three factors contributed to the prediction of behavior, and differences between meat and sodium consumption were found. For behavioral intent, each of the components made a significant contribution, with affect being the best predictor.     

Health beliefs and teenage condom use: a prospective study

The authors investigated the extent to which Health Belief Model (HBM) measures can be used to predict subsequent sexual activity and consistency of condom use among teenagers, especially those who report having new sex partners. Results from a longitudinal survey of sex behavior and HIV-relevant cognitions among 258 sexually active 16 and 18 year olds in Dundee, Scotland, are reported. Participants responded to a confidential postal questionnaire on their demographic characteristics, previous sexual experience, prior condom use, beliefs specified by the HBM, peer norms regarding condom use, and condom use intentions. Measures of sexual behavior and condom use consistency were then included in a follow-up questionnaire 1 year later. Demographic and HBM measures, as determined through discriminant analysis, did not account for significant proportions of variance in the consistency of condom use or mediate the effects of prior sexual experience or demographic measures. The respondents who reported more frequent sexual intercourse were less likely to use condoms consistently while those who had used condoms previously reported more consistent use. Female respondents were less likely than the young men to follow through upon their intentions to consistently use condoms.     

Some factors in condom use amongst first-year Nigerian University students and black and white South Africans

A questionnaire was administered to 213 sexually active first-year Nigerian university students and 150 Black and 150 White South African adults. Nigerian students gave 90% correct answers on 6 of the 10 items of a measure of condom knowledge (M = 6.1). The most common mistakes with respect to condom use were ignorance about putting a condom on just before ejaculation (37%), the use of an oil-based lubricant with a condom (29%), and when to take off a condom (28%). For the South African sample utility of the Health Belief Model and Theory of Reasoned Action for HIV prevention could be confirmed by intention to use condoms. Race and preventive benefits were predictive for current condom use. Findings have relevant implications for developing culturally diverse HIV intervention programs if confirmed with larger diverse groups.     

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.     

The Double-Edged Sword of Providing Information About the Prevalence of Safer Sex1

A group of 267 college students participated in an experiment to determine the effect of communicating different percentages (i.e., 12%, 36%, 64%, 88%) of the prevalence of safer sex in the student population on condom-use intention. A positive linear effect of prevalence information on condom-use intention was demonstrated, although the information that 64% engaged in safer sex seemed most effective in changing condom-use intention. This effect was independent of previous sexual behavior. Although prevalence information had a positive indirect effect on condom-use intention as a result of a change in perceived social norms, it had a negative indirect effect because of perceived risk. That is, information indicating a high prevalence of safer sex lowered the perceived risk of AIDS and, as a result, the intention to use condoms.     

Predicting Intentions to Use Condoms: A Meta-Analysis and Comparison of the Theories of Reasoned Action and Planned Behavior1

A meta-analysis was conducted on 23 psychosocial predictors of intentions to use condoms. Data from 67 independent samples were included in the review. Findings demonstrated that demographic, sexual experience, and personality variables had small average correlations with intentions. Knowledge about HIV/AIDS and perceptions of the threat of disease were also weakly related to decisions about using condoms. Attitudes and subjective norms from the theory of reasoned action, on the other hand, demonstrated medium to strong effect sizes. Two components of social influence not specified by the theory of reasoned action also received support. Evidence suggested that perceived behavioral control from the theory of planned behavior was a reliable predictor of behavioral intentions and explained variance over and above the effects of attitudes and subjective norms.     

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.     

Psychological predictors of HIV-preventive behavior among Zimbabwean students

This report is based on a study of 852 sexually active volunteer student teachers in Zimbabwe who were assessed on their AIDS risk reduction behavior and the Health Belief Model of Janz and Becker. The model posits that behavior modification occurs if there is knowledge of the disease and its severity, susceptibility, effective prevention, self- efficacy for prevention, accessible health care and advice, normative support for behavior change, and few barriers to action. Behavior change is measured by reduced numbers of sexual partners, increased condom use, and decreased prostitute contact. The 404 women showed no sex differences from the 448 men, except that men reported lower self- efficacy. The multiple linear regression analysis revealed that for men the Health Belief Model was significant and explained 15% of the variance (F=7.50, p.0001). Behavior risk reduction was predicted by self-efficacy (B=.10, p.0001), perceived barriers to action (B=-.19, p.01), and belief in the effectiveness of preventive practices (B-.10, p.001). The women's model was also significant and explained 12% of the variance (F=4.06, p.001). Preventive behavior was predicted by perceived susceptibility to infection (B=.19, p.01), access to health care and advice (B=.09, p.05), and belief in the efficacy of preventive measures (B=.06, p.05). Future research in planned to try to augment the Health Belief Model results by including the following variables: contact with AIDS-affected persons and specific barriers to action such as dependence on paid sex, the breakdown in traditional values, familial separation, and attitudes toward monogamy. Also, the role of alcohol and drugs in the context of sexual behavior will be considered. Other alternative models will also be examined, such as Bandura's social learning theory and Fishbein's theory of reasoned action. New theories which are uniquely applied to AIDS may need to be formulated.     

Physically active students' intentions and self-efficacy towards healthy eating

This study investigated intentions and self-efficacy of physically active university students towards healthy eating. The application of Planned Behavior theory has shown that attitudes, intention, perceived behavioral control, and subjective norms play an important role in shaping people's behavior. 96 students, who participated in physical activities, voluntarily completed the Questionnaire for the Planned Behavior Model and the Health Behavior Questionnaire. The former examines attitudes, intentions, perceived behavioral control, and the lately added attitude strength, and role identity towards the behavior factors. The latter assesses one's efficacy expectations towards healthy eating. The regression showed strong associations between the examined variables, signifying that attitudes, perceived behavioral control, and role identity could account for one's intention towards healthy eating behaviors. On the other hand, one's self-efficacy for healthy eating could be explained from the attitudes, intention, perceived behavioral control, and attitude strength held. Overall, systematic participation in physical activities appeared to be accompanied with a relatively healthier diet, while self-efficacy had a significant association with maintaining the healthy eating behaviors. Possible interpretations, limitations, and implications for health professionals are discussed.     

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 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.     

The Impact of Social Influences in the Context of Attitude,Self-Efficacy,Intention, and Previous Behavior as Predictors of Smoking Onset1

Three different constructs for measuring social influence were utilized in the present study to explain adolescents' present and future smoking behavior at 6 (T2), 12 (T3), and 18 months (T4) after the first test. Social influence was assessed by measuring the social norms, perceived smoking behavior, and direct pressure. The impact of the social influence constructs was also assessed in the context of broader models, including attitudes and self-efficacy expectations, intention, and previous behavior. The three social influence measures correlated significantly with intention and behavior. Stepwise regression analyses showed that perceived behavior and pressure made significant contributions, after entering social norms, in explaining actual and future adolescent smoking behavior. Adding attitudes and self-efficacy increased the predictive power of the model significantly. In agreement with the theory of Fishbein & Ajzen (1975), intention was the most powerful predictor in explaining present and future smoking behavior. Attitudes, self-efficacy, and the social influences also made small unique contributions improving the explanatory power by approximately 5%. Previous behavior, however, had a substantial unique contribution in predicting future behavior after attitudes, social influences, self-efficacy, and intention were entered in the equations. Since social influences may exert their impact via different routes, it is recommended that smoking prevention programs discuss not only overt pressures such as direct pressure from peers, parents, and media, but also address the more covert social pressures such as modeling and the adolescents' ability to cope with these covert influences. Furthermore, norms on nonsmoking should be made explicit.     

Psychological Predictors of Condom Use to Prevent HIV Transmission Among Zimbabwean Students

Psychologists have much to contribute to HIV prevention. It is important to identify predictors of HIV preventive behaviour and to incorporate this information in AIDS education. The Health Belief Model is an established model of health behaviour that has recently been applied to AIDS prevention. It originally posited that perceptions of susceptibility to, severity of, and solutions to, illness predicted health behaviour. It thus emphasized “disease” dimensions of illness. It was expanded to include barriers to, cues to, and social support for, health behaviour. The enlarged model thus incorporated “social” dimensions of health behaviour. Because preventing AIDS involves a partner and considerable social risks and skills, inclusion of social components may improve the capacity of the Health Belief Model to predict HIV preventive behaviour. An inventory measuring condom use and the enlarged Health Belief Model was completed by 181 male and 171 female teacher-trainees. Data were analysed using multiple regression with hierarchical entry, first of disease dimensions (susceptibility, severity, solution), then social dimensions (barriers, cues, social support). Addition of social dimensions to the disease dimension equation yielded a significant F-change among both sexes and increased the variance explained from 16% to 30% among males, and from 4% to 14% among females. The full regression was significant only among males. The implications of these results for intervention goals, messages and strategies among both sexes are elucidated.     

The AIDS Risk Reduction Model: Examining Intentions to Use Condoms Among Injection Drug Users1

This paper uses the AIDS Risk Reduction Model (ARRM) to examine psychosocial factors involved in adopting safer sex practices in a sample of Los Angeles injection drug users (IDUs; n= 161) who reported having more than one sex partner in the year preceding the interview. The ARRM hypothesizes that behavior change is a process occurring in three stages: (a) labeling one's behavior as problematic, (b) making a commitment to behavior change, and (c) taking action to accomplish that change. We test the first two stages of the model using a measure of perceived risk of HIV infection (Stage I), and intentions to use condoms always during vaginal or anal sex in the next year (Stage 2). We examine differences in the predictive value of the ARM between IDUs who reported using condoms in the year prior to the interview and those who reported not using them. We identify leverage points in the model-factors which appear to have a major influence on intentions to use condoms and which may be amenable to change through educational or other types of intervention. For both condom users and non-users, susceptibility to AIDS predicted perceived infection risk (Stage I). For condom users, knowledge about AIDS also predicted perceived risk. For both groups, self efficacy, peer norms concerning condom use, and the perceived pleasure of using condoms predicted intentions to use condoms (Stage 2). Our findings do not support either direct or indirect relationships between the Stage 1 and Stage 2 outcome variables for either group.