The prediction of condom use intention among South African university students

A questionnaire was administered to 294 sexually active, unmarried undergraduate students to investigate the role of social norms in the prediction of the intention to use condoms. Components of social cognitive theory and the theory of reasoned action and planned behaviour were integrated with those of the Health Belief Model to predict future intention to use condoms with a new partner. Logistic regression analyses of selected risky sexual behaviours on the intention to use condoms showed that, among males, attitudes towards using condoms and the Health Belief Model component of perceived barriers predicted the intention to use condoms. The Health Belief Model component of perceived benefits could not be interpreted. Attitudes, subjective norms and perceived self-efficacy were associated with female students' intention to use condoms. Implications for strategies of HIV/AIDS prevention are discussed.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.     

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.     

Correlates of spirituality and well-being in a community sample of people living with HIV disease

While the past several years have witnessed an increase in the amount of research examining the spiritual perspectives of people living with HIV/AIDS, this literature is still insufficient to guide the conceptualization and development of spiritually based interventions to improve the life quality of people living with HIV illness. The present study assessed a community sample of 275 persons living with HIV disease to examine relationships among their spirituality, quality of life, perceptions of social support, and coping and adjustment efforts. This study found relationships between social support, active problem solving, life satisfaction, and gender and race with higher levels of spirituality among people living with HIV/AIDS. Mental health providers may need to routinely include assessments of spirituality and religious practices. Caregivers, faith communities, and mental health providers will need to assist in developing supportive environments that enhance the spiritual life and social well-being of people living with HIV infection. Additionally, caregiver training programs will need to focus on spiritual practices as a means of establishing a support system that increases the psychosocial well-being of people living with HIV/AIDS.     

Psychological and social characteristics of attenders for breast screening

Abstract

Demographic characteristics, health behaviour and knowledge of breast cancer were assessed in 183 women from a regional breast screening unit and compared with those of 182 women from a breast clinic and 41 control subjects. A questionnaire yielded information on (i) demographic characteristics and cancer-related behaviours including breast self-examination (BSE), use of screening and promptness of presentation of breast symptoms in the clinic group, (ii) the extent and effects of knowledge about breast cancer and (iii) the role of Health Belief Model dimensions. Results showed the screening unit attenders to be significantly older and to be significantly more likely to be from higher social classes. Differences between the groups in health beliefs and knowledge did not remain once the effects of age and social class were partialled out. While attitudes towards BSE and its practice related to health beliefs. only a minority of the women indicated that they practised BSE with any regularity. The results suggest that screening is failing to attract a truly representative sample of the community and raise the possibility that this failure is a consequence of sociological as much as psychological factors.     

Predicting uptake of a routine cervical smear test: A comparison of the health belief model and the theory of planned behaviour

Abstract

This paper reports on a study carried out to identify predictors of uptake of cervical screening among 142 women (59% response rate) in inner London. Two social cognition models were used: The Health Belief Model (HBM; Becker, 1974) and the Theory of Planned Behaviour (TPB; Ajzen, 1991) and in addition anticipated affect following non-attendance for screening was assessed. The TPB emerged as by far the superior model for predicting screening intentions, explaining 51% of the variance in comparison with only 4% explained by the HBM variables. However, neither model was able to predict a significant amount of variance in uptake of screening three months later. Possible reasons for the poor prediction of this type of behaviour are discussed.     

Mental Health among Youth in South Australia: A Survey of Flourishing,Languishing, Struggling,and Floundering

The Complete State Model of Mental Health was used to describe the prevalence of flourishing, languishing, struggling, and floundering in life in a sample of young South Australians (n = 3,913; 13–17 years, 52% female). Categorisation was based on the relative proportion of mental health and mental illness symptoms reported on standardised measures and the association of these categories to health‐risk behaviour. Variability in categories and health‐risk behaviour due to gender or region was investigated. Results indicated that a disturbingly small proportion of adolescents (<50%) were flourishing in life, that poorer states of mental health were associated with increased health‐risk behaviour, and that the propensity to engage in health‐risk behaviour did vary by gender and region. The current study extends the platform from which positively focused mental health strategies can be tailored and launched to meet the mental health needs of adolescents.     

Knowledge of drug-related health problems among injecting drug users: Implications for the transmission of HIV infection

Abstract

In a project that investigated the HIV-related risk behaviour of injecting drug users, respondents were categorized along dimensions of expertness in HIV/AIDS knowledge and knowledge about drug-related health problems. Knowledge about drug-related health problems was found to be significantly associated with sharing. Better informed respondents were less likely to share injecting equipment and to predict they would share in future. They were more likely to adopt consistent injecting hygiene, seek information about AIDS, and perceive themselves as in control of their lives. No significant relationships were observed between sharing and HIV/AIDS knowledge. The data have relevance for AIDS educational strategies, since knowledge about AIDS and HIV transmission appears to be insufficient to induce behavioural change. Greater emphasis on the health problems that afflict most injectors may be a way of encouraging general harm minimization.     

Saints and Sinners: Training Papua New Guinean (PNG) Christian Clergy to Respond to HIV and AIDS Using a Model of Care

Papua New Guinea has experienced a growing HIV/AIDS epidemic. The Christian Churches have played a vital role in responding to HIV, through community support, encouragement and social change. Strong, effective Church leadership can help create safe environments of care and support for those infected and for prevention of HIV. Method A series of trainings in capacity development for clergy were undertaken by the National AIDS Council Secretariat (NACS)/National HIV/AIDS Support Project (NHASP). Results A model “Church’s Response to HIV and AIDS in a Care Continuum” was developed to assist the training. This paper discusses the model and the lessons learned.

Changes in health status after one year for persons at-risk for and with HIV infection

Abstract

Health status is an important component of the evaluation of patient outcome in HIV infection where disease is chronic, progressive, and debilitating. This paper compares patient self-report for 9 dimensions of health status for patients followed in ATHOS (AIDS Time-Oriented Health Outcome Study). We compared changes in functioning after 12 months for 1, 524 patients with varying HIV disease severity: 238 asymptomatic, 447 symptomatic, 441 AIDS, and 398 HIV-negative individuals who are at-risk for infection.

Declines in health status were observed for all HIV-infected persons, including also asymptomatic patients. Individuals with symptomatic disease or AIDS had significant declines (p < 0.001) in physical functioning, energy, global health, pain, and increased disease symptoms, but no significant declines in health distress, cognition, or mental health. Persons with AIDS had greater declines than those with symptomatic disease. All HIV-infected individuals reported significantly fewer hours at work and more disability days than HIV-negative patients from similar risk pools. The adverse impact that HIV infection has on the health status of HIV-positive asymptomatic individuals is striking; HIV-negative individuals are more similar to HIV-positive individuals than to the general population.     

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n?=?63, 31.3%, women, n?=?138, 68.7%, mean age?=?40.1, SD?=?10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

     

New dimensions of abnormal illness behaviour derived from the Illness Behaviour Questionnaire

The primary aim was to explore the factor structure of the Illness Behaviour Questionnaire (IBQ) and the generalisability of the derived dimensions to both general community members and four chronic illness groups. A questionnaire was administered to 675 participants, comprising 344 from the community, 80 with asthma, 95 with diabetes, 79 with chronic pain and 77 with chronic fatigue syndrome (CFS). Illness severity was calculated for all chronic illness participants (self-rated health for community members). Three IBQ scales were derived following an exploratory factor analysis for the whole sample: Affirmation of Illness (α = 0.71 (CFS)–0.79 (asthma, diabetes)), Concern for Health (α = 0.71 (asthma)–0.78 (pain)) and General Affective State (α = 0.70 (CFS)–0.80 (asthma)). Patterns of response across the five samples, and intercorrelations among the new scales and the original seven scales, were largely in accord with expectation. Long-standing criticisms of the IBQ were addressed by using systematic statistical principles to identify meaningful and psychometrically sound IBQ dimensions. The derived structure offers a more parsimonious account of possible illness responses, with the availability of a more concise yet informative index of abnormal illness behaviour having practical utility for researchers and clinicians alike.     

Gendered adversity and mental health of adolescents orphaned by AIDS in a rural South African community: An exploratory study

This study explored gender differences in adversity and mental health among South African adolescents orphaned by AIDS. Adolescents (N = 121; females = 45.5%; mean age 14.14 years, SD = 2.09) self-reported their childhood adversities and probable mental ill health on the Child Trauma and General Health Questionnaire. Results revealed that female participants orphaned by AIDS were significantly more likely to report childhood adversity at total score level as compared to male participants. However, both male and female participants reported comparable scores on subscales of childhood adversity (emotional abuse, physical abuse, sexual abuse, and physical neglect). Moreover, female participants displayed higher composite mental ill health and all its subscales except for social dysfunction. Our findings suggest that gender-sensitive programmes and policies to address the effect of childhood adversity and mental ill health among adolescents orphaned by AIDS, are urgently needed.     

Application of a modified health belief model to hiv preventive behavioral intentions among gay and bisexual men

Abstract

The utility of a modified health belief model (Janz and Becker, 1984) for predicting the intention to use condoms was tested in a study among gay and bisexual men. The model explained a reasonable amount of variance. It was found that younger men's decision to have safe sex was guided by factors other than those that influenced older men. Among younger men, the intention to use a condom was positively related to the relative number of persons with AIDS in their social environment (cues to action) and to the perceived benefits of HIV preventive behavior. Among older men, this behavioral intention was much more determined by their perception of the prevalence of HIV and by their perception of their vulnerability to HIV infection. These findings are important because they may partly explain the recent increase in AIDS-risk behavior among young gay and bisexual men. The discussion focuses on these findings and on the implications for interventions aimed at promoting safe sex.     

Psychosocial adjustment along the HIV disease continuum

Abstract

Evidence suggests that certain indices of stage of HIV disease are determinants of psychological distress, although information is lacking on how disease stage impacts on multiple domains of adjustment. The present study aimed: (1) to explore differences among clinical stages of HIV on measures of psychosocial adjustment, and (2) to explore the relationship between indices of psychosocial adjustment to HIV and self-report measures of physical health. Ninety six HIV-infected persons and 33 HIV seronegative comparison group participants were interviewed and completed self-administered scales. Participants were divided into four groups (the independent variable): a comparison group and three HIV groups, representing the three clinical indices of illness stage (asymptomatic, early symptomatic and AIDS). Three subjective health indices included number of HIV-related symptoms, global health rating, and T4 count. The dependent variables included 5 psychosocial adjustment measures. Results indicated that social and instrumental domains of adjustment were significantly associated with both clinical stage and all 3 subjective health indices. Levels of psychological distress were associated with number of physical symptoms and global health rating, but were unrelated to clinical stage and T4 count. Emotional and existential concerns were unrelated to all indices of illness stage.     

Modelling elderly patients’ perception of the community pharmacist image when providing professional services*

Professional pharmaceutical services may impact on patient’s health behaviour as well as influence on patients’ perceptions of the pharmacist image. The Health Belief Model predicts health-related behaviours using patients’ beliefs. However, health beliefs (HBs) could transcend beyond predicting health behaviour and may have an impact on the patients’ perceptions of the pharmacist image. This study objective was to develop and test a model that relates patients’ HBs to patient’s perception of the image of the pharmacist, and to assess if the provision of pharmacy services (Intervention group-IG) influences this perception compared to usual care (Control group). A qualitative study was undertaken and a questionnaire was created for the development of the model. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using Confirmatory Factor Analysis (CFA). Structural Equation Modelling (SEM) was used to explain relationships between dimensions of the final model and to analyse differences between groups. As a result, a final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: x²(80) = 125.726, p = .001, RMSEA = .04, SRMR = .04, GFI = .997, NFI = .93, CFI = .974). SEM indicated that ‘Perceived benefits’ were significantly associated with ‘Perceived Pharmacist Image’ in the whole sample. Differences were found in the IG with also ‘Self-efficacy’ significantly influencing ‘Perceived pharmacist image’. A model of patients’ HBs related to their image of the pharmacist was developed and tested. When pharmacists deliver professional services, these services modify some patients’ HBs that in turn influence public perception of the pharmacist.     

Cross-sectional and Longitudinal associations in coping strategies and physical health outcomes among HIV-Positive youth

This study assessed whether coping styles had an influence on physical health outcomes either concurrently or longitudinally in a sample of HIV-positive youth. Coping styles were characterized as positive, passive, depressive withdrawal, and escapist. A cross-sectional latent variable analysis (N = 279) assessed associations among environmental stress, self-esteem, social support, coping styles, AIDS symptoms, and CD4 count. A more restricted longitudinal analysis (N = 174) tested associations among earlier environmental stress, self-esteem, coping styles, and AIDS symptoms at follow-up. CD4 count was not associated with coping styles in the cross-sectional analysis. Concurrent AIDS symptoms were significantly predicted by depressive withdrawal and environmental stress. A passive coping style modestly predicted more AIDS symptoms longitudinally. Correlates of perceived health and well-being of persons with HIV/AIDS are important to investigate in addition to more objective measures such as CD4 count that may not be amenable to change through coping style interventions alone.     

Health beliefs,optimism, and health‐related decisions: A study with Hong Kong Chinese

T he Health Belief Model (HBM; Rosenstock, 1966) is the most widely used psychological theory of health‐related behaviours but its applicability to non‐Western, especially Asian, populations has not been systematically studied. The main objective of the current study was to examine the effects of components of the HBM and dispositional optimism on preventive intention in two separate samples of 220 Hong Kong Chinese adults and 340 Hong Kong Chinese adolescents. Two HBM variables, benefits and barriers, were experimentally manipulated for an imaginary flu outbreak and a hypothetical vaccine. Optimism in the two samples was assessed using the Chinese revised Life Orientation Test (Lai et al., 1998). Participants indicated their intention to take the hypothetical vaccine after reading information for each of the treatment combinations defined by the two HBM variables. The order of the presentation of each of the six treatment conditions was counterbalanced. Results of ANOVA showed that the effects of the two HBM variables were similar in the two groups. Higher benefits and lower barriers were associated with stronger behavioural intention to take the vaccine. The two HBM variables interacted significantly in the adolescent but not the adult sample. Among the adolescents, the difference in intention scores between low and high barriers became larger when the benefits of taking the vaccine increased. In addition, optimism had significant effect on preventive intention only among the adolescents. These findings suggest that age may be an important factor moderating the effects of HBM components as well as optimism on preventive intention in Hong Kong Chinese. Implications of these findings to future research among Chinese were discussed.     

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.     

COLLECTIVE RELIGIO‐SCIENTIFIC DISCUSSIONS ON ISLAM AND HIV/AIDS: I. BIOMEDICAL SCIENTISTS

During the 1990s, biomedical scientists and Muslim religious scholars collaborated to construe Islamic responses for the ethical questions raised by the AIDS pandemic. This is the first of a two‐part study examining this collective legal reasoning (ijtihād jamā‘ī). The main thesis is that the role of the biomedical scientists is not limited to presenting scientific information. They engaged in the human rights discourse pertinent to people living with HIV/AIDS, gave an account of the preventive strategy adopted by the World Health Organization, and offered an (Islamic) virtue‐based preventive model. Finally, these scientists tried to draft a number of Islamic legal rulings (a?kām), usually seen in Islamic jurisprudence as the exclusive business of Muslim religious scholars. This multilayered role played by the scientists reflects intriguing developments in the Islamic religio‐ethical discourse in general and in the field of Islamic jurisprudence in particular.