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.     

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.     

How much behaviour change should we expect from health promotion campaigns targeting cognitions? An approach to pre-intervention assessment

For those planning interventions based on social cognition models, it is usually not clear what impact on behaviour will follow from attempts to change the cognitions specified in these models. We describe a statistical simulation technique to assess the likely impact of health promotion targeting Theory of Reasoned Action (TRA)-based predictors of condom use. We apply regression-based simulation techniques to data from the SHARE project (n?=?756 Scottish adolescents) to assess the potential impact of changes in cognitions on condom use. Results support the predictive utility of TRA-based models of psychological antecedents of condom use but also provide a cautionary warning about the magnitude of behaviour change likely to be achieved by interventions based on such models.     

Exploring teenagers' adaptive and maladaptive thinking in relation to the threat of hiv infection

Abstract

Teenagers' HIV-preventive cognitions were explored within a protection motivation theory framework. Five hundred and seven adolescent men and women from two cohorts (sixteen and eighteen) completed a confidential postal questionnaire. The effect of demographic variables, previous sexual experience and appraisal of threat and coping resources upon HIV-relevant cognitions was investigated using path analysis. Cognitions promoting (adaptive) and inhibiting (maladaptive) preventive behaviour were considered. Anticipated condom use, intention to limit number of sexual partners and willingness to consider an HIV antibody test were included as adaptive HIV-preventive cognitions. Coping appraisal measures were strongly associated with anticipated condom use but threat appraisal measures were not. Gender, previous sexual experience, coping appraisal measures and denial accounted for 33% of the variance in anticipated condom use. Overall the results provided qualified support for Protection Motivation Theory. Implications for health education are highlighted.     

Efficacy of the Theory of Reasoned Action in Predicting AIDS-Related Sexual Risk Reduction Among Gay Men1

This study evaluates the utility of a social psychological theory, Ajzen and Fishbein's (1980) Theory of Reasoned Action, in explicating attitude-behavior relationships concerning the practice of “safer sex” in a sample of 297 gay men. As the theory predicts, results indicate that a positive attitude toward “safer sex” and a belief that important, influential referents encouraged such behavior covaried with intention to practice sexual behaviors that minimize risk of infection with Human Immunodeficiency Virus (HIV). In turn, intention predicted levels of sexual risk-taking and employment of HIV-risk reducing strategies. Results provide support for the theory of reasoned action as a viable model of attitude-behavior relationships in AIDS-related risk reduction behaviors of gay men.     

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.     

HIV risk factors,condom use,and HIV antibody testing among heterosexual Hispanics: the National AIDS Behavioral Surveys (NABS)

Although Hispanics comprise only 9% of the US population, they account for 16% of AIDS cases. This study used data from the 4390 heterosexual Hispanics interviewed as part of the 1990-91 National AIDS Behavioral Survey to determine the prevalence and demographic correlates of HIV antibody testing and condom use among Hispanics at risk for HIV. Overall, 16.4% of respondents reported an HIV risk factor, primarily two or more sexual partners in the last 12 months (64%) or a high-risk main sex partner (26%). Those at risk tended to be highly acculturated unmarried males aged 18-29 years of European Spanish, South American, or Caribbean origin, with more than 12 years of education, an annual income under US$10,000, and infrequent church attendance. 35.3% of these high-risk persons had been tested for HIV; male gender and middle-income status were the strongest predictors of testing. Condoms were used at least half the time with a primary partner by 22.4% and with secondary partners by 44.7%, with higher use rates among acculturated Hispanics. The low prevalence of condom use and HIV testing among high-risk Hispanics underscores the need for campaigns that reinforce the acceptability of condom use as a social norm. Because US Hispanics are a heterogeneous group, such campaigns should target specific subgroups, including different national origins and levels of acculturation.     

Intention, Context, and Safe Sex: Australian Adolescents' Responses to AIDS

This study examined the applicability to condom use of Ajzen and Madden's (1986) theory of planned behavior by examining the predictors of intention to use a condom and actual condom use in a specific sexual situation. In a sample of 144 sexually active heterosexual males and females, limited support was found for the model. Intentions to use a condom immediately before a particular sexual encounter, and those assessed some time prior to this encounter were found to have direct and positive effects on condom use. In addition, perceptions of the disadvantages of condoms (a measure of attitudes to condoms in general) had direct negative effects on condom use and, together with perceptions of the advantage of condoms, also had indirect effects on condom use via prior intention. A number of the postulated predictors of safe sexual practice related neither to intentions nor behavior. The contextual variables of sexual arousal, condom availability, and degree of communication with a sexual partner all influenced condom use. Discussion centered on first, differences in the predictive ability of the model when compared to other studies of planned behavior, and second, the factors limiting the relationship between intention and behavior when the behavior in question is not under complete, volitional control.     

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.     

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.     

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.     

Functional significance of psychological variables that are included in the Theory of Planned Behaviour: a Self-Determination Theory approach to the study of attitudes,subjective norms,perceptions of control and intentions

The Theory of Planned Behaviour was proposed by Ajzen (1985) in an attempt to expand the applicability of the Theory of Reasoned Action (TRA) to situations where behaviour is not under complete volitional control. However, recent research does not address the issue of the stability of intentions, yet this is considered a boundary condition of the TRA on theoretical grounds. Therefore, the purposes of the present article were, first, to make a theoretical approach to the study of the stability of behavioural intentions by discussing assumptions underlying self-determination theory. Second, because, according to self-determination theory (Deci & Ryan, 1985), stability of intentions is related to the functional significance of psychological events, investigation of the functional significance of attitudes, subjective norms and perceived behavioural control was attempted through a study dealing with leisure-time physical activity. Because investigation of functional significance requires instruments assessing behavioural regulations, instrument development took place. Results partially supported the validity of behavioural regulations with respect to leisure-time physical activity. Furthermore, subjective norms were found to represent only the controlling dimension of functional significance. Attitudes and perceived behavioural control were found to represent both the controlling and informational dimensions of functional significance. Results are discussed in relation to assumptions underlying the Theories of Reasoned Action and Planned Behaviour and the Theory of Trying. Implications for theory development are made. © 1998 John Wiley & Sons, Ltd.     

Safe and Unsafe Sexual Intentions and Behavior: The Effects of Norms and Attitudes1

A study of 85 heterosexual men, 85 heterosexual women, and 82 homosexual men was undertaken to examine the variables that influence intentions to engage in different sexual practices and actual sexual behavior. On the basis of Fishbein and Ajzen's (1975) theory of reasoned action, it was predicted that the strength of intentions would be related to whether behavior was in accord with intentions. Consistent with expectations, the strength of intention to engage in six different sexual practices (e. g., vaginal intercourse, anal intercourse, oral sex) and the three strategies that modify the risk of HIV transmission (sex with an exclusive partner, sex wearing a condom, and looking for a new partner) predicted actual behavior. Second, it was proposed that attitudes toward one's sexual practices and norms would be related to intentions to engage in safe sex. To reflect differential levels in the safety of behavioral intentions, five safety intention groups were formed: (a) nonpenetrative sex, (b) penetrative sex in an exclusive relationship with a condom, (c) penetrative sex in an exclusive relationship without a condom, (d) penetrative sex in a nonexclusive relationship with a condom, and (e) penetrative sex in a nonexclusive relationship without a condom. Norms, rather than attitudes, distinguished the five safety intention groups. the groups intending to engage in safe sex (nonpenetrative sex or penetrative sex with a condom) perceived lower levels of social approval for their sexual practices than the noncondom groups. Additional analyses showed that past behavior had a stabilizing effect on the intention-behavior relationship, but only for the nonpenetrative and noncondom safety intention groups.     

Use of pirated compact discs on four college campuses: a perspective from theory of planned behavior

The Theory of Planned Behavior was chosen as the framework, assuming that college students are rational decision makers seeking to maximize economic gains in purchasing compact discs. A questionnaire was given to 450 students from four college campuses in the Kaohsiung area of Taiwan. Analyses showed that the more positively rated the Behavioral Intention toward purchasing pirated music compact discs, the more likely the college students were to purchase them. Conversely, when Subjective Norms and Perceived Behavioral Control were higher, college students were less likely to make a purchase. Therefore, buying pirated compact discs was consistent with the premises for Attitude, Subjective Norms, and Behavioral Control.     

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

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

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.     

Changes in condom use among homosexual men in San Francisco

Employed data from two longitudinal surveys of gay men in San Francisco (a) to examine for cohort (Study 1) and attrition (Studies 1 and 2) bias effects on reported changes in condom use by gay men and (b) to investigate predictors of condom use (Study 2). Substantial increases in condom use were observed, and these changes were unrelated to attrition and cohort bias. In terms of predictors of condom use, men who always used condoms had higher levels of social support from informal sources of help, had more positive expectations that condoms would have positive interpersonal and personal consequences, and were more likely to be HIV positive than men who used condoms occasionally or never. The results are discussed in terms of their implications for HIV-prevention research.     

Perceived behavioural control,subjective norms,attitudes and intention to use condom: A longitudinal cross-lagged design

Based on the Theory of Planned Behaviour (TPB), the purpose of this investigation was to examine the directionality of the association among condom use, intention, attitudes, subjective norms and perceived behavioural control. The present study investigated the nature of these relationships using a longitudinal cross-lagged design applied to data from a cohort of 958 randomly selected Italian adults. Using structural equation modelling, two cross-lagged panel analyses revealed reciprocal relationships between intention and attitudes and between intention and condom use. Contrary to expectations, baseline subjective norms and perceived behavioural control did not predict subsequent intention to use condom when controlled for the autoregressive effect of intention at T1 on the same variable at T2. Also, perceived behavioural control at T1 did not influence condom use at T2 after controlling for the effect of baseline intention. The possibility of reciprocity was also tested for all relations and significant results were found. The moderation effect of perceived behavioural control on the relationship between intention and condom use was not significant. The differences in age, gender and partnership status were taken into account in the analyses.