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.     

Condom use among US students: the importance of confidence in normative and attitudinal perceptions

The author performed a study among U.S. undergraduates to test an earlier conclusion (D. Trafimow, 1994) that confidence in the correctness of one's perceptions of normative pressure to use a condom influences the correspondence between those perceptions and the intentions actually to perform the behavior. Consistent with previous findings (Trafimow), the participants' perceptions of normative pressure strongly predicted their intentions to use condoms only under conditions of extreme normative confidence. Otherwise, their attitudes were better predictors of their intentions to use condoms. In addition, 2 other variables (attitudinal confidence and perceived behavioral control) were found to be unimportant predictors of intentions. Results of a 2nd study suggest that behaviors performed by sexual partners and knowing the sexual partners affected the participants' normative confidence.     

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.     

Condom Use Among U.S. Students: The Importance of Confidence in Normative and Attitudinal Perceptions

Abstract

The author performed a study among U.S. undergraduates to test an earlier conclusion (D. Trafimow, 1994) that confidence in the correctness of one's perceptions of normative pressure to use a condom influences the correspondence between those perceptions and the intentions actually to perform the behavior. Consistent with previous findings (Trafimow), the participants' perceptions of normative pressure strongly predicted their intentions to use condoms only under conditions of extreme normative confidence. Otherwise, their attitudes were better predictors of their intentions to use condoms. In addition, 2 other variables (attitudinal confidence and perceived behavioral control) were found to be unimportant predictors of intentions. Results of a 2nd study suggest that behaviors performed by sexual partners and knowing the sexual partners affected the participants' normative confidence.     

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.     

Moderation and Mediation of HIV-Prevention Interventions: Relationship Status,Intentions, and Condom Use Among College Students1

This study examined the effects of 2 HIV prevention interventions on condom use and mediators of condom use. College students were randomly assigned to a control condition or an intervention (communication skills or technical skills). Those who received either intervention had greater condom use self-efficacy, more positive condom use attitudes, and stronger intentions to use condoms than did controls. Furthermore, 3-month follow-up data revealed that students in either intervention who were not in a steady dating relationship reported more consistent condom use than did those in the control condition, whereas students who were in either intervention and in a relationship reported somewhat less consistent condom use than did those in the control condition. Analyses suggested that effects of the interventions on condom use were mediated by increased intentions to use condoms.     

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

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

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.     

Theories of reasoned action and planned behavior as models of condom use: a meta-analysis

To examine how well the theories of reasoned action and planned behavior predict condom use, the authors synthesized 96 data sets (N = 22,594) containing associations between the models' key variables. Consistent with the theory of reasoned action's predictions, (a) condom use was related to intentions (weighted mean r. = .45), (b) intentions were based on attitudes (r. = .58) and subjective norms (r. = .39), and (c) attitudes were associated with behavioral beliefs (r. = .56) and norms were associated with normative beliefs (r. = .46). Consistent with the theory of planned behavior's predictions, perceived behavioral control was related to condom use intentions (r. = .45) and condom use (r. = .25), but in contrast to the theory, it did not contribute significantly to condom use. The strength of these associations, however, was influenced by the consideration of past behavior. Implications of these results for HIV prevention efforts are discussed.     

Justify your love: testing an online STI-risk communication intervention designed to promote condom use and STI-testing

The efficacy of a tailored, web-based intervention communicating the risks of sexually transmitted infections (STI) for heterosexual young adults was examined in a randomised, controlled trial. The main aims of the relationship-oriented intervention were to influence risk perceptions and to promote (maintenance of) condom use and STI-testing among young adults who reported being recently engaged in a heterosexual relationship. The intervention addressed risk perceptions, attitudes, normative beliefs, self-efficacy and skills related to condom use and STI-testing. Outcomes were compared immediately after the intervention (N = 171) and 3 months later (N = 115) to a non-tailored intervention group and to a control group. Cognitive and behavioural outcomes showed that the tailored intervention was efficacious in influencing perceived susceptibility to STI and STI-testing intentions immediately after the intervention, and in reducing rates of unprotected sex at 3 months.     

Birth Control Versus AIDS Prevention: A Hierarchical Model of Condom Use Among Young People1

The authors report the results of a nationwide survey of young people in Germany which applied the theory of planned behavior (Ajzen, 1985, 1991) to condom use for purposes of birth control and with new sexual partners (to prevent AIDS). A hierarchical model, in which the 2 functions of condom use were treated as separate 2nd-order factors, was found to be superior to a single-factor model. The hierarchical model also provided evidence for the convergent and discriminant validities of indicators used to assess the constructs in the theory of planned behavior. Attitudes, subjective norms, and perceptions of behavioral control all made significant contributions to the predictions of intentions, accounting for 62.0% and 70.9% of the variance for birth control and AIDS prevention, respectively. Perceived behavioral control carried most of the weight in the former prediction, while attitudes carried most of the weight in the latter. Implications of these findings are discussed.     

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.     

Incorporating adolescent females' perceptions of their partners' attitudes toward condoms into a model of female adolescent condom use

The highest rates of sexually transmitted infections in the U.S. occur among adolescent females. One prevention strategy promoted for sexually active adolescents is condom use: therefore, influences on correct and consistent condom use are worth examining. Because interventions and observational research into predicting and increasing condom use have yielded mixed results, we hypothesized that a theoretically driven model incorporating female adolescents' perceptions about partner sentiments along with their own perceptions, intentions, and behaviours would improve condom use predictions. We also measured condom use errors and consistency for a more precise estimate of effective use than is common in the literature. In three structural equation models tested on a sample of 519 female adolescents, we found that intentions were associated with both correct and consistent condom use; that females' expectancy beliefs about condom use were associated with intentions; and that females' expectancy beliefs about partners' sentiments reduced the impact of their expectancy beliefs about condom use. The implications of these relations upon condom use correctness and consistency are discussed with respect to informing interventions, among other future research.     

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.     

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

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

Factors Influencing Condom Use Among African American Women: Implications for Risk Reduction Interventions

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.     

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.     

The Influence of Skills,Message Frame,and Visual Aids on Prevention of Sexually Transmitted Diseases

In a large three week longitudinal study, we investigated the efficacy of framed messages for promoting condom use in sexually active young adults. We also investigated the influence of key risk literacy skills (i.e., numeracy and graph literacy) and visual aids (i.e., icon arrays) on the efficacy of framed messages. Finally, we investigated the underlying psychological mechanisms of behavioral change on the ability of icon arrays to improve message effectiveness. Results showed that framed messages including icon arrays increased adherence to self‐reported condom use by giving rise to enduring changes in attitudes and behavioral intentions, which influenced behavior. Icon arrays were found to be most beneficial among young adults with relatively low numeracy as long as they had high graph literacy. These findings build on the previous research in risk communication and extend psychological theories of health‐related decision making such as the theory of planned behavior. These findings also map the conditions under which well‐constructed visual aids can be among the most effective, transparent, and ethically desirable means of risk communication. Implications for risk communication and informed medical decision making are discussed. Copyright © 2013 John Wiley & Sons, Ltd.     

Structure of outcome beliefs in condom use. The Project RESPECT Study Group.

To study the structure of beliefs about condom use outcomes, the authors derived and tested 4 psychosocial hypothetical models: (a) a 2-factor model of the personal and social outcomes of condom use; (b) a 2-factor model of the pros and cons of the behavior; (c) a 3-factor model (i.e., physical, self-evaluative, and social) of outcome expectancies; and (d) a thematic 4-factor model of the protection, self-concept, pleasure, and interaction implications of the behavior. All 4 models were studied with a confirmatory factor analysis approach in a multisite study of 4,638 participants, and the thematic solution was consistently the most plausible. Self-concept and pleasure were most strongly associated with attitudes toward using condoms, intentions to use condoms, and actual condom use, whereas protection and interaction generally had little influence.     

Sexual Self‐Control and Male Condom‐Use Outcome Beliefs: Predicting Heterosexual Men's Condom‐Use Intentions and Behavior1

A model of condom‐use intentions and behavior that we previously developed for women was replicated and extended with heterosexual men (n= 203; M age = 20.1 years). The general determinants of intentions to use condoms were consistent for men and women. The predictors of general condom attitudes and condom‐use self‐efficacy differed across gender. Male condom‐use outcome beliefs and sexual self‐control emerged as predictors of sexually experienced men's condom attitudes and self‐efficacy, respectively. In a 3‐month follow‐up, intentions and sexual self‐control predicted condom‐use behavior. These findings have implications for specificity vs. generality in the correlates of common behaviors across groups, the study of gender differences in condom use, and the development of intervention content targeted to specific populations.