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

An extended model of reasoned action to understand the influence of individual- and network-level factors on African Americans' participation in HIV vaccine research

In the United States, the number and proportion of HIV/AIDS cases among black/African Americans continue to highlight the need for new biomedical prevention interventions, including an HIV vaccine, microbicide, or new antiretroviral (ARV) prevention strategies such as pre-exposure prophylaxis (PrEP) to complement existing condom usage, harm reduction methods, and behavioral change strategies to stem the HIV epidemic. Although black/African Americans are disproportionately impacted by HIV/AIDS, their participation in HIV clinical research continues to have unique challenges. We theorize that interaction among multilevel factors creates ideal alignment for minority participation in HIV clinical studies. Thus, we initially set out to test an extended model of reasoned action with 362 participants to understand the interplay of sociopsychological and network-level considerations influencing minority participation in HIV prevention research efforts. In this study, we linked the intrapersonal dimensions of attitudes, beliefs, and normative concerns to community-level components, appraisal of involvement with the clinical research organization, an entity which operates within a networked structure of community partner agencies, and identification with coalition advocacy aims. Various participatory outcomes were explored including involvement in future HIV vaccine community functions, participation in community promotion of HIV vaccine research, and community mobilization. Three-stage least squares estimates indicated similar findings across three models. Significant effects demonstrate the importance of positive attitudes toward HIV vaccine research, favorable health research beliefs, perceived social support for participation, HIV/AIDS issue engagement, and perceived relevance of the clinical research site's mission and values. Identification of these nuanced pathway effects provides implications for tailored community program development.

Availability of sports facilities as moderator of the intention-sports participation relationship among adolescents

This longitudinal study aimed to identify individual and environmental predictors of adolescents' sports participation and to examine whether availability of sports facilities moderated the intention-behaviour relation. Data were obtained from the ENvironmental Determinants of Obesity in Rotterdam SchoolchildrEn study (2005/2006 to 2007/2008). A total of 247 adolescents (48% boys, mean age at follow-up 15 years) completed the surveys at baseline and follow-up. At baseline, adolescents completed a survey that assessed engagement in sports participation, attitude, subjective norm, perceived behavioural control and intention towards sports participation. Availability of sports facilities (availability) was assessed using a geographic information system. At follow-up, sports participation was again examined. Multiple logistic regression analyses were conducted to test associations between availability of sports facilities, theory of planned behaviour variables and the interaction of intention by availability of sports facilities, with sports participation at follow-up. Simple slopes analysis was conducted to decompose the interaction effect. A significant availability x intention interaction effect [odds ratio: 1.10; 95% confidence interval: 1.00-1.20] was found. Simple slopes analysis showed that intention was more strongly associated with sports participation when sports facilities were more readily available. The results of this study indicate that the intention-sports participation association appears to be stronger when more facilities are available.

Young mothers' decisions to use marijuana: a test of an expanded Theory of Planned Behaviour

The current study examines the Theory of Planned Behaviour's (TPB) ability to predict marijuana use among young women who experienced a premarital pregnancy before the age of 18 years, using longitudinal data. The validity of the TPB assumption that all other variables work through TPB constructs is also tested. Indicators of four constructs that have been shown in the literature to be predictive of marijuana use-persistent environmental adversity, emotional distress, adolescent marijuana use and drug use in the social network-were tested as predictors of attitudes, norms and self-efficacy, in a structural equation modelling framework. All paths from distal predictors were through the mediating TPB constructs, in accordance with the tenets of the model. Implications of these findings for the TPB model and for understanding factors that lead to marijuana use are discussed.

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.

Examining the theory of planned behavior applied to condom use: the effect-indicator vs. causal-indicator models

The authors investigated whether a causal-indicator model or an effect-indicator model of the theory of planned behavior (TPB) is more suitable for predicting behavioral intention and for which behaviors. No previous studies have evaluated this question using the same sample and same behavior. In this study, African American adolescents ages 12-17 participating in risk reduction classes were assessed on their initial attitudes, norms, perceived control, and intention regarding condom use. Second-order structural equation modeling indicated that the effect-indicator model exhibited superior fit above the causal-indicator model. Furthermore, modeling the behavioral antecedents in a causal way may not be as accurate due to the underlying uni-dimensional nature of attitudes, subjective norms, and control. The TPB was not disconfirmed as a suitable model for African American adolescents' regarding condom use. Prevention programs may benefit by focusing on adolescent behavior change with regard to the global components in order to influence more specific concepts of these social cognitions. Editors' Strategic Implications: Despite limitations including correlational data, this study yields implications for prevention programming and, more broadly, an important theoretical elaboration on effect-indicator and causal-indicator models of the TPB.

The Role of Communication with Friends in Sexual Initiation

This study identifies a theoretical mechanism through which communication with friends about sex influences sexual initiation in a sample of adolescents. The Integrative Model was used to assess the effect of attitudes, normative pressure and self efficacy on intentions to have sex in a sample of virgin adolescents. Results show that the constructs of the theory partially mediated the effect of communication with friends on subsequent sexual initiation. The effect of communication with friends on sexual initiation was not different for males and females. Overall, the results suggest how conversations with friends about sex influence adolescents' intentions to initiate sexual intercourse, which in turn influence subsequent sexual initiation.

A Meta-Meta-Analysis: Empirical Review of Statistical Power, Type I Error Rates, Effect Sizes, and Model Selection of Meta-Analyses Published in Psychology

This article uses meta-analyses published in Psychological Bulletin from 1995 to 2005 to describe meta-analyses in psychology, including examination of statistical power, Type I errors resulting from multiple comparisons, and model choice. Retrospective power estimates indicated that univariate categorical and continuous moderators, individual moderators in multivariate analyses, and tests of residual variability within individual levels of categorical moderators had the lowest and most concerning levels of power. Using methods of calculating power prospectively for significance tests in meta-analysis, we illustrate how power varies as a function of the number of effect sizes, the average sample size per effect size, effect size magnitude, and level of heterogeneity of effect sizes. In most meta-analyses many significance tests were conducted, resulting in a sizable estimated probability of a Type I error, particularly for tests of means within levels of a moderator, univariate categorical moderators, and residual variability within individual levels of a moderator. Across all surveyed studies, the median effect size and the median difference between two levels of study level moderators were smaller than Cohen's (1988) conventions for a medium effect size for a correlation or difference between two correlations. The median Birge's (1932) ratio was larger than the convention of medium heterogeneity proposed by Hedges and Pigott (2001) and indicates that the typical meta-analysis shows variability in underlying effects well beyond that expected by sampling error alone. Fixed-effects models were used with greater frequency than random-effects models; however, random-effects models were used with increased frequency over time. Results related to model selection of this study are carefully compared with those from Schmidt, Oh, and Hayes (2009), who independently designed and produced a study similar to the one reported here. Recommendations for conducting future meta-analyses in light of the findings are provided.

Motivating goal-directed behavior through introspective self-talk: the role of the interrogative form of simple future tense

Although essential for psychology, introspective self-talk has rarely been studied with respect to its effects on behavior. Nevertheless, the interrogative compared with the declarative form of introspective talk may elicit more intrinsically motivated reasons for action, resulting in goal-directed behavior. In Experiment 1, participants were more likely to solve anagrams if they prepared for the task by asking themselves whether they would work on anagrams as opposed to declaring that they would. In the next three experiments, merely writing Will I as opposed to I will as part of an ostensibly unrelated handwriting task produced better anagram-solving performance and stronger intentions to exercise, which suggests that priming the interrogative structure of self-talk is enough to motivate goal-directed behavior. This effect was found to be mediated by the intrinsic motivation for action and moderated by the salience of the word order of the primes.

Social-cognitive determinants of condom use in a cohort of young gay and bisexual men

The aim of this prospective study was to identify relevant determinants of young gay and bisexual men's (YGBM) condom use when having anal sex with casual partners. Respondents (185 YGBM in the midst of their coming-out; mean age 18.9 years) completed an online questionnaire on social-cognitive determinants of condoms use derived from the theory of planned behavior (Ajzen, 1991) at Wave 1. At six months follow-up (Wave 2) sexual behavior with casual partners was assessed. A total of 63 YGBM reported sex with a casual partner in the six months between Waves 1 and 2, of whom 49% (N=31) had anal sex. Of the YGBM who had anal sex, 42% (N=13) had unprotected anal sex. Condom use with casual partners was best predicted by the intention to always use condoms. Furthermore, attitude, descriptive and personal norms, and perceived control significantly predicted intention to always use condoms. Interventions, targeting YGBM, aiming to promote condom use with casual partners should focus on increasing attitudes and strengthening skills to negotiate and use condoms.

Le tabou, un concept peu exploré en marketing

Malgré l'importance des tabous dans les sociétés contemporaines et leur influence sur la consommation, le concept de tabou reste peu exploré en marketing. Partant des approches anthropologique, sociologique et psychanalytique, cet article met en avant cinq caractéristiques définitoires du tabou qui viennent éclairer et enrichir les travaux antérieurs en marketing relevant de la question du tabou. Il propose des perspectives de recherche relatives à l'influence des caractéristiques des tabous sur le comportement du consommateur et sa perception par les individus tout en insistant sur la prudence mais aussi la créativité méthodologiques nécessaires dans L'étude de cet objet de recherche.

Testing a social-cognitive model of HIV transmission risk behaviors in HIV-infected MSM with and without depression

OBJECTIVE

Social-cognitive models have been used to explain health risk behaviors in numerous populations, including people with HIV. However, these models generally do not account for the influence of clinically significant psychological problems such as major depression.

DESIGN

This study examined whether a social-cognitive model would explain recent sexual transmission risk behavior among sexually active HIV-infected men who have sex with men (MSM) who meet or do not meet screening criteria for major depression.

MAIN OUTCOME MEASURES

Participants (n = 403) completed self-report assessments of negative expectancy, social models, and self-efficacy (SE) related to condom use, as well as recent STRB and a screening measure for major depression. Multiple group modeling was used to examine whether condom use SE explained associations of negative expectancy and social models for condom use with recent STRB among participants who screened positive (n = 47) or negative (n = 356) for major depression.

RESULTS

The multiple group model fit the data well (chi2(36) = 30.55, p = .73; CFI = 1.00; RMSEA<.01; SRMR = .05). Among MSM who screened negative for depression, lower condom use SE explained indirect paths from negative expectancy about condom use and poorer social models for condom use to greater STRB. Among MSM who screened positive for depression, only negative expectancy was associated with greater STRB.

CONCLUSION

Models of STRB may not generalize to HIV-infected individuals with clinical depression. Risk reduction interventions based on these models should account for comorbid mental health conditions to maximize effectiveness.

College women's sexual decision making: cognitive mediation of alcohol expectancy effects

OBJECTIVE

Alcohol has been linked to a variety of risky sexual practices, including inconsistent condom use. Due to the high rates of alcohol consumption among underage college women, greater understanding of the role of alcohol in young women's sexual decision making is warranted.

PARTICIPANTS AND METHODS

Female underage (18- to 20-year-old) social drinkers (N = 94) participated in an experiment in which they projected themselves into a written hypothetical sexual situation with a new partner. One half of the situations portrayed alcohol consumption; one half did not involve alcohol consumption. Their appraisals of the situation's sexual potential, impelling and inhibiting cognitions, and sexual behavior intentions were assessed.

RESULTS

Results revealed that alcohol's expectancy effects on young women's unprotected sexual intentions were mediated by their cognitive appraisals of the situation.

CONCLUSIONS

These findings indicate that alcohol expectancies and their influence on women's sexual decisions should be incorporated into sexual risk reduction efforts.

Understanding Women's Risk for HIV Infection Using Social Dominance Theory and the Four Bases of Gendered Power

Theoretical models to date have fallen short of accounting for the alarming worldwide rates of HIV infection in women through heterosexual contact. In this article, social dominance theory and the four bases of gendered power—force, resource control, social obligations, and consensual ideologies—are used to organize and explain international research findings on women's risk of contracting HIV from male sexual partners. Research suggests that the four bases of gendered power contribute to women having less power than men in heterosexual relationships, resulting in challenges to preventing HIV transmission from male partners. Social dominance theory also recognizes the intersections among various group-based hierarchies, such as race and class, thereby helping explain why women of color and low-income women are disproportionately affected by HIV. The intergroup focus of social dominance theory points to gender inequality as increasing men's risk of HIV infection as well, and the construct of social dominance orientation helps to explain individual differences in HIV risk behavior. We discuss the ways the current theoretical framework can prove useful in helping to guide future research addressing the connections between power and HIV risk, including exploring mediators and links to other theoretical models. We also discuss the implications the framework has for intervention efforts aimed at reducing HIV rates worldwide, such as supporting efforts at increasing women's representation in hierarchy-enhancing positions, incorporating empowerment issues into current interventions, promoting use of female condoms, and targeting heterosexual men for interventions.

What sense do people make of a theory of planned behaviour questionnaire?: a think-aloud study

This study aimed to understand the processes of interpretation of, and responses to, the task of completing a theory of planned behaviour (TPB) questionnaire. Forty-five adults verbalized their thoughts while completing a full TPB questionnaire on walking behaviour. On average, participants' verbalizations indicated around 16 problems with the 52 questions. Further, problems as identified from verbalizations were associated with increased endorsement of the middle option on the questionnaire. Normative and intention questions were found to be particularly problematic. The current standardized method to develop TPB measures systematically yields problematic questions, as indicated by both talk and questionnaire responses.

Conservation and human behaviour: lessons from social psychology

Despite increased effort from non-governmental organisations, academics and governments over recent decades, several threats continue to cause species declines and even extinctions. Resource use by a growing human population is a significant driver of biodiversity loss, so conservation scientists need to be interested in the factors that motivate human behaviour. Economic models have been applied to human decision making for many years; however, humans are not financially rational beings and other characteristics of the decision maker (including attitude) and the pressure that people perceive to behave in a certain way (subjective norms) may influence decision making; these are characteristics considered by social psychologists interested in human decision making. We review social-psychology theories of behaviour and how they have been used in the context of conservation and natural-resource management. Many studies focus on general attitudes towards conservation rather than attitudes towards specific behaviours of relevance to conservation and thus have limited value in designing interventions to change specific behaviours (e.g. reduce hunting of a threatened species). By more specifically defining the behaviour of interest, and investigating attitude in the context of other social-psychological predictors of behaviour (e.g. subjective norms, the presence of facilitating factors and moral obligation), behaviours that have an impact on conservation goals will be better understood, allowing for the improved design of interventions to influence them.

Tanning, skin cancer risk, and prevention: a content analysis of eight popular magazines that target female readers, 1997-2006

The majority of tanning bed users in the U.S. are women. Previous health communication research frequently focused on the risk of skin cancer, but few studies assessed the mediated communication environment that may surround women's beliefs and behaviors relevant to tanning. A content analysis of articles in eight magazines targeting girls, young women, older women, and women who are interested in fitness during the ten-year period of 1997-2006 was conducted. The amount of coverage of tanning bed use consequences was less than 50% of the coverage of tanning benefits. About 40% of the tanning benefits coverage touted looking healthy. The coverage of prevention methods focused on sunscreen use (55%), while the more important methods (e.g., protective clothing use) were rarely featured. Longitudinally, the coverage of the risk and prevention relevant issues increased between 1997 and 2006. The data indicate that the coverage of tanning benefits also increased during the same period.

The impact of simple donor education on donor behavioral deferral and infectious disease rates in São Paulo, Brazil

BACKGROUND

Studies have shown that human immunodeficiency virus (HIV) residual risk is higher in Brazilian than in US and European blood donors, probably due to failure to defer at-risk individuals in Brazil. This study assessed the impact of an educational brochure in enhancing blood donors' knowledge about screening test window phase and reducing at-risk individuals from donating.

STUDY DESIGN AND METHODS

This trial compared an educational intervention with a blood center's usual practice. The brochure was distributed in alternating months to all donors. After donating, sampled participants completed two questions about their HIV window period knowledge. The impact on HIV risk deferral, leaving without donation, confidential unit exclusion (CUE) use, and test positivity was also analyzed.

RESULTS

From August to November 2007 we evaluated 33,940 donations in the main collection center of Fundação Pró-Sangue/Hemocentro de São Paulo in São Paulo, Brazil. A significant (p < 0.001) pamphlet effect was found on correct responses to both questions assessing HIV window phase knowledge (68.1% vs. 52.9%) and transfusion risk (91.1% vs. 87.2%). After adjusting for sex and age, the pamphlet effect was strongest for people with more than 8 years of education. There was no significant pamphlet effect on HIV risk deferral rate, leaving without donation, use of CUE, or infectious disease rates.

CONCLUSION

While the educational pamphlet increased window period knowledge, contrary to expectations this information alone was not enough to make donors self-defer or acknowledge their behavioral risk.

AIDS Exceptionalism: On the Social Psychology of HIV Prevention Research

The current analysis considers the HIV prevention research record in the social sciences. We do so with special reference to what has been termed "AIDS Exceptionalism"- departures from standard public health practice and prevention research priorities in favor of alternative approaches to prevention that, it has been argued, emphasize individual rights at the expense of public health protection. In considering this issue, we review the historical context of the HIV epidemic; empirically demonstrate a pattern of prevention research characterized by systematic neglect of prevention interventions for HIV-infected persons; and articulate a rationale for "Prevention for Positives," supportive prevention efforts tailored to the needs of HIV+ individuals. We then propose a social psychological conceptualization of processes that appear to have influenced developments in HIV prevention research and directed its focus to particular target populations. Our concluding section considers whether there are social and research policy lessons to be learned from the record of HIV prevention research that might improve our ability to addresses effectively, equitably, and in timely fashion future epidemics that play out, as HIV does, at the junction of biology and behavior. At the first quarter century of the AIDS epidemic, it is important to weigh our accomplishments against our failures in the fight against AIDS…Future historians will conclude that we cannot escape responsibility for our failure to use effective, scientifically proven strategies to control the AIDS epidemic…They will also likely regard as tragic those instances when we allowed scarce resources to be used to support ideologically driven "prevention" that only served a particular political agenda.Editorial: A Quarter Century of AIDS. American Journal of Public Health. (Stall & Mills, 2006, p. 961).

Predicting intention to treat HIV-infected patients among Tanzanian and Sudanese medical and dental students using the theory of planned behaviour--a cross sectional study

Background

The HIV epidemic poses significant challenges to the low income countries in sub Saharan Africa (SSA), affecting the attrition rate among health care workers, their level of motivation, and absenteeism from work. Little is known about how to deal with deterioration of human resources in the health care systems. This study aimed to predict the intention to provide surgical treatment to HIV infected patients among medical- and dental students in Tanzania and Sudan using an extended version of the Theory of Planned Behaviour (TPB).

Methods

Four hundred and seventy five medical- and dental students at the University of Dar es Salaam (mean age, 25 yr) and 642 dental students attending 6 public and private dental faculties in Khartoum (mean age 21.7 yr) completed self-administered TPB questionnaires in 2005 and 2007, respectively.

Results

Both Tanzanian and Sudanese students demonstrated strong intentions to provide care for people with HIV and AIDS. Stepwise linear regression revealed that the TPB accounted for 51% (43% in Tanzania and Sudan) of the variance in intention across study sites. After having controlled for country and past behaviour, the TPB in terms of attitudes, subjective norms and perceived behavioural control accounted for 34% and moral norms for an additional 2,3% of the explainable variance in intention. Across both study sites, attitudes were the strongest predictor of intention followed in descending order by subjective norms, moral norms and perceived behavioural control.

Conclusion

The TPB is applicable to students' care delivery intentions in the context of HIV and AIDS across the two SSA countries investigated. It is suggested that attitudes, subjective norms, moral norms and perceived behavioural control are key factors in students' willingness to treat AIDS and HIV infected patients and should be targets of interventions aimed at improving the quality of health care delivery in this context.

Validation of questionnaire estimating predictors of behavior intention to engage in first sexual intercourse among eighth-grade pupils

AIM

To use structural equation modeling in testing the construct validity of the questionnaire on the first sexual intercourse among young adolescents.

METHODS

Previously created questionnaire for the estimation of different factors influencing the intention to engage in the first sexual intercourse was validated. The data were gathered anonymously from a nationally representative sample of 1217 elementary school pupils aged 14-15 in Slovenia. The construct validity was determined by the structural equation modeling, LISREL 8.7.

RESULTS

The reliability of the questionnaire was satisfactory (Cronbach alpha=0.73). Using the structural equation modeling analyses, the fit between empirical and theoretical models was confirmed, with 18 variables (17 independent and 1 dependent) for 6 latent indicators (5 external and 1 internal). The measures of goodness of fit were chi2(80)=57.040; P=0.976; the root mean square error of approximation was <0.001; the root mean square residual was 0.0249; the goodness of fit index was 0.994; the adjusted goodness of fit index was 0.988; the normed fit index was 0.993; and the relative fit index was 0.986. The instrument explained 34% of the variance in behavior intention.

CONCLUSION

The construct validity of the questionnaire on the intention to engage in the first sexual intercourse among young adolescents was satisfactory. This questionnaire could be a useful tool in health promotion programs.

Correlates of intention to use condoms among Sub-Saharan African youth: the applicability of the theory of planned behaviour

AIMS

To test the applicability of an extended version of the theory of planned behaviour for the study of condom use intentions among large samples of young people in South Africa and Tanzania.

METHODS

Baseline data of a randomized controlled trial of school-based HIV/AIDS prevention programmes were used. The setting comprised secondary schools in the regions of Cape Town, Polokwane and Dar es Salaam. Participants were 15,782 secondary school students. The main measures were scales for intentions, knowledge, risk perceptions, attitudes, perceived social norms and perceived self-efficacy regarding condom use.

RESULTS

Seven variables accounted for 77% of the variance in intentions to use condoms: attitudes (beta = 0.17), injunctive norms (beta = 0.27), self-efficacy (beta = 0.41), gender (lower condom use intentions among females), being a student at the Dar es Salaam site (lower scores than students in Cape Town and Polokwane), socioeconomic status (higher intentions with higher status), and access to condoms (higher intentions with higher access).

CONCLUSIONS

Our results are comparable to those of studies conducted in Europe and the USA. Social cognition models such as the theory of planned behaviour are applicable in understanding the correlates of condom use intentions in African contexts.

"One end has nothing to do with the other:" patient attitudes regarding help seeking intention for depression in gynecologic and obstetric settings

Many women rely on their obstetrician/gynecologist (OB/GYN) as their primary contact with the health care delivery system. There have been few studies exploring patient views on getting help for depression from these providers. The purpose of this study is to assess help seeking intention for depression and identify beliefs which moderate this intention. Telephone interviews of women following a routine gynecologic visit or in the immediate postpartum period (regarding prenatal care) were used to assess intention to seek help from their providers in a case of depression. For women who lacked this intention, related beliefs were elicited with the open ended question "why not?" Among the 225 women in the study more than half receiving gynecologic care (59%) and nearly a third of women who received prenatal care (29%; p < 0.001) stated they would not seek help from their OB/GYN for depression. Report that a prenatal provider had mentioned depression was associated with help seeking intention for depression but was not independent of confounding variables. Beliefs among women who lacked help seeking intention clustered into two attitude themes: 1) an OB/GYN is the wrong doctor for depression care and 2) OB/GYN is not a good setting for depression care. Many women have attitudes which reduce their intention to seek help for depression from their OB/GYN. Interventions aiming to increase delivery of depression care in these settings should consider these beliefs in their design.

Predictors of condom use among men enrolled in drug treatment programs

This study identified predictors of condom use and developed a model of condom use in a sample of men (n = 324) enrolled in drug treatment. Utilizing a series of logistic regression analyses reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed the following model of condom use among men in drug treatment: Taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use. These study findings identify condom availability in treatment programs as an important risk reduction intervention. Treatment programs can apply these predictors of condom use to better identify individuals at risk for HIV and sexually transmitted infections to better target prevention interventions.

Predictors of Black Students’ Race-Related Reasons for Choosing an HBCU and Intentions to Engage in Racial Identity—Relevant Behaviors

This study explores the antecedents and consequences of race-related reasons for historically Black college and university (HBCU) choice. A total of 109 undergraduate students attending a historically Black university completed questionnaires assessing their race-related reasons for choosing the university and their intention to engage in race-related activities, as well as individual difference measures. Students with less contact with other Blacks growing up or more central racial identities were more likely to cite race-related reasons for HBCU college choice. Furthermore, lack of contact and higher racial centrality predicted greater intention to engage in behaviors to develop racial identity (e.g., race-oriented clubs and personal reading). Critically, race-related reasons for college choice mediated the impact of both contact and centrality on behavioral intentions. Finally, non-race-related reasons for college choice (i.e., academic and financial) were distinct from race-related reasons and failed to predict race-relevant behavioral intentions. Thus, the race-related reasons behind this critical life choice form a bridge between the race-relevant aspects of the past and intentions to engage in racial identity— developing behaviors in the future.

How do social norms impact HIV sexual risk behavior in HIV-positive men who have sex with men?: multiple mediator effects

This study examines mediation of the association between social norms and unsafe sexual behavior. Self-report data were collected from 675 HIV-infected men enrolled in a study exploring interventions for HIV risk behavior. Unsafe sex included any unprotected anal sex with HIV-negative or HIV status unknown partners in the last three months. Norms for condom use indirectly influenced unsafe sex through condom self-efficacy and/or safer sex intentions. Additionally, sexual behavior discontrol influenced unsafe sex regardless of other individual or social factors. Our results suggest that interventions consider the combined effects of condom self-efficacy, safer sex intentions and sexual behavior control.

Social cognitive determinants of the intention to wear safety gear among adult in-line skaters

INTRODUCTION

In-line skating is increasing in popularity with a concomitant raise in the number of injuries associated with this activity. Studies have emphasized the value of protective gears in reducing the incidence of injuries and the subsequent need to identify the factors and processes involved in decision making about safety gear-wearing. The present study examined the contribution of the theory of planned behaviour (TPB) variables, and perceived susceptibility to and perceived severity of skating injury on the safety gear-wearing intention of adult skaters.

METHODS

Skaters (n=181) completed a questionnaire assessing the constructs of the TPB, perceived susceptibility to and perceived severity of skating injuries, and intention to wear safety gear.

RESULTS

Hierarchical regression analyses revealed significant contributions of instrumental attitude and subjective norm to the prediction of safety gear-wearing intention. In addition, perceived susceptibility to and perceived severity of injuries enhanced the prediction of intentions to wear safety gear over and above the contribution of TPB components.

CONCLUSION

As the TPB focuses only on behavioural evaluation, it seems promising to include threat perceptions in this theory as another aspect of health-related cognitions motivating intention formation about safety gear use. Practical implications for future campaigns and countermeasures are discussed.

Sexual risk reduction among Zambian couples

Zambia has over 1 million HIV infections nationwide and an urban prevalence rate of 23%. This study compared the impact of male involvement in multiple and single session risk reduction interventions among inconsistent condom users in Zambia and the role of serostatus among HIV-seropositive and serodiscordant couples. Couples (N=392) were randomised into intervention arms. Among inconsistent condom users at baseline (N=83), condom use increased in both conditions and this increase was maintained over a 12- month period. At 12 months, seronegative men in the multiple session condition increased sexual barrier (male and female condoms) use in comparison with those in the single session condition (F=16.13, =0.001) while seropositive individuals increased sexual barrier use regardless of condition. Results illustrate the importance of both single and multiple session risk reduction counseling among seronegative men in serodiscordant couples in Zambia, and highlight the differing perception of risk between seropositive and serodiscordant persons.

Money boys, HIV risks, and the associations between norms and safer sex: a respondent-driven sampling study in Shenzhen, China

Money boys (MBs) are male sex workers who sell sex to men who have sex with men (MSM). This study estimates the proportion of MBs in the Chinese MSM, compares HIV risks between MBs and non-MB MSM, and examines the associations between practicing safer sex and peer norms of condom use. Respondent-driven sampling (RDS) was used to sample 351 MSM in the city of Shenzhen in 2007. The RDS-adjusted proportion of MBs among MSM was 9%. Compared to non-MB MSM, more MBs reported having had multiple male and female sexual partners. Half of MBs and non-MB MSM had consistently used condoms. Both descriptive and subjective norms were positively associated with condom use. The MB proportion of 9% in MSM implies a relatively large population of MBs in China. The association between peer norms and consistent condom use can assist with the development of culturally competent HIV interventions that promote safer sex.

Help-seeking for mental health problems among Chinese: the application and extension of the theory of planned behavior

The underutilization of professional care is a perennial problem among Chinese populations. To examine the social-cognitive factors that may affect help-seeking intentions, the present study applied and extended Ajzen's theory of planned behavior (TPB) to understand the intention to seek help from mental health professionals among Chinese. The effect of mental health and perceived barriers to help-seeking were also examined. Nine hundred and forty-one Chinese were recruited using a randomized household design in Hong Kong. Results from structural equation modeling showed that attitude, subjective norm, perceived behavioral control, and perceived barriers significantly predicted help-seeking intention. Mental health showed no significant effect on help-seeking intention. In addition, subjective norm indirectly predicted intention to seek help from mental health professionals through influencing attitude and perceived behavioral control. Results from multi-group analyses revealed that all path coefficients were invariant across gender. Results supported the utilization of TPB in understanding help-seeking intentions and highlighted the importance of subjective norm among Chinese. Implications on the enhancement of mental health awareness and the promotion of mental health services through a social-cognitive approach were highlighted.

African American Adolescent Females: Mother-Involved HIV Risk-Reduction Intervention

African American adolescent females continue to be at disproportionate high risk for HIV infection. A repeated measures quasi-experimental comparison group design compared an HIV risk-reduction intervention delivered by mothers with an HIV risk-reduction intervention delivered by health professionals and with a health promotion intervention delivered by mothers. The three interventions were randomly assigned to one of three geographical distinct sites. A convenience sample of 553 low-income African American adolescent girls with a baseline age of 11 to 14 years participated in the study. The results revealed that over a 6-month period, compared to girls in the health promotion intervention, the girls in the HIV risk-reduction interventions had significant higher scores on HIV transmission knowledge, condom attitudes, and self-efficacy to use condoms. The implication is mothers who receive appropriate training may be able to deliver HIV risk reduction to their daughters as well as health professionals.

The Use of Meta-analysis in Psychology

In the discipline of psychology there are numerous examples of multiple published studies examining the same topic with contradictory results. Meta-analysis is viewed by proponents as a superior methodology that is based on a more reliable and objective process than narrative reviews in summarizing the results of multiple studies. To asses this claim, we reviewed 10 years of meta-analyses published in Psychological Bulletin, and examined the epistemic culture that informs the practice of meta-analysis. The practice of meta-analysis as examined within the sample of studies reviewed was characterized by methodological inconsistencies. This suggests that the methods set forth by the proponents of meta-analysis are not being followed by some researchers with rigour or consistency. Such preliminary findings, therefore, challenge the notion that meta-analysis is an inherently superior technique as compared to other forms of review. We discuss this in terms of the shared commitments and epistemic culture of researchers that rely on meta-analysis.

Coitus interruptus as a contraceptive method: Turkish women's perceptions and experiences

AIM

This paper is a report of a study conducted to determine the perceptions and experiences of coitus interruptus as a contraceptive method used by married women in Turkey.

BACKGROUND

Various factors affect women's choice of contraceptive methods. One of these factors is socioeconomic status, which may have an effect on the practice of coitus interruptus by women. Socioeconomic status refers to the relative position of a family or individual in a hierarchical social structure based on their access to or control over wealth, prestige and power.

METHODS

The study population consisted of married Turkish women from two different socioeconomic status groups in Turkey who were currently using coitus interruptus. Structured interviews on their demographic characteristics and perceptions and experiences of coitus interruptus were carried out between August 2004 and August 2005 with a convenience sample of 422 women (response rate 97.2%).

FINDINGS

Most participants were satisfied with the practice of coitus interruptus. Conception was the most common reason for discontinuing practice of the method. Age and educational level of participants did not affect failure in coitus interruptus practice in women of either socioeconomic status. The majority of the women of both socioeconomic statuses began practising coitus interruptus again after having stopped.

CONCLUSIONS

Women generally favoured coitus interruptus, believing in its efficacy and safety, and stated that both women and their husbands preferred to use it. Nurses and midwives should promote knowledge of all effective methods for fertility regulation while women are in the fertile ages.

Effects of an Internet-based intervention for HIV prevention: the Youthnet trials

Youth use the Internet and computers in unprecedented numbers. We have yet to identify interventions that can reach and retain large numbers of diverse youth online and demonstrate HIV prevention efficacy. We tested a single session condom promotion Internet intervention for 18-24 year olds in two RCTs: one sample recruited online and one recruited in clinics. All study elements were carried out on the Internet. Using repeated measures structural equation models we analyzed change in proportion of sex acts protected by condoms (PPA) over time. Among sexually active youth in the Internet sample, persons exposed to the intervention had very slight increases in condom norms, and this was the only factor impacting PPA. We saw no intervention effects in the clinic sample. Internet-based interventions need to be more intensive to see greater effects. We need to do more to reach high risk youth online and keep their attention for multiple sessions.

An agenda for advancing the science of implementation of evidence-based HIV prevention interventions

In the past 25 years, a tremendous amount of time and resources have been committed to developing evidence-based HIV prevention interventions. More recently, there have been noteworthy efforts to develop an infrastructure and related policies to promote the dissemination (i.e., "the targeted distribution of information and intervention materials to a specific public health or clinical practice audience") of evidence-based interventions. Despite these advances, however, we have had comparatively little success in the effective implementation (i.e., "the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings") of such interventions in everyday practice or community settings. The objective of the current paper is to highlight select and initial areas of research that are critically needed to advance the state-of-the-science of implementation of HIV prevention interventions in our broader efforts to curb the epidemic worldwide.

Attitudes and subjective norms: determinants of parents' intentions to reduce childhood fever with medications

Fever is a natural protective response of the host organism. Mild to moderate fevers, up to 40.0 degrees C, have immunological benefits and do not need to be reduced. However, parents regularly reduce fever with medications to prevent perceived harmful outcomes. This study identified the determinants of parents' intentions to reduce childhood fever with medications. A community-based cross-sectional survey was conducted with 391 Australian parents of children aged between 6 months and 5 years. Recruitment was through advertising, face-to-face and snowball methods. The survey targeted constructs of the Theory of Planned Behavior: attitudes, subjective norms, perceived behavioral control, intentions and previously identified background factors. Structural equation modeling identified 69% of the variance in intentions. The strongest influences were from non-scientifically based attitudes (phobic) (beta=0.55) and subjective norms (husband/partner and doctors) (beta=0.36). Attitudes (beta=0.69) and subjective norms (beta=0.52) were strongly determined by child medication behavior (whether the child took medications easily when febrile) which had a total effect on intentions of beta=0.66. Perceived control, education and number of children had minimal influence on intentions. There is an urgent need for (i) the education of both parents in the benefits of fever and (ii) for doctors to consistently provide parents with evidence-based information.

Seriously mentally ill women's safer sex behaviors and the theory of reasoned action

Seriously mentally ill women at risk for HIV infection (n = 96) participated in structured interviews assessing sexual and substance-use behavior over a 3-month period. The majority of the women (63.5%) did not use condoms. Consistent with the theory of reasoned action, attitudes toward condom use and perceived social norms about safer sex were associated with safer sex intentions. Supplementing variables from the theory of reasoned action with safer sex self-efficacy explained additional variance in safer sex intentions. Greater safer sex intentions were related to both greater condom use and less frequent unprotected intercourse. In addition, less frequent sex after drug use and a less fatalistic outlook were associated with less frequent unprotected intercourse. Life circumstances specific to this population are particularly important to examine to improve the effectiveness of risk reduction interventions for seriously mentally ill women.

Predicting preparatory behaviours for condom use in female undergraduate students: a one-year follow-up study

The objective of this study is to investigate whether the Theory of Planned Behaviour (i.e. attitude, subjective norm, perceived behavioural control and intention), fluctuations in motivation over time, and variables from the Prototype-Willingness Model (i.e. behavioural expectation and behavioural willingness to have unprotected sex) predict preparatory behaviours for condom use. Sixty-two female undergraduates completed baseline and one-year follow-up questionnaires. Having condoms at home and carrying condoms were predicted by behavioural willingness to have unsafe sex at baseline. Having bought condoms was predicted by the behavioural expectation to use condoms with new partners at baseline. Intention and fluctuations in motivation did not emerge as significant predictors of preparatory actions. Female undergraduates, who are more willing to have unprotected sex under risk-conducive circumstances, are also less likely to prepare adequately for condom use, and thereby increase their chances of encountering such situations. Overall, the findings are in support of the Prototype-Willingness Model.

Test of a brief theory of planned behaviour-based intervention to promote adolescent safe sex intentions

The present study tested a brief (303 word) intervention designed to change attitude, subjective norm, and perceived behavioural control regarding a safe sex behaviour in a sample of 16- to 18-year-olds. Participants (N=288) were randomized to receive either an experimental intervention or a control (knowledge only) intervention and completed measures of their reactions to the stimuli as well as pre- and post-test measures of theory of planned behaviour variables. The experimental intervention significantly increased message processing (mean between-group difference=0.73, 95% CI=0.40, 1.06; Cohen's d=.52), message acceptance (mean between-group difference=0.82, 95% CI=0.57, 1.07; Cohen's d=.77), subjective norm (adjusted Mean between-group difference=0.54, 95% CI = 0.26, 0.81; Cohen's d=.37; mean within-group difference for intervention condition=0.59, 95% CI = 0.36, 0.81; Cohen's d=.38) and intention (adjusted Mean between-group difference=0.27, 95% CI = 0.02, 0.53; Cohen's d=.20; mean within-group difference for intervention condition=0.54, 95% CI = 0.33, 0.75; Cohen's d=.31), but not attitude or perceived behavioural control. The effects of the experimental intervention on intention were mediated solely through subjective norm. The present findings: (a) compare favourably in terms of the effect sizes reported in previous research in this area (mean Cohen's d for within-group difference for intervention conditions=.009 and .09, for norms and intention, respectively, see Albarracín et al. (2003)), (b) imply that subjective norms are causally related to intentions, and (c) suggest that interventions designed to change subjective norms (as opposed to communication of risks and fear appeals) might ultimately be effective in changing behaviour.

The relationship-oriented information-motivation-behavioral skills model: a multilevel structural equation model among dyads

Transmission rates of HIV infection have increased steadily among heterosexual adults, however current theoretical models have not been tested statistically at the dyadic level in which risk behaviors occur. The purpose of the current study was to test an Information-Motivation-Behavioral skills (IMB) model of HIV risk behavior (IMB) specifically articulated for heterosexual couples in established relationships using data from both members of 75 dyads. The multilevel relationship-oriented information-motivation-behavioral skills (RELO-IMB) model was evaluated at the individual and dyadic level of analysis to examine partner differences on core variables. Results indicated that not only did the RELO-IMB model provide a good fit to the data when analyzed at the dyadic level, but that the structural relations among the core variables were quite different between the individual- and dyadic-level models. This is the first theoretical model of HIV risk behavior to be analyzed at the dyadic level, and the results suggest ways to effectively design intervention strategies for individuals in intimate relationships.

An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults

Despite the recent increase in the number of HIV infections in Central and Eastern Europe, patterns of sexual behavior have not been extensively researched, particularly among young people. The aim of the present study was to provide a comprehensive assessment of HIV/AIDS-related vulnerability and sexual risk-taking among young adults in Croatia. Data were collected in 2005 using a nationally representative, multi-stage stratified probability sample (n = 1,093) of women and men aged 18-24 years. The focus in this article was on predictors of sexual risk-taking measured by a composite risky sexual behaviors scale. Using hierarchical regression models, we analyzed gendered effects of community, family, peer group, and individual level factors. For both men and women, peer pressure, sensation seeking, personal risk-assessment, behavioral intention, condom use at first sexual intercourse, and sexual victimization were significant predictors of sexual risk-taking behaviors. A number of predictors were gender-specific: sexual assertiveness and condom self-efficacy for women and parental monitoring, traditional morality, HIV knowledge, and talking about sex with partner for men. Documenting substantial prevalence of potentially risky sexual behaviors among young people in Croatia, the findings call for prevention and intervention efforts that should focus on individual capacity building for responsible sexual behavior.

An event-level analysis of condom use as a function of mood, alcohol use, and safer sex negotiations

Daily self-reports of condom-protected intercourse were analyzed as a function of emotional states, alcohol consumption, and safer sex negotiations in a sample of single, low-income Hispanic students. The sample included 15 women and 17 men who reported a minimum of four sexual episodes as well as inconsistent condom use over a 3-month self-reporting period. The analyses focused on 829 days out of 2,586 daily self-reports on which sexual intercourse was reported. Hierarchical linear modeling was used to predict condom-protected intercourse as a function of mood states, substance use, and safer sex negotiations. Safer sex negotiation was the strongest positive predictor of condom use. Contrary to expectation, unprotected intercourse was less likely to occur in episodes characterized by greater negative affect and more likely in episodes in which greater positive mood was reported. No main effect of alcohol consumption on safer sex was observed; however, an interaction between alcohol consumption and positive mood emerged, indicating that unprotected intercourse was most likely to occur when positive mood was combined with alcohol consumption. The results contradict the assumption that emotional distress predicts engagement in more risky sexual behavior and indicate that safer sex negotiations are likely to outweigh any effects of mood or alcohol consumption on subsequent condom use.

Sub-Saharan African university students' beliefs about condoms, condom-use intention, and subsequent condom use: a prospective study

Whether certain behavioral beliefs, normative beliefs, and control beliefs predict the intention to use condoms and subsequent condom use was examined among 320 undergraduates at a university in South Africa who completed confidential questionnaires on two occasions separated by 3 months. Participants' mean age was 23.4 years, 47.8% were women, 48.9% were South Africans, and 51.1% were from other sub-Saharan African countries. Multiple regression revealed that condom-use intention was predicted by hedonistic behavioral beliefs, normative beliefs regarding sexual partners and peers, and control beliefs regarding condom-use technical skill and impulse control. Logistic regression revealed that baseline condom-use intention predicted consistent condom use and condom use during most recent intercourse at 3-month follow-up. HIV/STI risk-reduction interventions for undergraduates in South Africa should target their condom-use hedonistic beliefs, normative beliefs regarding partners and peers, and control beliefs regarding technical skill and impulse control.

A practitioner's guide to persuasion: an overview of 15 selected persuasion theories, models and frameworks

OBJECTIVE

To provide a brief overview of 15 selected persuasion theories and models, and to present examples of their use in health communication research.

RESULTS

The theories are categorized as message effects models, attitude-behavior approaches, cognitive processing theories and models, consistency theories, inoculation theory, and functional approaches.

CONCLUSIONS

As it is often the intent of a practitioner to shape, reinforce, or change a patient's behavior, familiarity with theories of persuasion may lead to the development of novel communication approaches with existing patients.

PRACTICE IMPLICATIONS

This article serves as an introductory primer to theories of persuasion with applications to health communication research. Understanding key constructs and general formulations of persuasive theories may allow practitioners to employ useful theoretical frameworks when interacting with patients.